Vol 26, No 5 (2021)
Research paper
Published online: 2021-09-24

open access

Page views 6124
Article views/downloads 372
Get Citation

Connect on Social Media

Connect on Social Media

Effect of contrast medium on treatment modalities planned with different photon beam energies: a planning study

Manindra Bhushan12, Deepak Tripathi2, Girigesh Yadav1, Lalit Kumar1, Abhinav Dewan1, Sarthak Tandon1, Gourav Kumar1, Inderjit Kaur Wahi1, Munish Gairola1
Rep Pract Oncol Radiother 2021;26(5):688-711.

Abstract

Background: Routinely, patient’s planning scans are acquired after administration of iodinized contrast media but they will be treated in the absence of that. Similarly, high energy photons have a better penetrating power, while low energy photons will result in tighter dose distribution and negligible neutron contamination.

The aim of the study was to investigate a suitable photon beam energy in the presence of intravenous contrast medium.

Materials and methods: An indigenously made original-contrast (OC) phantom was mentioned as virtual-contrast (VC) and virtual-without-contrast (VWC) phantom were generated by assigning the Hounsfield Units (HU) to different structures. Intensity-modulated (IMRT) and volumetric-modulated-arc (VMAT) plans were generated as per criteria of the TG-119 protocol.

Results: It was observed that the maximum dose to the spinal cord was better with 6 mega-voltage (MV) in IMRT. The coverage of Prostate PTV (PR PTV) was similar with all the photon energies and was comparable with TG-119, except for original-contrast (OC) phantom using the VMAT technique. Homogeneity-index (HI) was comparatively better for VMAT plans.

Conclusion: The contrast CT images lower the dose to targets. IMRT or VMAT plans, generated on such CT images will be delivered with higher doses than evaluated. However, the overdose remains non-significant

Article available in PDF format

View PDF Download PDF file

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020; 8(2): e191–e203.
  3. Zelefsky MJ, Lee WR, Zietman A, et al. Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey. Pract Radiat Oncol. 2013; 3(1): 2–8.
  4. d'Errico F. Dosimetric issues in radiation protection of radiotherapy patients. Radiat Prot Dosimetry. 2006; 118(2): 205–212.
  5. Uysal B, Beyzadeoğlu M, Sager O, et al. Dosimetric evaluation of intensity modulated radiotherapy and 4-field 3-d conformal radiotherapy in prostate cancer treatment. Balkan Med J. 2013; 30(1): 54–57.
  6. Hall E. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006; 65(1): 1–7.
  7. Kry SF, Salehpour M, Followill DS, et al. The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2005; 62(4): 1195–1203.
  8. Kumar L, Yadav G, Samuvel KR, et al. Dosimetric influence of filtered and flattening filter free photon beam on rapid arc (RA) radiotherapy planning in case of cervix carcinoma. Rep Pract Oncol Radiother. 2017; 22(1): 10–18.
  9. Bhushan M, Yadav G, Tripathi D, et al. Clinical dosimetric impact of AAA and Acuros XB on high-density metallic implants in case of carcinoma cervix. Oncol J India. 2019; 3(2): 28.
  10. Bhushan M, Yadav G, Tripathi D, et al. Dosimetric Analysis of Unflattened (FFFB) and Flattened (FB) Photon Beam Energy for Gastric Cancers Using IMRT and VMAT-a Comparative Study. J Gastrointest Cancer. 2019; 50(3): 408–419.
  11. Ezzell GA, Burmeister JW, Dogan N, et al. IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Med Phys. 2009; 36(11): 5359–5373.
  12. Mynampati DK, Yaparpalvi R, Hong L, et al. Application of AAPM TG 119 to volumetric arc therapy (VMAT). J Appl Clin Med Phys. 2012; 13(5): 3382.
  13. Nithya L, Raj NA, Rathinamuthu S, et al. Analyzing the performance of the planning system by use of AAPM TG 119 test cases. Radiol Phys Technol. 2016; 9(1): 22–29.
  14. Avgousti R, Armpilia C, Floros I, et al. Evaluation of intensity modulated radiation therapy delivery system using a volumetric phantom on the basis of the task group 119 report of american association of physicists in medicine. J Med Phys. 2017; 42(1): 33.
  15. Kaushik S, Tyagi A, Kumar L, et al. Validation of intensity-modulated radiotherapy commissioning as per recommendations in test plans of the American Association of Physicists in Medicine task group 119 report. Radiat Protect Environ. 2016; 39(3): 138.
  16. Yamada S, Ueguchi T, Ogata T, et al. Radiotherapy treatment planning with contrast-enhanced computed tomography: feasibility of dual-energy virtual unenhanced imaging for improved dose calculations. Radiat Oncol. 2014; 9: 168.
  17. Kim HJ, Chang AhR, Park YK, et al. Dosimetric effect of CT contrast agent in CyberKnife treatment plans. Radiat Oncol. 2013; 8: 244.
  18. Heydarheydari S, Farshchian N, Haghparast A. Influence of the contrast agents on treatment planning dose calculations of prostate and rectal cancers. Rep Pract Oncol Radiother. 2016; 21(5): 441–446.
  19. Ramm U, Damrau M, Mose S, et al. Influence of CT contrast agents on dose calculations in a 3D treatment planning system. Phys Med Biol. 2001; 46(10): 2631–2635.
  20. Jing H, Tian Y, Tang Yu, et al. Oral contrast agents lead to underestimation of dose calculation in volumetric-modulated arc therapy planning for pelvic irradiation. Chin Med J (Engl). 2020; 133(17): 2061–2070.
  21. Weber D, Rouzaud M, Miralbell R. Bladder opacification does not significantly influence dose distribution in conformal radiotherapy of prostate cancer. Radiother Oncol. 2001; 59(1): 95–97.
  22. Choi Y, Kim JK, Lee HS, et al. Influence of intravenous contrast agent on dose calculations of intensity modulated radiation therapy plans for head and neck cancer. Radiother Oncol. 2006; 81(2): 158–162.
  23. Wertz H, Jäkel O. Influence of iodine contrast agent on the range of ion beams for radiotherapy. Med Phys. 2004; 31(4): 767–773.
  24. Söderström S, Eklöf A, Brahme A. Aspects on the optimal photon beam energy for radiation therapy. Acta Oncol. 1999; 38(2): 179–187.
  25. Sze HCK, Lee MCH, Hung WM, et al. RapidArc radiotherapy planning for prostate cancer: single-arc and double-arc techniques vs. intensity-modulated radiotherapy. Med Dosim. 2012; 37(1): 87–91.
  26. Kumar L, Kishore V, Yadav G, et al. EP-1670: Impact of flatting filter free photon beam on Rapid-arc radiotherapy for gynecological malignancies. Radiother Oncol. 2016; 119: S780.
  27. Pirzkall A, Carol MP, Pickett B, et al. The effect of beam energy and number of fields on photon-based IMRT for deep-seated targets. Int J Radiat Oncol Biol Phys. 2002; 53(2): 434–442.
  28. Gurjar O, Jha V, Sharma S. Radiation dose to radiotherapy technologists due to induced activity in high energy medical electron linear accelerators. Radiat Protect Environ. 2014; 37(1): 25.
  29. Kry SF, Salehpour M, Followill DS, et al. Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2005; 62(4): 1204–1216.
  30. Zhai DY, Yin Y, Gong GZ, et al. RapidArc radiotherapy for whole pelvic lymph node in cervical cancer with 6 and 15 MV: a treatment planning comparison with fixed field IMRT. J Radiat Res. 2013; 54(1): 166–173.
  31. Yadav G, Bhushan M, Dewan A, et al. Dosimetric influence of photon beam energy and number of arcs on volumetric modulated arc therapy in carcinoma cervix: A planning study. Rep Pract Oncol Radiother. 2017; 22(1): 1–9.
  32. Hussein M, Aldridge S, Guerrero Urbano T, et al. The effect of 6 and 15 MV on intensity-modulated radiation therapy prostate cancer treatment: plan evaluation, tumour control probability and normal tissue complication probability analysis, and the theoretical risk of secondary induced malignancies. Br J Radiol. 2012; 85(1012): 423–432.
  33. Sung W, Park JM, Choi CH, et al. The effect of photon energy on intensity-modulated radiation therapy (IMRT) plans for prostate cancer. Radiat Oncol J. 2012; 30(1): 27–35.



Reports of Practical Oncology and Radiotherapy