Improved dose homogeneity using electronic compensation technique for total body irradiation

In total body irradiation (TBI) utilizing large parallel-opposed fields, the manual placement of lead compensators has conventionally been used to compensate for the varying thickness throughout the body. The goal of this study is to pursue utilizing the modern electronic compensation (E-comp) technique to more accurately deliver dose to TBI patients. Bilateral parallel-opposed TBI treatment plans were created using E-comp for 15 patients for whom CT data had been previously acquired. A desirable fluence pattern was manually painted within each field to yield a uniform dose distribution. The conventional compensation technique was simulated within the treatment planning system (TPS) using a field-in-field (FIF) method. This allows for a meaningful evaluation of the E-comp technique in comparison to the conventional method. Dose-volume histograms (DVH) were computed for all treatment plans. The mean total body dose using E-comp deviates from the prescribed dose (4 Gy) by an average of 2.4%. The mean total body dose using the conventional compensation deviates from the prescribed dose by an average of 4.5%. In all cases, the mean body dose calculated using E-comp technique deviates less than 10% from that of conventional compensation. The average reduction in maximum dose using E-comp compared to that of the conventional method was 30.3% ± 6.6% (standard deviation). In all cases, the s-index for the E-comp technique was lower (10.5% ± 0.7%) than that of the conventional method (15.8% ± 4.4%), indicating a more homogenous dose distribution. In conclusion, a large reduction in maximum body dose can be seen using the proposed E-comp technique while still producing a mean body dose that accurately complies with the prescription dose. Dose homogeneity was quantified using s-index which demonstrated a reduction in hotspots with E-comp technique. Electronic compensation technique is capable of more accurately delivering a total body dose compared to conventional methods.