title: Use of peripheral dose data from uniform dynamic multileaf collimation fields to estimate out-of-field organ dose in patients treated employing sliding window intensity-modulated radiotherapy.
abstract: Peripheral doses (PD) from uniform dynamic multileaf collimation (DMLC) fields were measured for 6 MV x-rays on a Varian linear accelerator using a 0.6 cc ionization chamber inserted at 5 cm depth into a 35 x 35 x 105 cm3 plastic water phantom. PD measurements were also carried out under identical conditions for seven patients treated for head and neck and cervical cancer employing sliding window intensity-modulated radiotherapy (IMRT). The measured PD from these patient-specific intensity-modulated beams (IMBs) were compared with the corresponding data from uniform DMLC fields having similar jaws setting. The measured PD per monitor unit (PD/MU) decreases almost exponentially with out-of-field distance for all uniform DMLC and static fields. For the same strip field width of 1.2 cm, uniform DMLC fields with a larger size of 14 x 22 cm2 deliver an average of 3.51 (SD = 0.51) times higher PD/MU at all out-of-field distances compared to 6 x 6 cm2. Similar to uniform DMLC fields, PD/MU measured from different patient-specific IMBs was found to decrease almost exponentially with out-of-field distance and increase with increase in field dimension. PD per MU from uniform DMLC fields and patient-specific IMBs having similar jaws setting shows good agreement (+/-7%) except at the most proximal distance, where a variation of more than 10% (maximum 15%) was observed. Our study shows that PD data generated from uniform DMLC fields can be used as baseline data to estimate out-of-field critical organ or whole-body dose in patients treated employing sliding window IMRT if an appropriate correction factor for field dimension is applied. The whole-body dose information can be used to estimate the possible increase in risk of fatal secondary malignancy in patients treated employing sliding window IMRT.
authors.affiliation: Department of Medical Physics, Tata Memorial Hospital, Dr Ernest Borg's Marg, Parel, Mumbai 400 012, India. shamu_d@yahoo.com
authors.forename: Shamurailatpam Dayananda
authors.initials: SD
authors.lastname: Sharma
authors.forename: Ritu Raj
authors.initials: RR
authors.lastname: Upreti
authors.forename: Deepak Dattatray
authors.initials: DD
authors.lastname: Deshpande
mesh_terms: D006801:Humans; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000295:instrumentation / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods*; D012062:Relative Biological Effectiveness; D012542:Scattering, Radiation; D014915:Whole-Body Counting