Conformal Terminology

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Presentation transcript:

Conformal Terminology Julie Puzzonia

Multileaf Collimator (MLC) Located in gantry head Below jaws 60-80 pairs Individual leaf widths vary by machine (1cm or less) Made of tungsten alloy1 X-ray transmission of less than 2% (intraleaf) Interleaf transmission less than 3% http://rwinc.com/wp-content/uploads/2014/11/Artistic-MLC-Photo.jpg

Purpose Creates treatment field shapes Alternative to blocks Leaves can move independent of each other Used in Step and Shoot and Volumetric Modulated Arc Therapy (VMAT)

Advantages of MLC versus Cast Blocks Incorporated into head of machine and computer automated No heavy lifting! No entering treatment room between fields No handling of toxic materials Allows for segment modulation More advanced treatment techniques Intensity Modulated Radiation Therapy (IMRT) VMAT Can cool off hot spots Protect critical structures Lower transmission of beam Cerrobend cast block: 7.5cm Cerrobend needed for <5% transmission1 https://image.slidesharecdn.com/17chap-13treatmentplanningiii-120423052904-phpapp02/95/17-chap-13-treatment-planning-iii-3-728.jpg?cb=1335159829

Disadvantages of MLC versus Cast Blocks More intense Quality Assurance procedures MapCheck, ArcCheck Limitations to MLC shapes Tongue and groove effect Scallop effect Island blocking https://www.sunnuclear.com/images/products/mapcheck/S2_MapCHECK.png

Tongue and Groove Effect MLC shape that is used to: Limit interleaf leakage Allow faster movement of leaves Problems: Poor synchronization of leaf motion can cause underdosage between overlapping adjacent leaves https://image.slidesharecdn.com/22chap-20intensitymodulatedradiationtherapy-120423045845-phpapp02/95/22-chap-20-intensity-modulated-radiation-therapy-74-728.jpg?cb=1335157426

“The MLC tongue-and-groove effect on IMRT dose distributions” Consider the article: “The MLC tongue-and-groove effect on IMRT dose distributions” Previous study: Sykes and Williams (1998) showed potential for 15-28% underdosage from tongue and groove effect Factors that matter: Patient setup uncertainty Co-planar vs non-coplanar beams Number of fields *These all contribute help to “smear” the tongue and groove effect limiting its impact on final dose delivery

“Smearing” Effect of increasing the number of treatment fields Smooths out the dose distribution and field shape https://www.slideserve.com/jill/multileaf-collimator-mlc-leaf-intrusion-an-optimum-value-variable-mlc-leaf-width

Scallop effect Due to the shape of the MLC, the outline of the field has scalloped appearance Does not produce true conformal shape compared to cast block https://image.slidesharecdn.com/17chap-13treatmentplanningiii-120423052904-phpapp02/95/17-chap-13-treatment-planning-iii-10-728.jpg?cb=1335159829

Scallop effect underlap Some areas of MLC overlap the block outline, while others underlap https://image.slidesharecdn.com/roleofradiotherapyinbraintumours-150919015057-lva1-app6892/95/role-of-radiotherapy-in-brain-tumours-23-638.jpg?cb=1442627553

Island Block MLC apertures cannot create island blocks easily Treatments that heavily rely on island blocking: TBI Lung blocks, kidney blocks Whole abdomen Kidney blocks https://upload.wikimedia.org/wikipedia/commons/thumb/6/65/Radiation_WholeAbdomen2.jpg/220px-Radiation_WholeAbdomen2.jpg

References: Khan FM. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014. Deng J, Pawlicki T, Chen Y, Li JS, Jiang SB, Ma C-M. The MLC tongue-and-groove effect on IMRT dose distributions. Physics in Medicine and Biology. 2001;46(4):1039-1060. http://dx.doi.org/10.1109/iembs.2000.900534.