mARC preoperative rectal cancer treatments vs. 3D conformal radiotherapy. A dose distribution comparative study.

PURPOSE: mARC (modulated arc) is the arc therapy technique provided by Siemens. The present study analyses the dose distributions and treatment times corresponding to preoperative rectal cancer mARC treatments. The results are compared to those corresponding to 3D-CRT plans. METHODS: The plans of 30 patients, each having one mARC and one 3D-CRT plan, were evaluated. Every plan was calculated on a sequential two-phase treatment scheme with prescription doses of 45 Gy in the initial phase and 5.4 Gy in the boost phase. Dosimetric parameters and mean DVHs corresponding to the PTVs and OARs were assessed for both techniques. RESULTS: All mARC plans were considered valid for treatment and yielded a highly significant improvement in the CI over 3D-CRT plans (p <0.001). They also showed statistically significant advantage on the parameters D98%, D95% and D2% of the high dose PTV. Regarding the OARs, mARC plans showed reductions in the mean dose of 3.5 Gy in the bladder and greater than 4 Gy in the femoral heads. Considering the small bowel, the mARC plans resulted in a 2.7 Gy mean reduction in the mean dose and lower irradiated volumes over the entire dose range. CONCLUSIONS: Arc therapy plans with the mARC technique for preoperative rectal cancer treatment in a sequential two-phase treatment scheme provide important advantages in the PTVs and OARs. mARC plans show superior protection of the femoral heads, bladder and small bowel, similar to the results found with other more widespread arc therapy techniques.

A dose index as a tool to estimate paediatric patient doses in digital projection radiography.

Radiation exposure during childhood is estimated to have a lifetime risk up to seven times greater than exposures at adult age. Therefore, paediatric patient dose monitoring is a major concern in radiology. The aim of this study is to evaluate the validity of a dose index, displayed at the digital imaging and communication in medicine (DICOM) header of the images, as a dosimetric quantity to estimate the entrance surface dose (ESD) for each procedure. It was carried out over a sample of 156 paediatric patients who underwent a chest examination. National Radiation Protection Board Report 318 model was used to categorise patients by age and to estimate their thickness. Corrected dose index values were compared with calculated ESD, estimated from tube output and radiographic technique. The deviation between both values remained within 2% for every age group, except for patients up to 1 y. Therefore, the index could be used to estimate ESD, allowing to manage greater patient dose databases.