Transitioning From Computed Radiography to Digital Radiography by Redesigning the Clinical Workflow for Total Body Irradiation with Lung Blocks
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PO-GePV-P-9 (Sunday, 7/10/2022) [Eastern Time (GMT-4)]
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Purpose: Total body irradiation (TBI) is a radiotherapy technique utilized to treat diseases such as multiple myeloma and leukemia. A common technique for TBI involves two high-energy photon fields delivered anteriorly and posteriorly to a patient standing at large (>300 cm) source-to-skin distances (SSD) to deposit dose homogenously (i.e., within 10% of prescription dose) to the entirety of the body1. Furthermore, lung blocks may be used to attenuate radiation and reduce the occurrence of lung pneumonitis. Lung block creation can be a laborious process within the TBI clinical workflow due to processes such as block size determination, accurate lung block placement, and verification prior to treatment. Recently, in our clinic, we transitioned from using computed radiography (CR) to digital radiography (DR) to simplify the lung block process and enhance image quality.
Methods: The previous workflow to generate TBI lung blocks utilized the linac to irradiate a large CR cassette placed behind a patient in treatment position. Employing a similar procedure, the CR cassette was replaced by a portable, wireless DR imager (DRX Core 3543C - Carestream). Also, the lung block contouring process transitioned from manual drawing on printed CR film to electronic digitization in ARIA. Feasibility of implementing the DR imager was evaluated by contrasting the two workflows.
Results: The DR imaging detector successfully replaced CR imaging in our TBI workflow to create lung blocks for TBI patients with enhanced image quality (Figures 1 and 2). A fully electronic workflow was developed with the DR imager to simplify workflow by digitizing contour lung blocks in ARIA and verify placement prior to treatment (Figure 2).
Conclusion: DR, which offers enhanced imaging and treatment quality for TBI lung block workflow, over CR has been successfully implemented.
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