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Radiosurgery using a 4MV linear accelerator. Technique and radiobiologic implications.

In the authors' technique, the stereotactically localized target is fixed to the isocenter of a 4 MV linear accelerator. The irradiation is carried out along 9-17 non-coplanar arcs distributed on a 160 degrees cylindrical sector. High doses (10-50 Gy) are delivered in one or two sessions. From 1982, 65 patients have been treated (shortest follow-up 6 months). The dose was chosen according to the pathology and to the volume of the lesion. Good clinical results have been obtained in low-grade gliomas, acoustic neuromas, arteriovenous malformations, and other selected types of intracranial lesions. Therapeutic effects in terms of clinical condition and size of the lesions have been plotted in relation to time elapsed and dose employed.

Adolescent↗

Determination of the recombination correction factor kS for some specific plane-parallel and cylindrical ionization chambers in pulsed photon and electron beams.

It has been shown from an evaluation of the inverse reading of the dosemeter (1/M) against the inverse of the polarizing voltage (1/V), obtained with a number of commercially available ionization chambers, using dose per pulse values between 0.16 and 5 mGy, that a linear relationship between the recombination correction factor kS and dose per pulse (DPP) can be found. At dose per pulse values above 1 mGy the method of a general equation with coefficients dependent on the chamber type gives more accurate results than the Boag method. This method was already proposed by Burns and McEwen (1998, Phys. Med. Biol. 43 2033) and avoids comprehensive and time-consuming measurements of Jaffé plots which are a prerequisite for the application of the multi-voltage analysis (MVA) or the two-voltage analysis (TVA). We evaluated and verified the response of ionization chambers on the recombination effect in pulsed accelerator beams for both photons and electrons. Our main conclusions are: (1) The correction factor k(S) depends only on the DPP and the chamber type. There is no influence of radiation type and energy. (2) For all the chambers investigated there is a linear relationship between kS and DPP up to 5 mGy/pulse, and for two chambers we could show linearity up to 40 mGy/pulse. (3) A general formalism, such as that of Boag, characterizes chambers exclusively by the distance of the electrodes and gives a trend for the correction factor, and therefore (4) a general formalism has to reflect the influence of the chamber construction on the recombination by the introduction of chamber-type dependent coefficients.

Biophysics↗

Stereotactic radiosurgery utilizing a linear accelerator.

The authors have developed a radiosurgical technique based on multiple arc irradiations. The target is fixed to the rotational isocenter of a Varian 4 MV linear accelerator. The first irradiation is carried out while the radiating source is rotating on a 100-140 degrees arc. The patient is then rotated around a vertical axis passing through the target, and arc irradiations are repeated in different angular positions. By this technique it is possible to obtain very steep dose gradients at the borders of the target volume. High doses are usually delivered in two shots. 47 patients have been treated so far in a clinical trial that started in November 1982. The paper deals with the preliminary results (more than 6 months' follow-up) obtained in patients affected by nonresectable brain tumors and AVMs.

Adolescent↗

[An experimental study of the role of prostaglandins in the mechanism of the occurrence of dyspeptic disorders during the primary reaction after body exposure to ionizing radiation at large doses].

The experiments with dogs exposed to 100 Gy of accelerated electrons demonstrated a significant role of prostaglandins in the origin of early post-radiation dyspepsia. Their significance for genesis of post-radiation dyspeptic disturbance caused by exposure to superhigh doses becomes clear-cut when a combination of an antiemetic and inhibitors of prostaglandin biosynthesis is used. A study of the effect of dexamethasone, a blocker of arachidonic acid release, and of voltaren, an inhibitor of prostaglandin formation from cyclic endoperoxide, suggests that it would be appropriate to prevent radiation vomiting and diarrhea by inhibiting both of the above stages in prostaglandin biosynthesis.

Acute Disease↗

[Demonstration of ultra-hard X-radiation by means of silicon photo-elements (author's transl)].

Commercial silicon photo-elements were irradiated with 8 MV X-rays and 10 MeV electrons in the linear accelerator SL 75/10, and their usability as monitors and dosemeters was examined. The short circuit current of the photo-elements, which is linear to the transmitted dose rate, was measured with an expressly developed impulse amplifier which is sensitive to electricity. Further examinations as to the energy dependence proved a nearly constant sensitivity within the scope of 1 to 10 MeV. However, there are irradiation damages within this scope, which lead to a decrease of the sensitivity to photo-electricity producing a degeneration rate of 100 to 9 MGy-1. The examination showed on the other hand that, because of their simple measuring principle, the easily reproducible results, and the high sensitivity, the photo-elements can find various applications as monitors with direct display for relative measurements.

Mathematics↗

Commissioning of a medical accelerator photon beam Monte Carlo simulation using wide-field profiles.

A method for commissioning an EGSnrc Monte Carlo simulation of medical linac photon beams through wide-field lateral profiles at moderate depth in a water phantom is presented. Although depth-dose profiles are commonly used for nominal energy determination, our study shows that they are quite insensitive to energy changes below 0.3 MeV (0.6 MeV) for a 6 MV (15 MV) photon beam. Also, the depth-dose profile dependence on beam radius adds an additional uncertainty in their use for tuning nominal energy. Simulated 40 cm x 40 cm lateral profiles at 5 cm depth in a water phantom show greater sensitivity to both nominal energy and radius. Beam parameters could be determined by comparing only these curves with measured data.

Algorithms↗

Transmission in concrete of primary and leakage x rays from a 24-MV medical linear accelerator.

The transmission of leakage radiation from a 24-MV/6-MV linear accelerator was measured through 52 in. of concrete forming the roof of a test cell, at angles of 30, 45, 90, 135 and 180 degrees relative to the direction of the electron beam at the target. Transmission of the primary beam was also included as a partial check on the suitability of the method. The latter results were in good agreement with recommended values. The leakage radiation tenth-value layers agreed well with theory at 90 degrees but, at greater and lesser angles, interpretation was less straightforward, owing it is believed to the multiple leakage sources and complex shielding geometries inherent in a bent-beam machine. The implications of the findings concerning shielding barrier design are discussed, including consideration of the new case presented by dual photon energy machines.

Construction Materials↗

Time-dependent chemical compositions of 13N and 15O induced in air by the operation of a high energy electron accelerator.

Time-dependent chemical compositions for 13N and 15O induced in the air atmosphere of a high energy electron accelerator room have been studied using a computer simulation method. A radiation chemistry model was developed to describe the chemical reactions of 13N and 15O species with the air molecules and their radiolytic products. By assuming several chemical forms of 13N and 15O generated by the (gamma, n) reaction, the variations of the concentrations of 13N and 15O species were simulated under a radiation field. From the comparison between the simulations and experiment in a 100 MeV electron linear accelerator (linac) facility, the following conclusions were obtained: (1) Just after the (gamma, n) reaction, 25-50% of 13N and 15O are present as atoms (13N, 15O) and/or their ions (13N+, 15O+) and the remainder as nitrogen and oxygen molecules (13NN, 15OO) and/or their ions (13NN+, 15OO+); (2) Neutralization of 13N+ and 15O+ ions into 13N and 15O atoms occurs instantaneously and the same is the case with the neutralization of 13NN+ and 15OO+ ions to 13NN and 15OO molecules; (3) The neutralized 13N and 15O atoms react with the air molecules and the radiolytic products to form nitrogen oxide compounds and ozone, while 13NN and 15OO remain as these molecules. Factors that control the chemical reactions of 13N and 15O are discussed.

Computer Simulation↗

Radiotherapy with laser-plasma accelerators: Monte Carlo simulation of dose deposited by an experimental quasimonoenergetic electron beam.

The most recent experimental results obtained with laser-plasma accelerators are applied to radio-therapy simulations. The narrow electron beam, produced during the interaction of the laser with the gas jet, has a high charge (0.5 nC) and is quasimonoenergetic (170 +/- 20 MeV). The dose deposition is calculated in a water phantom placed at different distances from the diverging electron source. We show that, using magnetic fields to refocus the electron beam inside the water phantom, the transverse penumbra is improved. This electron beam is well suited for delivering a high dose peaked on the propagation axis, a sharp and narrow tranverse penumbra combined with a deep penetration.

Body Burden↗

Characteristics of the high-energy photon beam of a 25-MeV accelerator.

The CGR Saturne 25 is an isocentrically mounted standing wave medical linear accelerator that produces dual-energy photon beams and a scanned electron beam with six selectable energies between 4 and 25 MeV. The highest energy photon beam is nominally referred to as 23 MV. For this beam the mean energy of the accelerated electron beam on the 1.3 radiation length (4 mm) tungsten x-ray target is found to be approximately 21 MeV, with the energy acceptance stated to be +/- 5%. The electron beam traverses a 270 degrees bending magnet upstream of the x-ray production target. The resulting bremsstrahlung beam passes through a combination steel and lead flattening filter, 4-cm maximum thickness. Dosimetric data for the 23-MV beam are presented with respect to rectangular field output factor, depth of maximum dose as a function of field size, surface and buildup dose, central axis percent depth dose, tissue-phantom ratios, beam profile, applicability of inverse square, and block transmission. Some data are also presented on the effect of different flattening filter designs on apparent beam energy.

Electrons↗

A practical target system for accelerator-based BNCT which may effectively double the dose rate.

A dose-limiting component of a proton accelerator-based source of epithermal neutrons is the neutron production target. Possible targets are lithium, producing high yield but having low melting point and thermal conductivity, and beryllium, presenting less engineering problems but a much smaller neutron yield. We propose that a hybrid Be-Li target would provide the best of both worlds, with the upstream beryllium component producing neutrons and providing containment to the lithium, and the downstream liquid lithium in turn producing further neutrons as well as cooling the beryllium. The engineering considerations associated with such a target system are within the range of current technology. Calculations suggest a yield of such a practical target that is at least double that from pure beryllium.

Beryllium↗

Accelerator mass spectrometry measurement of 240Pu/239Pu isotope ratios in Novaya Zemlya and Kara Sea sediments.

Generally low levels of plutonium in environmental samples, often combined with limited sample sizes, necessitate reliable low-level techniques for determination of Pu isotopes. Accelerator mass spectrometry (AMS) has proved to be a powerful method for measuring low-level Pu activity concentrations and Pu isotope ratios. Based on procedural blanks, detection limits for AMS were below 1 fg Pu (equivalent to ca. 2 microBq 139Pu), which can compete with both TIMS, high sensitivity ICP-MS, and certainly alpha-spectrometry, while showing less interference, memory and matrix effects as compared to routine ICP-MS techniques. In addition to low detection limits, the technique offers the advantage of giving information on Pu isotope ratios. Measurements of sediments collected from dumping sites at Novaya Zemlya showed deviation from global fallout 240Pu/239Pu ratios.

Environmental Monitoring↗

Execution of a single-isocenter three-field technique, using a multileaf collimator or tray-mounted cerrobend blocks: effect on treatment time.

PURPOSE: In this article, we studied the total treatment time of a single-isocenter three-field irradiation of breast and axilla, using either tray-mounted cerrobend blocks, or a multileaf collimator (MLC) for field shaping. METHODS AND MATERIALS: A total of 20 female, unselected patients were given 50 Gy (2 Gy/fraction) on breast and 46 Gy on axilla and supraclavicular region (2 Gy/fraction). Patients were randomized between two different treatment groups. The first group (n = 10) was treated on a Philips SL-75 linear accelerator (SL-75), using 5 MV photons with tray-mounted cerrobend blocks. The second group (n = 10) was treated on a Philips SL-25 linear accelerator, using 6 MV photons and a MLC (SL-25-MLC). RESULTS: Although the beam-on time on the SL-25-MLC was significantly higher (p < 0.0001) compared to the SL-75, overall treatment time was significantly shorter using a MLC instead of tray-mounted cerrobend blocks (p < 0.0001). The difference in total treatment time was in the range of 100 s per patient per day. The main difference between the two accelerators was observed when setup of the second and third field was done using the automatic setup facility of the SL-25-MLC (avoids entering the treatment room). A mean time gain of 124 s per treatment session was observed using automatic setup. Considering the yearly number of patients receiving this treatment, a total time gain equivalent to 16.15 8-h workdays was calculated. CONCLUSIONS: Compared to a technique using tray-mounted cerrobend blocks in the single-isocenter three-field irradiation of a breast and axilla, a MLC combined with automatic field setup provides a significant time advantage, by reducing the number of manipulations inside the treatment room.

Axilla↗

General collection efficiency for liquid isooctane and tetramethylsilane in pulsed radiation.

The general collection efficiency in pulsed radiation was studied for isooctane (C8H18) and tetramethylsilane (Si(CH3)4). These two liquids were used as sensitive media in a parallel-plate liquid ionization chamber with a 1 mm sensitive layer. Measurements were carried out using 20 MV photon radiation from a linear accelerator with a pulse repetition frequency of 30 pulses/second and a pulse length of 3.5 microseconds. The general collection efficiency was determined for polarizing voltages in the interval 1000-2000 V for isooctane and 500-2000 V for tetramethylsilane and for pulse doses in the interval 0.06-1.9 mGy/pulse. An air ionization chamber was used as a pulse dose reference monitor. The experimental results were compared with those predicted by the equation for the general collection efficiency for gases in pulsed radiation, using the permittivity of each of the liquids. It was found that for general collection efficiencies down to 80% the differences between the predicted and experimental general collection efficiencies in the two liquids were within +/- 1% at electric field strengths exceeding 10(6) V m-1.

Octanes↗

Determination of percentage depth dose for 6 and 10 MV x-rays using Ge-doped optical fibre and TLD-100.

Percentage depth doses for 6 and 10 MV x-ray beams from a linear accelerator were measured using approximately 1 cm long (approximately 0.3 mg) Ge-doped optical fibre as a thermoluminescence dosimeter for two field sizes, 5 x 5 and 10 x 10 cm2. The results indicate that the Ge-doped optical fibre dosimeter is in good agreement with the results from a PTW 30001 cylindrical ionisation chamber and TLD-100. For 6 MV x-ray beams we observe that the depth of maximum dose d(max) is 1.5 and 2 cm for field sizes of 5 x 5 and 10 x 10 cm2 respectively. For 10 MV d(max) is 2 cm for a field size of 5 x 5 cm2 and 2.5 cm for a 10 x 10 cm2 field.

Fiber Optic Technology↗

Estimate of the risk in radiation therapy due to unwanted neutrons.

The integral dose of accelerator-produced leakage neutrons to patients undergoing high-energy photon therapy is estimated and compared to other sources of integral dose. The leakage neutron component contributes about 5 g rad (1 rad = 10(-2) Gy) for a typical treatment course of 5000 rad. When averaged over a 70-kg tissue volume, the corresponding dose amounts to only 0.36 rad. From this, the risk of inducing fatal malignancies by leakage neutrons is estimated to be about 50 x 10(-6) per year following treatment. This is compared to other risks to which the patient is unavoidably exposed, and it is argued that the unwanted neutrons pose such small additional risk that regulatory intervention is not warranted. This assessment is performed without reference to neutron RBE or quality factor.

Humans↗

Imaging positron emitting radionuclides generated during radiation therapy.

In vivo generated positron emitting radioisotopes, primarily C-11 and N-13, have been documented following therapy with accelerators larger than 10 MeV. Six patients had positron emission tomography 15 to 25 minutes after radiation therapy with a 42 MeV accelerator. Five patients had recurrent colorectal malignancy, and one required therapy for a carcinoma of the common bile duct. We sought to determine whether state-of-the-art PET technology could be used to monitor the three-dimensional activity distribution of radiation-induced radioactivity. At the time of the examination all six patients had sufficient concentrations of C-11 and N-13 activity in the irradiated volume to permit the evaluation of the activity distribution. We found significant activity at the body surface, which permitted field delineation. We conclude that the in vivo generated radioactivity can be monitored with PET.

Aged↗

Effects of bremsstrahlung and electron radiation on rat motor performance.

Relatively high, rapidly delivered doses of ionizing radiation have been reported to produce an immediate decrement in performance (PD) in a number of animal species. This study investigated the effects of bremsstrahlung and electron radiation on the performance of rats unilaterally exposed by a linear accelerator (LINAC facility) at a midline tissue dose rate of 2000 rad/min. Relative radiation effects were determined by establishing median effective doses (ED50) for rats trained on the accelerod, which is a shock-avoidance test of motor performance. The ED50s were based on 10-min postexposure performance. Subjects were also tested at 15, 30, 60, and 120 min and 24 hr after exposure. Fifty-seven trained rats were exposed to bremsstrahlung radiation, and 40 trained rats were exposed to electrons. The ED50 was 8121 rad for the bremsstrahlung field and 6110 rad for the electron field, for a significantly different relative effectiveness of the electron field in producing PD of 1.35. The data imply that different radiation fields are not equally effective in producing PD.

Animals↗