Designed and Validation of In-House Head and Neck Phantom for Quality Assurance and Radiotherapy Dose Measurements

Document Type : Original Paper

Authors

1 1. Department of Radiotherapy, Delhi State Cancer Institute, Dilshad Garden, Delhi – 110095, India 2. II. Department of Physics, School of Basic Sciences & Research, Sharda University, Greater Noida, Uttar Pradesh- 201310, India

2 Department of Physics, School of Basic Sciences and Research, Sharda University, Greater Noida, India

3 Government Cancer Hospital, MGM Medical College, Indore

4 Army Hospital (Research & Referral), Delhi Cantonment, New Delhi-110010, India

Abstract

Introduction: In radiotherapy treatment of head and neck (H&N) cancers, more complex quality assurance checks and patient-specific dosimetry are required to ensure accuracy in modern technology. In this paper, a new cost-effective human tissue equivalent H&N phantom was designed to serve as an economical and adaptable tool for assessment and assurance of precise radiotherapy dose delivery.
Material and Methods: The phantom was designed using locally available paraffin wax and tissue-equivalent materials. Computed tomography (CT) images of the phantom were acquired using a conventional CT simulator and were registered with the images of a real patient having approximately similar physical dimensions. The geometric and attenuation properties of the structures in the phantom were studied and compared to the structures of the real patient. 
Results: Hounsfield unit (HU) values of different structures of the phantom were compared to the values obtained from the CT images of a real patient and were found to be in good agreement. HU values obtained for the right, and left eye, brain, larynx, and bone shell were 7(±10) HU, 6(±9), 30(±14) HU, -984(±6) HU and 873(±214) HU in phantom. Structures simulated in phantom agreed well on comparison regarding both their design and radiation properties with respect to real patient human tissues. Gamma analysis was performed for the axial dose plane at plan isocenter for both the calculated dose distribution in H&N phantom and the patient agrees for 98.79% passing rate for 3% /3mm criteria.
Conclusion: The designed phantom depicts human anatomy and meets the requirements of tissue equivalence. The result shows that phantom has proved to be a cost-effective and valuable tool for accurate verification of dose distributions in regions of clinical and dosimetric interests.

Keywords

Main Subjects

References

  1. Ma CM, Jiang SB, Pawlicki T, Chen Y, Li JS, Deng J, et al. A quality assurance phantom for IMRT dose verification. Proceedings of the 22nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (Cat. No. 00CH37143). 2000; 2:1180-3.
  2. Musolino SV. Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water; technical reports series (No. 398). 2000.
  3. Podgorsak EB. Radiation oncology physics: A Handbook for Teachers and Students. 2005.
  4. IAEA, Technical Reports Series No. 277. Absorbed Dose Determination in Photon and Electron Beams. IAEA, Vienna (2nd Edition in 1997). 1987.
  5. Khan FM, Gibbons JP. Khan's the physics of radiation therapy. Lippincott Williams & Wilkins; 2014.
  6. Andreo P, Cunningham JR, Hohlfeld K, Svensson H. Absorbed dose determination in photon and electron beams. An international Code of Practice.1987.
  7. DeWerd LA. The phantoms of medical and health physics. Kissick M, editor. Berlin: Springer; 2014.
  8. Tino R, Yeo A, Leary M, Brandt M, Kron T. A systematic review on 3D-printed imaging and dosimetry phantoms in radiation therapy. Technology in cancer research & treatment. 2019 Sep 12;18:1533033819870208.
  9. McGarry CK, Grattan LJ, Ivory AM, Leek F, Liney GP, Liu Y, et al. Tissue mimicking materials for imaging and therapy phantoms: a review. Physics in Medicine & Biology. 2020 Dec 16;65(23):23TR01.
  10. Ezzell GA, Burmeister JW, Dogan N, LoSasso TJ, Mechalakos JG, Mihailidis D, et al. IMRT commissioning: multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119. Medical physics. 2009 Nov;36(11):5359-73.
  11. Ju SG, Han Y, Kum O, Cheong KH, Shin EH, Shin JS, et al. Comparison of film dosimetry techniques used for quality assurance of intensity modulated radiation therapy. Medical physics. 2010 Jun;37(6Part1):2925-33.
  12. Ravichandran R, Bhasi S, Binukumar JP, Davis CA. Need of patient-specific quality assurance and pre-treatment verification program for special plans in radiotherapy. Journal of Medical Physics/Association of Medical Physicists of India. 2011 Jul;36(3):181.
  13. Molineu A, Followill DS, Balter PA, Hanson WF, Gillin MT, Huq MS, et al. Design and implementation of an anthropomorphic quality assurance phantom for intensity-modulated radiation therapy for the Radiation Therapy Oncology Group. International Journal of Radiation Oncology* Biology* Physics. 2005 Oct 1;63(2):577-83.
  14. Maulana A, Pawiro SA. Dosimetry verification on VMAT and IMRT radiotherapy techniques: In the case of prostate cancer. InJournal of Physics: Conference Series 2016 Mar 1 (Vol. 694, No. 1, p. 012010). IOP Publishing.
  15. Tazehmahalleh FE, Gholamhosseinian H, Layegh M, Tazehmahalleh NE, Esmaily H. Determining rectal dose through cervical cancer radiotherapy by 9 MV photon beam using TLD and XR type T GAFCHROMIC® Film. Iran. J. Radiat. Res. 2008 Dec 1;6(3):129-34.
  16. Kim MJ, Lee SR, Lee MY, Sohn JW, Yun HG, Choi JY, et al. Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy. PloS one. 2017 May 4;12(5):e0176227.
  17. Makris DN, Pappas EP, Zoros E, Papanikolaou N, Saenz DL, Kalaitzakis G, et al. Characterization of a novel 3D printed patient specific phantom for quality assurance in cranial stereotactic radiosurgery applications. Physics in Medicine & Biology. 2019 May 10;64(10):105009.
  18. Zhang F, Zhang H, Zhao H, He Z, Shi L, He Y, et al. Design and fabrication of a personalized anthropomorphic phantom using 3D printing and tissue equivalent materials. Quantitative imaging in medicine and surgery. 2019 Jan;9(1):94.
  19. Oinam AS, Singh L. Verification of IMRT dose calculations using AAA and PBC algorithms in dose buildup regions. Journal of applied clinical medical physics. 2010 Sep;11(4):105-21.
  20. Eng KY, Kandaiya S, Yahaya NZ. Radiotherapy dose verification on a customised head and neck perspex phantom. InJournal of Physics: Conference Series. 2017; 851(1): 012020.
  21. Webster GJ, Hardy MJ, Rowbottom CG, Mackay RI. Design and implementation of a head‐and‐neck phantom for system audit and verification of intensity‐modulated radiation therapy. Journal of Applied Clinical Medical Physics. 2008 Mar;9(2):46-56.
  22. Akpochafor MO, Aweda MA, Ibitoye AZ, Adeneye SO, Iloputaife C, Omojola AD. Verification of a treatment planning system using an in-house designed head and neck phantom. Archives of Physics Research. 2013;4(6):1-8.
  23. Verma TR, Painuly NK, Tyagi M, Johny D, Gupta R, Bhatt ML. Validation of the gel & wax boluses and comparison of their dosimetric performance with virtual bolus. Journal of Biomedical Physics & Engineering. 2019 Dec;9(6):629.
  24. Amour K, Maleka P, Maunda K, Mazunga M, Msaki P. Verification of Depth Dose Curves Derived on Beeswax, Paraffin and Water Phantoms Using FLUKA Monte Carlo Code. Tanzania Journal of Science. 2020 Oct 31;46(3):923-30.
  25. Rahman MA, Jamil HM, Elius IB, Khan AHAN, Haydar MA. Design and fabrication of wax cube phantoms for the assessment of paraffin wax as phantom material for radiotherapy. Nuclear science and applications. 2020; 29(1&2):37-41.
  26. Rahman MA, Bhuiyan MT, Rahman MM, Chowdhury MN. Comparative study of absorbed doses in different phantom materials and fabrication of a suitable phantom. Malaysian Journal of Medical and Biological Research. 2018 Jun 30;5(1):19-24.
  27. Hadi H and Ali Abed F. Introducing a simple tissue equivalent anthropomorphic phantom for radiation dosimetry in diagnostic radiology and radiotherapy. Journal of paramedical sciences. 2011; 2 (4) : 25-9. DOI:10.22037/JPS.V2I4.2718.
  28. Low DA, Moran JM, Dempsey JF, Dong L, Oldham M. Dosimetry tools and techniques for IMRT. Medical physics. 2011 Mar;38(3):1313-38.
  29. Rades D, Kronemann S, Meyners T, Bohlen G, Tribius S, Kazic N, et al. Comparison of four cisplatin-based radiochemotherapy regimens for nonmetastatic stage III/IV squamous cell carcinoma of the head and neck. Int. J. Radiat. Oncol. Biol. Phys. 2011 Jul 15;80(4):1037-44.
  30. Tribius S, Kronemann S, Kilic Y, Schroeder U, Hakim S, Schild SE, et al. Radiochemotherapy including cisplatin alone versus cisplatin+ 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Strahlentherapie und Onkologie. 2009 Oct 1;185(10):675.
  31. Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. New England Journal of Medicine. 2004 May 6;350(19):1945-52.
  32. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. New England Journal of Medicine. 2004 May 6;350(19):1937-44.
  33. Rades D, Fehlauer F, Wroblesky J, Albers D, Schild SE, Schmidt R. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy, or conventional radiotherapy. Oral oncology. 2007 Jul 1;43(6):535-43.
  34. Franzese C, Fogliata A, Franceschini D, Clerici E, D'AGOSTINO GI, Navarria P, et al. Treatment: outcome and toxicity of volumetric modulated arc therapy in oropharyngeal carcinoma. Anticancer Research. 2016 Jul 1;36(7):3451-7.
  35. Bucci MK, Bevan A, Roach III M. Advances in radiation therapy: conventional to 3D, to IMRT, to 4D, and beyond. CA: a cancer journal for clinicians. 2005 Mar;55(2):117-34.
  36. Amour K, Maleka P, Maunda K, Mazunga M, Msaki P. Verification of Depth Dose Curves Derived on Beeswax, Paraffin and Water Phantoms Using FLUKA Monte Carlo Code. Tanzania Journal of Science. 2020 Oct 31;46(3):923-30.
  37. Kamomae T, Shimizu H, Nakaya T, Okudaira K, Aoyama T, Oguchi H, et al. Three-dimensional printer-generated patient-specific phantom for artificial in vivo dosimetry in radiotherapy quality assurance. Physica medica. 2017 Dec 1;44:205-11.
  38. Oh D, Hong CS, Ju SG, Kim M, Koo BY, Choi S, et al. Development of patient-specific phantoms for verification of stereotactic body radiation therapy planning in patients with metallic screw fixation. Scientific reports. 2017 Jan 19;7(1):40922.
  39. Na KS, Seo SJ, Lee JH, Yoo SH. Radiotherapic Valuation of Paraffin Wax for Patients with Oral Cancer. The Journal of Korean Society for Radiation Therapy. 2011;23(1):41-9.

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 20, Issue 5
September and October 2023
Pages 282-289

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History

  • Receive Date: 08 February 2022
  • Revise Date: 31 August 2022
  • Accept Date: 18 September 2022

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