IJMPCERO  Vol.3 No.1 , February 2014
A Clinical Dosimetry Analysis of Total Body Irradiation for Leukemia Patients

Background and Purpose: To perform a retrospective in vivo dosimetry study of 129 total body irradiation (TBI) on leukemia and bone marrow transplant patients treated in our clinic from 2008 to 2011 and to find out if there is any indication of the necessity of developing a new efficient TBI approach. Materials and Methods: The in vivo dosimetry data of 129 patients treated with TBI between 2008 and 2011 were retrieved from the database and analyzed. These patients were mostly treated with the regime of a single fraction or 6 fractions with some exceptions of 8-fraction or 2-fraction treatments depending on the protocols that were applied. For every fraction of treatment, 10 pairs of diode dosimeters were used to monitor the doses to the midline of head, neck, arms, mediastinum, left lung, right lung, umbilicus, thigh, knee, and ankle for both AP and PA fields. The doses to the midline of the above body parts were considered to be the average of the AP and PA readings of each diode pair. Dose deviation from the prescribed value for each body part was studied by plotting the histogram of the frequency versus deviation and comparing this with the dose delivered to the midline of the umbilicus to where the dose was prescribed. The correlation of dose deviation to body part thickness was also studied. By studying the dose deviations, we can find the uniformity of general dose distributions for conventional TBI treatments. Results: The retrospective dosimetry study of the 129 TBI patient treatments indicates that for most of the patients treated in our clinic, the doses received by different body parts monitored with in vivo dosimetry were within the window of 10% difference from the prescribed dose. The inhomogeneity of dose on different body parts could be manually improved by using compensators, but the method is cumbersome and time consuming. The dose deviation in many histograms ranging from about ?10% to 10% indicates some incongruity of dose distribution. This could be due to the method of using lead compensators for a manual dose adjustment which could not ideally compensate for different body thicknesses everywhere. Conclusions: The conventional TBI could give uniform dose to the major body parts under the online in vivo dosimetry monitoring at the level of 10%, but the treatment procedure is cumbersome and time consuming. This implies the importance of developing a new and efficient TBI method by adopting modern radiation therapy technique.

Cite this paper: L. Lu, J. Filippi, A. Patel, N. Gupta, M. Weldon, J. Woollard, A. Ayan, Y. Rong, D. Martin, C. Pelloski and M. Welliver, "A Clinical Dosimetry Analysis of Total Body Irradiation for Leukemia Patients," International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol. 3 No. 1, 2014, pp. 31-42. doi: 10.4236/ijmpcero.2014.31006.

[1]   L. J. V. Dyk, et al., “The Physical Aspects of Total and Half Body Photon Irradiation,” AAPM Report No. 17 (Task Group 29), American Institute of Physics, College Park, 1986.

[2]   F. M. Khan, “The Physics of Radiation Therapy,” 4th Edition, Lippincott Williams & Wilkins, Philadelphia, 2009, p. 405.

[3]   R. Yao, D. Bernard, J. Turian, et al., “A Simplified Technique for Delivering Total Body Irradiation (TBI) with Improved Dose Homogeneity,” Medical Physics, Vol. 39, No. 4, 2012, pp. 2239-2248.

[4]   J. Y. Wong, A. Liu, T. Schultheiss, et al., “Targeted Total Marrow Irradiation Using Three-Dimensional Image-Guided Tomographic Intensity-Modulated Radiation Therapy: An Alternative to Standard Total Body Irradiation,” Biology of Blood and Marrow Transplantation, Vol. 12, No. 3, 2006, pp. 306-315.

[5]   S. K. Hui, J. Kapatoes, J. Fowler, et al., “Feasibility Study of Helical Tomotherapy for Total Body or Total Marrow Irradiation,” Medical Physics, Vol. 32, No. 10, 2005, pp. 3214-3224.

[6]   B. Aydogan, A. J. Mundt and J. C. Roeske, “Linac-Based Intensity Modulated Total Marrow Irradiation (IM-TMI),” Technology in Cancer Research and Treatment, Vol. 5, No. 5, 2006, pp. 513-519.

[7]   P. A. Jursinic, “Angular Dependence of Dose Sensitivity of Surface Diodes,” Medical Physics, Vol. 36, No. 6, 2009, pp. 2165-2171.

[8]   A. S. Stein, “Intensity-Modulated Radiation Therapy, Etoposide, and Cyclophosphamide Followed by Donor Stem Cell Transplant in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia,” Clinical Identifier: NCT00576979, 2013.

[9]   D. V. BonCoeur, C. Pelloski, N. Gupta, et al., “Using Intensity Modulated Radiation Therapy for Total Body Irradiation—A Phantom Study,” Medical Physics, Vol. 38, 2011, p. 3678.