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PubMed1998

A feasibility study for megavoltage cone beam CT using a commercial EPID.

This study used a standard commercial electronic portal imaging device (EPID) area detector attached to an isocentric linear accelerator and the Feldkamp algorithm to produce cone beam tomographic reconstructions. The EPID has a active area of 32.5 x 32.5 cm2, and can record 12-bit images using two monitor units (MU), with a resolution of 2.1 x 2.0 mm2 FWHM. Since the EPID was not large enough to record the full patient projection at about 1.5 geometric magnification, it was necessary to offset the detector to collect half-cone projections. Corrections are required to convert pixel values into units of exit dose and to realign the projections to overcome the +/- 4 mm support arm sag. With a geometric magnification of 1.5 the sensitive volume is a cylinder of radius 21 cm and length 17 cm. Unfortunately, the patient couch contains metal bed support rails that lie just outside this cylinder, and produce streak artefacts in the reconstruction. Using 90 views the system delivers a central dose of 90 cGy, and has a density resolution of 4%.

Algorithms↗

PubMed2002

Thermoluminescence measurements of neutron dose around a medical linac.

The photoncutron ambient dose around a 18 MV medical electron lineal accelerator has been measured with LiF:Mg,Ti chips of 3 x 3 x 1 mm inside moderating spheres. During the measurements a water phantom was irradiated in a field of 40 x 40 cm2. Two methods have been considered for comparison. In the first, a TLD-600/TLD-700 pair at the centre of a 25 cm diameter paraffine sphere was used, with the system behaving as a rem meter. In the second method, TLD-600/TLD-700 pairs, bare and at the centre of 7.6, 12.7, 20.3, 25.4, and 30.5 cm diameter polyethylene Bonner spheres were used to obtain the neutron spectrum. This was unfolded using the BUNKIUT code with the SPUNIT algorithm and the UTA4 and ARKI response functions. The neutron dose was followed by multiplying the unfolded neutron spectrum by the ambient dose equivalent to neutron fluence conversion factors. Both methods result in 0.5 mSv x Gy(-1) m away from the isocentre.

Electrons↗

PubMed1996

Characteristics of secondary electrons produced by 6, 10 and 24 MV x-ray beams.

Megavoltage x-ray beams generated by linear accelerators (linacs) deliver their maximum dose a few centimetres below the treatment or phantom surface. This skin-sparing effect is degraded by the generation of secondary electrons as the x-ray beam passes to the patient or phantom. This work measures the characteristics of these electrons. A light-weight electromagnet was constructed that could be mounted in the block-tray position, 58 cm from the x-ray source of a Varian Clinac 2100C or 2500 linac. A field strength as high as 0.1500 T was generated, which was strong enough to sweep secondary electrons out of a 10 cm x 10 cm field. For 6, 10 and 24 MV x-ray beams, secondary contamination electrons produced 18, 38 and 65% of the surface dose, corresponding to 3, 5 and 12% of the maximum dose, respectively. A parameterized depth-dose curve for the contamination electrons was produced and was valid for all the x-ray energies studied.

Biophysical Phenomena↗

PubMed1994

A Monte Carlo study of accelerator head scatter.

The production of off-focus x rays in the head of a 6 MV linac has been investigated using the EGS4 Monte Carlo code. The purpose of the study was to identify the sources of off-focus radiation and the relative contribution for each source. Even though a particular energy and linac were modeled, the broad conclusions are expected to be general since the effects of head scatter are similar for most conventional head designs, regardless of manufacturer, energy, and model. The head components that were modeled include the exit window of the accelerating structure, target, beam stopper, flattening filter, monitor chamber, primary and secondary collimators, and air. Monoenergetic 6 MeV electrons were followed through the exit window, target, and beam stopper until all energy was expended. Primary- and higher-order x rays produced throughout the head were followed until they were either absorbed or passed through a plane at the isocenter. Sites of off-focus radiation were found to be diffusely distributed throughout the head, with the most intense sources being the primary collimator, flattening filter, and beam stopper. Data analysis shows that the collimator effect is determined primarily by the volume of the extended head-scatter source that is exposed to the point of measurement through the collimating system. The results of this study provide a rationale for developing extended source models to calculate the collimator factor for fields defined by arbitrary collimation. An additional advantage is an improvement in the agreement between measured and calculated isodose distributions.

Energy Transfer↗

PubMed1999

Characterization of the output for helical delivery of intensity modulated slit beams.

The UW tomotherapy workbench utilizes a convolution/superposition based dose calculation and optimization program. It specifies the energy fluence that must be delivered from each leaf for each phantom projection angle. This requires that the spectrum of the radiation emitted from the one-dimensional MLC (multileaf collimator) attached to the linear accelerator be determined. The steps involved in that process are described. The spectrum along the central axis of the slit beam was determined, as well as the softening with off-axis position. Moreover, the magnitude of the energy-fluence output had to be quantified on a per MU (monitor unit) basis. This was done for a single leaf along the central axis of the beam. Factors, which modify that energy-fluence output, were investigated. The output increases with off-axis position due to the horns of the beam. The output for a leaf of interest will also increase if additional leaves are open due to the absence of the tongue-and-groove effect and penumbra blurring. The energy-fluence increase per leaf increase by 4.9% if an adjacent leaf is open. No other factors related to the state of additional leaves were found to significantly increase the energy-fluence output for an individual leaf.

Algorithms↗

PubMed1995

Total skin electron therapy at two energies on a linear accelerator.

We have implemented the AAPM Task Group 30 recommendations with respect to Total Skin Electron Therapy (TSET) for the treatment of Mycosis Fungoides. Extensive measurements have been performed on the Varian 2100c linear accelerator with a water equivalent phantom, cylindrical phantoms and an anthropomorphic phantom to validate the 12 beam technique and to measure calibration factors. The technique was developed at 2.5 MeV and 3.5 MeV (mean energy at the surface) with the energy degrading screen at 30 cm from the patient. Field flatness over the treatment area was within +/- 3% with no significant regional variation of energy. The bremstrahlung contamination was .06-1.2%. The absolute calibration of absorbed dose to the patient required the measurement of the ratio "skin dose to calibration point dose", this was confirmed by measurements with a parallel plate ionization chamber and thermoluminescence dosimetry. The results indicate the care that must be taken with ionization chamber measurements under TSET condition to avoid erroneous readings due to the "polarity effect". A protocol is suggested for the practical implementation and quality assurance of the technique. The results of two successful treatments are presented and compared with the predicted results from phantoms.

Biophysical Phenomena↗

PubMed2006

Radiotherapy of Langerhans' Cell Histiocytosis : Results and Implications of a National Patterns-of-Care Study.

PURPOSE: This patterns-of-care study was performed to define the current clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany and to define open questions resulting from this study. MATERIAL AND METHODS: A standardized questionnaire was sent to 198 German radiotherapy institutions. Data about patient characteristics, stage of disease, practice and fractionation of radiotherapy, outcome of therapy, etc. were systematically evaluated. 123 of 198 institutions answered the complete questionnaire (62.1%). RESULTS: Only 23 of the 123 institutions (18.7%) reported experience with radiotherapy of Langerhans' cell histiocytosis of adults. 18 institutions with 98 patients were evaluable. The majority of patients (72 of 98) was treated on a linear accelerator. The median single dose of radiotherapy was 2 Gy, while the median total dose was 24 Gy. 81 of 89 evaluable patients (91%) reached a local control of the treated lesion(s), 69 of those had a complete remission. Eight of 89 patients (9%) developed an in-field recurrence. 87.8% of patients experienced no acute and 97% of patients no late side effects of radiotherapy. CONCLUSION: Clinical experience with radiotherapy of Langerhans' cell histiocytosis in adults in Germany is still very limited. Nevertheless, the clinical results-with high remission and local control rates-confirm the effectiveness of radiotherapy in the multidisciplinary treatment of this disease. Due to the small number of patients in this study despite higher incidence rates, the knowledge of this disease has to be multiplied in Germany. Future patients should be systematically included into a prospective radiotherapy registry.

Adolescent↗

PubMedDate not supplied

Heavy-ion radiography: density resolution and specimen radiography.

Heavy-ion radiography is performed by the passage of a beam of nuclei accelerated to energies of several hundred MeV/nucleon through an object. The technique of recording transmitted nuclei in a downstream stack of plastic sheets affords excellent resolution of density by recording the nuclei only at their stopping points. Imaging of a phantom--which stimulated tumors of low density contrast in a body part--by conventional radiography, computed tomographic scanning and the heavy-ion technique indicated superior density resolution for heavy-ion imaging at radiation dose. Superior imaging of tumors in pathologic specimens was demonstrated for heavy-ion imaging compared to conventional radiography. Values of stopping power for various tumors and normal tissues were determined by a computer-aided technique. Heavy-ion radiography shows promise for superior imaging of low contrast tumors at relatively low radiation low levels.

Achilles Tendon↗

PubMed1999

[Determination of monitor radiation scattering contribution in photon radiation of clinical electron linear accelerators].

BACKGROUND: Modern linear accelerators permit the use of irregular fields due to their flexible collimator systems with separately movable jaws or multileaf collimators. When using such irregular fields in the clinical practice output factors have to be corrected for enhanced backscatter to the dose monitor as compared with the conventional block shieldings. METHODS: A method is presented to detect the monitor backscatter contributions to the output factor for irregular field settings. RESULTS: The monitor backscatter factors have been measured using a telescopic device for 2 different treatment head geometries (Varian Clinac 2100C/D, General Electric Saturne 15) and for 3 photon radiation qualities (nominal energies X6, X18, X12). A method is introduced to calculate the monitor backscatter for arbitrary irregular treatment fields from the experimental data for square or rectangular fields. CONCLUSIONS: Besides the corrections for changes in phantom scatter and changes in the aperture, corrections for monitor backscatter have to be taken into account in many clinical cases. They can contribute up to more than 10% compared with the monitor values for free regular fields.

Humans↗

PubMed1991

Dosimetry characteristics of metallic cones for intraoperative radiotherapy.

Dosimetry data were obtained on the first dedicated linear accelerator of its type designed for electron intraoperative radiotherapy (IORT) within an operating room. The linear accelerator uses a high dose rate, 9 Gy.min-1, to reduce the treatment time. Its chrome-plated brass treatment cones, designed with straight ends and 22.5 degrees beveled ends, are not mechanically attached to the collimator head, but are aligned using a laser projection system. Dosimetry measurements were made for each combination of energy (6, 9, 12, 15, and 16 MeV), cone size (diameters range from 5 to 12 cm), and cone type (22.5 degrees beveled or straight). From these data, depth-dose curves, cone output, and air-gap correction factors were generated that allow the calculation of the monitor setting for delivering a prescribed dose at any depth for any irradiation condition (energy, cone, air gap). Isodose data were measured for every cone using film in a solid water phantom. Scatter off the inside wall of the cone resulted in peripheral dose horns near the surface that were energy and cone dependent, being as large as 120%.

Electrons↗

PubMed1990

Distribution of trace levels of therapeutic gallium in bone as mapped by synchrotron x-ray microscopy.

Gallium nitrate, a drug that inhibits calcium release from bone, has been proven a safe and effective treatment for the accelerated bone resorption associated with cancer. Though bone is a target organ for gallium, the kinetics, sites, and effects of gallium accumulation in bone are not known. We have used synchrotron x-ray microscopy to map the distribution of trace levels of gallium in bone. After short-term in vivo administration of gallium nitrate to rats, trace (nanogram) amounts of gallium preferentially localized to the metabolically active regions in the metaphysis as well as the endosteal and periosteal surfaces of diaphyseal bone, regions where new bone formation and modeling were occurring. The amounts measured were well below the levels known to be cytotoxic. Iron and zinc, trace elements normally found in bone, were decreased in amount after in vivo administration of gallium. These studies represent a first step toward understanding the mechanism(s) of action of gallium in bone by suggesting the possible cellular, structural, and elemental "targets" of gallium.

Animals↗

PubMed2001

On the verification of the incident energy fluence in tomotherapy IMRT.

For any radiotherapy verification technique, it is desirable that issues with the accelerator, multileaf collimator and patient position be detected. In previous works, an effective method for this level of verification was presented. This paper identifies second-order issues affecting the part of the process in which the incident energy fluence is verified. These problems will affect any rotational intensity-modulated radiotherapy delivery that divides each rotation or arc into projections: however the solutions offered in this paper are specific to the method previously developed. The issues affecting the energy fluence verification method include leaf bouncing. delivery implementation and leaf latency. All three matters were found to introduce small errors in the verified energy fluence values for a small fraction of leaf states. The overall effect on the deposited dose over the course of a rotational delivery involving thousands of beam pulses per rotation is negligible. Regardless, effective correction strategies are presented; these are utilized in order to characterize both the delivered energy fluence and deposited dose as accurately as possible.

Energy Transfer↗

PubMed1995

Extrafocal radiation: a unified approach to the prediction of beam penumbra and output factors for megavoltage x-ray beams.

An extrafocal source model has been developed to explain the dependence of head scatter and beam penumbra on field size. In this model, the x-ray source of a medical linear accelerator is described by two components: a small but intense focal component; and a broadly distributed extrafocal component of low intensity. The extrafocal component is so large that it can be "eclipsed" by the field-defining collimators. Extrafocal radiation was found to account for 12% of the energy fluence on the central axis of the 6 MV x-ray beam from a Varian Clinac 2100 c accelerator. Head scatter factors were calculated "in-air" for symmetric, asymmetric, and half-blocked fields. Calculations agreed with measured values to better than 0.5%, on average. However, head scatter factors for asymmetric fields were underestimated by 1.2% when one of the field dimensions was reduced to 4 cm (the minimum jaw setting that was tested). The extrafocal source model was combined with a convolution/superposition dose calculation algorithm to calculate dose-per-monitor-unit calibration (output) factors and beam dose profiles in water. These dose calculations predict the degradation of the field edge as a function of field size, and calculate output factors to within 0.5%, on average. In the most extreme case of a 4 cm field width, output factors were underestimated by 2%. Dose profiles are predicted without the aid of an empirical fit to measured beam penumbra data. The extrafocal source model will be particularly useful for fields defined by independent jaw and multileaf collimation systems.

Air↗

PubMed2000

Superficial doses from serial tomotherapy delivery.

Serial tomotherapy patients are treated using a commercial computer-controlled treatment planning and delivery system and a linear accelerator in arc mode. Target volumes are irradiated using sequential 1.68-cm-thick slices with the patient moved between each successive slice delivery. Due to the method of delivery, superficial doses from a course of intensity modulated radiation therapy may be significantly different from doses delivered with conventional radiation therapy. An experimental investigation was conducted to determine the superficial depth-dose distribution for geometric target volumes. Treatment plans were conducted for 5-cm-diam, 5-cm-long right cylindrical target volumes embedded in a 16-cm-diam, 12-cm-long water-equivalent cylindrical phantom. Three experiments were conducted with centrally located, off-centered, and superficial targets. Doses at superficial depths were measured using 3 x 3 x 1 mm3 thermoluminescent dosimetry chips. For all three targets, the measured doses were slightly greater than the calculated doses. Doses measured in the buildup region for the superficial target indicated that bolus would be required to provide the prescribed dose at the phantom surface.

Algorithms↗

PubMed2003

Clinical dosimetry with MOSFET dosimeters to determine the dose along the field junction in a split beam technique.

BACKGROUND AND PURPOSE: We report on the accuracy of metal oxide-silicon semiconductor field effect transistor (MOSFET) detectors to measure dose distributions in the region of a field junction in a split beam technique, compared to ionisation chamber and photographic film. We present a study on five patients receiving loco-regional treatment for breast cancer. MATERIALS AND METHODS: The dose variation at the junction was measured with the patient dose verification system model TN-RD-50 (MOSFET system). Phantom measurements were performed to investigate the MOSFET accuracy in a half-field matching method and the influence of factors related to the accelerator. The aim of the patient measurements was to determine the effect of patient related factors on the dose at the junction over a period of 10 irradiation fractions. RESULTS: The MOSFET detector overestimates the dose in the junction area, therefore a correction factor was determined to correct the MOSFET results. Phantom measurements showed overdosages as well as underdosages, depending on the matching field direction (X or Y). Patient measurements showed dose values that deviated up to 133%+/-3% (2 S.D.). The average values of 10 irradiation sessions showed a continuous, almost linear, variation of dose value across the junction. CONCLUSIONS: (1) Significant dose deviations in the junction area average out over repeated treatments; (2) one individual measurement in the junction area should not lead to any action; (3) a linac QA procedure to check the dose at the junction line should simulate the clinical situation sufficiently; and (4) MOSFET dosimeters overestimate dose values in the penumbra region.

Breast Neoplasms↗

PubMed1994

An analytical solution for the dynamic control of multileaf collimators.

All current optimization techniques in radiation therapy benefit from the use of strongly non-uniform radiation beams. The most flexible way of generating these fields under real time control is by elementary beam scanning and/or dynamic multileaf collimation. In this work general analytical expressions are derived for the required motion of the collimator leaves to achieve a desired energy fluence distribution or collimator opening density in the patient in the shortest possible time. By simplification of the general expressions the equations of motion have been derived for both the shrinking field and the curtain shutter techniques with the associated approximations clearly quantified. The mechanical limitations on leaf motion, caused by the finite velocity and acceleration, are taken into account. It is shown that almost any desired energy fluence distribution can be created even when the limitations on velocity and acceleration are considered. The basic rule with the curtain shutter technique is that when the energy fluence gradient along the direction of motion of the leaves is positive, the leading leaf should move at maximum speed and the lagging leaf should modulate the field. In regions where the gradient is negative the lagging leaf should instead move at full speed and the leading leaf should modulate the field. The overall treatment time is then proportional to the total increment in energy fluence or opening density between consecutive minima and maxima. For energy fluence profiles with numerous high peaks the treatment time may therefore increase considerably over that for conventional uniform dose delivery. However, in general the treatment time is prolonged by a factor of about two compared to a traditional uniform treatment. Obviously the method developed here for multileaf collimators is also suitable for simple block collimators since it can be used to deliver arbitrary regular or irregular 'dynamic wedge' profiles along the direction of motion of the collimator blocks.

Humans↗

PubMed1999

Radiation safety system of the B-Factory at the Stanford Linear Accelerator Center.

The radiation safety system of the B-Factory accelerator facility at the Stanford Linear Accelerator Center is described. The radiation safety system, which is designed to protect people from prompt radiation exposure due to beam operation, consists of the access control system and the radiation containment system. The access control system prevents people from being exposed to the very high radiation levels inside a beamline shielding enclosure. The access control system consists of barriers, a standard entry module at every entrance, and beam stoppers. The radiation containment system prevents people from being exposed to the radiation outside a shielding enclosure due to either normal or abnormal operation. The radiation containment system consists of power limiting devices, shielding, dump and collimator, and an active radiation monitoring system. The inter-related elements for the access control system and radiation containment system, as well as the associated interlock network, are described. The policies and practices used in establishing the radiation safety system are also compared with the regulatory requirements.

California↗

PubMed1998

A simple method to verify in vivo the accuracy of target coordinates in linear accelerator radiosurgery.

PURPOSE: A simple method that verifies the coincidence of the isocenter with the center of the target volume in radiosurgery treatment conditions is described. The accuracy is compared to that of accepted computerized procedures employing fiducial markers. METHODS AND MATERIALS: The center of the beam is identified by a cylindrical localizer, fixed to the plate of the supplemental collimator, with a 2 x 50 mm tungsten rod coincident with the beam axis and is projected onto the x-ray portal verification films. Prior to irradiation, the coordinates of the intersection of the beams axes, which is in a known spatial relationship with the isocenter, are read directly on portal x-ray films and their coincidence with the coordinates set during patient positioning, is checked. RESULTS: The mean displacement in AP, Lat, and Vert coordinates respectively, over 84 patients, between the coordinates calculated by the computerized procedure employing fiducial markers and the coordinates calculated by using the rulers was 0.3 +/- 0.4 mm. CONCLUSIONS: From the results obtained with the two methods we can conclude that rulers method can be used as a fast indirect control of the position of the radiation isocenter. Moreover, the dimensions of the radiation field and the correct alignment of the tertiary circular collimator can be also documented.

Mathematics↗