SU-F-J-127: Multi-Institutional Evaluation of Setup, Organ Deformation, Precision Dosimetry in Total Marrow Irradiation.

PURPOSE: Totals Marrow Irradiation (TMI) is a highly focused radiation delivery to the human skeleton structure therefore requiring a high amount of precision and accuracy for a quality treatment. Not much is known on how the patient position varies across multiple treatment fractions and how that positioning impacts the dose delivery. Currently TMI is studied as an international collaboration with multiple centers around the world; however, many of these centers used different pretreatment techniques. The goal of this work is to measure the accuracy of patient positioning, its impact on dose delivery and compare the impact of each technique for multiple institutions.

METHODS: Using Tomotherapy pretreatment MVCTs and the planning KVCTs measurements are made of the 3D setup uncertainties of the TMI treatment. Then, using the dose and plan files of the treatment impact of patient position on dose can be measured. Measurement of organ deformation and center of mass change were done using the Velocity AI program from Varian. We are looking at four the boney targets (skull, spine, pelvis, and femur) and three key sensitive tissues (eyes, lungs, kidneys).

RESULTS: Position measurements have been made for 3 different institutions using 3 different pre-treatment techniques. Comparing the translation motion we can observe the greatest change in the Y and Z direction of patient set up. For intra-fractional motion the shoulder and clavicle represent the greatest potential for motion and therefore most likely to have a dose change.

CONCLUSION: All centers use different techniques for their treatment and this study shows that these techniques do not produce the same pretreatment results. We hope to expand this study further. Currently we have 3 centers participating in this study with more centers joining every day.