Document Type : Original Research

Authors

1 King George Medical University, UP, Lucknow, India

2 Dr.Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India

3 Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Abstract

Background: The dosimetric parameters required in lung cancer radiation therapy are taken from a homogeneous water phantom; however, during treatment, the expected results are being affected because of its inhomogeneity. Therefore, it becomes necessary to quantify these deviations.
Objective: The present study has been undertaken to find out inter- and intra- lung density variations and its dosimetric impact on lung cancer radiotherapy using Monte Carlo code FLUKA and PBC algorithms.
Material and Methods: Density of 100 lungs was recorded from their CT images along with age. Then, after PDD calculated by FLUKA MC Code and PBC algorithm for virtual phantom having density 0.2 gm/cm3 and 0.4 gm/cm3 (density range obtained from CT images of 100 lungs) using Co-60 10 x10 cm2 beams were compared.
Results: Average left and right lung densities were 0.275±0.387 and 0.270±0.383 respectively. The deviation in PBC calculated PDD were (+)216%, (+91%), (+)45%, (+)26.88%, (+)14%, (-)1%, (+)2%, (-)0.4%, (-)1%, (+)1%, (+)4%, (+)4.5% for 0.4 gm/cm3 and (+)311%, (+)177%, (+)118%, (+)90.95%, (+)72.23%, (+)55.83% ,(+)38.85%, (+)28.80%, (+)21.79%, (+)15.95%, (+)1.67%, (-) 2.13%, (+)1.27%, (+)0.35%, (-)1.79%, (-)2.75% for 0.2 gm/cm3 density mediums at depths of 1mm, 2mm, 3mm, 4mm, 5mm, 6 mm, 7 mm, 8mm, 9mm,10mm, 15mm, 30mm, 40mm, 50mm, 80mm and 100 mm, respectively.
Conclusion: Large variations in inter- and intra- lung density were recorded. PBC overestimated the dose at air/lung interface as well as inside lung. The results of Monte Carlo simulation can be used to assess the performance of other treatment planning systems used in lung cancer radiotherapy.

Keywords

  1. Fu W, Dai J, Hu Y. The influence of lateral electronic disequilibrium on the radiation treatment planning for lung cancer irradiation. Biomed Mater Eng. 2004;14:123-6. PubMed PMID: 14757959.
  2. Tada T, Minakuchi K, Sakamoto H, Fukuda H, Bun M, Nakajima T. Inhomogeneity correction in radiotherapy for lung cancer in multicenter clinical trials. Radiat Med. 2002;20:191-4. PubMed PMID: 12296435.
  3. Thomas SJ. A modified power-law formula for inhomogeneity corrections in beams of high-energy x rays. Med Phys. 1991;18:719-23. doi.org/10.1118/1.596665. PubMed PMID: 1921876.
  4. Orton CG, Chungbin S, Klein EE, Gillin MT, Schultheiss TE, Sause WT. Study of lung density corrections in a clinical trial (RTOG 88-08). Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1998;41:787-94. doi.org/10.1016/S0360-3016(98)00117-5. PubMed PMID: 9652839.
  5. Papanikolaou N, Battista JJ, Boyer AL, Kappas C, Klein E, Mackie TR, et al. Tissue inhomogeneity corrections for megavoltage photon beams. AAPM Task Group. 2004;65:1-142.
  6. Abdul Haneefa K, Cyriac TS, Musthafa M, Ganapathi Raman R, Hridya V, Siddhartha A, et al. FLUKA Monte Carlo for Basic Dosimetric Studies of Dual Energy Medical Linear Accelerator. Journal of Radiotherapy. 2014;2014.
  7. Battistoni G, Cerutti F, Fasso A, Ferrari A, Muraro S, Ranft J, et al., editors. The FLUKA code: Description and benchmarking. Hadronic Shower Simulation Workshop (AIP Conference Proceedings Volume 896); 2007.
  8. Ferrari A, Sala PR, Fasso A, Ranft J. FLUKA: A multi-particle transport code (Program version 2005). 2005.
  9. Botta F, Mairani A, Hobbs RF, Vergara Gil A, Pacilio M, Parodi K, et al. Use of the FLUKA Monte Carlo code for 3D patient-specific dosimetry on PET-CT and SPECT-CT images. Phys Med Biol. 2013;58:8099-120. doi.org/10.1088/0031-9155/58/22/8099. PubMed PMID: 24200697. PubMed PMCID: 4037810.
  10. Taleei R, Shahriari M, AGHAMIRI SMR. Evaluation of FLUKA Code in Simulation and Design of X-ray Tubes for X-ray Profile. 2006.
  11. Thomas SJ. Relative electron density calibration of CT scanners for radiotherapy treatment planning. Br J Radiol. 1999;72:781-6. doi.org/10.1259/bjr.72.860.10624344. PubMed PMID: 10624344.
  12. McKenzie A. Cobalt-60 gamma-ray beams. BJR supplement/BIR. 1995;25:46-61.
  13. Speigel M. Probability and Statistics. Schaum’s Outline Series in Mathematics. McGraw-Hill, New York; 1975
  14. Fujisaki T, Kikuchi K, Saitoh H, Tohyama N, Myojoyama A, Osawa A, et al. Effects of density changes in the chest on lung stereotactic radiotherapy. Radiat Med. 2004;22:233-8. PubMed PMID: 15468943.
  15. AC03205248 A. Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water: Internat. Atomic Energy Agency; 2000.
  16. Praveenkumar RD, Santhosh KP, Augustine A. Estimation of inhomogenity correction factors for a Co-60 beam using Monte Carlo simulation. J Cancer Res Ther. 2011;7:308-13. doi.org/10.4103/0973-1482.87030. PubMed PMID: 22044813.
  17. Verhaegen F, Seuntjens J. Monte Carlo modelling of external radiotherapy photon beams. Phys Med Biol. 2003;48:R107-64. doi.org/10.1088/0031-9155/48/21/R01. PubMed PMID: 14653555.
  18. Joshi CP, Darko J, Vidyasagar PB, Schreiner LJ. Dosimetry of interface region near closed air cavities for Co-60, 6 MV and 15 MV photon beams using Monte Carlo simulations. J Med Phys. 2010;35:73-80. doi.org/10.4103/0971-6203.62197. PubMed PMID: 20589116. PubMed PMCID: 2884308.
  19. Robinson D. Inhomogeneity correction and the analytic anisotropic algorithm. J Appl Clin Med Phys. 2008;9:2786. PubMed PMID: 18714283.
  20. Tachibana M, Noguchi Y, Fukunaga J, Hirano N, Yoshidome S, Hirose T. Influence on dose calculation by difference of dose calculation algorithms in stereotactic lung irradiation: comparison of pencil beam convolution (inhomogeneity correction: batho power law) and analytical anisotropic algorithm. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2009;65:1064-72. doi.org/10.6009/jjrt.65.1064. PubMed PMID: 19721315.
  21. Miura H, Masai N, Oh R-J, Shiomi H, Yamada K, Usmani MN, et al. Dosimetric Impact of Tumor Position and Lung Density Variations in Lung Stereotactic Body Radiotherapy. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology. 2014;2014.
  22. Aarup LR, Nahum AE, Zacharatou C, Juhler-Nottrup T, Knoos T, Nystrom H, et al. The effect of different lung densities on the accuracy of various radiotherapy dose calculation methods: implications for tumour coverage. Radiother Oncol. 2009;91:405-14. doi.org/10.1016/j.radonc.2009.01.008. PubMed PMID: 19297051.
  23. Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med. 2011;32:605-44. doi.org/10.1016/j.ccm.2011.09.001. PubMed PMID: 22054876. PubMed PMCID: 3864624.