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PubMed2004

An accelerator-based epithermal neutron beam design for BNCT and dosimetric evaluation using a voxel head phantom.

The beam shaping assembly design has been investigated in order to improve the epithermal neutron beam for accelerator-based boron neutron capture therapy in intensity and quality, and dosimetric evaluation for the beams has been performed using both mathematical and voxel head phantoms with MCNP runs. The neutron source was assumed to be produced from a conventional 2.5 MeV proton accelerator with a thick (7)Li target. The results indicate that it is possible to enhance epithermal neutron flux remarkably as well as to embody a good spectrum shaping to epithermal neutrons only with the proper combination of moderator and reflector. It is also found that a larger number of thermal neutrons can reach deeply into the brain and, therefore, can reduce considerably the treatment time for brain tumours. Consequently, the epithermal neutron beams designed in this study can treat more effectively deep-seated brain tumours.

Body Burden↗

PubMed1998

Multisphere neutron spectra measurements near a high energy medical accelerator.

Photoneutron spectral measurements in the vicinity of a high energy medical accelerator have been performed. A LiI (Eu) scintillator and paired thermoluminescent dosimeters were used in conjunction with moderating multispheres to measure the neutron spectra. The photoneutron fluence rate, fluence lethargy, average energy, and quality factors have been calculated using a recursive unfolding algorithm. The dose rates and dose equivalent rates received by the patient and operators due to these neutrons have been estimated from these unfolded spectra. Doses predicted by a semi-empirical dose-equivalent model were compared to the measured values at each point. The dose equivalent rate to operators was found to be 1.9 x 10(-11) Sv MU(-1).

Algorithms↗

PubMedDate not supplied

Testing of a medical linear accelerator's computer-control system.

In August of 1987, the Radiation Oncology Center at the Mallinckrodt Institute of Radiology became the first academic-medical-center user of Varian's computer-controlled therapy accelerator, a prototype version of the 2100C. Installation was accomplished by the retrofit of a computer system to our two-year-old Clinac 1800. Being well aware of the malfunctions that occurred in other computer-controlled accelerators, we took extraordinary measures to assure proper operation of the new, computerized, system. Our acceptance procedure included tests of (i) mechanical systems (isocentricity, digital readouts, etc.); (ii) radiation parameters (flatness, symmetry, output, etc.); (iii) manual safety systems (emergency off switches, etc.); (iv) the computer console systems (communications integrity, state integrity, etc.); and (v) the interlock systems (some 50 electrical, mechanical, and/or computer-controlled interlocks). As items (i), (ii), and (iii) do not differ significantly from the tests for a non-computer-controlled machine, they will not be discussed here. Rather, this report will concentrate on the methods that were devised to test the computer-control and interlock systems.

Computer Systems↗

PubMed1994

The head-scatter factor for small field sizes.

The head-scatter factors H were examined for four different linear accelerators and were found to be similar at field sizes larger than 3 x 3 cm2. Sharply reduced values for small collimator openings were observed for all the accelerators. It is concluded that the head-scatter (or collimator-scatter) factor has two major components. Scatter of photons in various structures in the beam path, especially the flattening filter, causes a slow (about 10%) increase with increased collimator opening. Insertion of a built-in wedge may double this number. When the collimators are closed, they ultimately block photons from the periphery of the source. This may cause a considerable reduction of the primary photon fluence and typically affects fields smaller than 3 x 3 cm2. The effect can be used to estimate the source size, with results that correlate with the design of the bending magnet.

Biophysical Phenomena↗

PubMed1999

Correcting for electron contamination at dose maximum in photon beams.

Data are presented to allow the photon beam quality specifier being used in the new AAPM TG-51 protocol, %dd(10)x, to be extracted from depth-dose data measured with a 1 mm lead foil either 50 cm or 30 cm from the phantom surface. %dd(10)x is the photon component of the percentage depth dose at 10 cm depth for a 10x10 cm2 field on the surface of a phantom at an SSD of 100 cm. The purpose of the foil is to remove the unknown electron contamination from the accelerator head. Monte Carlo calculations are done: (a) to show these electrons are reduced to a negligible level; (b) to calculate the amount of electron contamination from the lead foil at the depth of dose maximum; and (c) to calculate the effect of beam hardening on %dd(10). The analysis extends the earlier work of Li and Rogers [Med. Phys. 21, 791-798 (1994)] which only provided data for the foil at 50 cm. An error in the earlier Monte Carlo simulations is reported and a more convenient method of analyzing and using the data is presented. It is shown that 20% variations in the foil thickness have a negligible effect on the calculated corrections.

Electrons↗

PubMed2003

[Partial breast irradiation: high dose rate peroperative brachytherapy technique using the MammoSite].

In the conservative management of breast cancer, radiation therapy delivering 45 to 50 Gy to the whole breast, in 4.5 to 5 weeks, followed by a booster dose of 10 to 20 Gy is the standard of care. Based on the numerous studies which have reported that the local recurrences occurs within and surrounding the primary tumor site and in order to decrease the treatment duration and its morbidity, partial breast irradiation using several techniques has been developed. Partial irradiation may be considered as an alternative local adjuvant treatment for selected patients with favorable prognostic factors. Using external beam radiation therapy, the 3D-conformal technique is appropriate to deliver the whole dose to a limited volume. In UK, an intraoperative technique using a miniature beam of low energy of x-ray (50 Kv) has been developed (Targit). Milan's team have developed an intraoperative electrons beam radiotherapy using a dedicated linear accelerator in the operative room. In USA and Canada the MammoSite has been advised for clinical use in per-operative brachytherapy of the breast. These two last techniques are currently compared in phase III randomised studies to the standard whole breast irradiation followed by a tumour bed booster dose. In this review we will focus on the MammoSite technique and will describe the per-operative implantation procedure, radiological controls ad dosimetric aspects.

Age Factors↗

PubMed1990

[Stereotaxic radiosurgery:methods and indications in the treatment of cerebral arteriovenous malformations].

After Leksell and Steiner's pioneering experience with the use of the gamma units, another technically different system has been developed, using a linear accelerator. It's a very precise stereotactic radiosurgical approach which allows to deliver the necessary dose of radiation to the target volume while sparing the surrounding structures from potentially dangerous levels of radiation. This hyperselective irradiation is a new and complementary method of treatment of arteriovenous malformations located in central or functionally critical areas of the brain. The aim is to obtain a progressive and total obliteration of the lesion. The place of radiosurgery is obviously reserved for the patients who do not seem able to profit from the benefits of open surgery and/or embolization techniques.

Dose-Response Relationship, Radiation↗

PubMed1993

Dosimetric implications of shifts in linear accelerator electron beam energy detected in routine constancy checks: a scanning film densitometry detection method.

The effects of change in electron beam energy are primarily manifest by changes in the range parameters of the depth ionisation/dose curve. Even for a change of up to 10% in the mean energy at the surface, E0, the dose to the depth of maximum on the central axis changes by less than 1%. Using as a limit of acceptability that the change in the therapeutic range (R85) should not be more than +/- 1.5 mm, the precision required by beam energy checking is that a change of 0.4 MeV in E0 should be detectable for all electron beams provided by the accelerator. To satisfy this criterion a routine method is proposed that uses therapy verification film exposed to the electron beam under a perspex wedge. The automatically processed film is then scanned with the densitometer of a beam data acquisition system (BDAS). The optical density versus distance plot is analysed using the BDAS computer that converts it to a quasi-depth dose curve and then calculates E0 and Ep,0 from the range parameters. The results for electron beams from "console" energies of 5 to 14 MeV show that the test criterion is within the capability of the method, and that the method is very practical for routine use in a quality assurance program.

Calibration↗

PubMed1999

Delivery verification in sequential and helical tomotherapy.

Conformal and conformal avoidance radiation therapy are new therapeutic techniques that are generally characterized by high dose gradients. The success of this kind of treatment relies on quality assurance procedures in order to verify the delivery of the treatment. A delivery verification technique should consider quality assurance procedures for patient positioning and radiation delivery verification. A methodology for radiation delivery verification was developed and tested with our tomotherapy workbench. The procedure was investigated for two cases. The first treatment using a torus-shaped target was optimized for 72 beam directions and sequentially delivered as a single slice to a 33 cm diameter cylinder of homogeneous solid water. For the second treatment, a random pattern of energy fluence was helically delivered for two slices to a 9.0 cm diameter phantom containing inhomogeneities. The presented process provides the energy fluence (or a related quantity) delivered through the multileaf collimator (MLC) using the signal measured at the exit detector during the treatment delivery. As this information is created for every pulse of the accelerator, the energy fluence and state for each MLC leaf were verified on a pulse-by-pulse basis. The pulse-by-pulse results were averaged to obtain projection-by-projection information to allow for a comparison with the planned delivery. The errors between the planned and delivered energy fluences were concentrated between +/-2.0%, with none beyond +/-3.5%. In addition to accurately achieving radiation delivery verification, the process is fast, which could translate to radiation delivery verification in real time. This technique can also be extended to reconstruct the dose actually deposited in the patient or phantom (dose reconstruction).

Acrylates↗

PubMed2003

Deterministic photon transport calculations in general geometry for external beam radiation therapy.

A deterministic method is described for performing three-dimensional (3D) photon transport calculations of a LINAC head and phantom/patient geometry to obtain dose distributions for therapy planning. The space, energy, and directional-dependent photon flux density is obtained by numerically solving the Boltzmann equation in general 3D geometry using the method of characteristics. The deterministic transport calculations use similar ray tracing routines as found in Monte Carlo (MC) codes. A special treatment is developed to better represent the impact of scattering from accelerator head components. Equations are presented for computing the water kerma distribution due to the uncollided and collided photon flux density field in the patient region. Kerma results obtained from the deterministic computation are compared to Monte Carlo values for a variety of source spectra and field sizes. The agreement for kerma values in the beam is usually within the MC uncertainties. It is concluded that the deterministic method is a rigorous, first-principles approach that could provide a superior alternative to Monte Carlo calculations for some types of problems. However additional development is needed to provide capability for 3D electron transport calculations.

Algorithms↗

PubMed1992

[Radiosurgical treatment of minor intracranial arteriovenous malformations by using a linear accelerator].

This study deals with 43 patients with cerebral arteriovenous malformations (AVMs) of a maximum of 20 mm in diameter. All of them were radiosurgically treated with a linear accelerator in stereotatic conditions (UMIC). The delivered doses vary from 20 gys to 50 gys. Thirty-seven were controlled angiographically and 35 of them showed the disappearence of the AVM. Different parameters can modify the results: delivered dose, the size and shape of the lesion, target-volume, peripheral lesion isodosis (75%), location, underestimation of the size or dose. These results show that small lesions are best to treat than larger ones, particularly because their volume enables us to encompass them more easily. The uniformity of this series is related to the homogenous size of the treated AVMs, thus avoiding the discussion of global, unclear, results.

Adolescent↗

PubMed2005

[Quality of life of 192 disease-freely survival nasopharyngeal carcinoma patients after radiotherapy].

BACKGROUND & OBJECTIVE: With the elevation of survival rate of nasopharyngeal carcinoma (NPC) patients after treatment, their quality of life (QOL) is more and more emphasized. This study was designed to evaluate the QOL of disease-freely survival NPC patients after treatment, and to investigate the factors correlated with their QOL. METHODS: From Jul. to Aug. 2003, disease-freely survival NPC patients who had been treated from 1999 to 2000 in Cancer Center of Sun Yat-sen University were enrolled. The Chinese SF-36 questionnaire and a checklist consists of 14 items about self-rating symptoms were self-reported by all participants at clinic. Sociodemographic and clinical data of the patients were also collected, and their relationships with SF-36 data and symptoms were analyzed. RESULTS: A total of 192 patients were enrolled in the study. The median survival time was 3.6 years (ranged 2.4-4.6 years). Xerostomia was the first common symptom, followed by hypoacusis, hypomnesia, dysphagia, and trismus. Univariate analysis showed that gender, age, educational level, monthly income, economic status, religion, and the number of complications had influences on QOL; the patients in earlier T and N stages, irradiated by linear accelerator, with lower total dose and weekly dosage to the nasopharynx and neck, and those who had anterior nasal field radiation reported better QOL. Multiple stepwise regression analysis showed that the number of complications, monthly income, age, and T stage were independent factors affecting total QOL. CONCLUSIONS: Improving radiotherapy might enhance physical functions of NPC patients. The prevention and control of chronic diseases, the development of economy, and the increase of income may promote NPC patients' QOL.

Adolescent↗

PubMed1995

Optimization of dose distribution for LINAC based radiosurgery using elliptical collimators.

The use of non-circular collimators is considered on all or some of the arcs used for radiosurgery on a linear accelerator in order to obtain conformal dose distribution for non-spherical lesions using a single isocenter. An extension of software to allow for use of non-circular collimators and a mathematical optimization based on prescribed doses on the lesion surface and on points in normal tissue (critical structures) are presented. Tests of the optimization method on simulated cases indicate that several boosts from selected positions along the arcs, superimposed on an optimized arc configuration allows one to obtain a highly conformal dose distribution with simple elliptical inserts. The optimization method can be applied to any type of collimation and is particularly effective with variable dose-rate machines.

Brain Neoplasms↗

PubMed1992

Influence of shielding blocks on the output of photon beams as a function of energy and type of treatment unit.

The influence of field-defining shielding blocks on the output of a cobalt unit and of seven different accelerators (one with dual energy output) has been investigated. The quality indices range from 0.57 (cobalt-60) to 0.79. The loss in output due to shielding blocks has been calculated taking into account loss in phantom scatter only. Comparison with experimental results shows that the calculation algorithm is correct in most of the clinical conditions. However, for quality indices of 0.70 and higher, for blocks close to the central beam axis, an overestimation of the output by the algorithm has been found. The maximum deviation observed is about 5% for the highest energy and for block positions corresponding to those applied, e.g. for inverted Y-fields with narrow lumbo-aortic block spacing.

Algorithms↗

PubMed2005

A software tool for 2D/3D visualization and analysis of phase-space data generated by Monte Carlo modelling of medical linear accelerators.

A computer program has been developed for novel 2D/3D visualization and analysis of the phase-space parameters of Monte Carlo simulations of medical accelerator radiation beams. The software is written in the IDL language and reads the phase-space data generated in the BEAMnrc/BEAM Monte Carlo code format. Contour and colour-wash plots of the fluence, mean energy, energy fluence, mean angle, spectra distribution, energy fluence distribution, angular distribution, and slices and projections of the 3D ZLAST distribution can be calculated and displayed. Based on our experience of using it at Massachusetts General Hospital, the software has proven to be a useful tool for analysis and verification of the Monte Carlo generated phase-space files. The software is in the public domain.

Computer Graphics↗

PubMedDate not supplied

Characteristics of the 6-MV photon beam produced by a dual energy linear accelerator.

Clinical dosimetry data are presented for the lower-energy x-ray beam of a Varian Clinac 1800 linear accelerator. This beam has comparable characteristics to single energy linear accelerators with the same stated 6-MV x-ray energy. The nominal beam energy was found to be 5.3 +/- 0.3 MV on the central axis. Beam quality expressed in terms of half-value layer in water was found to vary by less than 10% over the entire field. The surface doses are only slightly, but consistently, larger than those reported in the literature for other 6-MV linacs. Dosimetric results presented include central axis percentage depth dose (% DD) and tissue-maximum ratio (TMR), surface and buildup doses, output factors, and inverse square law applicability. The flatness and symmetry characteristics are within the manufacturer's specifications for both large and small fields.

Biophysical Phenomena↗

PubMedDate not supplied

Applying a polynomial formula to photon beam output and equivalent square field.

The polynomial formula proposed by Chen [Med. Phys. 15, 348 (1988)] in calculating the electron beam output from a Therac 20 linear accelerator has been applied to generating the output factor of various machines with photon energies ranging from 100 kVp to 18 MeV. The calculated outputs are within 1% of the measured values. This formula can be very useful to the physicist in preparing an output table of photon beams or electron beams for a therapeutic unit. An equation is derived from this formula to calculate the equivalent square. The derivation shows that only under special circumstances is the equivalent square field equivalent to 2ab/(a + b); otherwise the equivalent square field depends on the formula's parameters as well as the sides of the rectangular field. These parameters, in turn, are dependent on the photon energy, the medium irradiated, and the collimator design.

Humans↗

PubMed1995

Calculation of x-ray spectra for radiosurgical beams.

As conformal radiosurgery using micromultileaf collimators gains feasibility, dose calculation algorithms based on Monte Carlo or convolution techniques may become necessary. These require radiosurgical x-ray spectra. The most accurate method currently available to estimate clinical radiosurgery spectra is the Monte Carlo method. In this study the EGS4 Monte Carlo system was used to simulate the thick target of a 6 MV linear accelerator used for radiosurgery in our center. The calculated spectrum was attenuated through any significant mass thickness of material downstream from the target. The attenuated thick-target spectral distributions calculated both with and without the flattening filter were compared to the attenuated, thin target spectrum based on the small angle Schiff analytical spectrum calculated for the same target and attenuator material, as well as with a published spectrum from a full Monte Carlo simulation of a treatment head with a flattener in place. The Schiff spectrum neglects contributions from lower-energy scattered electrons that significantly degrade the quality of the beam. The flattener is removed from our accelerator during radiosurgery to increase the dose rate to approximately 750 cGy/min for a 10 x 10 cm2 field at the depth of dose maximum. This leaves a substantial fluence of photons below 1 MeV that are not observed in published spectra calculated for accelerators with flattening filters. Removal of the flattening filter has a measurable effect on the central axis depth dose, reducing the percentage dose at 10 cm depth from 59.2% to 54.3% for a 10 mm diam field. Radiosurgical off-axis ratios and percentage depth dose distributions calculated from these spectra with the EGS4 Monte Carlo code were compared to measured data. Measured and calculated dose distributions both with and without flattener were in good agreement. The dose distributions were found to be insensitive to the differences in the various calculated spectral distributions. Thus, although the attenuated Schiff spectrum is significantly harder than the clinical beam, it is adequate for dose calculations of radiosurgical beams.

Computer Simulation↗