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Special Procedures: TBI, TSET and IORT
1. Rota%on
#
11
Special
Procedures:
TBI,
TSeT
and
IORT
Mentor:
Tim
Waldron
By
Vibha
Chaswal
2. TBI
•
•
•
•
•
•
•
Hand
MU
calcula%ons
Measuring
profiles
with
and
without
filter
Simula%ons
and
Treatments
Lung
block
manufacture
Compensator
determina%on
and
placement
Commissioning
procedure
discussion
with
TJW
AAPM
report
17
3. TBI
Goals
of
TBI:
• Immunosuppression
-‐
lymphocyte
elimina%on
to
allow
engraOment
of
donor
bonemarrow
• Eradica%on
of
malignant
cells
-‐
leukemia,
lymphoma,
rarely
solid
tumors
• Eradica%on
of
cells
with
gene%c
disorders
-‐
Fanconi's
anemia,
thalassemia
major,
WiskoT-‐Aldritch
syndrome
Dosimetric
goals
of
TBI
(AAPM
report
17):
•
Dose
Homogeneity
within
10
%
•
Prescribed
dose
to
mid-‐plane
•
Dose
rate
of
10-‐15
cGy/min
•
Verifica%on
by
Port
films
within
reasonable
margin
•
Lung
Shielding
4.
5.
6. TSET
Goals
of
TSET:
• Cutaneous
T
cell
lymphoma:
Mycosis
fungoides
Dosimetric
goals
of
TSET
(AAPM
report
23):
• Average
energy
at
treatment
plane
=
3-‐7
MeV
• Uniform
dose
to
the
en%re
skin
(ver%cal
uniformity
+/-‐
8
%
horizontal
+/-‐
4
%
in
the
central
treatment
plane
• X-‐ray
back
ground
<
1
%
•
Dose
prescribed
to
a
point
•
High
dose
rate
treatment
•
Verifica%on
by
TLDs
•
Eye
shields
• Boost
fields
for
under-‐dosed
areas
7.
8. 1 Treatment Cycle per week over two days:
Day 1 – AP/RPO/LPO
Day 2 – PA/LAO/RAO
