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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Modeling AeroForm tissue expander for postmastectomy radiation therapy.

Elaine Dziemianowicz1, Stephen J Gardner1, Karen Chin Snyder1

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|July 24, 2019
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Summary

The AeroForm tissue expander (TE) causes dose calculation inaccuracies in radiation therapy due to its metallic reservoir. The Acuros External Beam (AXB) algorithm offers improved accuracy over the Anisotropic Analytical Algorithm (AAA) for treatment planning.

Keywords:
AAAAcurosAeroFormdose calculationhigh densitypostmastectomy radiation therapytissue expander

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Medical Imaging

Background:

  • The AeroForm chest wall tissue expander (TE), used post-mastectomy, contains a metallic CO2 reservoir.
  • This metallic component introduces imaging artifacts and density misrepresentations on planning CT scans.
  • These issues complicate structure definition and impact radiation dose calculation accuracy.

Purpose of the Study:

  • To develop and validate a model of the AeroForm TE within the Eclipse treatment planning system (TPS).
  • To compare the accuracy of dose calculation algorithms, specifically Varian's Anisotropic Analytical Algorithm (AAA) and Acuros External Beam (AXB), for the AeroForm TE.
  • To evaluate the clinical significance of dose calculation differences and propose a modeling procedure.

Main Methods:

  • A validated TPS model of the AeroForm TE was created.
  • Transmission measurements using radiochromic film compared calculated vs. measured transmission.
  • Dose calculations were performed using AAA and AXB algorithms, followed by dose profile, gamma analysis, and clinical data evaluation.

Main Results:

  • Both AAA and AXB accurately modeled direct transmission through the AeroForm.
  • The AXB algorithm demonstrated superior modeling of lateral scatter compared to AAA.
  • AAA overestimated dose within the AeroForm device when compared to AXB; clinical impact varied by patient and plan.

Conclusions:

  • A clinical procedure for modeling the AeroForm TE in TPS was proposed.
  • The study highlights limitations in dose calculation accuracy around the metallic reservoir.
  • Accurate dose calculation is critical for assessing plan quality and guiding the use of AeroForm in postmastectomy radiation therapy.