Intraoperative radiation therapy with 50 kV x-rays: A multi-institutional review

Area of Science:

• Medical Physics
• Radiation Oncology
• Clinical Engineering

Background:

• Intraoperative radiation therapy (IORT) offers a targeted approach to cancer treatment.
• The INTRABEAM system provides low kV IORT, requiring specific implementation guidelines.
• Multi-institutional experience is crucial for establishing best practices in novel radiation technologies.

Purpose of the Study:

• To provide a comprehensive guide for the clinical implementation of low kV IORT with the INTRABEAM system.
• To share collective user experience on quality assurance, commissioning, workflow, and treatment planning.
• To identify research avenues for improving IORT accuracy and delivery.

Main Methods:

• Review of collective user experience from eight institutions.
• Description of INTRABEAM system commissioning and quality assurance (QA) tests.
• Analysis of clinical workflow, treatment planning, and safety protocols, including TG100 risk management.

Main Results:

• Detailed dosimetry measurements for beam verification (flatness, symmetry, output, depth dose).
• Emphasis on routine QA procedures (daily, monthly, annual) for program success.
• Discussion of challenges in in-vivo dosimetry and shielding requirements.

Conclusions:

• Successful clinical implementation of INTRABEAM IORT relies on rigorous QA and safety checks.
• Effective treatment planning, including Monte Carlo-based systems, is vital for accurate dose delivery.
• Further research is recommended for CT-based image-guided planning and improved dose accuracy.