Relative Dose Distributions Research Articles

A fast monitoring system for radiotherapeutic proton beams based on scintillating screens and a CCD camera

A facility in which a 62 MeV proton beam is employed in the radiotherapeutic treatment of several ocular disease has been active since March 2002 at Laboratori Nazionali del Sud. A fast and accurate quality control system of such beam has been designed and tested. The system consists of a scintillating screen mounted perpendicularly to the beam axis at a fixed distance and observed by a highly sensitive charge-coupled device camera. The basic idea is the possibility to obtain real time information about the relative spatial dose distribution delivered to tissue through the measurement of the light emission in the scintillating screen. A comparison with the presently used dosimetric system (a motorized silicon diode) that, in the future, will be replaced by the device introduced in this paper (if its experimental performance will be successful) has been carried out. The good capabilities of the system make it worthy of further investigations into its applicability in proton beams monitoring for radiotherapeutic treatments (i.e., reconstruction of depth dose distribution and beam monitoring during patient irradiation).

3-D dose verification for IMRT using optical CT based polymer gel dosimetry

In this study BANG® polymer gels in conjunction with OCTOPUS™ optical CT scanner (MGS Research Inc., Madison, CT) was employed to measure the relative 3D dose distribution of an IMRT treatment. Measured relative dose distributions from the gel measurement were compared with those from treatment planning system calculations and EDR2 film measurements with regard to planar dose distributions in axial, coronal, and sagittal orientations.

Total skin electron therapy treatment verification: Monte Carlo simulation and beam characteristics of large non-standard electron fields

Total skin electron therapy (TSET) is a complex technique which requires non-standard measurements and dosimetric procedures. This paper investigates an essential first step towards TSET Monte Carlo (MC) verification. The non-standard 6 MeV 40 × 40 cm2 electron beam at a source to surface distance (SSD) of 100 cm as well as its horizontal projection behind a polymethylmethacrylate (PMMA) screen to SSD = 380 cm were evaluated. The EGS4 OMEGA-BEAM code package running on a Linux home made 47 PCs cluster was used for the MC simulations. Percentage depth–dose curves and profiles were calculated and measured experimentally for the 40 × 40 cm2 field at both SSD = 100 cm and patient surface SSD = 380 cm. The output factor (OF) between the reference 40 × 40 cm2 open field and its horizontal projection as TSET beam at SSD = 380 cm was also measured for comparison with MC results. The accuracy of the simulated beam was validated by the good agreement to within 2% between measured relative dose distributions, including the beam characteristic parameters (R50, R80, R100, Rp, E0) and the MC calculated results. The energy spectrum, fluence and angular distribution at different stages of the beam (at SSD = 100 cm, at SSD = 364.2 cm, behind the PMMA beam spoiler screen and at treatment surface SSD = 380 cm) were derived from MC simulations. Results showed a final decrease in mean energy of almost 56% from the exit window to the treatment surface. A broader angular distribution (FWHM of the angular distribution increased from 13° at SSD = 100 cm to more than 30° at the treatment surface) was fully attributable to the PMMA beam spoiler screen. OF calculations and measurements agreed to less than 1%. The effect of changing the electron energy cut-off from 0.7 MeV to 0.521 MeV and air density fluctuations in the bunker which could affect the MC results were shown to have a negligible impact on the beam fluence distributions. Results proved the applicability of using MC as a treatment verification tool for complex radiotherapy techniques.

A Monte Carlo-based method to estimate radiation dose from spiral CT: from phantom testing to patient-specific models

The purpose of this work is to develop and test a method to estimate the relative and absolute absorbed radiation dose from axial and spiral CT scans using a Monte Carlo approach. Initial testing was done in phantoms and preliminary results were obtained from a standard mathematical anthropomorphic model (MIRD V) and voxelized patient data. To accomplish this we have modified a general purpose Monte Carlo transport code (MCNP4B) to simulate the CT x-ray source and movement, and then to calculate absorbed radiation dose in desired objects. The movement of the source in either axial or spiral modes was modelled explicitly while the CT system components were modelled using published information about x-ray spectra as well as information provided by the manufacturer. Simulations were performed for single axial scans using the head and body computed tomography dose index (CTDI) polymethylmethacrylate phantoms at both central and peripheral positions for all available beam energies and slice thicknesses. For comparison, corresponding physical measurements of CTDI in phantom were made with an ion chamber. To obtain absolute dose values, simulations and measurements were performed in air at the scanner isocentre for each beam energy. To extend the verification, the CT scanner model was applied to the MIRD V model and compared with published results using similar technical factors. After verification of the model, the generalized source was simulated and applied to voxelized models of patient anatomy. The simulated and measured absolute dose data in phantom agreed to within 2% for the head phantom and within 4% for the body phantom at 120 and 140 kVp; this extends to 8% for the head and 9% for the body phantom across all available beam energies and positions. For the head phantom, the simulated and measured absolute dose data agree to within 2% across all slice thicknesses at 120 kVp. Our results in the MIRD phantom agree within 11% of all the different organ dose values published by the UK’s ImPACT group for a scan using an equivalent scanner, kVp, collimation, pitch and mAs. The CT source model was shown to calculate both a relative and absolute radiation dose distribution throughout the entire volume in a patient-specific matrix geometry. Results of initial testing are promising and application to patient models was shown to be feasible.

Implementation of nuclear magnetic resonance polymer-gel dosimetry into clinical practice

The aim of this thesis research was to evaluate some basic properties of the polymer-gel dosimeter and test it in clinical practice. Dependence of polymer-gel dosimeter sensitivity on different photon and electron energies as well as on different mean dose rates of standard clinically used linear accelerator was studied. A physical/mathematical description of the effect of temperature on the polymer-gel dosimeter, able to correct a dosimeter 1/T2 response for different temperatures during the NMR measurement, was developed. The polymer-gel dosimeter was tested for the verification of stereotactic radiosurgery techniques with the Leksell Gamma Knife. There was an observed trend in polymer-gel dosimeter sensitivity dependence on quality index for the high-energy x ray beams. Similarly, there was an observed trend in dosimeter sensitivity dependence on mean electron energy. It was demonstrated that these trends were statistically significant. Polymer-gel dosimeter sensitivity was decreased with increased photon or electron energy. There was observed no trend in polymer-gel dosimeter sensitivity dependence on mean dose rates for both photon and electron beams within experimental errors. It was demonstrated in this study that the NMR 1/T2-dose response is increased for lower temperatures of the evaluated polymer-gel samples. The relaxation rate response can be expressed as a function consisting of two terms, one denoted for the temperature dependence and the other one for the dose dependence. Two clinical applications of the polymer-gel dosimeter were demonstrated in this study. The first experiment allowed a check of the entire stereotactic procedure with the Leksell gamma knife including target stereotactic localization on NMR,treatment planning, and irradiation. The second experiment evaluated dosimetric and geometric inaccuracies associated with the stereotactic irradiation of the experimental rat brain. It was demonstrated that polymer-gel can be effectively used in evaluation of relative dose distribution obtained in stereotactic radiosurgery procedures.

An investigation of entrance surface dose calculations for diagnostic radiology using Monte Carlo simulations and radiotherapy dosimetry formalisms

Our aim in this work was to investigate the methodology used in the determination of the entrance surface dose (ESD) in diagnostic radiology. In kV x-rays for low-energy photons (tube potential up to 160 kV, HVL: 1–8 mm Al), the ESD is based on the use of the ratio of mass-energy absorption coefficients and backscatter factors. A full simulation of the photon and electron transport in a kilovoltage x-ray unit, using the Monte Carlo code BEAM/EGS4, was performed to obtain an accurate beam phase space for use in dose calculation. The modelled phase space was experimentally validated for the beam qualities (measured HVL: 3.3 mm Al–2.2 mm Cu) and showed good agreement between calculated and measured HVLs, air kerma and relative dose distributions. We have computed the conversion factors from air kerma to water or soft tissue absorbed dose at the surface of a phantom for beam qualities (HVL: 3.3–8.35 mm Al). The same model was also used to calculate the ESD in water and in soft tissue for the low-energy photon range considered. The results show that the numerical differences between the air kerma and the water kerma based backscatter factors are insignificant. The same conclusion was reached for the (μen/ρ) ratios, for soft tissue to air, evaluated using either the primary photon spectra or the spectra at the surface of a phantom. Furthermore, the good agreement obtained for the computation of the conversion factors with a full BEAM/EGS4 model confirms the previous studies which are based on different sources for the spectral distribution and different beam geometries (pencil beam or point source assumptions). On the other hand, the ESD in water or soft tissue is well described either with the Bair or the Bw formalism. Conversion factors from air kerma to ESD in these media are proposed in this work for several beam qualities in diagnostic radiology.

Evaluation of Geometric and Dosimetric Inaccuracies of Stereotactic Irradiation in the Rat Brain

Objective: To evaluate geometric and dosimetric inaccuracies in the irradiation of the rat brain with the Leksell Gamma Knife. Materials and Methods: Altogether three types of dosimeters were employed for these measurements: (a) a thermoluminescent dosimeter, (b) a semiconductor detector and (c) a polymer gel dosimeter. The thermoluminescent dosimeter and the semiconductor detector were calibrated using an ion chamber and then implanted in the brain of a rat cadaver and used for absolute dose determination. A special glass phantom mimicking exactly the shape of the rat body filled with the polymer gel was used for measurements of the relative dose distribution and evaluation of geometric inaccuracies during the stereotactic irradiation in the rat brain. Results: Both thermoluminescent and semiconductor detectors, due to their size, measured mean doses. The observed results demonstrated that the Leksell GammaPlan can be employed for the calculation of absorbed doses in irradiation of experimental animals. In our case, it was necessary to apply a correction factor of 1.078 for the absolute absorbed dose to obtain reliable results. A comparison of calculated dose profiles using the treatment planning system in all three axes with those measured by the polymer gel dosimeter demonstrated a very good geometric agreement with the mean deviation in profile position of 0.5 mm. Conclusion: The results indicate that this technique can effectively check the geometric and dosimetric accuracy of stereotactic irradiation in the rat brain. The Leksell GammaPlan can be employed for the calculation of absorbed doses, but the correction factor of 1.078 had to be applied for the absolute dose calculations in our irradiation geometry.

On the practice of the clinical implementation of enhanced dynamic wedges

Practical aspects of the clinical implementation of enhanced dynamic wedges (EDW) replacing manual wedges are presented and discussed extensively. A comparison between measured and calculated data is also presented. Relative dose distributions and wedge factors were calculated with a commercially available treatment planning system and measured in a water-phantom and with an ionization chamber. Wedge factor calculations and measurements were also compared with an independent method of wedge factor calculations available from the literature. Aspects of the clinical implementation, such as safety and quality assurance, were evaluated. Measurements and calculations agreed very well and were slightly better than results of previous studies. Profiles and percentage depth doses (PDDs) agreed within 1% to 1.5% and within 0.5%, respectively. Measured and calculated wedge factors ratios agreed within 0.5% to 1%. Calculated and measured EDW dose distributions showed excellent agreement, both relative and absolute. However, for safe and practical use, specific aspects need to be taken into consideration. Once the treatment planning system is commissioned properly, the clinical implementation of EDW is rather straightforward.

Incorporating leaf transmission and head scatter corrections into step-and-shoot leaf sequences for IMRT

Purpose: Leaf transmission and head scatter are two important factors that influence intensity-modulated radiation therapy (IMRT) delivery and should be correctly taken into account when generating multileaf collimator (MLC) sequences. Significant discrepancies between the desired and delivered intensity profiles could otherwise result. The purpose of this article is to propose a reliable algorithm to minimize the dosimetric effects caused by the two factors in step-and-shoot mode. Methods and materials: The goal of the algorithm is to minimize the difference between the desired fluence map and the fluence map actually delivered. For this purpose, an error function, defined as the least-square difference between the desired and the delivered fluence maps, is introduced. The effects of transmission and head scatter are minimized by adjusting the fractional monitor units (MUs) in the initial MLC sequences, created by using the desired fluence map without inclusion of the contributions from the two factors. Computationally, a downhill simplex optimization method is used to minimize the error function with respect to the fractional MUs. A three-source model is used to evaluate the relative head scatter distribution for each segment at the beginning of the calculation. The algorithm has been assessed by comparing the dose distributions delivered by the corrected leaf sequence files and the theoretic predication, calculated by Monte Carlo simulation using the desired fluence maps, for an intuitive test field and several clinical IMRT cases. Results: The deviations between the desired fluence maps and those calculated using the corrected leaf sequence files are <0.3% of the maximum MU for the test field and <1.0% for the clinical IMRT cases. The experimental data show that both absolute and relative dose distributions delivered by the corrected leaf sequences agree with the desired ones within 2.5% of the maximum dose or 2 mm in high-dose gradient regions. Compared with the results obtained by using the leaf sequences in which only the transmission or none of the two effects is corrected, significant improvements in the fluence and dose distributions have been observed. Conclusions: Transmission and head scatter play important roles in the dosimetric behavior of IMRT delivery. A larger error may result if only one factor is considered because of the opposite effects of the two factors. We noted that the influence of the two effects is more pronounced in absolute dose than in the relative dose. The algorithm proposed in this work accurately corrects for these two effects in step-and-shoot delivery and provides a reliable tool for clinical IMRT application.

Evaluation of the performance of VIPAR polymer gels using a variety of x-ray and electron beams

The aim of this investigation was the evaluation of the usefulness of N-vinyl pyrrolidone argon (VIPAR) polymer gel dosimetry for relative dose measurements using the majority of types and energies of radiation beams used in clinical practice. For this reason, VIPAR polymer gels were irradiated with the following beams: 6 and 23 MV photons (maximum dose: 15 Gy) and 6, 9, 12, 15, 18 and 21 MeV electrons (90% dose: 15 Gy). Using 6 MV x-rays, a linear gel dose response was verified for doses up to 20 Gy. Assuming linearity of response for the rest of the photon and electron beams used in this study, percentage depth dose measurements were derived. For all beams used and the range of relative doses studied, a satisfying agreement was observed between percentage depth dose measurements performed using the VIPAR gel–MRI method and an ion chamber, validating the assumption that a linear gel dose response holds for all photon and electron beams studied. VIPAR gels, therefore, can be used for relative dose distribution measurements using photons or electrons of any typical energy used in external radiotherapy applications. It is also demonstrated that two-dimensional dose distribution measurements through an irradiated (9 MeV electrons, 3 cm × 3 cm cone) VIPAR gel volume can be easily obtained.

Three-dimensional dose verification using BANG gel: a clinical example

Object. The authors sought to demonstrate the possible value of three-dimensional dose verification by using gel dosimetry. Methods. In this study, commercially available BANG—25 Gy gel was used. This polymer gel is tissue equivalent and the relaxation rate (R2) measured using magnetic resonance (MR) imaging is proportional to the absorbed dose in the gel. A cylindrical container filled with BANG was mounted within an anthropomorphic head phantom and was handled using the same process as would be used for a patient undergoing gamma knife radiosurgery (GKS). An irregular target outline was constructed and a dose plan was created consisting of seven shots, three using the 8-mm and four using the 4-mm collimator helmet. The maximum dose specified was 25 Gy. A combination of several single spin-echo MR imaging sequences with different echo times was used to calculate the R2. The geometric resolution of the MR images was approximately 1 mm3. To compare the measured dose distribution with the calculated one, isodoses were overlaid in three orthogonal planes by using specially designed analysis software. Conclusions. Comparisons of the measured and calculated relative dose distributions showed good overall agreement, with differences of less than 3 mm between measured and calculated isodoses. High resolution BANG gel dosimetry for GKS can be useful for the verification of clinical treatment plans, especially when multiple shots are involved. Further verifications will be done using additional imaging parameters and absolute dose calibrations to improve the method.

The use of a multipurpose phantom for mailed dosimetry checks of therapeutic photon beams: ‘OPERA’ (operational phantom for external radiotherapy audit)

Background and purpose: This study presents a technical description of the solid multipurpose phantom (MPP) ‘OPERA’ (operational phantom for external radiotherapy audit) for mailed dosimetry checks of photon beams in reference and non-reference conditions. The aim is to test the functionality of this phantom by comparing the results provided by the local treatment planning system (TPS) with the measurements by film and thermoluminescence dosimeters (TLDs) in a number of clinical conditions. Material and methods: The polystyrene MPP is constructed to check the following five irradiation conditions: square fields, asymmetrical fields, wedged beams, oblique incidence and influence of inhomogeneities in the field. The absorbed dose on the central beam axis is measured with TLDs for the first three irradiation conditions and the relative dose distributions are verified with film. Results: The ‘OPERA’ phantom and the corresponding instruction sheets were mailed to radiotherapy centres of 12 different countries, in order to verify its functionality. A good agreement between TPS and the film data is found: the mean deviations between relative dose profiles obtained from film and locally applied TPS data range between −1.2 and 0.4%, except for the short side of the asymmetrical field. The standard deviations (SDs) generally increase off-axis, with a large SD on the asymmetrical side. Considering the TLD results, a mean ratio of measured to stated dose of 0.995±0.014 (1 SD), 0.988±0.019 (1 SD) and 0.981±0.024 (1 SD) for set-up 1 (square field), 2 (asymmetrical field) and 3 (wedged field), respectively, has been found. Conclusion: The ‘OPERA’ phantom can be useful for on- and off-axis verification of the TPS, as well as for mailed dosimetrical checks of photon beams in reference and non-reference conditions.

The Gray Lecture 2001: coming technical advances in radiation oncology

Purpose: To review the current limits on the efficacy of radiotherapy (RT) due to technical factors and to assess the potential for major improvements in technology.Methods and Materials: The method of this review was to assess the efficacy of current RT in general terms; strategies for improving RT; historical record of technological advances; rationale for further reductions of treatment volume; and importance of defining and excluding nontarget tissues from the target volume. The basis for the interest in proton beam RT is developed, and the relative dose distributions of intensity-modulated radiotherapy (IMRT) and intensity-modulated proton RT (IMPT) are discussed. The discovery of the proton and the first proposal that protons be used in RT is described. This is followed by a brief mention of the clinical outcome studies of proton RT. Likely technical advances to be integrated into advanced proton RT are considered, specifically, four-dimensional treatment planning and delivery. Finally, the increment in cost of some of these developments is presented.Results: For definitive RT, dose limits are set by the tolerance of normal tissues/structures adjacent or near to the target. Using imaging fusion of CT, MRI, positron emission tomography, magnetic resonance spectroscopic imaging, and other studies will result in improved definition of the target margins. Proton beams are likely to replace photon beams because of their physical characteristics. Namely, for each beam path, the dose deep to the target is zero, across the target it is uniform, and proximal to the target it is less. Proton therapy can use as many beams, beam angles, noncoplanar, and dynamic, as well as static, intensity modulation, as can photon plans. The ability for much greater accuracy in defining the target position in space and then maintaining the target in a constant position in the radiation beam despite target movement between and during dose fractions will be possible. The cost of proton RT will be modestly higher than comparable high technology photon therapy.Conclusion: The technology of RT is clearly experiencing intense and rapid technical developments as pertains to treatment planning and dose delivery. It is predicted that radical dose RT will move to proton beam technology and that the treatment will be four dimensional (the fourth dimension is time). The impact will be higher tumor control probability and reduced frequency and severity of treatment-related morbidity.

Dose distributions for intravascular brachytherapy sources used with balloon catheters

The dose distribution around an intravascular brachytherapy 90Y line source with centering balloon catheters was measured with a plastic scintillator, TLD and radiochromic film. The absolute dose rates measured with the three detectors in a solid water phantom at 1, 2 and 3 mm distance from the centering balloon surfaces are in agreement within 3.5%, when the detectors are calibrated with the same 90Sr/90Y source. The dose rates measured with the plastic scintillator in the solid water phantom are in agreement with those directly measured in water. The measured relative dose distributions can be reproduced by Monte Carlo calculations. Also, the influence of the balloon diameter on the dose rate can be reproduced by the calculations. The dose rate calibration routinely performed with the plastic scintillator was checked for fifty-one sources with a well chamber and with another dedicated dose rate checking device. These measurements show that the consistency of the calibration of these sources was better than 10%. In a previous paper absolute dose rates for five other 90Y sources measured with TLD and radiochromic film in a solid water phantom were compared with those obtained with the plastic scintillator in water [Piessens and Reynaert, "Verification of absolute dose rates for intravascular beta sources," Phys. Med. Biol. 45, 2219-2231 (2000)]. Differences of 25 to 41%, depending on the balloon diameter, were reported. In this paper we show the evidence for three main reasons for these previously observed discrepancies: an inconsistency between a detector calibration performed with a 6 MeV electron beam and with a calibrated 90Sr/90Y source from NIST (16%), inaccuracies of the measuring distances in the solid water phantom (maximum 7.5%) and a time instability of the plastic scintillator, probably due to radiation damage (6%).

Monte Carlo calculations of dosimetry parameters of the Urocor Prostaseed source

This report presents the results of Monte Carlo calculations of the dosimetric parameters of the Urocor ProstaSeed 1251 seed source. This source contains five spherical silver markers, of 0.5 mm diameter, with 1251 deposited on the spheres through ion exchange. The silver spheres are then encapsulated within a 0.8 mm in diameter and 4.5 mm long cylindrical shell of titanium, as is common to this type of sources. Physical dimensions of the source are confirmed by measurement. Four (4) geometric models of the source, based on different assumptions on the locations of the silver spheres within the seed, were used in dose rate calculations. Monte Carlo photon transport simulation was used to calculate the dosimetric parameters of dose rate constant, radial dose function, and anisotropy function using these geometric models of the source. The Monte Carlo calculated dose rate constant of the ProstaSeed source was found equal to 0.925 cGy/Uh with approximate uncertainties of 5%. Radial dose function values and anisotropy function values were derived from the relative dose distribution around the source calculated by the Monte Carlo code. The calculated values of these dosimetric parameters agree with previously published thermoluminescence-dosimeter-measured values for this source after consideration of measurement and calculation uncertainties.

Quality control of the stereotactic radiosurgery procedure with the polymer-gel dosimetry

Purpose: To assess the entire geometric and dosimetric (relative) uncertainties of the radiosurgery procedure with the Leksell gamma knife. Materials and methods: The entire Leksell gamma knife stereotactic radiosurgery treatment procedure was simulated with the use of a special water filled head phantom and polymer-gel dosimeter evaluated by nuclear magnetic resonance (NMR). A test vessel filled with the polymer-gel dosimeter was fixed in the head phantom. The phantom underwent stereotactic NMR imaging, treatment planning and then irradiation according to the treatment plan prepared exactly the same way as in the ordinary treatment procedure for a patient. The treatment plan was represented by one isocenter positioned approximately centrally in the head phantom. This procedure was subsequently repeated for all four collimators (4, 8, 14, 18 mm) used on the Leksell gamma knife. Evaluation of dosimeters was performed on a Siemens EXPERT 1 T NMR scanner. Dose profiles in X, Y and Z axes through the ellipsoidal shaped dose distribution were obtained to compare experimental results from the irradiated phantom with the treatment planning system calculations. Results: Reasonable agreement was observed between the treatment planning system calculations of relative dose distribution and the measured data. The maximum observed deviation in the spatial position between the center of the measured and calculated dose profiles was 0.6 mm. The maximum observed difference in full width of half maximum between calculated and measured profiles was 1.2 mm. Conclusions: The use of polymer-gel dosimetry for a verification of stereotactic procedures has some unique advantages that can be summarized as follows: the dosimeter itself is tissue equivalent, three-dimensional dose distributions can be measured and the dosimeter allows simulation of the patient's procedures without any limitations.

Dosimetric characteristics of the DRAXIMAGE model LS-1 1-125 interstitial brachytherapy source design: a Monte Carlo investigation.

(Received 5 June 2001; accepted for publication 26 December 2001; published 19 March 2002) We have used Monte Carlo photon transport simulations to evaluate dosimetric characteristics of a new 125I seed, the DRAXIMAGE BrachySeed (model LS-1) source for interstitial brachytherapy and to calculate the dosimetric parameters recommended by the AAPM Task Group 43 (TG-43). To eliminate thick end welds, preformed closed-ended Ti shells are welded together near the transverse plane. The radioactivity is localized near the seed ends in order to maximize isotropy at typical prescription distances. Transmission radiography reveals that its internal components can move by as much as 200 microm under the influence of gravitational forces affecting the dose-rate constant and relative dose distribution by as much as 5% and 10%, respectively. However, the clinical dose distribution can be well represented by a weighted average of dose distributions corresponding to three different orientation-dependent internal geometry configurations. This average dose distribution agrees closely (within 1% at 1 cm) with that derived from the geometry specified by the vendor model (seed components uniformly spaced), from which the recommended relative dosimetry parameters were derived. An average dose-rate constant of 0.935 cGy h(-1) U(-1) is recommended for clinical application and values of 0.919, 0.963, and 0.920 for vertical orientation, horizontal orientation, and the vendor specified geometries, respectively. The NIST wide-angle free-air chamber realization of the air-kerma strength primary standard, SKN99, was explicitly simulated. We show that the output of Ag characteristic x rays is about half that of the model 6711 source resulting in a relative dose distribution between that of the model 6711 source and pure 125I x-ray emitters. Finally, it is demonstrated that the TG-43 point-source formalism more accurately estimates solid-angle weighted dose at small distances if one uses a radial dose function data prepared using a point-source, rather than line-source, geometry factor.

Virtual bolus for inversion radiotherapy planning in intensity-modulated radiotherapy of breast carcinoma within the scope of adjuvant therapy

Intensity modulated radiotherapy (IMRT) provides better sparing of normal tissue. We investigated the feasibility of inverse treatment planning for IMRT in adjuvant radiotherapy for breast cancer. In addition to radiotherapy planning in conventional technique with tangential wedged 6-MV-photon beams we performed inversely planned IMRT (KonRad). In the CT scans for treatment planning we defined a 10-mm bolus of -60 HE density. The influence of this bolus on planning optimization was determined by optimization without and dose calculation with and without bolus. Dose calculation after dose optimization with bolus was performed using different bolus thickness to determine the influence of the bolus on dose calculation. The results were compared with dose distribution in conventional technique. Inverse optimization with a dose algorithm which considers tissue inhomogeneity results in unintended dose increase at the patient surface. With a virtual 10-mm bolus used for inverse optimization the dose increase was reduced. Thus, skin sparing was identical to conventional planning. The relative dose distribution was negligibly affected by the use of a 10-mm bolus. Difference in absolute dose was 3.4% compared to calculation without bolus. Therefore, the bolus must be removed before final dose calculation. The realization of inverse optimization for IMRT of the breast requires the use of a virtual bolus. Thereby, IMRT in accordance to the consensus recommendations of the EORTC, BCCG and EUSOMA is possible. Especially, the same target definition as in conventional technique may be used. IMRT techniques with a conventional beam arrangement of two tangential fields or multiple beam techniques can be realized.

Dosimetric verification of a dedicated 3D treatment planning system for episcleral plaque therapy

Purpose: Episcleral plaque therapy (EPT) is applied in the management of some malignant ocular tumors. A customized configuration of typically 4 to 20 radioactive seeds is fixed in a gold plaque, and the plaque is sutured to the scleral surface corresponding to the basis of the intraocular tumor, allowing for a localized radiation dose delivery to the tumor. Minimum target doses as high as 100 Gy are directed at malignant tumor sites close to critical normal tissues (e.g., optic disc and macula). Precise dosimetry is therefore fundamental for judging both the risk for normal tissue toxicity and tumor dose prescription. This paper describes the dosimetric verification of a commercially available dedicated treatment planning system (TPS) for EPT when realistic multiple-seed configurations are applied.Materials and Methods: The TPS Bebig Plaque Simulator is used to plan EPT at our institution. Relative dose distributions in a water phantom, including central axis depth dose and off-axis dose profiles for three different plaques, the University of Southern California (USC) #9 and the Collaborative Ocular Melanoma Study (COMS) 12-mm and 20-mm plaques, were measured with a diode detector. Each plaque was arranged with realistic multiple 125I seed configurations. The measured dose distributions were compared to the corresponding dose profiles calculated with the TPS. All measurements were corrected for the angular sensitivity variation of the diode.Results: Single-seed dose distributions measured with our dosimetry setup agreed with previously published data within 3%. For the three multiple-seed plaque configurations, the measured and calculated dose distributions were in good agreement. For the central axis depth doses, the agreement was within 4%, whereas deviations up to 11% were observed in single points far off-axis.Conclusions: The Bebig Plaque Simulator is a reliable TPS for calculating relative dose distributions around realistic multiple 125I seed configurations in EPT.

Impact of simple tissue inhomogeneity correction algorithms on conformal radiotherapy of lung tumours

Background and purpose: Conformal radiotherapy requires accurate dose calculation at the dose specification point, at other points in the planning target volume (PTV) and in organs at risk. To assess the limitations of treatment planning of lung tumours, errors in dose values, calculated by some simple tissue inhomogeneity correction algorithms available in a number of currently applied treatment planning systems, have been quantified. Materials and methods: Single multileaf collimator-shaped photon beams of 6, 8, 15 and 18 MV nominal energy were used to irradiate a 50 mm diameter spherical solid tumour, simulated by polystyrene, which was located centrally inside lung tissue, simulated by cork. The planned dose distribution was made conformal to the PTV, which was a 15 mm three-dimensional expansion of the tumour. Values of both the absolute dose at the International Commission on Radiation Units and Measurement (ICRU) reference point and relative dose distributions inside the PTV and in the lung were calculated using three inhomogeneity correction algorithms. The algorithms investigated in this study are the pencil beam algorithm with one-dimensional corrections, the modified Batho algorithm and the equivalent path length algorithm. The calculated data were compared with measurements for a simple beam set-up using radiographic film and ionization chambers. Results: For this specific configuration, deviations of up to 3.5% between calculated and measured values of the dose at the ICRU reference point were found. Discrepancies between measured and calculated beam fringe values (distance between the 50 and 90% isodose lines) of up to 14 mm have been observed. The differences in beam fringe and penumbra width (20–80%) increase with increasing beam energy. Our results demonstrate that an underdosage of the PTV up to 20% may occur if calculated dose values are used for treatment planning. The three algorithms predict a considerably higher dose in the lung, both along the central beam axis and in the lateral direction, compared with the actual delivered dose values. Conclusions: The dose at the ICRU reference point of such a tumour in lung geometry is calculated with acceptable accuracy. Differences between calculated and measured dose distributions are primarily due to changes in electron transport in the lung, which are not adequately taken into account by the simple tissue inhomogeneity correction algorithms investigated in this study. Particularly for high photon beam energies, clinically unacceptable errors will be introduced in the choice of field sizes employed for conformal treatments, leading to underdosage of the PTV. In addition, the dose to the lung will be wrongly predicted which may influence the choice of the prescribed dose level in dose-escalation studies.