Source-to-surface Distance Research Articles

소아백혈병의 전신방사선조사시 선량평가

Total body irradiation in the treatment of childhood leukemia, which is one of the pre-treatment with stem cell transplantation is being used, the current organization using compensators are treated. However, under the terms of the compensator organization long-term impact on the human body, it is difficult to assess directly. In this study, we use the mathematical simulation of radiation exposures body energy and the distance to the crew and the patient (source surface distance, SSD), and patients with tissue compensators change of the distance along the body of the organ doses were evaluated. As a result, the surface dose of energy 4 MV, SSD 280 cm, tissue compensators and the patient when the distance 30 cm 5.84 G / min showed the highest levels. In addition, patients with tissue compensators and the distance apart when 30 cm TBI represents the ideal dose distribution was found.

SU-E-T-541: An Optimum Normalization Technique for Electron Monte Carlo Treatment Planning

Purpose: To evaluate the optimum normalization technique using the treatment planning system (TPS) to calculate dose with Electron Monte Carlo (eMC) algorithms. Methods: Eclipse TPS was used to generate 6 and 9 MeV plans for field apertures ranging from 3 cm to 10 cm, calculation grid sizes from 1 mm to 5mm, source to surface distance (SSD) from 100 to 110, and beam incident angles from 0 to 30 degrees. Each plan was normalized to the (1) TPS global maximum and (2) the physical dmax depth on the central axis given by measured percent depth dose (PDD) data. To validate the eMC relative dose distributions, PDD and beam profiles (at dmax) were obtained in a water phantom. An irregular surface phantom and a small domed phantom were constructed for dose measurements. Results: In all cases, the TPS' PDD agreed with the measured PDD within 2.5 % beyond a depth of 0.5cm. Absolute dose measurements on the irregular surface and domed phantoms also agreed with an average difference of 2.5%. Normalizing to the physical dmax on the central axis resulted in MUs up to 10% higher than normalizing to TPS global maximum. This was due to the eMC dmax shifting as much as 6mm shallower in depth, or shifting away from the central axis vary based on field apertures and beam angle incidences. MU calculations based on tabular data from beam commissioning differed from measured by 11.1% on average when oblique angles and cutouts were used. The tabulated data are based on measurements performed in a flat phantom with no beam obliquity. Conclusion: The planned MUs using the global maximum are more closely matched with the measured values as compared with MUs generated from tabulated data. Thus, the TPS generated MUs should more accurately reflect dose delivered for patient treatments.

Dosimetric properties of an amorphous silicon EPID for verification of modulated electron radiotherapy

To investigate the dosimetric properties of an electronic portal imaging device (EPID) for electron beam detection and to evaluate its potential for quality assurance (QA) of modulated electron radiotherapy (MERT). A commercially available EPID was used to detect electron beams shaped by a photon multileaf collimator (MLC) at a source-surface distance of 70 cm. The fundamental dosimetric properties such as reproducibility, dose linearity, field size response, energy response, and saturation were investigated for electron beams. A new method to acquire the flood-field for the EPID calibration was tested. For validation purpose, profiles of open fields and various MLC fields (square and irregular) were measured with a diode in water and compared to the EPID measurements. Finally, in order to use the EPID for QA of MERT delivery, a method was developed to reconstruct EPID two-dimensional (2D) dose distributions in a water-equivalent depth of 1.5 cm. Comparisons were performed with film measurement for static and dynamic monoenergy fields as well as for multienergy fields composed by several segments of different electron energies. The advantageous EPID dosimetric properties already known for photons as reproducibility, linearity with dose, and dose rate were found to be identical for electron detection. The flood-field calibration method was proven to be effective and the EPID was capable to accurately reproduce the dose measured in water at 1.0 cm depth for 6 MeV, 1.3 cm for 9 MeV, and 1.5 cm for 12, 15, and 18 MeV. The deviations between the output factors measured with EPID and in water at these depths were within ±1.2% for all the energies with a mean deviation of 0.1%. The average gamma pass rate (criteria: 1.5%, 1.5 mm) for profile comparison between EPID and measurements in water was better than 99% for all the energies considered in this study. When comparing the reconstructed EPID 2D dose distributions at 1.5 cm depth to film measurements, the gamma pass rate (criteria: 2%, 2 mm) was better than 97% for all the tested cases. This study demonstrates the high potential of the EPID for electron dosimetry, and in particular, confirms the possibility to use it as an efficient verification tool for MERT delivery.

Dosimetric effects of weight loss or gain during volumetric modulated arc therapy and intensity-modulated radiation therapy for prostate cancer

Weight loss or gain during the course of radiation therapy for prostate cancer can alter the planned dose to the target volumes and critical organs. Typically, source-to-surface distance (SSD) measurements are documented by therapists on a weekly basis to ensure that patients' exterior surface and isocenter-to-skin surface distances remain stable. The radiation oncology team then determines whether the patient has undergone a physical change sufficient to require a new treatment plan. The effect of weight change (SSD increase or decrease) on intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) dosimetry is not well known, and it is unclear when rescanning or replanning is needed. The purpose of this study was to determine the effects of weight change (SSD increase or decrease) on IMRT or VMAT dose delivery in patients with prostate cancer and to determine the SSD change threshold for replanning. Whether IMRT or VMAT provides better dose stability under weight change conditions was also determined. We generated clinical IMRT and VMAT prostate and seminal vesicle treatment plans for varying SSDs for 10 randomly selected patients with prostate cancer. The differences due to SSD change were quantified by a specific dose change for a specified volume of interest. The target mean dose, decreased or increased by 2.9% per 1-cm SSD decrease or increase in IMRT and by 3.6% in VMAT. If the SSD deviation is more than 1cm, the radiation oncology team should determine whether to continue treatment without modifications, to adjust monitor units, or to resimulate and replan.

Underestimation of dose delivery in preclinical irradiation due to scattering conditions

The aim of this study was to evaluate, by comparing simulation results with measurement results, the impact of the lack of scattering volume in experimental conditions of preclinical irradiation. First, a Monte Carlo model of a small animal irradiator, the Faxitron CP-160, was developed with GATE (Geant4 Application for Tomography Emission). To validate the model, simulated data were compared to depth dose and off-axis ratio profiles measured with a plane-parallel ionization chamber and Gafchromic® EBT films, respectively, in a solid water phantom. The AAPM TG-61 protocol was applied to measure the dose rate at the surface of a semi-infinite reference phantom. Then, the model was used to determine the dose distributions in three different phantom settings: a semi-infinite water phantom, a 2.8-cm-thick water phantom and a 2.8-cm-diameter cylindrical water phantom. The dose distributions measured and simulated with Monte Carlo methods in a semi-infinite water phantom were similar (<2%), thus validating our Monte Carlo model. The highest dose underestimation was observed between the reference and the cylindrical phantom (more than 15% difference for the entrance dose) and was due to the lack of lateral scatter and backscatter. The use of standard backscatter factors and AAPM TG-61 protocol may result in a significant underestimation of the dose absorbed by small irradiated phantoms, such as mice or cells, in preclinical studies. Background: For preclinical radiotherapy studies, radiobiologists were used to determine the irradiation time depending only on the source surface distance. This work aimed to demonstrate that scatter conditions have a large impact on dose rate. Measurements and Monte Carlo simulations were used.

Monte Carlo investigation of the effect of small cutouts on beam profile parameters of 12 and 14 MeV electron beams

Cutouts, which are used as field-shaping shield, affect several electron beam parameters. These effects are more observable for small field sizes and high energy electron beams. Owing to the fact that small fields prevent the lateral scatter equilibrium, at higher energies larger field radius is required for the establishment of lateral equilibrium. The profile curves are derived from circular, triangular, and square cutout shapes and size placed in a 10 × 10 cm 2 electron applicator. These profile curves are obtained using parallel plane type ion chamber at the R 100 , R 90 , R 80 and R 50 depths. Correspondingly, the source surface distance is 100 cm. In this study MCNP Monte Carlo (MC) simulation was used to compare Percentage Depth Dose (PDD) and Profile of electron beams. Monte Carlo and measured results showed a good compliance for PDD and beam profile. The measurements and calculations showed that as the field width decreases, the Flatness and Penumbra Ratio also decreases. In other words, flatter plateau was available for larger fields. Also the Coverage Ratio for each of the profiles is presented. The flatness and symmetry values for triangle shapes were greater than the two other shapes. Knowledge of these changes are significant in radiation therapy. Accordingly, a comparison between the Monte Carlo data and the measured results can be beneficial for treatment simulation and development of treatment planning systems. ► Mesh Tally 1 and pedep keyword were used to calculate the PDD and profile values. ► In measurement the coverage for larger fields and fewer doses are better. ► By increasing the depth, the flatness and symmetry values were increased. ► The worst flatness and symmetry (between 3 compared shapes) belonged to triangle. ► The given Penumbra and Coverage Ratio can be helpful for PTV margin and coverage.

Dosimetric Consistency of Co-60 Teletherapy Unit : A Ten Years Study

The goal of the Radiation standards and Dosimetry is to ensure that the output of the Teletherapy Unit is within ±2% of the stated one and the output of the treatment dose calculation methods are within ±5%. In the present paper, we studied the dosimetry of Cobalt-60 (Co-60) Teletherapy unit at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) for last 10 years. Radioactivity is the phenomenon of disintegration of unstable nuclides called radionuclides. Among these radionuclides, Cobalt-60, incorporated in Telecobalt Unit, is commonly used in therapeutic treatment of cancer. Cobalt-60 being unstable decays continuously into Ni-60 with half life of 5.27 years thereby resulting in the decrease in its activity, hence dose rate (output). It is, therefore, mandatory to measure the dose rate of the Cobalt-60 source regularly so that the patient receives the same dose every time as prescribed by the radiation oncologist. The under dosage may lead to unsatisfactory treatment of cancer and over dosage may cause radiation hazards. Our study emphasizes the consistency between actual output and output obtained using decay method. The methodology involved in the present study is the calculations of actual dose rate of Co-60 Teletherapy Unit by two techniques i.e. Source to Surface Distance (SSD) and Source to Axis Distance (SAD), used for the External Beam Radiotherapy, of various cancers, using the standard methods. Thereby, a year wise comparison has been made between average actual dosimetric output (dose rate) and the average expected output values (obtained by using decay method for Co-60.). The present study shows that there is a consistency in the average output (dose rate) obtained by the actual dosimetry values and the expected output values obtained using decay method. The values obtained by actual dosimetry are within ±2% of the expected values. The results thus obtained in a year wise comparison of average output by actual dosimetry done regularly as a part of Quality Assurance of the Telecobalt Radiotherapy Unit and its deviation from the expected output data is within the permissible limits. Thus our study shows a trend towards uniformity and a better dose delivery.

Dosimetric aspects of inverse‐planned modulated‐arc total‐body irradiation

To develop optimal beam parameters and to verify the dosimetric aspects of the recently developed modulated-arc total-body irradiation (MATBI) technique, which delivers an inverse-planned dose to the entire body using gantry rotation. The patient is positioned prone and supine underneath the gantry at about 2 m source-to-surface distance (SSD). Then, up to 28 beams irradiate the patient from different gantry angles. Based on full-body computed-tomography (CT) images of the patient, the weight of each beam is optimized, using inverse planning, to create a uniform body dose. This study investigates how to best simulate patients and the ideal beam setup parameters, such as field size, number of beams, and beam geometry, for treatment time and dose homogeneity. In addition, three anthropomorphic water phantoms were constructed and utilized to verify the accuracy of dose delivery, with both diode array and ion chamber measurements. Furthermore, to improve the accuracy of the new technique, a beam model is created specifically for the extended-SSD positioning for MATBI. Low dose CT scans can be utilized for dose calculations without affecting the accuracy. The largest field size of 40 × 40 cm(2) was found to deliver the most uniform dose in the least amount of time. Moreover, a higher number of beams improves dose homogeneity. The average dose discrepancy between ion chamber measurements and extended-SSD beam model calculations was 1.2%, with the largest discrepancy being 3.2%. This average dose discrepancy was 1.4% with the standard beam model for delivery at isocenter. The optimum beam setup parameters, regarding dose uniformity and treatment duration, are laid out for modulated-arc TBI. In addition, the presented dose measurements show that these treatments can be delivered accurately. These measurements also indicated that a new beam model did not significantly improve the accuracy of dose calculations. The optimum beam setup parameters along with the measurements performed to ensure accurate dose delivery serve as a useful guide for the clinical implementation of MATBI.

Monte Carlo computed machine-specific correction factors for reference dosimetry of TomoTherapy static beam for several ion chambers

To determine k(Q(msr),Q(o) ) (f(msr),f(o) ) correction factors for machine-specific reference (msr) conditions by Monte Carlo (MC) simulations for reference dosimetry of TomoTherapy static beams for ion chambers Exradin A1SL, A12; PTW 30006, 31010 Semiflex, 31014 PinPoint, 31018 microLion; NE 2571. For the calibration of TomoTherapy units, reference conditions specified in current codes of practice like IAEA∕TRS-398 and AAPM∕TG-51 cannot be realized. To cope with this issue, Alfonso et al. [Med. Phys. 35, 5179-5186 (2008)] described a new formalism introducing msr factors k(Q(msr),Q(o) ) (f(msr),f(o) ) for reference dosimetry, applicable to static TomoTherapy beams. In this study, those factors were computed directly using MC simulations for Q(0) corresponding to a simplified (60)Co beam in TRS-398 reference conditions (at 10 cm depth). The msr conditions were a 10 × 5 cm(2) TomoTherapy beam, source-surface distance of 85 cm and 10 cm depth. The chambers were modeled according to technical drawings using the egs++ package and the MC simulations were run with the egs_chamber user code. Phase-space files used as the source input were produced using PENELOPE after simulation of a simplified (60)Co beam and the TomoTherapy treatment head modeled according to technical drawings. Correlated sampling, intermediate phase-space storage, and photon cross-section enhancement variance reduction techniques were used. The simulations were stopped when the combined standard uncertainty was below 0.2%. Computed k(Q(msr),Q(o) ) (f(msr),f(o) ) values were all close to one, in a range from 0.991 for the PinPoint chamber to 1.000 for the Exradin A12 with a statistical uncertainty below 0.2%. Considering a beam quality Q defined as the TPR(20,10) for a 6 MV Elekta photon beam (0.661), the additional correction k(Q(msr,)Q) (f(msr,)f(ref) ) to k(Q,Q(o) ) defined in Alfonso et al. [Med. Phys. 35, 5179-5186 (2008)] formalism was in a range from 0.997 to 1.004. The MC computed factors in this study are in agreement with measured factors for chamber types already studied in literature. This work provides msr correction factors for additional chambers used in reference dosimetry. All of them were close to one (within 1%).

SU-E-T-143: Effect of Physical and Virtual Wedges on the Surface Dose at Various SSD for 6 and 15 MV Photon Beam.

To study the effect of the virtual wedge and physical wedge filters on the surface and build-up region doses for 6 and 15MV high-energy photon beams for different field sizes and various source to surface distance(SSD). The measurements were made in water equivalent (PMMA) solid phantom in the build-up region at various SSD for various field sizes using virtual and physical wedge filters having different angles. A parallel-plate ion chamber (Markus) was used to measure the percent depth doses at surface and buildup region. Plane parallel ion chamber with fixed plate separation on the surface and buildup region would perturbate the dose measured, to get the proper dose over response correction factor was used. The percentage depth dose at surface (PDD0) increased as the field size increased for open, virtual, and physical wedged beams. For open, 30 degree physical, and virtual wedged beams, the surface doses were found to be 15.4%, 11.2%, and 15.2% with 6-MV photons and 11.2%, 9.4%, 11.2% with 15-MV photons, respectively, at 10 × 10 cm2 field size at 100cm SSD.As SSD increases percentage depth dose at surface (PDD0) decreases for open,physical and virtual wedge field. Percentage depth dose at surface (PDD0) of virtual wedged beams were similar to those of open beams. PDD0 of physical wedged beams were lower than those of open and virtual wedged beams. Surface doses for both PW and VW increases with field size and small increase in surface dose for both PW and VW fields as wedge angle increases especially for large fields.

SU-E-J-75: Practical Annual Quality Assurance Program for a Real Time Optical Tracking System.

To verify the accuracy of a real time optical surface tracking system using a practical annual quality assurance program with an anthropomorphic breast phantom. An anthropomorphic breast phantom was used to determine the accuracy of registration, shift, source to surface distance (SSD), and live monitoring features of the AlignRT system. Both the two and three camera AlignRT systems were tested. Registration and shift accuracy were evaluated by comparing software output with known phantom displacements and rotations at 0, 90, and 270 couch angles. These tests were performed in static capture and live monitoring modes. SSD accuracy was determined by comparing AlignRT results with expected values from the treatment planning system and optical distance indicator at 0, 90, and 270 degree couch rotations. For the two camera system, registration accuracy at 0, 90, and 270 degree couch angles was within 1.0mm in the lateral, longitudinal, and vertical directions and 0.04 degree. For shifts of +/-10mm and +/-5 degree, static mode shift accuracy was within 1.6mm and 0.23 degree. Registration accuracy of the shifted phantom in live monitoring mode was within 1.7mm and 0.2 degree. For the three camera system, registration accuracy at 0, 90, and 270 degree couch angles was within 1.1 mm in the lateral, longitudinal, and vertical directions and 0.2 degree. For shifts of +/-10mm and +/-5 degree, static mode shift accuracy was within 0.9mm and 0.2 degree. Registration accuracy of the shifted phantom in live monitoring mode was within 1.1mm and 0.2 degree. SSD determination was accurate to within 2mm for both systems and modes. The AlignRT system accuracy can be easily verified for annual quality assurance using a realistic clinical setup to within 2mm/0.5 degree. System accuracy was comparable for both two and three camera systems in static and live monitoring modes.

SU-E-T-145: MRI Gel Dosimetry Applied to Dose Profile Determination for 50kV X-Ray Tube.

The aim of this study was to use MRI gel dosimetry to determine the dose profile of 50kV MAGNUM® X-ray tube, MOXTEK Inc., in order to calibrate small solid dosimeters of alanine, tooth enamel and LiF-TLDs, commonly used in clinical quality assurance and datation dosimetry. MAGIC-f polymer gel was kept in two plastic containers of 100mL, avoiding attenuation of the primary beam trough the wall. Beam aberture of 3mm and dose rate of 16.5Gy/min were set, reproducing irradiation conditions of interest. The dose rate was assumed based on data of the vendor information of the tube and dose of 30Gy was delivered at the surface of the gel. MAGIC-f gel was irradiated at source-surface distances(SSD) of 0.1cm and 1.0cm. After 24hours of irradiation, gel was scanned in an Achieva® 3T Philips® MRI tomography using relaxometry sequence with 32 Echos, Time-to-Echo(TE) of 15.0ms, Time-to-Repetition(TR) of 6000ms and Field-of-View(FOV) of 0.5×0.5×2.0mm. Dose map at the central plain of irradiation was calculated from T2 relaxometry map. The gel dosimetry results evidenced a build-up depth of 0.13cm for SSD=0.1cm and no build-up was detected for SSD=1.0cm. However, the dose profile evidenced high gradient of dose in SSD=0.1, decreasing the dose from 100% to 30% in 1.4cm depth inside the gel; In turn, the dose distribution is homogeneous after 0.4cm deth for SSD=1.0cm. MRI gel dosimetry using MAGIC-f presented as feasible technique to determine dose profiles for kilovoltage x-rays tubes. The results evidenced that the calibration of small solid dosimeters can be performed using SSD of 1.0cm in the 50kV MAGNUM® X-ray tube using 0.4cm/g/cm3 filter. This work was funded supported by CNPQ, CAPES and FAPESP.

SU-E-T-147: Film Dosimetry Verification for TSE Using An Epson Scanner.

To commission and verify an Epson scanner for film dosimetry for total skin electron beam therapy (TSEB). Use data from an IBA PPC40 parallel-plate ion chamber and Sun Nuclear QED skin diode detectors as standard; we have made comparisons to the film measurement using Kodak XV films. Hurter-Driffield (HD) curve are established for 6 MeV total skin electron beams at a source-to-surface distance (SSD) of 5 m. Also HD curves are built for 6 MeV at a 100 cm SSD. Dose profiles for a series of oblique incident large electron fields are measured using the film for approximately 80 cGy dose delivered at the peak. The film is then scanned using two scanners, an Epson expression 10000 XL and a Vidar VXR-16 Dosimetry Pro. The optimal scanning conditions (e.g., dot per pixel size, internal color correction scheme) are chosen for the Epson scanner. Matlab is then used to analyze the optical density (OD) of the scanned films. A transmission densitometer made by Tobias Associates transmission is used to analyze the films to give a classical standard. The analysis of the Epson scanner is presented in two forms: one with and one without the HD correction from the established HD curve. The error analysis gives an uncertainty of 5% without the HD correction. An improved result of approximately 3% is found when an HD correction is applied to the analysis. A simple Epson scanner satisfies the commissioning standards for TSEB when an HD curve correction is applied.

SU‐E‐T‐274: Monte Carlo Simulations of Output Factors for a Small Animal Irradiator

Measurement of dosimetric parameters of small photon beams, with field sizes as small 1 mm in diameter, is particularly challenging. This work utilizes Monte Carlo techniques to calculate percent depth dose (PDD) and output factors for small photon fields from a kV x-ray based small animal irradiator. Absolute dose calibration of a commercial small animal stereotactic irradiator (XRAD225, Precision X-ray) was performed in accordance with the recommendations of AAPM TG-61 protocol. Both in-air and in-water calibrations were performed at a 30.4 cm source-to-surface distance (SSD) for a reference collimator 50 mm in diameter. The BEAM/EGS was used to model 225 kV photon beams used for most therapeutic applications. The Monte Carlo model was provided good agreement with measured beam characteristics, e.g. PDD and off-axis ratios. Subsequently, output factors for various square and circular applicators were measured using an ionization chamber and radiochromic film, and compared with MC simulations. Directional Bremsstrahlung splitting (DBS) was utilized for variance reduction to improve efficiency of the output factor simulations. The statistical uncertainty on the MC- calculated results is between 0.5% and 1% for most points. The absolute dose measured for reference collimator at 30.4 cm SSD in water and in air is 4.1 and 4.12 Gy/min. The agreement between simulated and measured output factors was excellent, ranging from 1% to 2.84%. The MC- simulated and measured depth dose data, normalized at the surface, show excellent agreement, with a maximum deviation is approximately 2.5 %. Monte Carlo simulation provides an indispensible tool for validating measurements of the smallest field sizes used in preclinical small animal irradiation.

TH‐C‐BRB‐02: Dosimetric Analysis of Inverse‐Planned Modulated‐Arc Total‐Body Irradiation

Purpose: To determine the key dosimetric characteristics of a newly developed and clinically implemented inverse‐planned modulated‐arc total‐body irradiation (MATBI) technique, including optimal treatment beam parameters, a redefined beam model, and patient‐specific quality assurance (QA). Methods: During MATBI treatment, the patient is positioned prone and supine underneath the gantry at 2 m source‐to‐surface distance (SSD). The dose is delivered using open‐field beams at different gantry angles. Monitor units per beam are inverse‐planned through beam‐weight optimization based on the patient's anatomy from full‐body computed tomography (CT) images. Beam output characteristics were measured at extended SSD and a new beam model was commissioned. Delivery time and dose uniformity were studied vs. beam field size and geometry. Dose delivery accuracy was determined by comparing ion chamber measurements inside anthropomorphic water phantoms to planning system predictions. A phantom with Gaf‐Chromic film inserts was designed for clinical use to streamline patient‐specific QA. Results: MATBI was used on 17 patients so far. The best dose uniformity and shortest delivery time were achieved for a beam field size of 40×40 cm2 at isocenter with 5° step size between adjacent beams, using 16 to 28 beams per side depending on patient size. Compared to the original beam model, the new beam model improved the dose delivery accuracy by a fraction of a percent to 1.2%. The largest discrepancy between measurement and prediction was 3.2%. The patient‐specific QA procedure showed that QA with a 5% tolerance limit could be routinely performed. Conclusions: The new inverse‐planned MATBI technique permits dose optimization, dose‐volume histogram calculation and dosimetric analysis. MATBI beam setup parameters for optimal dose uniformity and treatment duration were determined. The developed phantom allows for a patient‐specific quality assurance procedure, which is now used routinely. These results are the basis for the safe and accurate clinical implementation of MATBI. Work supported by Siemens.

An athymic rat model of cutaneous radiation injury designed to study human tissue-based wound therapy.

PurposeTo describe a pilot study for a novel preclinical model used to test human tissue-based therapies in the setting of cutaneous radiation injury.MethodsA protocol was designed to irradiate the skin of athymic rats while sparing the body and internal organs by utilizing a non-occlusive skin clamp along with an x-ray image guided stereotactic irradiator. Each rat was irradiated both on the right and the left flank with a circular field at a 20 cm source-to-surface distance (SSD). Single fractions of 30.4 Gy, 41.5 Gy, 52.6 Gy, 65.5 Gy, and 76.5 Gy were applied in a dose-finding trial. Eight additional wounds were created using the 41.5 Gy dose level. Each wound was photographed and the percentage of the irradiated area ulcerated at given time points was analyzed using ImageJ software.ResultsNo systemic or lethal sequelae occurred in any animals, and all irradiated skin areas in the multi-dose trial underwent ulceration. Greater than 60% of skin within each irradiated zone underwent ulceration within ten days, with peak ulceration ranging from 62.1% to 79.8%. Peak ulceration showed a weak correlation with radiation dose (r = 0.664). Mean ulceration rate over the study period is more closely correlated to dose (r = 0.753). With the highest dose excluded due to contraction-related distortions, correlation between dose and average ulceration showed a stronger relationship (r = 0.895). Eight additional wounds created using 41.5 Gy all reached peak ulceration above 50%, with all healing significantly but incompletely by the 65-day endpoint.ConclusionsWe developed a functional preclinical model which is currently used to evaluate human tissue-based therapies in the setting of cutaneous radiation injury. Similar models may be widely applicable and useful the development of novel therapies which may improve radiotherapy management over a broad clinical spectrum.

Ion-recombination correction for different ionization chambers in high dose rate flattening-filter-free photon beams

Recently, there has been an increased interest in flattening-filter-free (FFF) linear accelerators. Removal of the filter results in available dose rates up to 24 Gy min−1 (for nominal energy 10 MV in depth of maximum dose, a source–surface distance of 100 cm and a field size of 10×10 cm2). To guarantee accurate relative and reference dosimetry for the FFF beams, we investigated the charge collection efficiency of multiple air-vented and one liquid ionization chamber for dose rates up to 31.9 Gy min−1. For flattened beams, the ion-collection efficiency of all air-vented ionization chambers (except for the PinPoint chamber) was above 0.995. By removing the flattening filter, we found a reduction in collection efficiency of approximately 0.5–0.9% for a 10 MV beam. For FFF beams, the Markus chamber showed the largest collection efficiency of 0.994. The observed collection efficiencies were dependent on dose per pulse, but independent of the pulse repetition frequency. Using the liquid ionization chamber, the ion-collection efficiency for flattened beams was above 0.990 for all dose rates. However, this chamber showed a low collection efficiency of 0.940 for the FFF 10 MV beam at a dose rate of 31.9 Gy min−1. All investigated air-vented ionization chambers can be reliably used for relative dosimetry of FFF beams. The order of correction for reference dosimetry is given in the manuscript. Due to their increased saturation in high dose rate FFF beams, liquid ionization chambers appear to be unsuitable for dosimetry within these contexts.

Photon energy-modulated radiotherapy: Monte Carlo simulation and treatment planning study

To demonstrate the feasibility of photon energy-modulated radiotherapy during beam-on time. A cylindrical device made of aluminum was conceptually proposed as an energy modulator. The frame of the device was connected with 20 tubes through which mercury could be injected or drained to adjust the thickness of mercury along the beam axis. In Monte Carlo (MC) simulations, a flattening filter of 6 or 10 MV linac was replaced with the device. The thickness of mercury inside the device varied from 0 to 40 mm at the field sizes of 5 × 5 cm(2) (FS5), 10 × 10 cm(2) (FS10), and 20 × 20 cm(2) (FS20). At least 5 billion histories were followed for each simulation to create phase space files at 100 cm source to surface distance (SSD). In-water beam data were acquired by additional MC simulations using the above phase space files. A treatment planning system (TPS) was commissioned to generate a virtual machine using the MC-generated beam data. Intensity modulated radiation therapy (IMRT) plans for six clinical cases were generated using conventional 6 MV, 6 MV flattening filter free, and energy-modulated photon beams of the virtual machine. As increasing the thickness of mercury, Percentage depth doses (PDD) of modulated 6 and 10 MV after the depth of dose maximum were continuously increased. The amount of PDD increase at the depth of 10 and 20 cm for modulated 6 MV was 4.8% and 5.2% at FS5, 3.9% and 5.0% at FS10 and 3.2%-4.9% at FS20 as increasing the thickness of mercury from 0 to 20 mm. The same for modulated 10 MV was 4.5% and 5.0% at FS5, 3.8% and 4.7% at FS10 and 4.1% and 4.8% at FS20 as increasing the thickness of mercury from 0 to 25 mm. The outputs of modulated 6 MV with 20 mm mercury and of modulated 10 MV with 25 mm mercury were reduced into 30%, and 56% of conventional linac, respectively. The energy-modulated IMRT plans had less integral doses than 6 MV IMRT or 6 MV flattening filter free plans for tumors located in the periphery while maintaining the similar quality of target coverage, homogeneity, and conformity. The MC study for the designed energy modulator demonstrated the feasibility of energy-modulated photon beams available during beam-on time. The planning study showed an advantage of energy-and intensity modulated radiotherapy in terms of integral dose without sacrificing any quality of IMRT plan.

Characterization of an extendable multi-leaf collimator for clinical electron beams

An extendable x-ray multi-leaf collimator (eMLC) is investigated for collimation of electron beams on a linear accelerator. The conventional method of collimation using an electron applicator is impractical for conformal, modulated and mixed beam therapy techniques. An eMLC would allow faster, more complex treatments with potential for reduction in dose to organs-at-risk and critical structures. The add-on eMLC was modelled using the EGSnrc Monte Carlo code and validated against dose measurements at 6–21 MeV with the eMLC mounted on a Siemens Oncor linear accelerator at 71.6 and 81.6 cm source-to-collimator distances. Measurements and simulations at 8.4–18.4 cm airgaps showed agreement of 2%/2 mm. The eMLC dose profiles and percentage depth dose curves were compared with standard electron applicator parameters. The primary differences were a wider penumbra and up to 4.2% reduction in the build-up dose at 0.5 cm depth, with dose normalized on the central axis. At 90 cm source-to-surface distance (SSD)-–relevant to isocentric delivery-–the applicator and eMLC penumbrae agreed to 0.3 cm. The eMLC leaves, which were 7 cm thick, contributed up to 6.3% scattered electron dose at the depth of maximum dose for a 10 × 10 cm2 field, with the thick leaves effectively eliminating bremsstrahlung leakage. A Monte Carlo calculated wedge shaped dose distribution generated with all six beam energies matched across the maximum available eMLC field width demonstrated a therapeutic (80% of maximum dose) depth range of 2.1–6.8 cm. Field matching was particularly challenging at lower beam energies (6–12 MeV) due to the wider penumbrae and angular distribution of electron scattering. An eMLC isocentric electron breast boost was planned and compared with the conventional applicator fixed SSD plan, showing similar target coverage and dose to critical structures. The mean dose to the target differed by less than 2%. The low bremsstrahlung dose from the 7 cm thick MLC leaves had the added advantage of reducing the mean dose to the whole heart. Isocentric delivery using an extendable eMLC means that treatment room re-entry and repositioning the patient for SSD set-up is unnecessary. Monte Carlo simulation can accurately calculate the fluence below the eMLC and subsequent patient dose distributions. The eMLC generates similar dose distributions to the standard electron applicator but provides a practical method for more complex electron beam delivery.

The use of intensity-modulated radiation therapy photon beams for improving the dose uniformity of electron beams shaped with MLC

Electrons are ideal for treating shallow tumors and sparing adjacent normal tissue. Conventionally, electron beams are collimated by cut-outs that are time-consuming to make and difficult to adapt to tumor shape throughout the course of treatment. We propose that electron cut-outs can be replaced using photon multileaf collimator (MLC). Two major problems of this approach are that the scattering of electrons causes penumbra widening because of a large air gap, and available commercial treatment planning systems (TPSs) do not support MLC-collimated electron beams. In this study, these difficulties were overcome by (1) modeling electron beams collimated by photon MLC for a commercial TPS, and (2) developing a technique to reduce electron beam penumbra by adding low-energy intensity-modulated radiation therapy (IMRT) photons (4 MV). We used blocks to simulate MLC shielding in the TPS. Inverse planning was used to optimize boost photon beams. This technique was applied to a parotid and a central nervous system (CNS) clinical case. Combined photon and electron plans were compared with conventional plans and verified using ion chamber, film, and a 2D diode array. Our studies showed that the beam penumbra for mixed beams with 90 cm source to surface distance (SSD) is comparable with electron applicators and cut-outs at 100 cm SSD. Our mixed-beam technique yielded more uniform dose to the planning target volume and lower doses to various organs at risk for both parotid and CNS clinical cases. The plans were verified with measurements, with more than 95% points passing the gamma criteria of 5% in dose difference and 5 mm for distance to agreement. In conclusion, the study has demonstrated the feasibility and potential advantage of using photon MLC to collimate electron beams with boost photon IMRT fields.