Sharp Penumbra Research Articles

Unexpected changes of rat cervical spinal cord tolerance caused by inhomogeneous dose distributions

Purpose The effects of dose distribution on dose–effect relationships have been evaluated and, from this, iso-effective doses (ED 50) established. Methods and materials Wistar rats were irradiated on the cervical spinal cord with single doses of unmodulated protons (150 MeV) to obtain sharp lateral penumbras, using the shoot-through technique, which employs the plateau of the depth-dose profile rather than the Bragg peak. Two types of inhomogeneous dose distributions have been administered: (1) 2 4-mm fields with 8- or 12-mm spacing between the center of the fields (referred to as split-field) were irradiated with variable single doses and (2) cervical spinal cord was irradiated with various combinations of relatively low doses to a large volume (20 mm) combined with high doses to a small volume (4 mm) (referred to as bath and shower). The endpoint for estimating the dose–response relationships was paralysis of the fore or hind limbs. Results The split-field experiments (2 × 4 mm) showed a shift in the dose–response curves, giving significant higher ED 50 values of 45.4 Gy and 41.6 Gy for 8- and 12-mm spacing, respectively, compared with the ED 50 of 24.9 Gy for the single 8 mm (same total tissue volume irradiated). These values were closer to the ED 50 for a single 4-mm field of 53.7 Gy. The bath and shower experiments showed a large decrease of the ED 50 values from 15–22 Gy when compared with the 4-mm single field, even with a bath dose as low as 4 Gy. There were no histologic changes found in the low dose bath regions of the spinal cord at postmortem. Conclusions Not only the integral irradiated volume is a determining factor for the ED 50 of rat cervical spinal cord, but also the shape of the dose distribution is of great importance. The high ED 50 values of a small region or shower (4 mm) decreases significantly when the adjacent tissue is irradiated with a subthreshold dose (bath), even as low as 4 Gy. The significant shift to lower ED 50 values for induction of paralysis of the limbs by adding a low-dose bath was not accompanied by changes in histologic lesions. These observations may have implications for the interpretation of complex treatment plans and normal tissue complication probability in intensity-modulated radiotherapy.

A dosimetric comparison of two multileaf collimator designs

We present the results of measurements designed to compare two different multileaf collimator (MLC) designs using a novel evaluation technique. The MLC designs evaluated were: a "single-focused" MLC (SF-MLC) mounted below the jaws, and a "double-focused" MLC, which is a complete replacement for the lower jaws. The ability of each MLC to conform isodose lines to a prescribed field edge (PFE) was evaluated using film dosimetry. Circular fields, centered on axis and off axis, were used because they produce a range of "angles of approach" between the MLC leaves and the PFE. They also have the advantage that for an ideal field shaping system the resulting isodoses are concentric perfect circles, a well-defined basis for evaluation. The amplitude of the oscillations of the 50% isodose line about the PFE and the penumbra width as determined by the 20%, 80%, and 90% isodose lines was examined. We observe that the 50% isodose line oscillates around the PFE with greater amplitude for SF-MLC. We attribute this, at least in part, to the rounded ends of the SF-MLC leaves. However, the SF-MLC has a noticeably sharper penumbra, which we attribute to its position further from the source. We conclude that these results are relevant for accurate dosimetric modeling of these devices.

Matching tomographic IMRT fields with static photon fields.

The matching of abutting radiation fields presents a challenging problem in radiation therapy. Due to sharp penumbra of linear accelerator beams, small (1-2 mm) errors in field positioning can lead to large (>30%) hot or cold spots in the abutment region. With head and neck immobilization devices (thermoplastic mask/aquaplast) an average setup error of 3 mm has been reported. Therefore hot or cold spots approaching 50% of the prescription dose may occur along the matchline. Although abutting radiation fields have been investigated for static fields, there is no reported study regarding matching of tomographic IMRT and static fields. Compared to static fields, the matching of tomographic IMRT fields with static fields is more complicated. Since IMRT and static fields are planned on separate treatment planning computers, the dose in the abutment region is not specified. In addition, commonly used techniques for matching fields, such as feathering of junctions, are not practical. We have developed a method that substantially reduces dose inhomogeneity in the abutment region. In this method, a "buffer zone" around the matchline was created and was included as part of the target for both IMRT and static field plans. In both fields, a small dose gradient (< or =3%/mm) in the buffer zone was created. In the IMRT plan, the buffer zone was divided into three sections with dose varying from 83% to 25% of prescription dose. The static field dose profile was modified using either a specially designed physical (hard) or a dynamic (soft) wedge. When these modified fields were matched, the combined dose in the abutment region varied by < or =10% in the presence of setup errors spanning 4 mm (+/-2 mm) when the hard wedge was used and 10 mm (+/-5 mm) with the soft wedge.

Mixing intensity modulated electron and photon beams: combining a steep dose fall-off at depth with sharp and depth-independent penumbras and flat beam profiles

For application in radiotherapy, intensity modulated high-energy electron and photon beams were mixed to create dose distributions that feature: (a) a steep dose fall-off at larger depths, similar to pure electron beams, (b) flat beam profiles and sharp and depth-independent beam penumbras, as in photon beams, and (c) a selectable skin dose that is lower than for pure electron beams. To determine the required electron and photon beam fluence profiles, an inverse treatment planning algorithm was used. Mixed beams were realized at a MM50 racetrack microtron (Scanditronix Medical AB, Sweden), and evaluated by the dose distributions measured in a water phantom. The multileaf collimator of the MM50 was used in a static mode to shape overlapping electron beam segments, and the dynamic multileaf collimation mode was used to realize the intensity modulated photon beam profiles. Examples of mixed beams were generated at electron energies of up to 40 MeV. The intensity modulated electron beam component consists of two overlapping concentric fields with optimized field sizes, yielding broad, fairly depth-independent overall beam penumbras. The matched intensity modulated photon beam component has high fluence peaks at the field edges to sharpen this penumbra. The combination of the electron and the photon beams yields dose distributions with the characteristics (a)-(c) mentioned above.

Performance and beam characteristics of the Siemens Primus linear accelerator.

Siemens Primus is a small footprint, klystron driven medical linear accelerator incorporating a compact solid state modulator. A double focused multileaf collimator (MLC) replaces the lower jaw. The first Primus in the world was installed at St. Jude Children's Research Hospital in early 1997 with x-ray energies of 6 and 15 MV and electron energies of 8, 10, 12, 15, 18, and 21 MeV. The 10 cm depth dose for a 100 cm SSD 10 X 10 cm2 beam is 68% and 77% for 6 and 15 MV x rays, respectively. For both x-ray energies, beam flatness is slightly better than the manufacturers specification of 3% and beam symmetry is considerably better than 1%. The double focus design of the MLC produces a sharp penumbra (5-7 mm at 6 MV and 6-8 mm at 15 MV), increasing modestly with beam size. MLC leaf leakage is less than 1.25%. The depths of the 80% depth dose for the six electron energies of 8, 10, 12, 15, 18, and 21 MeV are 2.6, 3.2, 4.0, 4.9, 6.0, and 7.4 cm, respectively. Beam flatness is typically 2%-3% for all electron energies except 21 MeV, where it reaches 4% for a 25 X 25 cm2 cone. Electron beam symmetry is better than 1% for all energies except 21 MeV, where it is equal to 1%. The results are stored electronically and may be retrieved using anonymous ftp from the American Institute of Physics, Physics Auxiliary Publication Service.

Exploration of new treatment modalities offered by high energy (up to 50 MeV) electrons and photons

Background and purpose: A number of deep seated tumours are difficult to treat conformally with photon beams mainly due to the almost exponential dose decrease with depth. Materials and methods: In order to improve the conformity of these treatments a number of useful characteristics of high energy (above 20 MeV) electron beams of the MM50 Racetrack Microtron have been systematically investigated and clinically applied. Results: A typical characteristic of electron beams with energies up to 20 MeV is the sharp dose fall-off with depth. At higher energies this effect is less pronounced but may be improved by adding a small fraction of photons with a matching dose gradient (wedge). With this technique, high energy electrons can be used close to sensitive organs down to 17 cm depth. Another physical characteristic of high energy electrons is the sharp penumbra at depths down to 4–5 cm and the possibility to use opposed electron beams in order to enhance the dose centrally or near the centre of a body. Skin sparing by delivering a part of the absorbed dose with photons through the same beam portal as the electrons has also been systematically studied. These characteristics of the high-energy electron beams have been utilised in the optimisation of some clinical treatments. Conclusions: Electron beams in this high energy region give increased possibilities to achieve dose conformity. Enhanced conformity can be obtained especially if electrons and photons are combined to augment some specific characteristics of the electron beams.

A pencil beam algorithm for proton dose calculations

The sharp lateral penumbra and the rapid fall-off of dose at the end of range of a proton beam are among the major advantages of proton radiation therapy. These beam characteristics depend on the position and characteristics of upstream beam-modifying devices such as apertures and compensating boluses. The extent of separation, if any, between these beam-modifying devices and the patient is particularly critical in this respect. We have developed a pencil beam algorithm for proton dose calculations which takes accurate account of the effects of materials upstream of the patient and of the air gap between them and the patient. The model includes a new approach to picking the locations of the pencil beams so as to more accurately model the penumbra and to more effectively account for the multiple-scattering effects of the media around the point of interest. We also present a faster broad-beam version of the algorithm which gives a reasonably accurate penumbra. Predictions of the algorithm and results from experiments performed in a large-field proton beam are presented. In general the algorithm agrees well with the measurements.

Applicator for optimum cobalt-60 primary breast treatments

A breast applicator has been designed to optimize 3 field breast treatments for 60Co. The device has a six half value layer beam splitting block constructed in two sections. The larger permanently mounted section is sufficient for treating 90% of the patients. Slots are available for mounting cerroband blocks, and any of five brass half field wedges. A magnetically attached front and back-pointer assembly readily breaks away in the event of a collision between pointer and patient. With this design the breast applicator with wedges and blocks has in-field surface doses reduced to that of an open field without accessory devices. The 50–90% dose decrement of the radiation penumbra for the half field block is comparable to that for the field edge of a typical 6 MV X ray unit, although the 10%–50 decrement is larger. The average out-of-field dose at the surface is 8% and is 5% at the depth of dose maximum. The combination for this applicator of sharp penumbra and low out-of-field dose leads to reduced lung and opposite breast doses. The latter was confirmed with TLD measurements on 10 patients, and yielded an average opposite breast dose of 230 cGy for a 4600 cGy prescription. Thus, half-field blocking devices do not preclude, as has been stated in the literature, acceptable opposite breast doses. In addition, proper design of these devices can significantly improve the radiation characteristics for primary breast treatments.

Proton beam penumbra: effects of separation between patient and beam modifying devices.

The sharp lateral penumbra of a proton beam is often used to spare sensitive normal structures in treating clinical sites in which the target volume abuts, or even wraps around, these structures. Using Monte Carlo calculations and measurements, the factors which influence the penumbra of the proton beam at the Harvard Cyclotron Laboratory were investigated, with particular emphasis on the effects of separation between the patient and any beam modifying devices. Penumbra broadening, characterized by the distance over which the dose rises from 20% to 80% of the central dose, increases with greater amounts of scatterer introduced into the beam line. The broadening due to separation of the beam modifying devices and the patient is essentially linear with increasing air gap; the rate of increase depends on the details of these devices and on the depth of interest in the patient. For a particular portal, most of the parameters which affect the penumbra width are fixed by the patient's anatomy and the target volume. Only the thickness of the compensating bolus around the aperture edge and any air gap between the patient and the beam modifying devices can vary. Families of curves relating combinations of bolus thickness and air gap that maintain a constant penumbra width have been developed for guidelines during patient setup.

Precision, high dose radiotherapy. II. Helium ion treatment of tumors adjacent to critical central nervous system structures

In this paper we present a technique for treating relatively small, low grade tumors located very close to critical, radiation sensitive central nervous system structures such as the spinal cord and the brain stem. A beam of helium ions is used to irradiate the tumor. The nearby normal tissues are protected by exploiting the superb dose localization properties of this beam, particularly its well defined and controllable range in tissue, the increased dose deposited near the end of this range (i.e., the Bragg peak), the sharp decrease in dose beyond the Bragg peak, and the sharp penumbra of the beam. To execute this type of treatment, extreme care must be taken in localization of the tumor and normal tissues, as well as in treatment planning and dosimetry, patient immobilization, and verification of treatment delivery. To illustrate the technique, we present a group of 19 patients treated for chordomas, meningiomas and low grade chondrosarcomas in the base of the skull or spinal column. We have been able to deliver high, uniform doses to the target volumes (doses equivalent to 60 to 80 Gy of cobalt-60) while keeping the doses to the nearby critical tissues below the threshold for radiation damage. Follow-up on this group of patients is short, averaging 22 months (2 to 75 months). Currently, 15 patients have local control of their tumor. Two major complications, a spinal cord transection and optic tract damage, are discussed in detail. Our treatment policies have been modified to minimize the risk of these complications in the future, and we are continuing to use this method to treat such patients. We are enthusiastic about this technique, since we believe there is no other potentially curative treatment for these patients.

Clinical use of a match-line wedge for adjacent megavoltage radiation field matching

The divergence and sharp penumbra of linear accelerator beams pose notorious problems when joining such beams side by side. One way of reducing the dose distribution nonuniformity in the matching region is to create a wide pseudo-penumbra with the use of a “match-line wedge.” A single match-line wedge shape has been developed for 6 MV and 10 MV photon beams. The wide pseudo-penumbra created by the wedge drastically reduces the effect of random set-up errors. Special attention has been paid to ensure simple and reliable clinical use of the wedge. Details of the design, construction, dosimetry, and rules of practical application are presented. Comparisons of several matching methods are made.

Alfvén waves and the sunspot phenomenon

Parker's explanation of the sunspot phenomenon in terms of the enhanced emission of Alfven waves (solar vulcanology) is shown to be compatible with observation only if ∼ 90% of the waves propagate downwards. Further difficulties arise if the region of cooling by Alfven wave generation is restricted to a depth of 2 Mm. However, it is shown that, if Alfven wave generation is included in a recent model proposed by Meyer, Schmidt, Weiss and Wilson, these difficulties may be resolved. The problem of the sharp umbra and penumbra boundaries is discussed and it is shown that features of this combined model are relevant to the flare phenomenon.

Structure of a sunspot

From enlargements of patrol photographs of the disk passage of the sunspot of July 20 – August 2, 1966, intensity profiles across the spot are obtained at several positions near the disk-center and at each limb. It is found that these profiles show asymmetric features near each limb (increasingly sharp limb-side penumbra and poorly resolved disk-side penumbra) which are similar to those reported in Paper III of this series. It is suggested that these profile asymmetries are the essential feature of the center-limb variations in the appearance of a sunspot which have become known as the Wilson effect.

The 4 MeV linear accelerator at Newcastle upon Tyne.

An account, based on four years operation, is given of the first of the 4 MeV linear accelerators (Mullard) installed for medical use. Its “isocentric” mounting in conjunction with the specially designed single-pillar couch makes for rapid and accurate setting up of patients and it may be used for fixed or moving field therapy. The X-ray output is up to 250 r/minute at 100 cm F.S.D. and 400 p.p.s.; the H.V.L. 15·9 mm Cu. A sharp penumbra is obtained through the small focal spot and the use of beam defining diaphragms pivoted at target level. Central axis dosage measurements give a build-up peak at 1 cm depth in water and the dose at 10 cm depth for a 10 × 10 cm field is 62·8 per cent. The surface dose for this same size field is 17 per cent, largely due to secondary electrons from the air. Isodose curves were obtained by direct measurement and also by calculation from the central axis data and some typical curves for oblique fields, fields applied to curved surfaces and wedge fields are also given. The lo...