title: Monte Carlo study for designing a dedicated "D"-shaped collimator used in the external beam radiotherapy of retinoblastoma patients.
abstract: OBJECTIVE
  Retinoblastoma is the most common intraocular malignancy in the early childhood. Patients treated with external beam radiotherapy respond very well to the treatment. However, owing to the genotype of children suffering hereditary retinoblastoma, the risk of secondary radio-induced malignancies is high. The University Hospital of Essen has successfully treated these patients on a daily basis during nearly 30 years using a dedicated "D"-shaped collimator. The use of this collimator that delivers a highly conformed small radiation field, gives very good results in the control of the primary tumor as well as in preserving visual function, while it avoids the devastating side effects of deformation of midface bones. The purpose of the present paper is to propose a modified version of the "D"-shaped collimator that reduces even further the irradiation field with the scope to reduce as well the risk of radio-induced secondary malignancies. Concurrently, the new dedicated "D"-shaped collimator must be easier to build and at the same time produces dose distributions that only differ on the field size with respect to the dose distributions obtained by the current collimator in use. The scope of the former requirement is to facilitate the employment of the authors' irradiation technique both at the authors' and at other hospitals. The fulfillment of the latter allows the authors to continue using the clinical experience gained in more than 30 years.
  
  
  METHODS
  The Monte Carlo code PENELOPE was used to study the effect that the different structural elements of the dedicated "D"-shaped collimator have on the absorbed dose distribution. To perform this study, the radiation transport through a Varian Clinac 2100 C/D operating at 6 MV was simulated in order to tally phase-space files which were then used as radiation sources to simulate the considered collimators and the subsequent dose distributions. With the knowledge gained in that study, a new, simpler, "D"-shaped collimator is proposed.
  
  
  RESULTS
  The proposed collimator delivers a dose distribution which is 2.4 cm wide along the inferior-superior direction of the eyeball. This width is 0.3 cm narrower than that of the dose distribution obtained with the collimator currently in clinical use. The other relevant characteristics of the dose distribution obtained with the new collimator, namely, depth doses at clinically relevant positions, penumbrae width, and shape of the lateral profiles, are statistically compatible with the results obtained for the collimator currently in use.
  
  
  CONCLUSIONS
  The smaller field size delivered by the proposed collimator still fully covers the planning target volume with at least 95% of the maximum dose at a depth of 2 cm and provides a safety margin of 0.2 cm, so ensuring an adequate treatment while reducing the irradiated volume.
authors.affiliation: FISRAD S.A.S., CR 64 A # 22 - 41, Bogotá D C, Colombia and Departamento de Física Atómica, Molecular y Nuclear, Universidad de Granada, E-18071 Granada, Spain.
authors.forename: P A
authors.initials: PA
authors.lastname: Mayorga
authors.affiliation: NCTeam, Strahlenklinik, Universitätsklinikum Essen, Hufelandstraße 55, D-45122 Essen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Brualla
authors.affiliation: NCTeam, Strahlenklinik, Universitätsklinikum Essen, Hufelandstraße 55, D-45122 Essen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Sauerwein
authors.affiliation: Departamento de Física Atómica, Molecular y Nuclear, Universidad de Granada, E-18071 Granada, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Lallena
mesh_terms: D006801:Humans; D009010:Monte Carlo Method; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D019572:Retinal Neoplasms / Q000532:radiotherapy*; D012175:Retinoblastoma / Q000532:radiotherapy*