title: [Prostate radiation therapy: in vivo measurement of the dose delivered by kV-CBCT].
abstract: OBJECTIVE
  To investigate if the regular use of kV-CBCT notably increases the dose delivered to tumor and surrounding healthy tissues.
  
  
  METHODS
  Images were obtained using a Varian equipment (OBI version 1.3, 645 to 650 projections in 370 degrees to acquire image), and patients were irradiated at source-tumor distance: 100cm. In vivo measurements were performed using radio-thermoluminescent dosimeters Harshaw-TLD700H (TLD) at skin (anterior-posterior and lateral axis crossing the rotation axis), with a fourth TLD group under the table thanks to a retrolaser. TLD's were calibrated at the kV-CBCT effective energy (64 keV), and the method validated using an anthropomorphic phantom, in which Gafchromic EBT films were also inserted.
  
  
  RESULTS
  The phantom study showed that the dose distribution depends on the phantom position relative to the axis and that the doses measured at the phantom surface using TLD and films (good agreement) were maximum at the entrance of the anterior-posterior axis. Their arithmetic mean was equal, or a slightly greater than doses measured at mid-thickness of the phantom and at the level of the rectum (OAR). In vivo measurements performed on the five first patients (125 kV-CBCT) yield a mean skin dose per kV-CBCT varying from 5.8+/-0.1 to 7.3+/-0.2 cGy on the anterior-posterior axis. Lateral skin doses vary from 3.4+/-0.2 to 4.5+/-0.2 cGy.
  
  
  CONCLUSIONS
  Doses delivered by repeated kV-CBCT are not negligible. They should be taken into account, but questions about the RBE to be applied to kilovoltage X-rays are raised.
authors.affiliation: Unité de radiophysique et de radioprotection du patient, CHU Henri-Mondor, 94010 Créteil, France. ginette.marinello@hmn.aphp.fr
authors.forename: G
authors.initials: G
authors.lastname: Marinello
authors.forename: J-P
authors.initials: JP
authors.lastname: Mege
authors.forename: M-C
authors.initials: MC
authors.lastname: Besse
authors.forename: G
authors.initials: G
authors.lastname: Kerneur
authors.forename: J-L
authors.initials: JL
authors.lastname: Lagrange
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D019047:Phantoms, Imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012007:Rectum; D012867:Skin; D013819:Thermoluminescent Dosimetry / Q000295:instrumentation / Q000379:methods; D014962:X-Ray Film