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dc.contributor.authorGarcía-Vázquez, Verónica
dc.contributor.authorCalvo, Felipe A
dc.contributor.authorLedesma-Carbayo, María Jesús
dc.contributor.authorSole, Claudio V
dc.contributor.authorCalvo-Haro, José
dc.contributor.authorDesco, Manuel 
dc.contributor.authorPascau, Javier
dc.identifier.citationPLoS One. 2020; 15(1):e0227155es_ES
dc.description.abstractIn intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations.es_ES
dc.description.sponsorshipThis study was supported by Ministerio de Ciencia, Innovacion y Universidades ( [grant number TEC2013–48251-C2 to JP, VG-V and MJL-C], co-funded by European Regional Development Fund (ERDF), “A way of making Europe” (; by Ministerio de Ciencia, Innovacion y Universidades (, Instituto de Salud Carlos III ( [grant numbers DTS14/00192 to JP, VG-V and FAC; PI15/02121 to FAC and JC-H; PI18/01625 to JP], co-funded by European Regional Development Fund (ERDF), “A way of making Europe” (; and by Comunidad de Madrid ( [grant number TOPUS-CM S2013/ MIT3024 to JP], co-funded by European Structural and Investment Fund ( The CNIC is supported by the Ministerio de Ciencia, Innovacion y Universidades ( and the Pro CNIC Foundation ( [to MD], and is a Severo Ochoa Center of Excellence (SEV-2015-0505).es_ES
dc.relation.isversionofPublisher's versiones_ES
dc.titleIntraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observationses_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderMinisterio de Ciencia, Innovación y Universidades (España)es_ES
dc.contributor.funderEuropean Regional Development Fund (ERDF/FEDER)es_ES
dc.contributor.funderInstituto de Salud Carlos III - ISCIIIes_ES
dc.contributor.funderComunidad de Madrides_ES
dc.contributor.funderFundación ProCNICes_ES
dc.identifier.journalPloS onees_ES
dc.repisalud.orgCNICCNIC::Unidades técnicas::Imagen Avanzadaes_ES

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Atribución 4.0 Internacional
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