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Prone Breast Radiotherapy on the MR-Linac: A Technical Note on Skin-Couch Contact Dose Effects.

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Accelerated partial breast irradiation (APBI) on an MR-Linac may alter skin dose due to couch contact. The magnetic field

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • Accelerated partial breast irradiation (APBI) offers improved outcomes and cosmesis compared to whole breast irradiation.
  • The MR-Linac provides enhanced visualization for adaptive radiotherapy but poses challenges like skin-couch contact.
  • Skin dose is a critical factor in radiotherapy, especially with novel technologies.

Purpose of the Study:

  • To evaluate the impact of MR-Linac couch contact on skin dose distribution.
  • To compare skin dose in the presence and absence of the magnetic field during APBI.
  • To investigate potential alterations in skin dose deposition compared to conventional linear accelerators.

Main Methods:

  • Retrospective pilot study of three patients with left-sided breast cancer undergoing APBI in prone position.
  • Utilized a 1.5T MR simulator for imaging and contouring of target and organs-at-risk.
  • Step-and-shoot intensity-modulated radiation therapy (IMRT) plans were optimized and recalculated with and without magnetic field presence.

Main Results:

  • All treatment plans met target and organ-at-risk dose constraints.
  • Mean skin dose to the entire skin rind (Skin_Rind) was higher with the magnetic field present.
  • Dose to the couch-contact skin region (Skin_Rind_Ant) was consistently lower with the magnetic field present.

Conclusions:

  • MR-Linac couch contact influences skin dose distribution differently than conventional linacs.
  • Magnetic field and interface effects appear to alter skin dose deposition during APBI.
  • Further research is needed to fully understand and mitigate these effects for safe and effective MR-Linac treatments.