Dosimetric effects caused by couch tops and immobilization devices: report of AAPM Task Group 176.

The dosimetric impact from devices external to the patient is a complex combination of increased skin dose, reduced tumor dose, and altered dose distribution. Although small monitor unit or dose corrections are routinely made for blocking trays, ion chamber correction factors, e.g.

Two self-referencing methods for the measurement of beam spot position.

Purpose: Two quantitative methods of measuring electron beam spot position with respect to the collimator axis of rotation (CAOR) are described.

Methods: Method 1 uses a cylindrical ion chamber (IC) mounted on a jig corotational with the collimator making the relationship among the chamber, jaws, and CAOR fixed and independent of collimator angle. A jaw parallel to the IC axis is set to zero and the IC position adjusted so that the IC signal is approximately 50% of the open field value, providing a large dose gradient in the region of the IC.

Poster - Thur Eve - 32: Water tank referenced calibration method for detector array devices.

Introduction: Detector array devices, such as the I'mRT Matrixx (IBA Dosimetry), provide a means of evaluating beam profiles with respect to gantry for a range of dose rates and monitor units. The relative calibration of these devices is typically highly susceptible to even relatively small variations in beam output. An alternative method is proposed here, which directly references the device detector response to water tank data.

Sci-Fri PM: Delivery - 06: A generalized solution to the wide field array calibration method.

Multi detector arrays are commonly used in radiation oncology for IMRT and Linac QA. The calibration of detector arrays is usually based on the wide field calibration technique. Unfortunately small beam changes between measurements will result in large error propagation.

Junctioning longitudinally adjacent PTVs with Helical TomoTherapy.

Irradiation of longitudinally adjacent PTVs with Helical TomoTherapy (HT) may be clinically necessary, for example in treating a recurrent PTV adjacent to a previously-treated volume. In this work, the parameters which influence the cumulative dose distribution resulting from treating longitudinally adjacent PTVs are examined, including field width, pitch, and PTV location. In-phantom dose distributions were calculated for various on- and off-axis cylindrical PTVs and were verified by ion chamber and film measurement.

Dose perturbations by two carbon fiber treatment couches and the ability of a commercial treatment planning system to predict these effects.

Purpose: To measure the effect of the treatment couch on dose distributions and to investigate the ability of a modern planning system to accurately model these effects.

Methods: This work measured the dose perturbation at depth and in the dose buildup region when one of two treatment couches, CIVCO (formerly MED-TEC) or Medical Intelligence, was placed between a photon beam source (6, 10, and 18 MV) and the phantom. Beam attenuation was measured in the center of a cylindrical acrylic phantom with a Farmer type ion chamber at multiple gantry angles.

The emerging role of IG-IMRT for palliative radiotherapy: a single-institution experience.

Many modern radiotherapy centers now have image-guided intensity-modulated radiotherapy (IG-IMRT) tools available for clinical use, and the technique offers many options for patients requiring palliative radiotherapy. We describe a single-institution experience with IG-IMRT for short-course palliative radiotherapy, highlighting the unique situations in which the technique can be most effectively used.

Total scalp radiation using image-guided IMRT for progressive cutaneous T cell lymphoma.

Modern radiotherapy has advanced dramatically over the past decade and it is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the area(s) of tumour while sparing adjacent normal tissues even in seemingly complicated and difficult parts of the body. The case report presented here will illustrate how it is possible to irradiate the entire scalp for extensive cutaneous T cell lymphoma while minimising radiotherapy to the underlying brain, orbits and other critical structures.

Simultaneous treatment of multiple basal cell carcinoma lesions.

We present a rare case of advanced basal cell carcinoma where multiple large lesions, located on the anterior chest wall and back, were treated simultaneously using tomotherapy (TomoTherapy HiArt; TomoTherapy Inc, Madison, WI). A 74-year-old man presented with seven to eight separate extensive lesions on his body, some with a duration of 7 years or more. The image-guidance component of tomotherapy allowed daily verification of the position of the target and critical structures, enabling accurate targeting in the vicinity of sensitive critical structures.

Poster - Thurs Eve-32: Dose errors related to the treatment couch.

Modern radiotherapy linacs often use carbon fibre for their couch tops due to its radio translucent properties. Beam attenuation by the couches is often ignored during planning and MU calculation. This work examines beam attenuation and loss of "skin sparing" (dose build up region) when various photon beams transit either the MedTec (Siemens) or Medical Intelligence (Elekta) couches.

On-line rapid palliation using helical tomotherapy: a prospective feasibility study.

Rapid delivery of radiation therapy is expected to benefit patients requiring palliation. We investigated the feasibility of employing a helical tomotherapy unit to scan, plan, and deliver a radiation treatment in a single radiation therapy appointment. Eleven patients each had an MVCT scan acquired, a plan created, and delivery completed while the patient was on the treatment couch.

A study of prostate delineation referenced against a gold standard created from the visible human data.

Purpose: To measure inter- and intra-observer variation and systematic error in CT based prostate delineation, where individual delineations are referenced against a gold standard produced from photographic anatomical images from the Visible Human Project (VHP).

Materials And Methods: The CT and anatomical images of the VHP male form the basic data set for this study. The gold standard was established based on 1mm thick anatomical photographic images.

Using multileaf collimator interleaf leakage to extract absolute spatial information from electronic portal imaging device images.

Electronic portal imaging devices (EPIDs) are potentially valuable tools for linear accelerator quality assurance and for measuring and analyzing geometric variations in radiation treatment delivery. Geometric analysis is more robust if referenced against an absolute position such as the isocenter (collimator axis of rotation), allowing the observer to discriminate between various setup errors and jaw or multileaf collimator (MLC) calibration errors. Unfortunately, mechanical instabilities in EPIDs make such analysis difficult.

Investigating treatment dose error due to beam attenuation by a carbon fiber tabletop.

Carbon fiber is commonly used in radiation therapy for treatment tabletops and various immobilization and support devices, partially because it is generally perceived to be almost radiotransparent to high-energy photons. To avoid exposure to normal tissue during modern radiation therapy, one must deliver the radiation from all gantry angles; hence, beams often transit the couch proximal to the patient. The effects of the beam attenuation by the support structure of the couch are often neglected in the planning process.

A prospective comparison of three systems of patient immobilization for prostate radiotherapy.

Purpose: The study compared the setup reliability of 3 patient immobilization systems, a rubber leg cushion, the alpha cradle, and the thermoplastic Hipfix device, in 77 patients with cT1-T3, N0, M0 prostate cancer receiving conformal radiotherapy.

Methods And Materials: Port films were analyzed and compared to simulation films to estimate the setup errors in the three coordinate axes (anterior-posterior, cranial-caudal, medial-lateral). A total vector error was calculated from these shifts.

Effects of urethrography on prostate position: considerations for radiotherapy treatment planning of prostate carcinoma.

Purpose: Retrograde urethrography is commonly used to define the prostate apex at simulation. This study evaluated the hypothesis that urethrography causes prostate displacement, resulting in an error in treatment planning.

Methods And Materials: Forty-five patients with carcinoma of the prostate were evaluated.

Changes in muscle blood flow distribution during hyperthermia.

Blood flow is a critical parameter for obtaining satisfactory temperature distributions during clinical hyperthermia. This study examines the changes in blood flow distribution in normal porcine skeletal muscle before, during and after a period of regional microwave hyperthermia. The baseline blood flow distribution during general anaesthesia and after the insertion of the thermal probes was established independently in order to isolate the changes due to hyperthermia.

The effect of dose rate dependence of p-type silicon detectors on linac relative dosimetry.

Cumulative radiation damage to silicon semiconductor diode detectors can induce dose rate dependent sensitivity, a concern in the pulsed beam of a linac. Two p-Si diode photon detectors were used in this study, diodes A and B. Both were preirradiated by the supplier to 5 kGy, with diode A receiving an estimated 8 kGy from measurements, and diode B, 25 kGy.

Tissue preparation technique for microsphere assays of blood flow.

A simple method for preparing standardized tissue samples for microsphere assay of tissue blood flow is described. By reduction of tissue samples into a liquid state and centrifugation of the microspheres to the bottom of conical-shaped counting vials, the microspheres within all tissue and blood reference samples attain the same counting geometry. The validity and reproducibility of this technique has been established for planar-configured gamma-ray detectors in an in-situ porcine kidney model.

Lateral electron equilibrium and electron contamination in measurements of head-scatter factors using miniphantoms and brass caps.

The head-scatter factor (Sh) can be measured with a narrow miniphantom or a metal cap provided it is completely covered by the photon beam and its lateral size is thick enough to prevent electron contamination contributions. The effects of lateral electron equilibrium (LEE) and electron contamination on the Sh values were studied. The EGS4 Monte Carlo technique was used to calculate the minimum beam radii (rLEE) required to achieve complete LEE for photon beams ranging from 60Co to 24 MV.

Asymmetric arc technique for posterior pharyngeal wall and retropharyngeal space tumors.

Purpose: Tumors of the posterior pharyngeal wall and nasopharyngeal cancer with retropharyngeal extension can partly encircle the cervical vertebrae. Treating the patient within spinal cord tolerance can cause a geographic miss. A simple technique has been developed to avoid this problem.

Beam characteristics of the therapax DXT300 orthovoltage therapy unit.

The operating performance and beam characteristics of a new orthovoltage unit, the Therapax DXT300, have been evaluated. Percentage depth-dose and backscatter tables are presented for several applicator sizes, at 30 cm and 50 cm focal skin distances (FSDS) and for multiple x-ray beam qualities with the tube operating between 100 and 300 kVp accelerating potential. The unit has been found to provide beam characteristics similar to those reported for other orthovoltage therapy machines.

A translating-bed technique for total-body irradiation.

Total-body irradiation (TBI) is a therapy modality that is being used with increasing frequency, in conjunction with chemotherapy, for patients undergoing bone-marrow transplantation. At the Ottawa Regional Cancer Centre a technique has been developed for the delivery of TBI to patients prior to bone-marrow transplantation. In this technique patients are treated on a mobile couch at approximately 195 cm SSD with a field size of 66.

On the spatial resolution of clinical thermometers.

In this work the spatial resolution of type T (copper-Constantan) and type K (Chromel-Alumel) multipoint thermocouple thermometers was investigated. For clinical use, thermocouples are usually inserted within catheters to provide easy access, reproducibility, and a sterile environment. The effect of several types of catheter on the ability of these thermometers to accurately resolve thermal gradients was studied.