scholarly journals Total Body Irradiation with Step Translation and Dynamic Field Matching

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Ho-Hsing Chen ◽  
Jay Wu ◽  
Keh-Shih Chuang ◽  
Jia-Fu Lin ◽  
Jia-Cheng Lee ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Dose Distribution ◽  
The Body ◽  
Entire Body ◽  
Lung Dose ◽  
Tolerance Level ◽  
Treatment Room ◽  
Dynamic Field ◽  
Total Body ◽  
Overlapped Region

The purpose of this study is to develop a total body irradiation technique that does not require additional devices or sophisticated processes to overcome the space limitation of a small treatment room. The technique aims to deliver a uniform dose to the entire body while keeping the lung dose within the tolerance level. The technique treats the patient lying on the floor anteriorly and posteriorly. For each AP/PA treatment, two complementary fields with dynamic field edges are matched over an overlapped region defined by the marks on the body surface. A compensator, a spoiler, and lung shielding blocks were used during the treatment. Moreover, electron beams were used to further boost the chest wall around the lungs. The technique was validated in a RANDO phantom using GAFCHROMIC films. Dose ratios at different body sites along the midline ranged from 0.945 to 1.076. The dose variation in the AP direction ranged from 96.0% to 104.6%. The dose distribution in the overlapped region ranged from 98.5% to 102.8%. Lateral dose profiles at abdomen and head revealed 109.8% and 111.7% high doses, respectively, at the body edges. The results confirmed that the technique is capable of delivering a uniform dose distribution to the midline of the body in a small treatment room while keeping the lung dose within the tolerance level.

scholarly journals Total Body Irradiation for Hematopoietic Stem Cell Transplantation: What Can We Agree on?

2021 ◽  
Vol 28 (1) ◽  
pp. 903-917
Author(s):  
Mitchell Sabloff ◽  
Steven Tisseverasinghe ◽  
Mustafa Ege Babadagli ◽  
Rajiv Samant
Keyword(s):  
Cell Transplantation ◽  
Total Body Irradiation ◽  
Hematopoietic Cell Transplantation ◽  
Conditioning Regimen ◽  
Late Toxicity ◽  
Hepatic Function ◽  
Vascular Supply ◽  
Entire Body ◽  
Hematopoietic Stem ◽  
Total Body

Total body irradiation (TBI), used as part of the conditioning regimen prior to allogeneic and autologous hematopoietic cell transplantation, is the delivery of a relatively homogeneous dose of radiation to the entire body. TBI has a dual role, being cytotoxic and immunosuppressive. This allows it to eliminate disease and create “space” in the marrow while also impairing the immune system from rejecting the foreign donor cells being transplanted. Advantages that TBI may have over chemotherapy alone are that it may achieve greater tumour cytotoxicity and better tissue penetration than chemotherapy as its delivery is independent of vascular supply and physiologic barriers such as renal and hepatic function. Therefore, the so-called “sanctuary” sites such as the central nervous system (CNS), testes, and orbits or other sites with limited blood supply are not off-limits to radiation. Nevertheless, TBI is hampered by challenging logistics of administration, coordination between hematology and radiation oncology departments, increased rates of acute treatment-related morbidity and mortality along with late toxicity to other tissues. Newer technologies and a better understanding of the biology and physics of TBI has allowed the field to develop novel delivery systems which may help to deliver radiation more safely while maintaining its efficacy. However, continued research and collaboration are needed to determine the best approaches for the use of TBI in the future.

scholarly journals Total body irradiation induced mouse small intestine senescence as a late effect

2019 ◽  
Vol 60 (4) ◽  
pp. 442-450 ◽  
Author(s):  
Yu Zhao ◽  
Junling Zhang ◽  
Xiaodan Han ◽  
Saijun Fan
Keyword(s):  
Small Intestine ◽  
Total Body Irradiation ◽  
Profile Analysis ◽  
Bacterial Flora ◽  
Body Weight Loss ◽  
Underlying Mechanism ◽  
The Body ◽  
Mouse Small Intestine ◽  
Total Body ◽  
Almost All

Abstract Radiation can induce senescence in many organs and tissues; however, it is still unclear how radiation stimulates senescence in mouse small intestine. In this study, we use the bone marrow transplantation mouse model to explore the late effects of total body irradiation on small intestine. Our results showed that almost all of the body hairs of the irradiated mice were white (which is an indication of aging) 10 months after the exposure to radiation. Furthermore, compared with the age-matched control mice, there were more SA-β-galactosidase (SA-β-gal)–positive cells and an upregulation of p16 and p21 in 8 Gy–irradiated mice intestinal crypts, indicating that radiation induced senescence in the small intestine. Intestinal bacterial flora profile analysis showed that the diversity of the intestinal bacterial flora decreased in irradiated mice; in addition it showed that the principal components of the irradiated and control mice differed: there was increased abundance of Bacteroidia and a decreased abundance of Clostridia in irradiated mice. To explore the underlying mechanism, an RNA-sequence was executed; the results suggested that pancreatic secretion, and the digestion and absorption of proteins, carbohydrates, fats and vitamins were damaged in irradiated mice, which may be responsible for the body weight loss observed in irradiated mice. In summary, our study suggested that total body irradiation may induce senescence in the small intestine and damage the health status of the irradiated mice.

scholarly journals Total body irradiation in a case of thalassemia major with source to axis distance based planning: A case report

2020 ◽  
pp. 25-28
Author(s):  
Mayuresh D. Virkar ◽  
Rajkumar Chauhan ◽  
Pranav Chadha ◽  
Kaustav Talapatra ◽  
Reuben Jake Rodrigues ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Total Body Irradiation ◽  
Conditioning Regimen ◽  
Thalassemia Major ◽  
Entire Body ◽  
Hematopoietic Stem ◽  
Total Body

Background: The use of total body radiation (TBI) before hematopoietic stem cell transplantation (HSCT) would increase the engraftment without transplant-related morbidity or mortality among Thalassemia major (TM) cases. Case presentation: A 2-year-old female child, diagnosed with TM was scheduled for haploidentical allogenic transplant-based protocol, and after that, based on protocol she was scheduled to undergo a single session of TBI as a conditioning regimen before haploidentical allogenic hematopoietic stem cell tranplant. A total dose of 4 Gy was administered.. The incidence of graft failure was reduced as TBI was used before allogeneic stem cell transplantation. TBI provided a uniform dose of radiation to the entire body, penetrating areas such as the central nervous system (CNS) and testes. Conclusion: Total Body Irradiation with the SAD technique is the most effective way of treatment. As it is comfortable for the patient to undergo, easily reproducible, and it helps to achieve a uniform dose distribution.

scholarly journals Feasibility of hybrid TomoHelical- and TomoDirect-based volumetric gradient matching technique for total body irradiation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Chae-Seon Hong ◽  
Min-Joo Kim ◽  
Jihun Kim ◽  
Kyung Hwan Chang ◽  
Kwangwoo Park ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Dose Distribution ◽  
Longitudinal Direction ◽  
Target Volume ◽  
Average Dose ◽  
Setup Error ◽  
Matching Technique ◽  
Calculated Dose ◽  
Total Body ◽  
Dose Measurements

Abstract Background Tomotherapy-based total body irradiation (TBI) is performed using the head-first position (HFP) and feet-first position (FFP) due to treatment length exceeding the 135 cm limit. To reduce the dosimetric variation at the match lines, we propose and verify a volumetric gradient matching technique (VGMT) by combining TomoHelical (TH) and TomoDirect (TD) modes. Methods Two planning CT image sets were acquired with HFP and FFP using 15 × 55 × 18 cm3 of solid water phantom. Planning target volume (PTV) was divided into upper, lower, and gradient volumes. The junction comprised 2-cm thick five and seven gradient volumes (5-GVs and 7-GVs) to create a dose distribution with a gentle slope. TH-IMRT and TD-IMRT plans were generated with 5-GVs and 7-GVs. The setup error in the calculated dose was assessed by shifting dose distribution of the FFP plan by 5, 10, 15, and 20 mm in the longitudinal direction and comparing it with the original. Doses for 95% (D95) and 5% of the PTV (D5) were calculated for all simulated setup error plans. Absolute dose measurements were performed using an ionization chamber in the junction. Results The TH&TD plan produced a linear gradient in junction volume, comparable to that of the TH&TH plan. D5 of the PTV was 110% of the prescribed dose when the FFP plan was shifted 0.7 cm and 1.2 cm in the superior direction for 5-GVs and 7-GVs. D95 of the PTV decreased to < 90% of the prescribed dose when the FF plan was shifted 1.1 cm and 1.3 cm in the inferior direction for 5-GVs and 7-GVs. The absolute measured dose showed a good correlation with the calculated dose in the gradient junction volume. The average percent difference (±SD) in all measured points was − 0.7 ± 1.6%, and the average dose variations between depths was − 0.18 ± 1.07%. Conclusion VGMT can create a linear dose gradient across the junction area in both TH&TH and TH&TD and can minimize the dose sensitivity to longitudinal setup errors in tomotherapy-based TBI.

scholarly journals Feasibility study of volumetric modulated arc therapy with Halcyon™ linac for total body irradiation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takuya Uehara ◽  
Hajime Monzen ◽  
Mikoto Tamura ◽  
Masahiro Inada ◽  
Masakazu Otsuka ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Dose Calculation ◽  
Target Volume ◽  
The Body ◽  
Whole Body ◽  
Data Set ◽  
Arc Therapy ◽  
Total Body

Abstract Background The use of total body irradiation (TBI) with linac-based volumetric modulated arc therapy (VMAT) has been steadily increasing. Helical tomotherapy has been applied in TBI and total marrow irradiation to reduce the dose to critical organs, especially the lungs. However, the methodology of TBI with Halcyon™ linac remains unclear. This study aimed to evaluate whether VMAT with Halcyon™ linac can be clinically used for TBI. Methods VMAT planning with Halcyon™ linac was conducted using a whole-body computed tomography data set. The planning target volume (PTV) included the body cropped 3 mm from the source. A dose of 12 Gy in six fractions was prescribed for 50% of the PTV. The organs at risk (OARs) included the lens, lungs, kidneys, and testes. Results The PTV D98%, D95%, D50%, and D2% were 8.9 (74.2%), 10.1 (84.2%), 12.6 (105%), and 14.2 Gy (118%), respectively. The homogeneity index was 0.42. For OARs, the Dmean of the lungs, kidneys, lens, and testes were 9.6, 8.5, 8.9, and 4.4 Gy, respectively. The V12Gy of the lungs and kidneys were 4.5% and 0%, respectively. The Dmax of the testes was 5.8 Gy. Contouring took 1–2 h. Dose calculation and optimization was performed for 3–4 h. Quality assurance (QA) took 2–3 h. The treatment duration was 23 min. Conclusions A planning study of TBI with Halcyon™ to set up VMAT-TBI, dosimetric evaluation, and pretreatment QA, was established.

scholarly journals Adequate target volume in total-body irradiation by intensity-modulated radiation therapy using helical tomotherapy: a simulation study

2016 ◽  
Vol 58 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Ryosuke Takenaka ◽  
Akihiro Haga ◽  
Hideomi Yamashita ◽  
Keiichi Nakagawa
Keyword(s):  
Radiation Therapy ◽  
Total Body Irradiation ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
The Body ◽  
High Fluence ◽  
Intensity Modulated ◽  
Small Set ◽  
Total Body ◽  
Set Up

Abstract Recently, intensity-modulated radiation therapy (IMRT) has been used for total-body irradiation (TBI). Since the planning target volume (PTV) for TBI includes the surrounding air, a dose prescription to the PTV provides high fluence to the body surface. Thus with just a small set-up error, the body might be exposed to a high-fluence beam. This study aims to assess which target volume should be prescribed the dose, such as a clinical target volume (CTV) with a margin, or a CTV that excludes the surface area of the skin. Three treatment plans were created for each patient: the 5-mm clipped plan (Plan A), the 0-mm margin plan (Plan B) and the 5-mm margin plan (Plan C). The CTV was the whole body. PTVs were the CTV with the exception of 5 mm from the skin surface in Plan A, equal to the CTV in Plan B, and the CTV with a 5 mm margin in Plan C. The prescribed dose was 12 Gy in six fractions. To assess the influence of the set-up error, dose distributions were simulated on computed tomography (CT) images shifted 2 pixels (= 4.296 mm), 5 pixels (= 10.74 mm) and 10 pixels (= 21.48 mm) in the lateral direction from the original CT. With a set-up error of 10.74 mm, V110% was 8.8%, 11.1% and 23.3% in Plans A, B and C, respectively. The prescription to the PTV containing the surrounding air can be paradoxically vulnerable to a high-dose as a consequence of a small set-up error.

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