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R D Zwicker

Publications and source records attributed to R D Zwicker.

At least 19 recordsLinked to original sources
PubMed1998

A comparison of three stereotactic radiotherapy techniques; ARCS vs. noncoplanar fixed fields vs. intensity modulation.

PURPOSE: Linac arc based stereotactic radiotherapy is being used with increasing frequency to treat brain tumors. This approach can be used for single or fractionated treatments, and is typically carried out with circular collimators which are optimal for small, spherical targets. Treatment planning using fixed noncoplanar beams or intensity-modulated beams may enhance the ability to conform to irregularly shaped and/or large tumors, especially when combined with stereotactic localization. We compare the dose conformity and normal brain dose characteristics of three stereotactic techniques for various nonspherical target shapes. METHODS AND MATERIALS: Three intracranial test targets were constructed using a 3D treatment planning system after a patient underwent CT simulation. The targets included an ellipsoid with major axis dimensions of 4.0, 2.0, and 2.0 cm, a hemisphere with a diameter of 4.0 cm, and an irregularly shaped patient tumor with a maximum dimension of 5.3 cm. The following stereotactic techniques were compared for each target: a) 5 arcs as used in traditional linac radiosurgery/radiotherapy (noncoplanar arcs [ARCS]), b) 6 fixed noncoplanar custom blocked fields (3D), c) intensity modulation using 6 noncoplanar beams and a mini-multileaf collimator (intensity-modulated radiation therapy [IMRTI). Dose volume histograms were performed for each target/technique combination. RESULTS: For the ellipsoid, dose conformity is similar for all three techniques and normal brain isodose distributions are more favorable with the ARCS plan. For the hemisphere and irregular tumor targets, dose conformity and high/low isodose normal brain volumes are more favorable with the IMRT technique. CONCLUSIONS: For the targets described above, the intensity-modulated technique results in improved dose conformity and decreased dose to nontarget brain in high and low isodose regions as compared to the standard noncoplanar arc technique or noncoplanar fixed fields for the hemisphere and tumor targets. Intensity-modulated treatment delivery may allow for an increase in the therapeutic ratio for treating stereotactically defined large and/or irregularly shaped intracranial targets.

Brain Neoplasms↗
PubMed1998

Accelerated radiotherapy regimen for malignant gliomas using stereotactic concomitant boosts for dose escalation.

The purpose of this pilot study was to determine the feasibility and toxicities of an accelerated treatment program by using a concomitant stereotactic radiotherapy boost given weekly during a course of standard external-beam irradiation (EBXRT) in patients with malignant gliomas. Twelve patients underwent biopsy or subtotal resection of a malignant glioma and were enrolled on the protocol, which delivered 44 Gy-EBXRT and a 12-Gy stereotactic radiotherapy boost given on 3 consecutive weeks of treatment for a total dose of 80 Gy over 33 days. Three patients with anaplastic astrocytoma and nine patients with glioblastoma multiforme had median survival times of 33 months and 16 months, respectively. All of the tumor recurrences were within or were closely adjacent to the region of high-dose irradiation. None of the patients required a treatment break, and there were no acute complications. Two patients developed seizures in the follow-up period, and four patients were diagnosed with radionecrosis at the time of the second operation. The treatment program was found to be feasible and was well tolerated, and it resulted in a rate of late complications similar to those of radiosurgery or interstitial brachytherapy.

Adult↗
PubMed1997

The biological effectiveness of intermittent irradiation as a function of overall treatment time: development of correction factors for linac-based stereotactic radiotherapy.

PURPOSE: Continuous irradiation of relatively short duration as administered in gamma-ray stereotactic radiosurgery (SRS) is biologically not equivalent to the more protracted intermittent exposures during accelerator-based radiosurgery with multiple arcs. Accelerator-based SRS and fractionated stereotactic radiotherapy (SRT) is currently performed with a high degree of variability in equipment and techniques resulting in highly variable treatment delivery times. The present work is designed to quantify the effects of radiation delivery times on biological effectiveness. For this, the intermittent radiation delivery schemes, typical for linac-based SRS/SRT, have been simulated in vitro to derive biological correction factors. METHODS AND MATERIALS: The experiments were carried out using U-87MG human glioma cells in suspension at 37 degrees C irradiated with 6 MV X-rays to clinically relevant doses ranging from 6 to 18 Gy, delivered over total irradiation times from 16 min to 3 h. The resulting cell survival data was used to calculate dose correction factors to compensate for wide variations in dose delivery times. RESULTS: At each total dose level, cell survival increased with increasing total irradiation time. The increase in survival was more pronounced at higher dose levels. At a total dose of 12 Gy, cell survival increased by a factor of 4.7 when irradiation time was increased from 16 to 112 min. Dose correction factors were calculated to allow biologically equivalent irradiations over the range of exposure times. Cells irradiated with corrected total doses of 11.5 Gy delivered incrementally in 16 min up to 13.3 Gy in 112 min were found to exhibit the same survival within the experimental limits of accuracy. CONCLUSIONS: For a given total dose, variations in dose delivery time typical of SRS/SRT techniques will result in significant changes in cell survival. In the dose range studied, an isoeffect dose correction factor of 2 to 3 cGy/min was shown to compensate for the change in delivery time for U-87 MG human gloma cells in vitro.

Brain Neoplasms↗
PubMed1997

Electron/photon matched field technique for treatment of orbital disease.

PURPOSE: A number of approaches have been described in the literature for irradiation of malignant and benign diseases of the orbit. Techniques described to date do not deliver a homogeneous dose to the orbital contents while sparing the cornea and lens of excessive dose. This is a result of the geometry encountered in this region and the fact that the target volume, which includes the periorbital and retroorbital tissues but excludes the cornea, anterior chamber, and lens, cannot be readily accommodated by photon beams alone. To improve the dose distribution for these treatments, we have developed a technique that combines a low-energy electron field carefully matched with modified photon fields to achieve acceptable dose coverage and uniformity. METHODS AND MATERIALS: An anterior electron field and a lateral photon field setup is used to encompass the target volume. Modification of these fields permits accurate matching as well as conformation of the dose distribution to the orbit. A flat-surfaced wax compensator assures uniform electron penetration across the field, and a sunken lead alloy eye block prevents excessive dose to the central structures of the anterior segment. The anterior edge of the photon field is modified by broadening the penumbra using a form of pseudodynamic collimation. Direct measurements using film and ion chamber dosimetry were used to study the characteristics of the fall-off region of the electron field and the penumbra of the photon fields. From the data collected, the technique for accurate field matching and dose uniformity was generated. RESULTS: The isodose curves produced with this treatment technique demonstrate homogeneous dose coverage of the orbit, including the paralenticular region, and sufficient dose sparing of the anterior segment. The posterior lens accumulates less than 40% of the prescribed dose, and the lateral aspect of the lens receives less than 30%. A dose variation in the match region of +/-12% is confronted when an unmodified photon field edge is matched with the fall-off of the electron field at the 50% isodose lines. By modifying the penumbra, the dose variation is reduced to +/-2%. Treatment setup accuracy is essential. CONCLUSIONS: The electron/photon matched field technique offers a uniform isodose distribution for treatment of the orbit that has not been previously achieved. With this technique a homogeneous dose can be delivered to the entire orbit while avoiding a significant dose to the anterior segment and minimizing the risk of morbidity.

Electrons↗
PubMed1997

Transverse tomosynthesis on a digital simulator.

The availability of digital radiographic imaging on simulators has led to the investigation of a number of new imaging possibilities, including digital linear tomography (tomosynthesis). It has been shown that a single set of projections in this case is sufficient to reconstruct images from multiple planes, including planes tilted with respect to the tube motion. The present work examines the feasibility of tomosynthetic image reconstruction in transverse planes using a CCD-based digital radiotherapy simulator with conventional isocentric rotational geometry. General transformation equations were derived to permit image reconstruction in arbitrary transverse planes. Transverse images of the skull section of the humanoid phantom have been generated using a 360 degrees gantry sweep. Bone, air, and radiographic markers are well resolved, but the image quality is poor due to the suboptimal scanning geometry available on the simulator.

Biophysical Phenomena↗
PubMed1996

Comparison of dose homogeneity effects due to electron equilibrium loss in lung for 6 MV and 18 MV photons.

PURPOSE: Loss of electronic equilibrium within and adjacent to low density materials can result in a dose reduction along the central axis and near the beam edge for megavoltage photon beams. In this context, Radiation Therapy Oncology Group (RTOG) protocol #91-05 recommends the use of photon beams of energy 12 MV or less for nonsmall cell lung cancer therapy. This work presents data to support the use of higher energy photons for some clinical lung field setups. METHODS AND MATERIALS: Beam profiles were obtained from films inserted into homogeneous (polystyrene) and heterogeneous (polystyrene and lung-equivalent material) phantoms and irradiated in both single-field and parallel-opposed setups with 6 and 18 MV photon beams. Depth-dose curves were obtained with a parallel-plate ion chamber in the heterogeneous phantom to determine the range of field sizes over which the dose reduction at the lung/polystyrene interface becomes clinically significant. RESULTS: Opposed field profiles show less degradation in the penumbra (50-90% width) at the lung/polystyrene interface than single-field profiles. The difference between 6 and 18 MV penumbra widths at the interface also reduced when an opposed field is added. The central axis dose reduction at the interface was negligible for single fields of a width of 8 cm or more. CONCLUSION: Our results show that for opposed fields, the difference in penumbra degradation of the 6 and 18 MV photon beams is clinically insignificant compared to daily setup errors and patient motion. The central axis dose reduction is also shown to be small. Our data support the use of higher energy beams to obtain lower peripheral dose maxima in small clinical geometries.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

Short communication: Total craniofacial photon shell technique for radiotherapy of extensive angiosarcomas of the head.

Effective radiotherapy for extensive angiosarcomas of the face and scalp is technically difficult due to the complex shape of the volume at risk, which can consist of the superficial tissues of the entire head. This work reports the details of a rotational X-ray technique used to deliver a large part of the tumour dose. The technique consists of four consecutive 90 degree arcs with changing centre blocks to protect critical midline structures. Multilevel CT based treatment planning is carried out to determine the centre block dimensions and beam weights. As a result the radiation dose is delivered with acceptable uniformity over the entire shell of superficial tissues of the head. The overall treatment combines the rotational fields with large lateral field irradiation and/or local boosts with photons or electrons. Two of three patients treated with this technique had local control of the disease until their deaths at 13 and 18 months. A third patient responded well, with only a small region of stable disease at 9 months.

Aged↗
PubMed1995

Clinical use of a digital simulator for rapid setup verification in high dose rate brachytherapy.

PURPOSE: Fractionated high dose rate (HDR) brachytherapy provides a number of technical advantages over conventional implant therapy in that (a) it can be carried out on an outpatient basis, (b) personnel exposure is reduced to insignificant levels, and (c) patient motion during irradiation is minimized, resulting in a more accurate delivery of the planned radiation dose distribution to the target and critical structures. The patient discomfort associated with the repeated applicator insertions and/or treatment setups can be alleviated to the extent that the setup time is held to a minimum. This work describes the use of a prototype digital simulator to obtain fast, high-quality digital images for rapid setup verification. METHODS AND MATERIALS: The digital imaging system of the prototype simulator consists of a charge-coupled device (CCD) camera, which views the x-ray image optically transmitted from a conventional phosphor screen. Treatment is carried out with a remote afterloading HDR unit immediately after setup verification with the patient on the simulator stretcher. The high-resolution digital images are processed and displayed in about 5 s, as opposed to a minimum of approximately 2 min for film. RESULTS: The imaging system has been evaluated for a variety of implant types, both intracavitary and interstitial. The digital radiographs provided permanent high-resolution images as required in most cases for precise applicator positioning. The gray scale manipulation capabilities were found to be useful for imaging in regions of different density, such as lung and soft tissue, in the same radiograph. The advantages of short image acquisition and display times were observed in all cases, but were most evident in the intraluminal procedures, which sometimes involved several pretreatment applicator adjustments at a time of considerable patient discomfort. CONCLUSION: Pretreatment imaging is necessary to fully exploit the technical advantages of HDR brachytherapy. High-quality digital radiography offers unique advantages in HDR setup and verification by providing fast high-resolution, undistorted images with software manipulation capabilities and permanent storage of images.

Brachytherapy↗
PubMed1995

Tissue compensation using dynamic collimation on a linear accelerator.

PURPOSE: The availability of computer-controlled collimators on some accelerators has led to techniques for dynamic beam modification, mainly to simulate beam wedge filters. This work addresses the practical aspects of dynamic tissue compensation in one dimension using available treatment-planning software. METHODS AND MATERIALS: Data derived from the treatment-planning program is used with an iterative calculational routine to determine the monitor unit settings needed for the collimator-controlling computer. The method was first tested by simulating a 60 degrees physical wedge. Further studies were carried out on a specially fabricated plastic phantom that modeled the sagittal contour of the upper torso, neck, and lower head regions. RESULTS: Dynamic wedge point doses generated by the planning program agreed within 1% with the values directly measured in a polystyrene phantom. In the patient phantom, dynamic collimation achieved calculated dose uniformity within 0.5% in a reference plane near the phantom midline. A comparison of computer-generated and measured point doses in this case showed agreement within 3%. CONCLUSIONS: Dynamic collimation can provide effective compensation for contours that vary primarily along one direction. A conventional treatment-planning program can be used to plan dynamic collimation and deliver a prescribed dose with reliable accuracy.

Models, Anatomic↗
PubMed1995

Performance evaluation of a prototype high resolution digital radiographic/near real-time fluoroscopic computerized tomographic system for radiotherapy simulation.

PURPOSE: A new prototype digital radiographic/near real-time fluoroscopic and computerized tomographic (CT) imaging system has been developed and its performance is evaluated for future implementation in a radiotherapy simulator. METHODS AND MATERIALS: The new imaging modality uses a slow scan cooled charge-coupled device (CCD) camera with 2 k x 2 k x 12 bit image resolution. X-ray images formed by a Gd2O2S:Tb flat screen are directly viewed by the CCD camera via a 45 degrees angled mirror and a high speed objective lens. For CT image reconstruction, digital data from a slit image on the CCD array obtained from time-controlled x-ray scans around the object are transferred to a second tomographic computer for processing and display. RESULTS: In the digital radiographic mode, and for a 43.2 x 43.2 cm field size at the phosphor plane, the spatial resolution of the system is 2.3 +/- 0.1 lp/mm (1 sigma) as measured at the 4% level of the modulation transfer function (MTF), whereas the contrast resolution has a value of 0.5%. In the fluoroscopic mode, the system may be operated at a maximum rate of eight frames/s at a relatively lower spatial and contrast resolution. For CT scans, although the potential intrinsic spatial resolution at the isocenter is 0.35 mm, display-limited spatial resolutions of 1.2 and 1.6 mm were obtained for 30 and 40 cm reconstruction circle diameters, respectively. A contrast resolution of 1% at 0.015 Gy entrance dose was achieved, and CT reconstruction circles of up to 51 cm were attainable. CONCLUSION: The new CCD-based imaging system is capable of delivering high-quality digital radiographic and CT images for radiotherapy simulation, whereas the near real-time fluoroscopic mode yields acceptable flicker-free lower quality images at object speeds typical of simulation motions.

Fluoroscopy↗
PubMed1995

Dose uniformity in a planar interstitial implant system.

PURPOSE: This work makes use of a volume-ratio technique to examine dose uniformity in a planar interstitial implant system based entirely on geometrical constraints. The rationale for determining an upper limit for acceptable dose variation is examined and discussed. Variation of ribbon spacing and interplanar separation is evaluated in terms of its effect on dose homogeneity. METHODS AND MATERIALS: Volume-dose curves were generated for a range of planar implant dimensions. The volume inside the target region and enclosed between the reference isodose and a higher isodose surface was calculated as a measure of dose uniformity. Studies of homogeneity, target coverage, and external tissue irradiation were carried out to evaluate the importance of flexible interplanar spacing in optimizing implants. New dose tables were generated to accommodate the frequent clinical need to minimize the number of catheter insertions. RESULTS: Implants carried out in accordance with specified geometric constraints were found also to provide optimal dose homogeneity as determined using the volume ratio method with a flexible high dose limit. For two-plane implants, the interplanar spacing should be determined specifically in each case to ensure accurate target coverage. Calculations for specific cases showed that the tissue volume treated to unnecessarily high dose levels can be reduced by a large factor by careful positioning of the implant planes. A smaller ribbon and seed spacing will, in general, lead to better dose uniformity when this is evaluated in terms of the volumes treated to very high dose levels. CONCLUSIONS: Our studies showed that implants carried out using simple and useful geometric guidelines will also provide an acceptably uniform dose distribution. For double plane implants, the separation of the implant planes should be optimized for each target thickness.

Brachytherapy↗
PubMed1994

Use of styrene monomer-modified polyester in the fabrication of tissue-equivalent phantoms.

Tissue equivalent materials are often required both for routine quality control and for specialized studies in radiological physics. This work describes techniques and materials for casting of dosimetry devices from a widely available commercial resin suitable for use in a radiotherapy clinic. Methods are described for mixing and curing the material in such a way as to ensure complete reaction of the resin while maintaining a safe exothermic temperature. The clear plastic form of the cured resin is particularly useful for aligning measurement devices in the radiation field. Its specific gravity and narrow beam attenuation characteristics are similar to those of acrylic. The dosimetric characteristics of the material are reported, and its use in the construction of a patient phantom is described.

Humans↗
PubMed1991

Interstitial IR-192 implants of the oral cavity: the planning and construction of volume implants.

The success of radioactive implant therapy for head and neck carcinomas depends critically on careful planning and execution of the implant procedure. In this paper we discuss our experience with oral tongue and floor of mouth implants, and some innovations introduced to facilitate these procedures. Implants were carried out using standard angiocatheters modified with magnetic caps at the open end and terminated with Teflon spacers and lead shot at the closed end. The importance of accurate source placement and careful determination of the target dose rate is discussed with numerical examples. Differential hot-loading of sources is clearly indicated in cases of extension of the lesion to the dorsal or lateral tongue surface. For dorsal surface extension the use of Teflon spacers at the closed ends of the catheters helps to ensure adequate coverage of the target volume with the higher dose region enclosing the demonstrable tumor. All 10 patients implanted with this technique are controlled without recurrence at a median follow-up of 38 months. The two complications observed appeared to be associated with excessive hot-loading of edge plane sources.

Brachytherapy↗
PubMed1985

Planning of Ir-192 seed implants for boost irradiation to the breast.

The conservative management of early stage breast cancer with tumor excision and irradiation of the breast is becoming increasingly accepted as an alternative to modified radical mastectomy. The radiotherapy typically consists of 45 to 50 Gy delivered with external beam irradiation, followed by boost irradiation of 15 to 20 Gy to the tumor bed using electron beams or interstitial implantation. Pathological evaluation of the excised tumor, clinical assessment, and mammography are used to determine the tissue volume potentially containing a residual tumor burden and therefore requiring boost irradiation. In this paper we describe planning and implantation procedures for Quimby-type breast implants using Ir-192 seeds encapsulated in nylon tubing. This system deviates in several important respects from the requirements of the standard brachytherapy systems. For double-plane implants, optimized values of the interplanar spacing are given for a range of implant sizes, along with the corresponding target dose rates for 1.0 mCi seeds. We also describe a modification of the angiocatheter implantation technique, which allows the radioactive sources to be secured in place by a magnetic cap and washer, thus greatly facilitating the removal of the sources at the end of treatment.

Brachytherapy↗
PubMedDate not supplied

UV-induced second readout of LiF thermoluminescent dosimeters in the therapeutic dose range.

A previously developed technique for reading out LiF thermoluminescent dosimeters (TLD) a second and subsequent time by means of ultraviolet (UV)-induced repopulation of dosimetry traps was studied to determine the feasibility of maintaining a second readout capability in a radiotherapy clinical setting. It was found that with grouping of the TLDs according to second readout sensitivity, the UV-induced readout attained a precision comparable to that of the initial readout. However, the UV-induced TL response retained a strong previous dose memory following a standard high-temperature anneal, and routine calibration before each reuse is recommended.

Fluorides↗
PubMedDate not supplied

Thermal energy deposition from a single-loop rf whole-body applicator.

Whole-body hyperthermia at moderate temperatures (40.0 +/- 0.5 degrees C) is currently being investigated to assess its effectiveness as an adjuvant to other cancer therapies. At our institution, the whole-body heating is achieved by a combination of hot air circulation and rf inductive heating at 27.1 MHz. This paper reports the results of a study of the thermal energy deposition pattern associated with the rf applicator. The applicator consists of a single loop of nearly elliptical shape with dimensions 20 x 46 cm. The loop is embedded in a mattress and is fed by lead wires entering the side of the mattress. Temperature mapping in a heated gelatin phantom placed just above the rf loop showed maximum heating near the lead wires and a cool region above the center of the loop. Calculations of the magnetically induced and capacitive contributions to the electric field near the applicator indicate that the heating near the lead wires is largely capacitive in nature. This feature of the rf heating is of interest because capacitive fields result in preferential heating of fatty tissues. Further calculations showed that the capacitive heating contribution falls away much more rapidly than the induced field contribution with increasing distance from the plane of the rf loop.

Diathermy↗
PubMedDate not supplied

Dosimetry characteristics of large wedges for 4- and 6-MV x rays.

Two sets of newly designed large wedge filters for field sizes up to 20 X 20 cm2 have become commercially available for use with 4- and 6-MV linear accelerators. Such field sizes are sometimes required to ensure adequate coverage in certain treatment techniques. This work reports base line data resulting from an investigation of the dosimetric properties of these wedges. Measurements of wedge angles, transmission factors, and beam hardening effects are described, and comparisons are made with the smaller standard wedges.

Humans↗