Positron emission tomography guided dose painting by numbers of lung cancer: Alanine dosimetry in an anthropomorphic phantom
Papoutsis, Iosif; Knudtsen, Ingerid Skjei; Sande, Erlend Peter Skaug; Rekstad, Bernt Louni; Öllers, Michel; van Elmpt, Wouter; Arnesen, Marius Røthe; Malinen, Eirik
Peer reviewed, Journal article
Published version
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https://hdl.handle.net/11250/3044311Utgivelsesdato
2022Metadata
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Originalversjon
Physics and imaging in radiation oncology (PIRO). 2022, 21 101-107. 10.1016/j.phro.2022.02.013Sammendrag
Background and purpose
Dose painting by numbers (DPBN) require a high degree of dose modulation to fulfill the image-based voxel wise dose prescription. The aim of this study was to assess the dosimetric accuracy of 18F-fluoro-2-deoxy-glucose positron emission tomography(18F-FDG-PET)-based DPBN in an anthropomorphic lung phantom using alanine dosimetry.
Materials and methods
A linear dose prescription based on 18F-FDG-PET image intensities within the gross tumor volume (GTV) of a lung cancer patient was employed. One DPBN scheme with low dose modulation (Scheme A; minimum/maximum fraction dose to the GTV 2.92/4.26 Gy) and one with a high modulation (Scheme B; 2.81/4.52 Gy) were generated. The plans were transferred to a computed tomograpy (CT) scan of a thorax phantom based on CT images of the patient. Using volumetric modulated arc therapy (VMAT), DPBN was delivered to the phantom with embedded alanine dosimeters. A plan was also delivered to an intentionally misaligned phantom. Absorbed doses at various points in the phantom were measured by alanine dosimetry.
Results
A pointwise comparison between GTV doses from prescription, treatment plan calculation and VMAT delivery showed high correspondence, with a mean and maximum dose difference of <0.1 Gy and 0.3 Gy, respectively. No difference was found in dosimetric accuracy between scheme A and B. The misalignment caused deviations up to 1 Gy between prescription and delivery.
Conclusion
DPBN can be delivered with high accuracy, showing that the treatment may be applied correctly from a dosimetric perspective. Still, misalignment may cause considerable dosimetric erros, indicating the need for patient immobilization and monitoring.