Implementation of a lateral total body irradiation technique with 6 MV photons

The University of Texas Health Science Center in San Antonio experience

Francisco Mesa, Tony Y. Eng, Carlos Esquivel, Clifton D. Fuller, Nikos Papanikolaou, Modesto Sosa

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant. Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up. Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3%. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.

Original languageEnglish (US)
Pages (from-to)45-54
Number of pages10
JournalJournal of Radiotherapy in Practice
Volume10
Issue number1
DOIs
StatePublished - Mar 2011

Fingerprint

Whole-Body Irradiation
Photons
Health
Bone Marrow
Patient Positioning
Particle Accelerators
Supine Position
Abdomen
Prescriptions
Reading
Hand
Medicine
Radiation
Pediatrics
Transplants

Keywords

  • BMT
  • bone marrow transplant
  • Lateral TBI
  • paediatric patients
  • TLD
  • total body irradiation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

Cite this

Implementation of a lateral total body irradiation technique with 6 MV photons : The University of Texas Health Science Center in San Antonio experience. / Mesa, Francisco; Eng, Tony Y.; Esquivel, Carlos; Fuller, Clifton D.; Papanikolaou, Nikos; Sosa, Modesto.

In: Journal of Radiotherapy in Practice, Vol. 10, No. 1, 03.2011, p. 45-54.

Research output: Contribution to journalArticle

@article{ebcd665361834859b05a9a388127383f,
title = "Implementation of a lateral total body irradiation technique with 6 MV photons: The University of Texas Health Science Center in San Antonio experience",
abstract = "Purpose: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant. Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up. Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3{\%}. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.",
keywords = "BMT, bone marrow transplant, Lateral TBI, paediatric patients, TLD, total body irradiation",
author = "Francisco Mesa and Eng, {Tony Y.} and Carlos Esquivel and Fuller, {Clifton D.} and Nikos Papanikolaou and Modesto Sosa",
year = "2011",
month = "3",
doi = "10.1017/S1460396910000221",
language = "English (US)",
volume = "10",
pages = "45--54",
journal = "Journal of Radiotherapy in Practice",
issn = "1460-3969",
publisher = "Cambridge University Press",
number = "1",

}

TY - JOUR

T1 - Implementation of a lateral total body irradiation technique with 6 MV photons

T2 - The University of Texas Health Science Center in San Antonio experience

AU - Mesa, Francisco

AU - Eng, Tony Y.

AU - Esquivel, Carlos

AU - Fuller, Clifton D.

AU - Papanikolaou, Nikos

AU - Sosa, Modesto

PY - 2011/3

Y1 - 2011/3

N2 - Purpose: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant. Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up. Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3%. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.

AB - Purpose: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant. Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up. Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3%. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.

KW - BMT

KW - bone marrow transplant

KW - Lateral TBI

KW - paediatric patients

KW - TLD

KW - total body irradiation

UR - http://www.scopus.com/inward/record.url?scp=79952991188&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952991188&partnerID=8YFLogxK

U2 - 10.1017/S1460396910000221

DO - 10.1017/S1460396910000221

M3 - Article

VL - 10

SP - 45

EP - 54

JO - Journal of Radiotherapy in Practice

JF - Journal of Radiotherapy in Practice

SN - 1460-3969

IS - 1

ER -