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Combining CBCT Dose Into IMRT Treatment Planning

Z Grelewicz

Z Grelewicz*, R Wiersma , The University of Chicago, Chicago, IL


SU-E-J-36 Sunday 3:00PM - 6:00PM Room: Exhibit Hall

Purpose: Cone beam CT (CBCT) is increasingly used in patient setup for IMRT. Daily CBCT may provide effective localization, however, it introduces concern over excessive imaging dose. Previous studies investigated the calculation of excess CBCT dose, however, no study has yet treated this dose as a source of therapeutic radiation, optimized in consideration of PTV and OARs constrains. Here we present a novel combined MV+kV inverse optimization engine to weave the CBCT and MV dose together such that CBCT dose is used for both imaging and therapeutic purposes. This may mitigate some of the excess imaging dose effects of daily CBCT and allow complete evaluation of the CBCT dose prior to treatment.

Methods: The EGSnrc Monte Carlo system was used to model a Varian Trilogy CBCT system and 6 MV treatment beam. Using the model, the dose to patient from treatment beam and imaging beam was calculated for ten patients. The standard IMRT objective function was modified to include CBCT dose. Treatment plan optimization using the MOSEK optimization tool was performed retrospectively with and without assuming kV radiation dose from CBCT, assuming one CBCT per fraction.

Results: Across ten patients, the CBCT delivered peaks of between .4% and 3.0% of the prescription dose to the PTV, with average CBCT dose to the PTV between .3% and .8%. By including CBCT dose to skin as a constraint during optimization, peak skin dose is reduced by between 1.9% and 7.4%, and average skin dose is reduced by .2% to 3.3%.

Conclusions: Pre-treatment CBCT may deliver a substantial amount of radiation dose to the target volume. By considering CBCT dose to skin at the point of treatment planning, it is possible to reduce patient skin dose from current clinical levels, and to provide patient treatment with the improved accuracy that daily CBCT provides.

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