title: Evaluation of various approaches for assessing dose indicators and patient organ doses resulting from radiotherapy cone-beam CT.
abstract: OBJECTIVE
  The aim of this study was to evaluate various approaches for assessing patient organ doses resulting from radiotherapy cone-beam CT (CBCT), by the use of thermoluminescent dosimeter (TLD) measurements in anthropomorphic phantoms, a Monte Carlo based dose calculation software, and different dose indicators as presently defined.
  
  
  METHODS
  Dose evaluations were performed on a CBCT Elekta XVI (Elekta, Crawley, UK) for different protocols and anatomical regions. The first part of the study focuses on using pcxmc software (pcxmc 2.0, STUK, Helsinki, Finland) for calculating organ doses, adapting the input parameters to simulate the exposure geometry, and beam dose distribution in an appropriate way. The calculated doses were compared to readouts of TLDs placed in an anthropomorphic Rando phantom. After this validation, the software was used for analyzing organ dose variability associated with patients' differences in size and gender. At the same time, various dose indicators were evaluated: kerma area product (KAP), cumulative air-kerma at the isocenter (Kair), cone-beam dose index, and central cumulative dose. The latter was evaluated in a single phantom and in a stack of three adjacent computed tomography dose index phantoms. Based on the different dose indicators, a set of coefficients was calculated to estimate organ doses for a range of patient morphologies, using their equivalent diameters.
  
  
  RESULTS
  Maximum organ doses were about 1 mGy for head and neck and 25 mGy for chest and pelvis protocols. The differences between pcxmc and TLDs doses were generally below 10% for organs within the field of view and approximately 15% for organs at the boundaries of the radiation beam. When considering patient size and gender variability, differences in organ doses up to 40% were observed especially in the pelvic region; for the organs in the thorax, the maximum differences ranged between 20% and 30%. Phantom dose indexes provided better correlation with organ doses than Kair and KAP, with average ratios ranging between 0.9 and 1.1 and variations for different organs and protocols below 20%. The triple phantom setup allowed us to take into account scatter dose contributions, but nonetheless, the correlation with the evaluated organ doses was not improved with this method.
  
  
  CONCLUSIONS
  The simulation of rotational geometry and of asymmetric beam distribution by means of pcxmc 2.0 enabled us to determine patient organ doses depending on weight, height and gender. Alternatively, the measurement of an in phantom dose indicator combined with proper correction coefficients can be a useful tool for a first dose estimation of in-field organs. The data and coefficients provided in this study can be applied to any patient undergoing a scan by an Elekta XVI equipment.
authors.affiliation: Struttura Complessa Fisica Sanitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Corso Bramante 88, Torino 10126, Italy.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Rampado
authors.affiliation: Struttura Complessa Fisica Sanitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Corso Bramante 88, Torino 10126, Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Giglioli
authors.affiliation: Struttura Complessa Fisica Sanitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Corso Bramante 88, Torino 10126, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Rossetti
authors.affiliation: Radiation Oncology Department, University of Turin, Torino 10126, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Fiandra
authors.affiliation: Radiation Oncology Department, University of Turin, Torino 10126, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ragona
authors.affiliation: Struttura Complessa Fisica Sanitaria, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Corso Bramante 88, Torino 10126, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ropolo
mesh_terms: D000375:Aging; D003198:Computer Simulation; D054893:Cone-Beam Computed Tomography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006257:Head / Q000528:radiation effects; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008953:Models, Anatomic; D009010:Monte Carlo Method; D009333:Neck / Q000528:radiation effects; D010388:Pelvis / Q000528:radiation effects; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation / Q000379:methods*; D012727:Sex Characteristics; D012984:Software; D013819:Thermoluminescent Dosimetry / Q000295:instrumentation / Q000379:methods*; D013909:Thorax / Q000528:radiation effects; D055815:Young Adult