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Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy

Published online by Cambridge University Press:  18 February 2019

Rajesh Thiyagarajan Open the ORCID record for Rajesh Thiyagarajan [Opens in a new window] ,
Arunai Nambiraj Open the ORCID record for Arunai Nambiraj [Opens in a new window] ,
Durai Manigandan ,
Tamilseivan Singaravelu ,
Rajesh Selvaraj  and
Tejinder Kataria
Rajesh Thiyagarajan*
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Arunai Nambiraj
Affiliation:
Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT) VIT University, Vellore, Tamil Nadu, India
Durai Manigandan
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Tamilseivan Singaravelu
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Rajesh Selvaraj
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Tejinder Kataria
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
*
Author for correspondence: Rajesh Thiyagarajan, Senior Medical Physicist & RSO, Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India. E-mail: trajesh.tpt2000@gmail.com
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Abstract

Purpose

The purpose of this study is to evaluate variation in the treatment hold pattern and quantify its dosimetric impact in breath-hold radiotherapy, using fraction-specific post-treatment quality assurance.

Material and Methods

A patient with lung mets treated using intensity-modulated radiation therapy (IMRT) with active breath coordinator (ABC) was recruited for the study. Treatment beam hold conditions were recorded for all the 25 fractions. The linearity and reproducibility of the dosimetric system were measured. Variation in the dose output of unmodulated open beam with beam hold was studied. Patient-specific quality assurance (PSQA) was performed with and without beam hold, and the results were compared to quantify the dosimetric impact of beam hold.

Results

There was a considerable amount of variation observed in the number of beam hold for the given field and the monitor unit at which the beam held. Linearity and reproducibility of the dosimetric system were found within the acceptable limits. The average difference over the 25 measurements was 0·044% (0·557 to −0·318%) with standard deviation of 0·248.

Conclusion

Patient comfort with the ABC system and responsiveness to the therapist communication help to maintain consistent breathing pattern, in turn consistent treatment delivery pattern. However, the magnitude of dosimetric error is much less than the acceptable limits recommended by IROC. The dosimetric error induced by the beam hold is over and above the dose difference observed in conventional PSQA.

Keywords

active breath coordinatordeep inspiration breath holdpatient-specific quality assuranceverification
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 3 , September 2019 , pp. 262 - 270
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Thiyagarajan R, Nambiraj A, Manigandan D, Singaravelu T, Selvaraj R, Kataria T. (2019) Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy. Journal of Radiotherapy in Practice18: 262–270. doi: 10.1017/S1460396919000049

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