Document Type: Original Article

Authors

1 Ph.D of Medical Physics. Assistant professor, Department of Medical Physics and Radiotherapy, Arak university of Medical Sciences and Khansari hospital, Arak, Iran

2 Ph.D of Physics. Associate professor, Department of Physics, Arak University, Arak, Iran

3 Ms.c of Physics, Department of Physics, Arak University, Arak, Iran

Abstract

Introduction: Metal prostheses in patients affect the radiotherapy dose distribution. Metal prostheses with high density and atomic number cause major changes in scattering and attenuation of radiation. The present study aims to assess the impact of metal knee prosthesis with various dimensions and materials on radiotherapy dose distribution. Material and Methods: In this research, the Varian Linac and water phantom were simulated using the MCNPX code. Dose distribution of photon beam in a water phantom, with and without the presence of knee prostheses made of cobalt-chromium-molybdenum alloy, steel, titanium, and titanium alloy used in men and women was investigated using the Monte Carlo simulation.Results: The prosthesis led to an increase in dose in comparison with cases that there was used no prosthesis. According to values of the depth dose percentage, the maximum dose increase was found to be 6.8%, 6.1%, 4%, and 4.29%, and dose reduction 41.18%, 40.66%, 37.76%, and 37.51% for prosthetics with men’s knee dimensions made of cobalt-chromium-molybdenum alloy, steel, titanium alloy, and titanium, respectively. Above all, does increasing to 6.4%, 5.9%, 3.8%, and 3.94% and doses reducing to 40.87%, 40.36%, 36.94%, and 36.69 were observed in prosthetics for women. The highest amount of dose reduction for men’s prostheses made of mentioned materials was found to be 48.75%, 47.7%, 45%, and 45.8%, respectively. In addition, it was 46.36%, 45.8%, 43.8%, and 43.95% for women’s prostheses, respectively.Conclusion: Material will have a significant impact if a part of the knee bone places behind the prosthesis. According to the obtained values, it is recommended to utilize prostheses made of titanium and titanium alloys for knee arthroplasty. The prosthesis can either increase or decrease dose in tumor or lead to increase dose at organs at risk.

Keywords

  1. Reft C, Alecu R, Das IJ, Gerbi BJ, Keall P, Lief E, et al. Dosimetric considerations for patients with HIP prostheses undergoing pelvic irradiation. Report of the AAPM Radiation Therapy Committee Task Group 63. Med Phys. 2003;30:1162-82. doi: 10.1118/1.1565113. PubMed PMID: 12852541.
  2. Friedrich RE, Todorovic M, Krull A. Simulation of scattering effects of irradiation on surroundings using the example of titanium dental implants: a Monte Carlo approach. Anticancer Res. 2010;30:1727-30. PubMed PMID: 20592369.
  3. Wang R, Pillai K, Jones PK. Dosimetric measurement of scattered radiation from dental implants in simulated head and neck radiotherapy. Int J Oral Maxillofac Implants. 1998;13:197-203. PubMed PMID: 9581405.
  4. Rosewall T, Kong V, Vesprini D, Catton C, Chung P, Menard C, et al. Prostate delineation using CT and MRI for radiotherapy patients with bilateral hip prostheses. Radiother Oncol. 2009;90:325-30. doi: 10.1016/j.radonc.2008.11.015. PubMed PMID: 19121547.
  5. Bazalova M, Coolens C, Cury F, Childs P, Beaulieu L, Verhaegen F, editors. Monte Carlo dose calculations for phantoms with hip prostheses. Journal of Physics: Conference Series; 2008: IOP Publishing.doi: 10.1088/1742-6596/102/1/012001.
  6. Wieslander E, Knoos T. Dose perturbation in the presence of metallic implants: treatment planning system versus Monte Carlo simulations. Phys Med Biol. 2003;48:3295-305. doi: 10.1088/0031-9155/48/20/003. PubMed PMID: 14620059 .
  7. Mesbahi A, Nejad FS. Monte Carlo study on the impact of spinal fixation rods on dose distribution in photon beams. Reports of Practical Oncology & Radiotherapy. 2007;12:261-6.doi: 10.1016/s1507-1367(10)60064-8.
  8. Reitemeier B, Reitemeier G, Schmidt A, Schaal W, Blochberger P, Lehmann D, et al. Evaluation of a device for attenuation of electron release from dental restorations in a therapeutic radiation field. J Prosthet Dent. 2002;87:323-7.doi: 10.1067/mpr.2002.122506 . PubMed PMID: 11941360.
  9. Shahbazi GD, Changizi B, Jomehzadeh A, Larizadeh MH. The effect of contrast media on treatment planning and dose calculation in radiation therapy of pelvis cancers. J Med Isfahan School. 2017;34:1389-94.
  10. Chin DW, Treister N, Friedland B, Cormack RA, Tishler RB, Makrigiorgos GM, et al. Effect of dental restorations and prostheses on radiotherapy dose distribution: a Monte Carlo study. J Appl Clin Med Phys. 2009;10:2853. PubMed PMID: 19223833; PubMed Central PMCID: PMC5720502.
  11. Shimozato T, Yasui K, Kawanami R, Habara K, Aoyama Y, Tabushi K, et al. Dose distribution near thin titanium plate for skull fixation irradiated by a 4-MV photon beam. Journal of Medical Physics/Association of Medical Physicists of India. 2010;35:81.doi: 10.4103/0971-6203.62199.
  12. Cohen AJ, Koral KF. Backscattering and secondary-electron emission from metal targets of various thicknesses. 1965.
  13. Williams MV, Burnet NG, Sherwin E, Kestelman R, Geater AR, Thomas SJ, et al. A radiotherapy technique to improve dose homogeneity around bone prostheses. Sarcoma. 2004;8:37-42. doi: 10.1080/13577140410001679248. PubMed PMID: 18521392; PubMed Central PMCID: PMC2395598.
  14. Schneider U, Fiechtner A, Besserer J, Lomax A. Neutron dose from prostheses material during radiotherapy with protons and photons. Phys Med Biol. 2004;49:N119-24. doi: 10.1088/0031-9155/49/9/n01 .PubMed PMID: 15152934.
  15. Hammersley J. Monte carlo methods: Springer Science & Business Media; 2013.
  16. Seif F, Bayatiani MR. Evaluation of electron contamination in cancer treatment with megavoltage photon beams: monte carlo study. J Biomed Phys Eng. 2015;5:31-8. PubMed PMID: 25973409; PubMed Central PMCID: PMC4417618.
  17. Hosseinzadeh H, Tarabichi S, Shahi A. Special Considerations in Asian Knee Arthroplasty. Chapter. 2013.
  18. Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res. 1985:13-22. PubMed PMID: 3967412.
  19. Popa D, Tarnita DN, Tarnita D, Grecu D. The generation of the three-dimensional model of the human knee joint. Rom J Morphol Embryol. 2005;46:279-81. PubMed PMID: 16688363.
  20. Bahreyni Toossi MT, Behmadi M, Ghorbani M, Gholamhosseinian H. A Monte Carlo study on electron and neutron contamination caused by the presence of hip prosthesis in photon mode of a 15 MV Siemens PRIMUS linac. J Appl Clin Med Phys. 2013;14:52-67. doi: 10.1120/jacmp.v14i5.4253. PubMed PMID: 24036859; PubMed Central PMCID: PMC5714559.
  21. Jou M-DTS-B, Hsieh M-S. Three-dimensional geometric constraint evaluation and analysis for determining commercial knee prosthesis. Journal of Medical and Biological Engineering. 2002;22:139-45.
  22. Keall PJ, Siebers JV, Jeraj R, Mohan R. Radiotherapy dose calculations in the presence of hip prostheses. Med Dosim. 2003;28:107-12. doi: 10.1016/S0958-3947(02)00245-5. PubMed PMID: 12804709.
  23. Spezi E, Palleri F, Angelini A, Ferri A, Baruffaldi F, editors. Characterization of materials for prosthetic implants using the BEAMnrc Monte Carlo code. Journal of Physics: Conference Series; 2007;74:021016. doi: 10.1088/1742-6596/74/1/021016.