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Biomedical subjects

M T Gillin

Publications and source records attributed to M T Gillin.

At least 19 recordsLinked to original sources

Measurements of in-air output ratios for a linear accelerator with and without the flattening filter.

The in-air output ratio (Sc) for photon beams from linear accelerators describes the change of in-air output as a function of the collimator settings. The physical origin of the Sc is mainly due to the change in scattered radiation that can reach the point of measurement as the geometry of the head changes. The flattening filter (FF) and primary collimator are the major sources of scattered radiation. The change in amount of backscattered radiation from the collimator into the beam-monitoring chamber also contributes to the variation of output. In this work, we measured the Sc and backscatter factors (Sb) into the beam-monitoring chamber for a linear accelerator with and without the FF. We measured the Sc with a Farmer-type chamber in a miniphantom at the depth of 10 g/cm2 for 6- and 18-MV x-ray beams from a Varian Clinac 2100EX linear accelerator. The Sb were measured with a universal pulse counter and a diode array with build-in counting hardware and software. The head scatter component (Sh) was then derived from the relationship Sc= Sh x Sb, where Sb was the linear fit of measured results. Significant differences were observed for Sc with and without the FF. Within the range of experimental uncertainty, the Sb was similar with and without the FF. The variations in Sh differed significantly over the range of field sizes of 3 X 3 to 40 X 40 cm2 with and without the FF; for the 6-MV beam, it was 8% vs 3%, and for the 18-MV beam, 7% vs 1%. By analyzing the contributions of backscatter factor and total in-air output ratios with and without the FF, we directly gained insight into the contributions of different components to the total variations in Sc of a linear accelerator. Sc, Sb, and Sh are basic and useful dosimetric quantities for delivery of intensity-modulated radiation therapy using a linear accelerator operating in a mode without the FF.

Air↗

Preliminary evaluation of implantable MOSFET radiation dosimeters.

In this paper, we report on measurements performed on a new prototype implantable radiation detector that uses metal-oxide semiconductor field effect transistors (MOSFETs) designed for in vivo dosimetry. The dosimeters, which are encapsulated in hermetically sealed glass cylinders, are used in an unbiased mode during irradiation, unlike other MOSFET detectors previously used in radiotherapy applications. They are powered by radio frequency telemetry for dose measurements, obviating the need for a power supply within each capsule. We have studied the dosimetric characteristics of these MOSFET detectors in vitro under irradiation from a 60Co source. The detectors show a dose reproducibility generally within 5% or better, with the main sources of error being temperature fluctuations occurring between the pre- and post-irradiation measurements as well as detector orientation. A better temperature-controlled environment leads to a reproducibility within 2%. Our preliminary in vitro results show clearly that true non-invasive in vivo dosimetry measurements are feasible and can be performed remotely using telemetric technology.

Calibration↗

Derivation of the distribution of extrafocal radiation for head scatter factor calculation.

Head scatter factors for high energy photon beams from linear accelerators can be modeled using a two-source model consisting of focal and extrafocal radiation. The focal radiation can be approximated as a point source, and the distribution of the extrafocal radiation is a two-dimensional (2D) radial symmetric function. Various methods, including analytical, Monte Carlo, and empirical trial functions, have been used to determine the radial symmetric function of extrafocal radiation distribution. This article describes a method for directly determining the extrafocal radiation distribution without assuming any empirical trial function. The extrafocal radiation distribution is determined with measured head scatter factors for rectangular fields defined by the lower jaw (X) fixed at 40 cm and the upper jaw (Y) varying from 3 to 40 cm. The derivatives of the measured head scatter factors, with respect to the Y jaw position projected in the plane of extrafocal radiation, are proportional to the one-dimensional (1D) projection (also called the line spread function) of the extrafocal radiation distribution. Two methods are used to solve the radial function of extrafocal radiation from the 1D projection. The first method uses a 2D filtered backprojection algorithm, originally developed for parallel beam computed tomography reconstruction, to directly derive the radial dependence of the extrafocal radiation distribution. The method has been applied to 6 and 18 MV photon beams from a Siemens linear accelerator and has been tested by comparing measured and calculated head scatter factors for square and rectangular fields. The second method uses a Fourier transform followed by a Fourier-Bessel transform to solve the problem. The distributions of extrafocal radiation derived from these two methods are virtually identical.

Algorithms↗

Characteristics of sensitometric curves of radiographic films.

A new type of radiographic film, EDR (extended dose range) film, has been recently become available for film dosimetry. It is particularly attractive for composite isodose verification of intensity modulated radiation therapy because of its low sensitivity relative to the more common Kodak XV film. For XV film, the relationship between optical density and dose, commonly known as the sensitometric curve, depends linearly on the dose at low densities. Unlike XV film, the sensitometric curve of EDR film irradiated by megavoltage x rays is not linearly dependent on the dose at low densities. In this work, to understand the mechanisms governing the shape of the sensitometric curves, EDR film was studied with kilovoltage x rays, 60Co gamma rays, megavoltage x rays, and electron beams. As a comparison, XV film was also studied with the same beams mentioned above. The model originally developed by Silberstein [J. Opt. Soc. Am. 35, 93-107, 1945)] is used to fit experimental data. It is found that the single hit model can be used to predict the sensitometric curve for XV films irradiated by all beams used in this work and for EDR films exposed to kilovoltage x rays. For EDR film irradiated by 60Co gamma rays, megavoltage x rays, and electron beams, the double hit model is used to fit the sensitometric curves. For doses less than 100 cGy, a systematic difference between measured densities and that predicted by the double hit model is observed. Possible causes of the observed differences are discussed. The results of this work provide a theoretical explanation of the sensitometric behavior of EDR film.

Dose-Response Relationship, Radiation↗

Evaluation of Kodak EDR2 film for dose verification of intensity modulated radiation therapy delivered by a static multileaf collimator.

A new type of radiographic film, Kodak EDR2 film, was evaluated for dose verification of intensity modulated radiation therapy (IMRT) delivered by a static multileaf collimator (SMLC). A sensitometric curve of EDR2 film irradiated by a 6 MV x-ray beam was compared with that of Kodak X-OMAT V (XV) film. The effects of field size, depth and dose rate on the sensitometric curve were also studied. It is found that EDR2 film is much less sensitive than XV film. In high-energy x-ray beams, the double hit process is the dominant mechanism that renders the grains on EDR2 films developable. As a result, in the dose range that is commonly used for film dosimetry for IMRT and conventional external beam therapy, the sensitometric curves of EDR2 films cannot be approximated as a linear function, OD = c * D. Within experimental uncertainty, the film sensitivity does not depend on the dose rate (50 vs 300 MU/min) or dose per pulse (from 1.0 x 10(-4) to 4.21 x 10(-4) Gy/pulse). Field sizes and depths (up to field size of 10 x 10 cm2 and depth = 10 cm) have little effect on the sensitometric curves. Percent depth doses (PDDs) for both 6 and 23 MV x rays were measured with both EDR2 and XV films and compared with ion chamber data. Film data are within 2.5% of the ion chamber results. Dose profiles measured with EDR2 film are consistent with those measured with an ion chamber. Examples of measured IMRT isodose distributions versus calculated isodoses are presented. We have used EDR2 films for verification of all IMRT patients treated by SMLC in our clinic. In most cases, with EDR2 film, actual clinical daily fraction doses can be used for verification of composite isodose distributions of SMLC-based IMRT.

Adult↗

Dependence of virtual wedge factor on dose calibration and monitor units.

One of the important features of the Siemens Virtual Wedge (VW) is that the VW factor (VWF) is approximately equal to unity for all beams with a total deviation for a given wedge no greater than 0.05, as specified by Siemens. In this note we report the observed dependence of VWF on dose calibration (cGy/MU), monitor units (MU), and beam tuning for a Primus, a linear accelerator with two dose-rate ranges available for VW operation. The VWF is defined as the ratio of doses measured on the beam central axis for the wedge field to the open field; the open field dose is always measured with the nominal high dose-rate beam. When VW operates in the high dose-rate range, the VWF is independent of calibration (cGy/MU). When VW works in the low dose-rate range, the VWF varies linearly with the calibration of the low dose-rate mode. For a linear accelerator that has only one dose-rate range for VW, there is no observable dependence of VWF on the calibration. We also studied the monitor unit dependence of VWF. A discontinuity in VWF was observed at the switching point between the high and low dose-rate ranges. Working with Siemens, we have investigated causes of this discontinuity. As a result of this investigation, the discontinuity in VWF as a function monitor unit is practically removed.

Biophysical Phenomena↗

Comparison of dosimetric characteristics of Siemens virtual and physical wedges.

Dosimetric properties of Virtual Wedge (VW) and physical wedge (PW) in 6 and 23 MV photon beams from a Siemens Primus linear accelerator, including wedge factors, depth doses, dose profiles, peripheral doses and surface doses, are compared. While there is a great difference in absolute values of wedge factors, VW factors (VWFs) and PW factors (PWFs) have a similar trend as a function of field size. PWFs have a stronger depth dependence than VWF due to beam hardening in PW fields. VW dose profiles in the wedge direction, in general, match very well with PW, except in the toe area of large wedge angles with large field sizes. Dose profiles in the nonwedge direction show a significant reduction in PW fields due to off-axis beam softening and oblique filtration. PW fields have significantly higher peripheral doses than open and VW fields. VW fields have similar surface doses as the open fields while PW fields have lower surface doses. Surface doses for both VW and PW increase with field size and slightly with wedge angle. For VW fields with wedge angles 45 degrees and less, the initial gap up to 3 cm is dosimetrically acceptable when compared to dose profiles of PW. VW fields in general use less monitor units than PW fields.

Humans↗

Implementation and verification of virtual wedge in a three-dimensional radiotherapy planning system.

Virtual Wedge (VW) is a Siemens treatment modality which generates wedge-shaped dose distributions by moving a collimator jaw from closed to open at a constant speed while varying the dose rate in every 2 mm jaw position. In this work, the implementation and verification of VW in a radiotherapy treatment planning (RTP) system is presented. The VW implementation models the dose delivered by VW using the Siemens monitor units (MU) analytic formalism which determines the number of MU required to generate a wedge-fluence profile at points across the VW beam. For any set of treatment parameters, the VW algorithm generates an "intensity map" that is used to model the modification of fluence emanating from the collimator. The intensity map is calculated as the ratio of MU delivered on an axis point, divided by the monitor units delivered on the central-axis MU(0). The dose calculation is then performed using either the Clarkson or Convolution/ Superposition algorithms. The VW implementation also models the operational constraints for the delivery of VW due to dose rate and jaw speed limits. Dose verifications with measured profiles were performed using both the Clarkson and Convolution/Superposition algorithms for three photon beams; Siemens Primus 6 and 23 MV, and Mevatron MD 15 MV. Agreement within 2% or 2 mm was found between calculated and measured doses, over a large set of test cases, for 15, 30, 45, and 60 degree symmetric and asymmetric VW fields, using the manufacturer's supplied mu and c values for each beam.

Algorithms↗

Study of lung density corrections in a clinical trial (RTOG 88-08). Radiation Therapy Oncology Group.

PURPOSE: To investigate the effect of lung density corrections on the dose delivered to lung cancer radiotherapy patients in a multi-institutional clinical trial, and to determine whether commonly available density-correction algorithms are sufficient to improve the accuracy and precision of dose calculation in the clinical trials setting. METHODS AND MATERIALS: A benchmark problem was designed (and a corresponding phantom fabricated) to test density-correction algorithms under standard conditions for photon beams ranging from 60Co to 24 MV. Point doses and isodose distributions submitted for a Phase III trial in regionally advanced, unresectable non-small-cell lung cancer (Radiation Therapy Oncology Group 88-08) were calculated with and without density correction. Tumor doses were analyzed for 322 patients and 1236 separate fields. RESULTS: For the benchmark problem studied here, the overall correction factor for a four-field treatment varied significantly with energy, ranging from 1.14 (60Co) to 1.05 (24 MV) for measured doses, or 1.17 (60Co) to 1.05 (24 MV) for doses calculated by conventional density-correction algorithms. For the patient data, overall correction factors (calculated) ranged from 0.95 to 1.28, with a mean of 1.05 and distributional standard deviation of 0.05. The largest corrections were for lateral fields, with a mean correction factor of 1.11 and standard deviation of 0.08. CONCLUSIONS: Lung inhomogeneities can lead to significant variations in delivered dose between patients treated in a clinical trial. Existing density-correction algorithms are accurate enough to significantly reduce these variations.

Algorithms↗

Interstitial implantation of gynecologic malignancies.

Interstitial implantation is invaluable in the management of patients with extensive or large volume gynecologic malignancies, significant anatomical distortion, or recurrent disease. Such techniques are necessary components of the brachytherapy services available to patients with gynecologic malignancies giving superior results in terms of local tumor control and survival compared to those achieved with external beam alone or inadequate intracavitary applications. Local tumor control with an acceptable risk of complications can be achieved for these challenging disease presentations if these techniques are implemented skillfully through the joint efforts of the radiation oncologist and gynecologic surgeon.

Anesthesia, Epidural↗

Comparison of high dose-rate and low dose-rate dose distributions for vaginal cylinders.

PURPOSE: The identification of appropriate high dose-rate parameters required to produce a "uniform" dose distribution on the surface of a vaginal cylinder. The high dose-rate dose distribution is then compared to the traditional low dose-rate dose distributions obtained with Burnett cylinders. METHODS AND MATERIALS: Dose distributions were calculated for 2, 3, and 3.5 cm diameter Burnett cylinders with and without crossing sources. Three models for the high dose-rate cylinders were developed and compared. High dose-rate dose distributions were calculated for 2, 3, and 3.5 cm diameter cylinders with and without anisotropic corrections for various dose specification points. RESULTS: Low dose-rate distributions are not uniform over the surface of the applicator. The exact distribution depends upon cylinder diameter and upon the exact source loading. High dose rate dose distributions can be configured to provide for a "uniform" dose on the surface, if an apex dose specification point is used together with dose specification points on the surface of the applicator opposite each dwell position. CONCLUSIONS: The conversion of low dose rate techniques to high dose rate techniques for vaginal cylinders involves an appreciation of the details of dose distributions of both approaches. The comparison between traditional low dose-rate distributions and high dose-rate distributions shows that, unlike the low dose-rate distributions, a relatively uniform high dose-rate distribution can be obtained independent of cylinder diameter. The clinical significance of the differences in the low dose-rate and high dose-rate dose distributions remains to be determined by long-term follow up of patients treated with high dose-rate techniques.

Carcinoma↗

Microdosimetric single event spectra of Ytterbium-169 compared with commonly used brachytherapy sources and teletherapy beams.

Ytterbium-169 has been developed as a possible replacement for Iridium-192 and Iodine-125. The Theory of Dual Radiation Action predicts that the initial slope of the cell survival curve and therefore the relative biological effect at low dose rate is proportional to dose average lineal energy, yd, which is the microscopic analog of the dose average linear energy transferred. The quality factor used in radiation protection has been shown to be a function of the frequency average lineal energy, yf. Single event microdosimetric spectra for 60Co, 137Cs, 192Ir, 125I and 169Yb were measured in air and at several depths in phantom with a Rossi proportional counter. These spectra show marked differences between sources. The microscopic analogs of the track average and dose average LET, (yd and yf, respectively) differ between isotopes by factors of two or even higher in comparison to megavoltage electron beams. These yd's and yf's for 169Yb are consistently higher when compared to 60Co or 137Cs but are approximately equal to those for 125I. Values of yf and yd for 192Ir are intermediate between 60Co and 169Yb. The Theory of Dual Radiation Action predicts a low dose rate RBE (assuming a 1 micron effective site diameter) compared to 60Co (in air) of: 1.00 for 137Cs, 1.29 for 192Ir, 1.60 for 169Yb and 1.77 for 125I.

Brachytherapy↗

Improved dose localization with dual energy photon irradiation in treatment of lateralized intracranial malignancies.

Dual energy photon irradiation (6 MV and 20 MV) was compared to conventional treatment planning with 6 MV photons in a lateralized intracranial malignancy. Dose volume analysis was performed of both the tumor plus a 2 cm margin (target volume, TV) and normal tissues (NT). Parallel opposed treatment using weightings of 1:1, 1.5:1, and 2:1 were compared for 6 MV photons alone or in combination with 20 MV photons. Uniform treatment of the TV was accomplished within the 60 Gy isodose. Significant differences were observed, however, in NT volumes receiving greater than or equal to 60 Gy and 45-59 Gy. Dual photon energy reduced treatment of NT volumes to greater than or equal to 60 Gy by 13% (177 cm3 vs 204 cm3 in 2:1 weighting) to 70% (147 cm3 vs 498 cm3 in 1:1 weighting) for comparable plans. Dose optimization was also performed for both 6 MV alone or in combination with 20 MV photons. Usual approaches to achieve dose lateralization with conventional isocentric techniques were applied including parallel opposed 6 MV photons ipsilaterally weighted 3.4:1 (POP), and a 110 degrees arc rotational field used to limit treatment to the eye (ARC). Dual energy photon optimized plans included a three beam parallel opposed plan (TOP) and a mixed photon ipsilateral (IPSI) approach. The technique using parallel opposed 20 MV photons and ipsilateral 6 MV photons (TOP) used beam weightings of 1.1 (contralateral 20 MVX): 1.6 (ipsilateral 6 MVX): 1 (ipsilateral 20 MVX) to achieve dose optimization. The ipsilateral approach with 6 MVX and 20 MVX (IPSI) used beam weightings of 1:1.4, respectively. All optimized plans demonstrated a 41% (120 cm3; POP) to 53% (95 cm3; TOP) improvement over parallel opposed 6 MV photons weighted 2:1 (204 cm3) in NT volume receiving greater than or equal to 60 Gy. Comparison of optimized treatment showed the IPSI plan to be superior, treating 12% of NT volume to greater than or equal to 60 Gy and 38% to 45-59 Gy; the 6 MV POP plan resulted in NT volumes of 15% and 51%, respectively, for those dose levels. Dual photon energy irradiation of lateralized intracranial malignancies allows reduction of dose to normal tissue volumes while achieving excellent coverage of the target volume. Treatment planning should be performed in all lateralized intracranial lesions to achieve dose optimization exploiting depth dose characteristics.

Brain Neoplasms↗

Comparison of dose distribution by means of bolus versus water bath phantom techniques in treatment of cutaneous sarcoma of an extremity.

Cutaneous involvement by Kaposi's sarcoma (KS) is frequently diffuse, requiring large field irradiation. Selective tissue compensation techniques, accomplished with either a 1.5 cm bolus cast or water bath phantom, are compared. Dosimetric determinations were performed using 6 MVX with bone heterogeneity corrections. Application of 1.5 cm bolus effectively eliminated dose buildup and provided tissue compensation equivalent to water bath phantom technique. Treatment of other cutaneous malignancies, such as angiosarcoma, requiring higher total doses, should be accompanied by dosimetric evaluation, because cutaneous and midline dose inhomogeneity may result in a significant total dose differential over the target volume. Application of 1.5 cm bolus improved accuracy in treatment positioning, eliminated concerns regarding infection control in AIDS-related KS, and provided dose homogeneity comparable to the more standard water bath phantom technique.

Acquired Immunodeficiency Syndrome↗

Implementation of Beam's Eye View into routine treatment planning and delivery.

The use of oblique fields in the chest and abdomen is fraught with uncertainty, especially in the location of critical structures on simulator and port films. Targets near these structures may be underdosed because of the physician's uncertainty in shaping the treatment fields. To help alleviate this problem, we have found the Beam's Eye View option of the Theraplan Treatment Planning System to be a useful and effective tool. The Beam's Eye View program uses the external and internal contours we enter into the treatment planning system from CT scans. Once the necessary contours have been entered from the desired CT slices, the software will project the view that the beam would see as it passes through these structures. Using this "Beam's Eye View," we can determine the optimum angle and field shape to treat our target and minimize critical structure dose.

Adult↗