Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180

George X Ding; Parham Alaei; Bruce Curran; Ryan Flynn; Michael Gossman; T Rock Mackie; Moyed Miften; Richard Morin; X George Xu; Timothy C Zhu

doi:10.1002/mp.12824

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Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180

Journal article

Open access

Peer reviewed

Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180

George X Ding, Parham Alaei, Bruce Curran, Ryan Flynn, Michael Gossman, T Rock Mackie, Moyed Miften, Richard Morin, X George Xu and Timothy C Zhu

Medical physics (Lancaster), Vol.45(5), pp.e84-e99

05/2018

DOI: 10.1002/mp.12824

PMID: 29468678

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Abstract

With radiotherapy having entered the era of image guidance, or image-guided radiation therapy (IGRT), imaging procedures are routinely performed for patient positioning and target localization. The imaging dose delivered may result in excessive dose to sensitive organs and potentially increase the chance of secondary cancers and, therefore, needs to be managed. This task group was charged with: a) providing an overview on imaging dose, including megavoltage electronic portal imaging (MV EPI), kilovoltage digital radiography (kV DR), Tomotherapy MV-CT, megavoltage cone-beam CT (MV-CBCT) and kilovoltage cone-beam CT (kV-CBCT), and b) providing general guidelines for commissioning dose calculation methods and managing imaging dose to patients. We briefly review the dose to radiotherapy (RT) patients resulting from different image guidance procedures and list typical organ doses resulting from MV and kV image acquisition procedures. We provide recommendations for managing the imaging dose, including different methods for its calculation, and techniques for reducing it. The recommended threshold beyond which imaging dose should be considered in the treatment planning process is 5% of the therapeutic target dose. Although the imaging dose resulting from current kV acquisition procedures is generally below this threshold, the ALARA principle should always be applied in practice. Medical physicists should make radiation oncologists aware of the imaging doses delivered to patients under their care. Balancing ALARA with the requirement for effective target localization requires that imaging dose be managed based on the consideration of weighing risks and benefits to the patient.

Radiometry

Radiotherapy Dosage

Radiotherapy, Image-Guided - methods

Humans

Research Report

Radiation Dosage

Radiotherapy, Image-Guided - instrumentation

Radiotherapy Planning, Computer-Assisted

Cone-Beam Computed Tomography

Precision Medicine

Radiotherapy, Intensity-Modulated

Details

Title: Subtitle: Image guidance doses delivered during radiotherapy: Quantification, management, and reduction: Report of the AAPM Therapy Physics Committee Task Group 180
Creators: George X Ding - Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN, 37232, USA
Parham Alaei - University of Minnesota, Minneapolis, MN, 55455, USA
Bruce Curran - Virginia Commonwealth University, Richmond, VA, 23284, USA
Ryan Flynn - University of Iowa, Iowa City, IA, 52242, USA
Michael Gossman - Tri-State Regional Cancer Center, Ashland, KY, 41101, USA
T Rock Mackie - University of Wisconsin, Madison, WI, 53715, USA
Moyed Miften - University of Colorado, Aurora, CO, 80045, USA
Richard Morin - Mayo Clinic, Jacksonville, FL, 32224, USA
X George Xu - Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
Timothy C Zhu - University of Pennsylvania, Philadelphia, PA, 19104, USA
Resource Type: Journal article
Publication Details: Medical physics (Lancaster), Vol.45(5), pp.e84-e99
DOI: 10.1002/mp.12824
PMID: 29468678
NLM abbreviation: Med Phys
ISSN: 0094-2405
eISSN: 2473-4209
Publisher: United States
Grant note: P30 CA086862 / NCI NIH HHS
Language: English
Date published: 05/2018
Academic Unit: Radiation Oncology
Record Identifier: 9984047762402771

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