ArticleJournal of applied clinical medical physics2026
Reducing low-dose exposure in helical TomoTherapy for locally advanced left-sided breast cancer with a deformable image registration-based dose-mimicking workflow.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Article
- Reducing low-dose exposure in helical TomoTherapy for locally advanced left-sided breast cancer with a deformable image registration-based dose-mimicking workflow.Journal of applied clinical medical physics · 2026Article
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3 authors.
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Abstract
backgroundHelical TomoTherapy provides highly conformal dose distributions for breast irradiation but is limited by extensive low-dose spillage ("low-dose bath"), contributing to increased integral dose and potential long-term toxicities. Complete blocks can suppress low-dose spread, but at the cost of prolonged treatment times on legacy TomoTherapy systems. PURPOSE: To develop and validate a deformable image registration (DIR)-based workflow that predicts patient-specific low-dose distributions and generates personalized complete blocks for TomoTherapy, aiming to reduce low-dose exposure and integral dose. A secondary objective was to determine whether Radixact, a modern helical platform, could mitigate treatment-time penalties while preserving dosimetric benefits.
methodsTwenty-eight patients were retrospectively analyzed (18 tangential partial-arc volumetric modulated arc therapy [t-VMAT], 10 TomoTherapy). DIR-based dose prediction derived from t-VMAT atlases was used to construct complete blocks for replanning on Hi-Art (TOMO_RE) and Radixact (TOMO_FA). Dosimetric endpoints included target conformity, homogeneity, organ-at-risk (OAR) doses, and integral dose (ID). Statistical analyses used Mann-Whitney U test for independent cohorts and Friedman/Wilcoxon tests for paired TomoTherapy plans with Holm-Bonferroni correction.
resultsTOMO_FA significantly reduced low-dose exposure compared with TOMO_ORI, including lower contralateral lung mean dose (0.79 vs. 3.13 Gy, p < 0.01) and reduced Heart V5 (12.81% vs. 20.94%, p = 0.027). Body-PTV ID decreased meaningfully (103.14 vs. 114.52 Gy·L, p = 0.012). High-dose cardiac parameters (V25, V40) remained within clinically acceptable limits and comparable to t-VMAT. Treatment time improved substantially on Radixact (587.2 ± 44.3 s vs. 1118.0 ± 135.5 s).
conclusionsThe proposed DIR-based complete block workflow effectively reduces low-dose exposure and integral dose in helical TomoTherapy without compromising delivery efficiency when implemented on Radixact. TOMO_FA represents a practical, personalized planning option, particularly for patients requiring stringent low-dose sparing.
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