title: Monte Carlo simulations of patient dose perturbations in rotational-type radiotherapy due to a transverse magnetic field: a tomotherapy investigation.
abstract: OBJECTIVE
  Several groups are exploring the integration of magnetic resonance (MR) image guidance with radiotherapy to reduce tumor position uncertainty during photon radiotherapy. The therapeutic gain from reducing tumor position uncertainty using intrafraction MR imaging during radiotherapy could be partially offset if the negative effects of magnetic field-induced dose perturbations are not appreciated or accounted for. The authors hypothesize that a more rotationally symmetric modality such as helical tomotherapy will permit a systematic mediation of these dose perturbations. This investigation offers a unique look at the dose perturbations due to homogeneous transverse magnetic field during the delivery of Tomotherapy(®) Treatment System plans under varying degrees of rotational beamlet symmetry.
  
  
  METHODS
  The authors accurately reproduced treatment plan beamlet and patient configurations using the Monte Carlo code geant4. This code has a thoroughly benchmarked electromagnetic particle transport physics package well-suited for the radiotherapy energy regime. The three approved clinical treatment plans for this study were for a prostate, head and neck, and lung treatment. The dose heterogeneity index metric was used to quantify the effect of the dose perturbations to the target volumes.
  
  
  RESULTS
  The authors demonstrate the ability to reproduce the clinical dose-volume histograms (DVH) to within 4% dose agreement at each DVH point for the target volumes and most planning structures, and therefore, are able to confidently examine the effects of transverse magnetic fields on the plans. The authors investigated field strengths of 0.35, 0.7, 1, 1.5, and 3 T. Changes to the dose heterogeneity index of 0.1% were seen in the prostate and head and neck case, reflecting negligible dose perturbations to the target volumes, a change from 5.5% to 20.1% was observed with the lung case.
  
  
  CONCLUSIONS
  This study demonstrated that the effect of external magnetic fields can be mitigated by exploiting a more rotationally symmetric treatment modality.
authors: Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703.
authors: Y M
authors: YM
authors: Yang
authors: Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703.
authors: M
authors: M
authors: Geurts
authors: Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703.
authors: J B
authors: JB
authors: Smilowitz
authors: Molecular Imaging, Radiotherapy and Oncology, Université catholique de Louvain, Brussels, Belgium 1348.
authors: E
authors: E
authors: Sterpin
authors: Department of Medical Physics, Wisconsin Institutes for Medical Research, University of Wisconsin, Madison, Wisconsin 53703.
authors: B P
authors: BP
authors: Bednarz
mesh_terms: D006801:Humans; D060526:Magnetic Fields; D008279:Magnetic Resonance Imaging; D008297:Male; D009010:Monte Carlo Method; D009369:Neoplasms / Q000532:radiotherapy*; D058958:Organs at Risk / Q000528:radiation effects; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*
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