Contact roentgen therapy has certain inherent advantages due to the very short tissue-target distance and the relative low voltage employed. For the Philips contact tube these factors are 18 mm. distance and approximately 50 kv.p. This gives a source of intense irradiation of the order of 6,000 to 10,000 r per minute. The short tissue-target distance results in a very rapid falling off of intensity. The depth dose at 5 mm. is approximately 50 per cent of that at the surface, at 10 mm. 23 per cent, and at 40 mm. 1 per cent. The major disadvantage is that the tube aperture is only 2.5 cm. in diameter. Many thin lesions, both benign and malignant, such as hemangiomas, calluses, keloids, and some epitheliomas, for which the short tissue-target distance and low voltage would be advantageous, are too large for so limited a treatment field. Large-field contact therapy may also be desirable in cases in which the bulk of a tumor has been removed surgically, for intensive irradiation of the tumor base. Two methods have been used in the contact treatment of large areas. One consists in moving the tube, while energizing it, over the area to be treated; in the other the tube is moved from spot to spot, in an attempt to cover the entire lesion. With these methods it is difficult, if not impossible, to get a uniform distribution of radiation (1–3). In order to obtain uniform irradiation of a surface or plane, one of us (E. F. L.) has designed a grid containing squares measuring 1.5 × 1.5 cm. These are the largest squares which can be included within the 2.5 cm. round field of the tube. The grid consists of a sheet of lead, 22 × 22 cm., approximately 0.5 mm. thick, having an aperture in the center measuring 18 cm. on a side. A net is fashioned from nylon fishing line, having meshes 1.5 cm. square, the line being anchored to the lead by staples and stitches. Where the nylon lines cross, they are attached by passing a thread through the line and tying. This is done to avoid any distortion of the field, which is particularly important in treating uneven surfaces. This grid may be sterilized in any manner and used repeatedly. It furnishes uniform radiation to the surface and will fulfill most practical needs. For thicker lesions, in which it is desired to obtain uniform irradiation of other planes than the surface, the 1.5-cm. squares of the grid may be spaced at varying distances, depending upon the depth at which the uniform radiation is desired. For instance, for a plane 5 mm. below the surface, a spacing of 4 mm. is required. The radiation is not uniform below the plane of uniform irradiation because of the geometric spread resulting from the short target-tissue distance and subsequent overlap. The volume of tissue involved in this overlapping is, however, minimal (Fig. 1). Lead rubber can also be used for making the grid.
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