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Ontario accelerator dose intercomparison study.

An ionometric dose intercomparison has been carried out on eight accelertors, with maximum photon energies from 6 to 32 meV, at five radiotherapy centres in Ontario. The ratio of the dose based on the clinically-employed rad/monitor unit to the dose measured by the committee representative had a mean value of 0.994, with a range of 7.3% and a coefficient of variation of 2.5%. The ratio of the dose measured by the institution's physicist to the dose measured by the committee representative had a mean value of 1.000 with a range of 6.9% and a coefficient of variation of 2.3%. Eight recommendations regarding dose calibration procedures are presented.

Humans↗

A simple eye-lens shielding technique compatible with independent jaws of a linear accelerator.

A technique, compatible with accelerators having independent collimators, is presented, which greatly simplifies alignment of pencil eye-lens shields. The patient is placed so that the eye to be shielded is on the central axis of the beam and the accelerator's collimators are adjusted independently to define the field. A divergent lead shield 14 cm long is suspended from a wire that hangs along the central axis from a blocking tray in its usual location. The suspension length is variable and adjusted on the first day so that the shield is about 1 cm above the patient's eye. On subsequent treatment days, the wire is simply put in place on the tray with no further adjustment required. This technique reduces setup time and makes the shield positioning highly reproducible.

Eye Protective Devices↗

[Initial results in percutaneous radiotherapy of malignant melanomas of the choroid with the linear accelerator].

Twenty-seven eyes harboring a choroidal melanoma which could not be treated by other methods were treated with external beam radiation using a linear accelerator. After a mean follow-up period of 15.6 months 3 eyes had to be enucleated. In two eyes fresh tumors developed, which were successfully treated with local beta-radiation. In the remaining 22 eyes the tumor growth was stopped or the tumor regressed. External beam therapy for choroidal melanomas seems to be an effective alternative to enucleation in eyes with tumors not accessible for other methods of treatment and which cannot be enucleated, e.g., single eyes.

Choroid↗

Feasibility of megavoltage portal CT using an electronic portal imaging device (EPID) and a multi-level scheme algebraic reconstruction technique (MLS-ART).

Although electronic portal imaging devices (EPIDs) are efficient tools for radiation therapy verification, they only provide images of overlapped anatomic structures. We investigated using a fluorescent screen/CCD-based EPID, coupled with a novel multi-level scheme algebraic reconstruction technique (MLS-ART), for a feasibility study of portal computed tomography (CT) reconstructions. The CT images might be useful for radiation treatment planning and verification. We used an EPID, set it to work at the linear dynamic range and collimated 6 MV photons from a linear accelerator to a slit beam of 1 cm wide and 25 cm long. We performed scans under a total of approximately 200 monitor units (MUs) for several phantoms in which we varied the number of projections and MUs per projection. The reconstructed images demonstrated that using the new MLS-ART technique megavoltage portal CT with a total of 200 MUs can achieve a contrast detectibility of approximately 2.5% (object size 5 mm x 5 mm) and a spatial resolution of 2.5 mm.

Algorithms↗

Groundwater activation at the Superconducting Super Collider: a new design model.

A groundwater activation model was developed for use in designing the accelerators at the Superconducting Super Collider Laboratory. This model is based on the concept of a 4-m-thick "activation zone" surrounding the accelerator enclosure, which contains over 99% of the soil activation caused by beam losses. Empirical shielding formulae based on computer simulations indicate that the soil activation in the activation zone decreases exponentially with distance from the tunnel enclosure. From this assumption, the average activation in the activation zone is derived. It is shown that the average activity concentration in the activation zone is equal to the activity concentration 1 m from the accelerator enclosure. The activation concentration in the water averaged over the volume of the activation zone is compared to the drinking water standards. The goal of this model is to meet the drinking water regulatory standards by averaging the activation in the activation zone. Groundwater activation concentrations have been calculated for the Super Collider utilizing experimental measurements of production cross sections and leachability factors. Comparison is made to the groundwater activation criterion for both routine and accidental beam losses.

Equipment Design↗

Radiation exposure of personnel during intraoperative radiotherapy (IORT): radiation protection aspects.

Intraoperative radiotherapy (IORT) is a multidisciplinary procedure which combines two conventional methods of cancer treatment surgery and radiation therapy. The purpose is to deliver a large single dose to the surgically exposed tumor bed while minimizing doses to normal tissues. Intraoperative radiation therapy (IORT) is a technique which allows irradiating the patient directly after the surgical operation using a linear accelerator that can be situated in the operating room. For medical accelerators with energy over 10MeV the need to characterize the neutron spectra for this particular situation arises from the fact that, when neutron spectra is not fully known, it becomes necessary to be more cautious introducing a weight factor wR of 20 (maximum value). This leads to overesteem the equivalent dose due to neutrons and it indicates to introduce additional (mobile) shields for photon and neutrons radiation not easily achievable in an operating room.

Combined Modality Therapy↗

Radiotherapeutic computed tomography with scanned photon beams.

Radiotherapeutic computed tomography is a powerful technique to generate anatomical transversal tomograms of the patient in treatment position by using the therapy beam from the treatment unit. For this purpose the treatment unit has to be equipped with a detector array that can detect the beam transmitted through the patient and a computer that analyzes the data and performs the back projection. When the treatment unit uses scanned elementary photon beams, the only practical technique available for generating high quality high energy photon beams, the operation principle and, to some extent, the image quality is similar to that of a 3rd generation CT-scanner. The optimum choice of detection geometry and type of radiation detectors for radiotherapeutic computed tomography particularly at high photon energies are discussed indicating the merits of BGO (bismuthgermanate) or CWO (cadmiumtungstate) photodiod arrays. The first tomographic images of a thorax phantom at an acceleration potential of 50 MV using such detectors are presented. The image contrast is similar to that for 300 kV X rays mainly because the considerable influence of pair production at 50 MV. Line spread and modulation transfer functions are presented indicating a resolution of the order of two millimeters using a crystal thickness of 5 mm. The advantages with radiotherapeutic computed tomography, beside forming a new general communication channel between different diagnostic techniques, dose planning, and radiation delivery, are the elimination of position errors and the provision of exact attenuation data for dose planning.

Humans↗

Characteristics of the photoneutron contamination present in a high-energy radiotherapy treatment room.

The photoneutron contamination arising from a high-energy medical lineal accelerator is calculated using Monte Carlo simulation, as a function of the radiation field size. The information is used to model the neutron propagation in a radiotherapy treatment room and the transmission across concrete mazes. The Monte Carlo code MCNP4C is used to model the main components of a medical lineal accelerator. Simulations were performed to calculate the photoneutron yields and spectra as a function of the radiation field size. The yield of contaminant photoneutrons is observed to increase with the size of the radiation beam, but the energy spectra remain the same, suggesting that the contamination arises from above the movable collimator. The transport of the photoneutrons across a treatment room corroborates the validity of empirical models, but the transmission across a concrete maze produces a dose-equivalent tenth-value layer that differs from previous data.

Computer Simulation↗

Buildup region and skin-dose measurements for the Therac 6 linear accelerator for radiation therapy.

Buildup and surface-dose measurements were taken for the 6 MV photon beam from a Therac 6 linear accelerator manufactured by Atomic Energy of Canada Limited (AECL) with and without a lucite blocking tray in place. Further measurements were made with a copper filter designed to reduce secondary electrons emitted by photon interactions with the Lucite tray. The results are discussed in relation to skin-sparing for radiation therapy patients. The measurements were made with a fixed volume PTW parallel-plate ionization chamber and corrected to zero-chamber volume. The results were found to be consistent with similar measurements taken with a variable volume extrapolation chamber.

Humans↗

Characteristics of electron beams from a new 25-MeV linear accelerator.

Clinically useful electron fields are produced on the Atomic Energy of Canada, Limited Therac 25 linear accelerator by computer-controlled scanning of the electron beam. Measurements were made to determine the properties of these electron fields. Central axis percentage depth dose and bremsstrahlung background were compared for these fields and for the fields from selected machines that use scattering foils. Dose calibrations were made in both water and polystyrene using the American Association of Physicists in Medicine Task Group 21 protocol. Measurements were made to determine the relative output factors, virtual source position, and the attenuation of the electron fields by lead.

Electrons↗

Optimal radiographic magnification for portal imaging.

Two approaches to estimate the optimal radiographic magnification for a TV camera-based portal imaging system and portal films have been used. The first approach optimizes signal transfer while the second optimizes signal-to-noise ratio (SNR) transfer. In order to perform these optimization calculations, the physical characteristics of the imaging system (modulation transfer function and noise power spectrum) as well as the sizes of the radiation sources of our medical linear accelerators have been measured. Using these data, the optimal magnification considering signal transfer alone (M signal) has been calculated to range between 2.0 and 2.3 for the TV camera-based imaging system and is about 1.0 for portal films. Conversely, the optimal magnification considering SNR transfer (MSNR) has been calculated to range between 1.5 and 1.7 for the TV camera-based imaging system and is about 1.0 for portal films. The results suggest that most portal imaging systems are operated close to their optimal radiographic magnification.

Humans↗

The need for complex technology in radiation oncology. Correlations of facility characteristics and structure with outcome.

The Patterns of Care Study data are used to correlate therapy equipment and practice characteristics with outcome, using Hodgkin's disease, prostate cancer, and cervix cancer as examples. The shift to linear accelerators and higher photon energy is supported, as is the increased use of treatment simulators. Part-time practitioners of radiation therapy and facilities whose only equipment is a less-than-80-cm cobalt unit have poor technical support and exhibit poor staging, poor achievement of minimum tumor dose, and poor patient follow-up as compared to the national average or best-performing strata of practice. These facilities should either upgrade their equipment, technical support, and level of practice or close.

Delivery of Health Care↗

Neutron spectra in a tissue equivalent phantom during photon radiotherapy treatment by LINACS.

Bremsstrahlung photon beams produced by LINAC accelerators are currently the most used radiotherapy method for tumour treatments. When the photon energy exceeds the (gamma,n) reaction threshold energy, the patient receives an undesired dose due to photoneutron production both in the accelerator head and in the human body. In this paper, a method is presented for the assessment of the photoneutron spectra produced by Giant Dipole Resonance (GDR) during cancer radiotherapy with energetic photon beams. Experimental and numerical results have been obtained for the facility at Onkologik Klinik, Lund (Sweden), which is based on an ELEKTA 18 MV LINAC. Neutron spectra are evaluated both at the patient plane and inside an anthropomorphic phantom.

Computer Simulation↗

Experimental simulation of A-bomb gamma ray spectra: revisited.

It has been reported recently that the A-bomb gamma ray spectra received by the colon of the average Japanese survivor of Hiroshima and Nagasaki may be experimentally simulated using a hospital-based Philips SL15 linear accelerator. The simulated A-bomb gamma radiation may be used in radiobiology experiments to determine, amongst other things, the biological effectiveness of the A-bomb gamma radiation. However, in that study, the electron beams from the linear accelerator were poorly defined and photon contamination was ignored. In the study reported here, a Varian Clinac 2100C linear accelerator has been used for the same purpose but with photon contamination included in better defined output electron beams. It is found that the A-bomb gamma radiation can still be matched to an acceptable degree (<10%). The cause of the slightly poorer fit was due mainly to the different ranges of energies available from the linear accelerators used. The absorbed dose received by model breasts was also estimated in this study for the same situations as in the previous study. The ratio of the breast to colon doses was found to be only (3.9 +/- 4.0)% low compared with the expected values of 1.17 and 1.16 for Hiroshima and Nagasaki, respectively. These results provide further confirmation of the acceptability of the simple cylindrically symmetrical body models employed in these studies to represent the average Japanese survivor.

Breast↗

Neutron skyshine measurements at Fermilab.

Neutron skyshine has been a significant source of environmental radiation exposure at many high-energy proton accelerators. A particularly troublesome source of skyshine neutrons has existed at Fermilab during operation of the 400-GeV high-energy physics program. This paper reports on several measurements of this source made with a DePangher precision long counter at large distances. The spatial distribution of the neutron skyshine can approximately be described as an inverse square law dependence multiplied by an exponential with an approximate attenuation length of 1200 +/- 300 m. The absolute magnitude of the distributions can be matched directly to the conventionally measured absorbed dose distribution near the source.

Environmental Exposure↗

Field flatness and symmetry of photon beams: review of the current recommendations.

Flatness and symmetry are main parameters determining the quality of a photon beam produced by linear accelerators. The quality assurance in routine clinical practice of radiotherapy and consequently the treatment-outcome depend definitely on the physical parameters of treatment-delivery. Several recommendations from national and international associations are reported. By reviewing the current literature and mainly according to the World Health Organization (WHO) report of quality assurance in radiotherapy, we may suggest that for flatness and symmetry, the optimal level of deviation should be within +/- 3%. Flatness and symmetry should be checked monthly or once a year in accordance to the guidelines of national societies.

Calibration↗

Accelerated heavy ions and the lens. IV. Biomicroscopic and cytopathological analyses of the lenses of mice irradiated with 600 MeV/amu 56Fe ions.

The lenses of mice exposed to 600 MeV/amu iron ions were evaluated by slit-lamp biomicroscopy and cytopathological analyses. The doses ranged from 0.05 to 1.6 Gy, and the lenses were assessed at several intervals postirradiation. Cataract, the development of which is dependent on both time and dose, is significantly more advanced in all of the exposed mice when compared to the unirradiated controls. The great difference between the severity of the cataracts caused by 0.05 Gy (the lowest dose used) and those that developed spontaneously in the control animals is an indication that 0.05 Gy may far exceed the threshold dose for the production of cataracts by accelerated iron ions. Cytopathologically, a similar dose dependence was observed for a number of end points including micronucleation, interphase death, and meridional row disorganization. In addition the exposure to the 56Fe ions produced a long-term effect on the mitotic population and a pronounced "focal" loss of epithelial cytoarchitecture. The microscopic changes support the view that the mechanism of heavy-ion-induced cataractogenesis is the same as that for cataracts caused by low-LET radiation.

Animals↗

Frameless image-guided intracranial and extracranial radiosurgery using the Cyberknife robotic system.

The Cyberknife is an image-guided robotic radiosurgery system. The image guidance system includes a kilovoltage X-ray imaging source and amorphous silica detectors. The radiation delivery device is a mobile X-band linear accelerator mounted onto a robotic arm. Through a highly complex interplay between the image guidance system, an automated couch, and the high-speed linear accelerator, near real-time tracking of the target is achieved. The Cyberknife gained Federal Drug Administration clearance in the United States in 2001 for treatment of tumors "anywhere in the body where radiation treatment is indicated." Because the Cyberknife system does not rely on rigid fixation of a stereotactic frame, tumors outside of the intracranial compartment, even those tumors that move with respiration can be treated with a similar degree of ease as intracranial targets. A description of the Cyberknife technology and a review of some of the current intracranial and extracranial applications are detailed herein.

Humans↗