SU-E-T-487: Impact of Geometric Uncertainties in Accelerated Partial Breast Irradiation Using the Strut-Adjusted Volume Implant (SAVI)




Single-entry multi-catheter devices have been developed for accelerated partial breast irradiation (APBI). Rotational and translational uncertainties are usually mitigated by quality assurance, however its actual dosimetric impact has not been addressed, which is presented here for SAVI applicator.


Under Institutional Review Board exemption status, we retrospectively analyzed 48 APBI treatment plans using SAVI applicator. For quick calculation of dose-volume histogram (DVH) considering geometric uncertainties, the coordinate of each voxel of critical organs after rotation or translation along the central catheter was calculated using an in-house software instead of rotating or translating the entire dose distribution.


For most cases, the skin doses increased with rotation to both directions. At 10 degree of rotation, the increase of Dmax (percent prescribed dose) at 50% (median), 75%, 90%, and 100% (maximum) percentile were 0.3%, 1.7%, 5.6% and 25.0%, respectively. The increase of chest wall Dmax at 50%, 75%, 90%, and 100% percentile were 0.1%, 1.0%, 10.3% and 38.8%, respectively. The increase of skin Dmax of the patients with the distance between skin surface and lumpectomy cavity surface ≤16 mm was significantly larger than those with the distance >16 mm. Similarly, patients with the distance between lung and lumpectomy cavity surface ≤20 mm showed higher sensitivity of chest wall Dmax against rotation than patients with the distance <20 mm. Translation of the applicator showed larger impact on the skin dose than rotation, although the effects on chest wall was less than 2% even at 10 mm displacement. At 5 mm of translation, increase of skin Dmax at 50%, 75%, 90%, and 100% percentile were 2.3%, 8.0%, 15.3% and 77.7%, respectively.


The impacts of the geometric uncertainties (rotation and translation) of SAVI applicator were investigated. The skin-lumpectomy cavity and lung-lumpectomy cavity distances showed significant relationship with skin and chest wall doses, respectively.