Clinical implementation of Total Body Irradiation with Tomotherapy: from imaging to dose delivery

Total Body Irradiation (TBI) has been used as part of conditioning regimens pre-bone marrow transplantation for several years. With technology advances, IMRT started to be applied to this purpose, aiming potentially less toxicity by allowing OAR sparing and more homogeneous dose distribution. Tomotherapy® equipment has been used for modulated TBI and represents a sophisticated, safe and high quality method for this purpose. The main purpose of this paper is to present a methodology to clinically implement TBI treatments using Tomotherapy and to provide metrics of dose distribution based in our clinical experience. The presented methodology includes in a description of the immobilization accessories used and presenting a detailed workflow for treatment planning and delivery. Results of 20 patients showed good uniformity and target coverage, registration offsets averages inferior to 5 mm and in-vivo dosimetry with good agreement with the prescribed dose. The provided metrics could be used as a guide for those institutions that are willing to implement TBI with Tomotherapy.