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Rapid Treatment Field Uniformity Optimization for Total Skin Electron Beam Therapy Using Cherenkov Imaging

J Andreozzi

J Andreozzi1*, L Jarvis2 , R Zhang3 , B Williams4 , A Glaser5 , B Pogue6 , D Gladstone7 , (1) Dartmouth College, Hanover, NH, (2) Dartmouth-Hitchcock Medical Center, City Of Lebanon, New Hampshire, (3) Dartmouth College, Hanover, NH, (4) Dartmouth Hitchcock Medical Center, Lebanon, NH, (5) Dartmouth College, Hanover, NH, (6) Dartmouth College, Hanover, NH, (7) Dartmouth Hitchcock-Medical Center, Hanover, NH


MO-AB-BRA-8 (Monday, July 13, 2015) 7:30 AM - 9:30 AM Room: Ballroom A

Purpose: To evaluate treatment field heterogeneity resulting from gantry angle choice in total skin electron beam therapy (TSEBT) following a modified Stanford dual-field technique, and determine a relationship between source to surface distance (SSD) and optimized gantry angle spread.

Methods: Cherenkov imaging was used to image 62 treatment fields on a sheet of 1.2m x 2.2m x 1.2cm polyethylene following standard TSEBT setup at our institution (6 MeV, 888 MU/min, no spoiler, SSD=441cm), where gantry angles spanned from 239.5° to 300.5° at 1° increments. Average Cherenkov intensity and coefficient of variation in the region of interest were compared for the set of composite Cherenkov images created by summing all unique combinations of angle pairs to simulate dual-field treatment. The angle pair which produced the lowest coefficient of variation was further studied using an ionization chamber. The experiment was repeated at SSD=300cm, and SSD=370.5cm. Cherenkov imaging was also implemented during TSEBT of three patients.

Results: The most uniform treatment region from a symmetric angle spread was achieved using gantry angles +/-17.5° about the horizontal axis at SSD=441cm, +/-18.5° at SSD=370.5cm, and +/-19.5° at SSD=300cm. Ionization chamber measurements comparing the original treatment spread (+/-14.5°) and the optimized angle pair (+/-17.5°) at SSD=441cm showed no significant deviation (r=0.999) in percent depth dose curves, and chamber measurements from nine locations within the field showed an improvement in dose uniformity from 24.41% to 9.75%. Ionization chamber measurements correlated strongly (r=0.981) with Cherenkov intensity measured concurrently on the flat Plastic Water phantom. Patient images and TLD results also showed modest uniformity improvements.

Conclusion: A decreasing linear relationship between optimal angle spread and SSD was observed. Cherenkov imaging offers a new method of rapidly analyzing and optimizing TSEBT setup geometry by providing a 2D image of the treatment plane as a sum of the two fields.

Funding Support, Disclosures, and Conflict of Interest: This study has been funded by NIH grants R21EB17559 and R01CA109558 as well as Norris Cotton Cancer Center Pilot funding.

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