External beam electron therapy: pitfalls in treatment planning and deliverance.
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Biomedical subjects
Publications and source records attributed to J Bellotti.
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Many tumors in the brain and in other tissues can be delineated precisely in images obtained with a CT scanner. After the scan is obtained the patient is taken to another room for radiation therapy and is positioned in the beam with the aid of external markers, simulators or stereotactic devices. This procedure is time consuming and subject to error when precise localization of the beam is desired. The CT scanner itself, with the addition of a collimator, is capable of delivering radiation therapy with great precision without the need for external markers. The patient can be scanned and treated on the same table, the isocenter of the beam can be placed precisely in the center of the lesion, the beam can be restricted to just those planes in which the lesion appears several arcs can be obtained by simply tilting the gantry, and the position of the patient in the beam can be monitored continuously during therapy. We describe here the properties of the CTX, the CT scanner modified for therapy.
Data is presented that will aid in optimizing the arc angles used for rotational therapy for a 6 Mv x-ray beam. Computer calculations of isodose distributions were carried out and the Ap and Lateral dimensions of the 95 and 100% isodose line were tabularized as a function of the field width (6-14 cm), distance between isocenter and patient midline (0-3 cm), and bilateral 120 or 100 degrees arc angle. The 300 degrees rotation cases we studied were generally found to be inferior to 120 degrees or 100 degrees bilateral arc rotations. 120 degrees arcs are best when the target center is within 2 cm of the patient's Ap center. As that separation increases, the bilateral arc angle should be decreased or wedges should be rotated through 300 degrees to avoid maximum doses greater than 105%. The data tables can be used as a starting point for computer calculations to select the field width and the arc angle for a particular target location and size. Of note is the degree to which the dimensions of the 100% isodose line decreases for small field widths and large isocenter to patient midline distances.
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