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Establishing BMI-specific diagnostic reference levels for radiotherapy planning CT in breast and prostate cancer: A
M J Pereira1, M Abrantes2, P Matafome3
1Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., 3000-075, Coimbra, Portugal; Polytechnic University of Coimbra, ESTESC - Coimbra Health School, Medical Imaging and Radiotherapy, 3046-854, Coimbra, Portugal; Faculty of Sciences and Technology, University of Coimbra, 3040-248 Coimbra, Portugal.
Introduction:
Given the increase in obesity prevalence, there is also a higher number of patients with high body mass index (BMI) undergoing radiotherapy treatments. Besides the fact that diagnostic reference levels (DRLs) are defined for standard patients, they are an important tool to promote all patient safety. This study aimed to analyse typical radiotherapy planning computed tomography (CT) dose levels for breast and prostate cancer, for three BMI patient categorisations.
Methods:
Radiotherapy planning CT for the clinical indication of breast and prostate radiotherapy were retrospectively selected. Data of exposure and dose levels were collected and compared between three Portuguese institutions of excellence on Oncology and based on BMI categorisation according to WHO recommendations: Normal weight 18.5-24.99 kg/m2; Overweight 25-29.99 kg/m2; Obesity ≥30 kg/m2.
Results:
248 breast and 281 prostate radiotherapy planning CTs were analysed (total n = 529). Significant differences were found for CT dose index (CTDIvol), total dose length product (DLPt), and size-specific dose estimate (SSDE) values per BMI categorisations and institutions. The obtained dose values for breast cancer clinical indication were 8.56, 10.49, and 14.62 mGy (CTDIvol); 319.22, 393.44, and 558.87 mGy cm (DLPt), and 12.72, 14.65, and 17.96 mGy (SSDE) for normal weight, overweight, and obesity categorisation, respectively. For prostate cancer clinical indication, the obtained values were 11.02, 13.31, and 16.67 mGy (CTDIvol); 506.50, 629.13, and 814.15 mGy cm (DLPt), and 14.89, 16.37, and 18.45 mGy (SSDE) for normal weight, overweight, and obesity categories, respectively. CTDIvol and DLPt are mostly lower for patients with a normal weight and overweight than the European DRLs published.
Conclusion:
Dose levels of radiotherapy planning CT were established for BMI patient categorisations. This approach will contribute to personalised procedures optimisation.
Implications For Practice:
This approach could promote the optimisation of radiotherapy planning CT and contribute to dedicated radiation protection.
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