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PubMed2000

Determination of effective electron source size using multislit and pinhole cameras.

Two independent methods have been utilized for determination of effective source sizes for 6, 12, and 20 MeV electron beams generated by a Varian 2100C linear accelerator. First, a multislit camera has been constructed using parallel aluminum plates and plastic strip spacers, similar to the beam-spot camera for the photon source imaging. Second, pinhole imaging was performed using a lead plate with a small hole on the central axis of the beam. The plate thickness and the hole diameter varied with electron energy. The cameras were positioned directly at the opening of the movable photon collimator. The size of the source distribution from each camera was characterized by its full width at half-maximum (FWHM) value. The measured values of FWHM are different for each camera because of their different imaging principles. For the multislit camera, the measured FWHM values were (6.3 +/- 0.4) cm for the 6 MeV beam, (3.6 +/- 0.4) cm for 12 MeV, and (2.7 +/- 0.4) cm for 20 MeV. For the pinhole camera the measured values of FWHM were (7.9 +/- 0.6) cm for 6 MeV, (4.5 +/- 0.4) cm for 12 MeV, and (3.0 +/- 0.4) cm for the 20 MeV beam. Additionally, the effective source position was derived from output measurements at different values of the SSD, which were fitted to the inverse square law.

Electrons↗

PubMed2001

The efficiency and tolerance of half-body irradiation (HBI) in patients with multiple metastases. The Krakow experience.

AIM: To present our experience regarding the efficiency and tolerance of half-body irradiation in patients with multiple cancer metastases. PATIENTS AND METHODS: Between January 1986 and December 1997, 102 patients with multiple cancer metastases received half-body irradiation (HBI) at the Center of Oncology--Maria Sklodowska-Curie Memorial Institute in Krakow. Most of the patients (93/102) had bone metastases (Table 1). The HBI was performed with 9 MV photon beam from linear accelerator. In 88 patients only one region (upper, mid or lower) was treated, and 14 patients received upper and lower HBI (13 patients), or upper and mid HBI (one patient) (Table 2). The mean doses were: 6 Gy in upper HBI, 8 Gy in mid HBI, and 9 Gy in lower HBI (Table 3). RESULTS: The positive palliative effect (complete or partial pain relief) was observed in 77 (75.5%) patients (Table 4). Complete pain relief was higher in patients with prostate cancer, and in patients who received mid or lower HBI. During follow-up 47 (46.1%) patients developed pain progression after treatment (Table 5). The probability of survival without pain progression was higher in patients who developed complete pain relief (86.7% at 6 months, 69.3% at 12 and 24 months) than in patients with partial response (52.9% at 6 months, 32.8% at 12 months, and 5.5% at 24 months) (Figure 1). In most of the patients (74/102, 72.5%) the tolerance was good. CONCLUSIONS: HBI is an efficient method for palliation in patients with multiple painful metastases.

Adult↗

PubMed2006

Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: a comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy.

PURPOSE: To date, most intensity-modulated radiation therapy (IMRT) delivery has occurred using linear accelerators (linacs), although helical tomotherapy has become commercially available. To quantify the dosimetric difference, we compared linac-based and helical tomotherapy-based treatment plans for IMRT of the oropharynx. METHODS AND MATERIALS: We compared the dosimetry findings of 10 patients who had oropharyngeal carcinoma. Five patients each had cancers in the base of the tongue and tonsil. Each plan was independently optimized using either the CORVUS planning system (Nomos Corporation, Sewickly, PA), commissioned for a Varian 2300 CD linear accelerator (Varian Medical Systems, Palo Alto, CA) with 1-cm multileaf collimator leaves, or helical tomotherapy. The resulting treatment plans were evaluated by comparing the dose-volume histograms, equivalent uniform dose (EUD), dose uniformity, and normal tissue complication probabilities. RESULTS: Helical tomotherapy plans showed improvement of critical structure avoidance and target dose uniformity for all patients. The average equivalent uniform dose reduction for organs at risk (OARs) surrounding the base of tongue and the tonsil were 17.4% and 27.14% respectively. An 80% reduction in normal tissue complication probabilities for the parotid glands was observed in the tomotherapy plans relative to the linac-based plans. The standard deviation of the planning target volume dose was reduced by 71%. In our clinic, we use the combined dose-volume histograms for each class of plans as a reference goal for helical tomotherapy treatment planning optimization. CONCLUSIONS: Helical tomotherapy provides improved dose homogeneity and normal structure dose compared with linac-based IMRT in the treatment of oropharyngeal carcinoma resulting in a reduced risk for complications from focal hotspots within the planning target volume and for the adjacent parotid glands.

Carcinoma, Squamous Cell↗

PubMed2001

Combining the advantages of step-and-shoot and dynamic delivery of intensity-modulated radiotherapy by interrupted dynamic sequences.

PURPOSE: A hybrid between step-and-shoot and dynamic operation, called interrupted dynamic sequences, was investigated for prostate intensity-modulated radiotherapy (IMRT) delivered by a multisegment close-in technique. The new delivery mode was compared to the step-and-shoot mode concerning dose distribution. METHODS AND MATERIALS: Segments suitable for dynamic transition were selected using a system of segment classes. Transitions were only allowed between two segments of the same class, keeping intended sharp in-field dose gradients unchanged. Delivery was performed by an Elekta SLiplus (Crawley, UK) linear accelerator equipped with a dynamic multileaf collimator (MLC). Because no modeling of the dose during the transitions is made, accurate dose measurements were performed. Dose profiles were measured using a linear ion chamber array (LA48, PTW-Freiburg). The suitability of this detector for measurements in sharp dose gradients was investigated first. In addition, field flatness was examined for segments with a low monitor unit (MU) count. Uncertainties in dose output were investigated using an ionization chamber (30001, PTW-Freiburg). RESULTS: Because linear array measured penumbrae are only slightly broader (< or = 0.4 mm for MLC collimated field) than those obtained using a diamond detector, the array is a good device for profile measurements. Uncertainties related with the use of low MU beam segments are very small (< 1% for segments of minimum 3 MU), giving no contra-evidence for the step-and-shoot mode. Interrupted dynamic sequences are shown to introduce only small dosimetric differences as compared to the step-and-shoot delivery. CONCLUSION: Both delivery modes, step-and-shoot and interrupted dynamic sequences, result in similar dose distributions for the forward planned prostate class solution.

Humans↗

PubMed1990

Accelerated fractionation radiotherapy for advanced head and neck cancer.

Between 1981 and 1986, 89 patients with advanced head and neck squamous cancer were treated with a continuous accelerated fractionation radiotherapy (AFRT) regimen. Three fractions of 1.80 Gy, 4 h apart, were given on three treatment days per week (Monday, Wednesday, Friday), and the tumour dose was taken to 59.40 Gy in 33 fractions in 24-25 days. Acute mucosal reactions were generally quite severe, but a split was avoided by providing the patient with intensive support, often as an in-patient, until the reactions settled. Late radiation effects have been comparable to those obtained with conventional fractionation. The probability of local-regional control was 47% at 3 years for 69 previously untreated patients, whereas it was only 12% at one year for 20 patients treated for recurrence after radical surgery. Fifty-eight previously untreated patients with tumours arising in the upper aero-digestive tract were analysed in greater detail. The probability of local-regional control at 3 years was 78% for 17 Stage III patients and 15% for 31 Stage IV patients. This schedule of continuous AFRT is feasible and merits further investigation.

Carcinoma, Squamous Cell↗

PubMed1990

Radiosurgery of cerebral arteriovenous malformations with the dynamic stereotactic irradiation.

From December 1986 through December 1988, 33 patients with inoperable arteriovenous malformation (AVM) were treated in our center with the dynamic stereotactic radiosurgery, which uses a standard 10 MV isocentric linear accelerator. There were 18 females and 15 males with a median age of 26 years (range: 9-69) and a median follow-up time of 16 months (range: 7-32). The arteriovenous malformation volumes treated ranged from 0.2 to 42 cm3. The prescribed doses at the isocenter varied from 50 to 55 Gy and were given as a single fraction in the majority of the patients (31/33). Late complications consisting of intracranial bleeding and/or hemiparesis were observed in three patients. To date, 21 patients underwent repeat angiographic studies at 1 year post-treatment. A complete obliteration of the lesion was achieved in 38% of these patients. For the patients whose arteriovenous malformation nidus was covered by a minimum dose of 25 Gy, the total obliteration rate was 61.5% (8/13), whereas none of the patients who had received less than 25 Gy at the edge of the nidus obtained a total obliteration. Our preliminary analysis at 1 year post-radiosurgery reveals results comparable to those previously reported for other radiosurgical techniques for the same follow-up period.

Adolescent↗

PubMed2004

Isocenter characteristics of an external ring proton gantry.

PURPOSE: Determine the shape, size, geometric center, and virtual center of the isocenter for a proton gantry and compare to electron/X-ray accelerator gantries. METHODS AND MATERIALS: The majority of commercial electron/X-ray accelerator gantries consist of a rotating treatment head mounted to a stationary stand through a slewing ring bearing. The world's first proton gantry uses two rotating external rings, to which is mounted a fixed treatment nozzle with a movable snout that extends close to the center of rotation. The radial aspect of the isocenter for two similar proton gantries and two different electron/X-ray gantries were measured in the gantry frame of reference with a front pointer and a theodolite. These results were then transformed into room coordinates. The axial aspect of the isocenter was measured with a dial indicator. RESULTS: The radial aspect of the isocenter for slewing ring gantries has the shape of two concentric circles. The radial aspect of the isocenter for external ring gantries is shaped like a butterfly. The size of the mechanical isocenter is independent of the gantry style. CONCLUSIONS: The locations of the geometric and virtual centers can be determined to within 0.2 mm. Multiple gantry angle treatments can be delivered with a single setup allowing 2 mm for gantry and nozzle deflections. Precision treatments can be delivered allowing only 0.5 mm if the measured isocenter path is applied.

Calibration↗

PubMed1995

The fraction of photons undergoing head scatter in x-ray beams.

The output factor in air for a high-energy x-ray beam varies with the collimator setting. Collimator backscatter and obscuring of the source in the target contribute to this variation, but the main component is photon scatter in structures in the accelerator head. To determine the scatter-to-primary ratio, SPR, between the air kerma from such scattered photons and from those that originate directly from the source, it is essential to know the shape of this function SPR(c) of the square collimator opening c, especially for small c. To determine this, simulated head scatter was generated in lead blocks inside the head. By taking the ratio of the output factors for two such blocks of slightly different thickness, the effects of source obscuring and collimator backscatter were eliminated. Using the measured difference in transmission through the two lead blocks, the limiting value for c-->0 could be determined and hence the scatter-to-primary ratios SPR(c). The results could be fitted well with an error function, which then was applied to data measured for clinical beams of 6 and 25 MV. For c = 20 cm, SPR for one 6 MV beam was determined to be 0.016 without a flattening filter, 0.06 for the open beam, and 0.16 with the built-in wedge. At 25 MV, the SPR was higher, 0.09 and 0.20 for the open and wedged beams, respectively.

Humans↗

PubMed2004

Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose deposition in a transverse magnetic field.

Integrating magnetic resonance imaging (MRI) functionality with a radiotherapy accelerator can facilitate on-line, soft-tissue based, position verification. A technical feasibility study, in collaboration with Elekta Oncology Systems and Philips Medical Systems, led to the preliminary design specifications of a MRI accelerator. Basically the design is a 6 MV accelerator rotating around a 1.5 T MRI system. Several technical issues and the clinical rational are currently under investigation. The aim of this paper is to determine the impact of the transverse 1.5 T magnetic field on the dose deposition. Monte Carlo simulations were used to calculate the dose deposition kernel in the presence of 1.5 T. This kernel in turn was used to determine the dose deposition for larger fields. Also simulations and measurements were done in the presence of 1.1 T. The pencil beam dose deposition is asymmetric. For larger fields the asymmetry persists but decreases. For the latter the distance to dose maximum is reduced by approximately 5 mm, the penumbra is increased by approximately 1 mm, and the 50% isodose line is shifted approximately 1 mm. The dose deposition in the presence of 1.5 T is affected, but the effect can be taken into account in a conventional treatment planning procedure. The impact of the altered dose deposition for clinical IMRT treatments is the topic of further research.

Computer Simulation↗

PubMed2006

Electron radiotherapy: a study on dosimetric uncertainty using small cutouts.

This note investigated the dosimetric uncertainties due to the positional error when centring a small cutout to the machine central beam axis (CAX) in electron radiotherapy. A group of six circular cutouts with 4 cm diameter were made with their centres shifting 0, 2, 4, 6, 8 and 10 mm from the machine CAX for the 6 x 6 cm(2) applicator. The per cent depth doses, beam profiles and output factors were measured using the 4, 9 and 16 MeV clinical electron beams produced by a Varian 21 EX linear accelerator. The 2D isodose distributions in the z-x (or cross-line) and z-y (or in-line) plane were calculated by Monte Carlo simulation using the EGSnrc system. When the cutout centre was shifted away from the machine CAX for the 4 MeV beam, the d(m), R(80) and R(90) at the machine CAX had no significant change (<0.1 mm). For higher energies of 9 and 16 MeV beams, the d(m) was reduced by 0.45 and 1.63 mm per mm, between the cutout centre and the machine CAX with off-axis shift <6 mm respectively. R(80) and R(90) were reduced by more than 0.3 mm per mm off-axis shift for both energies. The isodose coverage of the in-line axis beam profile was reduced when the cutout centre was shifted away from machine CAX. It is important for oncology staff to note such dosimetric changes in the clinical electron radiotherapy, particularly when a high energy electron beam is used for small cutout. Such positional uncertainty is unavoidable in fabricating an electron cutout in the mould room.

Breast Neoplasms↗

PubMed2006

The use of a commercial QA device for daily output check of a helical tomotherapy unit.

Helical tomotherapy radiation therapy units, due to their particular design and differences from a traditional linear accelerator, require different procedures by which to perform routine quality assurance (QA). One of the principal QA tasks that should be performed daily on any radiation therapy equipment is the output constancy check. The daily output check on a Hi-Art TomoTherapy unit is commonly performed utilizing ionization chambers placed inside a solid water phantom. This provides a good check of output at one point, but does not give any information on either energy or symmetry of the beam, unless more than one point is measured. This also has the added disadvantage that it has to be done by the physics staff. To address these issues, and to simplify the process, such that it can be performed by radiation therapists, we investigated the use of a commercially available daily QA device to perform this task. The use of this device simplifies the task of daily output constancy checks and eliminates the need for continued physics involvement. This device can also be used to monitor the constancy of beam energy and cone profile and can potentially be used to detect gross errors in the couch movement or laser alignment.

Calibration↗

PubMed1995

Neutron generator at Hiroshima University for use in radiobiology study.

A neutron generator (HIRRAC) for use in radiobiology study has been constructed at the Research Institute for Radiation Biology and Medicine, Hiroshima University (RIRBM). Monoenergetic neutrons of which energy is less than 1.3 MeV are generated by the 7Li(p,n)7 Be reaction at proton energies up to 3 MeV. The protons are accelerated by a Schenkel-type-accelerator and are bombared onto the 7Li-target. An apparatus for the irradiation of biological material such as mice, cultured cells and so on, was designed and will be manufactured. Neutron and gamma-ray dose rates were measured by paired (TE-TE and C-CO2) ionization chambers. Contamination of the gamma ray was less than about 6% when using 10-microns-thick 7Li as a target. Maximum dose rates for the tissue equivalent materials was 40 cGy/min at a distance of 10 cm from the target. Energy distributions of the obtained neutrons have been measured by a 3He-gas proportional counter. The monoenergetic neutrons within an energy region from 0.1 to 1.3 MeV produced by thin 7Li or 7LiF targets had a small energy spread of about 50 keV (1 sigma width of gaussian). The energy spread of neutrons was about 10% or less at an incident proton energy of 2.3 MeV. We found that HIRRAC produces small energy spread neutrons and at sufficient dose rates for use in radiobiology studies.

Animals↗

PubMed2006

DAVID--a translucent multi-wire transmission ionization chamber for in vivo verification of IMRT and conformal irradiation techniques.

Permanent in vivo verification of IMRT photon beam profiles by a radiation detector with spatial resolution, positioned on the radiation entrance side of the patient, has not been clinically available so far. In this work we present the DAVID system, which is able to perform this quality assurance measurement while the patient is treated. The DAVID system is a flat, multi-wire transmission-type ionization chamber, placed in the accessory holder of the linear accelerator and constructed from translucent materials in order not to interfere with the light field. Each detection wire of the chamber is positioned exactly in the projection line of a MLC leaf pair, and the signal of each wire is proportional to the line integral of the ionization density along this wire. Thereby, each measurement channel essentially presents the line integral of the ionization density over the opening width of the associated leaf pair. The sum of all wire signals is a measure of the dose-area product of the transmitted photon beam and of the total radiant energy administered to the patient. After the dosimetric verification of an IMRT plan, the values measured by the DAVID system are stored as reference values. During daily treatment the signals are re-measured and compared to the reference values. A warning is output if there is a deviation beyond a threshold. The error detection capability is a leaf position error of less than 1 mm for an isocentric 1 cm x 1 cm field, and of 1 mm for an isocentric 20 cm x 20 cm field.

Humans↗

PubMedDate not supplied

Dosimetry of 24-MV x rays from a linear accelerator.

Dosimetric characteristics of a 24-MV photon beam produced by a Varian Clinac 2500 linear accelerator are presented. Particular attention is paid to measurements and applications relating to depth of maximum dose and scatter correction factors. New experimental methods were adopted to investigate scatter factors for field sizes ranging from 5 X 5 to 40 X 40 cm. For the largest field investigated, a 3% phantom scatter factor relative to a 10 X 10 cm field was determined. From the study, clinically useful scatter-phantom ratios were generated. The study also demonstrated that the estimated correction factors for scatter in a medium caused negligible changes (approximately equal to 0.1%) on the percent depth-dose values derived from the measured tissue-phantom ratio (TPR) data. The paper also quantitatively compares results obtained for dosimetric parameters like scatter output, tissue-phantom ratio, and percent depth-dose with those obtained from similar machines used for radiotherapy. Measured data relating to these parameters are expressed by taking a reference depth of 8 g/cm2 in a medium for normalization purposes and its importance discussed. Additional measurements presented in this work include beam quality and collimator effect on dose rate. Phantoms of various sizes and materials and a variety of detectors were used throughout the investigation.

Particle Accelerators↗

PubMed2004

The efficacy of stereotactic radiosurgery in the management of intracranial ependymoma.

OBJECTIVE: A retrospective analysis was performed to determine the outcome of patients with intracranial ependymoma treated with stereotactic radiosurgery (SRS). METHODS: Nine ependymoma patients have been treated with SRS (four with linear accelerator and five with Gamma Knife) since 1990. Two patients had WHO grade III tumors, and the remaining seven had WHO grade II tumors. Eight of nine patients received external beam radiation therapy at some point prior to radiosurgery to a total median dose of 54 Gy. The radiosurgery dose ranged from 14 to 20 Gy. RESULTS: The median follow-up was 28 months. The median age of patients at diagnosis was 35 years. Four patients developed progressive disease following radiosurgery, and two patients have died of progressive disease. The 3-year relapse-free survival was 55.6%. The 3-year overall survival was 71.1%. Patients treated with radiosurgery as a component of initial treatment (generally as a boost following external beam) had an improved relapse-free survival (100%) compared to those treated with radiosurgery to salvage an external beam local failure (20%). CONCLUSION: SRS is an effective treatment for intracranial ependymoma. Further clinical trials are warranted incorporating radiosurgery as a component of initial management in selected ependymoma patients.

Adolescent↗

PubMed2005

Application of a radiophotoluminescent glass plate dosimeter for small field dosimetry.

We have recently developed a prototypical radiophotoluminescent glass plate dosimeter (GPD) system as a device for small field dosimetry. The purpose of this study is to examine the usefulness of the GPD system for small field dosimetry. The profiles measured with the GPD were evaluated by comparing them to those from Kodak X-Omat V and GAFCROMIC XR type R film dosimeters for 2, 5, 9, and 15 mm circular collimators created by a linear accelerator-based radiosurgery system. The GPD output factors were compared with those of various detectors including an ion chamber, a p-type silicon diode detector, a glass rod dosimeter (GRD), and a diamond detector. The results measured with the GPD were also confirmed by comparing them to those from Monte Carlo simulations. The accuracy of a simulated beam is validated by the excellent agreement between Monte Carlo calculated and measured central axis depth-dose curves for 9- and 15 mm circular collimators using 4- and 10 MV photon beams. The GPD profiles show almost the same full width at half maximum as those of film dosimeters and Monte Carlo simulations at 4- and 10 MV photon beams, but a little narrower penumbrae than the film dosimeters and Monte Carlo simulations. The output factors measured with the GPD are in good agreement with those from a diode detector, a diamond detector, and the GRD with a small active volume and Monte Carlo simulations, except for a very small 2 mm circular collimator. It was found that the GPD is a very useful detector for small field dosimetry.

Computer Simulation↗

PubMed1985

[Measurement of neutrons from an electron accelerator by rem-counter].

In the measurement of neutrons from the medical electron accelerator by a rem counter, two problems disturb accurate measurements. One is the pile-up of signals produced by X-rays during each X-ray burst and the other is the increased counting loss caused by bunched nature of yielded neutrons. The time spectrum of neutrons measured by the rem counter 2202 D (manufactured by Studsvik) rises up to a maximum value by about 20 microseconds and then falls down exponentially with a time constant of about 90 microseconds. On the other hand, that of X-rays is roughly rectangular with several microseconds width. A time discriminating system was prepared to be combined with the rem counter, which was triggered by leading edge of electron beam pulses, rejected pile-up signals due to X-ray bursts, and counted pulses of neutrons in a specified time window. The system discriminated the pile-up enough to measure neutrons at a X-ray dose rate of at least 30 mGy/h. Nonparalyzable counting loss correction was practicable upto about 10 mSv/h for the beam pulse rate of 85 Hz, in which the dead time of the rem counter was estimated as 4 microseconds.

Neutrons↗

PubMed1992

[The special aspects in the planning and use of an electron linear accelerator facility for intraoperative radiotherapy (IORT)].

Limiting conditions for the planning of the installation of an electron linear accelerator in an operating theatre are described taking into account the radiotherapeutical and surgical requirements based on the example of the Essen facility for intraoperative radiotherapy (IORT) with electrons. Special features of the facility like a non-contact electron applicator system with television monitoring, table-top trolley, which is used also during irradiation, are explained in detail. Measured isodose curves for all tubes and all electron energies serve for the radiotherapist as criteria for decision on tube size and electron energy selection during surgical operation. The influence of misalignments of the tube on dose distributions is investigated. Limit values of alignment tolerances are deduced. Daily constancy tests for monitor calibration, electron energy, and tube alignment system are to be performed for quality assurance. Tables of the planned and realized treatments and of a representative time schedule of an IORT give a survey on the indications and the necessary time effort and staff. Completion of the set of tubes as well as optimization of the tube fixation accessory and of the table-top trolley are main subjects for future developments.

Anesthesiology↗