Measurement of dose exposure of image guidance in external beam accelerated partial breast irradiation: Evaluation of different techniques and linear accelerators

Abstract

Introduction: Verifying the patient position is always an essential part of the treatment process, especially in hypofractionated treatments such as accelerated partial breast irradiation (APBI). The purpose of the study was to compare five image guidance techniques with respect to imaging dose and image quality.

Methods and materials: We chose five types of imaging methods applicable for APBI and measured their dose exposure on four different accelerators (Synergy, TrueBeam, Artiste and CyberKnife). Absorbed dose was measured with ionization chamber in thorax phantom. Besides dose exposure image quality was also compared.

Results: The lowest dose exposure was measured with kV-kV planar imaging followed by kV-CBCT, MV-MV pair and MV-CBCT in ascending order. Average phantom dose with kV-kV image pair on CyberKnife was 0.01 cGy as the lowest and with MV-CBCT on Artiste was 7.11 cGy as the highest. Average dose exposures of MV-MV images with TrueBeam, Synergy and Artiste were 1.18 cGy, 2.13 cGy and 1.61 cGy, respectively, with similar image quality. For the same machines the doses of kV-CT imaging were comparable: 0.65 cGy, 0.65 cGy and 0.52 cGy, with some differences in image quality. MV-CBCT technique resulted in the highest dose and poorest image quality.

Conclusions: In APBI the position of the patient and tumour bed can be verified with many tools. When fiducials are available, often 2D imaging is enough to achieve appropriate positioning and the kV-kV method is recommended. Imaging with 2.5MV can also be a good solution instead of 6MV. Without fiducials 3D images should be acquired and the recommended method is the kV-CBCT.

Keywords: APBI; IGRT; Image quality; Imaging dose.