...

www.medrad.ir

: PDF

WWW.MEDRAD.IR

Physics of Radiation Therapy

Third by Faiz M. Khan Edition
Pertinent to the entire radiation oncology team, Physics of Radiation Therapy is clinically oriented and presents practical aspects as well as underlying theory to clarify basic concepts. The format begins with underlying physics, then progresses to treatment planning, and ends with radiation. This edition contains an expanded focus with seven new chapters on special procedures. Remaining chapters have been revised to detail any new developments in the field over the past eight years. Illustrations are overhauled to reflect current practice and to detail the new procedures added. Provides a solid foundation for residents and a strong review for practitioners. Features of Physics of Radiation Therapy:

Contents

Focus on team approach to practice of physics in the radiation oncology clinic Provides solid foundation for residents and a good review for practitioners Clinically oriented with a uniform approach by a single author renowned in the field Balanced coverage of theory and practice Includes dosimetry protocols Includes commissioning and quality assurance procedures Heavily referenced and illustrated (over 5,000 references and 300 illustrations) PAGE

Basic Physics 1. 2. 3. 4. 5. 6. 7. 8. Structure of Matter-------------------------------------------------------------------------------------11 Nuclear Transformations------------------------------------------------------------------------------23 Productions of X-Rays--------------------------------------------------------------------------------44 Clinical Radiation Generators------------------------------------------------------------------------60 Interactions of Ionizing Radiation--------------------------------------------------------------------87 Measurement of Ionizing Radiation------------------------------------------------------------------112 Quality of X-Ray Beams------------------------------------------------------------------------------137 Measurement of Absorbed Dose---------------------------------------------------------------------149

Classic Radiotherapy 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Dose Distribution and Scatter Analysis--------------------------------------------------------------227 A System of Dosimetric Calculations-----------------------------------------------------------------257 Treatment Planning I: Isodose Distributions---------------------------------------------------------285 Treatment Planning II: Patient Data, Corrections, and Setup--------------------------------------329 Treatment Planning III: Field Shaping, Skin Dose, and Field Separation------------------------395 Electron Beam Therapies-------------------------------------------------------------------------------436 Brachytherapy--------------------------------------------------------------------------------------------524 Radiation Protections------------------------------------------------------------------------------------591 Quality Assurances--------------------------------------------------------------------------------------626 Total Body Irradiation-----------------------------------------------------------------------------------679

Modern Radiotherapy 19. 20. 21. 22. 23. 24. Three-dimensional Conformal Radiotherapy--------------------------------------------------------692 Intensity-modulated Radiotherapy--------------------------------------------------------------------711 Stereo tactics Radio surgery---------------------------------------------------------------------------747 High Dose Rate Brachytherapy-----------------------------------------------------------------------765 Prostate Implants----------------------------------------------------------------------------------------789 Intravascular Brachytherapy---------------------------------------------------------------------------802

Appendices----------------------------------------------------------------------------------------------------------821

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Front of Book > Editors

Editors
Faiz M. Khan Ph.D. P r o f e s s o r E m e ri t u s D e p a r t me n t o f T h e r a p e u t i c R a dio lo g y , U niv e r s i t y o f M i nne s ot a M e d i c a l S c hoo l , M i n n e a p o li s , M i n n e s ota

Secondary Editors
J on a t h a n P i n e A c q u i s i ti o n s E d it o r Michael Standen D e v e lo p me n t a l E di to r L i s a R . K a i ri s D e v e lo p me n t a l E di to r T h om a s B oy c e P r o d u c t io n E d i to r Benjamin Rivera Manufacturing Manager C ov e r D e s i g n e r : Q T D e s i g n C om p os i t or : T e c h B o ok s Printer: Maple Press

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Front of Book > Dedication

T o v e r y s p e c i a l p e o p l e i n m y li fe : m y w i f e , K a t h y , a n d m y da u g h t e r s, Sarah, Yasmine, and Rachel

Dedication

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Front of Book > PREFACE TO THE FIRST EDITION

Most

PREFACE TO THE FIRST EDITION

t e x tb oo k s o n ra d i olo g i c al p hy s i c s pr e s e nt a b ro a d

f i el d

w hi c h

i nc l ud e s

p h y s i c s o f r a di a ti o n th e r a p y , d i a g no s i s , a nd nuc l e a r me d i ci ne . The e m p ha s i s i s o n t h e b a si c p h y s i c a l p r in c i p l e s w h i c h f o r m a c o m m o n f o und at io n f o r t he s e ar e a s . C o n s e q u e n t l y , t h e top i c s o f p r a c ti c a l i nt er e s t a r e di s c us s e d onl y s p a r i ng l y o r c o m pl e te l y le f t o u t . T h e n e e d i s f e l t f o r a b o o k s o le l y d ed i c at e d to r a d ia ti o n t h e r a p y p h y s i c s w i t h em p h a s i s o n t he p r a ct ic a l d et a il s . T h i s b oo k i s w r i tt e n pr i m a r il y w it h t he nee ds o f r e si de nt s a nd cl i ni c a l p hy s i c i st s i n m i n d . T h e r e f o re , g r e at e r e m p h a s i s i s gi v e n t o t he p r a ct i ce o f p hy s i c s i n t he c li ni c . F o r t h e re s id e n t s , t he b oo k p ro v i de s bo t h b a s i c r a di a tio n p hy s i c s a nd p hy s i c a l aspects of t r e at m e nt planning, us i ng pho t o n b e am s , e l e ct ro n beams, a nd b r a c h y t h e r a p y s o u r c es . F o r t h e c li ni c a l p hy s i c i st , a d di ti o nal l y , c ur r e nt i nf o rm a ti on i s p r o v id ed o n d o si m et r y . E x c e p t f o r s o m e s e ct io n s i n t h e b o o k d e al ing w i t h t he t he o r y o f a b s o r b ed d o se m e a s u r e m e n t s , t h e boo k s h o u l d a l s o a pp e a l t o t he r a d io t her a p y te c hno l og i st s . O f p a r t i c ul a r i n te r e st to t h e m a r e t he s e c tio ns o n t r e at m e nt t ec hni q ue s , p a t ie nt s e t u p s , a nd d o si m et r ic c a l c u l a t io ns . S i n c e t h e b oo k i s d es i g n e d f o r a mi x e d aud i e nc e , a c a r e f ul b al a nc e ha d t o be m a i n t a i n ed be t w ee n th e o r y a n d p r a ct i c al de t a il s . A c o ns ci o us e f fo r t w a s m ad e t o make the s u b j e ct pa l a t a bl e to t ho s e not f o r m al l y t r ai ne d in p hy s i c s (e.g., r e s i de n t s a n d t e c h n ic i a n s ) w i t h o ut d i mi nis hi ng t he v a l ue o f t he b o o k t o t he p h y s i c i s t . T h i s ob j e ct w a s h o p e f u l l y a c hi e v ed b y a c a r e f ul s el e c tio n o f t he t op i c s, s i m p li f i c at io n of the m a t h e m a t i c al f o r m al i s m s , a nd ample r ef e r e nc e s to t he r e l e v a n t li te r at u r e . In d e v e l op i n g t h i s tex t , I h a v e b ee n g re at l y hel p ed b y m y p hy s i c s c ol le a g ue s , D r s . J e f f W il li a m s o n , C h r i s D ei be l , Ba r r y W e r ne r , E d C y t a c k i , Br uc e G e r b i , a nd S u b h a s h S h a r m a . I w i s h t o t h a n k t he m f o r re v i e w i ng t he te x t i n i ts v a r i o us s t a ges o f d e v e lo p me n t . M y g r e a t a pp r e ci a ti o n goe s t o S a nd i K uit une n w ho t y p e d t he m a n u s c r i p t a n d p r o v id e d t h e n e ed e d o r g ani z a t i o n f o r t hi s l e ngt hy p r o j e ct . I a m a l s o t h a n k f u l t o K a th y M i t c h e l l a nd L y n ne O l s o n w ho p r e p a r e d m o st o f t he i ll u s t r a ti o n s f o r t h e bo o k . F i n a l l y , I g r e at l y v a l ue m y a s s o c i at io n w i t h D r . S e y m o ur L e v itt , t he c ha i r m a n o f t h i s de p a rt m e n t , f r om w h o m I g o t m uc h o f t he c li ni c a l p hil o so p hy I ne e d e d a s a physicist. F a i z M . K ha n

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Front of Book > PREFACE TO THE SECOND EDITION

T h e s e c o n d e d it io n is w r i t t e n w i t h t he sa m e o b je c ti v e a s t he f i r s t , na m e l y t o p r e s e n t r a di a ti o n o n c o lo g y p h y s i c s a s it i s p r a c t i ce d i n t he c li ni c. Ba s i c p hy s i c s i s d i s c u s s e d to p ro v i de ph y s i c a l r a t io na l e f o r the c l i ni c a l pr o ce d ur e s. A s t h e p r a ct i ce o f ph y s i c s i n t he cl i ni c inv o l v e s te a m w o r k am o ng p hy s i ci s t s , r a d i at io n o n c o lo gi s t s , d o s im e tr i st s , a nd t ec hno l o gi s t s , t he bo o k i s i nte nd e d fo r t h i s m i x ed a u d ie n c e . A d e li c a t e b a l a nc e i s c r e a t ed b et w e e n t he t he o re ti c a l a nd t h e p r a c ti c a l t o r et a i n t h e i n t e r es t o f a ll t hes e g r o up s . A l l t h e c h a p te r s i n th e p r e v io u s e di ti o n w e r e r e v ie w e d i n t he l i g ht o f mo de r n d e v e lo p me n t s a n d r ev i s e d a s n e ed e d . In t he b a s i c p hy s i c s pa r t o f t he boo k , g r e a te r d et a il s a r e p r o v id e d o n r a di a ti on g e ne r a t o r s , d et e cto r s , a nd p a r t i cl e beams. Chapter 8 on r a d i a ti o n do s i me t ry ha s been c o m pl e te l y r e v i se d a nd i n c l u d e s d er i v a ti o n of t h e A A P M T G - 2 1 p r ot o co l f r o m b a si c p r i nc i pl e s . I a m t h a n k f u l t o D a v i d R o ge r s f o r t a k i ng t he ti me t o r e vi e w t he c ha p ter . T o p i c s o f do s e c a l c u l at io n , i m a gi ng , a nd tr ea t m e nt p l a nni ng ha v e b e e n a ug me nt ed w i t h c u r r e n t i n f o r m atio n o n i n te r f a c e do s i me t r y , i nho mo g e nei t y co r r e ct io ns , f i e ld junctions, a s y m m et ric w il l be c ol li m a to r s , m ult ile a f c ol li m a to r s , a nd p o rt al - i m ag i ng bo o k o n s y s t e m s . T h e s u b j e c t o f t h r e e - d im e ns io na l t r e a t me nt p l a nni ng is d i s c us s e d o nl y b r i e fl y , b u t it p re s e n te d m o re co m p re he ns i v e l y i n a f ut ur e t r e at m e n t pl a n n i n g . T h e e l e ct r o n c h a p te r w a s u p d a t e d i n t he l i g ht o f t he A A P M T G - 2 5 r ep o rt . T he brachytherapy C o l l ab o r at i v e c h a p te r Wo r k i ng was re v i s e d a to inc l ud e of t he work by t he Int er s ti ti al a nd a Group, d e s c r ip ti o n r e mo te a f t e rl o a de r s ,

PREFACE TO THE SECOND EDITION

c o m m e n t a r y o n b r a c hy t h e r a p y d o s e s pe c i fi ca t io n. C h a p t e r 1 6 o n r a d i ati o n p r ot e ct io n w a s r e v i s e d to i nc l ude m or e r e c e nt N C R P g u i d el i n e s a n d t h e con c e p t o f e f f e c ti v e do se e q ui v a le nt . A n i m p or t a nt a d di ti o n to t h e c h a p te r i s t h e su m m a r y o u t li ne o f t he N R C r eg ul a ti o ns , whi c h I ho p e wi ll p r o v id e a q u i c k r e v ie w o f t h e s ub j e c t w hi l e us i ng t he f e de ra l r e gi s t er a s a r e f e r e n c e f o r g re a te r d e t ai l s . C h a p t e r 1 7 o n q u a l it y a s s u r a n c e i s a ne w a d d it io n t o t he b oo k . T r a d i tio na l l y , t hi s s u b j e c t i s i n te r s p er s ed w i t h ot h e r to pi c s . H o w e v e r , w i t h t he c ur re nt e m p ha si s o n q u a l it y a s s u r a n c e b y t h e h o s pi t al a c c r ed it ing b o di e s a nd t he r egul a t o r y a ge nc i e s , t h i s t o pi c h a s a s s u me d gr e a te r i m po r t a nce a nd a n i d e nti t y o f i t s o w n. P hy s i c a l a s p e c t s o f q u a l it y a s su r a n c e a r e p re s e nte d , i nc l ud i ng s t r uc t ure and p r o ce s s , w it h t h e o b je c ti v e o f i mp r ov i n g o u t c o me . I a c k n o w l e d ge t h e s a cr i f i c e t h a t m y f a m il y ha d to m a k e i n l et ti ng m e w o r k o n t his b o o k w it h o u t sp e n di n g q u a l it y ti m e wi t h the m . I a m t ha nk f ul f o r t hei r lo v e a nd understanding.

WWW.MEDRAD.IR

I a m a l s o a p p r e c i at i v e o f t h e s u p p o r t t ha t I ha v e r e c e i v e d o v e r t he y e a r s f r o m t he c h a i r m a n o f m y d e p a r t m e n t , D r . S e y m o ur Le v i tt , i n a l l m y p r o f e ss i o na l p ur s uit s . L a s t b u t n ot l e a st I am t h a n k f u l t o m y a s s is t a nt , S a ll y H um p hr e y s , f o r he r s upe rb t y p i n g a n d s k i ll f u l m a n a g e m e n t o f t hi s l e ngt hy p r o j e ct . F a i z M . K ha n

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Front of Book > PREFACE

N e w t e c h n ol o gi e s h a v e g r e atl y c h a ng e d r adi a ti o n t he r a p y i n t he la s t de c a d e o r so . A s a r e s u l t , c l i n i c al p r a c t i ce i n t he ne w m i ll e nni um i s a m i x tur e o f s t a nd a rd r a d i at io n t h e r ap y and s p e ci a l p ro c e d ure s based on c ur r e nt d e v e lo p me nt s in i m a gi n g t e c h n o lo g y , tr e a t me n t p l a nni ng , a nd t r e at m e nt de li v e r y . T he t hi r d e di ti o n r e p r e se n t s a r e v i si o n o f t h e s e co nd e di ti on w i t h a si g ni f i c a nt e x p a ns i o n o f t he m a t e ri a l to i n c l u de c u r r e n t to p i c s s uc h a s 3 - D c o nf o r m a l r ad i at ion t he r a p y , IM R T , s t e r eo ta c ti c r a di a ti o n t h e r a p y , h i g h do s e r at e b ra c hy t he r a p y , s e ed i m pl a nt s , a nd i n t r a v a s c u l a r b r a c h y th e r a p y . A c ha p t e r o n T BI i s a l s o a d d e d t o a ug m e nt t he l i s t o f t h e s e s p e ci a l p r o ced u r e s . It i s r e a li z e d t h a t n o t a l l i n s ti t ut io ns ha v e t he r e s o ur ce s to p r a c ti c e s t at e -o f - t he a r t r a di a ti o n t h e r ap y . S o , b ot h t h e c o nv e ntio na l a nd t he mo de r n r a d i a tio n t he r a p y p r o c ed u r e s are gi v en due a t t e nti o n i nst e a d of k e e pi ng o nly t he ne w a nd d i s c a r di n g t h e ol d . Ba s e d o n co nt e nt , t he b oo k i s o r g a ni z ed int o t hr ee p a rt s : B a s i c P h y s i c s , C l a s s i c a l R a d i at io n T he r a p y , a nd M o d e r n R a d i at io n T he r a p y . A n e w A A P M p r o t o col , T G - 5 1 , f o r t he c a li b r a tio n o f m e g a v ol ta g e p hot o n a nd e l e ct r o n b e am s w a s p u b l i s h e d i n S e pt e mb e r, 1 9 9 9 , f o ll o w ed b y t he IA E A p r o t o co l , TRS-398, in 2 0 00 . Chapter 8 ha s been e x t e ns i v e l y r e v i se d to up d a te t he d o s im e tr y f o r m a l i sm in t h e l i g h t o f t he se d ev e l op m e nt s . I h a v e e n j o y e d w r i ti n g t h e T h i r d E d it io n, pa r t l y b e ca us e o f m y r e t ir e m e nt a s o f J a n u a r y 2 0 0 1 . I s i m p ly h a d m o r e t i me t o res e a r c h, t hi nk , a nd m e d i t at e . I g r e a t l y v a l u e m y a ss o c i at io n w i t h D r . S ey m o ur L e v i tt w ho w a s C ha i r m a n o f m y d e p a rt m e n t f r o m 1 9 70 t o 2 00 0 . I o w e a lo t t o hi m f o r m y p ro f e s sio na l c a r ee r a s a m e d i c al p h y s i c i st . I g r e a tl y a p p re c i at e th e d e p a rt me nt a l s up po r t I ha v e re c ei v e d fr o m t he f a c ul t y a n d t h e c u r r e n t C h a i rw o m a n , D r . K a t hr y n D us e nb e r y . M y c o nt i nue d i nv o l v e me nt w i t h t e a c h i n g o f r e si de n t s a n d g r a d ua t e s t ud e nt s ha s he l p e d me k e e p a b r e a st o f c u r r e n t d e v el o pm e n t s i n t h e f i e ld . I e nj oy e d m y i nt e r a ct io ns w i t h t he p hy s i c s s t a f f : D r . B r u c e G e r bi , D r . P a t H i g gi ns , Dr . P a r ha m A l a e i , R a nd i W e a ve r , J a ne J o h n s o n , a n d S u e N o rd b e rg . I a c k no w l e dg e t he i r a s si st a nc e i n t he p r e pa r a ti o ns o f b o o k m at e ri a l s u c h a s i l l u s t r ati o n s a nd e x a m p l e s o f c l i ni c al d a t a . M y s p e c i al t h a n k s g o t o G r et c h e n T uc he l who t y pe d t he m a nus c r i p t a nd ma na g e d t h i s p r oj e ct w i t h g r e at p r o f e s s io n a l e x pe r ti se . F a i z M . K ha n

PREFACE

WWW.MEDRAD.IR

 Table of Contents

[-] Part I - Abasic Physics [+] 1 - Structure of Matter [+] 2 - Nuclear Transformations [+] 3 - Production of X-Rays [+] 4 - Clinical Radiation Generators [+] 5 - Interactions of Ionizing Radiation [+] 6 - Measurement of Ionizing Radiation [+] 7 - Quality of X-Ray Beams [+] 8 - Measurement of Absorbed Dose [-] Part II - Classical Radiation Therapy [+] 9 - Dose Distribution and Scatter Analysis [+] 10 - A System of Dosimetric Calculations [+] 11 - Treatment Planning I: Isodose Distributions [+] 12 - Treatment Planning II: Patient Data, Corrections, and Set-Up [+] 13 - Treatment Planning III: Field Shaping, Skin Dose, and Field Separation [+] page

WWW.MEDRAD.IR

14 - Electron Beam Therapy [+] 15 - Brachytherapy [+] 16 - Radiation Protection [+] 17 - Quality Assurance [+] 18 - Total Body Irradiation [-] Part III - Modern Radiation Therapy [+] 19 - Three-Dimensional Conformal Radiation Therapy [+] 20 - Intensity-Modulated Radiation Therapy [+] 21 - Stereotactic Radiosurgery [+] 22 - High Dose Rate Brachytherapy [+] 23 - Prostate Implants [+] 24 - Intravascular Brachytherapy
Back of Book

[-] Resources [+] Appendix Tables Colore Plates

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 1 - Structure of Matter

1 Structure of Matter
1.1. THE ATOM
A l l m a tt e r i s c om po se d o f i n di v i d ual e nti ti e s c a ll ed el e m e nt s . E a c h e l e m e nt i s d i s ti n g u i s h a b le f r o m t h e ot h e r s b y t he p hy s i c a l a nd c he mi c a l p r o pe r ti e s o f it s basic c om po n e n t t he a to m . O r i gi na ll y t ho ug ht to be t he s m a l l e st a nd i n d i v i s ib le p a r ti c le of m a t te r , t he at om i s no w k no w n t o ha v e a s ub s t r uc t ur e a nd c a n b e d i v i d ed i n t o s m a l le r c o m po ne nt s . E a c h a t o m c o ns i s t s o f a s m a l l c e nt r a l c o r e , t h e n u c l e u s , w h e r e m o st o f t he a t o mi c m a s s i s l o c at e d a nd a s ur r o und i ng c l o u d o f el e ct r o n s m o v i n g i n o r bi t s a r o und t he nuc l e us . W he re a s t he r ad i us o f t h e a to m ( r ad i u s o f th e e le c t ro n i c o r bi t s ) i s a p pr o x i m at el y 10 - 1 0 m , t he nuc l e us h a s a m u c h s m a l l er ra d i u s , n a m e l y , a bo ut 1 0 - 1 4 m . T hus , f o r a p a r ti c le o f si z e c o m p a r ab l e t o n u c l ear d i m e n s io ns , i t wi ll b e q uit e po s s ib le to p e ne t r at e se v e r a l a t o m s o f m at te r be f o re a co ll i si o n ha p pe ns . A s w i ll be po i nte d o ut i n t he c ha pt e r s a h e a d , it i s im p or t a nt to k ee p t r a c k o f t ho s e p a r ti c le s t ha t hav e no t i nte r a c te d w i t h t h e a to m s ( t he p r i m a r y be a m ) a nd tho s e t ha t ha v e s uf f e r e d c ol li s io ns ( t he s c a t te r e d be a m ) .

1.2. THE NUCLEUS

T h e p r o pe r ti e s o f at om s a r e de r i v ed f r om the c o ns t it uti o n o f t hei r nuc l e i a nd t he n u m b e r a n d t h e o r g a ni z a t io n o f t he o r bi t al el e c tr o ns . T h e n u c l e u s c o n t a i n s t w o k i n d s o f f und a m ent a l p a rt i cl e s : p ro to ns a nd ne ut r o ns . W h e r e a s p ro to n s a re p o s it i ve l y c ha r ge d , ne ut r o ns ha v e no c ha rg e . Be c a us e t he e l e ct r o n h a s a n e g a tiv e u n i t c h a r g e ( 1 . 60 1 0 - 1 9 c o ulo m b s ) a nd t he p r ot o n ha s a p o s it i ve u n i t c h a rg e , th e n u m b e r o f p r ot o ns i n t he nuc l e us i s e q ual to t he num b e r o f e l e ct r o n s o ut s i de th e n u c l e u s , t hus m a k i ng t he a t o m el e ct r i c all y ne ut r a l . A n a t o m i s c o mp le tel y s p e c i f ie d b y t he fo r m ul a
A Z

X , w he r e X i s t he c he m i c al

s y m b o l fo r t h e e le m e nt ; A i s t h e m a s s num be r , d e f i ned a s t he num b e r o f nuc l e o ns ( n e u t r o n s a n d p r ot o n s i n t h e n u c l e us ) ; a nd Z i s t he a t om i c num be r , d e not i ng t he number e x a m p le , of p ro to n s H and in the n u c l e us (or the num b e r of el e ct ro ns o ut s id e t he n u c l e u s ) . A n a t o m r ep r e s e n te d i n s uc h a m a nne r i s al s o c a ll ed a nuc l id e . Fo r
1 1 4 2

He r e p re s e n t at o m s o r nuc l e i o r nuc l id e s of hy d r o g e n a nd

h e l i u m , r e s pe c ti v e l y . O n t h e b a si s o f di f f e re n t p ro po r tio ns o f neut r o ns a nd p r ot o ns i n t he nuc l ei , a to m s h a v e b e e n c l a s si f i ed in t o t h e fo ll o w i ng c at eg o r ie s : i sot o pe s , a tom s ha v i ng nuc l e i w i t h t h e s a m e n u m b e r o f p ro to ns b ut d i ff e r e nt num b e r o f neut r o ns ; i so to ne s , h a v i n g t h e s a m e n u m b e r o f n e u t r o ns b ut d i f f e r e nt num b e r o f pr o to ns ; i s o b ar s , w i t h t h e s a m e n u m b er o f n u c l eo ns b ut d i f fe r e nt num b er o f p ro tons ; a nd i s om e r s , c o n t a i n i n g t h e s a me n u m b e r o f p r o to ns a s w e l l a s ne ut r o ns . T h e l a s t c a te g or y , namely i so m e r s , re pr e s e n t s i de nt i c al a tom s e x c e pt t hat t he y differ in t hei r

WWW.MEDRAD.IR

n u c l e a r e n e r g y s t a te s. F o r e x a m p l e , i s o me r o f
131 54

131m

54

X e ( m s t a nd s f o r m e t a s ta b l e st a t e) i s a n

Xe.

C e r t a i n co m bi n a t io n s o f n e u t r o n s a nd p r ot o ns r e s ult i n s t a bl e ( no nr a d io a c ti v e) n u c l i d e s t h a n o t h e r s . F o r i n st a n c e , s t ab l e e l em e nt s i n t he l o w a t o mi c num b er r a n g e h a v e a n a lm o st e q u a l n u m b e r o f ne ut r o ns , N , a nd p r ot o ns, Z . H o w e v e r , a s Z increases b e yo n d about 20 , t he ne ut ro n- t o -p r ot o n r at io f or s t a b le nuc l ei b e c o me s g re a te r t h a n 1 a n d i n c r e a s e s wi t h Z . T hi s i s e v i d e nt i n F i g . 1 . 1 , w hi c h s h o w s a p l o t o f t h e r a t io s o f n e u t r o ns to p ro to ns i n s t a b le nuc l e i .

F I G . 1 . 1 . A p l ot o f n e u t r o n s v e r s us p r o to ns i n s t a b l e nuc l ei . P.4

N u c l e a r s t ab il it y h a s a l s o be e n a na l y z e d in t e r m s o f e v e n a nd o d d num b er s o f n e u t r o n s a n d p ro to n s . O f a b o u t 3 0 0 d i f f e re nt s t ab l e i so to pe s , m o re t ha n ha l f ha v e e v e n n u m b e r s o f p ro to n s a n d n e ut ro ns a nd a r e k no w n a s e v e n-ev e n nuc l e i . T hi s suggests that n u c l ei H, gain st a bi li t y w he n ne ut r o ns a nd p ro tons are m ut ua ll y p a i r ed . O n t h e o t h e r h a n d , o n l y f o ur s t a b le nuc l e i e x i st t ha t ha v e b ot h od d Z a nd odd N, namely
2 1 6 3

Li ,

10

B, and

14

N . Ab o ut 2 0% o f t he st a bl e nuc l e i ha v e e v e n Z

a n d o d d N a n d a b o u t th e s a m e p r o po rt io n ha v e o d d Z a nd e v e n N .

1.3. ATOMIC MASS AND ENERGY UNITS

M a s s e s o f a t o m s a n d a t o mi c p a rt i cl e s a r e co nv e ni e nt l y gi v e n i n t e r m s o f at o mi c m a s s u n i t ( am u ) . A n a m u i s d e fi ne d a s 1/ 1 2 o f t he m a s s o f a c a r b o n i so to p e . T h u s t h e n u c l e u s o f 1 2 a m u . In b a s i c u n i t s o f m a s s , 1 amu = 1.66 10-27 kg T h e m a s s o f a n a t o m e x p r e s s ed i n te r m s o f a m u i s k no w n a s a t o mi c m a s s o r a t o mi c w e ig h t . A n o t he r u s e f u l t e r m i s g r am a t o mi c w e ig ht , w hi c h i s d e f i ne d a s the mass in grams numerically e q ua l to t he a to mi c w e i ght . A c c o r d i ng to A v o g a d r o ' s l a w , e v ery g r a m a to mi c w e ig ht o f a s ub s t a nc e co nt a i ns t he s a m e
12 6 12 6

C nuc l e us , a

C i s a r b i tr a r il y a s s i g ned t he m a s s e q ua l t o

WWW.MEDRAD.IR

n u m b e r o f at o m s . T h e n u m b e r , re f e r r ed to a s A v o g ad r o ' s num b e r ( N A ) ha s b ee n m e a s u r e d b y m a n y in v e s t i g at o r s , a nd i t s c ur r e nt l y a c c e pt ed va l ue i s 6 . 0 22 8 1 0 2 3 at o m s pe r g r a m at o mi c w e i g ht . F r o m t h e p r e v io u s d e fi n i ti o n s , o n e c a n c a l c ul a t e ot he r q ua nt it ie s o f i nt e r e st s uc h a s t h e n um b e r o f ato m s pe r g r a m , g r ams p e r a to m , a nd e lec t r o ns pe r g r a m . C o n s i d e ri n g h e l i u m a s a n e x a m p l e , i t s a to mic w e i g ht ( A W ) i s e q ua l t o 4 . 00 2 6 . Therefore,

P.5

T h e m a s s e s o f a to m i c p a r t i cl e s , a c co r di ng to t he a to m i c m a s s unit, a r e e le c t ro n = 0 . 0 0 05 48 a m u , p r o to n = 1 . 0 0 7 2 7 a m u, a nd ne ut r o n = 1 . 0 0 8 66 a m u. B e c a u s e t h e m a s s o f a n e l e ct r o n i s m uc h sm a l le r t ha n t hat o f a p r ot o n o r ne ut ro n a n d p r o to n s a n d n e u tr o n s h a v e ne a r l y t he s a m e m a s s , e q ua l t o a p p r o xi m a te l y 1 a m u , a l l t h e a to mi c m a s s e s i n u ni t s o f am u a r e v e r y ne a r l y e q ua l t o t he m a s s n u m b e r . H o w e v e r , i t i s i mp o rt a n t to po i nt o ut t ha t t he m a s s of a n a t o m i s not e x a c t l y e q u a l to t h e s u m o f t h e m a s s e s o f c o ns t i t ue nt p a rt i cl e s. T he r e a s o n f o r this is that, when the mass difference is n u c l e u s i s f o r m e d , a c e r t a i n m a s s is d e s t ro y e d the ma s s d e fe c t . Lo o k i ng at it fr o m a a nd c o n v e r t ed i n t o e n er g y t h a t a c t s a s a g l ue t o k e e p t he nuc l eo ns t o g et he r . T hi s c a l l ed di f f e r e nt p e r s pe c ti v e , a n a m o u n t o f e n e r g y eq ua l to t he m a s s d e f e ct m ust b e s up pl ie d t o s e p a r a te t h e n u c l e u s i n to i n di v i d ua l nuc le o ns . T he r e f o re , t hi s e ne r g y i s a l so c a l l ed t h e bi n d i n g e n er g y o f t h e nuc l e us . T h e b a s i c u n i t o f e n er g y i s t h e j o ul e ( J ) and i s e q ua l to t he wor k d o ne w he n a f o r c e o f 1 n e w to n a c t s t h r o u g h a di s t a nc e o f 1 m . T he ne w to n, i n tur n, i s a uni t o f f o r c e g i v e n b y t h e p ro d u c t o f m a ss ( 1 k g ) a nd a c c e le r a tio n ( 1 m/ s e c 2 ) . H o w e v er , a m o r e c o n v e n i e nt e n e r g y u n i t i n a t o mi c and nuc l e a r p hy s i c s i s t he e le c t ro n v o l t ( e V ) , d e f i n e d a s t h e k i n e t i c e n e r g y a c q ui re d b y a n e le c t ro n i n p a s s i ng t hro ug h a p o te n t ia l d i f f e r e n c e of 1 V . It c a n be s how n t ha t t he wo r k do ne i n t hi s c a s e is g i v e n b y t h e p r od u c t o f pot e n ti a l d i f f e re nc e a nd t he c ha r ge on t he el e ct r o n. Therefore, we have: 1 eV = 1 V 1.602 10 -19 C = 1.602 10 -19 J M u l t i pl e s o f t h i s u n i t a r e : 1 keV = 1,000 eV 1 m i ll io n e V ( M e V ) = 1 0 6 e V A c c o r d i n g t o t h e E i n s te i n ' s p r i n c ip le o f e q uiv a l e nc e o f m a s s a nd ene r g y , a m a s s m i s e q u i v a le n t to e n e r gy E a n d t h e r e l a ti o ns hi p i s gi v e n b y :

WWW.MEDRAD.IR

w h e r e c i s t h e v el o ci ty o f l i g h t (3 1 0 8 m/ s e c ) . F o r e x a m pl e , a m a s s o f 1 k g , i f c o n v e r t ed t o e n e r g y , is e q u i v a l e n t t o : E = 1 kg (3 108 m/sec2) = 9 1016 J = 5.62 1029 MeV T h e m a s s o f a n e le c tr o n a t re s t i s s o me tim e s e x p re s s ed i n t e rm s o f i t s e ne r g y e q u i v a le n t ( E 0 ) . B e c a u s e i t s m a s s i s 9 .1 1 0 - 3 1 k g , w e ha v e f r o m E q ua t i o n 1 . 1 : E0 = 0.511 MeV A n o t h e r u s e f u l c o n v e r s i o n i s t h a t o f a m u t o e ne r g y . It c a n b e s ho w n t ha t : 1 amu = 931 MeV

1.4. DISTRIBUTION OF ORBITAL ELECTRONS

A c c o r d i n g t o t h e m od e l p r op o se d b y N ie ls Bo hr i n 1 9 13 , t he e l e ct r o ns re v o l ve a r o u n d t h e n u c l e u s i n s p e c i f i c o r bi t s a nd a re p r e v e nte d f ro m le a v i ng t he at o m b y t h e c e n t ri p et a l f o r ce o f a t t r a ct io n b et w e e n t he p o si ti v e l y c ha r g ed nuc l e us a nd t he n e g a t i ve l y c h a r g e d ele c t ro n . O n t h e b a s i s o f c l a ss i c a l p h y s i c s , a n a c c e l e r at i ng o r r e v ol v i ng e le c t ro n m us t r a d i at e e n er g y . T h i s w o u l d r e s u lt i n a c o nt i nuo us d e c re a s e o f the r a d i us o f t he o r b it w it h t h e e le c t ro n e v e n t u a ll y s p i r al i ng int o t he nuc l e us . H o w ev e r , t he d at a o n t h e e mi s s io n o r a b sor p t io n o f r a d i at io n by e l e me nt s re v e a l t ha t t he c ha ng e o f e n e r g y i s n o t c o n ti n u o u s b u t d i s c re te . T o e x p l a i n t he o b se r v e d l i ne sp e ct r um of hydrogen, Bohr t h eor i z e d that t he s ha r p l i ne s of t he s pe c t rum r e p r e se nt ed e l e ct r o n j u m p s f r o m o n e o r bi t do w n t o a no t he r w it h t he e m i s s io n o f l i g ht o f a p a r t i c ul a r f r e q u e n c y or a q u a n t u m o f e ne r g y . H e p r o p o se d t wo P.6 f u n d a m e n t a l p o st u l a tes : ( a ) e l e c t ro ns c a n e x i s t o nl y i n t ho se o r bit s f o r w hi c h t he a n g u l a r m o m e nt u m o f t h e e le c t ro n i s a n i nte g r a l m ul ti p le o f h / 2 , w he r e h i s t he P l a n c k ' s c o n s t a n t (6 . 6 2 1 0 - 3 4 J - s e c ) ; a nd ( b ) no e ne rg y i s g ai ne d o r l o st w hile t h e e le c t ro n r e m a i n s in a n y o n e o f t he p e r mi s s i bl e o r b it s .

F I G . 1 . 2 . E l e c t ro n o r bi t s f o r h y d r o ge n, he l i um , a nd o x y g e n.

WWW.MEDRAD.IR

T h e a r r a n g e m e n t o f e l e ct r o n s o ut si de t he nuc l e us i s g o v e r ne d b y t he r ul e s o f quantum mechanics and the P a ul i e x cl us i o n p ri nc i pl e ( not d i s c us s e d he re ) . A l t h o u g h t h e a c t u a l co n f i g u r a t io n o f e l e ct rons i s r a t he r c o m p le x a nd d y na m i c , o ne m a y s i m p li f y t h e c o n c e p t b y a s s ig ni ng e le c tr o ns t o s pe c i f i c o r b it s. T he i nne r m o s t o r b it o r s h e ll i s c a lle d t h e K s he ll . T he ne x t s he l l s ar e L , M , N , a nd O . T he m a x i m u m n u m b e r o f e l e ct r o n s i n a n o r bi t i s g i ve n b y 2 n 2 , w he r e n i s t he o r bit n u m b e r . F o r e x a mp l e , a m a x i m u m o f 2 el e ct r o ns c a n e x i st i n t he f i r s t o r bi t , 8 i n t h e s e co n d , a n d 18 i n t h e t h i r d . Fi g ur e 1 . 2 s ho w s t he el e ct r o n o rb i t s o f hy d r og e n, h e l i u m , a n d o x y g e n a to m s . E l e c t ro n o rb it s c a n al so be co n s i d e re d a s e ne r g y le v e l s . T he e ne rgy i n t hi s ca s e i s t h e po t e nt i al e n e rg y of t h e e le c t ro ns . W i t h the o p po s it e si g n it m ay a l s o be c a ll ed t h e b i n di n g e n e r g y o f t h e e le c t ro n.

1.5. ATOMIC ENERGY LEVELS

It i s c u s t o m a r y t o r epr e s e n t t h e e ne rg y l e ve l s o f t he o rb it a l el e ct r o ns b y w ha t i s k n o w n a s t h e e n e r gy l e v el d i ag r a m e l e ct r o n s a t t r a ct io n in various shells d e pe nd a nd be t w ee n th e nucleus ( Fi g. 1 . 3 ) . T he b i ndi ng e ne r g ie s o f t he on t he t he m a g nit ud e of Co ul o mb Thus t he f o r ce of o r bi ta l e le c t ro ns . bi nd i ng

e n e r g ie s f o r t h e h igh e r Z a t o m s ar e gr ea t e r b e c a us e o f t he g r e at e r nuc l e a r c h a r g e . In t h e c a s e of t u n g s t e n ( Z = 7 4 ) , t he e le c t ro ns i n t he K, L , a nd M s he l ls h a v e b i n d i n g e n er g ie s o f a b o u t 6 9 , 50 0 , 11 ,0 0 0 , a nd 2 ,5 0 0 e V , r e s p e ct i v el y . T he s o - c a ll e d v a le n c e e lec t r o n s , w h i c h a r e r e s p o ns i bl e f o r c he mi ca l r e a c ti o ns a nd bonds be t w ee n a t o ms as well as t he em i s s io n of o pt i c al ra d i a tio n spectra, n o r m a l l y o c c u p y t h e o u t e r s h el l s . If e ne r gy i s i m p ar t ed t o o ne o f t he s e v a l e nce e l e ct r o n s to r a i se i t to a h i g h e r e ne r g y ( hig he r p ot e nti a l e ne rg y b ut l o w e r b i nd i ng e n e r g y ) o r bi t , t h i s w il l c r e at e a st a te o f a to m i c i ns t a bi li t y . T he e l e ct r o n w il l f a ll b a c k t o i t s n o rm a l po s it io n w i t h t he e m i ss i o n o f e ne rg y i n t he f o r m o f op ti c al r a d i at io n . The energy of the e m i t te d r ad i a ti o n w i ll be e q ual to t he e ne r g y d i f f e r e n c e o f t h e o r bi ts b e t w ee n w hi c h t he t r a ns i t io n t oo k p l a ce . If t h e t r a n s it io n i n v ol v e d i n n e r o rb it s , s uc h a s K , L , a nd M she l l s w he re t he e l e ct r o n s are mo r e t i g ht l y b o und ( b e c aus e of larger C o ulom b forces), t he a b s o r pt io n o r e m i s si on o f e n e r g y w i ll i nv ol v e hi g he r e ne r g y r ad i a ti o n. A l so , i f s u f f i c i e n t e n e r g y i s i mp a r t ed to a n P.7 i n n e r o r bi t el e ct r o n s o t h a t i t i s c o mp le te l y e j e ct e d f ro m t he at o m, t he v a c a nc y o r t h e h o l e c r e at e d i n t h a t s h e l l w i ll b e a l mo st i ns t a nt a neo us l y f i l l ed b y a n e l e c t r o n f r o m a h i g h e r le v e l o r b it , r e s u lt i ng i n t he e m i s si o n o f r a di at io n. T hi s i s t he m e c h a n i s m f o r t h e p ro d u c ti o n o f c ha r a c t e ris t i c x - r a y s .

WWW.MEDRAD.IR

F I G . 1 . 3 . A s i m p l i fi e d e n e r g y l e v e l di a g r a m o f t he t ung s t e n a t o m ( no t t o s c a l e ). O n l y f e w p o s s i b le t r an s i t io n s a r e s ho w n f o r i l l us t r at io n. Z e r o o f t he e ne r g y s c a l e i s a r b it r a ri l y s e t at t he p o si ti o n o f t he v a lenc e e l e ct r o ns w he n t he a t o m i s i n t he u n e x c i t e d s t at e .

1.6. NUCLEAR FORCES

A s d i s c u s s e d e a r li e r , t h e n u c l e us c o nt ai ns ne ut r o ns t ha t ha v e no c ha r g e a nd p r ot o n s w it h p o si ti v e c h a r g e . B u t ho w a r e the s e p a rt i cl e s hel d t og e t he r , i n s pi te o f t h e f a c t t h a t el e ctr o s t at i c re p ul si v e f o rc e s e x i st b et w e e n p ar t i cl e s o f s i m il a r c h a r g e ? E a r l ie r , i n s ec t io n 1 . 3 , t he t e r m s m a s s d e f e ct a nd bi nd ing e ne r g y o f t he n u c l e u s w e r e m e n ti o ne d . It w a s t he n s ug ges t e d t ha t t he e ne rg y r e q ui r ed to k ee p t h e n u c l e o n s t og et h e r i s p r o v i de d b y t he ma s s d e f e c t . H o w e v e r , t he na t ur e o f t he f o r c e s i n v o l v ed i n k e e p i n g t h e i nt e gr it y o f t he nuc l e us i s q ui t e c o m pl e x a nd w i ll b e d i s c u s s ed h e r e o n ly b r i e f l y . There are four d i f f er e n t forces in na t ure . T he s e are, in t he o r de r of t he i r s t r e n gt h s : ( a ) s t r o n g n u c l e a r f o r c e , ( b ) ele c t ro m a g net i c f o r ce , ( c ) w e a k nuc l e a r f o r c e , a n d ( d ) g r a v i t at io n a l f o r c e . O f t he s e , t he g r a v i t at io na l f o r ce i nv o l v e d i n t he n u c l e u s i s v e r y w e a k a n d c a n b e i g nor e d. T he e l e ct ro m a g net ic f o r c e b et w e e n c h a r g e d n u c l e o n s i s q u i t e st r o n g , b ut i t is r e p ul s i v e a nd te nds t o di s r up t t he n u c l e u s . A f o r c e m u c h l a r g e r t h a n t he el e ctr o m a g net i c fo r c e i s t he s t ro ng nuc l e a r f o r c e t h at i s re s po n s ib l e fo r h o ld i ng t he nuc l e o ns to ge t he r i n the nuc l e us . T he w e a k n u c l e a r f o r c e i s m u c h w e a k e r a nd a p p e a r s i n c e r t ai n t y pe s o f r a d i o a ct i v e decay (e.g., decay). T h e s t r o n g n u c le a r f or c e i s a s ho r t -r a ng e f o r c e t hat c om e s i nt o p l a y w he n t he d i s t a n c e be t w ee n t h e n u c l e o n s b e c o me s s ma l l er t ha n t he nuc l e a r d i a m et e r ( ~ 1 0 - 1 4 m ) . If w e a s s u m e t h a t a n u c l eo n ha s z e r o p o te nt ia l e ne r g y w hen i t i s a n i nf i ni te d i s t a n c e a pa r t f r o m t h e n u c l e u s , t he n a s i t a p p ro a c he s c l os e e no ug h t o t he nucleus to be within the range of nuc l e a r forces, it w i ll e x p e r ie nc e s t ro ng a t t r a ct io n a n d w i l l f a l l i n to t h e p ot e nti a l w e l l ( F ig . 1 . 4 A ) . T hi s p o te nt ia l w e ll i s f o r m e d a s a r e s u lt o f t h e m a s s de f e c t a nd pr o v i de s t he nuc l e a r b ind i ng e ne r g y . It a c t s a s a p o te n t i al b a rr i e r a g ai n s t a ny nuc l e o n e s c a p i ng t he nuc l eus .

WWW.MEDRAD.IR

In t h e c a s e o f a po s it iv e l y c h a r g ed p a rti c l e a p p r o a c hi ng t he nuc l eus , t he r e wi ll be a p ot e n ti a l b a r r ie r d ue to t h e C o ul om b f o r ce s o f r ep ul s io n, p r e vent i ng t he p a r ti c le f r o m a p p ro a c h i n g t he n u c l e u s . If , ho w e v e r , t he p a r ti c le i s ab l e t o ge t cl o se e n o u g h t o t h e n u c l e u s s o a s t o b e w i t hi n the r a ng e o f t he s t r o ng nuc l e a r f o r c e s , t h e r e p u l si v e f o r c e s wi ll b e o v e r co me P.8 a n d t h e p a r t i cl e w i ll b e a b l e to e nt e r t he nuc l e us . F i g ur e 1 . 4 B i l l us t r at e s t he p o te n t ia l b a r r ie r a g ain s t a c h a r g ed p a rt i cle s uc h a s a n p a rt i cl e (t r a v e li ng n u c l e u s ) a p p r oa c h i n g a
238 92 4 2

He

U n u c le us . C o nv e r s e l y , t he b a r ri e r se r v e s to p r e v e nt

a n p a rt i cl e e s c a pi n g f r o m t h e nuc l e us . A l t ho ug h it ap p e ar s , a c c o r di ng to t he c l a s s i c al i de a s , t h a t an p a r t i cl e w o uld r eq ui r e a m i nim um e ner g y e q ua l to t he h e i g h t o f t h e po te n t i al b a r ri e r ( 30 M e V ) i n o r d e r to p e net r at e t he

238 92

U nuc le us or

e s c a p e f r o m i t , t h e da t a s h o w t ha t t he b ar r i e r c a n b e c r o s se d w i t h m uc h l o w e r e n e r g ie s . T h i s h a s b e e n e x p l a i n ed b y a c om p l e x m at he m a ti c a l the o r y k no w n a s w a v e m e c h a n i c s , i n w h i c h p a r t i c l e s a r e co ns i d er e d a s s o ci a te d w i t h d e Br o g l ie waves.

F I G . 1 . 4 . E n e r g y l e v e l d i ag r a m o f a p a r t ic l e i n a nuc l e us : a , p a r t i cl e w it h no c h a r g e ; b , p a r ti c l e w i th p o s it i v e c ha r ge ; U ( r) i s t he p ot e nti a l e ne rg y a s a f unc t i o n o f d i st a n c e r f ro m t he c e n te r o f t he nuc l eus . B i s t he b a r ri e r he i g ht ; R i s t he nuclear radius.

1.7. NUCLEAR ENERGY LEVELS

T h e s h e l l m od e l o f t h e n u c l e u s a s s um e s t ha t t he nuc l e o ns a r e ar r a ng e d i n s he ll s , r e p r e se n t i n g di s c r et e e n e r g y st a te s o f t he nuc l e us s i mi l a r to t he a to mi c e ne rg y l e v e ls . If e n e r g y i s i mp a r t ed to t he nuc l e us , i t m a y b e r ai s ed to an e x c i t e d st a te , a n d w h e n i t r e t u r n s t o a l o w e r e ne r g y s t ate , i t w i ll g i v e o f f e ner g y e q ua l t o t he e n e r g y di f f e r e n c e o f th e t w o s t at e s . S o m eti m e s t he e ne r g y i s r ad i a te d i n st ep s , c o r r e s po n di n g to t he in t e r m ed i at e e ne r g y s ta t e s , be f o r e t he nuc leus s e t tl e s d o w n t o t h e st a b le o r g ro u n d s t a te .

WWW.MEDRAD.IR

F i g u r e 1 . 5 s h o w s a n e n e r g y le v e l di a g r a m w i t h a d e c a y s c he me f o r a c ob a lt -60 ( 6 0 2 7 C o ) n u c l e u s w h i c h h a s b e e n m a d e r a d i o a ct i ve i n a r e a c t or b y b o m b a r di ng s t a b le P.9 t h e n , i n t w o s u c c e s s iv e j u m p s , e mi t s p a c ke t s o f e ne rg y , k no w n a s p hot o ns . T he e m i s si o n o f a - p a r tic l e i s t h e re s ul t o f a nuc l e a r t r a ns f o r m at ion i n w hi c h o ne o f t h e n e u t ro n s i n t h e n u c l e u s d i si nt eg r a tes i nto a p r ot o n, a n e le c t ro n, a nd a n e u t r i n o . T h e e le c tr on a n d n e u t r i no a r e em i tt e d i ns t a nt a neo us ly a nd s ha r e t he r e l e a se d e n e r g y w i t h t h e r e co il i ng nuc l eus . T he process of d e c a y w il l b e discussed in the next chapter.
59 27

C o at o m s w it h n e u t r o n s . T he e x c i te d
-

60

27

C o nuc l e us f i r s t e m it s a p a rt i cl e,

k n o w n a s p a r t i c l e an d

F I G . 1 . 5 . E n e r g y l e v el d i a gr a m f o r t he d e cay o f

60

27

C o nuc l e us .

1.8. PARTICLE RADIATION

T h e t e r m r a d i at io n a p p li e s to t he e m i s si on a nd p r o p a g a t io n o f e ne r g y t hr o ug h s p a c e o r a ma t er i al me d i u m . B y p a r ti c l e r a di a ti o n, w e m e a n e ne rgy p r o p a g at ed b y t r a v e li n g c o rp u s c l e s t h a t h a v e a d e f i nit e r e s t m a s s a nd w i t hi n l i mi t s ha v e a d e f i n it e mo m e nt u m an d d e f i n ed po s it io n a t a ny i ns t a nt . H o w e v e r, t he di s ti nc t io n b e t w ee n p a r ti c l e r a dia t io n a n d e l e c t ro m a gne t i c w a v e s , b o t h o f w hi c h r e p r e s e nt m o d e s o f e n e r g y t r a v el , b e c a m e le s s s ha r p w he n, i n 1 9 2 5 , d e Br og l ie i nt ro d uc e d a h y p o t h e s i s co n c e r n i n g t h e d u a l na t ur e o f m a t te r . H e t he o ri z e d t ha t no t o nl y d o p h o to n s ( e le c t ro m a gn e t i c waves) so m et im e s a p pe a r to be hav e like p a r ti c le s ( e x h i b it mo m e n t u m ) b u t m at e ri a l p a rt i cl e s s uc h a s e le c t ro ns , p ro to ns , a nd a to m s h a v e s o m e t y pe o f w av e m o ti o n a s so c i at e d w i t h t he m ( s ho w r e f ra c t io n a nd o t her w a v e - l i k e p ro p e rti e s ) . B e s i d e s p ro to n s , n e u t r o n s , a n d e l e ct r o ns d i s c us s e d e a rl ie r , m a ny o t he r a t o m ic a n d s u b a to m i c p a rt i cle s h a v e be e n d i s co v e r e d . T he se pa r ti c le s c a n t r a v el w it h h i g h s p e ed s , d ep e n d in g o n t h e i r ki ne ti c e ne r g y , b ut ne v e r att a i n e x a c tl y t he s p e ed o f l i g ht i n a v ac u u m . A l s o , t he y i nt er a c t w i t h m at te r a nd p r o d uc e v a r y i ng d e g re e s o f e n e rg y t r an s f e r t o t h e m e di um .

WWW.MEDRAD.IR

T h e s o - c a l le d e l em e n ta r y p a r t i cl e s ha v e ei the r z e r o o r unit c ha r g e ( e q ual to t hat o f a n el e ct r o n ) . A ll ot h e r p a rt ic l e s ha v e c ha r g e s t ha t a re w hol e m ul t ip le s o f t he e l e ct r o ni c c h a r ge . S om e el e me n t a r y p a r ti cl e s o f i nt e re s t i n r adi ol o gi c al p hy s i c s a r e li s te d i n T a bl e 1 . 1. T h e i r p ro pe r ti e s a nd c l i ni c a l a p pl i c at io ns w i l l b e di s c us s e d l a t er i n t h i s b oo k .

1.9. ELECTROMAGNETIC RADIATION A. Wave Model

E l e c t ro m a g n et i c r a di at io n c o n s ti t ut e s t he m o d e o f e ne r g y p r opa g a t io n f o r s uc h p h e n o m e n a a s l i g ht w a v e s , h e a t w a v e s , r a d io w a v e s , m i c r o w a v e s , ul t r a v i ol et r a y s , x - r a y s , a n d r a y s . T h e s e r a d i a tio ns a r e c a ll e d e l e ct ro ma g ne t i c b e c a us e they were first de s cr i b ed , by M a x w el l , in Fig. in terms an of o s c il l at ing e le c t ri c wave can a nd be m a g n e ti c f i el d s . A s i ll u s t r a te d 1 .6 , e l e ct r o ma g ne tic

r e p r e se n t ed b y t h e spa t i al v a r i at io ns i n t he i nt e nsi ti e s o f a n e l e ct r i c f i el d ( E ) a nd a m a g n e t i c f ie l d ( H ) , t h e f i e ld s b ei ng a t r ig ht a ng l e s to e a c h o the r a t a ny g i v e n i n s t a n t . E n e r g y i s p r op a g a te d w i t h t he s pe ed o f l i g ht ( 3 1 0 8 m /s e c i n v a c uum ) P.10 i n t h e Z d i r e ct io n . T h e r e l at io n s hi p be t w een w a v e l e ng t h ( ) , f r e q ue nc y ( ) , a n d v e l o ci t y o f p ro p a g at ion ( c ) i s g i v e n b y :

TABLE 1.1. ELEMENTARY PARTICLES a

Particle

S y m b ol

Charge

M a ss

E l e c t ro n

e-, -

-1

0 . 0 0 05 48 a m u

P o s i tr o n

e+, +

+1

0 . 0 0 05 48 a m u

P r o to n

p,

H+

+1

1 . 0 0 72 7 a m u

Neutron

n,

1 . 0 0 86 6 a m u

Neutrino

< 1 / 2 , 0 00 m 0 b

Mesons

II + , II -

+1, -1

273 m0

II

264 m0

+, -

+1, -1

207 m0

WWW.MEDRAD.IR

K+, K-

1, -1

967 m0

973 m0

T h i s i s o n l y a p a rt ia l li s t . M a ny o t her e l e me nt a r y p a rt i cl e s b e s id e s t he ones l i st e d ab o v e ha v e been d i s co v e r e d . m 0 = r e s t m a s s o f a n e l e ct r o n.

common
b

F I G . 1 . 6 . G r a p h s h o w i n g e l e ct ro m a g net i c wa v e a t a g i v e n i ns t a nt o f t i me . E a nd H a r e , r e s pe c ti v el y , th e p e a k a mp li t ude s o f e le c t ri c a nd m a g ne tic f i e ld s . T he t w o f i e l d s a re p e rp e n d i c ula r t o e a c h o t he r . In t h e a b o v e e q u a ti o n, c s h o u l d be e xp r e s s ed i n m et e r s / se c o nd ; , i n m e te r s ; a nd , in cycles/second or hertz. F i g u r e 1 .7 s h o w s a s p e c t r u m o f e le c t rom a g ne ti c r a di a ti o ns w i t h w a v e l e ngt hs r a n g i n g a n y w h e r e f r om 1 0 7 ( r a di o w a v e s ) t o 1 0 - 1 3 m ( ul t r a hig h e ne r g y x - r a y s ) . S i n c e w a v e l e n g t h a nd f r e q u e n c y a r e i nv er s e l y r el a t ed , t he f r eq ue nc y s p e c t r um c o r r e s po n di n g t o t h e a b o v e r a n g e w il l be 3 1 0 1 - 3 1 0 2 1 c y c l e s / s e c . O nl y a very small po rt io n of the el e ct r o m ag ne ti c s p e ct r um c o ns ti t ut e s v i si b le li g ht b a n d s . T h e w a v e le n g th s o f t h e w a v e to w hic h t he hum a n e y e re sp o nd s r a nge f ro m 4 1 0 - 7 ( b l u e li g h t ) to 7 1 0 - 7 m ( r e d ) . The wave nature of the e le c t ro m a g net i c r a d i a ti o n can be de m o ns t r at ed by e x p e r im e nt s i n v o l v i n g p h e n o m e n a s uc h a s i nt e r f er e nc e a nd d i f fr a c t io n o f li g ht . S i m i l ar e f f e ct s h a v e b e e n o b se r v e d wi t h x - r a y s us i ng c r y s t a ls w hi c h p o s s e s s i n t e r at o mi c wavelength s p a ci n g be c o me s c o m p a r ab l e very small to or t he t he x-ray w a v e l e ng t hs . b e c o me s However, very as t he t he f r e q ue nc y large,

WWW.MEDRAD.IR

d o mi n a n t

b e h a v io r

of

e l e ct r o m ag ne ti c

r ad i a ti o ns

can

o nl y

be

e x p l ai ne d

by

c o n s i d er i n g t h ei r p a rt ic l e o r q u a n t um na t ur e.

B. Quantum Model
T o e x p l ai n t h e r e s u lts o f c e r t ai n e x p e ri m ent s i nv o l v i ng i nt e r a cti o n o f r a di a ti o n w i t h m a tt e r , s u c h a s th e p h o to el e ct r i c e f f e ct a nd t he C o mp to n s ca t t er i ng , o ne ha s t o c o n s id e r P.11 e l e ct r om a g n et i c r ad i at io n s a s p a r ti c le s r at he r t ha n w a v e s . T he a m o unt o f e ne rg y c a r r i e d b y s u c h a p a c k e t o f e n e r g y , o r p hoto n, i s g i v e n b y :

F I G . 1 . 7 . T h e e l e ct r om a g n e ti c s p e ct r um . R a ng e s a r e a p p ro x i m ate .

w h e r e E i s t h e e n e rgy ( j o u l e s ) ca r r ie d b y t he p hot o n, h i s t he P l a nc k ' s c o ns t a nt (6.62 10-34 J - s e c ), and i s t he f r eque nc y ( c y c l e s / s e c o nd) . By c o m b i ni ng e q u a t io n s 1 . 2 a n d 1 . 3, w e h a v e :

If E i s to be e x pr e s s ed i n e l e ct ro n v o lt s (eV ) a nd i n me te r s (m ) , t he n, s i nc e 1 eV = 1.602 10-19 J,

T h e a b o v e e q u a ti o n s i n d i c at e t ha t a s t he w a v e l e ngt h b e co m e s s ho r t er o r t he f r e q u e n c y b e c o me s l ar g e r , t h e e n er g y o f t he p ho to n b e co m e s g r ea t e r . T hi s i s al s o seen in Fig. 1.7.

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 2 - Nuclear Transfor mations

2 Nuclear Transformations
2.1. RADIOACTIVITY
P.12

R a d i o a ct i vi t y , f i r st d is c o v e r e d b y H e nri Bec q ue r e l i n 1 8 96 , i s a p he no m e no n i n w h i c h r a d i a t io n i s g i ve n o f f b y t h e n uc l e i o f t he e l e me nt s . T hi s r a d i a ti o n c a n b e i n t h e f o r m o f p a r ti c le s , e l e ct r om a g net i c r a di a ti o n, o r b ot h. F i g u r e 2 . 1 i ll u s t r at e s a m e t h o d i n w hi c h r a d i a tio n e m it te d by r a d i um c a n b e s e p a r a te d b y a m a g n e t i c fi el d . S i nc e p ar t i cl e s ( hel i um nuc l e i) a r e p o si ti v el y c h a r g e d a n d - p a rt i cle s ( e le c t ro ns ) a r e nega t i v el y c ha r g e d , t he y a r e d e fl e c te d i n o p po s it e di r e ct io n s . T h e d i f f e r e n c e i n t he ra d i i o f c ur v a t ur e i nd ic a t e s t ha t t he p a r t i cl e s a re m u c h h e a v i e r t h a n p a rt i cl e s . O n t he o t he r ha nd , r a y s , w hi c h a r e s i m il a r t o x - r a y s e x c ep t fo r t h ei r nuc le a r or i g i n, ha v e no c ha r g e a nd , t he re f o r e , a r e u n a f f e c t e d b y t h e m a g n e ti c f i e ld . It w a s m e n t i o n e d i n t h e f i r s t c ha p t e r ( se c t io n 1 . 6 ) t ha t t he re i s a p o te nt i al b a r r i er p r e v e n ti n g p ar t i cl e s f r o m e nte r i ng o r e s c a pi ng t he nuc l eus . A l t ho ug h t he p a r t i cl e s i n s i de t h e n u c l e u s p o s s e s s k i net i c e ne rg y , t hi s e ne rg y , i n a s t a b le n u c l e u s , i s n o t s u f f i c i e n t f o r a n y o f t he p a r t i cl e s to p e net r a te t he nuc l e a r b a r r i er . H o w e v e r , a r ad io a c ti v e n u c l e u s h a s e x c e s s e ne r g y t hat i s c o ns tant l y r ed i st r i b ut e d a m o n g t h e n u c l e o n s b y m u t u a l c o l li s io ns . A s a m a t t e r o f p r ob ab i li t y , o ne o f t he p a r t i cl e s m a y g a i n e n o u g h e n e r g y t o e s c a pe f r o m t he nuc l e us , t hus e na b l i ng t he n u c l e u s t o a c h i e v e a s t a t e o f lo w e r e ne rg y . A l s o , t he e mi s s io n of a p a r t i cl e m ay s t il l l e a v e t h e n u c l e u s i n a n e x c i t ed s t at e . In t ha t c a s e , t he nuc l eus w i l l c o nt i nue s t e pp i n g do w n t o t h e l o w e r e n e rg y s t a te s by e m i tt i ng p a rt i cl e s o r r a y s unt i l t he s t a b le o r t h e gr o u n d s t a t e h a s b ee n a c hi e v ed .

2.2. DECAY CONSTANT

T h e p r o c e s s o f r a di oa c t i v e de c a y o r d i si nt e g r ati o n i s a s t at i st ic a l p he no m e no n. W h e r e a s i t i s n ot po ss i b le to k n o w w he n a p a r t i c ul a r at o m w il l d i s i nt e g r at e , o ne c a n a c c u r a t e l y p r ed i ct , i n a l a rg e co ll e ct io n o f at o m s , t he p rop o rt io n t ha t w i ll d i s i nt e g r at e i n a g i ven t i m e . T h e m at he m at i c s o f r a d io a c ti v e dec a y i s b a s e d o n t h e s im p le f a ct t h a t th e n u m b e r o f a to m s di s i nte g r at i ng p e r uni t t i me , ( N / t ) i s p r o po r tio na l to t h e n u m b e r o f r a di o a ct i v e ato m s , ( N ) p r e s e nt . S y m b ol i c al l y ,

w h e r e i s a c o n s t a n t o f p r o po r ti o nal it y c a l le d t he d e c a y c o ns t a nt . T he m i nus s i g n i n d i c at e s t h a t t h e n u m b e r o f t h e r a di o a cti v e a t o m s de c r e a se s w i th t i m e .

WWW.MEDRAD.IR

If N a n d t a re so s m a ll t h a t t he y c a n b e r e pl a c ed b y t heir c o r re s po nd i ng d i f f e r e n ti a l s , d N a n d d t , t h e n E q ua t io n 2 .1 b e co m e s a di f f e r e ntia l eq ua t io n. T he s o l u ti o n o f t h i s eq u a t io n y i e l d s t h e f o ll o w i ng e q ua t io n:

w h e r e N 0 i s t h e i n it i al n u m b e r o f r a d i o a ct i ve a t o m s a nd e i s t he num b e r d e no ti ng t h e b a s e o f t h e n a t u r a l l og a r it h m ( e = 2 . 7 1 8 ) . E q ua t io n 2 . 2 i s t he w e l l - k no w n e x p o n e n ti a l eq u a t io n f o r r a d io a c ti v e de c a y .

FIG.

2.1.

D i a g r a m ma t i c e mi tt e d by

r ep r e se nt a ti o n u nd e r t he

of

t he

s e p a r a ti o n of

of

t hr e e f i e ld

t y pe s

of

r a d i at io n

radium

i nf l ue nc e

m ag ne tic

( ap p li ed

p e r pe n d i c u l a r t o t h e pl a n e o f t h e p a pe r ) . P.13

2.3. ACTIVITY
T h e r a t e o f de c a y i s re f e r r e d to a s t he a ct iv i t y o f a r a di o a ct i v e m a t e ri a l . If N / t i n E q u a t i o n 2 . 1 i s r ep la c e d b y A , t he s y m b o l f o r a c t i v it y , t he n:

S i m i l ar l y , E q u a t io n 2 . 2 c a n b e e x p r e s s ed i n t e r m s o f a c ti v i t y :

w h e r e A i s t h e a ct i vi ty r e m a i n i n g at ti m e t , a nd A 0 i s t he o ri g i nal a c t i v it y e q ua l to N0. T h e u n i t o f a c t i v i t y i s t h e c u r i e ( C i ) , d e f i ned a s : 1 C i = 3 . 7 1 0 1 0 d i sin t e g r at io n s / s e c ( d p s ) 1 F r a c t io n s o f t h i s u n i t a r e : 1 mCi = 10-3 Ci = 3.7 107 dps 1 Ci = 10-6 Ci = 3.7 104 dps 1 nCi = 10-9 Ci = 3.7 101 dps 1 pCi = 10-12 Ci = 3.7 10-2 dps T h e S I u n i t f o r a c ti v it y i s b e cq u e r el ( Bq ) . T he be c q ue r el i s a sm a l le r b ut mo r e b a s i c u n i t t h a n t h e c u r i e a n d i s d e fi ne d a s : 1 Bq = 1 dps = 2.70 10-11 Ci

WWW.MEDRAD.IR

2.4. THE HALF-LIFE AND THE MEAN LIFE

T h e t e r m h a l f - li f e ( T 1 / 2 ) o f a r a d io a c ti v e s ubs t a nc e i s de f i ne d a s the t i m e re q ui re d f o r e it h e r t h e a c ti v i ty o r t h e n u m b e r o f r a d i o a cti v e a t om s t o d e c a y t o ha l f t he i n i ti a l v a l u e . B y s u b s t it u t i n g N / N 0 = i n E q ua t i o n 2 . 2 o r A / A 0 = i n E q ua t i o n 2.4, at t = T1/2, we have:

P.14

w h e r e l n 2 i s t h e n a t u r a l l og a r it h m o f 2 ha v i ng a v a l ue o f 0 . 6 9 3 . T he r e f o r e ,

F I G . 2 . 2 . G e n e r a l de ca y c u r v e . A c t i v i t y a s a p e r c e nt a ge o f i nit i al a c t i v i t y pl ot te d against ti m e in units of half-life. A, p l ot on li ne a r g r a ph; B, plot on s e m il o g ar it h m i c g r a p h. F i g u r e 2 . 2 A il l u s t r at e s t h e e x p o n e nti a l d e cay o f a r a d i o a c ti v e s a mp l e a s a f unc t i o n o f ti m e , e x p r e s s ed i n u n i t s o f h a l f - li f e . It ca n b e s ee n t ha t a f t e r o ne ha l f - li f e , t he a c t i v it y i s t h e i n i tia l v a l u e , a ft e r t w o ha l f - l i v e s , it i s , a nd so o n. T hus , a f t er n h a l f - l i v e s , t h e a c t i v it y w i l l be r e d uc ed t o n o f t he i nit i al v a l ue . A l t h o u g h a n e x po n e n ti a l f u n c t io n c a n b e p lo tt e d o n a l i ne a r g r ap h ( F i g . 2 .2 A ) , i t is be tt e r p lo tt ed on a s e mi lo g p a pe r be c a us e it y ie ld s a s t r a i g ht li ne , as d e m o n st r a te d i n Fi g . 2 . 2 B . T h i s ge ne r a l c urv e a p pl ie s t o a ny r a dio a c ti v e m at e ri a l

WWW.MEDRAD.IR

a n d c a n b e u s e d to d et e r mi n e t h e f r a c tio na l a c t i v it y r e m ai ni ng i f t he e l ap s ed ti m e i s e x p r e s se d a s a f r a c t io n o f h a l f - l i f e . T h e m e a n o r a v e r a g e l i f e i s t h e a v e r a ge l i f et i me f o r t he d e c ay o f r a d i o a c ti v e a t o m s . A lt h o u g h , i n t h e o r y , it w i ll t a k e an i nf i ni t e a m o unt o f t i me f o r a ll t he a t o m s to d e c a y , t he co n c e p t o f a v e r a ge l i f e ( T a ) c a n b e und e r s too d i n te r m s o f a n i m a gi n a r y s o u r c e t h a t d e c a y s a t a c o ns t a nt r a t e e q ua l to t he i nit i al a c t i v it y a nd p r o d u c e s t h e s a m e t ot a l n u m b e r o f d i s i nt eg r a t io ns a s t he gi v e n s o ur c e d e c a y i ng e x p o n e n ti a ll y f r o m t im e t = 0 t o t = . B e c a us e t he i ni ti a l a ct iv i t y = N 0 ( f r o m E q u a t i o n 2 . 3 ) a n d t he to t al n u m b e r o f d i si nt e g ra ti o ns m us t b e e q ua l t o N 0 , w e have:

C o m p a r i n g E q u a ti o n s 2 . 5 a n d 2 . 6 , w e o b t ai n t he f o l lo w i ng r e l at io ns hi p b e t we e n h a l f - l i f e a n d a v e r a g e li f e :

Example 1
P.15

Calculate the number of atoms in 1 g of W h a t i s t h e a c t i vi t y o f 1 g o f

226

226

Ra .

R a ( ha l f - l i f e = 1 , 6 2 2 y e a r s ) ?

In s e c t i o n 1 . 3 , w e s ho w e d t ha t :

w h e r e N A = A v o g a d ro 's num b e r = 6 . 0 2 1 0 2 3 a to m s p e r g r a m a tom i c w e i g h t a n d A W i s t he a t o m i c w ei g ht . A l so , w e s t a t e d i n t he s a m e s e c t io n t h a t A W i s v e ry ne a r l y eq ua l to t he m a s s num b e r . T he re f o r e , for

226

Ra

A c t i v it y = N ( E q u a t i o n 2 . 3 , i g no r i ng t he m i nus s i g n) . S i nc e N = 2 . 6 6 1 0 2 1 at o m s /g ( e x a m p le a b o v e ) a nd :

Therefore,

WWW.MEDRAD.IR

T h e a c t i v it y p e r u n it m a s s o f a r a di o nuc l id e i s t e rm e d t he s pec i f i c a c ti v it y . A s s h o w n i n t h e p re v i o u s e x a m p le , t he s p e ci f i c a c t i v it y o f ra d i um i s s l i g ht l y le s s t ha n 1 C i / g , a lt h o u g h t h e c u r i e w a s o ri g i nal l y d e f i ne d a s t he de c ay r a t e o f 1 g o f r a d i u m . T h e re a s o n f o r t h i s d i s c re p a nc y , as m e nti o ned p re v io us ly , i s t he c ur r e nt r e v i s io n o f t h e a c t u a l d e c a y r a te o f r ad i um w i t ho ut m o di f i c at ion o f t he o ri gi na l d e f i n it io n o f t h e c u r i e . H i g h s p e c i f i c a c ti v i t y o f c e r t a i n r a d io nuc l ide s c a n b e a d v a nt a g e ous f o r a num b e r of a p p li c a ti o n s . For example, t he us e of e l e m e nt s as tracers in s t ud y i ng b i o c h em i c al p ro c e s se s r e q u i re s t ha t t he m as s o f t he i nc o r po r a te d e le m e nt s ho uld b e s o s ma ll t h a t i t d o e s no t i n t e r f e re w it h t he no r m al m et a bo li s m a nd y e t it s h o u l d e x h i b it m e a s ur a b l e a ct i v it y . A no t her e x a m p l e i s t he us e o f r a d i oi s ot op e s a s t e le t h e r ap y s o u r c es . O n e r e a s o n w hy c o b a l t -6 0 i s p r e fe r a bl e to c e s i um -1 3 7 , i n s p i te o f i t s l o w e r h a l f - l i f e (5 . 2 6 y e a r s f o r c a l c u l a ti o n s . ( It s h ou l d be a s s um ed in
60

C o v e r s us 3 0 . 0 ye a r s f o r c al c ul a ti o ns t ha t

137

C s ) i s it s sp e c i fi c

m u c h h i g he r s p e c i f i c a c t i v it y . T h e i nt e re s ted r e a de r m a y v e r i f y thi s f a c t b y a c t ua l t he s e t he a c t i v it ie s a r e f o r p u r e f o r m s o f t h e nuc l i d e s. )

Example 2

C a l c u l a t e t h e d e c a y co n s t a nt f o r c ob a lt - 6 0 ( T 1 / 2 = 5 . 26 y e a r s ) in uni t s o f month-1. W h a t w i l l b e t h e a c ti v it y o f a 5 , 0 0 0 - C i
60

Co s o ur c e a f t e r 4 y e a r s ?

F r o m E q u a t io n 2 . 5 , w e ha v e :

P.16

s i n c e T 1 / 2 = 5 . 2 6 y e a rs = 6 3 . 1 2 m o nt hs . T he r e f o re ,

t = 4 y e a r s = 4 8 m o nt hs . F r o m E q ua t i o ns 2 . 4 , w e ha v e :

WWW.MEDRAD.IR

A l t e r n at i v el y :

Therefore,

A l t e r n a ti v el y : decay curve

r e a di ng gi v e n in

t he Fig.

f r a ct io na l 2 .2 at

a ct iv i t y ti m e =

from 0.76

t he T1/2

uni v er s a l a nd the n

m u l t ip l y i n g i t w i t h t he i ni t i al a c ti v i t y , w e g et t he d e si r ed a ns w e r .

Example 3
When will 5 mCi of e q u a l a c ti v i ti e s ? f or A0 = 5 mCi and
131

I ( T 1 / 2 = 8 . 0 5 d a y s ) and 2 m C i o f I:

32

P ( T 1 / 2 = 1 4 . 3 d a y s ) ha v e

131

For and

32

P:

A0 = 2 mCi

S u p p o s e t h e a c t i vi ti es o f t h e t w o nuc l id es a r e e q ua l a f te r t da y s . T he n, f r o m Equation 2.4, 5 e-8.609

10-2 t

= 2 e-4.846

10-2 t

T a k i n g t h e n a t u r a l l og o f b o t h s i de s ,

A l t e r n a ti v el y , o n e m ay p l ot t h e a ct i v it y o f e a c h s a m p le a s a f unc t io n o f t i me . T he a c t i v it ie s o f t h e t w o s a m p l e s w i ll b e e q ua l a t t he t im e w he n t he t w o c ur v e s i n t e r se c t e a c h ot h e r .

2.5. RADIOACTIVE SERIES

T h e r e a r e a t ot a l o f 10 3 e le m e n t s k no w n t od a y . O f t he s e , t he f i r st 92 ( f ro m Z = 1 t o Z = 9 2 ) o c c u r n a t ur a l l y . T h e o t he r s ha v e b e e n p r od uc e d a rt i f i ci a ll y . In g e ne r a l , t h e el e me n t s wi t h l o we r Z t e n d to be st a ble w he r e a s t he o ne s w i t h hig he r Z a re r a d io a c ti v e . It P.17 a p p e a r s t h at a s t h e n u m b e r o f p a r ti c le s i nsi d e t he nuc l e us i nc r e a s e s , t he f o r c e s

WWW.MEDRAD.IR

t h a t k e e p t h e p a rt i cl es t o ge t h e r b e co m e l e ss e f f e c t i v e a nd , t her e fo r e , t he c ha nc e s o f p a r ti c le e m i s si o n ar e i n c r e a se d . T hi s i s s ug g e s te d b y t he o b se r v a t io n t ha t a ll e l e me n t s w i t h Z g r e ate r t h a n 8 2 ( l e ad ) a r e r a d io a c ti v e .

F I G . 2 . 3 . T h e u r a n i u m s e r i e s . ( D a t a f r o m U . S . D e p a r t m e nt o f H e a l t h, E d uc a t io n, and Welfare. R a d io lo gi c a l h e a lt h ha nd b o o k , rev. ed. W a s hi ng t o n, DC: U.S. G o v e r n m e n t P r i n ti n g O f f i c e , 1 9 7 0 . ) A l l n a t u r al l y o c c u r r i n g r a d io a c ti v e e le m e nt s ha v e b ee n g r o upe d int o t hr e e se r ie s : t h e u r a n i u m s e r i e s , th e a c t i n i u m s e ri e s , and t he t ho ri um s e r ies . T he ur a ni um s e r i e s o ri gi n a t e s w it h
238

U h a v i n g a ha l f -l i f e o f 4 . 5 1 1 0 9 y e a r s and g o e s t hr o ug h

a s e r ie s o f t r a n s f o r m at io n s i n v o l v i ng t he e mi s s io n o f a nd p a r tic l e s . r a y s a r e a l s o p ro d u c ed a s a r e s u l t o f s o m e o f t he s e t r a ns f o r m a t io ns . T he a c t i ni um s e r ie s s t a r t s f ro m with
232 235

U wi t h a h a l f - l i f e o f 7 . 1 3 1 0 8 y e a r s a nd t he t ho r i um s e r ie s be gi ns

T h w i t h h a l f - l i fe o f 1 . 3 9 1 0 1 0 y e a r s. A l l t he s e ri e s te r m i na t e a t t he s t a bl e

WWW.MEDRAD.IR

i s ot op e s o f l e ad w ith m a s s n u m b e r s 2 06, 2 0 7 , a nd 2 0 8 , re sp e c ti v e l y . A s a n e x a m p le a n d b e c a u s e i t i n c l u d e s r ad i um a s o ne o f it s de c a y p ro d uc t s , t he ur a ni um s e r i e s i s r e p re s e n te d in F i g . 2 . 3 .

2.6. RADIOACTIVE EQUILIBRIUM

Many r a d i o a c ti v e n u c l i de s u n d e r go s uc c e s s i v e tr a ns f o r m a ti ons in w hi c h t he o r i gi n a l n u c l i de , c a l l ed t h e p a r e nt , g i v e s ri s e to a r a d i o a ct i v e p r o d uc t nuc l id e , c a l l ed t h e d a u g h te r . T h e n a t u r a l l y o c c ur r i ng r a d i o a ct i v e s e ri e s p ro v i de s e x a m p le s o f s u c h t r a n s i t io n s . If t h e h a l f - l i f e o f t he p a r e nt i s l o nge r tha n t ha t o f t he d a u g h t e r , t h e n a f t e r a c e r t ai n ti m e , a c o nd i ti o n o f eq ui li b ri um w i l l b e a c hi e v ed , t h a t i s , t h e r a ti o o f d a u g h t e r a c t i vi t y to p a re nt a c t i vi t y P.18 w i l l b e co m e c o n s t a n t. In a d d i ti o n, t he ap p a r e nt d e c a y r at e o f t he d a ug ht e r n u c l i d e i s t h e n go v e r ne d b y t h e h a l f - l i f e o r d i s i nt e g r at io n r a t e o f t he p a r e nt .

F I G . 2 . 4 . Il l u s t r at io n o f t r a n s ie n t e q uil ib r i um b y t he de c a y o f b e e n a s s u m e d t h a t o n l y 8 8 % o f t he
99

99

Mo to

99m

T c . It ha s

M o a tom s d e c a y t o

99m

Tc.

T w o k i n d s o f r a d i o a ct iv e e q u i li b ri a ha v e b e en d e f i ne d , d e pe nd i ng o n t he ha l f - l i v es o f t h e p a r e nt a n d t h e d a u g h t e r n uc l i de s . If t he ha l f - l i f e o f t he p ar e nt i s not m uc h l o n g er t h a n t h a t o f t h e d a u g h t er , t he n the t y p e o f e q uil ib r i um e s t a bl is he d is c a l l ed t h e t r a n s ie n t eq u i l ib r i u m . O n t he o the r ha nd , i f t he ha l f - l i f e o f t he p a r e nt i s m u c h l o n g e r t h a n t h a t o f t h e d a ug ht e r , the n i t c a n g i v e r i s e to w ha t i s k no w n a s t h e s e c u l a r e q u il ib ri u m .

WWW.MEDRAD.IR

F i g u r e 2 . 4 i ll u s t r at e s t h e tr a n s i e nt e q uil ib r ium b e t we e n t he p a rent h) and the daughter parent,

99m

99

M o ( T 1 / 2 = 67

T c ( T 1 / 2 = 6 h) . T he s e c ul a r e q uil i b ri um i s i ll us t r a te d i n F i g .
222

2.5 showing the case of

226

R n ( T 1 / 2 = 3 . 8 d a y s ) a c hi e v i ng e q ui li b r i um w it h i t s

R a ( T 1 / 2 = 1 ,6 2 2 y e a r s ) .

A g e n e r a l e q u a ti o n c a n b e d e ri v e d re l ati ng t he a ct i v it ie s o f t he p a r e nt a nd daughter:

w h e r e A 1 a n d A 2 a r e th e a c t i v it ie s o f t he p ar e nt a nd t he d a ug hte r, r e s p e c ti v el y . 1 a n d 2 a r e t h e c o r re sp o n d i n g de c a y c o ns t ant s . In t e r m s o f t he ha l f - l i v e s , T 1 a nd T 2 , o f t h e p ar e n t a n d d a u g h t e r , r e sp e ct i v el y , t he a bo v e eq ua t io n c a n b e r e w r it te n as:

E q u a t i o n 2 . 9 , w h e n p l o tt e d , w i ll i nit i al l y e xhi b i t a g ro w t h c ur v e f o r t he d a ug ht er b e f o re a p pr o a c h i n g t he d e c a y c u r v e o f t he p a r e nt ( Fi g s . 2 . 4 a nd 2 . 5 ) . In t he c a s e o f a t r a n s i e n t eq u i li b ri u m , t h e t im e t t o r e ac h t he eq ui li b ri um v a lue i s v er y l a rge c o m p a re d w it h t h e h al f - l i f e o f t h e d a ug hte r. T hi s m a k e s t he e x po ne nt i al te r m i n E q u a t i o n 2 . 9 n e gl ig i bly s m a l l . P.19 T h u s , a f t e r t h e t r a n s ie n t e q u i li b ri um ha s b e e n a c hi e v e d , t he r e la t i v e a c ti v i ti e s o f t h e t w o n u c l i de s i s gi v e n b y :

WWW.MEDRAD.IR

F I G . 2 . 5 . Il l u s t r at io n o f s e c u l a r e q uil ib r i um b y t he d e c a y o f

226

R a to

222

R n.

o r i n t e r m s o f h a l f - l i ve s :

A p r a c t i c a l e x a mp le of t h e t r a n s i e nt e q uil ib r i um i s t he
99m

99

M o ge ne r a to r p r od uc i ng

T c f o r d i ag n o s ti c p r o c ed u r e s . S uc h a g e ne r a to r i s s o me tim e s c a ll e d co w
99m

b e c a u s e t h e d a u g h t er p r o d u c t , i n t hi s c as e

T c , i s r e mo v e d o r m i l k e d a t

r e g u l a r i n t er v a l s . E a ch t i me t h e g e ne r a to r is c o m pl et el y m il k e d , the g r o wt h o f t he d a u g h t e r a n d t h e d e ca y o f t h e p a r e nt a r e g o v e r ne d b y E q ua t io n 2 . 9 . It m a y b e m e n t io n e d that not

99

all

the

99

Mo

at om s

decay

to

99m

Tc.

A p p ro x i m a te l y
99m

12 %

p r o m pt l y d e c a y to c a l c u l a ti n g

Tc w i t h o u t p a s s i ng t hro ug h t he m e t a s t ab le s t a t e o f
99

Tc (1).

Thus the activity of

99m

M o s h o u l d b e e f f e c t i ve l y r e d uc ed b y 1 2 % fo r t he p ur po s e o f

T c a c t i v it y , u s i n g a ny o f E q ua t i o ns 2 . 8 , 2 . 9 , 2 . 10 , 2 . 1 1 .

S i n c e i n t h e c a s e o f a s e c u l a r eq ui li b ri um , the ha l f - l i f e o f t he p a re nt s ub s t a nc e i s v e r y l o n g c o m p a re d wi t h t h e h a l f - l i fe o f t he d a ug ht e r , 2 i s m uc h g r e a te r t ha n 1 . T h e r e f o r e , 1 c a n b e ig n o r e d i n E q ua t i o n 2 .8 :

WWW.MEDRAD.IR

E q u a t i o n 2 . 12 gi v e s th e i n i ti a l b ui ld up o f the d a ug ht e r nuc l id e , a p p r o a c hi ng t he a c t i v it y o f t h e p a r e nt a s y m p t ot i c al l y ( Fi g . 2. 5 ) . A t t he se c ul a r equi l i br i um , a f t e r a l o n g t i me , t h e p ro d uc t 2 t be c o me s l a rg e a nd t he e x po ne nt i al te r m i n E q ua t io n 2 . 1 2 a p pr o a c h e s z e ro . P.20 T h u s a t s e c u l a r e q u i l ib r i u m a n d t he r e a f te r :

or

R a d i u m s o u r c e i n a s e a l ed t u b e o r ne ed le ( t o k e e p i n t he r ad o n g a s ) i s a n e x c e ll e n t e x a m pl e o f s e c u l a r eq ui li b ri um . A f t e r a n i ni ti a l ti m e ( a p p r o xi m a te l y 1 m o n t h ) , a ll t h e d a u g ht e r p r od u c t s a re i n e qui l i br i um w it h t he p a re nt a nd w e ha v e t h e r e l at io n s h i p :

2.7. MODES OF RADIOACTIVE DECAY A. Particle Decay

R a d i o a ct i ve n u c l i d e s w i t h v e r y h i g h a t o m i c num b e r s ( g r e a t er t ha n 8 2 ) d e c a y m o st f r e q u e n t l y w it h t h e em i s s io n o f a n p a rt ic l e . It ap p e ar s t hat as t he num b e r o f p r ot o n s i n t h e n u c l eu s i n c r e a s e s be y o nd 8 2 , t he C o ul om b f or c e s o f re p ul s io n b e t w ee n t h e p ro to n s b e c o me l a r ge e no ug h to o ve r c o me t he nuc l e a r fo r c e s t h at b i n d t h e n u c l eo n s t oge t h e r . T h u s t he uns t a b l e nuc l e us e mi t s a pa r t i cl e c om p o se d o f t w o p r ot o n s a n d t w o n e u t r o n s . T hi s p a r t ic l e , w hi c h i s i n f a c t a he l i um nuc l e us , i s c a l le d t h e p ar ti c l e. A s a r e s u lt o f d e c ay , t h e a to m i c num b e r o f t he nuc l e us i s r educ e d b y t w o a nd t h e m a s s n u m b e r i s re d u c e d b y f o ur . T hus a g e ne r a l r e a cti o n f o r d e c a y c a n b e w r i t te n a s :
A Z

A - 4

Z - 2

Y +

He + Q

w h e r e Q re p re s e n t s th e to t al e ne r g y re le as e d i n t he p ro c e s s and i s ca ll e d t he d i s i nt e g r ati o n e n e rg y . T h i s e n e r g y , w hi c h i s e q ui v a l e nt t o t he dif f e r e nc e i n m a s s b e t w ee n t h e p a r e n t n u c l e u s a n d p r o d uc t nuc l e i , a pp e a r s a s k i ne tic e ne r g y o f t he p a r t i cl e a n d t h e k i n eti c e n e r g y o f t he p ro duc t nuc l e us . T he e q u a t io n a l s o s ho w s t h a t t h e c h a r g e i s c on s e r v e d , b e c a us e t he c ha r g e o n t he p a r e nt nuc l e us i s Z e ( w h e r e e i s t h e e l e ct ro n i c c h a r g e ) ; o n t he p r o d uc t nuc l e us it i s ( Z - 2 ) e a nd o n t h e p a r ti c le i t i s 2 e . A t y p i c a l e x a m pl e o f d e c a y i s t he t r a ns f o rm a t io n o f r a d i um to r a d o n:

S i n c e t h e m o me n t u m o f t h e p a rt i cl e m us t b e e q ua l t o t he r e coi l mo m e n t um o f t h e r a do n n u c l e u s a n d s i n c e t he r ad o n nuc l e us i s m uc h he a v i e r t ha n t he p a r t i cl e , i t ca n b e s ho w n t h a t t h e k i ne ti c e ne r g y po s s e s s ed b y t he r a do n nuc l e us i s n e gl i gi bl y s m a ll ( 0 .0 9 M e V ) a n d t ha t t he d i si nt e gr a ti o n e ne rg y a p p e a r s a l mo st e n t i re l y a s t h e k i n e ti c e n e r g y o f t he p a r tic l e ( 4 . 78 M e V ) .

WWW.MEDRAD.IR

It h a s b e e n f o u n d t h a t t h e p a rt i cl e s e mi tt e d b y r a di o a ct i v e sub s t a nc e s ha v e k i n e t i c e n e rg i e s o f a bo u t 5 to 1 0 M e V . F rom a s pe c i f i c nuc l i de , t he y a r e e mi tt e d w i t h d i s c r et e e n er g ie s.

B. Particle Decay
T h e p r o c e s s o f r a d ioa c t i v e de c a y , w hi c h i s a c c o m p a ni e d b y the e j e c tio n o f a p o s it i ve o r a n eg a ti v e e le c t ro n f r o m t he nuc l e us , i s c a l l ed t he de c a y . T he n e g a t i ve e le c t ro n , o r n e g a t r o n , i s de no ted b y - , a nd t he p o si ti v e e le c t ro n, o r p o s it ro n , i s r e p r e se n te d b y + . N e it he r o f the s e p a r ti c l e s e x i s t s as s uc h i ns i d e t he nucleus but is created at the i ns t a nt of t he decay p r oc e s s . T he basic t r a n s f o r m a ti o n s m a y b e w r i tt e n a s :

where

n,

p,

a n d v s t a n d f o r n e u t ro n , p r ot o n , a nt i ne ut r ino , a nd ne ut r i no , r e spe c t i ve l y . T he l a st t w o p a rt i cl e s , n a me l y a n t i n e u t ri no a nd ne ut r i no , a re id e nti c a l pa r t i cl e s b ut w it h o p po s it e s pi n s . T h e y c a r r y n o c h a r g e a nd p r a c t i c al l y no m a s s .

F I G . 2 . 6 . r a y e n e r gy s p e c t r u m f r o m P.21

32

P.

B.1. Negatron Emission

T h e r a d io n u c l i de s w i th a n e x c e s s i v e num b e r o f ne ut ro ns o r a hi g h ne ut r o n- to p r ot o n ( n / p ) r at io li e a b o v e t h e r eg io n o f s ta b i li t y ( Fi g . 1 .1 ) . T he s e nuc l e i t e nd to r e d u c e t h e n / p ra ti o t o a c h i e v e s t ab il it y . T hi s i s a c c o mp li s hed b y em it ti ng a n e g a t i ve e le c t ro n . T h e d i re c t e m i s si o n o f a ne ut r o n to r ed uc e t he n/ p r a ti o i s r a t h e r u n c o m m o n a nd o c c u r s w i t h s om e nuc l e i p ro d uc e d a s a r e s ul t o f f i s s io n r e a c ti o n s . T h e g e n e r a l e q u at io n f o r t h e n e g a t ro n o r - d e c a y i s w r i tt e n a s :

WWW.MEDRAD.IR

w h e r e Q i s t h e di s i n te g r a ti o n e n e r g y fo r the p r o ce s s . T hi s e ne rg y i s p r o vi d ed b y t h e d i f f e r e n c e i n m a ss b e t w e e n t he i nit i al nuc l e us o f t h e p r od u c t n u c l e u s

A Z + 1 A Z

X a nd t he s um o f t he m a s s e s

Y a n d t he p a rt i cl es e m i tt ed .

T h e e n e r g y Q i s s h a red b et w e e n t he e mi tt ed p a r ti c le s (i nc l ud i ng r a y s i f e m it te d b y t h e d a u g ht e r n u c l eu s ) a n d t h e r e co il nuc l e us . T he k i ne ti c e ne rg y p o s se s s e d b y t h e r e co il n u c l e u s i s n e g l ig ib l e be c a us e o f i t s m uc h g re a te r m a ss c o m p a re d w i t h t h e e mi tt e d p a rt i cl e s . T h u s p r a c t i c a ll y t he e nt i re d i si nte g r at io n e ne r g y i s c a r ri ed b y t h e e m itt e d p a r ti c le s . If t h e r e w e r e o nl y o ne k i nd o f p a rt i cl e inv o l v e d , a ll t he p a r t i cl e s e mi tt ed i n su c h a d i si n t e g ra ti o n wo ul d ha v e t he s a m e ene r g y e q ua l to Q , t h u s y i e l di n g a s h a r p l i n e sp e c t r um . H o w ev e r , t he ob s e r v ed s pe c t r um i n t he d e c a y i s co n t i n u o u s , w h i c h s u g g e s t s t hat the r e i s mo r e t ha n o ne p a r ti c le e mi tt ed in this process. For these r e a s o ns , W ol f g a ng P a ul i ( 1 93 1 )
2

i nt r o d uc ed

t he

h y p o t h e s i s t h at a s e c on d p a r t i cl e , l a te r k no w n a s t he ne ut r i no , p a r ti c le e m it te d a n d s h a r e d t h e a v a i l a bl e e ne r g y .

a c c o m p a nie d e a c h

T h e e x p e ri m e n ta l d a ta s h o w t h at t he pa r t i cl e s a r e e mi tt e d w i t h a ll e ne r gi e s r a n g i n g f r o m z e ro t o t h e m a x i m um e ne r gy c ha r a c t e r i st i c o f the t r a nsi ti o n. F i g u r e 2 . 6 s h o w s t h e d i s t r ib u t io n o f e ne rg y a m o ng t he p a rti c l e s o f o v e r a ll t r a n s it io n i s :

32

P . T he

A s s e e n i n F i g . 2 . 6 , t h e e n d po i n t e ne r g y o f t he - r a y s pe c t r um i s e q ua l t o t he d i s i nt e g r at io n e n e rg y a n d i s de s i g nat e d by E m a x , t he m a x im um e l e ct ro n e ne r g y . Although the shape of the e ne rg y s pec t r um a nd t he v a l ue s for Emax are c h a r a c t e r i st i c o f t h e p a r t i c u l a r n u c l i d e , t he a v e r a g e e ne r g y o f t he p a r t i cl e s f r om a e m it te r i s a p p ro x im a t el y E m a x / 3 . The neutrino has no charge a nd w it h p r a ct i ca l l y m a tt e r i s no very mass. s m al l Fo r tha t t he reason t he is p r o b ab il it y e x t r e me l y P.22 p r e di c te d t h e s h a p e of t h e - r a y sp e ct r a . Re c e nt l y , t he e xi s t e nce o f ne ut r i no s ha s b e e n v e r i f ie d b y d ir e ct e x p e ri m e n t s . o f i t s i n te r a c ti o n di f f i c u l t . However, a nd i t s d et e c tio n

F e r mi

s uc c e s s f ul l y

p r e se nt ed

t heo r et i cal

e v i d e n c e o f t h e e x i s ten c e o f t h e ne ut r i no a nd

B.2. Positron Emission

P o s i tr o n - e mi tt i n g n u cl i de s h a v e a de f i c it o f ne ut r o ns , a nd t heir n/ p r a t io s a re l o w e r t h a n t ho s e o f t h e st a b le nuc l ei o f t he s a me at o mi c num b e r o r ne ut r o n n u m b e r ( F i g . 1 .1 ) . F or t h e s e n u c l id e s t o a chi e v e s t ab il it y , t he de c a y m o de m u s t r e s u l t i n a n i n c r e a s e o f t h e n / p r a t io . O ne p o s s ib le m od e i s t he d e c a y i nv ol v i ng t h e e m i s si o n o f a p o si ti v e e le c t ro n o r p o si tr o n. T he o v e r a l l d e c ay r e a c t i o n i s as f o l lo w s :
A Z

Z-1

Y +

+1

+ v + Q

A s i n t h e c a s e o f t h e n e g a t ro n e mi s s io n, d is c us s e d p re v i o usl y , the d i si nt eg r a ti on e n e r g y Q i s s h a r e d by t h e p o si tr o n, t he ne ut r i no , a nd a ny r ay s e m i tt ed b y t he d a u g h t e r n u c l e u s . A ls o , l i k e t h e ne g at r ons , t he p o s it r o ns a re e m it te d w it h a s p e c t r u m o f e n e rg ie s . A s p e c i f i c e x a m pl e o f p o s it ro n e m i s s io n i s the d e c a y o f

22 11

Na:

WWW.MEDRAD.IR

T h e r e l e a se d e n e r g y , 1 . 8 2 M e V , i s t he s um o f t he m a x im um k i ne ti c e ne rg y o f t he p o s it ro n , 0 . 5 4 5 M e V , a n d t h e e n e r g y o f t he r a y , 1 . 2 7 5 M e V . A n e n e r g y l e v e l di a g ra m f o r t h e p o si t ro n de c a y o f a r r o w r e p r e se n ti n g
+ 22 11

N a i s s ho wn i n F i g . 2 . 7 . T he

d e c a y s t a r t s f r o m a p o i nt 2 m 0 c 2 ( = 1 . 0 2 M e V ) b e l o w t he

e n e r g y s ta t e o f t h e p ar e n t n u c l e u s . T hi s e x c e s s e ne rg y , w hi c h i s the e q ui v al e nt o f t w o e le c t ro n m a s s e s , m u s t b e a v a i l ab le a s p a r t o f t he t r a nsi ti on e ne r g y f o r t he p o s it ro n e mi s s io n to ta k e p l a ce . In ot he r wo r d s , t he e ne r g y l e v el s o f t he p a r e nt a n d t h e d a u g h t e r n u c l e u s m u s t b e s e p a r ate d b y m o r e t ha n 1 . 20 M e V f o r t he + d e c a y t o o c c u r . A l s o , i t c a n b e s ho w n t ha t t he e ne r g y r e le a s e d i s g i v e n b y t he a t o mi c m a s s d i f f e re n c e b e t we e n t he p a re nt a nd t he d a ug ht e r nuc l i de s m i nus t he 2 m 0 c 2 . T h e p o si t ro n is u n s t a b l e a nd e v e ntua l l y c o mb i ne s wi t h a no t he r e l e ct ro n, p r o d u c i n g a n n i h i l a ti o n o f t h e p a rt i cl e s . T his e v e nt r e s ult s i n t w o r a y p ho to ns , e a c h o f 0 . 5 1 M e V , t h u s c o n v e r t i n g t wo e le c tr o n m a s s e s i nt o e ne r gy .

C. Electron Capture
T h e e l e ct r o n c a pt u r e i s a p h e n o me no n i n w hi c h o ne o f t he o rb i t al el e ct r o ns i s c a p t u r e d b y t h e n u c l eu s , t h u s t r a ns f o r m i ng a p r o to n i nt o a ne ut ron:
1 1

p +

-1

n + v

F I G . 2 . 7 . E n e r g y l e v el d i a gr a m f o r t he po s it r o n d e c a y o f P.23

22

11

Na to

22

10

Ne.

T h e g e n e r a l e q u at io n o f t h e n u c l e a r d e c a y is :
A Z

X +

-1

Z-1

Y + v + Q

T h e e l e ct ro n c a p t u r e is a n a l te r n a t i v e p ro c es s t o t he p o si t ro n de ca y . T he uns t a b l e n u c l e i w i t h n e u t r o n de f i c ie n c y m a y i nc r e a s e t he i r n/ p r a ti o to g a i n s t a bi li t y b y e l e ct r o n c a p t u re . A s il l u s t r at ed i n F i g . 2 . 7 ,
22 11

N a de c a y s 10 % of t he t i me b y K

WWW.MEDRAD.IR

e l e ct r o n c a pt u r e . T h e r e s u l ti n g nuc l e us i s s t il l i n t he e x c it e d sta t e a nd r el e a se s i t s e x c e s s e n e r g y b y t h e e m i s si o n o f a r a y p hot o n. In g e ner a l , t he de c a y f o l lo w s t h e p a rt i cl e em i s s io n a l m o st i ns t a nt a ne o us l y ( le s s t ha n 1 0 - 9 s e c ) . T h e e l e c t ro n c a p t u r e p r o c e s s i n v ol v e s m o stl y t he K s he l l e l e ct r on b e c a us e o f i t s c l o s e n e ss t o t h e n u c le u s . T h e p r o c e s s i s t he n r e f e r r e d t o a s K c a p t ur e . H o w e v e r , o t h e r L o r M c a p t u r e pr o c e s s e s a re a l s o p o s si b le i n s o m e c a se s . T h e d e c a y b y e le c t ro n c a p t u r e c r e at e s a n em p t y hol e i n t he i nv o lv e d s he ll t ha t i s t h e n f i ll e d w i t h a n ot he r o u te r o r bi t e le c t ron, t hus g i v i ng r i se t o t he c ha r a c t er i st i c x - r a y s . T h e r e i s a l so t h e em i s si o n o f A ug e r el e ct r o ns , w hi c h ar e m o no e ne r ge ti c e l e ct r o n s p ro d u c e d by t h e a b s o r p ti o n o f c ha r a c t e r i st i c x - r a y s b y t he a t o m a nd r e e mi s s io n o f t h e e n er g y i n t h e f o r m o f o rb i t al e le c t ro ns e je c ted f r o m t he at om . T h e p r o c e s s c a n b e c r u d e l y d e s c ri b ed a s i nt e r na l p hot oe le c t ric e f f e c t ( t o be d i s c u s s e d i n l at e r c h ap t e r s ) p ro d uc ed b y the i nt e r a c ti o n o f t he e l e ct r o n c a pt ur e c h a r a c t e r i st i c x - r a y s w i t h t h e s a m e a to m .

D. Internal Conversion
T h e e m i s s io n o f r a y s f r o m t h e nuc l e us i s o ne m o de b y w hi c h a n uc l e us l e f t i n a n e x c i te d s t at e a ft e r a n u c l e a r t r a ns f o r m at ion g e t s ri d o f e x c e s s e ne r g y . T he r e i s a n o t h e r co m pe ti n g me c h a n i s m , c a l le d i nter na l c o nv e r s io n, b y whi c h t he nuc l e us c a n l o s e e ne r g y . In t h i s p r o ce s s , t he e x c e s s nuc l e a r e ne r g y i s p a ss e d o n to o ne o f t h e o r bi t al e le c t ro n s , w h i c h i s t he n e j e c t ed f r o m t he a t om . T he p r o c e s s c a n b e c r u d e l y li k e n e d t o a n i n t e r n a l p hot o el e ct r ic e f f e c t i n w hi c h t he r a y e s c a p i ng f r o m t h e n u c l e u s i n ter a c t s w it h a n o rb it a l e l e ct r o n o f t he s a m e a t o m . T he k i ne ti c e n e r g y o f t h e i n te r n a l co n v e r s i o n e le c t ron i s eq ua l t o e ne rg y r e le a s ed b y t he n u c l e u s m i n u s t h e b i n d i n g e n e r g y o f t he o r bi t al e le c t ro n i nv o l v e d . A s d i s c u s s e d i n t h e c a s e o f t h e e l ec t ro n c a p t ur e , t he e j e ct ion o f a n o r b i ta l e l e ct r o n b y i n t e r n al conversion w il l cr ea t e a v a c a nc y in t he i nv o l v ed s he ll , r e s u l ti n g i n t h e p r od u c t io n o f c h a r a c t e r i st i c p ho t o ns o r A ug e r el ec t r o ns .

D.1. Isomeric Transition

In most r a d i o a ct i v e t r a n s f o r m a t io ns , t he d a ug ht e r nuc l e us loses t he excess e n e r g y i m me di a te l y in t h e f o r m o f r a y s o r b y i nte r na l co nv e r s i o n. H o w e v e r , in t h e c a s e o f so m e n u c l i d e s , t h e e x c it e d s t a t e o f t he nuc l e us p e r si s t s f o r a n a p p r e ci a bl e m e t a st a b le ti m e . In that case, t he e x c it e d nuc l e us is s ai d to e xi s t f i na l in t he s t at e . T h e m e t a st a bl e nuc l e us i s a n i s o m e r o f the p r o d uc t

n u c l e u s w h i c h h a s t h e s a m e a to m i c a nd m as s num b e r b ut d i f f e rent e ne r g y s t at e . A n e x a m p l e o f s u c h a n u c l i d e c o m m o nl y us e d i n nuc l e a r m e d i ci ne i s i s a n i s o me r o f decay of

99 99 99m

T c , w hi c h

T c . A s d i s c u s s e d e ar li e r (s e c t io n 2 . 6 ) ,
99

99m

T c i s p r o d uc ed b y t he

M o ( T 1 / 2 = 67 h o u r s ) a nd i t s e l f dec a y s t o

T c w i t h a ha l f - l i f e o f 6 ho ur s .

2.8. NUCLEAR REACTIONS A. The ,p Reaction

T h e f i r s t n u c l e a r r e a cti o n w a s o b s er v e d b y Rut he r f o r d i n 19 1 9 i n a n e x p e r i m e nt i n w h i c h h e b o m b a r d ed n i t r o ge n g a s w i t h p a r t i cl e s f r o m a r ad i o a ct i ve s o ur c e . R u t h e r f o r d ' s o ri gi n a l tr a n s m u t a t io n r e a c ti o n c a n b e w r i t t e n a s :
14 7

N +

He

17

O +

H + Q

WWW.MEDRAD.IR

w h e r e Q g e n e r al l y r ep r e s e n t s t h e e ne rg y r e l e a se d o r a b so r b ed d ur i ng a nuc l e a r r e a c ti o n . If Q i s p o s it i v e , e n e rg y ha s b e en r e l e a s ed a nd t he re a c t io n i s c a ll ed e x o e rg i c , a n d i f Q i s P.24 n e g a t i ve , e n e rg y h a s b ee n a b so r be d a nd t he re a c ti o n i s e nd oe r g i c . Q i s al s o c a l l ed n u c l e a r re a c tio n e n e r g y or d i si nt eg r a t io n e ne rg y ( a s de f i ne d e ar li e r i n d e c a y r e a c ti o n s ) a n d i s e q u a l to t he di f f e re nc e i n t he m a s s e s of t he i ni t i al a nd f i n a l p a r ti c le s . A s a n e x a m p le , Q m a y b e ca l c ul a te d f o r t he p re v i o us r e a ct io n a s f o l lo w s :

M a s s of I n i t i a l P a r t ic l e s ( a m u )

M a ss of F i n a l P a r ti c le s ( a m u )

14

N = 1 4 . 0 03 0 74

17

O = 1 6 . 9 99 1 33

T h e t o t al m a s s o f f i n a l p a r ti c le s i s g r e at e r tha n t ha t o f t he i ni t i al p a r t i cl e s . D i f f e r e n c e i n m a s s e s , m = 0 . 0 0 1 2 81 a m u Since 1 amu = 931 MeV, we get: Q = - 0 . 0 0 1 2 81 9 3 1 = - 1 . 1 9 M e V T h u s t h e a b o v e r e a c tio n i s e n d oe r gi c , t ha t i s , a t le a s t 1 .1 9 M e V o f e ne r g y m u s t b e s u p p li e d f o r t h e r ea c t io n t o t a k e pl a c e . T hi s m i ni m um r e q ui r ed e ne r g y i s c a l le d t h e t h r e s ho l d e n e rg y f o r t h e r e a ct io n a nd m us t be a v a il a bl e f r o m t he k i ne tic e n e r g y o f t h e b om b a rd i n g p a rt i cl e . A r e a c t io n i n w h i c h a n p a r t i cl e i nt e r a ct s w i t h a nuc l e us t o f or m a c o m po und n u c l e u s w h i c h , i n t u r n , d i s i n t eg r a te s i mm e d i at el y i nto a ne w nuc l e us b y t he e j e ct io n o f a p r o to n i s c a l l e d a n , p r e a ct io n. T he f i r s t l e tt e r , , s t a nd s f o r t he b o m b a rd i n g p a r ti c le an d t h e s e co nd le tt e r , p , s t a nd s f o r t he ej ec t e d p a r ti c le , i n t h i s c a s e a p r ot o n . T h e g e n e r a l re a c ti o n o f thi s t y p e i s w r it t e n a s :
A Z

X +

He

A + 3

Z + 1

Y +

H + Q
A

A s i m p le r n o ta ti o n to r e p r e se n t t he p r e v ious r e a c t io n i s b e d et e r mi n e d b y t h e o t h e r . )

X ( ,p ) A

Y . ( It i s no t

n e c e s s a r y t o w r it e t he a t o mi c n u m b e r Z w i t h t he c he m i c a l s y m bo l , s i nc e o ne c a n

B. The ,n Reaction
T h e b o mb a r d me n t o f a n u c l e u s b y p a r ti cl e s w it h t he s ub s e q ue nt e mi s s io n o f n e u t r o n s i s d e si g n a ted a s a n , n r e a cti o n. A n e x a m p l e o f t hi s t y p e o f r e a ct io n i s
9

B e ( , n ) 1 2 C . T h i s w a s t h e f i r s t re a c ti o n us ed f o r p ro d uc i ng s m al l ne ut r o n s o ur c e s .

A m a t e ri a l co n t a i ni n g a m i x t u r e o f r a d i um and b e r y ll i um ha s b ee n c o m m o nl y us e d

WWW.MEDRAD.IR

a s a n e u t r o n s o u r c e in r e s e a r c h l a b o r at o ri es . In t hi s c a s e , t he p a r t i cl e s e m it te d b y r a d i u m b o mb a r d t he b e r y ll i u m nuc l e i a nd e j e c t ne ut ro ns .

C. Proton Bombardment
T h e m o s t co m mo n r ea c t io n c o n s i st s o f a p r ot o n be i ng c ap t ur ed b y t he nuc le us w i t h t h e e m i s si o n o f a r a y . T h e r e a c t i o n i s k no w n a s p , . E x a m p l e s a r e :
7

Li(p,)8Be and

12

C ( p , ) 1 3 N

O t h e r po s si b le re a c tio n s p ro d u c e d b y p r oto n bo m b a r dm e nt a r e o f t he t y pe p , n; p , d ; a n d p , . T h e s y m b o l d st a n d s f o r t he de ut e ro n ( 2 1 H ) .

D. Deuteron Bombardment
The d e u t e ro n p a rt i cle is a co m bi na t io n of a p ro to n a nd a ne ut r o n. T hi s c o m bi n a t io n a p pe a r s t o b r e a k do w n i n mo s t d e ute r o n bo m b ard m e nt s w it h t he r e s u l t t h at t h e c o mp ou n d P.25 n u c l e u s e m i t s ei t h e r a n e u t r o n o r a p ro ton. T he t w o t y pe s o f r e a c ti o ns c a n be w r i t te n a s
A Z

X(d,n)A

+ 1

Z + 1

Y and

X(d,p)A

+ 1

X.

A n i m p o r t a n t r e a ct io n t h a t h a s b e e n us e d a s a s o ur c e o f hi g h e n e r g y ne ut r o ns i s p r o d u c ed b y t h e b o mb a r d m e n t o f b e r y ll i um b y d e ut e r o ns . T he e q ua t io n f o r t he r e a c ti o n i s :
2 1

H +

Be

10

B +

T h e p r o ce s s i s k n o w n a s s t r ip pi n g . In t hi s pr o c e s s t he d e ute r o n i s no t c ap t ur ed b y t h e n u c l e u s b u t p a s s es c l o se t o i t . T he p rot o n i s s t ri pp e d o f f f r om t he d e ute r o n a n d t h e n e u t r o n c o n t in u e s t o t r a v e l w it h hi g h s p e e d .

E. Neutron Bombardment
Neutrons, because th e y possess no e l ec t r i c c ha r g e , are very effective in p e n e t r at i n g t h e n u c l e i a n d p r o d u c i ng nuc l e a r r e a c t io ns . F o r t he s a m e r e a s o n, t he n e u t r o n s do n ot h a v e t o p o s se s s hig h k i net i c e ne r gi e s i n o rd e r t o p e net r a te t he n u c l e u s . A s a m a t t e r o f f a c t , s l o w ne ut r ons o r t he r m a l ne ut r ons ( ne ut r o ns w i t h a v e r a g e e n e r g y e q u a l t o t h e e n e r g y o f t her m a l a gi t ati o n i n a ma t e ri a l , w hi c h i s a b o u t 0 . 0 25 e V a t roo m te m pe r a t ure ) ha v e b ee n f o und to b e ex t r e m el y e f f e c ti v e i n p r o d u c i n g n u c l e a r tr a n s f o r m a t io ns . A n e x a m p l e o f a s l o w ne ut r o n c a p t ur e i s t he n , r e a c t io n w i t h b o ron :
10 5

B +

Li +

He

T h e p r e v i o u s r e a ct ion f o r m s t h e b a s i s of ne ut r o n d e te c ti o n. In p r a c t i c e , a n i o n i z a ti o n c h a m be r ( to b e d i s c u s s ed l at e r ) i s f i ll ed w i t h b o ro n g a s s uc h a s BF 3 . T h e pa r ti c le r el e a se d b y t h e n, r e a ct ion w i t h bo r o n p r od uc es t he io ni z a t io n d e te c te d b y t h e c h a m b e r . T h e m o s t co m mo n p roc e s s o f n e u t ro n c a p t ur e i s t he n, r e a c ti o n. In t hi s c a s e t he c o m po u n d n u c l e u s i s r a i s e d to o ne o f i t s e x c i te d s ta t e s a nd the n i m m e di a te l y r e t u r n s t o i t s n o r m al s t a t e w it h t he e mi s si o n o f a r a y p ho t on. T he s e r a y s , c a l l ed c a p t u r e r a y s , c a n b e o b s e r v e d c o mi ng f r o m a hy d r o g e nous m a t e r i a l s uc h a s p a r a f f i n u s e d t o sl ow d o w n ( b y m ul t i pl e co ll i si o ns w i t h t he nuc le i ) t he ne ut ro ns a n d u l t i m at el y c a p t u re s o me o f t he sl o w neut r o ns . T he r e a c ti o n ca n b e w r i tt e n a s f o l lo w s :

WWW.MEDRAD.IR

H +

H +

B e c a u s e t h e t h e r m al n e u t r o n h a s ne g l ig ib l e k i net i c e ne r g y , the e ne r g y o f t he c a p t u r e r a y c a n b e c a l c u l at e d b y t he m a s s d i f f e r e nc e b etw e e n t he i nit i al p a r t i cl e s a n d t h e pr o du c t p a r t i cl e s , a s s um i ng ne g l ig ib le r e c oi l e ner g y o f e m it ti n g p a rt i cl e s . T y p i c a l e x a m pl e s a re :

59 27 2 1

H.

P r o d u c t s o f t h e n , r e a c t io n , i n mo s t c a s es , ha v e b e e n f o und to be r a di o a ct i v e , Co + n Co +

60

27

f o l lo w e d b y :

f o l lo w e d b y :

A n o t h e r t y p e o f r e a ct io n p r o d u c ed b y ne ut r o ns , na m e l y t he n, p r e a c ti o n, a l so y i e l d s e mi tt e r s i n m o st N + n C + H c a s e s . T hi s pr o c e s s wi t h sl o w neut r o ns ha s be e n o b s e r v ed i n t h e c a s e o f n i t r og e n :
14 7 1 0 14 6 1 1

P.26

f o l lo w e d b y :

T h e e x a m p l e o f a f a s t n e u t r o n n , p r e a c t io n is t he p r o d uc tio n o f
32 16

32

P:

S +

32

15

P +

f o l lo w e d b y :

It s h o u l d be po i n te d o u t t h a t w he t he r a r e a c ti o n w il l o c c ur w i t h f a s t or s lo w n e u t r o n s d e pe n d s o n t h e m a g n it ud e o f t he m a s s d i f f e r e nc e b et w e e n t he e x pe c te d p r o d u c t n u c l e u s a n d th e b o mb a r d ed nuc l e us . F o r e x a m pl e , i n t he c a s e o f a n n, p r e a c ti o n , i f t hi s m a s s d i f f e r e n c e e x c e ed s 0 .0 0 08 4 0 am u ( m a s s d if f e r e nc e b et w e e n a n e u t r o n a n d a p ro ton ) , t h e n o n l y f a s t ne ut r o ns w il l b e e f f e c ti v e i n p ro d uc i ng t he r e a c ti o n .

F. Photo Disintegration
A n i n t e r a ct io n o f a hi g h e n e rg y p hoto n w it h a n a to m i c nuc l e us c a n l ea d t o a n u c l e a r r e a c ti o n a n d to t h e e mi s s io n o f o ne o r m o re nuc l e o ns . In m o s t c a s e s , t hi s p r o c e s s o f p h ot o di s i nt e g r at io n r e s ult s i n t he e m i s si o n o f ne ut ro ns b y t he nuc l e i . A n e x a m p l e o f s u c h a r e a c ti o n i s p ro v i de d b y t he nuc l e us o f a p h o t o n b e am :
63 29 63

C u b o mb a r d ed w it h

Cu +

62

29

Cu + of

n energy, na m el y , t he d i f f e re nc e be t w e e n t he r e st

T h e a b o v e re a c ti o n h as a d e f i n it e t hr e s hol d , 1 0 . 8 6 M e V . T hi s c a n b e c a l c ul a t ed b y the d e f i ni ti o n threshold e n e r g y o f t h e t a rg et n u c l e u s a n d t ha t o f the r e s i d ual nuc l e us pl us t he e mi tt ed n u c l e o n ( s ) . B e c a u s e th e r e s t e n e rg ie s o f m a ny nuc l e i a r e k no w n t o a v e r y hi g h

WWW.MEDRAD.IR

a c c u r a c y , t h e p h o t o di s i n te g r at io n p r o c e s s c a n b e us e d a s a b a s i s f o r e ne rg y c a l i b ra ti o n o f m a c h i n es p r o d u c i n g hi g h e ne rg y p ho t o ns . In a d d i ti o n to t h e , n r e a c tio n , o t he r t y p e s o f p ho to di s i nte g r at ion p r o c e s se s ha v e b e e n ob s e r v e d . A mon g t h e s e a r e , p , , d , , t , a nd , , w he r e d s t a nd s f o r d e u t e ro n ( 2 1 H ) a n d t s t a n d s f o r t r ito n ( 3 1 H ) .

G. Fission
T h i s t y p e o f r e a c ti o n i s p r o d u c ed b y b o mb a r d i ng c e rt a i n hi g h a t o m i c num b e r n u c l e i b y n e u t ro n s . T h e n u c l e u s , a f t e r a b sor b i ng t he ne ut r o n, s pli t s i nt o nuc le i o f l o w e r a to mi c n u m b e r a s w e l l a s a d d i ti o nal ne ut r o ns . A t y p i c a l e x a m p l e i s t he fission of
235 92 235

U w i t h s l ow n e u t r o n s :
236 92

U +

141

56

Ba +

92

36

Kr + 310n + Q

T h e e n e r g y r e l e a se d Q c a n b e c a l c ul a t ed , a s us ua l , b y t he m a s s d i f f e r e nc e b e t w ee n t h e o r ig i n a l a n d t h e f i n a l p a rt i cl e s a nd , i n t he ab o v e r ea c t io n, a v e r a g e s m o r e t h a n 20 0 Me V . T h i s e n e r g y ap p ea r s a s t he ki ne ti c e ner g y o f t he p ro d uct p a r t i cl e s a s w e ll a s r a y s . T h e a d d it io na l ne ut r o ns r el e a s ed i n t he p ro c e s s m a y a l s o i nt e r a ct w i t h oth e r

235

U n u c l e i , t he reb y c r e a t i ng t he p o s sib i li t y o f a c ha i n

r e a c ti o n . H o w e v e r , a s u f f i c i e n t m a s s o r , mor e t e c hni c al l y , t he c r iti c a l m a s s o f t he f i s s i o n a bl e m at e ri a l i s r e q u i r e d t o p ro d uc e the c ha i n r e a c t i o n. A s s e e n i n t h e ab o v e i n s t a n c e , t he e ne rg y r e l e a se d p e r f i s s io n is e no r mo us . T he p r o c e s s , t h e r e fo r e , ha s b e co m e a m a jo r ene r g y s o ur c e a s i n t he c a s e o f nuc l e a r r e a c to r s .

H. Fusion
N u c l e a r f u s i o n m a y b e c o n s i d e re d t he r e v e r se o f nuc l e a r f i s s io n; tha t i s , l o w m a s s n u c l e i a r e c o mb i n ed to p r od u c e o ne nuc l e us . A t y p i c a l r e a c ti o n i s :
2 1

H +

He +

n + Q

P.27

B e c a u s e t h e to t al m a ss o f t h e pr o d uct p a rt ic l e s i s l e s s t ha n t he to t al m a s s o f t he r e a c t a n t s , e ne r g y Q is r e l e a se d i n t he pr o ce s s . In t he a b o v e e x a m p l e , t he lo s s i n m a s s i s a b o u t 0 .0 1 89 a m u , w h i c h g i v e s Q = 1 7 . 6 M e V . F o r t h e f u s i o n r e a c tio n t o o c c u r , t he nuc l e i m us t b e b ro ug ht suf f i c i e nt l y c lo s e t o ge t h e r s o t h a t t h e r e p u l s i ve c o ulo m b fo rc e s a r e o v e r c o me a nd t he s ho r t -r a ng e n u c l e a r f o r c e s c a n i ni ti a t e t h e f us io n r e a ct io n. T hi s i s a c c o mp lis he d b y he a ti ng l o w Z n u c l e i t o v e r y h i g h t e m pe r a t ure s ( g r ea t e r t ha n 1 0 7 K ) w hi c h a r e c o m p a r a b le w i t h t h e i n n e r c o r e te m p e r at u r e o f t he s un. In p r a c t i c e , f i s s i on r e a c t i o ns ha v e b e e n u s e d a s s t a rt e r s f o r t h e f u s i o n r e a c ti o ns .

2.9. ACTIVATION OF NUCLIDES

E l e m e n t s c a n b e m a de r a d io a c ti v e b y v a r io us nuc l e a r r e a c ti o ns, s o m e o f w hi c h h a v e b e e n de s c r ib e d i n t h e p r e ce di ng s ec t io n. T he y i el d o f a nuc l e a r r e a ct io n d e pe n d s o n p a r a m e ter s s u c h a s t he num b e r o f b o m b a r di ng p a r tic l e s , t he num b e r o f t a r ge t n u c le i , a n d t h e p ro b a bi li t y o f t he o c c ur r e nc e o f t he nuc l e a r r e a c ti o n. T h i s p r o b a bi li t y i s c a ll e d t h e c ro s s - s e ct io n a nd i s us ua l l y g i v e n i n u ni t s o f b a r ns , w h e r e a b a r n i s 1 0 - 2 4 c m 2 . T h e c ro s s - s e ct io n o f nuc l e a r r e a ct ion d e pe nd s o n t he

WWW.MEDRAD.IR

n a t u r e o f t h e t a r ge t m a t e ri a l a s w e ll a s t he t y p e o f t he b o mb a rd i ng p a rt i cl e s a nd t h e i r e n e rg y . A n o t h e r i mp o rt a n t a sp e c t o f a c ti v a ti o n i s the g r o w t h o f a c ti v i t y . It c a n b e s ho w n t h a t i n t h e a ct i v at io n o f i sot o pe s t he a ct iv i t y o f t he t r a ns f o r me d s a mp l e g ro w s e x p o n e n ti a ll y . If b o t h t h e a c t i v a ti o n a nd d e ca y o f t he m a t e r i a l a r e c o ns i d e r ed , t he a c t u a l g r o w t h o f a ct iv i t y f ol lo w s a net g ro w t h c ur v e t ha t re a che s a m a x i m um v a l u e , c a ll e d s a t u r at io n a c ti v i t y , a f t e r s e ve r a l hal f - l i v e s . W he n t ha t ha pp e ns , t he r a t e o f a c ti v a ti o n e q ua l s t h e r a te o f d e c a y . A s m e n t io n e d e a r li e r , t h e s lo w ( t he r m al ) neut r o ns a r e v e r y e f f e c ti v e i n a ct i v a ti ng nuclides. High fluxes of slow ne ut r o ns (1010 to 10 1 4 ne ut ro ns / c m 2 / s e c ) are a v a i l a bl e i n a n u c l e a r r e a c to r w h e r e ne ut r o ns a r e p r o d uc ed b y f i s s i o n r e a c ti o ns .

2.10. NUCLEAR REACTORS

In n u c l e a r r e a c to r s , th e f i s s i o n p ro c e s s i s m a d e s el f - s us t a i ni ng b y c ha i n r e a c t io n i n w h i c h s o m e o f t h e f i s s i o n n e u t ro ns a r e us e d to i nd uc e st il l mor e f i s s io ns . T he nuclear fuel is usually
235

U , a lt ho ug h t ho ri um a nd p l ut o ni um a r e o t he r po s s i ble

f u e l s . T h e f u e l , i n t h e f o r m o f c y l i nd ri c a l rod s , i s a r r a ng e d i n a la t ti c e w it hi n t he r e a c to r co r e . Be c a u s e t h e n e u t r o ns r e le a s ed d ur i ng f i s si o n a re f as t ne ut ro ns , t he y h a v e t o b e s l o w ed d ow n t o t h e r m a l e ne r g y ( a b o ut 0 . 0 25 e V ) b y c o l li s io ns w i t h nuclei heavy of low Z m a t e ri a l . H as part Such of m a t e r ia l s are c a l le d m ode r a to r s . T he f ue l or Typical rods are T he m o d er a to r s i n c l u d e g r a p h i te , b e r y ll i um , w a t e r , a nd hydrogen that
2 1

he a v y w a t e r ( w a t e r w it h

t he

m ol ec ul a r

s t r uc t ur e ) . as

i m m e r se d i n t h e mod e r a to r s . T he r e a c tion i s c o nt r o ll ed b y i ns e r ti ng r o d s o f m a t e ri a l e f f i c i en t l y a b s o rb s ne ut ro ns , s uc h c a d m i um bo r o n. p o s it io n o f t h e s e c on t r o l r od s i n t he rea c t o r co re de t er m i nes t he num b e r o f n e u t r o n s a v a i l ab le to i n d u c e f i s s io n a nd thus c o nt r o l t he f i s si on r a t e o r p o we r output. O n e o f t h e ma j o r u s es o f n u c l e a r r e ac to r s i s to p ro d uc e p o w e r . In t hi s c a s e , t he heat ge n e r a te d by th e a b s or p ti o n of rays a nd ne ut ro ns is us e d fo r t he g e n e r a ti o n o f el e ct r i ca l po w e r . In a d di ti o n, b e c a us e r e a ct o r s c a n p r o vi d e a l a r ge a n d c o n ti n u o u s s u p p ly o f n e u t ro ns , t he y a r e e xt r e me l y v a l ua bl e fo r p ro d uc i ng r a d io i so to p e s u s ed i n n u c l e a r m e d i ci ne , i ndus t r y , a nd r e s e a r c h.

REFERENCES
1. U.S. D e p a rt m e n t of H e a lt h , E d uc a t io n, a nd Welfare. Ra d i olo g i ca l he al t h h a n d b o o k r e v . e d . W as h i n g t o n , D C : U . S . G o v e r nm e nt P r i nt i ng O f f ic e , 1 9 70
1

T h i s d e f i ni ti o n i s b as e d o n t h e r at e o f d e c a y o f 1 g o f r adi um w hi c h w a s

o r i gi n a ll y m e a s u r e d to b e 3 . 7 1 0 1 0 d p s . A lt ho ug h t he r e c e nt m ea s ur e m e nt s ha v e e s t a bl i s h ed t h e d e c a y r a t e a s 3 . 6 1 1 0 1 0 dp s / g o f r a d i um , t he or i g i nal d e f i nit io n of curie remains unchanged.

2

N e u t r i no

is

the

g e ne r i c

name

for

t he

tw o

s p e ci f i c

p a r ti c le s,

ne ut r i no

a nd

antineurino.

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 3 - Pr oduction of X -Rays

3 Production of X-Rays

X - r a y s w e r e d i s co v e r ed b y R o e n tg e n i n 18 95 w hi l e st ud y i ng c a t ho d e r a y s ( st r e am o f el e c tr o n s ) i n a g a s d i s c h a r ge t ub e . H e ob s e r v e d t ha t a no t he r t y p e o f r a di at io n w a s p r o d uc e d ( p re s u m a b l y b y t h e i nt e r a cti o n o f e le c t ro ns w i t h t he g l a s s w a ll s o f t h e t u b e ) t h a t c o u ld b e d et e ct ed o ut si d e the t ub e . T hi s r a d i at ion c o ul d p e net r a te opaque s u b s t a n c es , p r o d u c e f l u o re s c e nc e, b l a c k e n a p ho t o g ra p hi c p l at e , a nd i o n i z e a g a s . H e n a m ed t h e n e w r a d i a ti o n x - r a y s . F o ll o w i n g t h i s h i sto r i c d i s co v e r y , t he na t ure o f x - r a y s w a s e x t e nsiv e l y s t udi e d a nd m a n y o t h e r p ro p e rt ies w e r e u n r a v e l e d . Our und e r s t a nd i ng o f t he i r na t ur e w a s g r e a tl y e n h a n c e d when they were c l a s s i fi e d a s o ne f or m o f e l e ct r o m ag ne ti c r a d i at io n ( s e c t io n 1 . 9) .

3.1. THE X-RAY TUBE

F i g u r e 3 . 1 i s a s c h e m a t i c r e pr e s e nta ti o n o f a c o nv e nt i o na l x - r a y t ub e . T he t ub e c o n s i s t s o f a g l a s s en v e l o pe w h i c h ha s b ee n e v a c ua t e d to hig h v a c uum . A t o ne end is a c at h o d e ( ne g a ti v e el e ct r od e ) and at t he o t he r a n a no d e ( po s it i ve e l e ct r od e ) , bo t h h e rm e ti c a ll y s e a le d i n the t ub e . T he c a t hode i s a t ung st e n f i l a m e n t w h i c h w h e n h e a t e d e mi t s el e ct ro ns , a p he no m e no n k no w n a s t he r m i o ni c e m i s si o n . T h e a n o d e c o n s i s t s o f a t hi c k c o pp e r r o d at t he e nd o f w hi c h i s p l a c e d a s m a l l p ie c e o f t u n g s ten t a r g et . W he n a hi g h v o l t ag e i s a pp li e d b et w e e n t he a no d e a n d t h e c a t h o de , t h e e l e ct r o n s e mi tt ed f r om t he f i l a me nt a r e a cc e l e r at ed to w a r d t h e a n o de a n d a c h i e ve h i g h v e lo c it ie s b e for e s t ri k i ng t he t a r ge t. T he x - r a y s a r e p r o d u c ed b y t h e s u d de n d e f l e ct io n o r a c ce le r a ti o n o f t he e le c t ron c a us e d b y t he a t t r a ct i v e fo r c e o f t he t u n g s te n nuc l e us . T he p hy s i c s o f x - r a y pr o d uc ti o n w il l be d i s c u s s e d l a te r , i n se c t io n 3 . 4 . T he x - r a y b e a m em e r ge s t hroug h a t hi n g l a s s w i n d o w i n t h e t u b e en v e l o pe . In s o m e t ube s , t hi n b er y l li um w i nd o w s a r e us ed to r e d u c e i n h e r e n t f il t r ati o n o f t h e x - r a y b e a m .

A. The Anode
T h e c h o i c e o f t u n g s ten a s t h e t a r g et m a t e ria l i n c o nv e nt io na l x - r a y t ub e s i s b a s ed o n t h e c r i te r i a t h a t th e t a r g et m us t ha v e hi g h a t o mi c num b e r a nd hi g h m e l ti ng p o i nt . A s w i l l b e d i sc u s s e d i n s e c t io n 3 .4 , t he e f f i c ie nc y o f x - r a y p r o d uc t io n d e pe n d s o n t h e a t o mic n u m b e r , a nd f o r t ha t r e a s o n, t ung s t e n w i t h Z = 7 4 i s a g o od t a r ge t m a te r i al . In a d d i ti o n , t ung s t e n, w hi c h ha s a me lt i ng p o i nt o f 3 , 37 0 C , i s t h e el e me n t o f c h oic e f o r w i t h st a nd i ng i nt e ns e he at p r od uc e d in t he t a r g et b y t h e e le c t ro n i c b om b a rd m e n t . E f f i c i e n t r e m o v al o f h e a t f r o m t he t a r ge t i s a n i m p o r t a nt r equi r e m e nt f o r t he a n o d e de s ig n . T h i s h a s b e e n a c hi e v ed in s o m e t ube s b y cond uc t i o n o f he at t h r o u g h a t h i c k c o p per a n o d e to t he o ut si de o f t he t ub e w he r e it i s c o ol e d b y oi l , w a t e r , o r a i r . R ot a ti n g a n o d e s h a v e a l s o bee n us e d i n d i a g no st i c x - r a y s t o r e d uc e t h e t e mp e r at u r e o f t he t a r g et a t a ny o ne s po t . T he he a t g e ne r at ed i n t he r o t at i ng

WWW.MEDRAD.IR

anode

is

r a di at e d

to

the

oi l

r e se r v oi r

s ur r o und i ng

t he

t ube .

It

s ho ul d

be

m e n t io n e d t h at t h e f u n c t i o n o f t he o il ba t h s ur r o und i ng a n x - r a y t ub e i s to i n s u l a t e t h e t u b e h o us i n g f r o m h ig h v o lt a ge a p pl ie d t o t he t ub e a s w e l l a s a b so rb h e a t f r o m t h e a n o de . S o m e st a ti o n a r y a n ode s a r e ho od e d b y a co p pe r a nd t ung s t e n shi e l d to p re v e nt s t r a y el e c tr o n s f r om st r i k i n g t h e w al l s o r o the r no nt a r ge t co m po ne nt s o f t he t ub e . These P.29 e l e ct r o n be a m . W h e r ea s c o p pe r i n t he ho od a b s o r b s t he s e c o nd a ry e l e c t ro ns , t he tungsten s h i el d s u r ro u n d i n g the co p pe r s hi e l d ab s o rb s t he unw a nt e d x-rays p r o d u c ed i n t h e c o pp er . are s e co n d a r y e l e ct ro n s p r od uc e d from t he t a r ge t whe n it is b ei ng b o m b a rd ed b y t h e p r im a r y

F I G . 3 . 1 . S c h e m a t i c di a g r a m o f a t he r ap y x - r a y t ub e w i t h ho o de d a no d e . A n i m p o r t a n t r eq u i r em e n t o f t h e a no d e d es i g n i s t he o pt i m um s i z e o f t he t a r get a r e a f r o m w h i c h t h e x - r a y s a r e e m i t te d . T his a r e a , w hi c h i s c a l l ed t he f o c a l s p ot , s h o u l d b e a s s m a l l a s p o s s ib le f o r p r od uc i ng s ha r p r a d i o g r ap hi c im a g e s . H o w e v e r , s m a l le r f o c a l s po t s ge n e r a t e mo r e he at pe r uni t a r e a o f t a rg et a nd , t he r e f o re , l i mi t c u r re n t s a n d e x p o s u r e . In t he r a p y tub e s , r e l at i ve l y l ar g er f o c a l sp ot s a re a c c e p t ab le s i n c e t h e ra d i og r a p h i c i m a ge q ua l it y i s no t t he o ve r r id i ng c o nc e r n. T h e a p p a r e nt si z e o f th e f o c a l s p ot c a n b e re d uc e d b y t he p ri nc i pl e o f li ne fo c us , i ll u s t r a te d i n F ig . 3 . 2 . T h e t a r g et i s mo unt ed o n a s t ee pl y i nc l i ned s ur f a c e o f t he a n o d e . T h e a p p a r e n t s i d e a i s e q ua l to A s in , w he r e A i s t he s i d e o f t he a c t ua l f o c a l s pot a t a n a n g l e w it h r e s pe c t t o t he e l e ct r o n b e a m . Si nc e t he ot he r si d e o f t h e a c t u a l f o c al s p ot is p e r p e n di c ul a r to t he e l e ct r o n, i t s ap p a r e nt l e ngt h r e m a i ns t h e s a m e a s t h e o r ig in a l . T h e d i m e ns i o ns o f t he a c t ua l f o c a l s po t a r e c ho s e n so t h a t t h e a p p a re n t f oc a l s po t re s ul t s i n an a p p r o x i m at e sq ua re . T he r e f o r e , b y m a k i n g t h e t ar g et a ng l e s m a ll , s i de a ca n b e r e d uc ed to a d e s i re d si z e . In d i a g n o st i c r a di ol og y , t h e t a rg et a ng le s a re q ui t e s m a ll ( 6 17 de gr e e s ) t o p r od uc e a p p a r e n t f o c al s po t s iz e s r a n g i n g f r o m 0 . 1 0 . 1 t o 2 2 m m . In m o s t t he r ap y P.30

WWW.MEDRAD.IR

t u b e s , h o w e v er , t h e ta r g e t a n g le i s la r g e r ( a b o ut 3 0 d eg r ee s ) and t he ap p a re nt f o c a l s p ot r a n g e s be tw e e n 5 5 t o 7 7 m m .

F I G . 3 . 2 . D i a g r a m i llu s t r a t i n g t h e p ri nc i pl e o f l i ne f o c us . T he s ide A o f t he a ct ua l f o c a l s po t i s r e d u ce d t o si d e a o f t he a ppa r e nt f o c a l sp ot . T he o t he r di m e nsi o n ( p e r pe n d i c u l a r t o t h e p l a n e o f t h e p ap e r ) o f t he f o c a l s p ot r e m ai ns unc ha ng e d . S i n c e t h e x - r a y s a r e pr o d u c e d at v a r i o us dep t hs i n t he t a rg et , t he y s uf f e r v a r y i ng a m o u n t s o f a tt e n u a t io n i n t h e t a rg et . T he r e i s g r e at e r at te nua t io n f o r x - r a y s c o m i n g f r o m g r e at e r d ep t h s t h a n t ho se f r o m ne a r t he s ur f a c e o f t he t a rg et . C o n s e q u e n t l y , t h e i nte n s i t y o f t h e x - r a y bea m d e c re a s e s f ro m t he c a t hod e t o t he a n o d e di r e ct io n o f t h e b e a m . T h i s v a r i a tion a c r o s s t he x - r a y b e a m i s c a l le d t he h e e l e f f e c t . T h e e f f e ct i s p a rt i c u l a rl y p ro no unc e d i n d i ag no s ti c t ub e s b e c a us e o f t h e lo w x - r a y e n e rg y a n d s t ee p t a r ge t a ngle s . T he p ro b le m c a n b e mi ni m i z ed by u s i n g a c o m p e n s a t i n g f i l t e r to p ro v i d e di f f er e nt i al a t te nua t io n a c r o s s t he b e a m i n o r d e r t o co m p e n s at e f o r t h e h e el e f f e c t a nd i m p ro v e t he uni f o r m ity o f t he b e a m .

B. The Cathode
T h e c a t h o d e a s s e m bl y i n a m o d e r n x - r a y t u b e ( C o ol i dg e t ube ) c ons i s t s o f a w i r e f i l a m e n t , a c i r c ui t to p r o v id e f i l am e nt c ur r ent , a nd a ne g a t i v e l y cha r g e d f o c us i ng c u p . T h e f u n c t i o n o f th e c a t h o de c up i s to d i r e ct t he e le c t ro ns to w a r d t he a nod e s o t h a t t h e y st r i k e t he t a rg et i n a w el l -d e f ine d a r e a , t he f o c al s po t . S i nc e s i z e o f focal s pot de p e n d s o n f i l a me n t si z e , t he di a g no st i c t ub e s us ua l l y ha v e t wo s e p a r a te f i l a me n t s t o p r o v id e d ua l - f o c us , na m e l y o ne s m a l l a nd o ne l a r g e f o c a l s p o t . T h e m at e ri a l o f t h e f i l a me n t i s t ung s te n, w hi c h i s c ho s e n be c a us e o f it s hi g h m e lt i n g po i n t .

3.2. BASIC X-RAY CIRCUIT

T h e a c t u a l c i r c u i t o f a m o d e r n x - r a y m a c h i ne i s v e r y c o m p le x . In t hi s s e c t i o n, h o w e v e r , w e w i l l c o ns i d e r o n l y t he b a s i c a s p e c t s o f t he x - r a y c i r c ui t . F o r mo r e d e t ai le d i n f o r m at io n th e r e a d e r i s r e fe r r e d to t he li t er a t ur e . A s i m p li f i ed d i ag r a m o f a s e l f - r e ct i f ie d the r a p y uni t i s s ho w n i n F i g . 3 . 3 . T he c i r c u i t c a n b e di v i ded i n t o t w o p a rt s : t he hi g h- v o lt a g e ci r c ui t t o p ro v i de t he a c c e l e r at i n g p ot e n ti a l f o r t h e e l e ct ro ns a nd t he l o w - v o lt a ge ci r c ui t to s up pl y

WWW.MEDRAD.IR

h e a t i n g c u r re n t t o t he f il a m e n t . Si nc e t he v o lt a ge a pp li e d be t we e n t he c a t ho d e a n d t h e a n o de i s h i g h e n o u g h to a c c el e r at e a l l t he e l e ct ro ns a c r os s t o t he t a r ge t , the f i l a m e nt t e mp e r at u r e o r f i l a me nt c ur r e nt c o nt ro l s t he t ub e c ur r e nt ( t he c u r r e n t i n t h e c i r c u it d u e t o t h e f l o w o f el ec t r o ns a c r o s s t he t ube ) a nd he nc e t he x-ray intensity.

F I G . 3 . 3 . S i m pl i f ie d ci r c u i t di a g r a m o f a s e lf - r e c t i f ie d x - r a y uni t . P.31

T h e f i l a m e nt s u p pl y f o r el e ct r o n e m i s si o n us ua l l y c o ns i s t s o f 1 0 V a t a bo ut 6 A . A s s h o w n i n F i g . 3 . 3 , t h i s c a n b e a c c o mp li she d b y us i ng a st e p -do w n t r a ns f o r m e r i n t h e A C l i n e v ol t ag e . T h e f i l a me nt c ur r e nt c a n b e a dj us t ed b y v a r y i ng t he v o l t ag e a pp li e d t o t h e f i l a me n t . S i nc e a s m a l l c ha ng e i n t his v o lt a g e o r f i l am e nt c u r r e n t p ro d u c e s a l a rg e c h a n g e i n e le c t ro n e m i s si o n o r t he c ur r ent ( F i g . 3 . 10 ) , a s p e c i al k i n d o f t r a n s f o r m e r i s u s e d w hi c h e li m i na te s no rm a l va r i a ti o ns i n l i ne v o l t ag e . T h e h i g h v ol t ag e to th e x - r a y t ub e i s s up pl i ed b y t he s te p - up tr a ns f o r m e r ( Fi g . 3 . 3 ) . T h e p r i m a r y o f t h i s t r a n s f o r m e r i s c onne c t e d to a n a ut o t r ans f o r m e r a nd a r h e o s t at . T h e f u n c t io n o f t h e a u to t r a ns f o rme r i s to p r o v id e a st e pw i s e a dj us t m e nt i n v o lt a g e . T h e d e v ic e c o n s i st s o f a c oi l o f w i r e wo und o n an i r o n c o re a nd o p e r at e s o n t h e p r i nc i p le o f i n d uc t a nc e . W he n a n a l t e r na t i ng l i ne v o lt a ge i s a p p li e d t o t h e c oi l , po t e nt i al i s di v i de d be tw e e n t he t ur ns o f t he c o i l . By us i ng a s e l e ct o r s w it c h , a c on t a c t c a n be m ad e to a ny t ur n, t hus v a r y i ng t he o ut p ut v o l t ag e w h i c h i s me as u r e d be t w ee n t he f ir s t t ur n o f t he co il a nd t he se le c to r contact. T h e r h e o s ta t i s a v a r ia b l e r e si s te r , i .e . , a co il o f w i r e w o und o n s o m e c yl i nd ri c a l o b je c t w i t h a s li di n g c o n t a ct t o i nt ro d uc e a s m uc h r e si s t a nc e i n t he c i r c uit a s d e s i re d a n d t h u s v a r y t h e v o lt a ge i n a c o nti nuo us m a nne r . It m a y b e m e nti o ned t h a t , w h e r e a s t h e r e i s a p pr e c i ab le po w e r l o s s i n t he r he o st a t b e c a us e o f t he r e s i st a n c e o f t h e wi r es , t h e p o w e r lo s s i s sm a l l i n t he c a s e o f t he i nd uc t a nc e co il s i n c e t h e w i r e s h a v e lo w r e s i s ta n c e .

WWW.MEDRAD.IR

T h e v o l t a ge i n p u t t o th e h i g h - t e n s i o n t r a ns f o r m e r o r t he x - r a y t r a ns f o r m e r c a n b e r e a d o n a v o lt m et e r in t h e p r i m a r y p a rt o f i t s c i r c ui t . T he v o lt m et e r , ho w e v e r , i s c a l i b ra t ed so that its reading co r r e s po nd s to t he k i lo v o lt a ge w hi c h will be g e n e r a te d b y t h e x - r a y t r a n s f o r m e r s e c o nd a r y c oi l i n t he o utp ut p a rt o f t he c i r c u i t a n d a pp li e d t o t h e x - r a y t ub e . T he t ub e v ol t a ge c a n b e m e a s ur e d b y t he s p h e r e g a p m et h o d i n w h i c h t he vo lt a g e i s ap pl i ed t o t wo m e t al li c s p he re s s e p a r a te d b y a n a i r ga p . T h e s p he re s a r e s l o w l y b r o ug ht to ge t he r unt il a sp a r k a p p e a r s . T h e r e i s a m a t h e m a ti c a l r el a tio ns hi p b et w e e n t he v o lt a ge , t he d i a m et er o f t h e s p he re s , a n d th e d i s t a n c e b et w e e n the m a t t he i ns t a nt t ha t t he s pa r k f i r st appears. T h e t u b e c u r re n t c a n b e r e a d o n a m il li am m e te r i n t he hig h- v o lt a g e p a rt o f t he t u b e c i r c u it . T h e m e t er i s a c t u a l l y p l a ce d a t t he m i d po i nt o f t he x - r a y t r a ns f o r m e r s e c o n d a r y co il , w h i c h i s g ro u n d e d . T he m et e r , t he r e f o re , c a n be s a f e l y pl a c e d a t t h e o pe r a to r ' s c o n s ol e. T h e a l te r n a t i n g v o lt ag e a pp li ed to t he x - ra y t ub e i s c ha r a c te r iz e d b y t he pe a k v o l t ag e a n d t h e f r equ e n c y . F o r e x a m p le , i f t he l i ne v o lt a ge i s 22 0 V at 60 c y c l e s / s e c , t h e p e a k v o l t ag e w il l b e 2 20 2 = 3 11 V , s i nc e t he li ne v o lt a ge is n o r m a l l y e x p r e s se d a s t h e r oo t m e a n sq ua r e v a l ue . T hus , i f t hi s v o lt a ge i s s t e pp e d up b y a n x - r a y t r a n s f o r m e r o f t ur n r a t i o 5 00 : 1 , t he r e s ul ta nt p e a k v o l t ag e a pp li e d t o t h e x - r a y t u b e w i l l b e 220 2 5 0 0 = 1 5 5 , 56 4 V = 1 5 5 . 6 k V . S i n c e t h e a n o d e i s po s it i v e w it h r e s p e ct to t he c a t hod e o nl y thr o ug h ha l f t he v o l t ag e c y c l e , t h e t u b e c u r r e n t f l o w s t hroug h t ha t ha l f o f t he c y c l e . D ur i ng t he n e x t h a l f - c y c l e , t h e vo lt a g e i s re v e r s e d a nd t he c ur r e nt c a nnot f lo w i n t he re v e r s e d i r e ct io n . T h u s t h e t u b e c u r r e n t a s w e ll a s t he x - r a y s w i l l b e g e ne r a te d o nl y d u r i n g t h e h a l f - c y c l e w h e n t h e a no d e i s p o s it i ve . A m a c hi ne o p e r at i ng i n t his m a n n e r i s c a l l e d t h e s e l f - r e ct i f ie d uni t . T he v a r i a t io n w i t h t i me o f t he v o l t a ge , t u b e c u r r e n t , a n d x - r a y i n t e n s i t y 1 i s il l ust r a te d i n F i g . 3 . 4 .

3.3. VOLTAGE RECTIFICATION

T h e d i s a d v a n t a g e o f t h e s e l f - r e c ti f i ed c i rc ui t i s t ha t no x - r a y s a r e g e ne r a t ed d u r i n g t h e i n v e r s e vo lt a g e c y cl e ( w he n the a no d e i s ne g at i v e r e l at i v e t o t he c a t h o d e) , a n d t h e r e fo r e , t h e o u t p ut o f the m a c hi ne i s r el a ti v e l y lo w . A no t he r p r o bl e m a ri s e s w h e n t h e t a r g et g et s P.32 h o t a n d e m it s el e ct ron s b y t h e p ro c e s s o f the r m i o ni c e mi s s io n. Dur i ng t he i nv e r s e v o l t ag e c y c le , t h e se e l e ct ro n s w i l l fl o w f r o m t he a nod e t o the c a t ho de a nd b o m b a rd t h e c a t ho d e f i l a m e n t . T hi s c a n d e st r o y t he f il a m e nt .

WWW.MEDRAD.IR

F I G . 3 . 4 . G r a p h s i ll u s t r a ti n g t h e v a r i at io n w i t h ti m e o f t he l i ne v o l t ag e , t he t ub e k i l o vo lt a g e , t h e t u be c u r r e n t , a nd t he x - r a y i nt e ns it y f o r s el f - o r ha l f - w a v e r e c ti f i c a ti o n . The half-wave rectifier ci r c ui t is s ho w n on t he r i g ht . R e c ti f i er i n d i c at e s t h e di r e ct io n o f c o n v e n t i o na l c ur r ent ( o p po s it e to t he f low o f e l e c t ro ns ) . T h e p r o bl e m o f t u be c o n d u c t io n d ur i ng i nv e r s e v ol t ag e c a n be s o l v ed b y us i ng v o l t ag e re c ti f i e r s . R e ct i f ie r s pl a c ed i n se r ie s i n t he hig h- v o lt a ge pa r t o f t he ci r c ui t p r e v e n t t h e t u be f r om c o n d u c t i n g d ur i ng t he i nv e r s e vo lt a ge cy c l e . T he c ur r e nt w i l l f lo w a s u s u a l d u r i n g t h e c y c l e w he n t he a no d e i s po s it i v e r e l a ti v e t o t he cathode. This t y pe of r e c ti f i c at io n is ca l l ed ha l f - w a v e r e ct if i c a t io n a nd is i ll u s t r a te d i n F i g . 3 .4 . T h e h i g h - v o l t a ge r e ct if i e r s a r e ei t he r v a l ve o r s ol i d st a te t y pe . T he v a l v e r e c ti f ie r i s s i m il a r i n p r i n c ip l e t o t h e x - r a y t ub e . T he c a t ho d e i s a t ung st e n f i l a m e nt a nd t h e a n od e i s a m et a lli c pl a te o r c y li nd e r sur r o und i ng t he f i la m ent . T he c ur r e nt 2 f l o w s o n l y f ro m a n ode to t h e c a t ho d e b ut t he v a l v e w i ll not cond uc t d ur i ng t he i n v e r s e c y c l e e v e n i f th e x - r a y t a r g e t g et s ho t a nd e mi t s el e ct r o ns. A v a l v e r e c t i f ie r c a n b e r e pl a c ed b y s o li d st a t e re c ti f i er s . T he s e r e c ti f i e r s co ns i st o f c o n d u c to r s w h i c h ha v e b ee n c o at e d w it h c e r t ai n s e mi c o nd uc ti ng el e me nt s s uc h a s s e le n i u m , s il i co n , a n d g e r m a n i um . T he se s e mi c o nd uc to r s co nd uc t el e ct r o ns i n o n e di r e ct io n o n l y a n d c a n w i t h st a nd r e v ers e v ol t a ge up to a cer t a i n m ag ni t ude . B e c a u s e o f t h ei r v e r y s m a l l si z e , t ho us a nd s o f t he s e r e ct i f ie r s ca n b e s t a c k ed i n s e r i e s i n o r d e r t o w it h s t a n d t h e g i v e n i nv e r se v o l t ag e . R e c t i fi e r s c a n a l s o b e u s e d t o p r o vi d e f ul l -w a v e r e c t i f i c at io n. F o r e x a m p l e , f o ur r e c ti f i e r s c a n b e a r r a ng e d i n t h e hig h- v o lt a ge p a r t o f t he c i r c uit so t ha t t he x - r a y t u b e c a t ho d e i s n e g at i v e a n d t he a no d e is p o s it i v e d ur i ng bo th ha l f - c y c l e s o f v o l t ag e . T h i s i s s c h e m a t i c al l y s ho w n i n F i g . 3 . 5 . T he e l e ct r o ni c c ur r e nt f l o w s t h r o u g h t h e t u b e vi a A B C D E F G H w he n t he t r a ns f o r m e r e nd A i s ne g a t i ve a nd v i a H G C D E F B A w h e n A i s p o si ti v e . T hus t he ele c t ro ns f l o w f r o m t he f i l a me nt t o t he t a r g et d u r i n g b ot h h a lf - c y c l e s o f t he t r a ns f or m e r v ol t ag e . A s a r es ul t o f f ul l - w a v e

WWW.MEDRAD.IR

r e c ti f i c a ti o n , t h e e f f ec t i v e t u be c ur r e nt i s hi g he r s i nc e t he c ur r e nt f l o w s d ur i ng both half-cycles.

F I G . 3 . 5 . G r a p h s i ll u s t r a ti n g t h e v a r i at io n w i t h ti m e o f t he l i ne v o l t ag e , t he t ub e k i l o vo lt a g e , t h e t u be c u r r e n t , a n d t he x - r ay i nt e ns it y f o r f ul l - w av e r e c ti f i c at io n. T h e r e c t i f ie r c i r c u it is s h o w n o n t he r i g ht . T he a r r o w s y m b o l o n t he r e c ti f i er d i a g r a m i n d i c at e s t h e d i r e ct io n o f c o nv e nt io na l c ur r e nt f l o w (o pp o s it e t o t he f l o w o f e l e ct r o ni c c u r r e n t ) . P.33

In a d d i t io n t o r e c ti f ic a t io n , t h e v o l t a ge a c r o s s t he t ub e m a y b e k e p t ne a r l y c o n s t a n t b y a s m oo th i n g c o n d e n s e r ( hi g h c a p a c i t a nc e ) pl a c ed a c r o s s t he x - r a y t u b e . S u c h c o n s t a n t p o te n t ia l ci r c uit s a r e c o m m o nl y us e d i n x - r a y m a c hi ne s f o r therapy.

3.4. PHYSICS OF X-RAY PRODUCTION

T h e r e a r e t wo di f f e r e nt m e c h a n i s m s b y w hi ch x - r a y s a r e p r o d uc e d. O ne g i v e s ri s e t o b re m s s t r a hl u n g x - r a y s a n d t he o t he r cha r a c t e r i st i c x - r a y s . T he s e p r o c e s se s w e r e b ri e f l y m e n ti o n ed e a rl ie r ( s e ct io ns 1 .5 a nd 3 . 1 ) b ut no w w i ll b e p r e se nt ed i n g r e a te r d et a il .

A. Bremsstrahlung
The p r o c e s s o f b re ms s t r a h l u n g ( i n t e r a c ti on ) between ( b r a k i ng r a d i at io n) i s t he a hi g h- s p e ed e l e ct ro n r e sul t a o f r a d i at i ve nuc l e us . T he c o l li s io n a nd

e l e ct r o n w h i le p a s s i ng n e a r a n uc l e us m a y b e d e f le c t ed f r o m i t s p at h b y t he a c t io n o f Co u l om b for c e s o f a tt r a c tio n a nd lo s e e ne rg y a s b re m s s t r a hl ung , a p h e n o m e n o n p r e di c ted b y M a x w e ll ' s ge ne ra l t heo r y o f el e ct r o ma g ne t i c r a di a ti o n. A c c o r d i n g t o t h i s t h eor y , e n e r g y i s p r op a g at e d t hr o ug h s p a c e b y e l e ct r om a g net i c f i e l d s . A s t h e el e ct r on , w i t h i t s a s s o c i at e d e l e ct r o m ag ne ti c f i el d, p a s s e s i n t he v i c i n i t y o f a n u c l e u s , i t s u f f e r s a s ud de n d ef l e c ti o n a nd a c c el e r atio n. A s a r e s ul t ,

WWW.MEDRAD.IR

a p a r t o r al l o f i t s e n e r g y i s di s s o ci a te d f r o m i t a nd pr o p aga t e s i n s p a ce a s e l e ct r om a g n et i c r ad ia t io n . The m e c ha ni sm of b re m s s t r a hl ung p ro d uc ti o n is i ll u s t r a te d i n F i g . 3 .6 . S i n c e a n e l e c t ro n ma y h a v e o n e o r m o re b r e m s st r a hl ung i nte r a c ti o ns i n t he m a t e ri a l a n d a n i n t er a c t io n m a y r e s ult i n p a r ti a l o r co m pl et e l o s s o f el e c tr o n e n e r g y , t h e r es u l ti n g b r e m s st r a hl ung p ho to n m a y ha v e a ny e n e r g y up to t he i n i ti a l e n e rg y o f t h e e l e ct r o n . A l s o , t he dir e c ti o n o f e m i s si o n of b r e m s s t r a hl ung p h o to n s d e pe n d s o n th e e n e r g y o f t he i nc id e nt el e ct r o ns ( F ig . 3. 7 ) . A t e l e ct r o n e n e r g ie s b e lo w ab o u t 1 00 k e V , x - r a y s a re e m itt e d m o re o r l e ss e q ua ll y i n a ll d i r e ct io n s . A s t h e k i n e t i c e n e r g y o f t he e lec t r o ns i nc r e a se s , t he d i r e ct io n o f x - r a y e m i s si o n be c o me s i n cr e a s i n g l y fo r w a r d . T he r e f o re , t r a ns m i s si o n-t y p e t a r ge t s a re u s e d i n m e g a v ol t ag e x - r a y t u b e s ( a c c e l e r at o r s ) i n w hi c h t he e le c t ro ns b o m b a rd t h e t a r ge t f r o m o n e s id e a n d t h e x - r a y b e a m i s o b t ai ne d o n t he o t he r s id e . In t he l o w v o lt a ge x - r a y t u b e s , P.34 i t i s t e c h n i c al l y ad v a n t a g e o u s to o bt a i n t he x - r a y be a m o n t he s a m e si d e o f t he t a r g et , i . e . , a t 90 d e gr e e s w i t h r e s pe c t t o the e l e ct r o n b e a m d i r ec t io n.

F I G . 3 . 6 . Il l u s t r at io n o f b r e m s s tr a hl ung p r oc e s s . T h e e n e r g y l o s s pe r a to m b y el e c tr o ns d e pe nd s o n t he s q uar e o f t he a to m i c n u m b e r ( Z 2 ) . T h u s t he p ro b ab il it y o f b r e ms s t r a hl ung p ro d uc ti o n v a r i e s w i t h Z 2 o f t h e t a rg et m at e ri a l . H o w e v e r t h e e f f i c ie nc y o f x - r a y p r od uc t io n d e pe nd s o n t he f i r s t po w e r o f a to m i c n u m b e r a nd t he v olt a g e ap pl ie d t o t he t ub e . T he te r m e f f i c i e n c y i s de f i n e d as t h e r a t io o f o ut p ut e ne r g y e m itt e d a s x - ra y s t o t he i np ut e n e r g y d e po s it ed b y el e c tr o n s . It c a n b e s h o w n ( 1 , 2 ) t ha t : Efficiency = 9 10-10 ZV w h e r e V i s t u b e vo lt ag e i n v ol t s . F r o m t he a b o v e e q ua t io n i t c an b e s ho w n t h a t t h e e f f i c ie n c y o f x - r a y p r o d u c ti o n w i t h t ung s t e n t a r ge t ( Z = 74 ) f o r e le c t ro ns a c c e l e r at ed t h ro u g h 10 0 k V i s le s s t ha n 1 %. T he r e s t o f t he i np ut e ne r g y ( ~ 99 % ) a p p e a r s a s h e a t . T h e a c c u r a c y o f a b o v e e q ua t io n i s l i mi te d to a f e w M V .

B. Characteristic X-rays
WWW.MEDRAD.IR

E l e c t ro n s

i n c i de n t

on

the

t a r ge t

al s o

p r o d uc e

c ha r a ct e ri s tic

x-rays.

T he

m e c h a n i s m o f t h e i r p ro d u c ti o n i s i ll us t r at e d i n F i g . 3 . 8 . A n e l e c t ro n, w i t h k i ne t i c e n e r g y E 0 , m a y i n t e ra c t w i t h t he a to m s o f t he ta r g et b y ej ec t i ng a n o rb it al e l e ct r o n , s u c h a s a K , L , o r M e le c t ro n, l ea v i ng t he a to m io ni ze d . T he o ri g i nal e l e ct r o n w il l r e ce d e f ro m t h e c ol li s io n w i t h e ne r g y P.35 E 0 - E , w h e r e E i s t h e e n e r g y g i v e n t o t he o r bi t al e le c t ro n. A p a r t o f E i s s p e nt i n o v e r c o mi n g t h e b in d i n g e n e r g y o f t he e l e ct r o n a nd t he re s t i s c a r r i ed b y t he e j e ct e d e le c t ro n . W h e n a v a c a n c y i s c r e a t ed i n a n o r bi t , a n o ut er o r bi t al el e ct r o n w i l l f al l do w n t o fi ll th a t v a c a n c y . I n s o d oi ng , t he e ne rg y i s r adi a t ed i n t he f o r m of el e c tr o m ag n e ti c r a d i at io n . T hi s is c a l l ed c ha r a c te r i st i c r a d i at io n, i . e ., c h a r a c t e r i st i c o f t h e a t o m s i n t he t a rg et a nd o f t he s he l l s b e tw e e n w hi c h t he t r a n s i ti o n s t oo k pl a ce . W i t h h ig he r a to mic num b e r t a rg et s a nd t he t r a ns it io ns i n v o l v i n g i n n e r s h e l l s s u c h a s K , L , M , a nd N , t he c ha r a c t e ri s ti c ra d i a tio ns e m it ted are of high enough e n e r g ie s T a b le to be c ons i d e r ed gi v e s t he in t he x - ra y part of t he e l e ct r om a g n et i c sp e ct r u m . 3.1 m a j or c ha r a ct e ri s ti c r a di a ti o n

p r o d u c ed i n a t u n g s t en t a r g e t .

F I G . 3 . 7 . S c h e m a ti c i ll u s t r a ti o n o f s p at i al d i st r ib ut io n o f x - r a ys a r o und a t hi n t a r g et .

WWW.MEDRAD.IR

F I G . 3 . 8 . D i a gr a m to e x p l a i n t h e pr o d uct io n o f c ha r a c t e r i st i c r a dia t io n. It s h o u l d b e n o t ed t ha t , u n l i k e b r e m s s tr a hlung , c ha r a c t e r i s t i c r ad i a ti o n o r x - r a y s a r e e mi tt ed at di s c r ete e n e rg i e s . If t he t r a ns i ti o n i nv o l v e d a n el ec t r o n de s c e ndi ng f r o m t h e L s h e l l t o t he K s h e l l , t h e n t he p ho to n e m i tt ed w i ll ha v e e ne r g y hv = E K E L , w h e r e E K a n d E L a r e t h e el e ct ro n- b i nd ing e ne r gi e s o f t he K s he ll a nd t he L s h e l l , r e s pe c ti v e l y . T h e t h r e s h o l d e n e r g y t h a t a n i n c i d e nt e le c t ro n m us t p o s se s s i n o rd e r to f i r s t st r ip a n e l e ct r o n f ro m t h e a t o m i s c al le d c ri ti c a l a b s o rp ti o n e ner g y . The s e e ne rg i e s f o r s o m e el e me n t s a r e giv e n i n T a b l e 3 . 2 .

3.5. X-RAY ENERGY SPECTRA

X - r a y p h o t o n s p r od u c e d b y a n x - r a y m a c h i ne a r e he te r og e no us i n e ne r g y . T he energy s pe c t r u m sh o w s a c o nti nuo us by d i st r ib ut io n c ha r a c t e r i st i c of ene r g i e s of for t he b r e m s s tr a h l u n g p h oto n s s u p e r i mp o se d r a d ia t io n di s c r et e

e n e r g ie s . A t y p i c a l s pe c t r al d i st r ib ut io n i s s ho w n i n F i g . 3 . 9 . If n o f i l t r a tio n , i n h e r e n t o r a d d e d , o f t he bea m i s a s s um e d , t he c a l c ul a te d e ne r g y spectrum wi ll be a s t r a ig h t l i ne ( s ho wn as d ot te d l i ne s in Fig. 3 .9 ) a nd m a t h e m a ti c a ll y g i v e n b y K r a m e r ' s e q ua ti o n ( 3 ) :

w h e r e I E i s t h e i n t e n s it y o f p h o t o ns w i t h e ne r g y , E , Z i s t he a t o m i c num b e r o f t he t a r g et , E m i s t h e m a x i m u m p h ot o n e ne rg y , a nd K i s a co ns t a nt . A s p o i nt e d o ut e a r li e r , t h e m a x i m u m p o s s i bl e e ne rg y t ha t a b r e m s s t r a hl ung p ho to n c a n ha v e i s e q u a l t o t h e e n e r g y of t h e i n c i d e nt el e ct r o n. T he m a x i m um e ner gy i n k i lo el e ct r o n v o l t s i s n u m e r i c al l y e q u a l to t he ap pl ie d k i l o v ol t s p e a k ( k V p) . H o w e v e r , t he i n t e n s it y o f s u c h p h oto n s i s z e ro a s p re d i cte d b y t he p r e v io us equa t i o n, t ha t is , I E = 0 when E = Em. T h e u n f i l t e re d e n e rg y s p e c t r u m d i s c us s e d p r e v io us l y i s c o ns i d e ra b l y m o di f i ed a s t h e p h ot o n s e x p e ri e n ce i n h e r e n t f i lt r a ti o n (a b s o r pt io n i n t he t a rge t , gl a s s w a ll s o f t h e t u be , o r t h i n b e r yl li u m w i n d o w ) . T he i nhe r e nt f i lt r at io n i n c onv e nt i o na l x - r a y t u b e s i s us u a l l y eq u i v a l e n t t o ab o ut 0 . 5 - to 1 . 0 - mm a l um i num . A d d e d fi lt r a ti o n, p l a c ed e x t e r n al l y to th e P.36

WWW.MEDRAD.IR

t u b e , f u r t h e r m o d i fi e s t h e s p e c t r um . It s ho ul d b e no te d t ha t t he f i l t r a tio n a f f e c t s p r i m a ri l y the i n it i al low-energy p a rt of t he s p e c t r um a nd does no t a f f e ct s i g n i f i c a n tl y t h e h i g h -e n e r g y p h o to n d i st r ibut i o n.

F I G . 3 . 9 . S p e c tr a l dis t r i b ut io n o f x - r a y s c a l c ul a te d f o r a t hi c k t ung s t e n t a r ge t u s i n g E q u a t io n 3 . 1 . D o tt e d c u r v e s a re f o r no f il t r at io n a nd t he sol i d c ur v e s a re f or a f i l t r at io n o f 1 - m m a l u m i n u m . ( R e d r a w n f r o m J o hns H E , C u nn i ng ha m J R . T he p h y s i c s o f r a di ol og y , 3 r d ed . S p r i ng f ie ld , IL : C ha r l e s C T ho m a s , 1 9 69 , w i t h p e r m i s sio n . )

TABLE 3.1. PRINCIPAL CHARACTERISTIC X-RAY ENERGIES FOR TUNGSTEN

Series

Lines

T r a n si t i on

Energy (keV)

K Series

K2

NIII K

69.09

K1

MIII K

67.23

K1

LIII K

59.31

K2

LII K

57.97

L Series

L1

NIV LII

11.28

WWW.MEDRAD.IR

L2

NV LIII

9.96

L1

MIV LII

9.67

LI

MV LIII

8.40

L2

MIV LIII

8.33

D a t a f ro m U . S . D e p ar t m e n t o f He a lt h, E d uc a t i o n, a nd W e l f a re . R a d io lo gi cal h e a l t h h a n d b oo k . R e v . e d . W a s hi ng t o n, D C : U . S . G o v e r nm e nt P r int i ng O f f i c e , 1 9 70 .

T h e p u r p o s e o f t h e a d d e d fi lt r a ti o n i s to e nr i c h t he be a m w it h hi g he r - e ne rg y p h o to n s b y ab s o rb i ng t h e lo w e r - e ner g y c o m po ne nt s o f t he sp e c t r um . A s t he f i l t r at io n i s i n c r e a se d, t h e t r a n s m i tt ed b ea m ha r d e ns , i . e . , i t a c hi e v e s hi g h e r a v e r a g e e n e r g y a n d t h e r e f o re g re a te r p e ne t r at i ng p o w e r . T hus t he ad d it io n o f f i l t r at io n i s o n e w a y o f i m p ro v i n g t he pe ne t r at i ng p o w e r o f t he b e a m . T he o t her m e t h od , o f c o u r s e , i s b y i n c r e a s i ng t he v ol t a ge a c r o s s t he t ube. S i nc e t he to t al i n t e n s it y of the b e am (area u nd e r t he c ur v e s in Fig. 3.9) d e c r e a se s w i th i n c r e a s i n g f i lt r at io n a n d i n c r e a s e s w i t h v o lt a g e , a p r op e r c om b ina t i o n o f v o lt a ge a n d f i lt r a ti o n i s re q ui r e d to a c h ie v e d e si re d ha r de ni ng o f t he b e a m a s w e ll a s a c c e p t ab le i n t e n si t y . T h e s h a p e o f t h e x - ra y e n e r g y s p e c tr um is t he r e s ult o f t he alt e r na ti ng v o lt a ge a p p li e d t o t h e t u be , m u l t ip le b r e m s st r a hl ung i nt e r a ct io ns w i t hi n t he t a r ge t a nd f i l t r at io n i n t h e b e a m . H o w e v e r , e v e n i f t he x - r a y t ub e w e r e t o be e ne r g i z ed w i t h a c o n s t a n t p ot e nt i al , t h e x - r a y be a m w oul d s ti ll be het e ro gene o us i n e ne rg y b e c a u s e o f t h e m ul ti pl e b re m s s t r a hl ung p r oc e s s e s t ha t re s ul t i n d i f f e r e nt e ne r g y p h o to n s . B e c a u s e o f t h e x - r a y b e a m h a v i ng a s p e c t r al d i st r ib ut io n o f e ne r g i e s , w hi c h d e pe n d s o n v o l t a ge a s w e l l a s f i l t r at io n, i t i s d i f f i c ul t to c ha r a c t e ri z e t he b e a m q u a l it y i n t e r m s o f en e r g y , p e n e t r at i ng pow e r , o r d e g re e o f b ea m ha r d e ni ng . A r u l e o f t h u m b i s o f te n u s e d w hi c h s t a tes t ha t t he a v e r a ge x - r a y e ne r g y i s a p p r o xi m a te l y o n e - t h ir d o f t h e m a x im um ene r g y o r k V p . O f co urs e , t he o ne - t hi r d r u l e i s a r o u g h a p p ro x i m a tio n s i nc e f i l t r at io n s i g ni f i c a ntl y a l ter s t he a v e r a g e e n e r g y . A n o t h e r q u a n ti t y , k n o w n a s ha l f - v a lue l a y e r , ha s be e n de f i ne d t o d e s c ri b e t h e q u a l it y o f a n x - r a y b e a m . T h i s t o p i c i s d i s c us s e d i n de t ai l i n C ha p t e r 7 .

TABLE 3.2. CRITICAL ABSORPTION ENERGIES (keV)

WWW.MEDRAD.IR

Le ve l

Element H C O Al Ca Cu Sn I Ba W Pb U

1 3

2 0

2 9

5 0

5 3

5 6

7 4

8 2

9 2

0 . 0 1 3 6

0 . 2 8 3

0 . 5 3 1

1 . 5 5 9

4 . 0 3 8

8 . 9 8 0

2 9 . 1 9 0

3 3 . 1 6 4

3 7 . 4 1

6 9 . 5 0 8

8 8 . 0 0 1

1 1 5 . 5 9

0 . 0 8 7

0 . 3 9 9

1 . 1 0 0

4 . 4 6 4

5 . 1 9 0

5 . 9 9 5

1 2 . 0 9 0

1 5 . 8 7 0

2 1 . 7 5 3

Data

from

U.S.

D e p a r tm e nt handbook.

of

H e a lth, Rev. ed.

E d uc a t i o n,

a nd

Welfare. DC: U.S.

R a d i ol og i c al

h e a lt h

W a s hi ng to n,

G o v e r n m e n t P r i n ti n g O f f i c e , 1 9 7 0 .

WWW.MEDRAD.IR

F I G . 3 . 1 0 . Il l u s t r at io n o f t y p i c al o pe r a ting c ha r a c t e ri s ti c s . P lo t s o f re l at i ve e x p o s u r e r at e v e r s u s a , f i l a m e n t c ur re nt a t a gi v e n k V p ; b , t ub e c ur r e nt a t a g i v e n k V p ; a n d c , t u b e v o l t ag e a t a gi v e n tub e c ur r e nt .

3.6. OPERATING CHARACTERISTICS

P.37

In t h i s s e c ti o n , t h e re l a tio n s h i p s be t w ee n x - r a y o ut p ut , f il a m ent c ur r e nt , t ube c u r r e n t , a n d t u b e v o l ta g e a r e b ri e f l y di s c us s e d . T h e f i l a m e n t c u r r e n t a f f e c t s t h e e m i s s io n o f e l e c t ro ns f r o m the f i l a m e nt a nd , t h e r e f o re , t h e t u b e cu r r e n t . F i g u r e 3 . 1 0 A s ho w s t he t y pi c a l r el at io ns hi p be t w ee n t h e r e la ti v e e x po s u r e r a t e a n d t h e f i l a me nt c ur r e nt m e a s ur e d i n a m p e r e s ( A ) . T he f i g u r e s h o w s t h a t u n d e r t y p i c al o p e r at i ng c o nd it io ns ( f i l a me nt cur r e nt o f 5 to 6 A ) , a s m a l l c h a n g e i n f i l a me n t constancy of the x-ray output. T h e o u t p u t o f a n x - r a y m a c h i n e c a n a l s o b e e x p r e s s e d i n t e r m s o f t he i o ni z a t io n i t p r o d u c e s i n a i r . T h i s q u a n t i t y , w hi c h i s a m e a s ur e o f io ni z a ti o n p e r uni t m a s s o f a i r , i s c a ll ed e x po s u r e . In F i g u r e 3 . 1 0 B, t he e x p o s ure r at e i s p lo tte d a s a f unc t io n o f t h e t u b e c u r r e n t . T h e r e i s a l i ne a r r e l at ions hi p b e t w e e n e x po s ur e r a t e a nd t ub e c u r r e n t . A s t h e c u r r e n t o r m il li a m pe r a g e i s d o ub le d , t he o ut p ut i s a l s o d o ubl ed . T h e i n c r e a s e i n t h e x - r a y o u t p ut w it h i nc r e a s e i n v o lt a g e , ho w e v e r , i s m uc h g r e a te r t h a n t h a t gi v en b y a l i n e a r r el a ti o nshi p . A lt ho ug h t he a c tua l s ha p e o f t he c u r v e ( F i g . 3 . 10 C ) de p e n d s o n t he f i lt r a ti o n, t he o utp ut o f an x - r a y m a c hi ne v a r i e s a p p ro x i m at el y a s a s q u a r e o f k i l o v ol ta g e . c ur r e nt p r o d uc e s a l ar g e c ha ng e i n re l at i v e e x p o s u r e ra t e . T h i s me a n s t h a t t he co ns t a nc y o f f i l a me nt c ur re nt i s c ri ti c a l to t he

REFERENCES
WWW.MEDRAD.IR

1 . B o t d e n P . M o d e r n t r e n d s i n d i ag no st i c ra d i olo g i c i ns t r um e nt at io n. In: M o s e l e y R , R u s t J , e d s . T h e r e d u c ti o n o f p at ie nt d o se b y d i ag no s ti c i ns t r um e nt at io n . S p r i n g f i el d , IL : C h a r l es C T h o m a s , 1 9 6 4 : 1 5 . 2 . H e n d e e W R . M e d i c a l r a d i at io n p hy s i c s , 2 nd e d . C hi c a g o : Y ea r Bo o k M e d i c al P u b l i s h e r s , 1 97 9 . 3 . K r a m e r s H A . O n t h e t h e o r y o f x - r a y a b s o r pt io n a nd t he co nt i nuo us x - r a y s p e c t r u m . P h i l M a g 192 3 ; 46 : 8 36 .

1

In t e n s i t y i s d e f i n ed a s t h e t i m e v a r i a tio n o f e ne r g y f l ue nc e o r t o t al e ne r g y

c a r r i e d b y p a r ti c le s (in t h i s c a se , p hot o ns ) p e r uni t a r e a pe r uni t t im e . T he t e rm i s a l s o c al l ed e n e r g y fl u x d e n s i t y .

2

H e r e t h e c u r re n t m ea n s c o n v e nt i o na l c ur re nt . T he e l e ct ro ni c cur r e nt w i l l fl o w

f r o m t h e c a t h od e to th e a n o d e .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 4 - C lin ical Radiation Generators

P.38

Clinical Radiation Generators

4.1. KILOVOLTAGE UNITS
U p to ab o u t 1 95 0 , mos t o f t h e e x t e r nal be am r a d io t he r a p y w a s ca r r i e d o ut w i t h x r a y s g e n e r a te d a t v olt a g e s u p t o 30 0 k V p . S ub s e q ue nt d e v el opm e nt o f hi g he r e n e r g y m a c h i n e s a n d t h e i n c r e a s i ng p o p ul a ri t y o f t he c ob a lt - 60 uni t s i n t he 1 95 0 s a n d t h e 1 9 60 s r e s ult e d i n a g r a d ua l d em i s e o f t he c o nv e ntio na l k il o vo lt a g e m a c h i n e s . H o w e v e r , th e s e m a c h i ne s ha v e no t co m pl et el y d i s ap p ea r e d . E v e n i n t he p r e s e n t e r a o f t h e me g a v ol t a ge be a m s , t he r e i s st il l so m e us e f o r t he lo w e r e n e r g y b e a m s , e s pe c ia l l y i n t h e t re a t me nt o f s up e r f i c i al s k i n l e s io ns . In C h a p t e r 3 , w e di sc u s s e d i n g e ne r al t he p ri nc i pl e a nd op e r at io n o f a n x - r a y g e n e r a to r . In t h i s c h a p t e r , w e w il l co ns i de r i n p a rt i c ul a r t he sa l i e nt f e a t ur e s o f the therapy machines. O n t h e b a s i s o f be a m q u a l i t y a n d t hei r us e, t he x - r a y t he r a p y i n t he k i lo v o lt a ge r a n g e h a s b e e n d i v id ed i n to s u b c a te go r ie s (1 , 2 ) . T he f o ll o wi ng r ang e s a r e mo r e i n a c c o r d a n c e w it h t h e N a t io n a l C o u nc i l o n R a di a ti o n P r o te c ti o n ( 2 ) .

A. Grenz-ray Therapy
T h e t e r m g re n z - r a y t h e r a p y i s u s e d to de s c ri b e t r e at m e nt w it h b ea m s o f v e r y s o f t ( l o w - e n e rg y ) x - r a y s pr o d u c e d a t po te nt i al s b e lo w 20 k V . Be c a us e o f t he v e r y lo w d e pt h o f p e n et r a ti o n ( F i g . 4 . 1 , l i ne a ) , suc h r a d i a ti o ns a re no lo ng er us e d i n r a d i at io n t h e r a p y .

B. Contact Therapy
A c o n t a c t t h e r a p y o r e n d o c a v it a r y m a c hi ne o p e r a te s a t p ot e nt i als o f 4 0 t o 5 0 k V a n d f a c i l it a te s i r r ad i ati o n o f a c c e s si bl e le s ions a t v e r y s ho r t s o ur ce ( f o c a l s pot ) to s u r f a c e d i st a n c e s ( S SD ) . T h e m a c hi ne o per a t e s t y p i c al l y a t a tub e c ur r e nt o f 2 m A . A p p l i c at o r s a v ai la b l e w it h s uc h m a c hi ne s c a n p r o v i de a n S S D o f 2 . 0 c m o r l e s s . A f i l t e r o f 0 . 5 - to 1 . 0 - m m t hi c k a l um inum i s us ua l l y i nt e r po s e d i n t he b e am t o a b so r b t h e v e r y s o ft c o m po n e n t o f t he e ne r g y s p e ct r um . B e c a u s e o f v e r y s h o rt S S D a n d lo w v o lt a ge , t he co nt a c t t he r ap y b e a m p r od uc e s a v e r y r a p id l y de c r e a sin g d e pt h do s e 1 i n t i ss ue . F o r t ha t re a s o n, i f t he be a m i s i n c i d e nt o n a p a ti e n t , t h e s k i n s ur f a c e i s m a x i m a l l y i rr a d i at ed b ut t he und e r l y i ng t i s s u e s ar e sp a r ed to a n i n c r e a si ng de g r ee w it h d ep t h. T he d os e v e r s us de pt h c u r v e o r s im p l y t h e de p t h - do s e c ur v e o f a t y p i c al c o nt a c t t he r a py b e a m i s s ho w n i n F i g . 4 . 1 , l i n e b . It i s r e a d il y s e e n t ha t t hi s q ua l it y o f r a d i at io n i s us e f ul f o r t u m o r s no t d ee p e r t ha n 1 to 2 m m . T he bea m i s a l mo s t c o mp le te l y a b so r be d w i t h 2 c m o f s o f t t is s u e .

C. Superficial Therapy
WWW.MEDRAD.IR

The

term

s u p e r f i ci a l

therapy

ap pl i e s

to

t r e at m e nt

w it h

x-rays

p r o d uc ed

at

p o te n t ia l s r a n g i n g f rom 5 0 to 1 50 k V . V a r y ing t hi c k ne s s e s o f fi lt ra t io n ( us ua l l y 1 t o 6 - m m a l u mi n u m ) a r e a d de d t o ha r de n t he b e am to a de s ir e d de g r ee . A s m e n t io n e d P.39 d e f i n e d a s t h e t h i c k n e s s o f a s pe c i f ie d mat e ri a l t ha t , w he n i nt ro d uc e d i nto t he p a t h o f t h e b e a m , r ed u c e s t h e e x p o s ur e ra t e b y o ne - ha l f . T y p i c a l H V L s us e d i n t h e s u p e r f i c i al r a n g e a r e 1 . 0 - to 8 . 0 - m m A l. i n s e ct io n 3 . 5 , t h e d e g re e o f ha r d e ni ng o r b e a m q ua l i t y c a n be e x p r e s s ed a s t h e h a l f - v a l u e l a y e r ( H V L ) . T h e H V L i s

F I G . 4 . 1 . D e p t h do s e c u r v e s i n w a t e r o r so f t ti s s ue s f o r v a r io us q ua l it y b e a m s . L i n e a : G r e n z r a y s , H V L = 0 . 0 4 mm A l , f ie l d d i am e te r [ a s y m pto ti c a ll y e q ua l to ] 3 3 c m , S S D = 10 c m . L i n e b : C o nt a ct t he r ap y , H V L = 1 . 5 m m Al , f i e l d di a m et e r = 2 . 0 c m , S S D = 2 c m . L i n e c : S up e r f i c ia l t he r a p y , H V L = 3 . 0 m m A l , f i e l d d i a m et e r = 3 . 6 c m , S S D = 2 0 c m . L i n e d : O r t ho v ol t a ge , H V L = 2 . 0 m m C u, f i e l d s i z e = 10 1 0 c m , SS D = 5 0 c m . L i n e e : C o b a lt - 60 r a y s , f i eld s i z e = 1 0 1 0 c m , S S D = 8 0 c m . ( P l o tt ed f r o m d at a i n C o he n M , J o ne s D E A , G r e e n D , e d s . C e n t r a l a x i s d ep t h dos e d at a f o r us e i n r a di ot he r a p y . Br J R a di ol 1 9 78 [ s up pl 11 ] .

WWW.MEDRAD.IR

T h e B r i t i s h In s t i t u t e of R a d i o lo g y , L o ndo n, w i t h p e r mi s s io n. ) T h e s u p e r f i c i al t re a tme n t s a r e u s ua ll y g i v e n w i t h t he hel p o f a pp li c a to r s o r c o ne s a t t a c h a bl e t o t h e d i aph r a g m o f t he m a c hi ne. T he S S D t y p i c a ll y r a ng e s b et w e e n 15 a n d 2 0 c m . T h e m a c h i n e i s u s u a l l y o p e r at e d a t a t ub e c ur r e nt o f 5 t o 8 m A . A s s e e n i n F ig . 4 . 1 , li n e c , a s u p e r f i ci a l be a m o f t he q ua li t y s ho w n i s us e f ul f o r i r r a di a ti n g t u m o r s co n f i n e d to a b o ut 5 - m m d e pt h ( ~ 9 0 % de p t h do s e ) . Be y o nd t his d e pt h , t h e d o s e d ro po f f i s t o o se v e r e to d e li v e r a d eq ua t e de pt h d o s e w it ho ut c o n s i d er a b le o v e rd o sin g o f t h e s k i n s ur f a c e .

D. Orthovoltage Therapy or Deep Therapy

T h e t e r m o r t ho v o lt age t h e r ap y , o r de ep the r a p y , i s us e d t o de s c r i be t re a tm e nt w i t h x - r a y s p r o d u c ed a t po t e nt i al s r a ng i ng fr o m 15 0 t o 5 0 0 k V . Mo s t o r t ho vo lt a ge e q u i p me n t i s o pe r a ted a t 20 0 t o 3 00 k V a nd 1 0 to 20 m A . V a r io us f i l te r s ha v e been de s ig n e d to ac h i e v e h a l f - v a l ue l ay e r s b et w e e n 1 a nd 4 mm C u. An o r t h o vo lt a g e m a c h i n e i s s h o w n i n F i g . 4 . 2 . A l t h o u g h c o n e s c a n b e u s e d t o co ll i m at e t he b e a m i nto a d e si r e d s i z e , a m o v a b le d i a p h r a g m , co n s i s ti n g o f l e ad p l at e s , p e r mit s a c o nti nuo us l y a d j us t a b le f i el d si z e . The SSD is usually set at 50 cm.

F I G . 4 . 2 . P h o t og r a p h o f S i e m a n ' s S t a b il a p an. P.40

F i g u r e 4 . 1 , l i n e d s h ow s a d e p t h d o se c ur v e f o r a m o d e r at el y f i lt er e d o rt ho v ol t age beam. be A lt h o u g h from the this actual curve d ep t h a b o ut do s e t he d i st r ib ut io n w o uld d e pe nd on m a ny T he c o n d it io n s s u c h a s k i l o v o lt a ge , H V L , S S D , a nd f i e l d s i z e , s o me g ene r a l i z a ti o ns c a n m a de o rtho v o l t ag e beam c ha ra c t e ri s ti c s . m a x i m u m d o s e o c c u r s c l o s e t o t h e s k i n s ur f a c e , w i t h 9 0% o f t ha t v a l ue o c c ur r i ng a t a d e pt h o f a bo u t 2 c m . T h u s , i n a s i ngl e f i e l d t re a tm e nt , ad e qua t e do s e c a nnot

WWW.MEDRAD.IR

b e de li v e r e d to a t u mo r b e yo n d t hi s d ep t h. H o w e v e r , b y i nc r e a si ng b e a m fi lt r a ti o n o r H V L a n d c o mb i n i ng t w o o r mo r e b e a m s d i r e ct ed a t t he t um o r f r o m d i f f e r e nt d i r e ct io n s , a h i g h e r do s e t o d e ep e r t um o r s i s d el i ve r e d . A s w il l b e di s c us s e d i n further d e ta il in Chapter 11, t he r e are severe l i mit a ti o ns to t he us e of o r t h o vo lt a g e b e a m in t r e a t i n g l e si o ns de e pe r t ha n 2 t o 3 c m . T he g r e a t e st l i mi t at io n i s t h e s k i n d o se , w h i c h b e co m es p r o hib it i v el y l a rg e w he n a d e q ua te d o s e s a re to b e de li v e r e d t o de e p - se a te d tum o r s . In t he e a r l y d a y s o f r a d i a ti o n t h e r a p y , w h e n o r t h o vo lt a g e w a s t he hi g hes t e ne rg y a v a i l a bl e , t r e at m e nt s w er e g i v e n u n t i l r ad i at io n t ol e r a n c e o f t he s k i n w a s r e a c he d . A l t ho ug h m e t hod s w e r e d e v e lo pe d to u s e m u l ti p le b e a m s a nd o t he r t e c hni q ue s to k e ep t he s k i n d o s e u n d e r t o le r a n c e li m its , t h e p r o bl e m o f hi g h s k i n d o s e r e m ai ne d a n o v e r r id i ng c o n c e r n i n t h e o r t ho v o lt a g e e r a . W it h t he a v a i l a bi li t y o f co b al t t e le t he r ap y , t he s k i n - s p a r i n g pr o pe r ti es o f h i g h e r e ne r g y r ad i a ti o n ( F ig . 4 . 1 , li ne e ) b e c a m e t he m a j o r r e a so n f o r t h e m o d er n t r e n d to m e g av o l t ag e be a m s . A l t h o u g h s k i n do s e a n d d ep t h d o s e di s t ri b uti o n ha v e be e n p re s e nt e d he r e a s t wo e x a m p le s of the lim i t at io n s p o s ed by l o w - e ne r g y be a m s , t he r e are ot he r p r o pe r ti e s s u c h a s i n cr e a s e d ab s o rb e d d o se i n b o ne a nd i nc r e a s ed s c a t te r i ng t ha t m a k e o r t h o vo lt a g e bea m s u n s u i t a b l e f o r t he t r e at m e nt o f t um o r s b e hi nd b o ne .

E. Supervoltage Therapy
X - r a y t h e r a p y i n t h e r a n g e o f 5 0 0 t o 1 ,0 0 0 k V ha s b e e n d es i g na t ed a s hi g hv o l t ag e t h e r a p y o r su p e r v o lt a ge t he r ap y . In a q ue s t f o r hi g he r - e ne r g y x - r a y beams, c o n s id e r ab l e the p r o g re s s was m a de T he d ur i ng major It t he p o st w a r at b e c a me years t ha t t o w a rd was t ha t d e v e lo pi n g insulating P.41 a b o v e 30 0 k V p . H o w e v e r , w i t h t h e r a p i dl y a d v a nc i ng t e c hno lo g y of t he t i m e s , ne w a p p r o a c h e s to t h e de s i g n o f h ig h- e ne r g y m a c hi ne s w e r e f o und . O ne o f t he se m a c h i n e s i s t h e r e son a n t t r a n s f o r m e r , i n w hi c h t he v o l t a ge i s s t e pp e d up i n a very efficient manner. h i g h e r - vol t a ge m a c hi ne s . p r ob l em ti m e

h i g h- v o l t ag e

t r a ns f o r m e r.

soon

a p p a r e nt

c o n v e n t i o n al t r a n s f o rm e r s y s t e m s w e r e not s ui t a b le f o r p r od uc i ng p ot e nti a l m uc h

WWW.MEDRAD.IR

F I G . 4 . 3 . D i a gr a m o f a r e s o n a n t t r a ns f o r m er uni t .

E.1. Resonant Transformer Units

R e s o n a n t t r a n s f o r m e r u n i t s h a v e b ee n us e d t o g e ne r at e x - r a y s f r om 3 00 t o 2 , 0 00 kV. The schematic di a g r a m of t he ap p a ra t us is s ho w n in Fig . 4.3. In t hi s a p p a r a t u s , t h e se c o n da r y o f t h e hi g h- v ol t age t r a ns f o rm e r ( wi t ho ut t he i ro n co r e ) i s c o n n e c t ed i n p a r a ll e l w it h c a p a c it o r s dis t r i b ut e d l e ngt hw i s e i ns i d e t he x - r a y tube. The c o m bi n a t io n o f t h e t r a ns f o r me r s e c o nd a r y a nd t he c a p a c it a nc e in p a r a l le l e x h i b it s t h e p h e n o m e n o n o f r e so na nc e . A t t he r e s o na nt f r e q ue nc y , t he o s c il l at i n g p ot e nt i al att a i n s v e r y hi g h a m pl itud e . T hus t he p e a k v ol t a ge a c ro s s t he x - r a y t u b e b e co m e s ve r y l a r g e w he n t he t ra ns f o r m e r i s t une d to r e s o na te a t t he i n p u t f r e q u e n c y . S i n c e t h e el e ct r o ns at ta i n hi g h e ne r gi e s bef o r e s t ri k i ng t he t a r g et , a t r a n s m i s s io n - t y p e t a rg e t ( s e ct io n 3 . 4 ) m a y b e us e d t o o b t ai n t he x - r a y b e a m o n t h e o t h e r si d e o f t h e t a rg et . T h e e l e ct r i c al i ns ul a ti o n i s p r o v i de d b y p r e s s u r i z e d F re o n g a s.

F. Megavoltage Therapy
X - r a y b e a m s o f e n e r gy 1 M V o r g r e at e r c an b e c la s s i f ie d a s m eg a v o lt a g e be a m s . A l t h o u g h t h e t e r m s tri c tl y a p p li e s to t he x - r a y b e a m s , t he r a y b e a m s p r od uc e d b y r a d io n u c l i de s a re a l s o co m mo nl y i ncl ud e d i n t hi s c at eg o r y i f t he i r e ne r g y i s 1 M e V o r g r e at e r . E x a mp l e s o f cl i n i c al me g a vo lt a g e m a c hi ne s a re ac c e l e r ato r s s uc h a s V a n d e G r a a f f g e n e r a to r , l i ne a r a c c el e r at o r , b et a tr o n a nd m i c r o tr o n, a nd t e le t h e r ap y r a y u n i t s s u c h a s c o b a l t -6 0 .

4.2. VAN DE GRAAFF GENERATOR

T h e V a n d e G r a a f f m a c h i n e i s a n e l e c t ro s t at i c a c c el e r at o r de s i g ne d t o a c c el e ra te c h a r g e d p a r ti c le s . In r a d i ot h e r a p y , t he uni t a c c e l e r at e s el e ct r o ns t o p ro d uc e hi g he n e r g y x - r a y s , t y p i c a ll y a t 2 M V . F i g u r e 4 .4 s h o w s a s ch e m a t i c d i ag r a m il l ust r a ti ng t he b a s i c p r i nc i p le o f a V a n d e G r a a f f g e n e r a t o r . In t h i s m a c h i ne , a c ha r g e v o lt a g e o f 2 0 t o 4 0 k V i s a p p l ied a c r o s s a m o v i n g be lt o f i n s u l a ti ng m a t er i al. A c o ro na di s c ha r g e t a k e s pl a c e a nd e l e ct r o n s a re s p r a y ed o n t o t h e be lt . T he s e e l e ct r o ns a re c a r ri e d t o t he to p w he re t h e y a r e r e m o v ed b y a c o l le c to r c o nne c te d t o a s p he r i c al d o me . A s t he ne g a t i v e c h a r g e s c ol le c t o n t h e s p h e re , a hig h p ot ent i a l i s d e v el op e d b etw e e n t he sp he re a n d t h e g ro u n d . T h i s p ot e n ti a l i s a pp li e d a c r o s s t he x - r a y t ub e c o ns i s ti ng o f a f i l a m e n t , a s e ri e s o f m e t al ri n g s , a nd a t a r ge t . T he r i ng s ar e c o nne ct e d to r e s i st o r s t o p ro v id e a u n i f o r m d r o p o f p ote nt i al f r o m t he b ot tom t o t he to p . X r a y s a r e p r o d u c e d w h e n t h e e l e ct r o ns s t ri ke t he t a r ge t . V a n d e G r a a f f m a c h i n e s a r e c a p a bl e o f re a c hi ng e ne r gi e s up t o 10 M V , l i mi te d o n l y b y s i z e a n d r eq u i r e d hi g h - v o lt a ge ins ul a t i o n. N or m a ll y the i ns ul a t io n is p r o v id e d b y a m i x t u r e P.42 o f n i t r og e n a n d C O 2 . T h e g e n e r a to r i s e nclo s e d i n a s t e el t a nk a nd i s f i l le d w it h t h e g a s m i x t u r e at a p r e s s u r e o f a b o ut 20 a tm .

WWW.MEDRAD.IR

FIG. 4.4. A Van de Graaff generator. V a n d e G r a a f f a n d r e s o n a n t t r a n s f o r m er ( se c t io n 4 . 1 . E ) uni t s f or c l i ni c al us e a r e n o l o n g e r p r od u c e d co m m e r ci a ll y . T he r e a s o n f o r t he i r de m i se is t he e m e r ge nc e o f t e c h n i c a ll y b e tt e r m a c h i n e s s u c h a s c o b a l t - 60 uni t s a nd l i ne a r a c c e l e r at o r s .

4.3. LINEAR ACCELERATOR

The linear a c c el e ra t o r ( li n a c ) is a d e v i ce t ha t us es hi g h- f r e q ue nc y e l e ct r om a g n et i c w a v es t o a c c el e r at e c ha r ge d p a rt i cl e s s uc h a s e l e ct r o ns to hi g h e n e r g ie s t h ro u g h a li n e a r t u be . T he hi g h- e ne r g y el e ct r o n be a m i ts e l f c a n b e us e d f o r t r e at i n g s u p e r fi c i al t u m o r s , o r i t c a n b e m a d e to s t r i ke a t a r ge t to p ro d uc e x r a y s f o r t r e a ti n g d e ep- s e a t ed t u m o r s . T h e r e a r e s e v e r a l t y p e s o f l i ne a r a c c e le ra t o r de s ig ns , b ut t he o ne s us e d i n r a d i at io n therapy ac c e l e r at e of e le c t ro ns f r e q ue nc y e i t her in t he by t r a v el ing or r e g io n s t at io na r y ( ~ 3 , 0 00 e l e ct r om a g n et i c waves microwave

m e g a c y c le s / s e c ) . T h e d i f f e r e n c e b et w e e n t r a v e li ng w a v e a nd s t a ti o na r y w a v e a c c e l e r ato r s i s t h e des i g n o f t h e a c c el e r at or s t r uc t ur e . F unc t i o nal l y , t he t r a v el i ng w a v e s t r u c t u r e s re q u ir e a t e r mi na t i ng , o r d um m y , l o a d t o ab so r b t he re s i d ual p o w e r a t t he e n d o f th e s t r u c t u r e , t hus p r e v e nt i ng a b a c k w a r d r e f l e c te d w a v e . O n t h e o t h er h a n d , t h e s t a n d i n g w a v e s t r uc t ure s p r o v id e m a x i m um r e f l e ct io n o f t he w a v e s a t b ot h e n d s o f t h e s t r uc t ur e so tha t t he c o mb i na ti o n o f f o r w a r d a nd r e v e r s e t r a v e li n g w a ve s w i ll gi v e ri s e t o s ta t io na r y w a v e s . In t he s t a ndi ng w a v e d e s ig n , t h e m i c ro w av e p o w e r i s c o upl ed i nt o t he s t r uct ur e v i a s i de c o upl i ng c a v i t ie s r at h e r t h a n th r o u g h t h e be a m ap er t ur e . S uc h a d e si g n t e nd s t o b e m or e e f f i c i e n t t h a n t h e t r a ve l i n g w a v e d e si g ns s inc e a x i a l , b e a m t r a ns p o rt c a v i t ie s , a nd the s id e c a vi ti e s c an be i n de pe nd e ntl y o p ti mi z e d (3 ) . H o w ev e r , it is m o re

WWW.MEDRAD.IR

e x p e n s i v e a n d re q u i res i n s t a ll a ti o n o f a c i r cul a t o r (o r i s ol a to r ) b et w e e n t he p o we r s o u r c e a n d t h e st r u c tu r e t o p re v e nt re f l e cti o ns f r o m r e a c hi ng t he po w e r so ur c e . F o r f u r t h e r d et a il s o n t h i s s u b j e ct a nd li nea r a c c e l er a to r op e r at io n t he r e ad e r i s r e f e r r e d t o K a r z m a r k , N u n a n , a n d T a na b e ( 3 ) . F i g u r e 4 .5 i s a b lo ck d i a g r a m o f a m ed ic a l li ne a r a c c el e r at o r s ho w i ng m a j or c o m po n e n t s a n d a u x ili a r y s y s t e m s . A p o w er s up p l y pr o v id e s d i re c t c ur r e nt ( D C ) p o w e r t o t h e mo d u l ato r , w h i c h i nc l ud e s t he p ul s e - fo r m i ng net wo r k a nd a s w it c h tube known as hydrogen P.43 t h y r a t r o n . H i g h - v o lt ag e p u l s e s f r o m t he m o d ul at o r s e ct io n a r e f l a t - to pp e d DC p u l s e s o f a f e w m i c ro s e co n d s i n d ur a tio n. T he s e p ul s e s a re d e li v e r ed to t he m a g n e t ro n microwaves e l e ct r o n s , or kl y s t ro n 2 in by and the an s i m ult a neous l y m ag ne t ro n g un , or to t he el e ct r on are p ul s e g un. P ul s e d t he t he p ro d u c e d p ro d u c ed k l y s t ro n a l so i nj e c te d i nje c t ed i nto i nto

a c c e l e r ato r t u b e o r s t r u c t u r e vi a a w a v e g ui d e s y s t em . A t t he p ro pe r i ns t a nt e l e c tr o n are a c c e l e r ato r s t r u c t u r e .

F I G . 4 . 5 . A b l o c k di ag r a m o f t y p i c al m ed i ca l l i ne a r a c ce l er a to r . T h e a c c e l e r at o r st r u c t u r e ( o r a c c el e r at o r w a v e g ui d e ) c o nsi s t s o f a c o p pe r t ube w i t h i t s i n te r io r di v i de d b y c op pe r di s c s or d i a p hr a gm s o f v a r y ing a p e r t ure a nd s p a c i n g . T h i s s e c ti o n is e v a c u a t e d to a hi g h v a c uum . A s t he e l e c t ro ns a r e i nj e ct ed i n t o t h e a c c el e ra to r s tr u c t u r e w i t h a n i ni t i a l e ne r g y o f a b o ut 5 0 ke V , t he e l e ct r o ns i n t e r a ct w i t h t h e e lec t r o m ag n e ti c f i e ld o f t he m i c r o w a v e s . T he e l e ct r o ns g a i n e n e r g y f r o m t h e s i n u s o i d al e le c t ri c f i el d b y a n a c c e l e r a t io n p r o ce s s a na l o go us t o that of a surf rider. A s t h e h i g h - e n e r g y el e c tr o n s e me r ge f r o m t he e x it w i ndo w o f t he a c c el e r at o r s t r u c t u r e , t h e y a r e i n t h e f o r m o f a p e nc i l b e a m o f a b o ut 3 m m i n d i a m e t er . In t h e l o w -e n e r g y li n a c s ( u p t o 6 M V ) w i t h r e l at i v el y s ho r t a c c ele r a to r t ub e , t he e l e ct r o n s a re a llo w ed to p ro c ee d st r a ight on a nd s t ri k e a t a r ge t fo r x-ray p r o d u c tio n . In t h e h i g h e r - e n e r g y l i na c s , how e v e r , t he a c c e l e ra tor s t r uc t ur e i s to o l o n g a n d , t h e r e fo r e , i s pl a c e d ho ri z o nt a ll y o r at a n a ngl e w it h r e s pe c t t o t he h o r i z o n t al . T h e el e c tro n s a r e t h e n b e nt t hro ug h a s ui t ab l e a ng l e ( us ua l l y a b o ut 9 0

WWW.MEDRAD.IR

o r 27 0 d eg r e e s ) be t we e n t h e a c c el e r at o r st r uc t ur e a nd t he t a r ge t . T he p r e ci s io n b e n d i n g o f t h e el e ctr o n b e a m i s a c co mp li s he d b y t he b e a m tr a ns p o r t s y s t e m c o n s i s ti n g o f b e n di n g m a g n e t s , f o c us i ng c oi ls , a nd o t he r c o m po nent s .

A. The Magnetron
T h e m a g n e t r o n i s a d e v i c e t h a t p ro d uc e s m i c r o w a v e s . It f unc t io ns a s a hi g hp o w e r o s c il l at o r , g e ne r a ti n g m i c ro w a v e p ul s e s o f s e v e r al m i c ro se c o nd s d ur at io n a n d w i t h a re p et it io n r a t e o f s e v e r al hund r ed p ul s e s p er s e co nd . T he f r e q ue nc y o f t h e m i c ro w a v e s w i t h i n e a c h p u l s e i s a b o ut 3, 0 0 0 M H z . T h e m a g n e t ro n h a s a c y l i n d r i c al c o ns tr uc t io n, ha v i ng a c e nt r a l c a t ho d e a nd a n o u t e r a n od e w it h r e son a n t c a v i t i e s m a c hi ned o ut o f a s o li d p ie c e o f c o pp e r ( Fi g . 4 . 6 ) . T h e s p a c e b et w e e n t h e c a t hod e a nd the a no d e i s e v a c ua t ed . T he c a t ho d e is h e a t e d b y a n i n n e r f i l a m e n t a nd t he e lec t r o ns a r e g e ne r at ed b y t he r m i o ni c e m i s si o n . A s t at i c ma g n e t i c f i el d i s a p pl ie d pe r p e ndi c ul a r t o the p l a ne o f t he c r o s s - s e ct io n o f t h e ca v i t ie s a n d a p ul s ed D C e l e ct r i c f ie ld i s a pp l ie d be t w ee n t he c a t h o d e a n d t h e a n o de . T h e e le c t ro ns e mi tt e d f r o m t he c at ho d e a r e a c c el e r ated toward spirals P.44 t o w a r d t h e r e so n a n t c a v i t ie s , r a d i at i ng e ne r g y i n t he f o r m o f m i c r o w a v e s . T he g e n e r a te d waveguide. m ic r o w a v e pulses are l ed to t he a c c e l e r ato r s tr uc t ur e via t he t he a n od e by the a c ti o n o f t he p ul s e d DC el e ct r i c f i e ld . U nd e r t he s i m u l t a n eo u s i n f l u e n ce o f t h e m a g net i c f ie l d , t he el e ct r o ns mo v e i n co m pl e x

WWW.MEDRAD.IR

F I G . 4 . 6 . A , B : C u t aw a y m a g n e t ro n pi c t ure s . C : C r o s s - se c ti o na l d i ag r a m s ho w i ng p r i n c i pl e o f m a g n et r on o p e r at io n. ( F r o m Ka r z m a r k C J , M o r t o n R J . A p r i m e r o n t h e o r y a n d op e r at io n o f li n e a r a c c e le r a to rs i n r a di a ti o n t he r a py . R o c k v i l le , M D: U . S . D e p a r t me n t o f H e a l t h a n d H um a n S e r v i c e s , Bur e a u o f R a d i ol og i c al H e a lt h, 1 9 81 , w i t h p e r mi s s io n . )

WWW.MEDRAD.IR

T y p i c a l l y , m a g n et ro n s o p e r at e at 2 M W p ea k p o w e r o ut p ut t o po w e r lo w - e ne r g y linacs (6 MV or les s ) . Although most hi g he r - e ne r g y li na cs us e k l y s t r o ns , a c c e l e r ato r s o f e n e r gy a s h i g h a s 2 5 M e V ha v e b e e n d e s ig ne d to us e m a g ne t ro ns of about 5 MW power.

B. The Klystron
T h e k l y s t r o n i s n ot a g e n e r a to r o f m i c ro w a v e s b ut r a t he r a m i c ro w a v e a m p li f ie r . It n e e d s t o be d r i ve n b y a l o w - p o w e r mi c r ow a v e o s c i ll a to r .

F I G . 4 . 7 . C r o s s - s e ct io n a l dr a w i n g o f a t w o - c a v i t y kl y s t r o n. ( F ro m K a r z m a r k C J, M o r to n R J . A p r i m e r o n t h e o r y a nd o p e r ati o n o f l i ne a r a c c el e r at o r s i n r a d i at io n t h e r a p y . R o c k v i ll e , MD : U . S . D e p a r tm e nt of H e a l t h a nd H um a n S e r v i c e s , Bur e a u o f R a d i ol og i c al H e a lt h , 1 9 8 1 , w i t h p er m i s si on. ) P.45

F i g u r e 4 . 7 s h o w s a cro s s - s e ct io n a l d r a wi ng o f a n el e me nt a r y t wo- c a v i t y k l y s t ro n. T h e e le c t ro n s p ro d u ce d b y t h e c a t hod e a re a c c el e r at ed b y a ne g a ti v e p ul s e o f v o l t ag e i n to t h e f i r st c a v i t y , c a l l ed t he b unc he r c a v i t y , w hi c h i s e ne r g i z ed b y l o w p o w e r mi c r o w a v e s . T h e m i c ro w a v e s s e t up a n a l t e r na ti ng el e ct r i c f i e l d a c ro s s t he c a v i t y . T h e v e lo c it y of t h e el e ct r o ns i s a lt er e d b y t he a ct io n o f thi s e le c t ri c f ie ld t o a v a r y i n g d e g re e by a p r o c e s s k no w n a s v e l o ci t y mo d ul at io n. S o m e el e ct r o ns a r e s p ee de d u p w h ile ot h e r s a r e s lo w e d d o w n a nd s o me a r e una f f e c t e d . T hi s r e s u l t s i n b u n c h i n g o f e le c t ro n s a s t he v e loc i t y - m od ul a te d b e a m p a s s e s t hr o ug h a f i e l d - f re e s p a ce i n t h e d r i f t t u b e . A s t h e e le c t ro n b u n c h e s a r r i v e a t t he c at c he r c a v i t y ( Fi g . 4 .7 ) , t he y i nd uc e c h a r g e s o n t h e e n d s of t h e c a v it y a nd t he r eb y g e ne r at e a re t a rd ing e le c t ri c f ie ld . T h e e l e c tr o n s s u f f e r d e c e le r a ti o n , a nd b y t he p r i nc ip l e o f c o ns e r v a t io n o f e ne r g y , t h e k i n e ti c e n e r g y o f e l e ct r o n s i s co nv e r t ed i nt o hi g h- po w e r m i c ro w a v e s .

C. The Linac X-ray Beam

B r e m s s t r a h l u n g x - r a y s a r e p r o d u c ed w he n t he e le c t ro ns a r e i nc id e nt o n a t a r ge t o f a h i g h - Z m a t e r i al s u c h a s t u ng s t e n. T h e t a r ge t i s w at e r c ool e d a nd i s t hi c k e n o u g h t o ab s o r b m os t o f t h e i n c i de nt el ec t r o ns . A s a r e s ul t o f b r e m s s tr a hl ung -

WWW.MEDRAD.IR

type

i n t e r a ct io n s

( se c t io n

3.4.A),

t he

e l e ct r o n

e ne r g y

is

c o nv e r t ed

i nto

s p e c t r u m o f x - r a y e n e r g ie s w i t h m a x i m um e ne r g y e q ua l t o t he i nc i d e nt e l e ct ro n e n e r g y . T h e a v e r a g e p h o to n e n e r g y o f t he b e a m i s a p p ro x i m at ely o ne t hi rd o f t he maximum energy. It is c u s to m a r y fo r some of t he m a nuf a c t ur e r s to de s ig na t e t he i r li ne a r a c c e l e r ato r s t h a t h a ve b ot h e le c t ro n a nd x - r a y t r e a t me nt c ap a b il it ie s b y t he m a x i m u m e n e r g y o f th e e le c t ro n b ea m a v ai l a bl e . Fo r e x a m p le , the V a r i a n C l i na c 1 8 u n i t p r od u c e s e le c tr o n b e a m s o f e ne r g y 6 , 9 , 1 2 , 1 5 , a nd 1 8 M e V a nd x - r a y s o f e n e r g y 1 0 M V . T h e e le c t ro n b e a m i s de s ig na t e d b y mi ll io n e l e ct ro n v o l t s be c a us e i t i s al m o st m o no e n er g e ti c b e fo r e i nci d e nc e o n t he p a ti e nt s ur f a c e . T he x - r a y b e a m , o n t h e o t h e r h a n d , i s h e t e r og e ne o us i n e ne r g y a nd i s d e s ig na t ed b y m e g a v ol t s , a s i f t h e be a m w e r e p ro d uc e d by a p p l y i ng t ha t v o lt a ge a c r o s s a n x - r a y tube.

D. The Electron Beam

A s m e n t io n e d p r e v iou s l y , t h e e le c t ro n be a m , a s it e x it s t he w i nd o w o f t he a c c e l e r ato r t u b e i s a n a r r o w p e n c il ab o ut 3 m m i n di a m et e r . In the e le c t ro n mo de o f l i n a c o pe r a ti o n , t h is b e a m , i n s t e ad o f s tr i k i ng t he t a rg et , i s m a d e to s t ri k e a n e l e ct r o n s c at te r i n g f oi l t o sp r e ad t he b e am a s w e ll a s ge t a uni f o r m e le c t ro n f l u e n c e a c r o s s t h e t r ea t m e n t fi el d . T he s c at t er i ng f oi l c o ns i st s of a t hi n m et a ll i c f o i l , u s u a ll y o f le a d . T h e t h i c k n e s s o f t he f o i l i s s uc h t ha t m o st o f t he e le c t ro ns a r e s c a t te r ed i n s te a d o f s u f f e r i n g b r e m s s tr a hl ung . H o w e v e r , a s m a l l f r a c ti o n o f t h e t ot a l e n e r g y i s s t il l c o n v e rt e d i nt o b r e m s s tr a hl ung a nd a p p e a r s a s x - r a y c o n t a m i n at io n o f t h e e l e ct r o n be a m .

WWW.MEDRAD.IR

F I G . 4 . 8 . C o m po n e n ts o f t r e at m e nt he a d . A : X - r a y t he r a p y mo d e . B : E l e ct r o n t h e r a p y mo d e . ( F ro m K a r z m a r k C J , M o r t o n R J . A p r i m er o n t he o ry a nd o p er a ti on o f l i n e ar a c c el e r at o r s i n r a d i at io n t he r ap y . R o c k v i l le , M D : U . S . D e p a rt m e nt of Health and Human Services, Bur e a u of R a d io lo gi c a l He a lt h, 1 9 81 , with p e r m i s sio n . ) P.46

In this

some

linacs,

the

b r o ad e n i n g

of

t he

e le c t ro n some

be a m

is

a c c o m pl i s he d st il l pr o d uc ed

by by

e l e ct r om a g n et i c s c a n n i n g o f t h e e l e ct r o n p enc i l b e a m o v e r a l a r ge a r e a . A l t ho ug h m i n im i z e s the x-ray c o n t a m i na ti o n, x-rays are e l e ct r o n s s t ri k i n g t h e c o l li m a to r w a l l s o r ot he r hi g h a t o m i c num b e r m a t er i al s i n t h e e le c t ro n c o ll i m at ion s y s t e m .

E. Treatment Head
T h e t r e a t me n t h e a d (F i g . 4 . 8 ) c o ns i st s o f a t hi c k s he l l o f hi g h- d e ns i t y s hi el di ng m a t e ri a l s u c h a s l ead , t u n g s te n, o r l e ad -t ung s t e n al lo y . It c ont a i ns a n x - r a y t a r g et , s c at t er i n g fo il , f l a tt e n i ng f i lt e r , ion c ha m be r , f i x ed a nd mo v a b le c o ll i m at o r , a n d l i g ht l o ca li z e r s y s te m . The he a d p r o v id e s s uf f i c i e nt s hi e ld i ng a g a i n s t le a k a g e r ad i at io n i n a c c o r d a nc e w it h r a d i a tio n p r o te c ti on g ui d e li ne s ( s ee Chapter 16).

F. Target and Flattening Filter

In s e c t i o n 3 . 4 . A , w e d i s c u s s e d t he a ng ula r d i st r ib ut io n o f x - ra y s p r o d uc ed b y e l e ct r o n s o f v a r io u s e n e r g i e s i nc i d e nt on a t a r g e t . S i nc e l ine a r a c c e l e r at o rs p r o d u c e e le c t ro n s i n th e m e g a v ol t ag e r a ng e, t he x - r a y i nt e ns i t y is p e a k e d i n t he forward di r e ct io n . To make the be a m int e ns i t y uni f o r m a c ro s s t he f i el d , a f l a t te n i n g f i lt e r i s i n s e r t ed i n t h e b e a m ( Fig . 4 . 8 A ) . T hi s f i l t e r i s us ua l l y m a d e o f l e a d , a lt h o u g h t u n g s te n , u r a n i u m , s t e e l , a l um i num , o r a c o m b ina t i o n ha s a l so b e e n u s e d o r s u g g e ste d . T h e c h o i c e o f t a rg e t a nd f l a tt e ni ng f i lte r m a t e ri a l s ha s b e e n d i s c u s s ed b y P o dg o r s a k e t al . ( 4 ) .

G. Beam Collimation and Monitoring

T h e t r e a t me n t b e a m i s f i r s t c o ll i m at ed b y a f i x e d p r i m a r y c o ll i m at o r lo c at ed i m m ed i at e l y be y o n d th e x - r a y t a r g e t . In t he c a s e o f x - r a y s , t he c o ll i m at ed b e a m t h e n p a s s e s t h r o u g h t h e f l a t t e n i n g f il t er . In t he e l e c tr o n m o de , t he f i l te r i s m o v ed o u t o f t h e w a y ( F i g . 4. 8 B ) . T h e f l a t te n e d x - r a y be a m o r t h e el e ct r o n be a m i s i nc i d e nt o n t he d o se m o nito r i ng c h a m b e r s . T h e m o n ito r i n g s y s te m co ns i s t s o f s e v e r a l io n c ha m b e r s or a s i ngl e c h a m b e r w i t h m u l ti p le p l a te s . A l t ho ug h t he c ha m b e r s a r e us ua l l y t r a ns m i s si o n t y p e , i . e . , f l a t p a r a lle l pl a te c ha m b e r s to c o v e r t he e nti r e bea m , c y l i nd r i c al t h i m bl e c h a m b e r s h a v e a l s o be e n us e d i n s om e l i na c s . T h e f u n c t i o n o f t h e io n c h a m b e r i s to m oni t o r do s e r at e , i nt e gr a t e d d o se , a nd f i e l d s y m m et r y . S i n c e t h e c h a m b er s a r e i n a hi g h- i nt e ns it y r a di at io n f i e ld a nd t he b e a m i s p u l se d , it i s i m po r t a n t t o m a k e s ur e t ha t t he io n c o ll e cti o n e f f i c ie nc y o f the chambers P.47

WWW.MEDRAD.IR

r e m a i n s u n c h a n g e d w i t h c h a n g e s i n t he dos e r a te . Bi a s v ol t a ge s i n t he r a nge o f 3 0 0 to 1 ,0 0 0 V a r e a p p li e d a c r o s s t he cha m b e r el e ct r od e s , de p e ndi ng o n t he chamber influenced d e si g n . by Contrary to and t he beam c a l i b r at io n of t he c ha m b er s , air. t he m o ni to r t he se c h a m b e r s i n t h e t r e atm e n t h e a d a r e us ua l ly s e a l e d s o t hat t he i r r e s p o ns e i s n ot t e mp er a t u r e p r e s s ur e o ut si d e However, c h a m b e r s h a v e t o b e p e r io di c a ll y c he c k e d f o r l e a k s . A f t e r p a s s i n g t h r o u gh t h e i o n c ha m b e r s , t he b e a m i s f ur t he r c o ll i m at ed b y a c o n t i n u o u s l y m o v a bl e x - r a y c o l l i m a to r . T hi s c o ll i m at o r co ns i s t s o f t w o p a i r s o f l e a d o r t u n g st e n b lo ck s ( j a w s ) w hi c h p r o v i d e a r e ct a ng ul a r o p e ni ng f r o m 0 0 to t h e m a x i m u m f ie ld s iz e ( 4 0 40 c m o r a l it tl e l e s s ) p r oj e ct ed a t a st a nd a rd d i s t a n c e s u c h a s 1 0 0 c m f r o m t he x - r a y s o ur c e ( f o c a l s po t o n t he t a r ge t ) . T he c o ll i m at o r bl o c k s a r e c o n s t r a i n ed t o mo v e s o t ha t t he bl o c k e dg e i s a l w a y s a l o ng a r a d i a l li n e p a s si n g th r o u g h t h e t a r g et . T h e f i e l d si z e d e f i ni tio n i s p r o vi d ed b y a l ig ht lo c a li z i ng s y s t e m i n t he t r e at m e nt h e a d . A c o m bi n a ti o n of m i r r o r a n d a li g ht s our c e l o c at ed i n t he s pa c e b et w e e n t he c h a m b e r s a n d t h e j a w s p r o j e ct s a l i g ht bea m a s i f e m i t ti ng f r om t he x - r a y f o c a l s p o t . T h u s t h e li g h t f i e ld i s c o n g r ue nt w ith t he r a di a ti o n f ie ld . F r e q ue nt c he c k s a r e r e q u i re d to e n s u r e t h i s i m po r t a nt re q ui re m e nt o f f i el d a li g nm ent . W h e r e a s t h e x - r a y co ll i m at io n s y s t e m s o f m o s t m ed i c al li na c s a r e s im il a r , t he e l e ct r o n col li m a ti o n sy s t e m s v a r y w id el y . S i nc e el e ct r o ns s c at te r r e ad il y i n ai r, t h e b e a m c ol li m a ti o n m u s t b e a c hi e v e d c los e t o t he s k i n s ur f a c e o f t he p a t ie nt . There is a co n s i de r ab l e s c a tt e ri ng of el ec t r o ns f ro m t he co ll im a t o r s ur f a c e s i n c l u d i n g t h e m o v a bl e j a w s . D o s e r at e c a n c ha ng e b y a f a c t o r o f t w o o r t hr e e as t h e c ol li m a to r j a w s a re o pe n e d t o m a x i m um f i e ld s i z e l i mi t s . If the e l e ct ro ns a r e c o ll i m at ed b y t h e sam e j a w s , a s f o r x - r a ys , t he r e w il l b e a n e xt r e me l y s t ri ng e nt r e q u i r em e n t on the accuracy of t he jaw o p e ni ng , s i nc e o utp ut so c rit i c al l y d e pe n d s o n t h e s u r f a c e a r e a o f t he c ol li ma t o r . T hi s p ro bl e m has b e e n s ol v e d b y k e e p i n g t h e x - r a y c oll i m at o r w i de o p e n a nd a tt a c hi ng a n a ux il i ar y c o ll i m at or f o r e l e ct r o n s i n t h e fo r m o f t r i m me r s e x te nd ed d o w n t o t he s k i n s ur f a c e . In o t he r s y s t e m s , t h e a u x i li a r y e le c t ro n c ol li m at o r co ns i s t s o f a s e t o f at ta c ha b l e co ne s of various sizes. The dose d i st r i b ut ion in an e l e c t ro n f i el d is si g ni fi c a nt l y i nf l ue nc e d by t he c o ll i m at io n s y s t e m p ro v i de d w i t h t he m a c hine b e c a us e o f e le c t ron s c a t t e r i ng .

H. Gantry
M o s t o f t h e li n e a r a cc e l e r ato r s c ur r e nt l y pr o d uc e d a re c o ns t r uct e d s o t ha t t he s o u r c e o f r a di a ti o n ca n r o t a te a b o ut a hor i z o nt a l a xi s ( F i g . 4 .9 ) . A s t he g a nt r y r o t at e s , t h e co ll i m ator a x i s ( s u p p o s ed l y c oi nc i d e nt w i t h t he c e nt r a l a x i s o f t he b e a m ) mo v e s i n a v ert i c al pl a n e . T he p oi nt o f i nte r s e ct io n o f t he c ol li m a to r a x i s a n d t h e a x i s o f r o t at ion o f t h e g a nt r y i s k no w n a s t he i s o c e nt e r . T h e i s o ce n t r i c m o u n t in g o f t h e ra d i at io n ma c hi ne s ha s a d v a nt a ge s o v e r t he unit s t h a t m o v e o n l y u p a n d d o w n . T he l a t t e r uni t s a r e no t s ui t a ble f o r i s o c e ntr i c t r e at m e n t t e c h n i q u e s i n w h i c h b e a m s a re d i r e ct ed f r o m d i f f e rent d i re c ti o ns b ut i n t e r se c t a t t h e s a me p o i nt , t h e i s o ce nt e r , pl a c e d i nsi d e t he p at ient . H o w e v e r , t he n o n i s o c e n t ri c u n i t s a re u s u a l l y s w i v e l m o unt e d , t ha t i s , t he t rea t m e nt he a d c a n b e s w i v el ed or r ot at ed i n a n y di r e ct io n w hi l e t he g a nt r y c a n m o ve o nl y up w a rd or

WWW.MEDRAD.IR

downward.

Although

these

units

are

no t

as

f l e x i b le ,

t he y

are

m e c ha ni c a l ly

s i m p le r , m o re r e li a bl e, a n d l e s s e x p e ns i v e tha n t he i s o c e nt r i c mod e l s .

4.4. BETATRON
T h e o p e r a ti o n o f t h e b e t a t ro n i s b a s e d on t he p r i nc i p l e t ha t a n e l e c t ro n i n a c h a n g i n g m a g n et i c fi el d e x p e ri e n c e s a c ce ler a t io n i n a c i r c ul a r o rb i t . F i g ur e 4 . 10 s h o w s a s c h e m a t i c d ra w i n g o f t h e m a c hi ne . T he a c c e l e r a ti ng t ub e i s s ha p e d l i ke a h o l lo w do u g h n u t and is pl a c e d b et w e e n t he po le s of an a lt er na t i ng c ur r e nt m a g n e t . A p u l s e o f el e c tr o n s i s i nt r od uc e d i nt o t hi s e v a c ua t ed d o ug hnut b y a n i n j e c to r a t t h e i n s t a n t t h a t t h e a lt e r na ti ng c ur r e nt c y c l e b eg i ns . A s t he m a g ne ti c field P.48 the a lt e r n at i n g m a gn e t i c fi el d , t he el e ct r o ns ha v e m ad e se v e r a l t ho us a nd r i se s , t h e el e ctr o n s e x pe r ie nc e a c c el e r at io n c o nti nuo us l y a nd s pi n w i th i n c r e a s i n g v e lo c it y a ro u n d t h e t u b e . By t he e nd o f t he f i r s t q ua r te r c y c l e o f

r e v o l u ti o n s a n d a c h i ev e d m a x i m um e ne r g y. A t t hi s i ns t a nt o r ea r l ie r , d ep e ndi ng o n t h e e n e r g y de s i red , t h e e le c t ro ns a r e m a d e to s pi r a l o ut o f t he o r bi t b y a n a d d it io n a l at tr a c ti v e f o r c e . T h e hig h- e ne rg y e le c t ro ns t he n s tr i k e a t a r ge t to p r o d u c e x - r a y s o r a s c a t t er i n g f oi l to p ro d uc e a b r o a d be a m o f e lec t r o ns .

F I G . 4 . 9 . P h o t og r a p h o f a l i n ea r a c c el e r at o r, i s o c e ntr i c al l y mo unt e d . ( C o ur te s y o f V a r i a n A s s o c i a te s , P a lo A l to , C a l i f o r ni a . ) B e t a t ro n s w e r e f i r s t us e d f o r r a di ot he r a p y in t he e a r l y 1 9 50 s . T he y p r e c e de d t he i n t r od u c t io n o f l i n e ar a c c e le r a to r s b y a f ew y e a r s . A l t ho ug h t he b et at r o ns c a n p r o v id e x - r a y a n d e lec t r o n t h e r a p y b e a m s o v e r a wi d e r a ng e o f e ne r gi e s , f ro m l e s s t h a n 6 t o m o re th a n 4 0 M e V , t he y a r e i nhe r e nt l y l o w - el e ct ro n- b e a m c ur r e nt d e v i c e s . T h e x - r a y d os e r a t e s a n d fi e ld s i ze c a p a bi li ti e s o f m e dic a l b et a t ro ns a r e l o w c o m pa r e d w it h m e d i c al l i n a c s a nd e v e n m o d e r n c o b al t uni t s . H o w e v e r , i n t he

WWW.MEDRAD.IR

e l e ct r o n t h e r a p y m ode , t h e b e a m c ur r e nt i s a d e q ua te to p r o vi d e a hi g h d o s e r at e . T h e r e a s o n f o r t h i s d i ff e r e n c e b et w e e n x - r a y a nd e l e c t ro n d o se P.49 r a t e s i s t h a t t h e x - r ay p r o d u c ti o n v i a b r e ms s t r a hl ung a s w e ll a s b e a m f l at te ni ng r e q u i r e s a m u c h l a rge r p ri m a r y el e ct r o n be a m c ur r e nt ( a b o ut 1, 0 0 0 t i me s ) t ha n t h a t r e q u i re d f o r t he e l e ct r o n t h e r ap y b e a m.

F I G . 4 . 1 0 . D i a g r a m i ll u s t r a ti n g t he op e r at io n o f a b e t a tr o n. T h e a v a i l a b il it y o f m e d i u m e n e r g y li na c s w i t h hi g h x - r a y d o e s r a t e s , l a r ge f i e ld sizes, and el e ct r o n therapy e n e rg ie s up to 20 MeV ha s gi ve n t he l i na c s a c o n s i d er a b le e dg e i n p o p u l a ri t y o v e r t he b e t at r o ns . M o re o v e r, m a ny r a d i a t io n t h e r a pi s t s r eg a r d t h e s m a l l f i el d s i ze a nd d o s e r a te c a p a bi li ti e s of t he b e t a tr o n a s s e r io u s increase d i sa d v a n t a ges in b et a t ro n to the ge ne r a l in use t hi s of t he d e vi c e . T hus a s i g ni f i c a nt l i na c s , i n s t a ll a tio ns c o unt r y , p a r a ll el i ng m e di c a l

seems unlikely.

4.5. MICROTRON
T h e m i c r ot ro n i s a n el e c tr o n a c c el e r at or t ha t c om b i ne s t he p r i nci p le s o f b ot h t he l i n e a r a c ce l er a to r a n d t h e c y c l ot r o n ( s e ct ion 4 . 6 ) . In t he m i c r o tro n, t he e le c t ro ns a r e a c c e le r a te d b y t he o s c il l at i n g e l e ct ri c f i e ld o f o ne o r m o re mi c r o w a v e c a v it i e s ( F i g . 4 . 11 A , B ) . A m a g n e t i c f i el d f or c e s t he e le c t ro ns to mo v e in a c i r c ul a r or bit a n d r e t u r n to t h e c av i t y . A s t h e e le c t ro ns r e c ei v e hi g her a nd hi g he r e ne rg y b y r e p e at ed p a s se s t h r ou g h t h e c a v it y , t he y d e s c r ib e o rb it s o f i ncr e a s i ng r a d i us i n t h e m ag n e ti c f ie ld . T h e c a v i t y vo lt a g e , f r e q ue nc y , a nd m a g ne t i c f ie l d a r e so a d j u s t ed t h a t t h e el ec t r o n s a r ri v e e a c h tim e i n t he co r re c t p ha s e a t t he c a v it y . B e c a u s e t h e el e c tr o n s t r a v el w it h a n ap p rox i m a t el y co ns t a nt v elo c it y ( a l mo st t he s p e ed o f li g h t ) , t h e ab o v e c o n di tio n c a n b e m a i nt a i ned i f t he p at h l e ng t h o f t he o r b it s i n c r e a se s w i t h o n e P.50 m i c r o w a v e w a v e l e n gth p e r r e v o l ut io n. T he m i c r o w a v e p o w e r s our c e i s e i t he r a k l y s t r o n o r a m a g n et ro n .

WWW.MEDRAD.IR

F I G . 4 . 1 1 . A : S c h e m a t i c di a g r a m o f a c i rc ul a r m i c r ot ro n uni t . ( R e p r i nte d w it h p e r m i s sio n Tanabe E. from AB Scanditronix, el e c tr o n U pp s al a , S w e d e n. ) York: B: E l ec t r o n o rb it s a nd w it h a c c e l e r at i n g c a v it i e s i n a r a c et r a c k mi c r otr o n. ( F r o m K a r z m a r k C J , N una n C S , M e d i c al a c c el e r at or s . New M c G r a w -H i l l , 1 9 93 , p e r m i s sio n . ) The e x t r a c ti o n o f the e le c t ro n s from a n o r bi t is a c c o mp li s he d by a na r r ow

d e f l e ct io n t u b e o f s tee l t h a t s c r ee ns t he ef f e c t o f t he m a g ne ti c f i e l d . W he n t he b e a m e n e rg y i s se l ec t e d , t h e d e fl e ct io n t ub e i s a ut o m at i c al l y m o v e d t o t he a p p r op r i at e o r b it to ex t r a c t t h e be a m . T h e p r i n c i p al a d v a n t ag e s o f t h e mi c ro t ro n o v e r a li ne a r a c c el e r at o r o f c o m p a r ab le e n e r g y a r e i t s s i mp li c it y , e a s y e n e r g y s e l e c ti o n, a nd s m a l l b e a m ene r g y s p r e a d a s w e l l a s t h e sm a ll e r siz e o f t h e m a c hi ne . Bec a us e o f t he lo w e ne rg y s p r e ad o f t he a c c e l e r at ed e l e ct ro n s a n d s m a ll b e a m e mit t a nc e ( p r od uc t o f bea m d i am e te r a nd d i v e r ge n c e ) , the be a m t r a n s po r t system is g re a tl y s im p l i fi e d . T he se c h a r a c t e r i st i c s h a v e en c o u r a g e d t he us e o f a s i ng l e mi c r ot ro n t o s up p l y a b e a m to s e v e r a l t re a tm e n t r oom s . Although the m et h od of a c ce le r a ti ng e le c t ro ns us e d in t he m i c ro t ro n was p r o po s ed a s e a rl y a s i n 1 9 44 b y V e k s l er ( 5) , t he f i r s t mi c r ot ro n f o r r a d io t he r ap y ( a 1 0 - M e V u n i t ) w a s d e s c r ib e d b y R ei st a d a nd Br a hm e ( 6 ) i n 197 2 . L at e r , a 22 MeV m i c r ot ro n (7) was d e v e lo p ed by AB S c a nd i t r o ni x a nd i ns t a ll e d at t he U n i v e r s it y o f U m e , S w e d e n . T h i s p a r t i c ul ar m o d el ( M M 2 2 ) p ro duc e d t w o x - r a y s

WWW.MEDRAD.IR

b e a m s o f e n e r g y 6 o r 1 0 a n d 21 M V a nd 10 e le c t ro n b e a m s o f 2, 5 , 7 , 9 , 1 1 , 1 3 , 1 6 , 1 8 , 2 0 , a n d 2 2 M eV . T h e c i r c u l a r m i c ro t ro n , a s d e s c r i be d a bo v e a nd s ho w n s c he m a t i c a l l y i n F i g . 4 . 11 A , i s a b u l k y st r u c t u r e b e c a u s e i t re q ui re s a l a r ge m a g net i c g a p t o a c co m mo d at e a c c e l e r at i n g c a v it y a n d l a r g e di a m et e r m agne t i c f i el d to a c c o m mo d a te t he l a rg e n u m b e r o f s p a c e d o rbi t s w it h l i mi t ed e ne r gy g a i n p e r o r bi t . T he se c o ns t r a i nt s a r e r e m o v ed b y a r a c e t ra c k m i c r o t ro n, w hi c h us e s a s t a nd i ng w a v e l i na c s t r uc t u re (instead of a si n g le cavity) are to a c ce l er at e t he el e ct r o ns et al . ( Fig . 4 . 1 1 B) . T he p a r a m et e r s o f a 5 0 - Me V r a c e t r a c k m i c ro t ron d e v e l op e d at t he Ro y a l Ins t i t ute o f Technology, St o c k h olm , given by R os a nd e r (8). A r e v i e w i s a l so p r o v id e d b y K a r z m a r k e t a l . ( 3 ) .

4.6. CYCLOTRON
T h e c y c l o t ro n i s a c h a r g e d p ar ti c l e a c ce le ra t o r , m ai nl y us e d f o r nuc l e a r p hy s i c s r e s e a r c h . In r a d i at ion t h e r a p y , t he se m a chi ne s ha v e b ee n us ed a s a so ur c e o f h i g h - e n e r g y p r ot o n s f o r p r ot o n b e a m t he r ap y . M o r e r e c e nt l y , t he c y c l o t ro ns ha v e b e e n a do pt e d fo r g en e r a t i n g n e ut ro n b e am s . In t he l a t te r c a se , t he de ut e ro ns ( 2 1 H + ) a re a c c el e r at ed to h i g h e n e r gi e s a nd t he n m ad e to s tr i k e a s ui t ab l e t ar g et t o p r od u c e n e u t ro n s by n u c l e a r r e a ct io ns . O ne s uc h r e a c t io n o c c ur s w he n a b e am o f d e u t e ro n s , a c c e l e ra t e d to a h i g h e ne r g y ( ~ 1 5 t o 5 0 M e V ) , s tr i k e s a t a r g et o f l o w a to m i c n u m b e r , su c h a s b e r y l l i um . N e ut r o ns a r e p ro d uc ed b y a p r o c e s s c al l ed s t r i pp i n g ( s e ct io n 2 . 8 .D ) . A n o t h e r i m po r t a nt us e o f t he c y c lo t ro n in m e d i ci ne i s a s a p a r t i cl e a c c el e r at o r f o r t h e p r od uc t io n o f c e r t ai n r a d i o nuc li d e s . A s c h e m a t i c d i a g ra m i ll u s t r a ti n g t he p r i nc ip l e o f c y c l ot ro n o p e ra t io n i s s ho w n i n F i g . 4 . 12 . T h e m a c h in e c o n s i s t s e s s e nt i al ly o f a s ho r t m et a ll i c c y l i nd e r d i vi d ed i n t o t wo P.51 s e c t io n s , u s u a l l y r e f er r e d to a s D s . T he s e D s a r e hi g hl y e v a c ua t e d a nd pl a c ed b e t w ee n t h e p ol e s o f a d i re c t c u r r e nt m a g ne t ( not s ho w n) , p ro d uc i ng a c o nst a nt m a g n e ti c f i e ld . A n a l te r n a t i n g po te nt i al i s a p p li e d b et w e e n t he tw o D s . P o s i ti v e l y c h a r g e d p a rt i cl e s s u c h a s p r o to n s o r d e ut er o ns a r e i nj e c te d i nto t he c ha m b e r a t t h e c e nt e r o f t h e t w o D s . U n de r t he a ct ion o f t he m a g net i c f iel d , t he pa r ti c le s t r a v e l i n a c i r c u l a r o rb i t . T h e f r e q ue nc y o f t he a l te r na t i ng p ot e nti a l i s a dj us t ed s o t h a t a s t h e p a r t ic l e p a s s e s f r o m o ne D to t he o t he r , it i s a cc e l e r at ed b y t he e l e ct r i c f ie ld o f t h e r i g h t po l a ri t y . W i t h e ac h p a s s b e t w e e n t he D s , t he p a r t i cle r e c e i v e s a n i n c r e me n t o f e n e r g y a nd t he ra d i us o f i t s o r bi t i nc re a s e s . T hus , b y m a k i n g m a n y r e v o l u t io n s , t h e p a r t i cl e s uc h a s a d e ut e r o n a c hi e v e s k i ne t i c e ne rg y as high as 30 MeV.

WWW.MEDRAD.IR

F I G . 4 . 1 2 . D i a g r a m i ll u s t r a ti n g t he p ri nc i ple o f o p e ra ti o n o f a c y c l ot r o n. T h e r e i s a l im it to t he e n e r g y t ha t a p ar tic l e c a n a t t ai n b y t he a b o v e p ro c e s s . A c c o r d i n g t o t h e t h eor y o f r e l a ti v it y , a s t he p a r ti c le r e a c he s hi gh v e l o c it y ( i n t he r e l at i v i st i c r a n g e ) , f u r t h e r a c c el e r at io n c a us e s t he p a r ti c le t o g ai n i n m a s s . T hi s tends to sl o w do w n the p a rt i cl e , w hi c h can t he n get o ut of s t ep w i t h t he f r e q u e n c y o f t h e a l t er n a t i n g p ot e nti a l a pp li e d to t he D s . T hi s pr o b le m ha s b e e n s o l v ed i n t h e s y n c h r ot r o n s w h e r e t he f r e que nc y o f t he p ot e nti al i s ad j us t ed to c o m p e n s at e f o r t h e dec r e a s e i n p a r ti c le v e loc i t y .

4.7. MACHINES USING RADIONUCLIDES

R a d i o n u c li d e s s u c h a s r a d i u m - 22 6 , ce s i um -1 3 7 , a nd co b al t -6 0 hav e b e e n us ed a s sources of rays for t e le t h e r ap y . 3 These rays are e m i tt e d from t he r a d io n u c l i de s a s t h e y u n d e r g o r a di o a ct i v e dis i nt e g ra ti o n. O f a l l t h e r ad io n u c l i de s ,
60

C o h a s p r o v ed t o b e t he mo s t s ui t ab l e f o r e xt e r nal

b e a m r a di ot h e r a p y . T h e r e a s o n s f o r it s c hoi c e o v e r r ad i um a nd ce s i um a r e hi g he r p o s s ib le s pe c i f i c a c ti vi t y ( c u r ie s pe r g r a m ) , g r e at e r r a d ia ti o n o utp ut pe r c ur ie a nd h i g h e r a v e r a ge p h ot on e n e r g y . T he s e c ha r a c t e ri s ti c s f o r t he t hre e r a di o nuc li d e s a r e c o mp a r ed i n T a ble 4 . 1 . In a d di ti o n, r ad i um i s m uc h m o r e ex p e ns i v e a nd ha s g r e a te r s e l f - ab s o rp ti on o f i t s r a d i at io n t ha n e i t he r c e si um o r c ob al t .

A. Cobalt-60 Unit A.1. Source

The The
60

C o s o u r c e i s p rod u c e d b y i r ra d i at i ng or d i na r y s t a bl e
59

59

C o w it h ne ut r o ns i n a
60

r e a c to r . T h e n u c l e a r r e a c t io n c a n b e r e p re se nt e d b y
60

Co ( n , )

Co.

C o so u r c e , u s u a l l y i n t h e fo r m o f a s o li d c y l i nde r , di s cs , o r p al le t s , i s

c o n t a i n ed i n s id e a s ta i n l e s s - st e el c a p s ule a nd s e a l ed b y w e l di ng . T hi s c a p s ul e i s p l a c ed i n to a n ot h e r st e el c a p s u le w hi c h i s a g a i n s e al e d b y w e l ding . T he d o ub l ew e l d ed s e a l i s n e c e s sa r y t o p r e v e nt a ny l e ak a g e o f t he r a d io a ct i ve m a t e ri a l . The

60

C o s o u r c e d e c a ys t o

60

N i w it h t he e m is s i o n o f p a rt i cl e s ( E m a x = 0 . 32 M e V )

a n d t w o p h o t o n s p e r d i s i nt e g r at io n o f e ne r g i e s 1 . 17 a nd 1 . 3 3 M eV ( d e c a y s c he m e g i v e n i n Fi g . 1 .5 ) . Th e s e r a y s c o ns ti t ute t he us e f ul t re a t ment b e a m . T he p a r t i cl e s r e s u l ti n g a re in a b so r be d the in the of co b a lt me t a l a nd t he s t ai nl es s - s t e el a nd a small c a p s ule s of e m is s i o n b r e m s st r a hlung x-rays a m o unt

WWW.MEDRAD.IR

c h a r a c t e r i st i c x - r a y s . H o w e v e r , t he s e x - r ay s o f a v e r a g e e ne rg y a r o und 0 . 1 M e V d o n o t c o nt r ib u t e a p pr e c i a bl y t o t he do s e in t he p a t i e nt be c a us e t he y a r e s t r o ng l y a t t e n u a te d in the m a t e ri a l of t he s our c e a nd t he c a p sul e . T he o t he r c o n t a m i n a n t s t o t h e t re a t me n t b e a m a r e t he l o w e r - e ne r g y r ay s p r od uc e d b y t h e i n t e r a ct io n o f t h e p r i m a r y r a d i a t io n w i t h t he s o ur c e i t se l f , t he s ur r o und i ng capsule, the source housing, a nd t he c o l li m a to r s y s t em . T he s c a t t e r ed c o m po n e n t s o f t h e b ea m c o n t r i b ut e s i g ni fi ca nt l y ( ~ 1 0 % ) to t he to t al i nt e ns it y o f t h e b e a m ( 9 ) . A ll t h e se s e c o n d a r y i nte r a c ti ons t hus , t o P.52 s o m e e x t e nt , r e s u lt in h e t e ro g e n ei t y o f t he b ea m . In a d d it io n, e l e ct r o ns ar e al s o p r o d u c ed b y t h e s e i n te r a c ti o n s a nd c o ns t itut e w ha t i s us ua l l y r e f e r r e d t o a s t he e l e ct r o n c o nt a m i n a ti on o f t h e p h o t o n b e a m .

TABLE 4.1. TELETHERAPY SOURCE CHARACTERISTICS

HalfLife R a d i on u c l i d e (yr) -Ray E n e r gy MeV

Valuea

Specific Activity Achieved Practice (Ci/g) in

R a d i u m - 2 26 ( f i l te r e d 0.5 mm Pt) by

1,622

0.83 (avg.)

0.825

~0.98

C e s i u m - 1 37

30.0

0.66

0.326

~50

C o b a lt - 60

5.26

1.17, 1.33

1.30

~200

E x p o s u r e r at e co n st a n t ( ) i s d i s c us s ed i n C ha p te r 8 . T he hi g he r t he

v a l u e , t h e g r e at e r wi ll b e t h e e x po s ur e r a t e o r o utp ut pe r cur i e o f t he t e le t h e r ap y s o u r c e .

A t y p i c a l t el et h e r a p y

60

C o s o u r c e i s a c y li nde r o f di a m et e r r a ngi ng f r o m 1 .0 to 2 . 0

c m a n d i s po s it io n e d i n t h e c ob a lt uni t w it h i t s ci r c ul a r e nd f a c i ng t he pa ti e nt. T h e f a c t t h a t t h e r adi a ti o n so u r c e i s not a p oi nt so ur c e c o mp li c a t e s t he be a m g e o me t r y a n d g i ve s r is e t o w h a t i s k no w n a s t he g e o me t ri c p e num b r a .

A.2. Source Housing

T h e h o u s i n g f o r t he so u r c e i s ca ll e d t he sour c e he a d ( F ig . 4 . 1 3 ) . It c o ns i st s o f a s t e el s h e ll f i ll ed w i t h l e a d f o r s hie ld i ng pur p o s e s a nd a d e vi c e f o r b r i ng i ng t he s o u r c e i n f r o n t o f a n o p e n i n g i n t he he a d f r om w hi c h t he us e f ul b e a m e m e r ge s .

WWW.MEDRAD.IR

A l s o , a h e a v y me t al al lo y s l ee v e i s pr o v id ed to f o rm a n a dd it io na l p ri m a r y s hie ld w h e n t h e s o u r c e i s i n t h e o f f p o s it io n. A n u m b e r o f m e t h o d s h a v e b e e n d e v e lo ped f o r m o v i ng t he so ur c e f r o m t he o f f p o s it io n t o t he o n p o si ti o n . T h e s e m e t hod s ha v e b e e n d i s c us s e d in d e t a il b y J o hns and Cunningham (10). It will s uf f i c e he r e to m e nti o n b r ie f ly f o ur d i f f e r e nt m e c h a n i s m s : ( a ) t h e s o u r c e mo u nt e d o n a r ot a ti ng w he el i ns i de t he so ur c e he ad t o c a r r y t h e so u r c e f r o m t h e o f f p o si ti o n t o t he o n p o si ti o n; ( b ) t he so ur c e m o u n t e d o n a h e a v y m e t al d r a w e r pl us i t s a b i li t y to s li de ho r i zo nt a ll y t hr o ug h a h o l e r u n n i n g t h r o u g h t h e s o u r c e he a d i n t he o n p o si ti o n t he s o ur c e f a c e s t he a p e r t u r e f o r t h e t r e atm e n t be a m a nd i n t he o f f po si ti o n t he so ur c e mo v e s t o i ts s h i e l de d lo c a ti o n a n d a l ig h t so u r c e m o unt ed o n t he s am e d r a w e r o c c up ie s t he o n p o s it io n o f t h e so u r c e; ( c ) m e r c u r y i s al lo we d t o f lo w i nt o t he spa c e i m me di a te l y b e lo w t h e s o u r ce to s h u t o f f t h e b e a m ; a nd ( d ) t he s o ur c e i s f i x ed i n f r o nt o f t he a p e r t u r e a n d t he b eam c a n b e t u r ne d o n and o f f b y a s hut te r cons i s t i ng o f he a v y m e t al j a w s . A ll o f t h e a b o v e me c ha ni s m s i nco r po r a te a s a f et y f e a tur e i n w hi c h t he s o u r c e i s r et u r n e d a u to m a ti c a ll y t o t he o f f p o s it io n i n c a s e o f a p ow e r f a i l ur e .

A.3. Beam Collimation and Penumbra

A c o l li m a to r s y s t e m is d e s i g n ed t o v a r y t he s i z e a nd s ha p e o f the b e a m t o me et the i n d i vi d u a l tr e a tm e n t r e q u ir e m e nt s . T he s i m p le s t form of a c o nt i nuo us l y a d j u s t a bl e di a p h r a g m c o n s i s t s o f t w o p ai r s o f he a v y m e t a l bl o c ks . E a c h p a i r c a n b e mo v e d i n d ep e n den t l y to o bt a i n a sq ua r e or a re c t a ngl e - s ha p e d fi el d . S om e c o ll i m at o r s a r e m ul tiv a n e t y p e , i .e . , m ul ti p le bl o c k s t o c o nt ro l t he s i ze o f t he b e a m . In e i t h e r c a s e , i f t h e i n n e r s ur f a c e o f t he b l o c k s i s m a de p a r a l l el to t he c e n t r a l a x i s o f t h e b e a m , t h e r a di at io n w i l l p a s s t hr o ug h the e d g e s o f t he c o ll i m at i n g b lo c k s r e su l t i n g i n w ha t i s k now n a s t he t r a ns m i s si on p e num b r a . T he e x t e n t o f t h i s p e n u mb r a w il l b e mo r e p rono unc e d f o r l a r ge r col li m a to r o pe ni ng s b e c a u s e o f g r e at e r ob li q u i t y o f t h e r a y s a t the e d g e s o f t he bl o c k s. T hi s e f f e c t ha s b e e n mi n i mi z e d i n so m e d e si g n s b y s ha pi ng t he c ol li m at o r b lo c k s s o t ha t t he i n n e r s u r f a c e o f t h e b l o c k s re m a i ns a l w a ys p a r a l le l t o t he ed ge o f t he be a m . In t h e s e co ll im a to r s , t h e b lo c k s a r e hi ng ed t o t he t op o f t he co ll i ma t o r ho us i ng so t h a t t h e s lo pe o f t h e b l o c k s i s P.53 c o i n c id e n t wi t h the included a ng le of t he b ea m . A lt ho ug h the t r a ns m i s si o n

p e n u m b r a c a n b e m i ni m i z ed w i t h s uc h a n a r r a ng e m e nt , it c a nno t be c o mp le t el y r e m o v ed f o r a l l f ie ld s i z e s .

WWW.MEDRAD.IR

F I G . 4 . 1 3 . P h o t og r a ph o f c o b al t uni t , T he ra t r o n 78 0 . ( Co ur t e s y o f A t om i c E ne r g y o f C a n a d a , L t d . , O t t aw a , C a n a d a . ) T h e t e r m pe n u m b r a , i n a g e n e r a l se ns e , m e a ns t he r eg io n, a t t he ed ge o f a r a d i at io n b e a m , o v e r w h i c h t h e dose r a te c ha ng e s r a p i dl y a s a f u nc t i o n o f d i s t a n c e f ro m t h e b e am a x i s ( 1 0 ) . T he t r a ns m i s s io n p e num b r a , m e nt io ne d a bo v e , i s t h e re gi o n i r ra d i at ed b y p h ot o ns w hi c h a re t r a ns m it te d t hr o ug h t he e dg e o f t he c o ll i m at o r blo c k . A n o t h e r t y pe o f p e n u m b r a , k n o w n a s t he g e om e tr i c p e num b r a , i s il l us tr a te d i n F i g . 4 .1 4 . T h e g eo m et r i c wi d t h o f t he pe num b r a ( P d ) at a ny dep t h ( d ) f r o m t he s u r f a c e o f a p a t i e n t ca n b e d e te r m i ned b y c o ns i d er i ng s i mi l a r t r ia ng l e s A BC a nd DEC. From geometry, we have:

If A B = s , t h e s o u r c e d i a m et e r , O M = S D D , t he s o ur c e to d i ap hr ag m d i st a nc e , O F = S S D , t h e so u r c e to s u r f a c e d i st a nc e , the n f r o m t he p re v i ous e q ua t io n, t he p e n u m b r a ( D E ) a t d e pt h d i s g i v e n b y :

T h e p e n u m b r a a t t h e s u r f a c e c a n b e c a l c ul a t e d b y s ub s ti t uti ng d = 0 i n E q ua t i o n 4.2.

WWW.MEDRAD.IR

F I G . 4 . 1 4 . D i a g r a m fo r c a l c u l at i n g ge o me t ri c p e num b r a . P.54

A s E q u a t i o n 4 . 2 i n d i ca t e s , t h e pe num b r a w i d t h i nc r e a s e s w i t h i nc r e a s e i n s o ur ce d i a m et e r , S S D , a n d de p t h b ut de c r e a s e s w it h a n i nc r e a s e i n S D D. T he g e om e tr i c p e n u m b r a , h o w e v e r , is i n d ep e n d e nt o f fi el d s i z e a s lo ng a s t he m o v e m e nt o f t he d i a p h r a g m i s i n o n e p la n e , t h a t i s , S D D s t a y s c o ns t a nt w i t h i nc r e as e i n f i e l d si z e . B e c a u s e S D D i s a n i mp o rt a n t p a r a me te r i n d e te r m i ni ng t he p e num b r a w i dt h, t hi s d i s t a n c e c a n b e i n c re a s e d b y e x te nd a b le p e num b r a t r i m me r s . T he s e t r i m m e rs c o n s i s t o f h e a v y m et al b a r s to a tt e nua te t he b e am i n t he pe num b r a r eg io n, t hus sharpening the f i el d ed g e s . T he p e num b r a , ho w e v e r , is no t el i mi na te d c o m pl e te l y b u t r ed u c e d s i n c e S D D w i t h t he t r i m me r s e x t e nde d i s i nc r e a s e d . T he n e w S D D i s eq u a l to t h e so u r c e t o t ri mm e r di s ta nc e . A n a lte r na t i v e w a y o f r e d u c i n g t h e p e n u m b ra i s to u s e se c o nd a r y b l o c k s , p l a ce d cl os e to t he p at ie nt , f or r e d e f i ni n g o r s h a pi n g t h e f i el d . A s w i ll b e d i s c us s ed i n C ha p t er 1 3 , t he bl o c k s s h o u l d n ot b e p l a ced c lo s e r t h a n 1 5 to 2 0 c m f ro m t he p at i e nt be c a us e o f e x c e s s i v e el e ct r o n c o nt a m i n a n t s p ro d uc e d by t he b l o c k c a r r y i ng t ra y . T h e c o m bi n e d e f f e c t o f t h e t r a n s m i s si o n and g e om et r i c p e num br a s i s t o c re a te a r e g io n o f d o s e v a r i at io n a t t h e f i e ld e d ge s . A d o s e p r o f il e o f t he b e a m m e a s ur ed across dose the be a m at in the air at a given is d i st a nc e from of t he not s o urc e o nl y w o ul d s ho w a nd d o s im e tr i c al l y t h e e x te n t o f t h e pe num b r a . H o w e v e r , a t a d ep t h in t he p a t ie nt t he v a r i a tio n f i el d b o rd e r a f unc t i o n g eo m et r i c t r a n s m i s s io n pe n u m b r a s b u t a l so t he s c at t er e d r a di at io n p r od uc ed i n t he p at i e nt . T h u s , d o s i m e t ri c al l y , t h e te r m p hy s i c al p e num b r a w i d t h ha s b een d e f i ne d a s t he l a t er a l di s t a n c e be t w ee n t w o s p e ci f i e d i s od os e c ur v e s 4 a t a s p e c i f ie d d ep t h ( 1 1 ) .

WWW.MEDRAD.IR

4.8. HEAVY PARTICLE BEAMS

W h e r e a s x - r a y s a n d e l e c t ro n s a r e t he m a i n ra d i a tio ns us e d i n r a d io t he r ap y , he a v y p a r t i cl e b e a m s o f f e r s p e c i al a d v a nt a g e s w i t h r e g a r d t o d o s e l o c a li z a ti o n a nd t h e r a p e ut i c g ai n ( g r ea t e r e f f e c t o n t um o r tha n o n no r m a l t i s s ue ). T he s e p a r t i c le s i n c l u d e n e ut r o n s , p r oto n s , d e u te r o ns , p art i cl e s , neg a ti v e p io ns , a nd he a v y io ns a c c e l e r at ed to h i g h e n e r g ie s . T h e i r P.55 u s e i n r a di at io n t h e r ap y i s st il l e x pe r i me nta l , a nd b e c a us e o f t he e no rm o us co st i n v o l v e d , o n l y a f e w i n s t it u t io n s ha v e b een a b l e t o a c q ui re t hes e m od a li ti e s fo r c l i n i c al t ri a l s . Fr o m the li te r a t ure , w hi c h is f ul l of e nc o ur ag i ng as w el l as d i s c o u r ag i n g re po r t s a b o u t t h ei r e f f i c a c y, i t ap p e a r s t ha t t he r ol e o f he a v y

p a r t i cl e s i n r a di a ti o n t h e r a p y i s no t y e t e sta b l i s hed . H o w e v e r , t he r a d io b io lo gi c al i n t e re s t i n t h e f i el d rem a i n s a s s t r o ng a s e v e r .

A. Neutrons
H i g h - e n e r g y n e u t ro n b e a m s f or r a di ot he r ap y a r e pr o d uc ed b y de ut e ri um t ri ti um ( D - T ) g e n e r at o r s , c y c lo t ro n s , o r li ne a r a c c ele r a to r s . T he b o mb a r ding p a r t i cl e s a re e i t h er d e u te r o n s o r p ro to n s a n d t he t a r ge t m a t e ri a l i s us ua l l y b e ry l l i um , e x c e pt i n t h e D - T g e n e r at o r i n w h i c h t r i t i u m i s us e d a s t he t a r g et .

A.1. D-T Generator

A l o w - e n e r g y d e u te r on b e a m ( 1 0 0 3 00 k eV ) i nc i d e nt o n a t r it ium t a r g e t y ie l ds n e u t r o n s b y t h e f o l lo wi n g r e a c ti o n:

T h e d i s i n te g r a tio n e n e r g y o f 1 7 . 6 M e V i s s ha r e d b e t we e n t he he l i um nuc l e us ( p a r t i cl e ) a n d t h e n e u tr o n , w i t h a b o ut 14 M e V g i v e n to t he ne ut ro n. T he ne ut r o ns t h u s p r o d u c e d a r e es s e n t i al l y m o noe ne r ge t i c a nd i so tr o pi c ( sa m e y i e ld i n a l l d i r e ct io n s ) . T h e m a j o r p r o bl e m i s t he l a c k of s uf f i c i e nt d o se r a te a t t he t r e at m e nt d i s t a n c e . T h e h i g h e st d o se r a t e t ha t ha s b e e n a c hi e v e d so f a r i s a b o ut 15 c G y / m i n a t 1 m . T h e a d v a n t a g e o f D - T g e ne r a to r s o v e r o t he r sour c e s i s t ha t i t s s i z e i s s m a ll e n o u g h to a l lo w i s o ce nt r i c mo unt i ng o n a g a nt r y .

A.2. Cyclotron
D e u t e ro n s a c c el e r at e d t o h ig h e ne r gi e s ( ~15 50 M e V ) b y a c y c lot r o n bo m b a rd a l o w at o mi c n u m b e r t ar g e t s u c h a s be r y l li um to p ro d uc e ne ut ro ns a c c o r di ng t o a s t r i pp i n g re a c ti o n ( s ee s e c ti o n 2 . 8 . D ) :
2 1

H +

Be

10

B +

n m o st l y in t he f or w a r d d i re c ti o n w it h a s p e c t r um of

Neutrons

are

p r od u c e d

e n e r g ie s , a s s h o w n in F i g . 4 . 1 5 . T he a ver a g e ne ut ro n e ne r g y i s a bo ut 40 % t o 5 0 % o f t h e de u t e ro n e n e r g y .

WWW.MEDRAD.IR

F I G . 4 . 1 5 . N e u t r o n s p e c t r a p ro d uc ed b y d e ut e ro ns o n b e r y ll i um t a r g et . ( F r o m R a j u M R . H e a v y p a r t i c l e r a di ot h e r a p y . N ew Y o r k : A c a d e m i c P r e s s , 1 9 8 0 . D at a f r o m H a l l E J , R o i z i n -T o w l e L , A t ti x F H . R a d i ob io lo gi c a l st ud i e s w i t h c y c l o t ro np r o d u c ed n e u t r o n s c u r r e n t l y u s e d f o r r a di ot he r a p y . I nt J R a d io l -O nc o l Bi ol P hy s 1 9 75 ; 1 : 33 , a n d G r a ve s R G , S m a t he r s J B, A l m o nd P R , et a l . N e ut r o n e ne rg y spectra of d ( 49 ) - B e and P ( 4 1 ) - Be ne utr o n r a d io t he r ap y s our c e s . Med P hy s 1 9 79 ; 6 : 12 3 ; w it h p e rm i s s io n . )

F I G . 4 . 1 6 . D e pt h d os e d i st ri b u ti o n c ha r ac t e ri s ti c o f he a v y c ha r g e d p a r ti c le s , showing Bragg peak. P.56

T h e b o mb a r di n g p a rt ic l e s c a n al s o b e p ro to ns a c c e le r a te d to hig h e ne r gi e s b y a c y c l o t ro n o r a l i n e ar a c c e l e r at o r . T he neut r o n s p e c t r um p ro duc e d b y 4 1 M e V p r ot o n s i s s h o w n i n Fi g . 4 . 15 . A hy d r o g e nous m a t e r i al f il te r ( e . g. , p o l y et hy l e ne ) i s u s e d t o re d u c e t h e n u m b e r o f l o w - e ne rg y ne ut r o ns i n t he s p e c tr um .

WWW.MEDRAD.IR

B. Protons and Heavy Ions

P r o to n b e am s f o r t h er a p e u ti c a pp li c a ti o n ra ng e i n e ne r g y f ro m 1 5 0 to 2 5 0 M e V. T h e s e b e a m s c a n b e p r o d u c ed b y a c y cl ot ro n o r a l i ne a r a c c el e ra t o r . T he m aj or a d v a n t a g e o f h i g h - e n e r g y p r oto ns a nd o the r he a v y c ha r g e d pa r t i cl e s i s t hei r c h a r a c t e r i st i c d i st ri b ut io n o f do s e w i t h d e pt h ( F i g . 4 . 1 6 ) . A s t he b e a m t r a v e r se s t h e t i s s u e s , t h e d o se d ep o si te d i s ap p ro x im a t el y c o ns ta nt w it h d ep t h unt il ne a r t h e e n d o f t h e r a n g e w h e r e t h e d o se pe a k s o ut to a hi g h v a l ue fo ll o w ed b y a r ap id f a l l o f f to z e ro . T h e r eg i o n o f h i g h d o se at the e nd o f t he p a r ti c le r a ng e i s c al le d the Bragg peak. F i g u r e 14 . 1 7 s h o w s th e r a n g e e ne r g y re l at io ns hi p f o r p rot o ns . T he a p p r o x im a te r a n g e f o r o t h e r p a r ti cl e s w it h t h e s a me i nit i al v e lo c it y c a n b e ca l c ul a te d b y t he f o l lo w i n g r el a ti o n s h i p :

w h e r e R 1 a n d R 2 a re pa r t i cl e r a n ge s , M 1 a nd M 2 a r e t he m a s s e s , and Z 1 a nd Z 2 a r e t h e c h a r g e s o f t h e tw o p a r ti c l e s b ei ng c om p a r e d . T hus f r o m the r a ng e e ne r g y d a t a f o r p ro to n s o n e c a n c a l c u l a t e t he r a ng e o f o t he r p a rt i cl e s . T h e e n e r g y o f h e a v y c h a r g e d p a r ti c l e s o r s t r i p pe d nuc l e i i s o f t e n e x p r e s se d i n t e r m s o f k i n et i c e n e r gy p e r n u c l eo n ( s p e ci f ic k i ne t i c e ne r g y ) o r Me V / u w he r e u i s the mass number of the n u c l e us . P a r t i cl e s w it h t he s am e MeV/ u ha v e a p p r o xi m a te l y t h e s am e v e l o ci t y a nd r a ng e . F o r e x a m p le , 1 5 0 M e V p r o to ns , 3 0 0 M e V d e u t e ro n s , a n d 6 0 0 M e V h e l i um i o ns al l ha v e a p p r o x im a t el y t he s a m e r a ng e o f a b o u t 1 6 c m i n w a te r . H o w e v e r , f o r i o ns he a v i e r t ha n he l i um , t he r a ng e f o r t he s a m e M e V / u i s so m e wh a t le s s t h a n t ha t fo r p r ot o ns . A s p r e di c te d b y E q ua t io n 4 . 4 , t h e r a n g e i s d e pe n d en t o n A / Z 2 , w he r e A i s t he a t o mi c num b e r a nd Z i s t he n u c l e a r c h a r g e . S i n ce A / Z 2 d e c re a s e s a s t he io ns ge t he a v ie r , t he r a nge of h e a v i e r io n s i s l e s s t ha n t h e r a n g e o f l i g hter i o ns f o r t he s a m e Me V / u .

C. Negative Pions
T h e e x i s te n c e o f p i me s o n s w a s t heo r et i c all y p r ed i ct e d b y Y uk a w a i n 1 9 35 w he n h e p o st u l at e d t h a t p ro to n s a n d ne ut ro ns in t he nuc l e us a re held to ge t he r b y a m u t u a l e x c h a n g e o f p i m e s o n s . A p i m e s o n (o r p io n) ha s a m a s s 2 7 3 ti m e s t hat o f e l e ct r o n a n d m a y h a v e a p o s i ti v e c ha r g e , a ne g a t i v e c ha r g e , o r m a y b e ne ut r a l . T h e c h a r g e d p io n s d e ca y i n t o m u P.57 m e s o n s a n d n e u t r i n o s w i t h a m e a n l i f e o f 2 . 5 4 1 0 - 8 s e c o nd s a nd t he ne ut r a l p i o n s de c a y i n t o p ai r s o f p h o t o n s w i t h a m ea n l i f e o f a b o ut 10 - 1 6 se c o nd s .

WWW.MEDRAD.IR

F I G . 4 . 1 7 . R a n g e e n er g y r e l at io ns hi p fo r pro to ns . ( F r o m R aj u M R . H e a v y p a r ti c le r a d io t h e r ap y . N e w Y o r k : A c a d e m i c P r e s s , 1 98 0 , w i t h p e r mi s s io n. ) O n l y n e g a t i v e pi o n s h a v e b e e n u s e d f o r r a di a ti o n t he r a p y . B e a m s o f n e g a t i v e p ion s c a n b e p r o d uc e d i n a n uc l e a r r e a c t io n. P r o to ns o f e ne r g y i n t h e r a n g e o f 40 0 to 8 00 M e V , p ro d uc ed i n a c y c l ot r o n o r a li ne a r a c c el e r at o r are usually used for pion beam p r od uc t io n for r a d i ot he r a p y . Be r y l l i um is a s u i t a bl e t a r g et m at e ri a l . P io n s o f po s it i v e, ne g a t i v e , a nd z er o c ha r g e w i t h a s p e c t r u m o f e n e r gi e s a r e p r o d u c e d a nd ne g a ti v e p io ns o f s ui ta b l e e ne rg y a r e e x t r a c te d f r o m t h e tar g e t u s i n g b e ndi ng and f o c us i ng m a g ne t s . P i o ns o f e ne r g y c l o s e to 1 00 M e V a re o f i n t e re s t i n r a di a ti on t he r a p y , p r o v id i ng a r a ng e i n w a te r o f a b o u t 24 c m . T h e B r a g g p e a k e x h i bit e d b y p io n s i s mo r e p r o no unc e d t ha n o t her he a v y p a r t i cl e s b e c a u s e o f t h e a dd iti o n a l e f f e c t o f nuc lea r d i si nt eg r a ti o n b y - c a pt ur e . T hi s phenomenon, P.58

WWW.MEDRAD.IR

c o m m o n l y k n o w n a s s t a r f o r m a ti o n , o c c ur s w he n a p i o n i s c a p t ure d b y a nuc l e us i n t h e me di u m n e a r th e e n d o f i t s r a ng e . A p io n c a p t ure r e s ult s i n t he re le a s e o f s e v e r a l ot h e r p a rt i cl e s s u c h a s p r o to ns , ne ut r o ns , a nd p a r t i cl e s . A l t h o u g h p io n b e am s h a v e a t t r a ct i v e r ad io b io lo gi c p ro pe r ti e s , t he y s uf f e r f r o m t h e p r ob l em s o f l o w do s e r a te s , b e a m c o nt am i na t io n, a nd hi g h c o s t .

REFERENCES
1. 2. P a t e r so n N a ti o n a l R. The t r e at m e n t on of m al igna nt P r ot e cti o n. d i s e a se M e di c a l by r adi um and a nd x-rays. ray B a l t i mo r e : Wi ll i a m s & W i l k i n s , 1 9 63 . Council R a d i at io n x-ray gamma p r ot e c tio n f o r e n e r gi es u p to 1 0 M e V . N C RP r e po r t 3 4 W a s hi ngto n, D C : N a ti o nal C o u n c i l o n R a d i at io n P r o te c ti o n a nd M e a s ur em e nt s , 1 9 70 . 3 . K a r z m a r k C J , N u n a n C S , T a n a b e E . M e d i c a l e le c t ro n a c c e le ra t o r s . N e w Yo r k : M c G r a w - H i l l , 1 99 3 . 4. P o dg o r s a k EB, Rawlinson JA, Jo hns HE. X-ray depth d os e s from li ne ar a c c e l e r ato r s i n t h e e n e r g y r a n g e f r o m 1 0 t o 3 2 M e V . A J R 1 9 7 5 ; 123 : 1 82 . 5 . V e k s l e r V J . A n e w m e t h od f o r a c c e l er a tio n o f r e l a ti v i s ti c p a rti c l e s . Do kl A k a d N a u k S S S R 1 9 4 4 ; 43 : 32 9 . 6 . R e i s t ad D , B r a h m e A . T h e m i c r o t ro n, a ne w a c c e l e r a to r f o r ra d i a tio n t he r a p y . The Third ICMP on Executive C o m mi tt ee , ed . D i ge s t of t he 3r d i nte r na t io na l U ni v e r s it y of conference me di ca l physics. G t e nbo rg , S w e d e n: C ha l m e rs

T e c h n o l o g y , 1 97 2 :2 3 .5 . 7 . S v e n s s o n H , J o h n s s o n L , L a r s s o n L G , et a l . A 2 2 M e V m i c ro tro n f o r r a d i at io n t h e r a p y . A c t a R a d io l Th e r P h y s B i o l 19 7 7 ;1 6: 1 4 5 . 8 . R o s a n d e r S , S e d l ac e k M , W e r ho l m O . T he 5 0 M e V r a c e tr a c k m i c r ot r o n at t he R o y a l In s t i t u te o f T e ch n o l o g y , S t o c k hol m . N uc l I ns t M e t h 1 98 2 ; 20 4 : 1 2 0 . 9 . C o r m a c k D V , J o h n s H E . S p e c t r a l d i st r ib ut io n o f s c a tt e re d ra d i a tio n f r o m a k i l o c u r ie c o ba lt 6 0 u n it . B r J R a d i o l 19 5 8 ;3 1: 4 9 7 . 1 0 . J o h n s H E , C u n n i n g h a m J R . T he p hy s i c s o f r a d i ol og y , 3 r d ed . S p r i ng f i el d , IL : C h a r l e s C T h o m a s , 1 9 6 9 : 12 0 . 1 1 . In t e r n a t io n a l C o mm i s s io n o n R a d i a ti o n U ni t s . D et e r mi na t io n o f a b s o r be d do s e i n a p a t i e n t i r r ad i at ed b y b e a m s o f x - o r g a m m a r a y s i n r a d i o t he ra p y p r o c e d ur e s . IC R U r e p o rt 2 4 . W a sh i n g t o n , D C : Int e r na t io na l C om m i s si o n o n R a d i at io n U nit s a n d M e a s u r e m e n t s , 1 97 6 : 54 .

1

T h e t e rm do s e , o r ab s o r be d d o se , i s d e f ine d a s t he e ne rg y ab s o r be d p e r unit M a g n e t ro n a n d k l y s t r o n a r e b ot h d e v i c e s f o r p r o d uc i ng mi c r ow a v e s . W he r e a s

m a s s o f t h e i r r a di a te d m a t e r i al .
2

m a g n e t ro n s a r e g e n er a l l y l e s s e x pe ns i v e tha n k l y s t r o ns , t he l a t t er ha v e a l o ng l i f e sp a n . In a d d i ti o n, k l y s t r o n s a r e c ap ab l e o f d el i ve r i ng highe r - p o w e r l e v el s r e q u i r ed f o r h i g h - e ne r g y a c c el e r at o r s a nd a r e p r e f e rr e d a s the b e a m e ne r g y approaches 20 MeV or higher.

3

T e l et h e r a p y i s a ge n e r a l t e rm a pp li e d to e x t e r na l b e am tr e a tme nt s i n w hi c h t he A n i s o d o se c u r v e i s a l i n e p a s s i n g t hr o ug h p o i nt s o f e q ua l do s e .

s o u r c e o f r a d i at io n i s a t a l a r g e di s ta nc e f r om t he p a ti e nt .
4

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 5 - Interactions of Ion izing Radiation

5 Interactions of Ionizing Radiation

W h e n a n x - o r r a y b e a m p a s s e s t hr o ug h a m e d i um , i nt e r a ct io n b e t w ee n p hot o ns a n d m a t te r c a n t a k e p l a c e w i t h t he r e s ul t t ha t e ner g y i s t r ans f e r r e d to t he m e d i u m . T h e i n i ti a l s te p i n t h e e ne r g y t r a ns f e r i nv o l v e s t he e j e ct io n o f e l e c tr o ns f r o m t h e a to m s o f t he a b s o rb i n g me di um . T he s e hi g h- s p e ed ele c t ro ns t r a ns f e r t h e i r e n e rg y b y p r o du c i n g i o n i z a ti o n a nd e x c i t a ti o n o f t he a to m s a l o ng t hei r p a t h s . If t h e a b so r bi ng m ed i u m co ns i s t s o f b o d y t i s s ue s , s uf f i c ie nt e ne rg y m a y be d e po s it e d w it h i n t h e ce l l s , de s t ro y i ng t hei r r e p r od uc t i ve c a p a c it y . H o w e v e r , m o s t o f t h e a b s o rb e d e ne r gy i s c o n v e r t e d i nt o hea t , p r o d uci ng no b io log i c e f f e c t .

5.1. IONIZATION
T h e p r o ce s s b y w h i c h a n e u t r a l a to m a c q uir e s a po s it i ve o r a neg a t i ve c ha r g e i s k n o w n a s i o n i z a ti o n . R e m o v a l o f a n o r bi t al el e ct r o n l e a v e s t he a t om po s it i v el y c h a r g e d , re s u l ti n g i n a n io n p ai r . T he str i p pe d e le c t ro n, i n thi s c a s e , i s t he n e g a t i ve i o n a n d t h e r e s i d u a l a to m i s t he pos i ti v e i o n. In s o m e c a s e s , a n e l e c t r o n may be a c q u i r ed by a neutral a to m a nd t he ne g at i v el y c ha r g e d at o m t he n b e c o me s t h e n e g at i v e i o n . Charged p a rt i cl e s s uc h a s e l e ct r o ns , p r ot o ns , a nd p a rt i cl es a r e k no w n a s d i r e ct l y io n i z i n g r a di at io n p ro v i de d t he y hav e s uf f i c i e nt k i ne ti c ene r g y t o p r od uc e i o n i z a ti o n b y c ol li s ion 1 a s t h e y pe ne t r at e m a t te r . T he e ne r g y o f t he i nc id e nt p a r t i cl e i s lo s t i n a l a r g e n u m b e r o f s m a ll i nc r e m e nt s al o ng t he i oni z a t i o n t ra c k i n t h e m e di u m , w i t h a n o c c a s io n a l i nte r a c tio n i n w hi c h t he e j e c te d e l e ct r o n r e ce i v es s u f f i c i e n t e n e r g y t o pr o d u c e a s e c o nd a r y t ra c k o f i t s o w n, k no w n a s a r a y . If , o n t h e ot h e r h a n d , th e e n e r g y l o st b y t he i nc id e nt p a rt i cl e i s no t s uf f i ci e nt to e j e ct a n e l e c tr o n f r om t h e a t o m b ut i s us e d to r a i s e t he e l e ct r o ns to hi g he r e n e r g y l e v el s , t h e p roc e s s i s t e r me d e x ci t ati o n . T h e u n c h a r g e d p a r ti cl e s s u c h a s ne ut r o ns a nd p ho to ns a r e i nd i r e ct l y i o ni zi ng r a d i at io n b e c a u s e t h ey l i be r a te di r e ct l y io ni z i ng p a rt i cl e s f ro m ma t t er w he n t he y i n t e r a ct w i t h m a tt e r . Io n i z i n g p h ot o n s i n t er a c t w it h t he a to m s o f a m at e ri a l o r a b so r b e r to p r od uce h i g h - s p e ed e l e ct ro n s b y t h r e e m a j o r p r oc e s s e s : p ho to el e ct r i c e f f e c t , C o m p t on e f f e c t , a n d pa i r p r odu c t i o n . B e f o re co ns i de r i ng e a c h p ro c e s s i n d et a il , w e s ha ll d i s c u s s t h e m a t h e m at ic a l a s p e ct s o f r a d i at ion a b s o r p ti o n.

5.2. PHOTON BEAM DESCRIPTION

A n x - r a y b e a m em it t ed f r o m a t a r g et o r a r a y b e a m e mi tt e d f ro m a r a d io a ct i v e s o u r c e co n s i s t s o f a la r g e n u m b e r o f p ho tons , us ua l l y w i t h a v a ri e t y o f e ne rg ie s . A b e a m o f p h oto n s c a n b e d e s c ri b ed b y m any t e r m s , s o m e o f w hi c h a r e d e f i ne d as f o l lo w s : P.60

WWW.MEDRAD.IR

T h e f l u e n c e ( ) o f p h o t o ns i s t he q uo ti ent d N b y d a , w he r e d N i s t he n u m b e r o f p h o t o n s t h a t e nt e r a n i m a g i na r y s p he r e o f c r o s s - s e c tio na l a r e a da.

F l u e n c e r a t e o r f l u x d e n s i t y ( ) i s t he f l ue nc e p e r uni t ti m e .

w h e r e d t i s t h e t i me in t e r v a l .

E n e r g y f l u e n c e ( ) i s t h e q uot ie nt o f d E f l b y d a , w he r e d E f l i s the s um o f t h e e n e r gi e s o f a ll t h e p h ot o ns t hat e nte r a s p he r e o f c r o s s - se ct io na l a r e a da.

F o r a m o n oe n e r ge ti c b e a m , d E f l i s j us t t he num b e r o f p ho to ns d N t i me s e n e r g y h c a r r i e d b y e a c h p ho t o n:

E n e r g y f l u e n c e r a t e , e n e r g y f l ux d e ns i t y , o r i nt e nsi t y ( ) i s the e ne r g y f l u e n c e p e r u n i t ti m e :

5.3. PHOTON BEAM ATTENUATION

A n e x p e r i me n t a l a r r a n g e m e n t d e si g ned to me a s ur e t he a tt e nua t ion c ha r a c t e r i st i cs o f a p h o to n b ea m i s sh o w n i n F i g . 5 . 1 . A na r r o w b e a m o f mo no ene r g e ti c p hoto ns i s i n c id e n t o n a n a b so r b e r o f v a ri a bl e t hi ck ne s s . A d e te c to r i s p l a c ed a t a f i x ed d i s t a n c e f r o m t h e s o ur c e a n d s u f f i c ie nt l y f a r t he r a w a y f r o m t he a b s o r be r so t ha t only the p ri m a r y p h o to n s (those p ho to ns t ha t p a s s ed t hr o ug h t he a b s o rb er w i t h o u t i n te r a ct i n g ) ar e m e a s u r e d b y t he de t e ct o r . A ny p ho to n s c a t t er e d b y t he a b s o r be r i s n ot s u p pos e d t o b e me a s ur e d in t hi s a r r a ng e me nt . Thus , i f a p ho to n i n t e r a ct s w it h a n at om , i t i s ei t he r c o mp let e l y a b s or b ed o r s c att e r ed a w a y f r om t h e d et e c to r .

WWW.MEDRAD.IR

Under

these

co n d it io n s ,

the

r e d uc t io n

in

t he

num b e r

of

p ho to ns

(dN)

is

p r o po r tio na l to t h e n u m b e r o f i n c i de nt p ho to ns ( N ) a nd t o t he t hi c k ne s s o f t he a b s o r be r ( d x ) . M a t h em a t i c al l y , dN
Ndx or

P.61

w h e r e i s t h e co n s t an t o f p ro po r ti o nal it y , c a l l ed t he a tt e nua ti o n c o e f f i ci e nt . T he m i n u s s i g n i n d i c at e s t h a t t h e num b e r o f p ho t o ns de c r e a se s a s t he a b s o rb e r t h i c k n e s s i n c r e a s e s . T h e a b o v e e q ua ti o n c an a l s o b e w r i tt e n i n te r m s o f i nt e ns it y (I): dI = -Idx or

If t h i c k n e s s x i s e x p r e s s e d a s a l e ng t h, t he n i s c a l l e d t he l i ne a r a t te nua t i on c o e f f i c ie n t . Fo r e x a m pl e , i f t h e t hi c k ne s s i s m e a s ur e d i n c e nt i me te r s , t he uni t s o f are 1/cm, or cm-1.

F I G . 5 . 1 . D i a g r a m t o i ll u s t r a te a n e x p e ri me nt a l a r r a nge m e nt fo r s t ud y i ng na r r o w beam a tt e n u a t io n through an absorber. M e a s ur e m e nt s are und e r g o od g e o me t r y , i . e . , s c a t te r e d p h oto n s a r e no t m e a s ur e d . E q u a t i o n 5 . 7 i s i d e nt ic a l to E q u at io n 2 . 1 , w hi c h d e s c r ib e s r ad ioa c t i v e d e c a y , a nd i s a n a l o g o u s to de c a y c o n s t a nt . A s b e f o r e , t he di f f e r e nt i al e q ua ti o n f o r a t t e n u a ti o n c a n b e s olv e d t o y ie l d t he f o ll o wi ng e q ua ti o n:

w h e r e I ( x ) i s t h e i n te n s i t y t r a n s m it te d b y a t hi c k ne s s x a nd I 0 i s t he i nt e ns it y i n c i d e nt o n t h e a b s or b e r . If I ( x ) i s p l o t te d a s a f u nc t i o n o f x f o r a na r r o w m o n o e n e rg et i c b e a m , a s t r ai g h t l i ne wi ll b e ob t ai ne d o n s e mi lo g a ri t hm i c p a pe r

WWW.MEDRAD.IR

( F i g . 5 .2 A ) , s h o w i n g t h a t t h e a tt e nua ti o n o f a mo no e ne rg et i c be a m i s d e s c ri be d b y a n e x p o n e n t i a l f u n c t io n . T h e t e r m a n a lo go u s to h a l f - li f e ( s e ct io n 2 .4 ) i s t he ha l f - v a l ue lay e r ( H V L ) d e f i ned a s t h e t h i c k n e s s o f a n a b s o r be r r e q ui re d to a t t e nua te t he i nte ns i ty o f t he b e a m to h a l f i t s o r ig i n a l v a l u e. T h a t m e a ns t ha t w he n x = H V L , I / I 0 = 1 /2 , b y d e fi ni ti o n. T h u s f r o m E q u a t i o n 5 . 8 i t c a n b e s ho w n t ha t:

F I G . 5 . 2 . A : G r a p h s h o w i n g pe r c e nt t r a ns m i s s io n o f a na r r o w m o noe ne r ge ti c p h o to n b e a m a s a f u n c t i o n o f a b s o rb e r t hi c k ne s s . F o r t hi s qua l i t y b e am a nd a b s o r be r m at e ri a l , H V L = 2 c m a nd = 0 . 3 47 c m - 1 . B : U ni ve r s a l at te nua t io n curve showing p e r cen t t r a n s m i s si o n of a na r r o w m o noe ne r ge t i c b e am as a f u n c t i o n o f a b s o r be r th i c k n e s s i n uni t s o f h a l f - v a l ue l a y e r ( H V L ) .

P.62

As

m e n t io n e d

p re v io u s l y , be a m. Figure

e x po ne nt i al 5.2B is a

a t t e nua ti o n g e ne r a l

st ri c tl y

a p pl ie s c ur v e

to for

a a

m o n o e n e rg et i c

at te nua t i on

m o n o e n e rg et i c b e a m o r a be a m w ho s e hal f - v a l ue l a y e r d oe s no t c ha ng e wi t h a b s o r be r t h i c k n e s s . S u c h a c u r v e m a y b e us e d t o c a l c ul at e t he num b e r o f H V L s r e q u i r ed to r e d u c e t h e t r a n s m it te d i nte ns ity t o a g i v e n pe r c e nt ag e o f t he i nc i de nt i n t e n s it y .

WWW.MEDRAD.IR

p r a c t i c al

beam

pro d u c e d

by

an

x-ray

g e ne r a to r ,

ho w e v e r,

c o ns i s t s

of

s p e c t r u m o f p h o to n e n e r g ie s . A t te nua t io n o f s uc h a b e a m i s no l o nge r q uite e x p o n e n ti a l . T h i s e f f e c t i s s ee n i n F i g . 5 . 3 , i n w hi c h t he p l o t o f tr a ns m i tted i n t e n s it y on s e mi lo ga r i t h m i c curve d ec r e a s e s p a pe r with is not a s t r ai g ht a b s o rb e r l i ne . The s l op e of t he t he a t t e n u a ti o n i nc r e a si ng t hi c k nes s b e c a us e

a b s o r be r o r f il te r p ref e r e n t i al l y r e mo v e s the l o w e r -e ne r g y p hoto ns . A s s ho w n i n F i g . 5 . 3 , t h e f i r st H V L i s d e f i n e d a s t ha t t hic k ne s s o f m a t e r i al w hi c h r e d uc e s t he P.63 i n c i d e nt b e a m i n te n s i ty b y 5 0 % . T he s e c o nd H V L r e d uc e s t he b ea m t o 5 0% o f i t s i n t e n s it y a f t e r it h a s b e e n t r a n s m it t ed t hr oug h t he f i r st H V L . S im i l a rl y , t he t hi rd H V L r e p r e se n t s t h e qu a l i t y o f t h e b e a m a f te r it ha s be e n t r a ns mi tt e d t hr o ug h t he a b s o r be r o f t h i c k n e s s e q u a l t o t w o H V L s . In g e ne r a l , f o r a he t e ro g e neo us b e a m , t h e f i r s t H V L i s l e s s th a n t h e s u b s e q ue nt H V L s . A s t he f i l t e r t hi ck ne s s i nc r e a s e s , t h e a v e r a g e e n e r g y o f t h e t r a n s mi tt e d be a m i nc r e a se s o r t he b e a m b e co m e s i n c r e a s i n gl y h a r d e r . Th u s , b y i n c r e a s i ng t he f i l t r at io n i n s uc h a n x - r a y b e a m , o ne i n c r e a s e s t h e pe n e t r ati n g p o w e r o r t he ha l f - v a l ue l a y e r o f t he b e am .

FIG.

5.3.

Schematic

graph

s h o w i ng

t r a ns m i s s io n

of

an

x-ray

beam

with

WWW.MEDRAD.IR

s p e c t r u m o f p h o to n en e r g i e s t h ro ug h a n a lum i num a b s o r be r . Fi rs t H V L = 0 . 9 9 m m Al, second HVL = 1.9 mm Al, third HVL = 2.0 mm Al.

5.4. COEFFICIENTS A. Attenuation Coefficient

In t h e p r e v i o u s s e ct ion , w e d i s c us s e d t he li ne a r a tt e nua t io n c o ef f i c i e nt , w hi c h h a s u n i t s o f c m - 1 . In g e n e r a l , t hi s co e f fi c i e nt de p e nd s o n t he e ne rg y o f t he p h o to n s a n d t h e n a tu r e o f t h e m a te r i al . S i nc e t he att e nua t io n p r od uc e d b y a t h i c k n e s s x d e p e n d s o n t h e n u m b e r o f e l ec t r o ns p r e se nt ed i n tha t t hi c k ne s s , d e pe n d s o n t h e d e n s it y o f t h e m at e ri a l . Thus , b y d i v i d i ng by d e ns i t y , t he r e s u l ti n g c oe f f i c ie n t ( / ) w i ll be i nde pe nde nt o f d e ns it y ; / is k no w n a s t he m a s s a t te n u a t io n c o ef f i c i e n t . T hi s i s a mo r e f und a m e nt al c oe f f i c i e nt t ha n t he l i n e a r c oe f f i c i e n t , s i n ce t h e de n s i t y ha s b e en f a c t o r ed o ut a nd it s d ep e nd e nc e o n the nature of the m a t e ri a l d oe s no t i nv o l v e de ns i t y b ut r at he r t he ato m i c c o m po s it io n . T h e m a s s a t te n u a t io n c o e f f i ci e n t ha s uni t s o f c m 2 / g b e c a us e / = c m - 1 / ( g / c m 3 ). When using / in the a t t e n ua ti o n E q ua t i o n 5.8, t he t hi ck ne s s s ho ul d be e x p r e s s ed a s x , w h i c h h a s u n i t s o f g / c m 2 , b e c a us e x = ( / ) ( x ) a n d x = (g/cm3)(cm). In a d d i t io n t o t h e c m a n d g / c m 2 uni t s , t he a b s o r be r t hi c k nes s c a n a l s o b e e x p r e s s ed i n u n i t s o f e l e ct r o n s / c m 2 a nd a tom s / c m 2 . T he c o r r e s pond i ng c o e f f i ci e nt s f o r t h e l a st t wo u n i t s a r e el e ct r o ni c a tte nua t i o n c oe f f i c ie nt ( e ) a nd a to m i c a t t e n u a ti o n c oe f f i c i e nt ( a ) , r e s pe c ti v e l y .

w h e r e Z i s t h e a to m i c n u m b e r a n d N 0 i s t he num b e r o f el e ct r o ns p e r g r a m a nd N 0 is given by:

w h e r e N A i s A v o g a d ro 's n u m b e r a nd A W i s t he a t o mi c w e ig ht ( s e e s e c t io n 1 . 3 ) . T h e a t te n u a t i o n p r o ces s o r t h e a tt e nua ti o n c o e f f i ci e nt re p re s e nts t he f r a c ti o n o f p h o to n s r e m o v ed p e r u n i t t h i c k ne s s . T he t r a ns m i tt ed i nt e nsi t y I ( x ) i n E q ua t i o n 5 . 8 i s c a use d b y p h o to n s t h a t d i d no t i nte ra c t w i t h t he m at e ri a l . T ho s e p hot o ns w h i c h p r o d u c e d i n te r ac t io n s w i ll t r a ns f e r p ar t o f t hei r e ne rg y to the m a t er i al a nd r e s u l t i n p a rt o r a ll o f t h a t e n e r g y b ei ng a bs o r b ed .

B. Energy Transfer Coefficient

W h e n a p h o t o n i n t e r ac t s w i t h t h e e le c t ro ns i n t he m a t e r ia l , a p a r t o r al l o f it s e n e r g y is co n v e r t ed in t o k i n et i c e ne rg y o f e l e ct r o ns . If o nl y a pa r t o f t he p hot o n e n e r g y i s gi v e n to th e e l e ct r o n, t he p hot o n it s el f i s s c a tt e red w i t h r ed uc e d e n e r g y . T h e s c a t te r ed p h o to n m a y i nte r ac t a g a i n w it h a p a r ti a l o r c o mp le te t r a n s f e r o f e n e r g y t o th e e le c t ro n s . T hus a pho t o n m a y e x p e ri e nc e o ne o r m ult ip le

WWW.MEDRAD.IR

i n t e r a ct io n s i n w h i c h t h e e n e rg y l o st b y t he p hot o n i s c o nv e rt e d i nto k i ne ti c e n e r g y o f e le c t ro n s . If w e c o n s i d e r a p h o ton b e a m t r a v e r s i ng a m a t e ri a l , t he f r a c t io n o f p ho t o n e ne r g y t r a n s f e r r e d i n t o ki n e tic e n e r g y o f c ha r g ed pa r t i cl e s pe r uni t t hi c k ne s s o f a b s o rb e r is given P.64 b y t h e e n e r g y t r a n s f e r c o e f f i c ie n t ( t r ) . T hi s c o e f f i c ie nt i s r el a te d to a s f o l lo w s :

where

tr

is

the

a ve r a g e

energy

t r a ns f er r e d

i nt o

k i ne ti c

e ne r g y

of

c ha r ge d

p a r t i cl e s pe r i n te r a c tio n . T h e m a s s e ne r g y t r a ns f e r c o e f f i c i e nt i s g i v e n b y t r / .

C. Energy Absorption Coefficient

M o s t o f t h e e l e ct ro n s s e t i n m ot io n b y t he p ho t o ns w il l lo s e t he i r e ne rg y b y i n e l a st i c c ol li s io n s ( io n i z a t io n a nd e x c i t at io n) with a t o mi c ele c t ro ns of t he m a t e ri a l . A f e w , d e p en d i n g o n t h e a t o mi c num b e r o f t he m a te r i al, w i l l l o se e ne r g y b y b r e m s s tr a h l u n g i n t e r a ct io n s w i t h t he nuc l e i . T he b r em s s t r ahl ung e ne r g y i s r a d i at e d o u t o f t h e lo ca l v o l u me a s x - r a y s and i s not i nc l ude d i n the c a l c ul a ti o n o f l o c al l y a b s or b ed e n e rg y . The energy a b s o rp tio n c o e f f i c ie nt (en) is d e f i ne d as t he p ro d uc t of e ne rg y t r a n s f e r c oe f f i c i e n t a n d ( 1 - g ) w he r e g i s the f r a c t io n o f t he e ner g y o f s e co nd a r y c h a r g e d p a rt i cl e s t h a t i s l o st t o b re m s st r a hlung i n t he m a t e r i al .

A s b e f o r e , t h e m a s s en e r g y a b s o r pt io n c o e f fi c i e nt i s g i v e n b y e n / . F o r m o st i n t er a c ti o n s i n v o l v i n g s o f t t i s s ue s o r ot he r lo w Z m a t e ri a l i n w hi c h e l e ct r o n s lo s e e n e rg y a l m o s t e nt i re l y b y i oni z a t i o n c ol li s io ns , t he b r e m s st r a hl ung c o m po n e n t i s n eg li g ibl e . T h u s e n = t r und e r t ho se c o ndi ti o ns . T he s e c o e f f i ci e nts c a n d i f f e r a pp r e ci a bl y w h e n t h e k i net i c e ne r g ie s o f t he s e co nd ar y p a r ti c le s a r e h i g h a n d m a t e r i al t r a ve r s e d h a s a hi g h a t o mi c num b e r . T h e e n e r g y a b s o r pt io n c o e f f i c i e nt i s a n i m p or t a nt q ua nt it y i n r a d i ot he r a p y s i nc e it a l lo w s t h e e v al u a t io n o f e n e r g y a b so r be d i n t he ti s s ue s , a q ua nt it y o f i nte r e st i n p r e di c ti n g t h e bi ol o gi c e f f e c t s o f r a d i at io n.

5.5. INTERACTIONS OF PHOTONS WITH MATTER

A t t e n u a ti o n o f a p ho to n b e a m b y a n ab s o rb i ng m at e ri a l i s c a us e d b y f i v e m aj or t y p e s o f i n t e r a ct io n s . O n e o f t he s e , p hot o di s i nt e g r at io n, w a s c o ns i d e re d i n s e c t io n 2 . 8 F . T h i s r e a c t io n b e t w ee n p ho t o n a nd n uc l e us i s o nl y i m p o rt a nt a t v e r y high p h o to n e n e rg ies (>10 MeV). T he o t he r fo ur p ro c e s ses are co he r e nt s c a t te r i n g , t h e p h oto el e c tr i c e f f e ct , t he C om p to n e f f e c t , a nd t he p a i r p ro d uc ti o n. E a c h o f t h e s e p r o ce ss e s c a n b e r e p re s e nte d b y it s o w n a t te nua t io n c o e f f i ci e nt , w h i c h v a r i e s i n i t s pa r t i c u l a r w a y w i t h t he e ne rg y o f t he p hoto n a nd w i t h t he a t o mi c n u m b e r o f t h e a b s o r b i n g m at e ri a l . T he t o t al a t te nua t io n c o e f f i c ie nt i s t he s u m o f i n d i v i d u a l c oe ff i c i e n t s f o r t he s e p ro ce s s e s :

w h e r e c o h , , c , a n d a re a tt e nua t io n c o e f f i ci e nt s fo r c o he r e nt s c at te r i ng , p h o to el e c tr i c e f f e ct , C o m pt o n e f f e c t , a nd p ai r p r od uc t io n, r e s p e ct iv e l y .

WWW.MEDRAD.IR

5.6. COHERENT SCATTERING

T h e c o h e r e n t s c at t er in g , a l s o k n o w n a s c l a s s i c a l s c at te r i ng o r R ay l e i g h s c at te r i ng , i s i ll u s t r a te d i n F i g . 5 . 4 . T h e p r o c e s s c a n b e v i s ua l i z ed b y c o ns i d e ri ng t he w a v e nature of e l e ct r o ma g n e t i c r a di at io n. T hi s i nt e r a c ti o n c ons i s t s of an e l e ct r om a g n et i c w a v e p a s s i n g n e a r t he el e c tr o n a nd s e tt i ng i t i nt o o s c il l at io n. T he o s c il l at i n g e le c t ro n r er a d i at e s t h e e ne r g y at t he s a m e f r e q ue nc y a s t he i nc id e nt e l e ct r om a g n et i c w a v e . T h e s e s c a t t e re d x - r ay s P.65 h a v e t h e s a m e w a v e l e n g t h a s t h e i nc i d e nt b e a m . T hus no e ne r g y i s c ha ng e d i nt o e l e ct r o ni c m o ti o n a n d n o e n e r g y i s a b s o r be d i n t he m e d i um . T he o nl y e f f e c t i s t he s c a t te r i n g o f t h e p hot o n a t sm a ll a ng le s . T he c o he r e nt s c at te r ing i s p ro b a bl e i n h i g h a t o m i c n u m b e r ma t e ri a l s a n d w i t h p ho to ns o f l o w e ne r g y . T he p r o c e s s i s o nl y o f a c a d e m i c i n t e re s t in r a d i a t io n t he r a p y .

F I G . 5 . 4 . D i a g r a m i llu s t r a t i n g t he p ro c e s s o f c o he r e nt s c a tt e ri ng . T he s c a t te r ed p h o to n h a s t h e s a m e w a v e l e n g t h a s t he i nc id e nt p hot o n. N o e ne r gy i s t r a ns f e r r e d .

5.7. PHOTOELECTRIC EFFECT

T h e p h o to el e ct r i c e f f e c t i s a p h e no me no n i n w hi c h a p ho to n int e r a c t s w i t h an a t o m a n d ej e ct s o n e o f t h e o r bi t al el e ct ro ns f r o m t he ato m (F i g . 5 .5 ) . In t hi s p r o c e s s , t h e e n ti r e en e r g y h o f t he p ho to n i s f i r s t ab s o rb e d b y t he a t om a nd t h e n t r a n s f e r r e d to t h e a t o mi c e le c t ro n. T he k i ne t i c e ne r g y o f t he e j e ct e d el e ct r o n ( c a l l ed t h e p ho to el e c tr o n ) i s e q u a l to h - E B , w he r e E B is t he bind i ng e ne rg y o f t h e el e ct r o n . In t e r a c ti o n s o f t h i s t y p e c a n t a k e pl a c e w it h el e ct ro ns i n t he K , L , M, or N shells. A f t e r t h e e le c t ro n h a s b e e n e j e ct ed f r o m t he a to m , a v a c a nc y i s c r e at e d i n t he s h e l l , t h u s l e a vi n g t he a t om i n a n e x c i te d s t a t e . T he v a c a nc y c a n b e f i l le d b y a n o u t e r o rb it a l e le c t ro n w i t h t h e em i s si o n o f c ha r a c t e ri s ti c x - r a y s ( s e c ti o n 3 . 4 B) . T h e r e i s a l s o t he p o ss i b il it y o f e m i s si o n o f A ug e r e l e c tr o ns ( s e ct io n 2 . 7 C ) , w hi c h a r e m o n o e n er g et i c ele c t ro n s p r o d uc ed b y t he a b s o rp ti o n o f c ha r a c t e ri s ti c x - r a y s i n t e r n a ll y b y t h e at om . B e c a u s e t he K s hel l b i ndi ng e ne r g y o f so f t t i s s ue s i s o nly a b o u t 0 .5 k e V , t h e e n e r g y o f t he c ha r a ct e ri s ti c p hot o ns p ro duc e d i n b io lo gi c

WWW.MEDRAD.IR

a b s o r be r s i s v e r y l o w a n d c a n b e c o ns i d e re d t o be lo c a ll y a b s o rb e d . F o r hi g he r e n e r g y p ho to n s a n d h i g h e r at o mi c num b er m a te r i al s , t he c ha r ac t e ri s ti c p ho to ns a r e o f h i g h e r e n e r g y a n d m a y d e p o s it e ne rg y a t l a r g e di s t a nc e s c o m p a r ed w i t h the range P.66 o f t h e p h o to el e ct r o n . In s u c h c a s e s , t he l o ca l e ne rg y a b so r p tio n is r e d uc e d b y t he energy e m it te d as c h a r a c t e r i st i c r a di at ion (also c a l le d f l uo r es c e nt r a d i at io n) w h i c h i s c o n s i d e r ed t o b e r e m ot el y a b s o rb e d.

F I G . 5 . 5 . Il l u s t r at io n o f t h e p h o to el e ct r i c e ff e c t .

WWW.MEDRAD.IR

F I G . 5 . 6 . M a s s p h o toe l e ct r i c at te nua t i o n co e f f i c ie nt ( / ) p lo tt ed a g a i ns t p hot o n e n e r g y . C u r v e s f o r wa t e r ( Z e f f = 7 . 4 2 ) a nd l e ad ( Z = 8 2 ) . (D a ta f r o m G ro d st ei n G W . X - r a y a t t e n u a t io n c o e f f i c ie nt s f r o m 1 0 k e V t o 1 0 0 MeV . P ub . N o . 5 8 3 . W a s h i n g t o n , D C : U . S . B u r e a u o f S t a nd a r d s , 1 9 57 . ) T h e p r o ba b il it y o f ph o t oe le c t ri c a b so r pt ion d e p e nd s o n t he pho t o n e ne r g y a s i ll u s t r a te d i n F ig . 5 . 6 , w h e r e t h e m a s s p ho to e le c t ri c at te nua t io n c o e f f i c ie nt ( / ) i s p lo tt e d a s a f u n c t i on o f p h o t o n e ne r g y . D a t a a r e s ho w n f o r w a t e r , r e p r e se nt i ng a l o w a t o mi c n u m b e r m a t e ri a l s i mi la r t o ti ss ue , a nd f o r l e a d , r e pr e s e nti ng a hi g h a t o mi c n u m b e r m at e ria l . O n l o ga r it hm i c p ape r , t he g r ap h i s a lm o st a s t r ai g ht l i ne w i t h a s l o pe o f a p pro x i m a te l y - 3 ; t he r e f or e , w e g e t t he f o ll ow i ng r e l at io ns hi p b e t w ee n / a n d p h o to n e n e r g y :

T h e g r a p h f o r l e ad h as d i s co n t i n uit i e s a t ab o ut 1 5 a nd 8 8 k e V . T he s e a r e c al le d a b s o r pt io n ed ge s a n d c o r re s p o n d to t he bi nd i ng e ne r gi e s o f L a nd K s hel l s . A p h o to n w i t h e n e rg y l es s t h a n 1 5 k e V do e s no t ha v e e no ug h e nerg y t o e j e ct a n L e l e ct r o n . T h u s , b el o w 1 5 ke V , t he i nt e r a ct io n i s l i mi te d to t he M o r hig he r - s he ll e l e ct r o n s . W h e n t h e ph o t o n h a s a n e ne r g y t ha t j us t e q ua l s t he bi nd i ng e ne rg y o f t h e L s h e ll , r e so n a n c e o c c u r s a nd t he pr o b a bi li t y o f p ho to ele c t ri c a b so r pt io n i n v o l v i n g t h e L s h el l b e c o me s v e r y hi g h. Be y o nd t hi s p oi nt , i f the p ho to n e ne r g y i s i n c r e a s ed , t h e p r oba b i li t y o f p hot oe le c t ric a t t e nua t io n d e c re a se s a p p r o xi m a te l y a s 1 / E 3 u n t i l t h e n e x t d i s c o nt i n u i t y , t he K a b s o r pt io n e dg e . A t thi s p o i nt o n t he g r a p h , t h e p h o t o n h a s 8 8 k e V e ne r g y , w hi c h i s j us t e no ug h t o e j e ct t he K e l e ct r o n . A s s ee n i n F i g . 5 . 6 , t he a b so r pt io n p r ob a bi li t y i n l e ad a t t hi s c r it i c al e n e r g y i n c r e a s e s d r am a t i c al l y , b y a f a c t o r o f a b o ut 10 . T h e d i s c o nt i n u i ti e s or a b s o rp ti o n ed g e s fo r w a t e r a r e not s how n i n t he g r a p h b e c a u s e t h e K a b s o rp t io n e d ge f o r w a t e r o c c ur s a t v e r y l o w p ho to n e ne r g ie s (~0.5 keV). P.67

T h e d a t a f o r v a r io u s m a t e ri a l s i nd i c at e tha t p ho to el e ct r i c at te nua t i o n de p e nd s s t r o n gl y on t he a tom i c number of t he a b s o rb i ng m at e ri al . T he f o ll o w i ng a p p r o xi m a te r e l at io n sh i p h o l d s :

T h i s r e l at io n s h i p fo r ms t h e b a s i s o f m a ny ap p li c a ti o ns i n di a g no st i c r ad io lo g y . T he difference in Z of various t i s s ue s s uc h as b o ne , m us c l e , a nd fat a mp li f i es d i f f e r e n c e s i n x - r a y a b s o r pt io n , p ro v i de d t he p ri m a r y mo de o f i nte r a c ti o n i s p h o to el e c tr i c . T h i s Z 3 d e pe n d e n c e i s a l so e xp l oi te d w he n us i ng c o nt r a s t m a te r i al s s u c h a s B a S O 4 m i x a n d H y p a q u e . In t he r a p e ut i c r a di ol og y , t he l ow - e ne r g y b e a m s p r o d u c ed by superficial and o r t ho vo lt a ge m a c hi ne s

3

c a us e

u nne c e s s a r y

hi g h

a b s o r pt io n o f x - r a y e n e r g y i n b o n e a s a r e s ul t o f t hi s Z d ep e nd e nc e ; t hi s p r ob le m w i l l b e d i s c u s s ed l a te r i n s e ct io n 5 . 10 . By c o m bi ni ng E q ua ti o ns 5 .1 6 a nd 5 . 1 7 , we have:

WWW.MEDRAD.IR

T h e a n g u l a r d i s t r i b ut io n o f e l e c t ro ns e m it te d i n a p ho t oe l e ct ri c p r o c e s s de p e nds o n t h e p ho to n e n e r gy . F o r a lo w - e ne r g y p ho to n, t he p hoto e lec t r o n i s e mi tt ed m o s t l i k el y a t 9 0 d e gr e e s r el a ti v e to t he dir e c ti o n o f t he i nc i d e nt p ho to n. A s t he p h o to n e n e r g y i n c r ea s e s , t h e d i r e ct io n . p ho to e le c tr o ns a r e e m i tt ed in a more forward

5.8. COMPTON EFFECT

In t h e C o m pt o n p ro c es s , t h e p h oto n i nte r a ct s w it h a n a to m i c e le ct r o n a s t ho ug h i t w e r e a f r e e e le c t ron . T h e t e r m f r ee he r e m e a ns t ha t t he b i nding e ne r g y o f t he e l e ct r o n is much l es s than the e ne r g y of t he b o m b a rd i ng p ho t o n. In t hi s i n t e r a ct io n , t h e el e ct ro n r e ce i v e s s o me e ner g y f r o m t he p hot o n and i s e m itt e d a t a n a n g l e ( Fi g . 5 . 7 ) . T h e p h ot o n, w it h re duc e d e ne rg y , i s s c a tte r e d a t a n a ng le . The C o m p to n p r o ce ss can be a na l y z e d in terms of a co ll i sio n b et w e e n t wo p a r t i cl e s , a p h o to n a n d a n e l e c t r o n. By a p p l y i ng t he l a w s o f c o ns e r v a t io n o f e n e r g y a n d m o m e n t um , o n e c a n d e r i v e t he f o l lo w i ng r e l at io ns hi ps :

w h e r e h 0 , h , a n d E a r e t h e e n e rg ie s o f the i nc i de nt p ho to n, sc a t t er e d p hot o n, a n d e l e ct r o n , r e s pe c tiv e l y a n d , = h 0 / m 0 c 2 , w he r e m 0 c 2 i s t he re s t e ne rg y o f t he e l e ct r o n ( 0 . 51 1 M e V ) . If h 0 i s e x p r e s s e d i n M e V , t he n = h 0 / 0 . 5 1 1 .

F I G . 5 . 7 . D i a gr a m i ll us t r a ti n g t h e C o m pt o n e f f e c t . P.68

A. Special Cases of Compton Effect A.1. Direct Hit

WWW.MEDRAD.IR

If a p h o t o n m a k e s a d i r e ct h i t w it h t he el ec t r o n, t he el e ct r o n w il l t r a ve l f o r w a r d ( = 0 d e g re e s ) a n d th e s c a t t e re d p ho to n w i ll t r a v el b a c k w a r d ( = 1 8 0 d eg r e e s) a f t e r t h e col li s io n . In s u c h a c o l li s io n, t he e l e ct r o n w il l r e c ei v e m a x i m um e ne r g y E m a x a n d t h e s c a tt e red p h ot o n w il l b e l e f t w i t h m i nim um e ne r gy h m i n . O ne c a n c a l c u l a te Emax and hmin by s u b s ti t uti ng cos = c o s 1 80 d e g re e s = -1 in E q u a t i o n s 5 . 19 a n d 5 . 2 0 .

A.2. Grazing Hit

If a p h o t o n m a k e s a g r a z i n g h i t wi t h t he el e c tr o n, t he e l e ct ro n w i l l b e em it te d at r i g h t a n g le s ( = 9 0 d e g r ee s ) a nd t he s c a t t er e d p ho to n w i l l go i n t he f o r w a r d d i r e ct io n ( = 0 de g re e s ) . B y s u b s t it ut i ng c o s = c o s 0 d eg r ee s = 1 i n E q ua t io ns 5 . 1 9 a n d 5 . 2 0 , o ne c a n s h o w t h a t f o r t hi s c o ll i si o n E = 0 a nd h = h 0 .

A.3. 90-Degree Photon Scatter

If a p h o t o n i s s c at te re d at r ig h t a ngl e s t o it s o ri gi na l d i re c ti o n ( = 9 0 de g re e s ) , o n e c a n c a l c u la t e E an d h f r o m E q ua t io ns 5 . 1 9 a nd 5 . 20 b y s ub s t it ut i ng co s = c o s 9 0 de g r ee s = 0 . T h e a n g l e o f t he e le c t ro n e m i s s io n i n t hi s c a s e w i l l de pe nd o n , a c c o r d i n g t o E q u a tio n 5 . 2 1 .

Examples
S o m e u s e f u l e x a mp l es w i l l no w b e g i v e n to il l us t r at e ap pl i c at ion o f t he C o m pto n e f f e c t to p r a c ti c a l p rob l e m s .

I n t e r a ct io n o f a l o w - en e r g y p ho to n . If t he i nc i d e nt p hot o n e ne rgy i s m uc h l e s s t h a n t h e re s t e n er g y o f t he el e ct r o n, onl y a s m a l l p a rt o f i t s e ne r g y i s i m p a rt e d t o t h e el e ct r o n , r e s ul ti ng i n a s c a t te r e d p ho to n o f a l m o st t he s a m e e n e r g y a s t h e i nc i d e nt p ho to n. F o r e x a m p l e , s up po s e h 0 = 5 1 . 1 k e V ; t h e n = h 0 / m 0 c 2 = 0 . 0 5 11 M e V /0 . 5 11 M eV = 0 . 1 . F r o m E q ua t io ns 5 . 22 and 5.23,

T h u s , f o r a l o w - e n e r gy p h o t o n b e a m , t he C o m pt o n s c a t te r ed p hot o ns ha v e a p p r o xi m a te l y t h e s am e e ne r g y a s t he o ri g i nal p ho to ns . Ind e e d , a s t he i n c i d e nt p h ot o n e ne r gy a p p r o a c he s ze r o , t he C o m pt o n e f f e c t be co m e s t he c l a s s i c al s c a t te r i n g p ro c e s s d e s cr i be d i n s e ct io n 5 . 6 .

I n t e r a ct io n o f a h i g h e n e r g y p ho to n . If t he i nc i d e nt p ho to n ha s a v e r y hi g h e n e r g y ( m u c h g r e at er t h a n t he re s t e ne rg y o f t he el e ct r o n) , t he p hot on l o s e s m o st o f i t s e n e rg y t o t he C o mp to n e le c t ro n a nd t he s c at ter e d p hoto n

WWW.MEDRAD.IR

h a s m u c h l e s s e n e rgy . S up p o s e h 0 = 5 . 1 1 M e V ; t he n = 10 . 0 . F r om E q u a t i o n s 5 . 22 a n d 5 . 2 3 ,

P.69

In c o n t r a s t t o e x a mp le ( a ) ab o v e , t he s c a tte r e d p hot o ns p r od uc ed b y hig he n e r g y p h o to n s c a r r y a w a y o nl y a s m a l l f r a c t io n o f t he i ni t i al e ner g y . T hus , a t h i g h p h o to n e n e r g y , t he C o m p to n e f f e c t c a us e s a l a r g e a m o unt o f e n e r g y a b s o rp ti o n c om p a r e d w it h t he C o mp t o n i nte r a c ti o ns i nv ol v i ng l o w e n e r g y p h o to n s .

C o m p to n

s c a tt e r

at

90

d eg r e e s

a nd

1 80

d eg r ee s .

In

d e s ig ni ng

r a d i at io n p r ot e ct io n ba r r i e r s ( w a ll s ) to a tte nua t e s c a tt e re d r a dia t io n, o ne n e e d s to k n o w t h e e ne r g y o f t he p ho to ns s c a t t er e d at di f f e r e nt ang l e s . T he energy of the p ho ton s s c a t t e re d by a pa t i e nt und e r t r e at m ent at 90 d e g re e s w it h r e sp e c t t o t he i nc i de nt be am i s o f p a r ti c ul a r int e r e st i n c a l c u l a ti n g b a r r ie r o r w a l l t hi c k ne s s e s a g ai ns t s c a t te r ed r a d i at io n. B y s u b s t i t u t i n g = 9 0 d e g re e s i n E q ua t io n 5 . 2 0 , w e o b ta i n:

F o r h i g h - e n e r g y p h ot on s w i t h

1 , t he p r e v i o us e q ua ti o n r e d uc es t o :

or h = m0c2 = 0.511 MeV S i m i l ar c a l c u l at io n s f or s c a t t er a t = 1 80 d e g re e s w il l i nd i c at e h = 0 . 2 5 5 M e V . T h u s , i f t h e e n e r g y o f t h e i n c i d e nt p ho to n is hi g h (
i m po r t a n t r a d i at io n g e n e r al i z at io n s : s c a t te r ed (a) is t he r a dia t io n 1 ) , w e ha v e t he f o l lo w i ng at r i g ht a ngl e s a nd ha s is a s c a t te r ed of i nc i de nt

i n d e pe n d e n t o f i n c i den t e n e r g y a nd ha s a m a x i m um v a l ue o f 0 .5 1 1 M e V ; (b ) t he ba c k w a r d s i nd ep e nd e nt e ner g y maximum value of 0.255 MeV.

WWW.MEDRAD.IR

The

maximum

e n e r gy

of

r a d i a ti o n

s c a tt er e d

at

a ngl e s

be t w ee n

90

a nd

1 80

d e g re e s w il l li e b e t we e n t h e ab o v e e ne r gy l i mi t s . H o w e ve r , t he e ne r g y o f t he p h o to n s s c a t t e re d a t a n g l e s l e s s t ha n 9 0 de g r ee s w i l l be g r e at e r t ha n 0 . 5 1 1 M e V a n d w i l l a p p ro a c h t h e i n c i d e nt p h ot o n e ne r gy f o r t he co nd it io n o f f o r w a r d s c a tt e r . B e c a u s e t h e e n e r g y of t h e s c a tt e re d p ho ton p l us t ha t o f t he el ec t r o n m us t e q ual t h e i n c id e n t e n e r g y , th e e le c t ro n m a y a c q ui r e a ny e ne rg y b et w ee n z e r o a nd E m a x ( g i v e n b y E q u a t i o n 5 .2 2 ) .

B. Dependence of Compton Effect on Energy and Atomic Number

It w a s m e n t i o n e d p rev i o u s l y t h a t t he C o m pt o n e f f e c t i s a n i nt e r ac t io n b e t w ee n a p h o to n a n d a f r ee el ec t r o n . P r a c ti c a ll y , t hi s m e a ns t ha t t he e ne r gy o f t he i nc i de nt p h o to n m u s t b e l a r ge c o m p a re d w i t h t he e l e c tr o n b i ndi ng e ne r g y . T hi s i s i n contrast to the p h o to e le c t ri c e f f e c t w hi c h b e c o me s mo st p rob a b le w he n t he e n e r g y o f t h e i n c i den t p h o t o n i s eq ua l to o r s l ig ht l y g re a te r t ha n t he b i nd i ng e n e r g y o f t h e e l e ct r on . T h u s , a s t he p ho t on e ne r g y i nc r e a s e s b ey o nd t he b i nd i ng e n e r g y o f t h e K e l e ctr o n , t h e p h o t oe le c t ri c e f f e c t d e c r e a se s r a p id l y w i t h e ne r g y ( E q u a t i o n 5 . 16 ) ( F ig . 5 . 6 ) a n d t he C o mpt o n e f f e c t b e co m e s m o r e a nd mo r e i m po r t a n t . H o w e ve r , a s s h o w n i n F i g . 5 . 8 , the C o m p to n e f f e c t al so d e c re a s e s w it h i n c r e a s i n g p h oto n e n e r g y . Because the C o m pt on i n t e r a ct io n i nv ol v es e s s e nti a ll y f r ee ele c t ro ns in t he a b s o r bi n g m a te r i al , it i s i n de p e nde nt o f a t o mi c num b e r Z . It f o l lo w s t ha t t he C o m p to n m a s s a t t e n ua t io n c o e f f i c ie nt ( / ) i s i nd e p e nde nt o f Z a nd d e p e nd s o nl y o n t h e n u m b e r o f el e ct r o n s p er g r a m . A lt houg h t he num b e r o f e lec t r o ns p er g r a m of e le m e n t s d e c re a se s s lo w l y b ut s y s tem i c a ll y with at o mi c num b e r , most m a t e ri a l s e x c e pt h y d ro g e n c a n be co ns i d e re d a s ha v i ng ap p ro x im a t el y t he s a me n u m b e r o f e l e c tr o n s p e r g r a m ( T a b le 5 . 1 ). T h us , / i s ne a r l y t he s a m e f o r a l l m a t e ri a l s . F r o m t h e p re v i o u s di sc u s s i o n , i t f o ll o w s t ha t i f t he e ne r g y o f t he b e a m i s i n t he r e g io n P.70 a t t e n u a ti o n o f t h e bea m w i l l o c c ur i n a ny m a t e r i al o f eq ua l d ens i t y t hi c k ne s s , 2 e x p r e s s ed a s g / c m 2 . Fo r e x a mp l e , i n t he c as e o f a b y C o m p to n e f f e c t , t he a t te n u a t io n p e r g / cm
2 60

where

the

Co m pt o n

e f f e ct

is

t he

o nl y

p o s si bl e

m o de

of

i nt e r a ct io n,

a p p r o xi m a te l y t h e s am e

C o r a y be am t ha t i nte r a c t s

f o r b o ne i s ne a r l y t he s a m e a s t ha t

f o r s o f t ti s s u e . H o w ev e r , 1 c m o f bo ne wi ll a tt e nua t e m or e t ha n 1 c m o f s o ft t i s s u e , b e c a u s e bo n e h a s a h i g h e r e l e c t ro n d e ns i t y , 3 e ( num b e r o f e l e c t ro ns p er c u b i c c e n t i me te r ) , w h i c h i s g i v e n b y d e ns it y t i me s t he num b e r o f e l e ct ro ns p e r g r a m . If t h e d e n s it y of b o n e i s a s s um ed to b e 1 . 85 g / c m 3 a nd t hat o f s o ft ti s s ue 1 g / c m 3 , t h e n t h e a tt e nu a t i o n p ro d uc e d b y 1 c m o f b o ne w i ll b e eq ui v a l e nt t o t hat p r o d u c ed b y 1 . 6 5 c m o f s o f t ti s s u e :

WWW.MEDRAD.IR

F I G . 5 . 8 . A p lo t o f C o m pt o n el e ct r o ni c c oef f i c i e nt e a ga i ns t p hot o n e ne rg y . T he m a s s c o e f f i ci e n t ( / ) i s o bt ai n e d b y m ulti p l yi ng t he el e ct ro ni c c o e f f i c ie nt w it h t h e n u m b e r o f e le c t ro n s p e r g r a m f o r a gi v e n m a t e ri a l . ( D at a f r o m H ub b e ll J H . P r o to n c r o s s s e c ti o n s a t t e n u a t io n c o e f f i ci ent s a nd e ne r g y a b s o rp t io n c o e f f i ci e nt s f r o m 1 0 ke V to 1 00 G e V . P u b . N o . 2 9 . W as hi ng t o n, D C : U . S . N a t io na l Bur e a u o f S t a n d a r d s , 1 96 9 . )

5.9. PAIR PRODUCTION

If t h e e n e r g y o f t h e p h o to n i s g re a te r t han 1 . 0 2 M e V , t he p ho to n m a y i nt e r a ct w i t h m a tt e r t h r o u g h th e m e c h a n i s m o f p a i r p r o d uc tio n. In t hi s p ro c e s s ( Fi g . 5 . 9 ) , t h e p ho to n i n te r a c t s st r o n gl y w it h t he el e c tr o m a g net i c f i el d o f a n a to m i c nuc l e us a n d g i v e s u p a ll it s e n e r g y i n t he p ro c e ss o f c r e a ti ng a p a i r c o ns i s ti ng o f a n e g a t i ve e l e ct ro n ( e - ) a n d a p o s i t i v e e le c tro n ( e + ) . Be c a us e t he r e s t m a s s e ne r g y o f t h e el e c tr o n i s equ i v a l e n t to 0 . 51 M e V, a m i ni m um e ne r g y o f 1 . 0 2 M e V i s r e q u i r ed to c r e at e t he p a i r o f e l e ct ro ns . T hus t he t hr e s ho l d e ne r g y f o r t he pa i r p r o d u c tio n p r o c e s s i s 1 . 0 2 M e V . T he p ho t o n e ne r g y i n e x c e s s o f t hi s t hr e s ho l d i s s h a r e d b et w e e n t h e pa r t i cl e s a s k i ne ti c e ner g y . T he t o t al k i ne ti c e ne r g y a v a i l a ble for the P.71 e l e ct r o n - po si t ro n p a i r i s gi v e n b y ( h - 1 . 0 2 ) M e V . T he p a r tic l e s t e nd t o be e m it t ed i n t h e f o r w a r d d i r e ct io n r e l at i v e to the i nc i d e nt p ho to n.

TABLE 5.1. NUMBER OF ELECTRONS PER GRAM OF VARIOUS MATERIALS

WWW.MEDRAD.IR

Material

Density (g/cm3)

A t om i c N u m b e r

N u m be r

of

E l e c t r on s pe r G r a m

Hydrogen

0 . 0 0 00 89 9

6.00 1023

Carbon

2.25

3.01 1023

Oxygen

0 . 0 0 14 29

3.01 1023

Aluminum

2.7

13

2.90 1023

Copper

8.9

29

2.75 1023

Lead

11.3

82

2.38 1023

E f f e c t iv e Number

A t om i c

Fat

0.916

5.92

3.48 1023

Muscle

1.00

7.42

3.36 1023

Water

1.00

7.42

3.34 1023

Air

0 . 0 0 12 93

7.64

3.01 1023

Bone

1.85

13.8

3.00 1023

D a t a f ro m Jo h n s H E , C u n n i n g ha m J R . T h e p hy s i c s o f r ad io lo gy . 3 r d e d . S p r i n g f i el d , IL : C h a r l es C T h o m a s , 1 9 6 9 .

T h e m o s t p ro b a bl e d is t r i b ut io n o f e ner g y is f o r e a c h p a r ti c le to a c q ui r e ha l f t he a v a i l a bl e k i n et ic e ne r g y , a lt h o ug h a ny e ne r g y di s t ri b uti o n is po s s ib le . For e x a m p le , i n a n e x t r e m e c a s e , i t i s p o s si ble t ha t o ne p a r ti c le m a y r e c e i v e a l l t he e n e r g y w h i l e t h e o t h er r e c e i v e s n o e ne rg y . The p a i r p r od u c t io n p r o c e s s i s a n e x a m p l e o f a n e v e nt i n w hi c h e ne r g y i s c o n v e r t ed i n t o m a s s , a s p r e d i c te d b y E i ns t e i n' s e q uat io n E = m c 2 . T he r e v e r s e p r o c e s s , na me l y t h e co n v e r s i o n o f m a s s i nto e ne rg y , t a k e s p l a ce w he n a p o si t ro n

WWW.MEDRAD.IR

c o m bi n e s r a d i at io n .

with

an

e le c t ro n

to

p ro d uc e

tw o

p ho to ns ,

called

t he

a nni hi l a ti o n

A. Annihilation Radiation
T h e p o s it r o n c r e at e d a s a r e s u l t o f p a i r p ro d uc ti o n p r o ce s s lo s es i t s e ne r g y a s it t r a v e r s e s t h e m a tt e r b y t h e s a m e t y p e o f i nt e r a ct io ns a s an e l e c tr o n do e s , n a m e l y b y i o n i z a ti o n , e x c i t a ti o n , a nd b r e ms s t r a hl ung . N e a r t he e nd o f i t s r a ng e , t h e s lo w l y mo v i n g pos i t ro n c o mb i ne s wi t h o ne o f t he f r ee el e ct ro ns i n it s v i ci ni t y t o g i v e r i s e to t w o an n i h i l a t io n p hot o ns , ea c h ha v i ng 0 . 5 1 M e V e ne r g y . Be c a us e m o m e n t u m i s co n s e r ve d i n t h e p ro c e s s , t he t wo p hoto ns a r e e je c t ed i n o pp o si te d i r e ct io n s ( F i g . 5 . 10 ) .

B. Variation of Pair Production with Energy and Atomic Number

B e c a u s e t h e p a i r p ro du c t i o n r e s u lt s f r o m an i nt e r a c ti o n w i t h t he e l e ct r o m ag ne ti c f i e l d o f t h e n u c l e u s , th e p r ob a bi li t y o f t hi s p r o c e s s i nc r e a se s r api d l y wi t h at o mi c number. The P.72 a t t e n u a ti o n co e f f i c ie nt f o r p ai r p r o d uct io n ( ) v a r i e s w it h Z 2 p e r a to m , Z pe r e l e ct r o n , a n d ap p r o xim a t el y Z p e r gr a m . In a d d i tio n, f o r a gi v e n m a t e ri a l , t he l i k el i h oo d o f t h i s i n te r a c ti o n i n c r e a s e s a s t he l og a r it hm o f t he i nc i de nt p ho to n e n e r g y a bo v e t h e t h r es h o l d e n e r g y ; t he se re l a tio ns hi p s a r e s ho w n i n F i g . 5 . 11 . To r e m o v e t h e m a jo r d ep e n d e n c e o f t he p ai r p r o d uc tio n p r o c e s s o n a t o m i c num b e r, t h e co e f f i c ie n t s p e r a to m h a v e b e e n d i v id ed b y Z 2 b e f o re pl ott i ng . F o r e ne r gi e s up t o a bo u t 2 0 M e V , t h e c u r v e s a r e a l m o s t c o i nc id e nt f o r a ll m a te r i al s , i nd i c a ti ng that
a

Z 2 . A t h i g h e r e n e r g ie s , t he c ur v e s f o r hi g he r Z m a t e r i al s f a l l b el o w t he

l o w Z m at e ri a l s b e c au s e o f t h e s c r e e ni ng o f t he nuc le a r c ha rg e b y t he o r b it al e l e ct r o n s .

F I G . 5 . 9 . D i a gr a m i ll us t r a ti n g t h e p ai r p r oduc t i o n p ro c e s s .

WWW.MEDRAD.IR

F I G . 5 . 1 0 . D i a g r a m i ll u s t r a ti n g t he p ro d uc tio n o f a nni hi l a t io n r a d ia t io n.

F I G . 5 . 1 1 . P l ot o f p a ir a t o mi c a t te nua t io n c o e f f i c ie nt di v i d ed b y the s q ua r e o f t he a t o mi c n u m b e r a s a f u n c t i o n o f p ho to n e ner g y f o r c a r b o n ( Z = 6 ) a nd l e a d ( Z = 82). the The mass a t ten u a t i o n (Data from c o e f f i ci e nt Hubbell ca n be o bt a i ned cross by m ul t ip l y i ng a /Z2 o b t ai n e d f ro m t h e g rap h , f i r s t b y Z 2 a nd t hen b y t he num b e r o f a to m s p e r g r a m o f a b s o rb e r . JH. Proton s e ct io ns a t t e nua ti on c o e f f i c ie n t s a n d e n e r gy a b s o r p ti o n c oe f f i c i ent s f r o m 1 0 k e V t o 100 G e V . P ub . N o . 2 9 . W a s h i n g t o n , D C : U . S . N a t i o n a l Bur e a u o f S t a nd a r d s , 1 96 9 . ) P.73

WWW.MEDRAD.IR

5.10.

RELATIVE

IMPORTANCE

OF

VARIOUS

TYPES

OF

INTERACTIONS
T h e t o t al m a s s a tt e nu a t i o n c oe f f i c i e nt ( / ) i s t he s um o f t he f o ur i nd i v i d ua l c o e f f i c ie n t s :

A s n o t e d p re v i o u sl y , c o h e r e n t s c at te r i ng is o nl y i m po r t a nt f o r v e r y l o w p ho to n e n e r g ie s ( < 1 0 k e V ) a n d h i g h Z m a t e r i al s. A t t he r a p e uti c e ne rg i e s , it i s o f t e n o m it te d f r o m t h e s u m . F i g u r e 5 . 1 2 i s t h e p lo t o f t ot a l c oe f f i c i e nt ( / ) t o t a l v s . e ner g y f o r t w o di f f e r e nt m a t e ri a l s , water and le a d , re p re s e nt at iv e of low a nd hig h a to m i c num b er m a t e ri a l s . T h e m a s s a t t e n u a ti o n co e f f i ci e nt i s l a rg e fo r lo w e ne r g ie s a nd hig h a t o mi c n u m b e r m e d ia b e c a u s e o f t he p r e do m i na nc e o f p ho to el ec t r i c i nte r a c ti o ns u n d e r t h e s e c o n d iti o ns . T h e a t te n u a t io n c oe f f ic i e n t d e c re a s e s r a pi dly w i t h e ner g y unt il t he p hoto n e ne r g y f a r e x c e e d s t h e el e ctr o n b i n d i n g e ne r gi e s a nd t he C o m p to n e f f e c t be c o me s t he p r e do m i n a n t m od e o f i n t er a c ti o n . In t he C o m pt o n r a nge o f e ne rg i e s , t he / o f l e a d a n d w a te r do n ot d i f f e r g r e at l y , s i nce thi s t y p e o f i nt e r a ct io n i s i nd e pe nd e nt o f a t o mi c n u m b e r . T h e c o e f f i c i e nt , ho w e v e r , d e c r e a se s w i t h e ne r g y unt i l p a i r p r o d u c tio n b e g i n s to b e c o me i m po rt a nt . T he d o mi na nc e o f p a i r p r o d uc ti o n o c c u r s a t e n e r gi e s m u c h g r e at e r t h a n t h e t hr e s hol d e ne r g y o f 1 . 0 2 M e V . T h e r e l a ti v e i m po r ta n c e o f v a r i o u s t y p e s o f i nt e r a c ti o ns i s p re s e nt e d i n T a b le 5 . 2 . T h e s e d a t a f o r w a te r w i l l al s o b e t r ue fo r so f t t i s s ue . T he p ho ton e ne r g ie s li s te d i n c ol u m n 1 o f T a b le 5 . 2 r ep r e se nt mo no e ne r g et i c b e am s . A s di sc us s e d i n C ha p te r 3 , a n x - r a y t u b e o pe r a ti n g a t a gi v e n pe a k v o l t ag e p ro d uc e s r a d i a ti o n o f a l l e n e r g ie s le s s t h a n th e p e a k e ne rg y . A s a r o ug h a pp r o x i ma ti o n a nd f o r t he p u r p o s e s o f T a b le 5 . 2, o n e m a y c o ns id e r t he a v e r a ge e ne r g y o f an x - r a y b e a m t o b e e q ui v a l e n t t o o n e- t h i r d o f t he p e a k ene r g y . T hus a 3 0 - k e V m o no e ne r ge ti c b e a m i n c ol u m n 1 s h o u l d b e c o n s id e re d a s e q ui v a le nt t o a n x - r a y b e a m p r o d uc ed b y a n x - r a y t u b e o p e ra t e d at a b o ut 9 0 k V p . O f c o ur s e , t he P.74 a c c u r a c y o f t h i s a p pr ox i m a t io n i s li mi te d b y t he e f f e c t s o f fi lt r a tio n o n t he e ne r g y s p e c t r u m o f t h e be a m.

WWW.MEDRAD.IR

F I G . 5 . 1 2 . P l o t o f to ta l m a s s a tt e nua t io n c o e f f i c ie nt ( / ) a s a f unc t i o n o f p hot on energy for lead a nd water. ( R e p r i nt e d with p e r m i s si o n from J o hns HE, C u n n i n g h a m J R . T h e p h y s i c s o f r a di ol ogy , 3 r d e d . S pr i ng f ie ld , IL : C ha r l e s C Thomas, 1969.)

TABLE 5.2. RELATIVE IMPORTANCE OF PHOTOELECTRIC ( ), COMPTON (), AND PAIR PRODUCTION () PROCESSES IN WATER

R e l a t iv e N u m be r of I n t e r a c t i on s ( % ) P h ot on E n e r g y ( M e V )

0.01

95

0.026

50

50

0.060

93

0.150

100

4.00

94

WWW.MEDRAD.IR

10.00

77

23

24.00

50

50

1 0 0 . 00

16

84

D a t a f r o m Jo h n s H E , C u n n i n g ha m J R . T h e p hy s i c s o f r a dio log y . 3 r d ed . S p r i n g f i el d , IL : C h a r l es C T h o m a s , 1 9 6 9 .

5.11. INTERACTIONS OF CHARGED PARTICLES

Whereas p h o to n s i nt e r a ct with m a tt e r by p ho to e le c t ri c , C om p to n, or pair p r o d u c tio n p r o ce s s , ch a r g e d p a rti c l e s ( el e ct r o ns , p ro to ns , p a rti c l e s , a nd nuc l e i ) i n t e r a ct p r i n c ip a ll y b y io n i z a t io n a nd e x c it at io n. R a d i at i v e co ll i sio ns i n w hi c h t he c h a r g e d p a r ti c le i n ter a c t s b y t h e b r e m s str a hl ung p r o c e s s a r e p o s s ib le b ut a r e m u c h m o r e l i k el y f o r e l e ct r o n s t h a n f o r he a v i e r c ha r g e d p a rt i cl e s . T h e c h a r g e d p a r ti c l e i n t e r a c ti o n s o r co ll is i o ns a r e m e di a te d by C o ul o m b f o r ce b e t w ee n t h e el e ct r i c f i e l d o f t h e t r a v el i ng p a r ti c le a nd el e ct r i c f i el d s o f o r bi t al e l e ct r o n s a n d n u c l e i of a t o m s o f t he m a te r ia l . C o l li s io ns b e t we e n t he p a r t i cl e a nd t h e a to mi c el e ct r o n s r e s u l t i n io ni z a ti o n and e x c i t at io n o f t he a t o m s . Co ll i si o ns b e t w ee n the p a rt i cl e and the nuc l e us r es ul t in r a di a ti v e lo ss of e ne r g y or b r e m s s tr a h l u n g . P a r t ic l e s a l so s u f f e r s c a t t er i ng w i t ho ut si g ni f i c a nt l o s s o f e ne r g y . B e c a u s e o f m u c h s m al l e r m a s s , e l e ct ro ns suf f e r g r e a te r m ult ip le s c a t te r i ng t ha n d o h e a v i e r p ar ti c l e s . In a d d i t io n t o t h e C o ul o mb f o r c e i nt e r a ct io ns , he a v y c ha r g e d p a r ti c l e s g i v e ri s e t o n u c l e a r r e a c tio n s , t h er e b y p ro d u c i ng r ad io ac t i v e nuc li d e s . Fo r e xa m p l e , a p ro to n b e a m p a s si n g t h ro u g h t i s s u e p ro d uc e s s ho rt - li v e d r a dio i so to p e s w h i c h a r e p o s i t ro n e mi tt e r s . T h e r a t e o f k i n e ti c en e r g y l o s s p e r uni t pa t h l e ngt h o f t he pa rt i cl e ( d E / d x ) i s k n o w n a s t h e st op p i ng po w e r ( S ) . T he q uant i t y S / i s c a ll ed t he m a s s s to p pi ng p o w e r , w h e r e i s t he d e n s it y o f t he m e di um a nd i s us ua l l y e x p r e s s e d i n M e V cm2/g.
11

C,

13

N , a nd

15

O,

A. Heavy Charged Particles

T h e r a t e o f e n e r g y l os s o r s to pp i ng po w e r c a us e d b y io ni z a ti o n i nt e r a ct io ns f o r charged p a r ti c le s is p r o p o rti o n a l to t he s q ua r e of t he particle c ha r g e a nd i n v e r s e l y p r op o rt io n a l t o t h e s q ua r e o f i t s v e l o c it y . T hus , a s t he p a r t i cl e s lo w s d o w n , i t s r a t e o f e n er g y l o s s i n c r e a s e s a nd s o d o e s t he i o ni z ati o n o r a b s o rb ed d o s e t o t h e m ed i u m . A s w a s s e e n i n F i g . 4 . 1 6 , t he d o s e dep o s it ed i n w a t e r i n c r e a s e s a t f i r s t v e ry s l o w l y w i t h d e p t h a nd t he n v e r y s ha r p l y ne a r t he e nd o f t h e r a n g e , b e f o re d r op p i n g to a n a l m o st z er o v a l ue . T hi s p e a k i ng o f d o s e ne a r t he e n d o f t h e p a r ti c le r a n g e i s c a ll e d t he Br a g g p e a k .

WWW.MEDRAD.IR

B e c a u s e o f t h e B r a g g p e a k e f f e c t a nd mi ni m a l s c at te r i ng , p ro to ns a nd he a v i er c h a r g e d p a rt i cl e b e am s p r o v id e a m uc h s oug ht - a f t e r a d v a nt ag e i n r a d io t he r ap y t h e a b il it y t o c o n c e nt r a te d o se i ns i d e t he t a r g et v o l um e a nd m i ni m i z e do s e t o s u r r o u n d i n g n o r m a l tis s u e s . P.75

B. Electrons
In t e r a c t io n s o f e le c t ro n s w h e n p a s s i ng t hr o ug h m a tt e r a re q ui te s i m il a r t o t ho se o f h e a v y p a r ti c le s . H ow e v e r , b e c a us e o f t hei r r el a ti v el y s m a ll m as s , t he el e ct r o ns suffer g r e a t e r m u l ti pl e s c at t er i ng a nd c ha ng e s in d ir e c tio n of m o t io n. As a c o n s e q u e nc e , t h e B r a g g p e a k i s no t o b se rv e d f o r e l e ct r o ns . M ul ti p le c ha ng e s i n d i r e ct io n d u r i n g t h e s lo w i n g d o w n p r o ce s s sm e a r s o ut t he Br a gg pe a k . In w a t e r o r s o f t ti ss u e , e l e ct r o ns , li k e o t he r c ha r ge d p ar ti c le s , l o se e ne rg y p r e do m i n a n tl y b y i o n iz a t i o n a n d e x c it a ti o n. T hi s r e s ult s i n d ep o sit io n o f e ne r g y o r a b s o r be d d o se i n t h e m e d i u m . A s st a te d e ar l i er , t he i o ni z a t io n p ro c e s s co ns i s t s o f s t r i pp i n g el e ct r o n s f r o m t h e a t om s . If t h e e ne r g y t r a ns f e r r e d t o t he o r bi t al e l e ct r o n i s n o t s u f f i c ie n t t o o v e r co me t he b i nd i ng e ne rg y , i t i s d i s pl a c ed f r o m i ts s t a b le po s it io n and then r e t ur ns to it ; t hi s e f f e ct is ca l l ed e x c it a ti o n . e le c t ro n F u r t h e r m o r e , i n t h e p r o c e s s o f i o ni z a t ion, o c c a s i o na ll y t he s t r i pp ed e l e ct r o n i s c al l ed a s ec o n d a r y e l e ct ro n, o r a r a y . Again, energy because is lo s t of as its s m a ll mass, T he an e l e ct ro n of may int e r a c t lo s s as a with re s ul t t he of e l e ct r om a g n et i c f ie ld o f a n u c l e u s a nd b e de c e le r a te d so r a pi dl y t ha t a p a rt o f it s br e m s s t r a h l ung . rate e ner g y b r e m s s tr a h l u n g i n c r e as e s w i t h t h e i nc r e a se i n t he e ne rg y o f t he el e c tr o n a nd t he a t o mi c n u m b e r o f t h e m e d i u m . T he to pi c o f e l e ct r o n i nt e r a ct io ns w i l l b e di s c us s e d further in Chapter 14.

r e c e i v e s s u f f i c i e n t e n e r g y to p ro d uc e a n ioni z a t i o n t r a c k o f it s ow n. T hi s e j e c t ed

5.12. INTERACTIONS OF NEUTRONS

L i k e x - r a y s a n d r a y s , n e u t r o n s a r e i nd i r ec t l y i o ni z i ng . H o w e v er , t he i r m o de o f i n t e r a ct io n w i t h m a tt er i s d i f f e re nt . N e ut ro ns i nt e r a ct b a s i c al l y b y t w o p ro c e s s e s: (a) r e co il i n g p r ot o n s from h y d ro g e n t he a nd r e c oi li ng is he a v y nuc l e i after from t he ot her e l e me n t s , a n d (b ) n u c l e a r d i si n t eg r a ti o ns . T he f i r s t p r o ce s s m a y b e l i k e ned t o a b i ll i a rd - b al l b e t w ee n the c ol li s io n i n co ll id i ng which e ne r g y r e d i s t ri b ute d t r a ns f e r is c ol li s io n if t he p a r ti c le s . T he e ner g y ve r y e f f i c i e nt

c o ll i di n g p a rt i cl e s h a v e t h e s a m e m a s s , e . g. , a ne ut r o n c o l li di ng w i t h a hy d r o g en n u c l e u s . O n t h e ot h er h a n d , t h e ne ut ro n lo s e s v er y li tt le e ne rgy w he n c o l li di ng w i t h a h e a v ie r n u c l e us . T h u s t h e m o st e f f i ci e nt ab s o rb e r s o f a ne ut r o n b e a m a r e t h e h y d r o ge n o u s m a ter i a l s s u c h a s p a r a f f i n w a x o r p ol y e t hy l e ne . L e a d , w hi c h i s a v e r y g o o d ab s o r be r f or x - r a y s , i s a p o o r s hi e l di ng m a te r i al a g a i nst ne ut r o ns .

WWW.MEDRAD.IR

FIG.

5.13.

D e pt h - do s e

d i st r i b ut io n

of

ne ut r o ns

p ro d uc e d

by

d e ut ro ns

on

b e r y ll i u m , c o m pa r e d w i t h a c o b al t -6 0 be a m . ( F r o m R a j u M R . H e a v y p a r t i c le r a d io t h e r ap y . N e w Y o r k : A c a d e m i c P r e s s , 1 9 80 . D a t a f r o m H us s e y D H , F l e t c her G H , C a d e r a o J B . E x p e r ie n c e w i t h f a s t ne ut r o n t he r ap y us i ng t he T e x a s A & M v a r i a b le e n e r g y c y c l otr o n . C a n c e r 1 9 7 4 ; 34 :6 5 . )

FIG.

5.14.

D e p t h - do s e

di s t ri b utio n

for

v a r i o us

he a v y

p a r ti c l e

beams

wi t h

m o d u l at e d B r a g g pe ak a t a d ep t h o f 10 cm a nd no r m al i ze d at t he pe a k c e nte r . ( F r o m R a j u M R . H e a v y p a r t i cl e r a di ot he r a p y . N e w Y o r k : A c a d e m i c P r e s s , 1 9 8 0 . ) P.76

WWW.MEDRAD.IR

D o s e d ep o si te d i n tis s u e f r o m a hig h- e ne r g y ne ut ro n b e a m is p r e do mi na nt l y c o n t r ib u t ed b y re c oi l p r ot o n s . B e c a us e o f the hi g he r hy d ro g e n co nt e nt , t he d o se a b s o r be d i n f a t e x p o se d t o a n e ut r o n b e am i s a b o ut 2 0% hi g he r t ha n i n m us c l e . N u c l e a r d i s i nt e g ra ti on s p r o d u c e d b y ne ut r o ns r e s ul t i n t he em i s s io n o f he a v y c h a r g e d p a rt i cl e s , n eu t r o n s , a n d r a y s a n d g i v e ri s e to a bo ut 30 % o f t he t i s s ue dose. Because of su c h diverse s e c o nda r y r a d i a ti o n p r od uc e d by ne ut r o n i n t e r a ct io n s , t h e n e u tr o n d o si m et r y i s r el a ti v e l y mo r e co mp li c a t ed t ha n t he ot h er t y p e s o f c li n i c a l be a ms .

5.13. COMPARATIVE BEAM CHARACTERISTICS

N o o n e k i n d o f r a di a tio n b e a m i s i d e al f o r ra d i a tio n t he r a p y . W he r e a s x - r a y s a nd e l e ct r o n s a re t h e mo st u s e f u l b e a m s , p a rt ic l e be a m s ha v e s o m e uni q ue p hy s i c a l a n d r a d i ob io lo gi c P.77 c h a r a c t e r i st i c s that have a t t r a c te d t he a t t e nt io n of m a ny i nv e s t i g at o r s . Fo r

d e t ai l s t h e r e a de r i s re f e r r e d t o r e fe r e nc e 1.

F I G . 5 . 1 5 . C o m p a r iso n o f d e pt h - d o se d is t r i b ut io n f o r p r ot o ns a nd e l e c t ro ns . (From K oe h l e r AM, Preston WM. P r o to ns in r a d i a ti o n t he r a p y . R a d i olo g y 1 9 72 ; 1 04 : 19 1 , w i t h pe r m i s si o n . ) P h y s i c a l a d v a n t a ge s of a r a di a ti o n t he r a p y b e a m a re d e ri v e d f rom t he d ep t h- do s e d i s t ri b u tio n s a n d s c a t t e r c h a r a c t er i st i c s . F ig ur e s 5 . 1 3 , 5 . 14 , a nd 5 . 1 5 c om p a re t h e de pt h - d o se c h a r ac t e ri s ti c s o f v a r io us b e a m s . It i s s e e n t hat t he de pt h do s e d i s t ri b u tio n o f n e u t ron b e a m s i s q ua l it a ti v el y s i mi l a r to t he
60

C o r a y s . T he he a v y

c h a r g e d p a r ti c le be am s , t h e B r a gg pe a k s o f w hi c h w e r e m od ul a t ed us i ng f i lt e rs

WWW.MEDRAD.IR

( a s i s t y p i c a ll y d o n e i n c l i n i c a l s it ua ti o ns ) , s ho w a f l a t d o s e di st r i b ut io n a t t he p e a k r eg io n a n d a sh a r p d o se d r op o f f bey o nd t he r a ng e . E le ct r o n b e a m s a l so s h o w a c o n st a n t d o se r e g io n u p to a bo ut ha l f t he p a rt i cl e r a ng e and a s ha r p d o se d r o po f f beyond that p oi n t . However, for hi g he r el e ct r o n e ne r g ie s , t he c h a r a c t e r i st i c f a ll o f f in d o s e be c o me s mo r e g r a d ua l . P r ot o ns , o n t he ot he r ha n d , m a i n t a i n a s h a r p c u t of f i n d o s e b e y o nd t he r a ng e , i r r e s pe c ti v e o f e ne r g y .

REFERENCES
1 . R a j u M R . H e a v y p a r t i cl e r a di ot he r a p y . N ew Y o r k : A c a d e m i c P r es s , 1 9 8 0 .
1

T h e p r o ce s s o f co ll is i o n i s a n i nt e r a ct ion b e t w ee n t he el e ct ro m a g net i c f ie ld s

a s s o c i at e d w it h t h e co ll i di n g p a rt i cl e a nd or b i t al el e ct r o n. A c t ua l p hy s i c a l c o nt a c t b e t w ee n t h e p a r ti c le s i s n o t r e q ui r e d .
2

D e n s it y t h i c k n e s s i s e q u a l to t h e l i ne a r t hi c k ne s s m ul t i pl ie d b y d e ns i t y , i . e . , c m In t h e li te r a t u r e , t h e t e rm el e ct r o n d e ns it y ha s b ee n d e fi ne d b oth a s t he num b er

g/cm3 = g/cm2.
3

o f e l e ct ro n s p e r g r a m a n d a s t h e num b e r of e l e c t ro ns p e r c ubi c c e nt i me te r . T he r e a d e r s h o u ld b e a w a re o f t h i s p o s si bl e s o urc e o f c o nf us i o n.

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 6 - Measurement of Ionizing Radiation

P.78

Measurement of Ionizing Radiation

6.1. INTRODUCTION
In t h e e a r l y d a y s o f x - r a y u s a g e f o r d i a g no s i s a nd t he r ap y , a t te m p t s w e re m a de t o m e a s u r e i o ni z i n g ra d i a tio n o n t he b a si s o f c he mi c a l a nd bi olo g i c e f f e ct s . F o r i n s t a n c e , r a di a ti o n e ff e c t s o n p hot og r a p hic e m ul si o ns , c ha ng e s i n t he c ol or o f s o m e c h e mi c a l c o mp ou n d s , a n d r e d d e ni ng o f t he hum a n s k i n c oul d b e r el a te d t o t h e a m o u n t o f r a d i at io n a b s o r be d . H o w e v e r, t he s e e f f e c t s w e r e po o rl y und e r s t ood a t t h e ti m e a n d c o ul d o n l y p ro v i de c r ud e e s ti m a ti o n o f r a dia t io n d o s e . F o r e x a m p le , i n r a d io t h e ra p y , a u n i t c a l l e d s k in e r y t he m a d o s e ( S ED ) w a s d e f i ne d a s t h a t a mo un t o f x o r r a d i at io n t hat j us t p ro d uc e d r e dd e ni ng o f the hum a n s k i n. However, the unit has many drawbacks. Skin e r y t he m a dep e nd s on m a ny c o n d it io n s , s u c h a s th e t y p e o f s k i n, t he q ua l it y o f r ad i at io n, the e x t e nt o f s ki n e x p o s ed , d o se f r a c t ion a t i o n ( do s e p er f r a c t io n a nd i nt e r v a l be tw e e n f r a c t i o ns ) , a n d d i f f e r e n c e s b et w ee n e a r l y a n d d e l a y ed s k i n r e a c t io ns . A l t h o u g h t h e S E D w as l at e r d i s c a rd ed i n f a v o r o f a mo r e p r e cis e l y me a s ur a b le u n i t s u c h a s t h e r o en t g e n , t h e s k i n e r y the m a w a s us e d b y p hy s i c i a ns a s a n a p p r o xi m a te i n de x o f r e s p o n s e to t he r ad i at io n t r e at m e nt s . T hi s ha p p e ne d i n t he o r t h o vo lt a g e era when the skin was t he li m it i ng o rg a n to t he d e li v e r y of t u m o r i ci d al d o se s . T h e r el i a n c e o n s k i n r ea c t io n f o r t he a s s e s sm e nt o f r a di a ti on r e s p o n s e h a d to b e a b a n d o n e d w he n m e ga v o l t ag e be a m s w i t h t he s k i n- s p a r i ng p r o pe r ti e s be c a m e t h e m a i n t o ol s o f r a di a ti on t he r a p y . In 1 9 2 8 , t h e In t e r n at io n a l C o m mi s s io n on R a d i a ti o n U nit s a nd M e a s ur e m e nts ( IC R U ) a d o p te d t h e roe n t g e n a s t he unit o f m e a s ur i ng x a nd r a d i a ti o n e x po s ur e . T h e u n i t i s d e n o te d b y R .

6.2. THE ROENTGEN

T h e r o e n t ge n i s a u n i t o f e x po s ur e . T he q ua nt i t y e x po s ur e is a m e a s ur e o f i o n i z a ti o n p r od u c e d i n a i r b y p h oto ns . T he IC R U ( 1 ) d e f i ne s e x po s ur e ( X ) a s t he q u o ti e n t o f d Q b y d m w h e r e d Q i s t he a b so l ute v a l ue o f t he to ta l c ha r g e o f t he i o n s o f o n e s ig n p r o du c e d i n a i r w he n a l l the e l e ct r o ns ( ne g at r ons a nd p o s i t ro ns ) l i be r a te d b y p h ot o n s in a i r o f m a s s d m a r e c o m pl e te l y s to pp e d i n a i r .

The

Systems

In t e r n a t io n a l e

d U nit e s

( S I)

uni t

for
1

e x p o s ur e

is

c o ul om b

p er

k i l og r a m ( C / k g ) b u t th e s p e c i al u ni t i s r o e nt g e n ( R ) .

WWW.MEDRAD.IR

1R = 2.58 10-4 C/kg air

F I G . 6 . 1 . D i a gr a m i ll us t r a ti n g e le c t ro ni c e qui l i br i um i n a f r e e - a i r c ha m b e r . P.79

T h e d e f i n it io n o f r oen t g e n i s i ll us t r a te d in F i g . 6 . 1 . A n x - r a y b e a m i n p as s i ng t h r o u g h a i r se t s i n mo ti o n el e ct r o ns b y p ho to el e c tr i c e f f e c t , C om p to n e f f e c t , o r p a i r p ro d uc ti o n . T h e s e h i g h - s p e ed e l e ct ro ns p r o d uc e io ni z a t io n a l o ng t hei r t r a c k s . B e c a u s e o f t h e e le c tr i c f i el d p r od uc e d b y t he v ol t ag e ap p li ed a c r o s s t he io nc o ll e ct io n p l at e s , t h e p o si ti v e c ha r ge s mov e t o w a rd t he ne g at iv e p l at e a nd t he n e g a t i ve c h a r g e s m o ve t o w a r d t h e po s it i ve p l a t e . T hi s c o ns ti t utes a c ur r e nt . T he c o ll e ct e d c h a r g e o f e ith e r s i g n c a n b e m e a s ur e d b y a n e l e ct r o me ter . A c c o r d i n g to t h e de f in i t io n o f ro e ntg e n, t he el e ct r o ns p r od uc e d b y p ho to ns i n a s p e c i f ie d v ol u m e ( s h a d e d i n F i g . 6 . 1 ) m us t s p e nd a l l t he ir e ne r gi e s b y i o ni z a tio n i n a i r e n c l o s ed b y t h e p l a t e s ( r eg io n o f i o n c o l le c ti o n) a nd t he to t al i o ni c c ha r g e o f e it h e r s i g n s h o u ld b e m e a s u r e d . H o wev e r , s o m e el e ct r o ns p r o d uc ed i n t he s p e c i f ie d v o l u me de pos i t t h ei r e n er g y o ut s ide t he r eg io n o f io n c oll e c ti o n a nd t hus a r e n o t m e a s u r ed . O n t h e ot h e r ha nd , e lec t r o ns p ro d uc ed o ut sid e t he s p e ci f i ed v o l u m e m a y e n te r t he i o n - co ll e ct i ng r eg ion a nd p r o d uc e io ni z a ti o n t he re . If t he i o n i z a ti o n lo s s i s c o mp e n s a t ed b y t he i o ni za t io n g a i ne d , a c o nd iti o n o f e l e ct ro ni c e q u i li b ri u m e x i st s . U n d e r t hi s c o ndi ti o n, t he d e f i ni ti o n o f ro e ntge n i s e f f e c ti v e l y s a t i s f ie d . T h i s i s t h e pr i n c i pl e o f f r e e - ai r io ni z a t io n c ha m b e r , d e s cr i b ed b el o w .

6.3. FREE-AIR IONIZATION CHAMBER

The free-air, or of st an d a r d , the is used i o n i z at io n only for c ha m b e r to it s is an of i ns t r ume nt s e cond a r y a re us e d in t he a measurement primary d e s ig n e d for r o e nt g e n The a c co r di ng t he d e f i nit io n. Ge ne r a ll y , t hus s uc h

s t a n d ar d f ie ld

c a l i b ra ti o n

i ns t r um e nt s c o nf i ne d

use.

free-air

c ham b e r

i ns t al la ti o ns

p r i n c i p al l y to s o me o f t h e n a t io n a l s t a nd a r d s l a b o r at o ri e s .

WWW.MEDRAD.IR

A f r e e - a i r c h a m b e r is r e p r e s e nt e d s c he ma t i c al l y i n F i g . 6 . 2 . A n x - r a y b e a m , o r i gi n a ti n g f r o m a fo c a l s po t S , i s d e f i ne d b y t he di a p hr a gm D , a nd p a s s e s c e n t r a ll y b et w ee n a pa i r o f p a r al le l p l at e s . A hi g h- v o lt a ge ( f ie ld s t r e ngt h o f t he o r d e r o f 1 00 V / c m ) i s a p p li e d b et w e e n t he p l a te s to c ol le c t i o ns p r o d uc ed i n t he a i r be t w ee n t h e p l at es . T h e i o ni z a t io n i s me a s ur e d f or a l e ngt h L d e fi ne d b y t he l i mi ti n g li n e s o f f o r c e t o t h e ed ge s o f t he col l e ct io n pl a te C . T he line s o f f o r c e a r e m a d e s t r ai g h t a n d p erp e n d i c u l a r t o t he c o ll ec t o r b y a g ua r d r i ng G. A s d i s c u s s e d p re v i o u sl y , e l e ct r o n s p ro d uc ed b y t he p hot o n be am i n t he s p e ci f i ed v o l u m e ( s h a de d i n F ig . 6 . 2 ) m ust s pe nd a l l t he i r e ne r g y b y io ni z a t io n o f ai r b e t w ee n t h e P.80 p l a te s . S u c h a c o n d it io n c a n e x i s t o nl y i f the r a ng e o f t he el e ct ro ns l ib e r at e d b y the i n c i d e nt p h o to n s i s l e s s t ha n t he In a d d it io n , for d i s t a nc e b e t we e n e a c h p l a t e to exist, a nd t he s p e c i f ie d vo l u m e . el e ct ro ni c e q ui li b ri um t he b e am

i n t e n s it y ( p h ot o n f l u en c e p e r u n i t ti m e ) mus t r e m ai n c o nst a nt ac r o s s t he l e ngt h o f t h e s pe c i f ie d v ol u m e , a n d t h e s ep a r a ti on b e t w e e n t he d i ap hr a g m a nd t he i o nc o ll e ct i n g r eg io n m u s t e x c e e d t h e el e ct r o n ra ng e i n a i r .

F I G . 6 . 2 . A s c h e m a t i c d i a g r a m o f a f r e e - ai r c ha m b e r . If Q i s t h e c h a r g e col l e ct ed i n C o ulo m b s and i s t he d e ns it y ( k g / m 3 ) o f ai r , t he n t h e e x p o s u r e X p at t h e c e n t e r o f t he s p e ci f ied v o l um e ( po i nt P ) i s :

w h e r e A p i s t h e c r o s s- s e c t io n a l a r e a (i n m e t e r s sq ua r e d ) o f t he b e a m a t po i nt P a n d L ( i n m e t e r s ) i s t h e l e n g t h o f t he c ol le c t i ng v ol um e . In p r a c t i c e , it i s m o re c o n v e n i e n t t o s t at e t he e x po s u r e ( X ) at t he p o s it io n o f t he d ia p hra g m . S up p o se f 1 a n d f 2 a r e t h e d i s t an c e s o f t h e x - r a y s o ur c e t o t he di a p hr a gm a nd p o i nt P ,

WWW.MEDRAD.IR

r e s p e ct i v el y . B e c a u s e t h e i n te n s i t y a t p oi nt P a nd a t t he di a p hr a gm a r e r e la t ed b y a n i n v e r s e s q u a r e l a w f a c t o r ( f 1 / f 2 ) 2 , w hi c h a l s o r el a te s t he a r e a o f t he b e a m s at t h e d i a p h r ag m a n d a t p o i nt P , e x p o s ur e X D a t t he d i ap hr a g m i s gi v e n b y :

w h e r e A D i s t h e d i ap h r a g m a p e rt u r e a r e a . A c c u r a t e m e a s u r em e nt s w it h a f r e e -a i r i o ni z a t io n c ha m b e r r e q uir e c o ns id e r ab le c a r e . A f e w co r r e ct ion s t h a t a re us ua ll y a p p li e d i ncl ud e ( a ) co r r e ct io n f o r a i r a t t e n u a ti o n ; (b ) co r re c t io n f o r r e co m bi na t io n o f i o ns ; ( c ) c or r e c ti o n f o r t he e f f e c t s o f te m pe r a t u re , p r e s s u r e , a nd hum i d it y o n t he de ns ity o f a i r ; a nd ( d ) c o r r e ct io n f o r i o ni z a t io n p r o d u c ed b y s c a tte r e d p ho to ns . F o r d et a il s o f v a r i o us c o r r e ct io n s t h e r e a de r i s r e f e r r e d t o N a tio na l Bur e a u o f S t a nd a r d s ha nd b o o k ( 2 ) . T h e r e a r e l i mi t at io n s o n t h e d e s i g n o f a f r e e - a i r c ha m b e r f o r t he m e a s ur e m e nt o f r o e n tg e n s f o r h i g h - en e r g y x - r a y b e a m s . A s t he p ho to n e ne rgy i nc r e a s e s , t he r a n g e o f t h e e le c t ron s l i b e r at e d i n a i r i nc r e a s e s r a pi d l y . T hi s ne c e s s i t at e s a n i n c r e a s e i n t he s ep a ra t io n o f t h e p l at e s to m a i nt ai n el e ct r o ni c e q ui li b ri um . T oo l a r g e a s ep a r a ti o n , h o w e v e r , c r e a te s p ro b le m s o f no nuni f o r m e le c t ri c f i e ld a nd g r e a te r i o n r e co m bi n at io n . A l t h o ug h t he pl at e se p a r at io n c a n b e re d uc e d b y us i ng a i r a t h i g h p r e s s u r e s , t h e p r ob l em s s t il l re ma i n i n r e g a r d P.81 to air at te n u a t i o n , p h o to n s c a t t er , a nd r e d uc t io n in t he ef f i c i e nc y of ion

c o ll e ct io n . B e c a u s e o f t h e s e p r o bl e m s , t he r e i s a n up p e r l i mit o n t he p ho to n e n e r g y a b o ve w h i c h t h e r oe n t g e n c a nnot b e a c c ur at e l y me as ur e d . T hi s l i mi t o c c u r s a t a b o u t 3 M e V.

6.4. THIMBLE CHAMBERS

F r e e - a i r i o n i z at io n c h a m b e r s a r e to o de li ca t e a nd b ul k y f o r r o ut i ne us e . T he i r m a i n f u n c t i o n i s i n th e s t a n d a r di z i ng l a bor a t o ri e s w he r e t he y c a n b e us ed to c a l i b ra t e f ie ld i n s t r u me n t s s u c h a s a t hi m b l e c ha m b e r . T h e p r i n c ip le o f t h e t h i m bl e c h a m be r i s i ll us t r a te d i n F ig . 6 . 3 . In F i g . 6 . 3 A , a s p h e r i c a l vo l u m e o f a i r i s s h o w n w i t h a n a i r c a v i t y a t t he c e nt er . S up p o s e t his s p h e r e o f a i r i s i r r ad ia t e d u n i f or m l y w it h a p ho to n b e a m . Al s o , s up p o s e t ha t t he d i s t a n c e be t w ee n t h e o u t e r s p h e re a nd t he i nne r c a v i t y i s e q ua l to t he m a x i m um r a n g e o f e le c t ro n s g en e r a t e d i n a i r . If t he num b e r o f e l e ct r o ns ent e r i ng t he c a v it y i s t h e s a me a s t h a t l ea v i n g t h e c a v i t y , e le c tr o ni c e q uil i b ri um e x i s ts . S up p o s e a lso t h a t w e a r e a b le t o m e a s u r e t h e i o ni z a tion c ha r g e p ro d uc ed i n t he c a vi t y b y t he e l e ct r o n s l ib e r at e d i n t h e a i r s u r r o und i ng t he c a v i t y . T he n b y k now i ng t he v ol um e o r m a s s o f a i r i n si d e th e c a v i t y , w e c a n c a l c ul a t e t he c ha r ge p e r uni t m a s s o r t he b e a m e x po s u r e a t t he c e n t e r o f t he c a v i ty . N o w i f t he a i r w a l l i n F i g . 6 . 3 A i s c o m p re s s e d i nt o a s o li d s h e l l a s i n F i g . 6 . 3B, w e g e t a t hi m b l e cha m b e r . A l t ho ug h t h e t h i mb le w a l l i s sol i d , i t i s a i r e q ui v al e nt , i . e . , it s e f f e ct i v e at o mi c num b e r i s t h e s a m e a s t h at o f a ir . In a d d i t io n, t he t hic k ne s s o f t he t hi m bl e w a l l i s s uc h t h at t h e e l e ct ro n i c e q u il i b ri u m o c c u r s i ns i d e t he c a v i t y , j us t a s i t d i d i n F i g . 6 . 3 A . A s b e f o re , it f ol lo w s t h a t t h e w a ll t hi c k ne s s m us t b e eq ua l t o o r g r e a te r t ha n t he m a x i m u m r a n g e o f t h e e l e ct r o n s li b e r at ed i n t he t hi m bl e w a l l .

WWW.MEDRAD.IR

S i n c e t h e d e n si t y o f th e s o li d a i r -e q ui v al e nt w a l l i s m uc h g r e a te r t ha n t ha t o f f r e e a i r , t h e t hi c k n e s s e s r eq u i r e d fo r el e c tr o ni c eq ui l ib r i um i n t he t himb l e c ha m be r a r e c o n s i d er a b l y r ed u c e d . F o r e x a m pl e , i n t he 1 0 0 t o 25 0 k V p x - r a y r a ng e , t he w a ll t h i c k n e s s o f t h e t h i mb l e ( a s s u m i ng uni t dens i t y ) i s a bo ut 1 m m , a nd i n t he c a s e of

60

C o r a y s ( a v e rag e h 1 . 2 5 Me V ) , it i s ap p ro x i m at el y 5 m m . In p r a c t i c e ,

h o w e v e r , a t h i m bl e c ha m b e r i s co ns t r uc te d w i t h w a l l t hi c k ne s s e s o f 1 m m o r l e s s a n d t h i s i s s u pp l em en t e d w it h c lo s e - fi tt i ng c a p s o f P le x i gl a s or ot he r pl a s ti c t o b r i n g t h e to t al w a ll t h i c k n e s s u p t o t ha t nee d ed f o r el e ct r o ni c equi l i br i um fo r t he r a d i at io n i n q u e s t io n .

A. Chamber Wall
F i g u r e 6 . 3 C s h o w s a t y p i c a l t h i mb le i o ni z at io n c ha m b e r . T he w a l l i s s ha p e d l i ke a s e w i n g t hi m bl e h e n ce t h e n a m e . T he i nne r s ur f a c e o f t he t hi mb l e w a l l i s co at e d by a special P.82 m a t e ri a l t o m a k e i t el e c tr i c al l y c o nd uct i ng . T hi s f o r m s o ne el e ctr o d e . T he ot he r e l e ct r od e i s a r od o f l o w a to m i c num b e r ma t e ri a l s uc h a s g r a p hi t e o r a l umi num h e l d i n t h e ce n t e r o f t h e t h i mb l e b ut el ec t r i c al l y i ns ul at e d f rom i t . A s ui t ab le v o l t ag e i s a pp li e d be tw e e n t h e t w o e le c t ro de s t o c ol le c t t he i o ns p r o d uc ed i n t he air cavity.

F I G . 6 . 3 . S c h e m a t i c d i a g r am il l us t r at i ng t he na t ur e o f t he thi m b le io ni z a ti o n c h a m b e r . A : A i r s h e l l w i t h a i r c a v i t y . B : S o l id a i r s he ll w i t h a i r c a v i t y . C : T he t h i m bl e c h a m b e r . A s m e n t io n e d p r e v io u s l y , m o s t o f t he io ni za t io n p r od uc e d i n t he c a v i t y a i r a r i se s from e le c t ro n s li b e r at e d i n t h e s ur r o und ing wall ( f o r at le a st up to 2 M eV p h o to n s ) . F o r t h e t h im b l e c h a m b e r to be e q ui v a le nt to a f r e e -a i r c ha m b e r , t he t h i m bl e w al l s ho u l d b e a i r e q u i v a le nt . T hi s co nd it io n w o ul d e ns ur e t ha t t he e ne r g y s p e c t r u m o f el e ct r o n s l i be r a te d i n t he t hi m ble w a l l i s s i mi l ar t o t ha t i n a i r . F o r t he t h im b le c h a mb e r t o b e a i r e q ui v a l ent , t he e f f e c t i ve a to mi c num b e r o f t he w a l l m a te r i al a n d t h e c e n t r a l el e ct r od e m us t b e s uc h t ha t t he sy s t e m a s a w ho l e b e h a v e s li k e a f r e e - ai r c h a m b e r . Mo s t com m o nl y us e d w a ll ma t e ri a l s a re m a de

WWW.MEDRAD.IR

e i t h er o f g r a p hi te ( ca r b o n ) , B a k e li te , o r a p l a st i c c o at ed o n t he i nsi d e b y a c o n d u c t i n g l a y e r o f g ra p h i t e o r o f a c o nd uc t i ng m i x t ur e o f Ba k e l it e a nd g r a p hi te . T h e e f f e c ti v e at o mi c n u m b e r o f t he w al l i s g e ne r al l y a l it tl e l e s s t ha n t ha t o f a i r. It i s c l o s er t o t h a t o f c a r b o n ( Z = 6 ) . A s a c o ns e q ue nc e , s uc h a w a l l s ho ul d g i ve r i s e t o le s s i o n i z at io n i n t h e a i r c a v it y t han a f r e e - ai r w a ll . H o we v e r , t he us ua l l y g r e a te r a to mi c number of the ce nt r al e l e ct r od e , it s di me ns i o ns , a nd t he p l a c e me n t ge o me t r y w i t h i n t h e t hi m bl e c an p r o v i de c o mp e ns a tio n f o r t he lo w e r a t o mi c n u m b e r o f t h e w a l l .

B. Effective Atomic Number

It i s i n s t r u c t i v e t o di sc u s s t h e t e r m e f f e c ti v e a t o mi c num b e r (

) i n a g r e a t e r de t ai l .

i s t h e a t om i c n u m b e r o f a n e l e m e nt w i t h w hi c h p ho t o ns i nt e r a ct t he s a m e w a y a s with the gi v e n c o mp o s it e m a te r i al . S i nc e p hot o el e ct ri c effect is hi g hl y Z d e pe n d e n t ( s e ct io n 5 . 7 ) ,

is

c o n si d e re d

fo r

ph o t oe le c t ri c

i nt e r a ct io ns .

M a y ne o r d

(3 )

ha s

d e f i ne d

t he

e f f e c t i v e at o mi c n u m b e r o f a c o m po und a s f o ll o w s :

w h e r e a 1 , a 2 , a 3 , a n a r e t h e f r a c ti o na l co ntr i b uti o ns o f e a c h el em e nt to t he tot a l n u m b e r o f e l e ct r o n s in t h e m i x t u r e .

Example 1. Calculation of Symbol . for Air

C o m p o si ti o n b y w e i g ht : n i t ro g e n 7 5 .5 % , o xy g e n 2 3 . 2 % , a nd a r g on 1 . 3 % N u m b e r o f e le c t ro n s / g o f a i r :

T o t a l n u m b e r o f e l e ct ro n s / g o f a i r = 3 . 0 1 1 0 2 3 ( T a bl e 5 . 1)

P.83

WWW.MEDRAD.IR

C. Chamber Calibration
A t h i m b le c h a m b e r cou l d b e u s ed d i re c tl y to m e a s ur e e x p o s ur e if ( a ) i t w e r e ai r e q u i v a le n t , thickness (b) its cavity to v o l u me p ro v i de were a c c ur a t e l y k no w n, a nd (c) it s wall was s u f f i c ie n t e le c tr o ni c e q uil ib r i um . Und e r t he above

c o n d it io n s , t h e e x p o su r e X i s g i v e n b y :

w h e r e Q i s t h e i o n i za t io n c h a r g e l i be r a te d i n t he c a v i t y a i r of d e ns i t y a nd v o l u m e ; A i s t h e fr a c t io n o f t he e ner g y f l ue nc e t r a ns m it te d t hr o ug h t he a i r e q u i v a le n t w a ll o f e qu i l i br i u m t hi c k ne s s . T he f a c t o r A i s s li g htly l e s s t ha n 1 . 00 a n d i s u se d h e re t o c al c u l a te t h e e x p o s ur e f o r t he e ne r g y f l ue nc e t ha t w o ul d e x i st a t t h e p oi n t o f m e a s u re m e n t i n t he a b se nc e o f t he c ha m b e r . T h e r e a r e p r a ct i c al d i f f i c u l ti e s i n d e s ig ning a c ha m b e r t ha t w o ul d ri go r o us l y s a t i s f y t h e c o n d it io n s o f E q u a t i o n 6 . 5 . It i s a l m o s t i m po s s ib le t o c o ns tr uc t a t h i m bl e c h a m be r t ha t is exactly ai r eq ui v a l e nt , al t ho ug h with a p ro p er c o m bi n a t io n o f w a ll ma t e ri a l a n d t he ce nt r al e le c t ro d e o ne c a n a chi e v e a c c ep t ab l e a i r e q ui v a l e n c e i n a l i mi te d p ho to n e ne r gy r a ng e . In a d d i ti o n, i t i s di f f i c ul t t o d e te r m i n e a c c u r at e l y t h e c h a m b e r v ol um e d i r e ct l y . T he r e f o re , i n a c t ua l p r a c ti c e, t h e t h i mb le c h a m b e r s a r e a l w a y s c a li b r at ed a g a i ns t a f r e e - ai r c ha m b e r f o r x - r a y s u p to a fe w h u n d r e d k i lo v o lt s (2 ) . A t hi ghe r e ne r gi e s ( up t o

60

C o r a y s ) , t he

t h i m bl e c h a m b e r s a r e c a l i b r at e d a g ai ns t a s t a nd a r d c a v i t y c ha m b e r w i t h ne a r l y a i r - e q ui v a l e n t w al l s (e . g . , g r a p hit e ) a nd ac c ur a t e l y k no w n v o l um e ( 4 ) . In a ny case, the e x po s u r e c a l i b ra ti o n of a t him b l e c ha m b e r r em o ve s t he ne ed f or k n o w i n g i t s c a v i t y v o lu m e ( s e e C ha p t e r 8 ) . A l t h o u g h a d eq u a t e wa l l t h i c k n e s s i s ne ce ss a r y t o a c hi e v e el e ct ro ni c e q uil ib r i um , t h e w a l l p r od u c e s s om e a tt e n u a t io n o f t he p ho to n f l ux . F i g ur e 6 . 4 s ho w s t he e f f e c t o f w a l l t h i c k n es s o n t h e c ha m be r re s p o ns e . W he n t he w a l l t hi c k ne s s i s m u c h l e s s t h a n t h a t r e q u i re d f o r e q uil ibr i um o r m a xi m um ioni z a t i o n, too f e w e l e ct r o n s a re ge n e r at e d i n t h e w a l l , a nd t hus t he c ha m b er re s p o ns e i s l o w . B e y o n d t h e e q u il ib r i um t h i c k n e s s , t he c ha m b e r r e sp o ns e i s ag a in r e d uc e d b e c a us e o f i n c r e a s ed a tt e n u a ti o n o f t h e b e am i n the w a l l . T he t r ue e x p o s ur e ( w it ho ut a t t e n u a ti o n ) ca n b e o b t ai n e d b y e x t r a po la t i ng li ne a r l y t he att e nua t io n c ur v e b e y o n d t h e m a x i m u m b a c k t o z e r o t hi c k ne s s , a s s ho w n i n F i g . 6 . 4 . If t he c ha m b e r r e s p o n s e i s n o r m al i z ed t o t h e m a x im um r ea d i ng , t he n t he e x t r ap o l at ed v a l ue f or z e r o w a ll t h i c k n e s s gi v e s t h e co r r e ct io n fa c t o r 1 / A us ed i n E qua t i o n 6 . 5 . T he c o r r e ct io n f o r z e r o w a l l t h i c k n e s s , ho w e v e r , i s us ua l l y a l l o w e d f o r i n t he e x p o s ur e c a l i b ra ti o n o f t h e c h am b e r a n d i s i nhe r e nt i n t he c al ib r a tio n f a c t o r . T hus , w he n t h e c a li b r at io n f a c t o r i s a p pl ie d t o t he c ha m b e r r e ad i ng ( co r r e cte d f o r c ha ng e s i n t e m pe r a t u re a n d p re ss u r e o f c a v it y a i r ) , i t c o nv e r t s t he v a l ue i nto t r ue e x po s ur e i n f r e e a ir ( w i t ho u t ch a m b e r ) . T he e x po s ur e v a l ue t hus ob t ai ne d i s f r e e f ro m t he w a l l a tt e n u a t io n o r t he p e r t u rb i n g i nf l ue nc e o f t he c ha m b e r .

WWW.MEDRAD.IR

F I G . 6 . 4 . T h e e f f e c t of w a l l t h i c k ne s s o n c h a m b e r r e sp o ns e ( s c hem a t i c ) . P.84

D. Desirable Chamber Characteristics

A p r a c t i c al io n c h a m b e r f o r e x p o s ur e mea s ur e m e nt s ho ul d hav e t he f o ll o wi ng c h a r a c t e r i st i c s .

T h e r e s h o u l d b e m i n im a l v a r i a ti o n i n s e ns i ti v i t y o r e x po s ur e ca l i b r ati o n f a c t o r o v e r a w i de r a n g e o f p hot o n e ne r gi e s. T h e r e s h o u l d be s u it ab l e vo l um e t o al lo w m e a s ur e m e nt s fo r t he e x p e c te d r a n g e o f e x p o s u r e s . T h e s e ns i t i v it y ( c ha r g e m e a s ur e d pe r r oent g e n) i s d i r e ct l y p ro po r ti o n a l t o t he c ha m be r s e ns it i v e v ol um e . F o r e x am p l e , t he r e a d i n g ob t ai n e d f o r a gi v e n e x po s ur e w i t h a 3 0 - c m 3 c ha mb e r w il l be a p p r o xi m a te l y 5 0 t ime s h i g he r t ha n t ha t ob t a i ned w i t h a 0 . 6 - c m 3 c ha m b e r . H o w e v e r , t h e r a ti o ma y n o t b e e x a c tl y 5 0, b e c a us e a c ha m b e r r e s p o nse a l s o de p e n d s o n t h e c h a m b e r d e si g n, a s d i sc us s e d p r e v io us l y .

There

should

be

min i m a l

v a ri a ti o n i n

se ns i ti v i t y

wi t h t he

di r e ct io n

of

i n c i d e nt r a d i at io n . A l th o u g h t hi s k i nd o f v a r i a ti o n c a n b e m i ni miz e d i n t he d e s ig n o f t h e c h a m b e r , c a r e i s t a k e n t o us e t he c ha m b e r i n t he s a m e c o n f i g u r a ti o n with r e s p e ct to t he be a m as specified und e r c ha m b e r c a l i b ra ti o n c o n d it io n s .

T h e r e s h o u l d be mi n im a l st e m l e a k a ge . A c ha m b e r i s k no w n t o ha v e s t e m l e a k a g e i f i t r e co r d s io n i z a t io n p r od uc e d a ny w he r e o t he r t ha n i t s s e ns i t i ve v o l u m e . T h e p r o bl e m o f s t e m le a k a g e i s di sc us s e d l a te r i n t hi s c ha p t e r .

T h e c h a m b e r s h o u l d h a v e b e e n c a l ib r a te d f o r e x p o s ur e ag a i ns t a s t a nd a r d i n s t r u m e n t f o r a ll r a dia t io n q ua l i ti e s o f i nt e re s t . T h e r e s h o u l d b e m i nim a l i o n re c o mb i na ti on l o s s e s . If t he c ha mb e r v ol t ag e i s n ot h ig h e n o u g h o r r e gi o ns o f l o w e le c t ric f i el d st r e ngt h o c c ur i ns i d e t he c h a m b e r , s u c h a s i n t h e v i c i ni t y o f s ha r ply c o nc a v e s ur f a c e s or c o r ne r s ,

WWW.MEDRAD.IR

ions

may

re c o mb i n e

b e f o re

co nt r ib ut i ng

to

t he

m e a s ur ed

cha r g e .

T he

p r o bl e m be c om e s s e ve r e w i t h hi g h- i nte ns i ty o r p ul s e d b e am s .

6.5. PRACTICAL THIMBLE CHAMBERS A. Condenser Chambers

A c o n d e n s e r c h a m b e r i s a t h i m b l e io ni z a tio n c ha m b e r c o nne c t ed t o a c o nd e ns e r . F i g u r e 6 . 5 s h o w s a V i c t o re e n c o nd e ns e r c ha m b e r , m a nuf a c t ur e d b y V i c t o re e n In s t r u m e n t Company. The thimble at the r i g ht - ha nd e nd c o ns i s t s of an a p p r o xi m a te l y a i r e q ui v a l e n t w al l ( Ba k e li te , ny l o n, o r ot he r c o mp o s it io n) w i t h a l a y e r o f c a r b o n c o ate d o n t h e i ns id e to m a k e i t e le c t ri c a ll y c o nd uc t i ng . T he conducting l a y er makes contact with t he m e t al stem. T he c e nt r a l el e ct r ode ( a l u m i n u m r o d ) i s co nn e c t e d to a co nd uc t i ng l a y e r o f c a r bo n c o ate d o n t he i ns i de o f a h o l l o w po l y st y r en e i n s u l a t o r . T hi s a r ra ng e m e nt o f a n o ut e r m e t a l s hie l d a nd a n i n n e r c o n d u c t i n g la y e r w i t h a n i ns ul a tor i n b et w e e n c o ns ti t ut e s a n el e c tr i c al c o n d e n s e r c a p a bl e o f s t o r i n g c h a r g e . T he c e nt r a l w i r e a nd t he t hi m bl e ' s i nne r c o n d u c t i n g s u r f a c e tog e t h e r a l so a ct a s a c o nd e ns e r . T hus t he c ha m b e r ha s a t ot a l c ap a c it a n c e ( C ) b et w e e n t he c e nt r al e le c t ro d e a nd t he out e r m et a l s he a t h which is given by:

P.85

w h e r e C c a n d C t a r e th e c a p a c i t a nc e o f t he c o nd e ns e r a nd t hi mbl e , r e s pe c ti v e l y . Usually Cc is much greater than Ct.

F I G . 6 . 5 . S c h e m a t i c di a g r a m o f a t y pi c a l c ond e ns e r c ha m b e r . T h e d e v i c e f o r c h a r g in g t h e c o n d e ns e r c ha m b e r a nd m e a s ur i ng i t s c ha r g e i s a n e l e ct r om et e r (d e s c ri be d l a te r i n t hi s se c tio n) . W he n f ul l y c ha r ge d , t he po te nt i al d i f f e r e n c e b e t we e n t he c a r b o n l a y e r o f t he t hi m bl e w a ll a nd t he c e nt r a l e l e ct ro d e i s o f t h e o r d e r o f 4 00 V . W h e n t h e c ha m b e r i s e x p o se d to r a di a tio n, e l e ct r o ns a r e g e n e r a te d i n t h e t h im b l e w a ll a nd p ro d uce i o ni z at io n o f t he a ir i n t he t hi m bl e c a v i t y . T h e n e g a t i v e io n s a r e a t t r a ct e d t o the p o s it i v e c e nt r al e le c t ro d e a nd t he

WWW.MEDRAD.IR

p o s it i ve i o n s a r e a tt ra c t e d to t h e ne g at i v e i nne r w a l l . A s i o ns a r e c o ll e ct e d , t he c h a r g e o n t h e e le c t rod e s i s r ed u c e d . T he r e d uc t io n i n c ha r g e i s p r o po r ti o na l t o the exposure. In g e n e r a l , al l t h e i on i z a t i o n m e a s ur e d i s p r o d uc ed i n t he ai r vo l um e w i t hi n t he t h i m bl e . A lt h o u g h t h e i o n i z at io n i s a l so p r o d uc ed i n t he ai r w i t hi n t he ho llo w p o rt io n o f t h e s t e m , th e s e i o n s r e co m bi ne s i nc e t he y a r e i n a f i e ld - f r e e r eg io n. F i g u r e 6 .6 s h o w s s e ve r a l V i cto r e e n co nd e ns e r c ha m b e r s d e si g ned w i t h di f f e r e nt s e n s i ti v i ti e s . T h e c h am b e r s a re d e si g na te d b y t he m a x i m um e x po s ur e t ha t c a n b e m e a s u r e d . Fo r e x a mpl e , a 1 0 0- R c ha m b e r i s c a p ab l e o f me a s ur ing e x p o s ur e s up t o 10 0 R . T h i s c h am b e r h a s a s e ns it i ve v o l um e o f a bo ut 0 . 4 5 c m 3 . A 25 - R c h a m b e r h a s a vo l um e o f a b o ut 1 .8 c m 3 , w hi c h i s f o ur t ime s t ha t o f 1 00 - R c h a m b e r a n d , t h e r e for e , a bo u t fo ur ti m e s a s s e ns it i v e , si nc e c ha m b e r se ns it i v it y i s d i re c tl y p r o po r tio n a l t o s e n si ti v e v o l um e (s e e E q ua t io n 6 . 1 1 ) .

A.1. Chamber Sensitivity

S u p p o s e a c h a m be r w it h v o l u m e i s gi v e n a n e x p o s ur e X . T he c ha r g e Q c ol le c te d is given by:

w h e r e a i r i s t h e de n s i t y o f a ir a nd a i r i s t he m a s s o f t he a i r v ol um e . T he E q u a t i o n 6 . 7 i s i n a c co r d a n c e w i t h t he de f ini t io n o f e x p o s ur e , g iv e n b y E q ua t i o n 6 . 1 a s w e l l a s E q u a t ion 6 . 5 P.86 i f A i s a s s u m e d e q u a l t o 1 . U s i n g a pp r op r i ate uni t s ,

F I G . 6 . 6 . A s et o f V i c t o re e n co nd e ns e r c ha m b e r s w it h a st r ing e le c t ro m e t e r . ( C o u r t e s y o f V i c to r ee n , In c . , M e l b o ur ne , F l o ri d a . ) Q ( c o u l o mb s ) = X ( R ) ( 2 . 5 8 1 0 - 4 C / k g a i r ) a i r ( k g / m 3 ) ( m 3 ) If a i r i s a s s u m e d to b e at st a n d a r d te m p er a t ur e a nd p r e s s ure (0 C a nd 7 60 mm Hg), air = 1.29 kg/m3. Then,

WWW.MEDRAD.IR

If C i s t h e to t al c a p ac i t a n c e o f t he c ha m be r ( E q ua ti o n 6 . 6 ) i n f a r a d s , t he n t he v o l t ag e d ro p V a c r o s s t h e c h a m b e r i s :

T h e v o l t a ge d r op p e r ro e n t ge n i s :

T h e v o lt a g e d ro p pe r r o e n tg e n i s k no w n a s t he s e ns it i v it y o f t he c ha m b er . T hus the chamber s e n si ti v i t y is di r e ct l y p ro por t io na l to t he c ha mb e r v ol um e a nd i n v e r s e l y to t h e c h a m b e r c a p a c it a nc e . If t h e c h a m b e r i s c o nn e c t e d to a n el e ct r o me t e r o f c ap a c it a nc e C e us e d to me a s ure t h e c h a r g e , t h e n t h e s e n s i ti v i t y o f t he c ha mb e r i s m od i fi e d :

A.2. Stem Effect

F i g u r e 6 . 7 s h o w s a n a r r a n g e m e n t us ed f o r m e a s ur i ng e x p o s ure w i t h a c o nd e ns e r c h a m b e r . A c h a m b e r i s o r i e n te d w i t h t he a x i s o f t he c ha m b e r a t a r i g ht a ng l e to t h e d i re c ti o n o f t h e be a m . D i f f e r e nt l e ng t hs o f t he c ha m b e r s t em a r e i nc l ud e d i n t h e f i e ld , d e pe n d i n g o n t h e f i e ld s i z e . H ow e v e r , t he c a l i b r at ion o f t he t hi m b l e c h a m b e r a g ai n s t a sta n d a r d c h a m b e r i s pe r f o r m ed w it h a f i x ed f i el d t ha t m a y c o v e r t h e e nt i r e st e m o r o n l y a s m a ll po r ti on o f t he s t e m . If t he ir r a d i at io n o f t he s t e m g i ve s ri s e to i o ni z a t io n t h at c a n b e me a s ur e d b y t he c ha m be r , t he c ha m b e r r e a d i n g d ep e n d s o n t he a m o u n t o f t he st e m i n t he be a m . T hus a c o r r e ct io n w i ll be n e c e s s a r y w h e n e v e r th e l e n gt h o f t he st e m i r r a di a te d d i f f e r s f r om t ha t i r r ad i at ed a t t h e ti m e o f t h e c h am b e r c a li b r at io n. S t e m e f f e c t c a n b e ca u s e d b y t w o p r ob lem s : ( a ) me a s ur a b le io ni z a t io n i n t he b o d y o f t h e st e m a n d ( b ) i o n i z at io n o f t he a i r b et w e e n t he e nd o f t he c ha m be r a n d t h e m e t a l c a p . A s d i s c u s s e d e a r li e r , t he i o ni z a ti o n p r od uc e d i n a i r i n t he c e n t r a l h o ll o w p or ti o n o f t h e st e m i s no r m al l y not me a s ur e d s i nce t hi s i s a fi el d f r e e r e gi o n a n d t h e ion s p r o d u c e d t he re P.87 r e c o mb i n e . Ho w e v e r , e le c t ro n s ej e ct e d f ro m t he me t al st e m a nd t he i ns ul a to r c o u l d re a c h t h e ce n t r al el e ct r od e a nd re d uc e i t s c ha rg e . T hi s k i nd o f s t em le a k a g e i s u s u a l l y s m a ll a n d o c c u r s o n l y w i t h hi g h- e ne r g y r a d i ati o n ( ~ 2 M e V o r hi g he r ) . T h e s t e m l e a k a ge c a u s e d b y i o ni z a ti o n o f t he a i r s ur r o und i ng t he s t e m e nd i s e l im i n a te d o r mi n i mi z e d b y a m e ta l c a p whi c h f i t s o v e r t he e nd o f t he c ha m b er a n d c o v e r s u p t h e ce n t r a l el e ct ro d e . In a d d it io n, t he e nd c ap a t te nua t e s t he r a d i at io n a n d r e d u c es t h e s te m i o ni z at ion. T hi s c a p m us t b e i n p l a ce d ur i ng i r r a di a ti o n ( F ig . 6 . 6 ) . If t h e c a p d o e s not f it p r o pe r l y o ve r t he c ham b e r e nd , so m e c h a r g e c a n b e c o l le ct e d i n t h e a i r a dj a c ent t o t he e nd o f t he e l e c tr o de , t hus c a u s i n g s t e m l e a k ag e . C o r r e ct io n f o r t he s t em e f f e c t m a y b e a s l ar g e a s 1 0 % . Fo r f u r t h e r d e t ai l s c o n c e rn i n g c o n d e n s e r c ha m be r s t e m le a k a g e , s ee A d a m s ( 5 ) .

WWW.MEDRAD.IR

F I G . 6 . 7 . G e o me t r y of e x p o s u r e m e a s ur e me nt s w i t h a c o nd e ns e r c ha m b e r .

F I G . 6 . 8 . G e o me t r y of s t e m c o r r e ct io n d et er m i na t io n. T h e s t e m co r re c ti o n m a y b e de te r mi ne d as i ll us t r at e d i n F ig . 6. 8 . M e a s ur e m e nts a r e m a de w it h t h e ch a m b e r or i e nt e d i n e a c h o f t he t wo po si ti o ns s ho w n. A n u m b e r o f p o i n t s i n t h e f i e l d a r e s el e ct ed f o r s uc h m e a s ur e m e nt s a nd c o r r e ct io n f a c t o r s a re o bt a i n e d a s a f u n c t i o n o f t he s t e m le ng t h e x p o sed r el a ti v e t o t he a m o u n t o f t h e s te m e x p o s ed d u r i ng c a li b ra t io n. F i g ur e 6 . 9 p res e nt s d at a f o r a p a r t i c ul a r c h a m b e r w h i c h h a d b e e n c a l i b r at ed f o r

60

C o e x p o s ure w i t h t he c e nt e r of

t h e c h a m b e r s e n s it i v e v o l u m e at t he c e nt e r o f a 10 10 - c m f ie ld . It a p pe a r s t h at i n t h i s c a s e t h e m ajo r s t em e f f e c t i s o cc ur r i ng a t t he s te m e nd w he r e t he p r ot e c ti v e c a p s e al s th e c h a m b e r .

B. Farmer Chamber
C o n d e n s e r c h a m be r s a r e s u it a bl e fo r me a sur i ng e x po s ur e r at e i n a i r f o r r e l at i ve l y l o w e r -e n e r g y be a m s ( 2 M e V ) . A l t ho ug h the r e a r e no b a si c li mi t at io ns to t hei r use for P.88

WWW.MEDRAD.IR

h i g h e r - e n e r g y r ad i at io n , t h e de s ig n o f t he s te m a nd e x c e s s i ve s te m le a k a ge c r e a t e do s i me t ri c p r ob l e m s , e s pe c i al l y w hen m a k i ng m e a s ur e ment s i n p ha nto m s . In 1 9 5 5 , F a r m e r ( 6 ) d e s ig n e d a c ha m b e r w hi c h p r o v i d e d a s t ab l e a nd r e li a bl e s e c o n d a r y s t a n d a r d fo r x - r a y s a nd r a y s f o r a l l e ne r g ie s i n t he t he r a p e uti c r a n g e . T h i s c h a m b e r c o n n e c t e d t o a s p e ci f ic e l e ct r o me te r ( to m ea s ur e i o ni z a ti o n c h a r g e ) i s k n o w n a s t h e B a l d w i n - F a r m e r s ub s t a nd a r d do s im et e r .

F I G . 6 . 9 . P l ot o f s t em c o r r e c tio n f a c t o r (m ul t ip li c a ti v e ) a s a f unc t i o n o f s t e m l e n g t h , m e a s u r ed f r om c e n t e r o f s e ns it i v e v o l um e .

F I G . 6 . 1 0 . F a r m e r g r a p h i te / a l u mi num c ha m b e r . No m i na l a i r v o l um e , 0 .6 ml . PTCFE, d e s ig n p o l y t r i c h lo r o flu o r e t h y l e n e . of a t hi m ble chamber ( R ed r a wn fo r t he from Aird EGA, Farmer P hy s FT. Med T he Bi o l Farmer do s i me te r .

1 9 72 ; 1 7 :1 69 . ) T h e o r i gi n a l d e s ig n o f t h e F a r m e r c ha m b e r w a s l a t e r m od i f ie d b y A i r d a nd F a r me r ( 7 ) t o p ro v i de b e tt e r (f l a t te r ) e n e r g y r e s po ns e c ha r a c t e r i st i c s a nd m o r e c o ns t a nc y o f d e si g n f ro m o n e ch a m b e r t o a no t he r . Thi s c ha m b e r i s s ho w n s c he m a ti c a ll y i n

WWW.MEDRAD.IR

Fig.

6 . 10 .

Actual

d im e n s i o n s is of

of pure

t he

t him b l e

a nd T he

t he

ce nt ra l

el e c tr o de c o ns i s t s

are of

i n d i c at e d o n t h e di ag r a m . T h e t him b le wa l l i s m ad e o f p ur e g r a p hi te a nd t he central cm3. T h e r e a r e t h r e e e l e ctr o d e s i n a w e ll - g ua r de d io n c ha m b e r : t he c e nt r a l e le c t ro de o r t h e co ll e ct o r , t h e th i m b le w a ll a nd t he gua r d e le c t ro de . T he co ll e c to r d el i v er s t h e c u r r e n t t o a c h a rg e m e a s u r i ng de v i c e , a n e l e c t ro m et e r . T he e l e ct r o me te r i s p r o v id e d w it h a d u a l p o l a ri t y H V s o ur c e t o ho ld t he c o ll e ct o r a t a hi g h b i a s v o l t ag e ( e . g . , 3 00 V ) . T h e t h i m b l e i s a t g round p o t e nti a l a nd t he g ua r d i s k e p t a t t h e s a m e po te n t i al a s t h e co ll e ct o r . Mo s t of t e n t he col l e cto r i s o p e r at ed w it h a p o s it i ve v o l t ag e to c ol l e ct n e g a ti v e c ha r g e a l t ho ug h e it he r p ol a rit y s ho ul d c o ll e ct t h e s a m e m a g n it u d e of i o n i z a ti o n c ha r ge , i f t he c ha m b e r i s d e s ig ne d w it h m i ni m al p o l ar it y e f f e c t s ( to b e d i s c u s s e d l at e r ) . T h e g u a r d e l e c tr o de s e r v e s t w o di f f e r e nt p ur p o s e s . O ne i s to p r e v e nt le a k a g e c u r r e n t f r o m t h e h i g h v o l t a ge e l e ct ro d e ( t he c o ll e c to r ) a nd t he ot he r i s t o de f i ne t h e io n c ol l e ct i n g v o l um e . In a p l a ne - p a r al le l i o n c ha m b e r ( to be d i s c us s e d l at e r ) t h e p l a n e - co ll e ct i n g el e c tr o de i s s ur r o und ed b y a w i d e m a r gi n o f g ua r d r i ng to prevent undue c u r v at u r e of the e l e ct ri c f i e ld o ve r t he c ol le c t or . In s uc h a c h a m b e r , w h e n g r a p h i t e c o at i n g s a re us e d a s c o l le c ti ng s ur f a c e s o n a n i ns ul a t o r , t h e c o ll e ct o r c a n b e s e p a r a t ed f r o m t he g ua r d r i ng b y a s c r a t c h t hr o ug h t he g r a p h i te c o at i n g . T h e e n e r g y r e s po n s e o f t h e c h a m b er d e si g ne d b y A i rd a nd F a r m er i s s ho w n i n t he f o r m o f a p l o t o f c a lib r a t io n f a c t o r a s a f u nc t i o n o f b e a m ha l f - v a l ue l a y e r ( F i g . 6 . 1 1 ) . T h e r e s po n s e is a l m o st c o ns t a nt f r om 0 . 3 m m C u H V L up w a r d a nd w i t hi n 4 % f r o m 0 . 05 m m P.89 C u u p w a r d . A i r d a n d F a r m e r f o u nd t he t ota l s te m l e a k a ge o f t hi s c ha m b er to b e a b o u t 0 . 4% w h e n i r r a d i a te d w it h 4 - M V x - r a y s w i t h t he w ho l e s t em i n t he b e a m . e le c t ro d e a l uminum . i ns ul a t or p o l yt r i c h lo ro f l u o r et h y le n e . T h e c o l le c ti ng v o l um e o f t he c ha m b e r i s no m i na ll y 0 . 6

F I G . 6 . 1 1 . E n e r g y r e s p o n s e o f t he c ha m be r s ho w n i n F i g . 6 .1 0. ( R e d r a w n f r o m

WWW.MEDRAD.IR

A i r d E G A , F a r m e r F T . T h e d e s ig n o f a t hi mbl e c ha m be r f or t he F ar m e r do s im e te r . P h y s M e d B i o l 1 9 72 ; 17 : 1 69 . ) F a r m e r c h a m b e r s , l i ke t h e o n e d e s c ri be d ab o v e a nd o t her F a r m er - t y p e c ha m b e r s a r e c o mm e r ci a ll y a v a i l a bl e . T h e l at te r c ham b e r s a re co ns t r uc t ed s i mi l a r to t he o r i gi n a l F a r m er c h a m b e r b u t v a r y w i t h r es p e c t t o t he co m po s it io n o f t he w a l l m a t e ri a l o r t h e c e n t ra l e le c t ro de . T he us e r o f a ny s uc h c ha m b e r i s c a ut io ned a g a i n s t u si n g a c h a m be r t h e c h a r a c t e ri s ti c s o f w hi c h ha v e no t b een e v a l ua t e d a nd f o u n d a c c e p t ab le . F o r f u r t h e r d et a il s o f c ha m b e r d e s ig n a nd c ha r a c t e ri s ti c s t he r e a d e r i s r e f e r r ed to B o a g ( 8 ) .

6.6. ELECTROMETERS A. String Electrometer

T h e e l e ct r o me te r i s ba s i c a ll y a c ha r g e m e as ur i ng d e v i c e . T he st ri ng e le c t ro m et e r is a type of e le c t ro m et e r that o p e r at es on t he p r i nc i p le of a g o l d - le a f e l e ct r o s co pe . S u c h e le c t ro m et e r s a r e co mm o nl y us e d f o r t he m e a s ur e m e nt of c h a r g e o n a c o n d e n se r c h a m b e r . F i g ur e 6. 1 2 s ho w s t he m e c hani s m o f a s t r i ng e l e ct r om et e r used in a V i c to r ee n R m e te r . T he d e v i ce c o nsis t s of a st r i ng ( p l a ti n u m w i r e ) s t re t ch i n g a lo n g a s upp o rt ro d a nd m a i nta i ne d und e r t e ns io n b y a q u a r t z l oo p a tt a c h e d a t o n e e n d o f t he ro d . A de f l e ct io n e le c tr o d e i s mo unt ed n e a r t h e m i d dl e o f t he s t r i n g . W he n t he s up p o r t ro d a nd t he pl a ti num w i r e a r e p o s it i ve l y c h a r g e d , a n e g a t i ve c h a r g e i s i nd uc e d o n t he de f l e ct io n e l e ct r od e . T he d e f l e ct io n el e ct r od e at t r a ct s t h e wi r e t ha t m o v e s a di s t a nc e t hat d ep e nd s o n t he a m o u n t o f c h a r g e o n t h e wi r e . T he de f l e ct io n o f t he wi r e i s v ie w e d t hr o ug h a s m a l l m i c ro s c op e t h at s h o w s a s ha d o w o f t he w ir e p r oj e c te d on a n i l l umi na t ed scale. To o pe r at e the i n st r u m e n t , t he c o nd ens e r c ha m b e r is i ns e r t ed i nt o t he e l e ct r om et e r . T h i s c o nn e c t s t h e c e nt ra l el e ct r od e o f t he c ha m be r w i t h t he s up po r t r o d a n d t h e w i re . T h e c h a m b e r a nd t he e le c t ro m et e r a re t he n c ha r g e d unt il t he s h a d o w o f t h e wi r e c o i n c id e s wi t h t he ze r o e nd o f t he s c a le ( f ul l y c ha r ged p o s it io n ) . T h e v o lt a g e a c r o s s t h e c ha m be r e l e ct r od e s at t hi s i ns ta nt i s a bo ut 4 00 V . T h e c h a m b e r i s t h en r e m o v e d f r o m t he el e c tr o me te r a nd e x p os e d to r a di a ti o n. T h e i o n i z a ti o n p r od u c e d i n t h e t h i mb le a i r of t he c ha m b e r r e d uc e s P.90 t h e c h a r g e o n t h e c e n t r a l el e ct r od e . A s t he c ha m b e r i s r e co nne c t e d t o t he e l e ct r om et e r , the r ed u c t io n in c ha r g e is s ha r e d by t he chamber a nd t he e l e ct r om et e r . T h e at tr a c t io n b et w e e n t he w i r e a nd t he d e fl e ct io n e le c t ro de i s d e c r e a se d a n d t h e st r in g s h a d o w m o v e s up sc a l e . T he r e a di ng o n the s c a l e r e f le c ts t h e a m o u n t o f r a d i at io n r e c ei v e d b y t he c ha m b e r . T he e x po s ur e i n r o e ntg e ns c a n b e c al c u l a te d b y m u lti p l yi n g t h e r e ad i ng wi t h s e ve r a l co r re c ti o n f a c t o r s s uc h a s t e m pe r a t u re a n d p r es s u r e c o r re c ti o n, c ham b e r c al ib r a ti o n f a cto r f o r t he gi v e n q u a l it y o f r a d i a tio n , a n d s t e m c o r re c ti o n.

WWW.MEDRAD.IR

FIG.

6.12.

S c h e m a ti c

di a g r a m

of

V i ct o re e n

el e ct r om e te r .

( Ad a p te d

from

d i a g r a m b y V i c t o re e n , In c . )

B. Other Electrometers
T h e c o n d e n s e r c h a m be r s d e s cr i be d e a r li e r a r e de t a c hed f r o m the e le c t ro m et er d u r i n g e x p o s u re a n d t h e n r e a tt a c he d t o m e a s ur e t he c ha r ge . O t he r e x po s ur e m e a s u r i n g de v i c e s a re a v a i l ab le i n w hi c h the c ha m b e r re m a i ns c o nne c t e d to t he e l e ct r om et e r d u r i n g ex p o s u r e . T he c a bl e i s l o ng e no ug h so t ha t t he el e ct r o me te r i s p l a ce d o ut s i de t h e r o o m at t h e co nt r ol co ns o le o f t he r ad i at ion g e ne r a t or . T hi s a r r a n g e m e n t i s m o re c o n v e n i e n t t ha n t ha t o f t he d et a c ha b le co nd e ns e r c ha m be r i n w h i c h t h e o p e r a to r m u s t c a r r y t he c ha m b e r to t he r oo m , r e t ur n t o t he c o nt ro l c o n s o le , op e r at e t h e m a c h i n e , a nd t he n g o b a c k i n t he r oo m t o r et r ie v e t he c h a m b e r f o r c h a r g e me a s u r e m e n t . In c a l i b ra t i ng a r a di a ti o n uni t , t hi s a m o unt s to a l a r g e n u m b e r o f t ri ps , g o i n g i n a nd o ut o f t he r o om .

B.1. Operational Amplifiers

S i n c e t h e i o n i z at io n c u r r e n t o r c ha r ge t o b e me a s ur e d i s v e ry s m a l l , s pe c i al e l e ct r om et e r ci r c u it s h a v e b ee n d e si g ned t o m e a s ur e it a c c ura t e l y . T he m o st commonly Figure measure used e le ct r o me te r s in the us e ne g a ti v e - f e ed b a c k si m p li f ie d rate mod e , o pe r a tio na l t hat a nd a m p li f i e r s . use d to 6.13 s c h em a ti c a ll y shows t hr ee ci r c ui t s mo de , are

io n i z a t io n

i n t e g r at e

d i r e ct - r e ad i ng

d o s im e te r m o de . T h e o pe r a ti o n al a mp li f i e r i s d e si g na te d a s a tr i a ng l e w it h t wo i n p u t p oi n t s . T h e n e g a t i ve t e r mi na l i s ca l l ed t he i nv e r ti ng te r m i na l a nd t he p o s it i ve P.91 o n e a s t h e n o n i n v e r tin g p o si ti o n . T hi s te r mi no lo g y im p li e s t ha t a ne g a ti v e v ol t a ge

WWW.MEDRAD.IR

a p p li e d to t h e i n v e r ti n g te r m i n al w il l g i ve a p o si ti v e a mp li f i ed v o lt a ge a nd a p o s it i ve v o l t ag e a p pl ie d t o t h e n o ni nv e rt i ng t e r m i na l w il l g i ve a p o s it i v e a m pl i f ied v o l t ag e . A n e g at i v e - fe e db a c k c o nne c ti o n is p r o v id e d , w hi c h c ont a i ns e it he r a c a p a c i to r o r a r e si s to r.

F I G . 6 . 1 3 . S c h e m a t i c d i a g r am s o f i o n c ham b e r s co nne c t ed to ne g a ti v e - f e ed b a c k o p e r at io n a l a m pl i fi e r s. A : I n t e g r a t e mo de. B : R a t e m o d e . C : D i r e ct - e x po s ur e r e a d i n g mo d e . T h e o pe r a ti o n a l a m pli f i e r h a s a hig h op e n- l oo p g a i n ( > 1 0 4 ) and a hi g h i np ut i m p ed e n c e ( > 1 0 1 2 o h m ) . B e c a u s e o f t hi s , t he o ut p ut vo lt a g e i s d i ct a te d b y t he f e e d b a c k el e me n t , i n de p e n de n t o f t he op e n- l oo p g ai n, a nd t he po t e nt i al be t w ee n t h e p o si ti v e a n d n e ga t i v e i n p u t s o f t he am p l i fi e r ( c al le d t he er r o r v o lt a ge ) is m a i n t a i n ed v e r y l o w (< 1 0 0 m V ) . F o r e x a m p l e , i f t he io ni z a t io n c ur r e nt i s 1 0 - 8 A a n d t h e r e s i sto r i n th e f e e db a c k c i r c ui t of F i g . 6 . 1 3 B i s 1 0 9 ohm , t he o ut p ut v o l t ag e w il l b e c u r r e nt ti m e s t h e r e si s t a nc e o r 1 0 V . A s s um i ng op e n- l oo p g a i n o f 1 0 4 , t h e e r r o r v ol t ag e b et w e e n t he i np ut t er m i na l s o f t he a m pl i fie r w il l b e 10 - 3 V o r 1 m V . T h i s l e ad s t o a v e r y s t ab le op e r a ti o n, a nd t he v ol t a ge a c ro s s t he f e e d b a c k e l em e n t c a n b e a c c u r a te l y me a s ure d w it h t he cl o se d -l oop g a i n o f a l mo st unity. In t h e i n t e g r a t e m od e ( F i g . 6 . 1 3 A ) , t he c ha r g e Q c o l le c te d b y t he i o n c ha m b e r i s d e po s it e d o n t h e f e ed b a c k c a p a c ito r C . T he v o l t ag e V a c ro s s C i s r e a d b y a v o l t me te r a n d i s g i ve n b y Q / C , w he r e C i s t he c a p a c i t y . M ea s ur e m e nt o f t hi s v o l t ag e i s e s se n t ia ll y t h e m e a s u r e m e nt o f io ni z a t io n c ha r g e . In t h e r a te mo de ( Fi g . 6 . 1 3 B ) , t he c a p ac i to r i s re p l a ce d b y a r e s i st a nc e R . Ir r a d i a ti o n o f t h e c ha m b e r c a u s e s a n i o ni z a t io n c ur r e nt I to fl o w t hro ug h t he r e s i st o r , g e n e r at i n g a v o l t a ge V = I R a c r o s s t he r e s i s t a nc e . T he m e a s ur e m e nt o f t h i s v o lt a g e re f l e ct s th e m a g n i t u d e o f t he io ni z a t io n c ur r e nt . F o r t ot a l c ap a c it a ti v e o r r e s i st i v e f e ed b a ck c i r c ui t s , t he c lo s e d- l oo p g ai n o f t he o p e r at io n a l a mp li f i e r i s u n i t y , i . e . , t he o ut p ut v ol t ag e i s g i v e n b y t he v o l ta g e

WWW.MEDRAD.IR

a c r o s s t h e f ee d b a c k e l e me n t . If a v a ri a ble f r a c ti o n o f t he o utp ut v ol t ag e i s fe d b a c k t o t h e i n p u t a s b y a v o l t a g e di v i de r ( F i g . 6 . 1 3 C ) , t he e le ct r o me te r c a n b e c o n v e r t ed i n t o a d i rec t e x p o s u r e - re a di ng ( R o r R / m i n) i ns t r um e nt f o r a g i v e n c h a m b e r a n d a g i v e n q u a l it y o f r a d i a tio n. S p e c i al e le c t ro me te r ci r c u i t s h a v e be e n d e sig ne d to m e a s ur e a c c ur a t el y i o ni z at io n c u r r e n t s , e v e n a s l o w a s 1 0 - 1 5 A . T he r e a de r i s r e f e r re d to J o hns ( 9 ) f o r f ur t he r d e t ai l s . S e v e r a l co m bi n a t io n s o f c h a m b e r s a nd e le c tr o m et e r s us i ng o pe r ati o na l a mp li f i er s a r e c o m m e r ci a ll y a v a i l a bl e . F ig u r e 6 . 1 4 sho w s o ne o f s uc h s y s t e m s . A F a r m e r 0 . 6 - c m 3 i o n c h a m be r is c o n n e c t ed t hr o ug h a l o ng s hi el d ed c a bl e to a Ke it hl e y 6 1 6 e l e ct r om et e r . T h e s y s t e m c a n b e us e d to me a s ur e i nt e g r at ed c har g e o r i o ni z a t io n c u r r e n t . B o t h t h e c h a m b e r a n d t h e el e ct rom e t er a r e c al ib r a te d so t ha t t he re a di ng can be converted into exposure.

6.7. SPECIAL CHAMBERS

A c y l i n d r i c al t h i m bl e c h a m b e r i s mo st o ft e n us e d f o r e x p o s ure c a li b r at io n of r a d i at io n b e a m s w h e n t h e d o s e g r a di e nt a c r o s s t he c ha m b e r v o l um e i s m i ni m al . It i s n o t s u it a bl e f o r s ur f a c e d o s e m e a s ur e me nt s . A s w i l l b e di s cus s e d i n C ha p t e r 1 3 , h i g h - e n e r g y p h oto n b e a m s e x hi b it a d o s e b uil d up e f f e ct , t ha t i s , a r a p i d i n c r e a s e o f d o se w i t h d e pt h i n t h e f i r s t f e w m i ll i me te r s . T o m e a s ur e t he d o se a t a p o i nt i n t h i s b u il d u p r e g io n o r a t t he s ur f a c e , t he d et e ct o r m ust b e v e r y t hi n s o t h a t t h e re i s n o d o se g r a d ie n t a c r o s s i t s s e ns i t i v e v ol um e . In a d d i ti o n, t he c h a m b e r m u s t n o t s ign i f i c a n t l y pe r t urb t he r a d i at io n f i el d . S pe c i al c ha m b er s ha v e b e e n d e si g n e d t o a c h ie v e t h e a b o ve r e q ui rem e nt s .

A. Extrapolation Chamber
F a i ll a ( 10 ) de s ig n e d a n i o n i z a tio n c ha m b er f o r me a s ur i ng s ur fa c e do s e i n a n i r r a di a te d p h a n t o m in 1 9 3 7 . H e c a l le d t hi s c ha m b e r a n e x t r ap o l at io n c ha m b e r ( F i g . 6 .1 5 ) . T h e b e am e n t er s t h ro ug h a thi n f o i l w hi c h i s c a r bo n c o at e d to fo r m t h e u p pe r e le c t ro de . T h e l o we r o r t he co ll ec t i ng e le c t ro de i s a sm a l l c oi n- s ha p e d r e g io n s u r r o u n d e d b y a g u a r d r i ng a nd i s c o nne c t ed to a n ele c t ro m et e r . T he e l e ct r od e s p a ci n g c a n b e v a r i ed a c c ur a te l y b y mi c r o me te r s c re w s . By m e a s ur i ng the i o n i z at io n p e r u n i t the s u p e r f ic i a l volume d o se a s a f un c t io n o f e l e c t ro de t he s p a c i ng , o ne to can z e ro e s t im a te b y e x t r a pol a ti ng io ni z a ti o n c ur v e s

e l e ct r od e s p a ci n g .

WWW.MEDRAD.IR

F I G . 6 . 1 4 . A p h o t og ra p h o f a F a r m e r 0 . 6 -c m 3 i o n c ha m be r w it h a K e it hl e y 61 6 e l e ct r om et e r . ( C o u r t es y o f K e i t h l e y Ins t r um e nt s , Inc . , C l e v e l a nd , O hi o . )

WWW.MEDRAD.IR

FIG.

6.15.

E x t r a p ola t io n

io n

c ha m b e r

by

F a i ll a .

( Re d r a w n

from

Boa g

JW.

Io n i z a t i o n c h a m b e r s . In : A t t i x F H , R o e s c h W C , e d s . R a d i a t io n d o s i me t r y , V o l 2 . N e w Y o r k : A c a d e m i c Pr e s s , 1 9 69 : 1 . ) P.92

P.93

T h e e x t r a p ol a ti o n c h a m b e r s o f t he t y pe d e s c r ib e d a bo v e ha v e b e e n us e d f o r s p e c i al d o si m et r y , e . g . , t h e m e a s ur e m e nt o f d o s e i n t he s up e r f i c i a l l a y e r s o f a m e d i u m a n d t h e do s im e t r y o f e le c t ro ns a nd p a r ti c le s .

B. Parallel-plate Chambers
P a r a l l el - pl a te c h a m ber s a r e si m il a r t o t he e x t r a po l at io n c ha m b er s e x c e pt f o r t he v a r i a b le el e ct r o de s pa c i n g . T h e e le c t ro de s p a c i ng o f t he p a r al lel - p l at e c ha mb e r s i s s m a ll ( ~ 2 m m ) b ut f i x e d . A t hi n w a l l o r w i nd o w ( e . g . , f o il s of 0 . 0 1 - to 0 . 03 m m - t h i c k M y l a r , pol y s t y r e n e , o r m i c a ) a llo w s m e a s ur e me nt s pr a c t i c al l y at t he s u r f a c e o f a p h a n t o m w i t h o u t s i g ni f i c a nt w a l l a t te nua t io n. By a d d i ng l a y e r s o f p h a n t o m m at e ri a l o n t o p o f t h e c ha m b e r w i nd o w , o ne c a n st ud y t he v a ri a ti o n i n d o s e a s a f u n c t io n o f d e pt h , a t s ha l lo w de p t hs w he r e c y l i ndr i ca l c ha m b e rs a re u n s u i t a b l e be c a u s e o f t h e i r l a rg e r v ol um e . The small e le c t ro d e spacing in a p a r al l el - pl a te c ha m b e r m i ni m i z e s cavity p e r t u r b at io n s i n t h e r a d i at io n f i e ld . T hi s f e a t ur e i s e s p e ci a ll y im p o rt a nt i n t he d o s im e tr y o f el e ct r o n b e a m s w h e r e c y l i nd ri c a l c ha m be r s m a y p ro d uc e si g ni f i c a nt p e r t u r b at io n s i n t h e e le c t ro n f i e l d .

6.8. ION COLLECTION A. Saturation

A s t h e v o l ta g e d i f f e r en c e b e t w ee n t he el e ct r od e s o f a n io n c ha m b e r e x po s ed to r a d i at io n i s i n c r e a s e d , t h e i o n i z a ti o n c ur r e nt i nc r e a s e s a t f i r s t al mo s t li ne a r l y a nd l a t er mo r e sl o wl y . T h e c u r v e f i n a ll y a p p ro ac he s a s a t ur a tio n v a lue f o r t he gi v e n e x p o s u r e r a te ( F ig . 6 .1 6 ) . T h e i n i ti a l i nc r e as e o f i o ni z a t io n c ur r ent w i t h vo lt a g e is c a u s e d b y i n co m pl et e i o n c ol le c ti o n at l o w vo lt a g e s . T he ne g a ti v e a nd t he po s it i ve i o n s te n d t o r e co m bin e u n l e s s t he y a re qui c k l y s e p a r at e d b y the e le c t ri c f ie l d . T h i s r e c o m bi n a t io n c a n b e m i n i m i z ed b y i nc r e a s i ng t he f ie l d st r e ng t h ( V / c m ) . If t h e v o lt a ge i s i n c r ea s e d m u c h be y o nd s at ur a t io n, t he io ns , a cc e l e r at ed b y t he e l e ct r i c f i el d , c a n g a in e n o u g h e ne r g y t o pr o d uc e i o ni z at io n b y co ll i si o n w it h g a s m o le c u l e s . T h i s r e s u lt s i n a r a p i d m ult i pl ic a t io n o f i o ns , a nd t he c ur r e nt , o nc e a g a i n , b e co m es s t ro ng l y de p e n de nt o n t he a p pl i ed v ol t ag e . T he c ha m b e r s ho ul d b e u s e d i n t h e s at u ra t io n r e gi o n so t hat s m a l l c ha ng e s i n t he v o l t ag e d o no t r e s u l t i n c h a n g e s i n th e i o n i c c u r r e nt .

B. Collection Efficiency

WWW.MEDRAD.IR

A s p r e v io u s l y di s c u s s ed , t h e m a xi m um f i el d t ha t c a n be a pp li e d to t he c ha m be r i s l i mi te d b y t h e o n s e t o f i o n i z at io n b y c o l li si o n. D e pe nd i ng o n t he c ha m b e r d e si g n a n d t h e i o n i z a ti o n P.94 i n t e n s it y , a c e r t a i n am o u n t o f i o ni z at io n l os s b y r e c o m bi na t io n c a n b e e x p e c te d . E s p e c i a ll y a t v e r y h ig h i o n i z at io n i nte ns i ty , s uc h a s i s p o s si ble i n t he c a s e o f p u l s e d be a m s , s i g n i fic a n t l o s s o f c ha r g e b y r e c o m bi na t io n m ay o c c ur e v e n a t m a x i m u m p o s si bl e c h a m b e r vo lt a g e s . U nd er t he s e c o ndi ti o ns , t he r e co m bi na t io n l o s s e s m a y h a v e t o be a c c e p t ed a nd t he c o rr e c ti o n a p pl ie d f o r t hes e l o s se s .

F I G . 6 . 1 6 . S a t u r a t io n c u r v e f o r a n i o n c ha m b e r . T h e c o l le c ti o n e f f i ci e nc y , d e f i n e d a s t he r ati o o f t he num b e r o f io ns c o ll e ct e d t o t h e n u m b e r pr o d u c ed, m a y b e de te r m i ned e it he r b y c al c ul a ti on ( 8 , 1 1 ) o r b y m e a s u r e m e n t s ( 11 ) . E x p e r i m e n t al l y , t he me a s ur e d c ur r e nt i s p lo tt e d a g ai ns t t he i n v e r s e o f t h e po l a ri z i n g v ol t ag e i n t he r eg i o n o f l o s se s be lo w 5 % . T he id e al s a t u r a t io n c u r r e n t i s t h e n d e t er m i ned b y l i ne a r i nte r po l at io n o f t he c ur v e to infinite p ol a r i zi n g v ol t a ge . A n o t he r , s im pl e r , m et ho d , c al le d t he t w o - vo lt a g e t e s ti n g te c h n i q u e , h a s b e e n d e s c r ib ed b y Bo a g a nd C ur r a nt ( 1 2 ) f o r d e t e rm i ni ng t h e e f f i c ie n c y o f i o n c o ll e ct io n . In t hi s m e t ho d , m e a s ur e me nt s a r e m a d e at t w o d i f f e r e n t v o lt a ge s , o ne gi v e n w o r k i ng v olt ag e a nd t he o t he r m uc h l o w e r vo lt a g e . B y c o m b i n i n g t h e t wo r e a d i n g s i n a c c o rd a nc e w i t h t he t heo r et i c al f o r m ul a b y Bo ag a n d C u r r a n t ( 1 2 ) , o n e c a n o b t a i n t he c ol le c ti o n e f f i c ie nc y a t t he gi v e n v o l t ag e . A m o r e p r a ct i c al m eth o d o f d et e r mi ni ng ion r e c o m bi na t io n c o r r ec t io n ( P i o n ) i s to m e a s u r e io n i z a ti o n a t t w o bi a s v ol t ag e s , V 1 a nd V 2 , s o t ha t V 1 = 2 V 2 . T he r a t io o f t h e t wo r ea d i n g s i s r el a t ed t o P i o n . Fi g ur e 6 . 1 7 i s b a se d o n t he w or k b y Bo a g (1 3) a n d A l m o n d ( 14 ) a n d m a y b e u s e d t o d e te rm i ne P i o n f o r a c ha mbe r f o r c o nt i nuo us r a d i at io n ( e . g . , a c c e l e r ato r s . W h e n e v e r p o s s ib le , th e v o l t a ge o n t he c ha m b e r s ho ul d be a r r ang e d to g i v e l e s s t h a n 1 % lo s s o f c h a r g e b y r e co m bi na t io n, t ha t i s , co ll e ct io n e ff i c i e nc y o f b et ter t h a n 9 9 % . In a 0 . 6 - c m 3 F a r m e r -t y p e c ha mb e r , t hi s i s g e ne ra ll y a c hi e v e d i f t he
60

C o ) , p u l s ed r a di a ti o n, o r p ul s ed s c a nni ng be am s p r od uc e d b y

WWW.MEDRAD.IR

c o ll e ct io n v o lt a ge i s ab o u t 3 00 V o r hi g he r a nd a do s e p e r p ul s e i n t he c ha m be r c a v i t y i s 0 . 1 c G y o r l es s .

F I G . 6 . 1 7 . Io n r e c om b i n a ti o n c o r re c ti o n f a c t o r s ( P i o n ) f o r c o nti nuo us r a d i a ti o n ( C o 6 0 , V a n d e G r a a f f ) , p u l s e d r ad i at io n ( a c c e l e r ato r - p ro d uc e d x - ra y s a nd e l e c tr o n b e a m s ) , a n d p ul s e d sc a n n i n g b e a m s . T he se d at a a r e ap pl i c ab l e w he n V 1 = 2 V 2 . ( F r o m A A P M . A p r o to co l f o r t h e de te r m i nat io n o f a b s o rb ed do s e fr o m hi g h- e ne rg y p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 8 3 ;1 0 : 74 1 , w i t h p e rm i s sio n. ) P.95

6.9. CHAMBER POLARITY EFFECTS

It i s so m eti m e s fo u n d t h a t f o r a gi v e n e x po s ur e t he i o ni c c ha r ge c ol le c te d b y a n i o n c h a m b e r c h a n g e s i n m a g n i t ud e a s t he p o l a ri t y o f t he c ol lec t i ng v o lt a ge i s r e v e r s e d . T h e re a r e m a n y p o s s i bl e c a us e s o f s uc h p o l a ri t y e f f e c t s , s o me o f w hi ch h a v e b e e n r e vi e w e d b y B o a g ( 8) . W i t h t he c ha m b e r o pe r a ti ng und e r s a t ur a ti o n c o n d it io n s , m a j o r c a u s e s o f t h e p ol a r it y e f f e c t s i nc l ude t he f o ll o wi ng :

H i g h e n e r g y e le c t ro n s s u c h a s C o m p t o n e le c t ro ns e j e ct e d b y hi g h- e ne r g y p h o to n s c o n s t i t ut e a c u r r e nt ( a l s o c a ll e d t he C o m p t o n c ur r e nt ) i nde p e nde nt of gas i o ni z a t io n . This may add to or r e d uc e t he co ll e c tor c ur r e nt , d e pe n d i n g o n t h e po la r i t y o f t he c ol le c ti ng e le c t ro de . In a d d it ion, s o m e o f t h e s e e le c t ro n s m a y s t o p i n t he c o l le c to r but m a y no t b e e nt i r ely b a l a nc e d b y e je c ti o n o f r e co il e l e ct r o ns f r o m t he col l e ct or . T he pr e v io us e f f e c t s a re m i n i m i z ed b y m a k i n g t h e c e nt r a l e le c t ro de v e r y t hi n. E r r o r s d ue t o t he se c a u s e s a r e l i ke l y to be a p p re c i a bl e fo r p a ra l l el - pl a te c ha m b e r s w i t h s m a ll e l e ct r od e s p a ci n g . H o w e v e r , t he t r ue i o ni z at io n c ur r e nt i n t hi s c a s e c a n b e

WWW.MEDRAD.IR

d e te r m i n ed b y t a k i n g t h e m e a n o f t w o c ur r e nt s o bt a i ned b y r e v e r s i ng t he c h a m b e r p ol a r it y .

E x t r a c a m e r a l c u r r e n t , f o r e x a m p l e , c ur r e nt c o l le c te d o ut si de t he s e ns i t i v e v o l u m e o f t h e c h a m b er , m a y c a us e t he p ol ar i t y e f f e ct . S uc h c ur r e nt m a y b e c o ll e ct e d at i n a d e q u ate l y s c r ee ne d co ll e ct o r c i r c ui t po i nt s . Al s o , ir r a d i at io n o f t h e c a bl e c o n n e c ti n g t he c ha m be r w ith t he e l e ct ro m et e r ca n c a us e e x t r a c a m e r al c u r r e n t a s w e l l a s t he C om p to n c ur r e nt di s c us s e d a b o v e . T he e r r o r s c a u s e d b y t h es e e f f e c t s c a n b e mini m i z e d b ut no t el i mi na t e d b y r e v e r s i n g t h e c h a m b er p o l a ri t y a nd t a k i ng t he m e a n v a l ue o f t h e c o l le c tor current.

In

general,

the

chamber

po l ar it y

effects

are

re l at i v el y

more

se v e r e

for

m e a s u r e m e n t s i n el e ct r o n be a m s t ha n p ho to n b e a m s , a nd i n a d di ti o n, t he e f f e ct i n c r e a s e s w i t h d e c re as i n g e l e ct r o n e ne r g y . T he r e f o r e , i t i s im p or ta nt t o d et e r mi ne p o l ar it y e f f e c t s o f a ch a m b e r a t v a ri o us dep t hs i n a p ha nto m . T he p ol a r it y e f f e c t i s v e r y m u c h de pe n de n t o n c h a m b e r d e sig n a nd i r ra d i at io n cond i t io ns . S e v e r al c o m m e r ci a ll y a v a il a ble c h a m b e r s ha v e b een s t ud i ed f o r t hi s e f f e c t (1 5 , 16 ) a nd t h e r e a de r i s r e f e r re d t o t h e se r e po r t s f or f ur t he r d et a il s . M a n y o f t h e p ol a r it y e f f e c t s a n d st e m l e a ka g e c a n b e m i ni mi z e d i n t he de s ig n o f t h e c h a m b e r a n d t h e a s s o c i at e d ci r c ui t r y . A l s o , t he a d e q ua c y o f c ha m b e r v o l t a ge i s a n i mp o rt a n t f a cto r i n m i n i mi z i ng som e o f t he o t her po la r i t y e f f e c t s ( n ot m e n t io n e d h e re b ut di s c u s s e d b y Bo a g [8 ] ). F i na l l y , it i s r e co mm e nd e d t ha t t he d i f f e r e n c e be t w ee n t h e i o n i z a ti o n c ur r e nts m e a s ur e d a t p o si tiv e a nd ne g a t i v e p o l ar i z i n g po te n t i al s h o u l d b e l e s s t ha n 0 . 5% f o r a ny r a d i a t io n b e a m q ua l it y .

6.10. ENVIRONMENTAL CONDITIONS

If t h e i o n c h a m be r i s n o t s e al ed , it s r e sp o ns e i s a f f e ct e d b y a ir te m p e r at ur e a nd p r e s s u r e . In f a c t , m o s t c h a m b e r s a r e uns e a l e d a nd c o m m uni c ate t o t he o ut s i de a t m o sp h e r e . B e c a u s e t h e de n s i t y o f ai r d e pe nd s o n t he t e mp e r atur e a nd p re s s ur e , i n a c c o r d a n c e w i t h t he g a s l a w s , t he d e ns it y o f a i r i n t he c ha m b e r v o l um e w il l l i k e w i se de pe n d o n t he s e at m o sp he r i c c o ndi ti o ns . T he de ns i t y o r t he m a s s o f ai r i n t h e c h a m b e r v o l um e w i l l i n c r e a s e a s the t e m pe r a t ur e de c r ea s e s o r p r e s s ure i n c r e a s e s . Si n c e e x po s u r e i s gi v e n b y t he io ni z a ti o n c ha r ge co ll e c te d p e r unit m a s s o f a i r ( s e cti o n 6. 2 ) , t h e c h a m b e r re a di ng f o r a gi v e n e x p o sur e w i l l i nc r e a se a s t h e t e m pe r a t u re d ec r e a s e s o r a s t he p re ss ur e i nc r e a s e s . S t a n d a r d l ab o ra to r ie s c a l i b ra t e c ha m b e r s und e r t he c o ndi ti o ns p res e nt a t t he t i me o f c a l ib r a ti o n . T h i s f a c t o r i s t h e n c o nv e r te d to s p e ci f i c at m o sphe r i c c o ndi ti o ns , n a m e l y , 7 6 0 mm H g p r e s s u r e a nd 22 C t e m pe r a t ure . T he c o r r e ct io n C T , P f o r c o n d it io n s o t h e r t h a n t h e a b o v e r e fe r e nc e co nd it io ns c a n b e c a l c ul a t ed .

w h e r e P i s t h e p r e s s ur e i n mi ll im et e r s o f me r c ur y a nd t i s t e mp er a t ur e i n d eg r ee s Celsius. P.96 T h e s e c o n d b r a c k et ed t e r m g i v e s t he r ati o o f t e mp e r at ur e t t o t he r e f e re nc e

WWW.MEDRAD.IR

t e m pe r a t u re ( 2 2 C ) , b o t h c o n v e rt e d t o t he a b s ol ut e s c a le o f t e m pe r a t ure ( i n d e g re e s K el v i n ) b y a d d i n g 2 73 . 2 to t he C e l si us t e m pe r a t ur e s .

6.11. MEASUREMENT OF EXPOSURE

E x p o s u r e i n u n i t s o f ro e n t ge n c a n b e m e a sur e d w i t h a t hi mb l e cha m b e r ha v i ng a n e x p o s u r e c a li b r at io n f a c t o r N C t r a ce a bl e to the N a t i o nal Ins t i t ute o f S t a nd a r d s a nd T e c h n o l o g y ( N IS T ) f o r a gi v e n q ua li t y o f ra d i a tio n. T he c ha m b er i s hel d a t t he d e s i re d p oi n t o f m e a su r e m e n t i n t he s a me c o nf i g ur a ti o n a s us ed i n t he c ha mb e r c a l i b ra ti o n ( F ig . 6 .7 ) . P r e c a u t io n s a r e t a k e n t o a v o id me d i a , ot he r t ha n a i r , i n t he v i c i n i t y o f t h e c h a mbe r w h i c h m i g ht s c a tte r r a di a ti o n. S up po s e a r e a di ng M i s o b t ai n e d f o r a gi v e n ex p o s u r e . T h i s c a n b e c o nv e r t ed t o ro e ntg e ns a s f o l l o w s :

w h e r e C T , P i s t h e c o r re c t io n f o r te m pe r a t ure a nd p r e s s ur e ( E q ua t io n 6 . 12 ) , C s is t h e c o r re c ti o n f o r l o ss o f i o n i z at io n a s a r e s ul t o f r e c o mb i na tion ( s e c t io n 6 . 8 ) , a n d C s t i s t h e s te m le a k a g e co r r e ct io n ( s e c t io n 6 . 5 ) . T he q uant i t y X g i ve n b y E q u a t i o n 6 .1 3 i s t h e e x p o s u r e t h a t w o uld b e e x pe c te d i n f r e e ai r a t t he po i nt o f m e a s u r e m e n t i n t h e a b s e n c e o f t he c ha mb e r . In o t he r w o r d s , t he c o r re c ti o n fo r a n y p e r t u r b a ti o n pr o du c e d i n t h e b e a m b y the c ha m b e r i s i nhe r e nt i n t he c ha mb e r c a l i b ra ti o n f a c t o r N C . F o r l o w e r -e n e r g y r ad ia t io n s u c h a s i n t he sup e r f i c i al a nd o rt ho v ol t a ge r a nge , t he t h i m bl e c h a m be r s a re u s u a l l y c a l ib r a te d a nd us e d w i t ho ut a b ui l d up c ap . F o r h i g h e r e n er g ie s s u c h a s co b a lt - 60 , a L uc i t e b uil d up c a p i s us e d unl e s s t he c h a m b e r w a l l i s a l rea d y t h i c k e no ug h to p r o v id e el e ct r o ni c eq ui l ib r i um (e . g . , V i c t o re e n h i g h - e n e r gy c h a m b e r s ) . I n e i t he r c a s e , t he c o r r e ct io n t o z e r o w a ll t h i c k n e s s ( s e c ti o n 6 . 4) i s i n h e r e n t i n t he c ha m b e r c a li b r at io n f a c t o r N C .

REFERENCES
1 . In t e r n a t i o n a l C o mm i s s io n o n R a d i a ti o n U ni t s a nd M e a s ur e m e nt s . R a d i at io n q u a n t i ti e s a n d u n i t s . R e p o rt N o . 3 3 . W a s hi ng t o n, D C : IC R U , 1 9 8 0 . 2 . W y c k o f f H O , A t t i x F H . D e s i g n o f f r e e - ai r i o ni z a ti o n c ha m b e r s . N a t i o nal Bur e a u o f S t a n d a r d s H a n d b ook N o . 6 4 . W a s hi ng t o n, D C : U . S . G o v e r nm e nt P r i nt i ng O f f i c e , 1 9 57 . 3 . M a y n e o r d W V . T h e s i g n i fi c a n c e o f t he r nt g e n. A ct a I nt U ni on A g a i ns t C a nc e r 1 9 37 ; 2 : 27 1 . 4 . L o f t u s T P , W e a v e r J T . S t a n d a r d i z a ti o n o f 5. Adams GD. On the use of t him b le
60

C o a nd

137

C s g a mm a - r a y b e a m s i n p ha nt o m s . R a di ol og y

t e r m s o f e x po s u r e . J R e s N a t l B u r S t a nd ( U S ) 1 9 7 4 ;7 8 A ( P hy s C he m ) : 4 6 5 . c ha m b e r s in 1 9 62 ; 7 8 :7 7 . 6 . F a r m e r F T . A s u b s t a n d a r d x - r a y d o s e - m et e r . Br J R a d i ol 1 9 55 ;2 8 : 30 4 . 7. 8. Aird Boag EGA, JW. Farmer FT. The d e s ig n In: of a t hi mb l e FH, c ha m b e r WC, for t he F a r m er d o s im e te r . P h y s M e d B i o l 19 72 ; 1 7 :1 69 . Io ni z a ti o n c h a m be r s A tt i x R oe s c h eds. R a di at io n d o s im e tr y V o l 2 . N e w Y o r k : A c a d e m i c P r e s s , 1 9 6 9 :1 . 9 . J o h n s H E , C u n n i n g h a m J R . T he p hy s i c s o f r a d io lo g y , 4t h e d . S p r i ng f i el d , IL : Charles C Thomas, 1983. 1 0 . F a il l a G . T h e mea s u r e m e n t o f ti s s ue d o s e i n t e r m s o f t he s a m e uni t fo r al l i o n i z i n g r a di at io n s . R a d i ol og y 1 93 7 ; 29 : 20 2 .

WWW.MEDRAD.IR

1 1 . In t e r n a ti o n a l C om m i s s io n o n R a di a tio n U ni t s a nd M e a s ure m e nt s . P hy s i c a l a s p e c t s o f i r r a di a ti o n . R e p o rt N o . 1 0 b . H a ndb o o k 85 . W a s hi ng t o n, D C : N BS , 1 9 6 4 . 1 2 . B o a g J W , C u r r a n t J . C u r r e nt c o l le c tio n a nd i o ni c r e co m bi na t io n i n s m a ll c y l i n d r i c al io n i z a ti o n chambers e x po s ed to p ul s ed r a di a ti on. Br J R a d i ol 1 9 80 ; 5 3 :4 71 . 1 3 . B o a g J W . T h e r e co m bi n a t io n c o r re c ti o n f o r a n io ni z a ti o n c ham b e r e x p o se d t o p u l s e d r a di a tio n i n a s w e p t b e am t e c hni q ue . P hy s M e d Bi o l 1 9 82; 2 7 : 20 1 . 1 4 . A l mo n d P R . U s e o f a V i ct o re e n 50 0 e le c t ro m et e r to d ete r m i ne io ni z a ti o n c h a m b e r c o ll e ct io n e f f i c i e n ci e s . M e d P hy s 1 98 1 ; 8 :9 0 1 . 1 5 . M a t t s so n L O , J o h a n s s o n K A , S v e ns s o n H . C a l i b r a ti o n a nd us e o f p l a ne - p a r al le l i o n i z a ti o n c h a m be r s fo r t h e d et e rm i na ti o n o f a b s or b ed do s e i n e l e ct r o n b e a m s . A c t a R a d io l O n c o l 1 9 81 ; 2 0 :3 8 5 . 1 6 . G e rb i B J , K h a n F M . T h e p ol a r it y e f fe c t fo r co m m e r ci a ll y a v a i l ab l e pl a ne p a r a l le l i o n i z at io n c h a m b e r s . M e d P hy s 1 9 8 7; 1 4 : 21 0 .
1

R o e n tg e n w a s o r i gi n a l l y d e f i n ed a s 1 R = 1 e l e ct r o st a ti c uni t ( e s u) / c m 3 a i r a t te m pe r a t u re and p r e s s ur e ( S TP ) (0C, 760 mm Hg). T he c ur r e nt

standard

d e f i n it io n o f 1 R = 2 . 58 1 0 - 4 C / k g ai r i s eq ui v a l e nt t o t he o r ig ina l i f t he c ha r ge i s e x p re s s e d i n c o u lom b s ( 1 e s u = 3 . 3 33 1 0 - 1 0 C ) a nd t he v o l um e o f a i r i s c h a n g e d t o m a s s ( 1 cm 3 o f a i r a t S T P w e i g hs 1 . 2 9 3 1 0 - 6 k g ) .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 7 - Q uality of X-Ray Beams

7 Quality of X-Ray Beams

In C h a p t e r 5 , w e d e sc r i b ed x - r a y b e a m i n t e r m s o f p hot o n f l ue nc e a nd e ne r g y f l u e n c e . S u c h a d e s c ri p ti o n r e q u i re s t he k no w l ed g e o f t he num be r a nd e ne r g y o f t h e p h ot o n s i n t h e b ea m . In t h i s c ha p te r , w e w i ll c ha r a c te r i z e an x - r a y b e a m i n t e r m s o f i t s ab il it y to p e n e t r at e m at e ri al s o f k no w n c o m p o si ti o n. T he p e ne t r at i ng a b i li t y o f t h e r ad i at io n i s o f t e n d e s c ri be d a s t he q ua l it y o f t he r a d ia t io n. A n i d e al w a y to d e s cr i b e t h e q u a li t y o f a n x - r a y b e a m i s to s pe c i f y it s s pe c t ra l d i s t ri b u tio n , t h a t i s , en e r g y f l u e nc e i n e a c h e ne r g y i nt e r v al a s s ho w n i n F i g . 3 . 9 . H o w e v e r , s p e c t r al d i st r i b ut io n s a r e d i f f i c ul t t o m e a s ur e a nd , f ur t he r m o r e , s uc h a c o m pl e te s pe c i f i c at ion o f t h e b e a m q ua l it y i s no t ne ce s s a r y i n m o s t cl i ni c al s i t u a ti o n s . S i n c e t h e b io lo gi c e f f e ct s o f x - r a y s a r e no t v e r y s e ns i ti v e t o t he q u a l it y o f t h e be a m , in r a d i ot h e r a p y o ne i s i nt e re s t ed p ri m a r il y i n t he p e net r a tio n o f t h e b e am i nt o t h e p a ti e n t r a t he r t ha n i t s d et a il ed e ne rg y sp e c t r um . T hus a c r u d e b u t s i m pl e r s pec i f i c a ti o n o f t he be a m q ua l i t y i s o ft e n us e d , na m e l y t he ha l f value layer.

7.1. HALF-VALUE LAYER

A s d e f i n e d e a r li e r ( C h a p t e r 5 ) , t he te r m ha lf - v a l ue l a y e r ( H V L ) i s t he t hi c k ne s s o f a n a b s o r b e r o f s pe c i fi e d c om po s it io n r e q uir e d to a t te nua t e t he i nt e ns it y o f t he b e a m to ha l f i t s o r i gin a l v a l u e . A l t ho ug h a l l be a m s c a n b e d e s c ri b ed i n t e r m s o f t h e i r H V L , t h e q u a l it y o f a r a y b e am i s us ua l l y s t at ed i n t e rm s o f t he e ne rg y o f t h e r a y s o r i t s n u c l i de o f o ri gi n w hi c h ha s a k no w n e m i s s i o n s p e c t r um . F or e x a m p le , t h e q u a li t y o f a r a y b e a m e m it te d f r o m a
60

Co s o ur c e c a n b e s t a te d i n

t e r m s o f 1 . 1 7 a n d 1. 3 3 M e V ( a v e r a ge 1 . 2 5 Me V ) or si m pl y co b a lt - 60 b e a m . B e c a u s e a ll x - r a y be am s p ro d u c e d b y r ad i at io n g e ne r ato r s a re he t e ro ge ne o us i n e n e r g y , t h a t i s , po s se s s c o n t i n uo us e ne r gy s p e c t r a t ha t de pe nd o n t he p e a k v o l t ag e , ta r g et m at e ri a l , a n d be a m f il t r at io n, t he y a r e us ua l l y d e s c r ib e d b y t he H V L , a s i n g l e p a r a m ete r s p e c i f y i n g t he o v e ra l l pe ne t r at i ng a bi li t y o f t he b e a m . In the case of lo w - e n e r g y f or m o st x-ray b e a ms ( b e lo w m e ga v o lt ag e r a ng e ) , it is c u s t o m a r y to d e s c ri be q u a li t y i n t er m s o f H V L t og et he r w it h k V p , a l t ho ug h H VL a l o n e i s ad e q u a te c li ni c a l a p pl ic a t io ns . O n t he o t he r ha nd , i n t he m e g a v ol t ag e x - r a y r an g e , t h e q u al it y i s spe c i f ie d b y t he pe a k ene r g y a nd r a r el y b y t h e H V L . T h e r e a so n f o r t h i s co nv e nt io n i s t ha t i n t he m eg a vo lt a g e r a nge t he beam is so h e a vi l y f i lt e re d t hr o ug h t he t r a ns mi s s io n t y pe t a r ge t a nd t he f l a t te n i n g f ilt e r t h a t an y a d d it io n a l f il tr a ti on d o e s not si g ni f i c a ntly a l te r t he b e a m q u a l it y o r it s H V L . T h u s f o r a h a r d b e a m w i t h a f i x e d f il t r at io n, t he x - r a y e ne r g y s p e c t r u m i s a f u n c t i on p r i m a r i l y o f t he pea k e ne r g y a nd s o i s t he b e a m q ua l it y . T h e a v e r a g e e n e rg y o f s u c h a b e a m i s a p p r o xi m a te l y o ne t hi r d o f t he p e ak energy.

WWW.MEDRAD.IR

7.2. FILTERS
In s e c t i o n 3 . 5 , w e b r ie f l y d i s c u s s e d t he e ner g y s p e c t r um o f a n x - r a y b e a m . T he x r a y s p r o d u c ed b y a n x- r a y g e n e r a to r s ho w a c o nt i nuo us di st r i b ut ion o f e ne r gi e s o f b r e m s s tr a h l u n g p h o ton s o n w h i c h i s s up e r im p o s ed di s c r et e l i ne s o f c ha r a c t e ri s ti c r a d i at io n ( F i g . 7 . 1 ) . C u r v e A i n F i g . 7 . 1 s c he m a t i c al l y r ep r e sent s t he e ne rg y s p e c t r u m o f a 2 00 - k V p x - r a y b e a m f i l t e re d b y a 1 - m m - t hi c k a l um i num f i l t e r . T hi s d i s t ri b u tio n i n c l u d e s th e e f f e c t s o f a t te nua t io n i n P.98 t h e g l a s s e n v e l op e o f t h e x - r a y t ub e , t he sur r o und i ng o il , a nd t he e x i t wi nd o w o f the tube housing as well. This s o - c al l ed i nhe r e nt f i lt r a ti o n is e q ui v a l e nt to a p p r o xi m a te l y 1 - m m A l i n m o s t x - r a y t ub e s.

F I G . 7 . 1 . S c h e m a t i c g r a p h s h o w i ng c ha ng es i n s p e c t r al di s t ri b utio n o f 2 0 0 k V p x r a y b e a m w it h v a r io u s f i lt e r s . C u r v e A i s f o r A l , c ur v e B i s f o r S n + A l , a nd c ur v e C is for Sn + Cu + Al. T h e K c h a r a c t e ri s ti c x - r a y s p r o d uc e d i n the t ung s t e n t a r g et po s s e s s di s c r ete e n e r g ie s b et w e e n 5 8 a n d 6 9 k e V ( T a b l e 3 . 1 ) . O t he r e m i s si o n l ine s o f t ung s t e n, h o w e v e r , h a v e m u c h l o w e r e n e rg ie s a nd a r e no t s ho w n i n F i g . 7 . 1 b e c a us e t he y a r e e f f e c t i ve l y r e mo v ed b y t h e i n he r e nt f i lt ra t io n a s w e l l a s t he ad d e d f il t ra ti o n. T h e e n e r g y f l u e n c e o f t h e K li n e s o f t ung ste n c a n b e p r e f e re nt i all y r e d uc e d us i ng a t i n f i lt e r . B e c a u s e th e K a b s o r pt io n e d ge o f t i n i s a t ab o ut 2 9 . 2 k e V ( T a b l e 3 . 2 ) , it s tr o n gl y a b s o rb s p h o to n s above 29.2 keV by t he p ho toe l e ct r i c p r o ce s s . H o w e v e r , l o w e r -e n e r gy p h o t o n s c a nno t e j ec t t he K e le c t ro ns . A s s e e n i n c ur v e B o f F i g . 7 . 1 , t he e n e rg y f l u e n c e i n t he r egi o n f r o m 3 0 to 70 k eV i s c o ns id e r ab l y r e d u c e d re l at i v e t o ei th e r t h e h i g he r - e ne rg y p a r t o f t he sp e c tr um o r t he s pe c t r um b e lo w 2 9 k e V . B e c a u se t h e L ab s o rp ti o n edg e o f t i n i s o nl y 4 . 5 ke V , t he r e i s li tt le r e d u c t io n i n t h e s pe ct r u m b el o w 2 9 k e V . In a d d i ti o n t o t he abo v e e f f e ct s , ti n p r o d u c e s it s o w n c h ar a c t e ri s ti c r a di a ti o n by t he p hot oe le c t ri c pr o c e s s i nv o l v i ng t h e K s h e ll , a n d t h es e l i n e s a r e s up er i mp o s ed o n t he s p e ct r um b e lo w t he t i n a b s o r pt io n e d ge .

WWW.MEDRAD.IR

T o a b s o r b p re f e r e nt i all y t h e e n e r g y f l ue nc e b e lo w t he K e d ge o f t in, i nc l ud i ng t he c h a r a c t e r i st i c x - r a y s o f t i n , a c op p er f i lt e r i s q uit e e f f i ci e nt . T he K e d ge o f co p pe r i s a t 9 k e V , a n d t h e re f o r e , t h e p hot o ns bel o w 29 k e V a r e st r o ng l y a b so r b ed b y t h e c o pp e r f il te r a s s ee n i n c u r v e C o f F i g . 7 . 1 T he v e r y l o w e ne rg y c ha r a c t e r i st i c x - r a y s p r o d u c e d b y c o p pe r c a n b e e f f e c t i ve l y a b s o rb e d b y a d ding a n a l um i num f i l te r n e x t t o t h e c o ppe r f i l te r . C o m b i n a ti o n f il te r s co n t a i n i n g p l at e s o f tin, c o p p e r , a nd al um inum ha v e b e e n d e s ig n e d to i n c re a s e t h e r e s u lt i ng ha l f - v a l ue l a y e r o f t he or tho v o l t ag e b e am s w i t h o u t r e d u ci n g t h e b e a m i n t e n si t y t o una c c e p t ab l y l o w v a l ue s . S uc h f i l t e r s a r e c a l l ed T h o r a e u s f i lt e r s ( 1 ) a n d a r e d e s c r i bed i n T a b l e 7 . 1 . It i s im p o rt a nt t ha t t he c o m bi n a t io n f i l te r s P.99 b e a r r a n g ed i n t h e pro p e r o r de r , w i t h t he hi g he s t at om i c num b e r m a t e ri a l ne a re s t t h e x - r a y t a rg et . T h u s a T h o r a e u s f il te r i s i ns e r te d w it h ti n f a c i ng t he x - r a y t ub e a n d t h e a l u m i n u m f a c in g t h e p a ti e nt , w it h the c o p pe r s a nd w i c he d b e t w ee n t he ti n a n d t h e a l u m i n u m p l a te s .

TABLE

7.1.

THORAEUS

FILTERS

USED

WITH

ORTHOVOLTAGE X-RAYS

Filter

C om p os i t i on

Thoraeus I

0.2 mm Sn + 0.25 mm Cu + 1 mm Al

T h o r a e u s II

0.4 mm Sn + 0.25 mm Cu + 1 mm Al

T h o r a e u s II I

0.6 mm Sn + 0.25 mm Cu + 1 mm Al

In t h e d i a g n o s t i c a nd s u p e r f i c i al x - r a y e ne r g y r a ng e ( s e c t io n 4 . 1 ) , p r i m a r il y a l u m i n u m f i l t e r s a r e u s e d t o h a r d e n t he b e a m . T he ha l f - v a l ue l a y e r s o f t he s e beams value are a l so e xp r e s s ed range in te r m s 1 of m i l li m et e r s mm of a lum i num . a nd In t he o r t h o vo lt a g e r a n g e , ho w e v e r , c om b i nat io n f i l te r s a r e o ft e n us e d t o ob t ai n ha l f layers in the o f a b o ut to 4 C u . F o r c e s i um c o b a lt t e le t h e r ap y m a c h i n e s , o n t h e o t he r ha nd , f i l t e r s a re no t ne e de d b e c a us e t he b e a m s a r e a lm o st m on o e n e r g et i c . A l t h o u g h a m e g a v ol ta g e x - r a y b e a m ha s a s p e c t r um o f e ne r gie s , t he b e a m i s h a r d e n e d b y t h e i n h e r e n t f i lt r a tio n o f t he t r a ns m i s s io n t a r g et a s w e l l a s b y t r a n s m i s s io n t h r o u g h t h e f l a tt e n i ng f i lt e r . Thus no a d d i ti o nal f i lt ra t io n i s r eq ui r ed t o i m p ro v e t h e be a m q u a l i t y . It m a y b e m e nt io ne d t ha t t he pr i m a r y p ur p o se o f

WWW.MEDRAD.IR

t h e f l at te n i n g f il te r i s t o m a k e t h e b e a m i nt e ns it y uni f o r m i n c r os s - s e c t io n r at he r t h a n t o i m p ro v e t h e be a m q u a l it y .

7.3. MEASUREMENT OF BEAM QUALITY PARAMETERS A. Half-Value Layer

A s d i s c u s s e d i n s e ct ion 5 . 3 , t h e ha l f - v a l ue la y e r o f a be a m i s r el at e d to t he l i ne ar a t t e n u a ti o n c oe f f i c i e nt ( ) b y t h e f o l lo w i ng e q ua t io n:

L i k e t h e a tt e n u a ti o n c o e f f i c ie n t , t he ha l f - v a l ue l a y e r m us t b e m e a s ur e d und er n a r r o w - b e a m o r go od g e o me t r y co nd it io ns . S uc h a g e o m et r y c an b e a c hi e v ed b y u s i n g a n a r r o w b e a m a n d a l a r g e di s t a nc e b e t w ee n t he a b so r b e r a nd t he d e te c tor s u c h a s a n i o n c h a m b e r ( F i g . 5 . 1 ) . U nde r the s e c o nd it io ns , t he e x p o s ur e r e ad i ng i s m ai n l y a r e s u lt o f t h e p h ot o ns t ha t ar e t r a ns m i tt ed t hr o ug h t he a b s or b e r w i t h o u t i n t e r a ct io n an d p r a c ti c a ll y no s ca t t er e d p hot o ns a r e d e te c te d b y t he c h a m b e r . T h e a tt e n u a t io n d a t a ar e o bt a i ned b y m e a s ur i ng t r a nsm i tt e d e x po s ur e t h r o u g h a b so r b e rs o f v a r y i n g t h i c k ne s s b ut c o ns t a nt co m po si ti o n. T he s e d at a a re t h e n p lo tt e d o n a s e mi lo g a ri t h m i c g r a p h p ap e r to de t er m i ne H V L . If t he b e a m ha s a l o w f il t r at io n o r co n t a i n s a n a p p re c i ab l e am o unt o f lo w - e ne r g y co m po ne nt i n t he s p e c t r u m , t h e sl op e of t h e at te n ua t i o n c urv e d e c re a s e s w i t h i nc r e a s i ng ab s o rb er t h i c k n e s s ( F i g . 5 . 3 ) . T h u s d i f f e r e nt ha l f - v a l ue l a y e r b e a m s c a n b e ob t ai ne d f ro m such a beam a by u s in g d i f f e re n t of f il te r s . In g e ne r a l , t he HVL i nc r e a se s a w it h i n c r e a s i n g f il te r t h i c k n e s s a s t h e be a m bec o m e s i nc r e a s i ngl y ha r d e r , t ha t i s, contains g re a te r p r o po r tio n hi g he r- e ne r g y p hot o ns . Bey o nd c e r t ai n t h i c k n e s s , h o w e v e r , a d d it io n a l f i lt r a ti o n m ay r e s ul t i n s o f t e ni ng o f t he b e a m b y C o m p to n s c a t te r i n g . B e c a u s e a n i n c r e a s e i n f i l t r a ti o n i s a c c o mpa ni e d b y a r e d uc t io n i n t he a v a i l a bl e e x p o s u r e r a te , t h e f i ltr a t io n i s c a r e f ul l y c hos e n t o o bt a i n a s ui t ab le H V L a s w e l l a s a c c e p t ab le b e a m o u t pu t . In a d d i t io n, a s d i sc us s e d i n t he p r e vi o us s e c t io n, c e r t ai n f i l te r s a r e m o r e e f f i cie n t t h a n o t he r s i n s e le c t i ve l y r e m o vi ng l o w- e ne r g y p ho to ns f r o m t h e b e am , i n c l ud i n g c h a r a c te r i st i c x -r a y s w hi c h a r e und e s ir a b l e f o r t he r a p y b e c a u s e o f t h ei r l o w en e r g y .

B. Peak Voltage
N e i t h e r t h e H V L n o r t h e t u be pot e nti a l nor b ot h p ro v i de s uf f i c ie nt i nf o r ma ti o n r e g a r di n g t h e s pe c t r al di s t ri b u ti o n o f t he r a d i at io n. H o w e v e r , fo r mo s t cl i ni c a l p u r p o s e s , t h e s e t wo p a r a m et e r s g i v e a n a p p r op r i at e s p e ci f i c ati o n o f r a di a ti o n q u a l it y . It h a s be e n re c o m me n d e d ( 2 ) t ha t t he q ua li t y o f t he cl i nic a l be a m s i n t he s u p e r f i c i al P.100 and o rt h ov o l t ag e r a ng e be s pe c i f ie d by t he HVL a nd t he kVp in p r e f e r e n c e t o t he H V L a l o n e .

T h e d e t e r mi n a ti o n o f x - r a y t u b e p o t e nti a l i s d i f f i c ul t be c a us e t he hi g h- t e ns io n c i r c u i t s o f m o st x - r a y e q u i p me n t a r e se a l ed a nd he nc e a r e no t e a s i l y a c c es s i ble f o r d i r e ct v o lt a g e mea s u r e m e n t . Ind i r e c t m e t hod s , t he r e f o re , a r e o f t e n us e d t o measure the kVp w it h o u t a pp r o a c h to the hi g h- t e ns io n c i r cui t s . H o w e v e r , i f

WWW.MEDRAD.IR

a c c e s s to t h e h ig h - v ol t a ge t e r mi na l s c a n be a c hi e v ed , di r e ct mea s ur e m e nt s c a n b e m a d e b y p re c i si o n v o l t ag e di v i de r s o r a s p he r e - g ap a p p a r at us .

B.1. Direct Measurement

V o l ta g e D i v id e r . If t h e h i g h - t e n s io n l e a d s o f t he x - r a y t ub e a r e a c c e s s i b le , t he n t h e e f f e ct i v e v o lt a ge a c r o s s t h e t ub e c an b e me a s ur e d d i re ct l y b y a v ol t ag e d i v i de r . T h e v o lt a g e d i v i de r i s a ci r c ui t in w hi c h s e v e r a l hi g h r e s i s t a nc e s a re c o n n e c t e d i n s e ri e s to f o r m a r e si s ta nc e to w e r w hi c h i s p l a ce d a c r o s s t he hig ht e n s io n l e a d s . T h e tot a l po te n t i al i s t hus d i v i de d a mo ng t he s ep a r a t e re s i st e r s . T h e e f f e c t i v e v ol t ag e b e t w ee n a ny t w o p oi nt s i s gi v e n b y t he e f f e c t i v e c ur r e nt t h r o u g h t h e to w e r ti me s t h e r e si s t a nc e b etw e e n t he t w o p oi nt s . T he r a t i o o f to t al r e s i st a n c e to the ou t p u t re s i st a nc e be tw e e n two s el e ct e d p o i nt s gi v e s t he c a l i b ra ti o n f a c t or , w h i c h w h e n m ul t i p li ed by t he o b s e r ve d o utp ut v o lt a g e a c ro s s t h o s e po i nt s g i ve s t h e t ot a l v ol t ag e a c ro s s the v o l t ag e di v i de r . F or f ur t he r d e t ai ls of the m et h o d , the reader is r e f er r e d to Gi l be r t so n a nd F ing e r hut (3) a nd Giarratano et al. (4). S p h e r e - G a p Me t h od . T h e s p h e r e -g a p me t ho d i s o ne o f t he ol de s t me t ho d s o f d e te r m i ni n g t h e k V p . E a c h h i g h - v o l t a ge l e ad o f t he x - r a y t ube i s c o nne c t e d to a p o li s h e d m et a ll i c sp h e r e b y a c a bl e ad a pt e r . T he d i st a nc e bet w e e n t he t wo s p h e r e s i s re d u c ed u n t il a n e l e ct ri c s p a r k pa s s e s be t w ee n t he m . By k no w i ng t he c r i ti c a l di st a n c e , c o r re c t ed f o r ai r d e ns it y a nd hum i d i t y , o ne ca n c a l c ul a t e t he p e a k v o l ta g e a c ro s s th e x - r a y t u b e .

B.2. Indirect Measurement

F l u o r e s ce n c e M e t ho d . T h e f l u o r e s c e nc e m et ho d i s b a se d o n t w o p r i nc ip l e s ( 5 ) . F i r s t , t h e pe a k p h o ton e n e r g y i s g i v e n b y t he p e a k p ot e nti al , i . e . , hv m a x i n k e V i s numerically phenomenon of the K 7.2 e q u al in to the K kVp. o rb it S e c o nd , K edge a b s o rp ti o n is a t hr e s ho l d w h i ch f l uo r e s ce nc e by us i ng ( c ha r a c te r i st i c m a t e r i al s of for x-ray p r od uc t io n) di f f e r e nt K A

o c c u r s w h e n t h e p h o t o n e n e r g y i s j us t e q ua l t o o r g re a te r t ha n t he b i nd i ng e ne rg y shell el e ct r o n . an Hence, s e ve r a l t he a b s o r pt io n e d ge s , o n e c a n c a l i b r a te t he k V p d i a l o n t he m a c hi ne . Figure i ll u s t r at es e x p e ri m e nt a l a r r a ng e m e nt p r o ce d ur e . s e c o n d a r y r a di a to r (a t t e n u a to r ) , t he K ab s o r pt io n e dg e o f w hi c h i s a c c ur a t el y k n o w n , i s p l a c e d at an a n g l e o f 45 de g r ee s t o t he c e nt r al a x i s o f t he b e am . W hi l e o n e io n i z a ti o n c h a m be r , pl a c e d be hi nd t he r a d i at or , m e a s ur e s the t r a ns m it te d x r a y s , a s e c o n d c h a m b e r , p l a ce d a t a n a ng l e o f 9 0 de g r ee s to t he b e a m a x i s , m e a s u r e s s c a tt e r ed an d f l u o r e s c e nt r a di at io n. T hi s c ha m b e r i s s hi e l de d to p re v e nt t h e r e c ep ti o n o f r a dia t io n o t h e r t ha n t ha t f r o m t he r ad i at o r . F ur t he r m o r e , a d i f f e r e n ti a l f il te r ( l o w Z a b s o r b e r ) i s us e d i n f r o nt o f t hi s c ha m b e r t o m i ni mi z e t he e f f e c t o f lo w - e n e r g y sc a t t er e d x - r a y s . When the tube v olt ag e i s b el o w t he K e d ge , b ot h t he t r a ns m i tt e d a nd t he s c a t te r e d ra d i at io n i nc r e a s e at a f a s t er r at e . Be c a us e o f a s udd e n i nc r e a se i n a b s o r pt io n a t a n d b e yo n d t h e K e d ge , t he t ra ns m i t te d r a di a ti o n de c r e a s e s a nd t he s e c o n d a r y r a di a ti o n in c r e a s e s a s a r e s ul t o f t he p ro d uc ti o n o f c ha r a c t e r i st ic f l u o r e s c e n t r a di a ti o n . T h u s , i f t he r a ti o o f t he t r a ns m it te d to t he s e c o nd ar y r a d i at io n i s pl ot te d aga i n s t t h e t ub e p ot e nt ia l , a b r e a k i n t he c urv e i s o b se r v e d a t t h e K e d g e t h r e s ho l d ( F i g . 7 . 3 ) . T he a p p l ied k V p a t t ha t p o i nt i s num e r i c a l l y e q ual t o t h e K ed g e a bs o r ptio n e n e r g y e x p r e s s ed in k e V .

WWW.MEDRAD.IR

A t t e n u a ti o n M e t ho d . Th e a t t e n u a ti o n m et hod , d e s c r ib e d b y M o r g an ( 6 ) a nd N e w e l l a n d H e n n y ( 7 ) , i s b a s e d o n t h e ob s e r v at io n t ha t t he s lo pe o f t he t r a ns m i s si o n c u r v e o f a n x - r a y b e a m a t h i g h f i lt r a ti o n d e pe nd s o n t he p e a k k i l o v ol t ag e . T he a p p a r a t u s co n s i s t s o f a d e te c to r s uc h a s a n i o n c ha m b er w i t h t w o c a p s o f c op p er or a l u m i nu m of different t h i c k ne s s e s . The i ns t r um e nt is f i rs t c a l ib r a te d by d e te r m i ni n g t h e r a ti o o f t h e de t e cto r r e spo ns e w it h t he t w o c ap s i n pl a c e a s a f u n c t i o n o f k V p o f x - r a y b e a m s p r o d uc ed b y a P.101 g e n e r a to r o f a c c u r a tel y k n o w n p e a k p o t e nti a l s . A c c o r di ng l y , a n unk no w n k V p o f a n x - r a y b e a m c a n b e e s t im a te d f r o m t he c a l i b r at io n c ur v e b y d e t e rm i ni ng t he r a t io o f t h e de te c to r re s p o n s e f o r t he s a m e t w o c a p s . T hi s m et hod , ho w e v e r , has a l i mit e d a c c u r a c y a n d d e pe n d s st r o ngl y o n t he w a v e f o r m o f t he x - r a y t ub e p o te n t ia l .

FIG.

7.2.

E x p e r i m en t a l

a r r a n g e me nt

fo r

m e a s ur i ng

t ub e

v o l t ag e

by

f l u o r e s c e n c e me t ho d . C h a m b e r 1 m e a s ure s r a d i at io n t r a ns m itt e d t hr o ug h t he a t t e n u a to r a n d c h a mb e r 2 me a s ur e s c ha ra c t e ri s ti c a s w e ll a s s c a t te r e d x - r a y s . T h e f i l t e r i n f r o n t o f c h a m b e r 2 a b s o rb s m o s t o f t he s c a tt e re d ra d i a tio n f r o m t he a t t e n u a to r . P e n e t r a m et e r . The o p e r at io n of t he pe ne t r a me te r c o ns i st s of c o m p a ri ng

t r a n s m i s s io n t h r o u g h t w o m at e ri a l s w it h x - ra y a b s o rp ti o ns t ha t cha ng e d i f f e re nt l y w i t h p h o to n e n e r g y . T h e o r i gi n a l pe ne t ram e t er w a s d e si g ne d b y Be no i s t (8 ) i n 1 9 01 . T h e d e si g n w as o pt i mi z e d i n 19 6 6 b y S t a nto n e t a l . (9 ) . T he i r de v i ce c o n s i s t s o f a r e ct a n g ul a r c e nt r a l r e f e re nc e b l o c k o f p ol y e t hy le ne , o n bot h s i de s o f w h i c h a r e i d e n t i c al m et a l s te p w e dg e s . A l umi num w e d g e s P.102

WWW.MEDRAD.IR

a r e r e co m m e n de d fo r t h e lo w k il o v ol t r a ng e a nd br a s s w e dg e s f o r t he hi g he r k i l o vo lt . T h e c e n t r a l po l y et h y l e n e bl o c k i s sur r o und e d o n i t s si des b y l e a d s c a tt e r shields.

F I G . 7 . 3 . P l ot o f t he t r a n s m it t ed ( c ha m b e r 1 r e ad i ng ) to s ca t t er e d r ad i at io n ( c h a m b e r 2 r e ad i n g ) a s a f u n c t i o n o f t ub e k i l o vo lt a g e . T he di s c ont i nui t y o c c ur s i n t h e c u r v e at t h e t u b e v o lt a g e n um e r i c al l y e q ua l t o t he K e d ge t hr e s ho ld o f t he a t t e n u a to r . F o r k i l o vo lt a ge m e a s u r e m e n t , t h e p e ne t r a me t e r i s r a d io g r a p hed in t he b e a m w i t h h e a v y f i l t r at io n a n d s c a t te r s h ie l di ng . T he op ti c a l de ns i t y r a ti o s o f ad j a c e nt w e d g e a n d re f e r e n ce a r e a s a r e u s ed to ob ta i n t he m a t c hi ng st ep p o si ti o n. If t he instrument has be e n c a l i br a t ed a g ai ns t k no w n p o t e nti a l s , t he d e si r ed peak v o l t ag e c a n b e r e a d f ro m t h e c a li b r at io n c ur v e . A n o t h e r p e n e tr a m et e r i s k n o w n a s t he A r d r a n- C r o o k s c a s s e t te ( 1 0 ) . T hi s d e v i ce c o n s i s t s o f a f i l m w h i c h i s c o v e r e d p a rt l y w i t h a s l o w i nt e ns i fy i ng s c r e e n a nd p a r t l y w it h a f a s t s c r e e n . A c o p p e r st e p s y s t e m i s s up e ri m po se d o n t he f a s t s c r e e n , w h i l e t h e s low s c r e e n i s k e pt unc ov e r e d t o s e r v e a s a re f e r e nc e . A s hee t o f le a d a ll o w s o n l y sm a l l ( 0 . 5 - c m di a m et er ) b e a m to p a s s t hr oug h e a c h c op p er s t e p a n d t h e u n c o v e re d s lo w s c r e e n. W he n a r a d i o gr a p h i s t a k en, t he m a t c h o f a step de n s i t y with th e reference curve, d e pe nds can on t he k i l o v ol t age . t he d e si r e d By us i ng an A a p p r op r i at e c al ib r a tio n o ne d e te r m i ne ki lo v o lt s .

c o m m e r ci a l v e r s io n o f t h e A r dr a n - C r o o k s pene t r a m et e r i s k no w n a s t he Wi s c o ns i n T e s t C a s s e tt e . 1

C. Effective Energy
B e c a u s e x - r a y b e a m s u s e d i n r ad io lo g y a re a l w a y s he t e ro ge ne o us i n e ne rg y , it i s c o n v e n i e n t so m et i me s t o e x p r e s s t he q ua lit y o f a n x - r a y b e am i n t e r m s o f t he e f f e c t i v e e n e r g y . T h e e f f e c ti v e (o r eq ui v a le nt ) e ne rg y o f a n x -r a y b e a m i s t he e n e r g y o f p h ot o n s i n a m o n o e n e rg et i c be am w hi c h i s a t t e nua te d a t t he s a m e r at e a s t h e r ad i at io n i n q u e s t io n . S i n c e t he at tenua t i o n c ur v e f o r a gi v e n m a te r i al i s c h a r a c t e r i z ed b y t h e s l o pe o r t h e l i ne a r att e nua t io n c o e f f i ci e nt ( ) , t he e f f e c t i v e e n e r g y i s d et e r mi n e d b y f i n d i n g t he e ne r g y o f m o no e ne rg e ti c p ho to ns w hi c h ha v e

WWW.MEDRAD.IR

t h e s a m e a s t h e g i ve n b e a m . In g e ne r a l , ho w e v e r , t he o r t he e f f e c t i v e e ne rg y o f a h e t e r og e n eo u s b ea m v a r i e s w i t h t he a bs o r b e r t hi c k ne s s ( F i g . 5 . 3 ) . B e c a u s e a n d H V L a re i n te r r el a te d ( E q uat io n 7 . 1 ) , t he e f f e ct i v e e ne r g y m a y a l so b e d e fi n e d a s t h e e n er g y o f a m o no e ne rg e ti c p ho to n b e a m ha v i ng t he s a m e H VL a s t h e g i v e n b e a m . Fi g u r e 7 . 4 s ho w s t he r e l at io ns hi p b et w e e n e f f e c t i v e e ne r g y a n d h a l f - v a l u e l a y e r f o r x - r a y b e a m s i n the s up e r f i c i al a nd o r tho v o l t ag e r a nge . T h e s e d a t a w e r e c al c u l a t ed b y u s i ng E q ua t i on 7 . 1 P.103 t o o bt a i n a n d f i n din g t h e e n e rg y o f a m o no e ne rg et i c p ho ton b e a m w it h t he s a m e g i v e n i n t h e A p p e n di x .

FIG.

7.4.

P l ot

of

ef f e c t i v e

e n e rg y

as

f unc t i o n

of

ha l f - v a l ue

layer.

Data

c a l c u l a te d f r o m a tt e nu a t i o n c oe f f i c i e nt s o f m o no e ne rg et i c p hot o n b e a m s . A l t h o u g h le a d i s c o mm o n l y u s e d to e xp r e ss ha l f - v a l ue l a ye r s f o r t he me g a v olt a ge b e a m s , it i s n ot n e c e ss a r i l y t h e be s t c ho i c e f o r c ha r a c t e ri z i ng t he b e a m q ua l it y i n t h i s e n e r g y r a n g e . It h a s b e e n s ho w n t ha t t he l o w at o mi c num b er m a t e ri a l s s uc h a s w a t e r a re m o re s en s i t i v e t o c ha ng e s i n s p e c t r al q ual it y o f m eg a v o lt a g e x - r a y s t h a n t h e h i g h a t o m i c n u m b e r m a t e ri a l s s uch a s l e a d ( 1 1 ) . T hi s c a n b e s e e n i n F i g . 7 . 5 i n w h i c h H V L i s plo tt e d a s a f unc t i o n o f p e a k p hot o n e ne rg y . T he H V L i n t e r ms o f l e ad b eg i n s to de cr e a s e w it h i nc r e a s e in e ne r g y b e y o nd ab out 2 0 M V . T hi s i s because the mass at t e n u a ti o n c oe f f i c ie nt of lead f i r st d e c rea s e s a nd t he n i n c r e a s e s wi t h i n c r e as e i n e n e r g y , w he r e as f o r w a te r i t m o no toni c a l l y d e c re a s e s ( s e e s e c tio n 5 . 1 0 ) .

D. Mean Energy
The s p e c tr a l d i st r ibu t i o n of a r ad i at ion field ( p a rt i cl e s or p hoto ns ) is c h a r a c t e r i z ed b y t h e d i s t ri b u tio n o f f l ue nc e o r e ne r g y f l ue nc e w i t h r e s pe c t to e n e r g y . S u p p o s e ( E ) d e n o te s f l ue nc e o f p ho to ns w i t h e ne r g y be t w e e n 0 a nd E . T h e d i f f e r e n t i al di s t ri bu t i o n ( E ) o f t he f l ue nc e w i t h r e s p e ct to e ner g y i s g i v e n b y :

WWW.MEDRAD.IR

T h e p r o d u c t E d E i s th e f l u e n c e o f p ho t o ns w i t h e ne r g ie s l y i ng bet w e e n E a nd E + d E . T h e t o t a l f l u e n c e ( ) i s g i v e n b y :

T h e m e a n e n e r g y o f a p h o t o n b e a m c a n be c a l c ul a te d a s :

P.104

T h e m e a n e n e r g y c a n a l s o be c a l c ul at e d f r om t he e ne r g y f l ue nc e ( E ) d i s t ri b uti o n.

T h e a b o v e t w o e x p re ss i o n s , h o w e v e r , l e a d t o di f f e r e nt v a l ue s o f b e c a us e E E . T h u s i t i s im p o rt an t to s pe c i f y t he t y pe o f di s t ri b uti o n us ed in c a l c ul a ti ng t he mean energy.

F I G . 7 . 5 . H a l f - v a l u e l a y e r a s a f unc t i o n o f p e a k p hot o n e ne rg y f o r w a t e r a nd l e a d . No t e: S i n c e t h e se d a t a w e re c a l c ul at ed f r o m t hi n-t a r g et S chi f f ( 1 2 ) s p e ct r a , H V L v a l u e s p lo tt ed h e r e a r e sl ig ht l y l o we r t ha n t ho se m e a s ur e d i n p r a c ti c a l r a d io t h e r ap y m a c h i n es . ( D a t a f ro m N at h R , S c hul z R J . O n t he c ho i c e o f m a te r i al f o r h a l f - v a l u e - l a y e r me a s u r e m e n t s f o r m eg av o l t ag e x - r a y s . M e d P hy s 1 9 7 7 ; 4 : 13 2 , w i t h p e r mi s s io n . )

WWW.MEDRAD.IR

7.4. MEASUREMENT OF MEGAVOLTAGE BEAM ENERGY

T h e c o m p le te e n e rg y s p e c t r u m o f a m e g a vo lt a g e x - r a y be a m c an b e o bt a i ned b y c a l c u l a ti o n s p e c t ro m et r y using th i n t a r g et and b r e m s str a hl ung p ho t o a ct iv a t i o n spectra ( 15 ) . ( 12 ) , However, s c i nti ll a ti o n for t he ( 1 3 ,14 ) ,

c h a r a c t e r i z at io n o f a m e g a v o lt a g e x - r a y b e a m b y a s i ng l e e ne r g y p a r a m et e r , n a m e l y , b y it s m a x im u m e n e r g y , o ne nee d s to d et e r mi ne t he e ne r g y o f t he e l e ct r o n be a m b e fo r e i n c i d e n c e o n t he t a rg e t . S e v e r al m et ho d s f o r d e te r m i ni ng t h i s e n e r g y a r e di s c u s s e d i n C h a p t e r 14 . T h e m o s t p r a ct i c al me t h o d o f d et e r mi ni ng t he me g a v ol t ag e b ea m e ne r g y i s b y m e a s u r i n g pe r c e n t d ep t h do s e di s tr i b ut io n, t i s s ue - ai r r at io s , o r t i s s ue - m a x im um r a t io s ( C h a p t e r 1 0 ) an d c o m p a r i ng t he m wi t h t he p ub li s he d d ata s uc h a s t ho s e f r o m t h e H o s pi t al P h y s i c i s t ' s A s s o ci a ti o n (1 6 ) . A l t ho ug h c li ni c a ll y r e l e v a nt , t he m e t h od is only a p pr o x i m at e s i nc e d ep th dose d i s t ri b uti o ns are r e l a ti v e l y i n s e n s i ti v e to s m a l l c ha n g e s i n t h e p e a k e ner g y . A s e n s i ti v e m et h o d o f m o n it o ri n g x - r a y b e am s p e ct r a l q ua l it y has b e e n p r op o se d b y N a t h a n d S c h u l z ( 1 7 ) a n d i s r e f e r re d t o a s t he p ho to a c ti v at io n r a ti o ( P A R ) m e t h od . T h e b a si c pr o c e d u r e i nv ol v e s i r ra d i a ti ng a p ai r o f f oi l s t ha t ca n b e a c t i v a te d b y t h e p h oto d i si n t eg r a tio n p r o ces s ( s e c ti o n 2 . 8 F ) . T he c ho i ce o f f o il s m u s t b e s u c h t h a t o n e o f t h e m i s se ns i ti v e t o hi g he r e ne r g ie s tha n t he o t he r i n the energy s pe c t r um of the x-ray be a m . After i rr a d i atio n, t he i nd uc e d r a d io a c ti v i t y i n t h e fo il s i s m e a s ur ed us i ng a s c i nt il l at io n c o unt e r . T he r a ti o o f i n d u c e d a c ti v i ti e s gi ve s t h e P A R w hi c h c a n b e r e l at ed to t he p e ak p ho t o n e ne r g y . T h e P A R m e t h o d p ro vi d e s a mo r e se ns it i v e m e t hod o f m e a s uri ng x - r a y s p e c t r al q u a l it y t h a n t h e c o n v e n t i o n a l me t hod o f m e as ur i ng H V L i n w a t e r .

7.5. MEASUREMENT OF ENERGY SPECTRUM

A l t h o u g h t h e H V L i s a p r a c t i c al p a r a m et e r cha r a c t e r i z i ng t he r a peut i c b e a m s , it i s o n l y a p p ro x i m at e a n d c a n n o t b e us e d i n s y s t e m s t ha t ar e s e nsi ti v e to s p e ct r al d i s t ri b u tio n o f p h o ton s . F o r e x a m p le , s om e r a d ia ti o n de t e ctor s s ho w a l a r g e v a r i a t io n i n re s p o n s e w i t h d i f f e re nt p ho to n e ne r g ie s ( e .g . , f i l m , di o de s ) , a nd e ve n i o n c h a m b e r s a r e mo re o r l e s s e ne r g y d e pend e nt , d e pe nd i ng o n t he i r de s i g n. In s u c h i n s t a n c e s , s p e ct ra l di s t ri b u ti o n i s t he re l e v a nt p a r a me te r o f b e a m q ua l it y . In t h i s a n d o t h e r i n v e s ti g a ti v e w o r k , i t i s im p o rt a nt to d e te r mi ne e x p e r im e nt al ly s p e c t r al di s t ri b u tio n s o f p h ot o n be a m s . T he r e a r e m a ny r e f e r e nc e s d e al i ng wi t h s p e c t ro m et r y ( 12 , 1 3, 1 4 , 1 5) , a nd t he int e r e st e d r e a de r i s re f e r r e d to t ho s e papers. Only one me t h o d , n a me l y s c i nt il l at io n s p e ct r o me t r y , will be b r ie f l y d e s c r ib e d h e re . T h e s c i n t i ll a ti o n s p e ct r o me te r c o ns i st s o f a c r y s t a l o r p ho s p ho r, us ua l l y s o d i um i o di de , a tt a c h e d t o a p h o to m u lt i pl ie r t ub e ( F i g . 7 .6 ) . W he n a p ho to n b e a m i s i n c i d e nt o n t h e c r y s ta l , e l e ct r o ns a r e ej ec t e d w hi c h t r a v e l i n t he c r y s t a l a nd p r o d u c e io n i z a ti o n a nd e x c it a ti o n o f t he c ry s t a l at o m s . A s a r es ul t , p hot o ns o f e n e r g y i n t h e o p ti c a l o r u l t r a v io le t r e gi o n ar e p r o d uc ed a l o ng t he e l e c t ro n t r a c k s . T h e s e li g h t p h o to n s , o n s t ri k i n g t he p hot os e ns i ti v e s ur f a c e ( p ho to c a t hod e ) o f a p h o to m u l ti pl ie r t u be , e j e ct l o w - e ne rg y p ho to el e c tr o ns w hi c h ar e c ol le c te d a nd m u l t ip li e d ab o u t a mi ll io n t i me s b y t he p hoto m ul ti pl ie r d y no d e s . Thi s r e s ul t s i n a n o u t p u t p u l se w h i c h i s p r o p o rti o na l to t he e ne r g y o f t he o r i g ina l x - r a y p ho t o n e n t e ri n g t h e cr y s t a l . A m u l ti c h a nne l p ul se he i g ht a na l y z e r i s us e d to s or t o ut

WWW.MEDRAD.IR

e l e ct r o ni c a ll y d i f f e re n t - s i z e p u l s e s . E a c h c ha nne l c o r r e sp o nd s to a p a r ti c ul a r i np ut p h o to n e n e r g y a n d ac c u m u l a t e s co unt s o r num b e r o f p hot o ns w i t h a p a rt i c ul ar e n e r g y . T h e s p e c t r um i s t h e n d i sp l a y ed i n t e r m s o f p hoto ns p e r uni t e ne rg y i n t e r v a l a s a f u n c t i o n o f p h o to n e ne r g y ( F i g . 7 . 6 ) .

FIG.

7.6.

Energy

spectrum

of

an

x-ray

beam

d e te r m i ned

by

s c i nt i ll a ti o n

s p e c t ro m et e r ( s h o w n in t h e i n s e t ) . P.105

REFERENCES
1 . T h o r a e u s R . A s t u d y o f t h e i o ni z a t io n m e t ho d f o r m e a s uri ng the i nt e ns i t y a nd a b s o r pt io n 2. of x-rays and of d i f f e r e nt on f i l t er s us e d a nd in t he r a p y . Acta R a d i ol 1 9 32 ; 1 5 [ s u pp l ] . In t e r n a t io n a l Co mm i s s io n R a di a ti o n U ni t s M e a s ur em e nt s . P hy s i c a l a s p e c t s o f i r r a d i at ion . R e p o r t 1 0b . W a s hi ng to n, D C : U . S . N a t io na l Bur e a u o f S t a n d a r d s , 1 96 4 . 3 . G i l b e rt so n J D , F i n g e r h u t A G . S t a nd a r d i z a t i o n o f d i a g no s ti c x - r a y g e ne r a t o r s. R a d i ol og y 1 96 9 ; 93 : 103 3 . 4 . G i a r r at a n o J C , W a gg e n e r R G , H e v e z i J M , e t al . C o mp a r i so n o f v o l ta g e -d i v id e r , m o di f i ed A r d r a n - C r ook s c a s s e tt e a nd G e ( Li ) s pe c t ro m et e r m et ho d s t o de te r m i ne t h e p e a k k i lo v o lt a ge (k V p ) o f d i a g no st i c x - ra y uni t s . M e d P hy s 1 9 7 6 ; 3 :1 4 2 . 5 . G r e e n i n g J . T h e me a s u r e m e n t o f i o ni z ati o n me t hod s o f t he pe a k k i lo v ol t a ge a c r o s s x - r a y t u b e s . B r J A p p l P h y s 1 9 5 5 ; 6 :73 . 6 . M o r g a n R . A s i m p le m e t ho d o f m e a s uri ng p e a k v o lt a ge i n d i ag no s ti c r o e nt g en e q u i p me n t . A J R 1 9 44 ;5 2 : 30 8 . 7 . N e w e l l R R , H e n n y G C . I n f e r e n t i a l k il o v olt m et e r : m e a s uri ng x - r a y k i l o v o lt a ge b y a b s o r pt io n i n t w o f i lt er s . R a d i o lo g y 19 55 ; 6 4: 8 8 .

WWW.MEDRAD.IR

8 . G l a s s e r O , Q u i m b y E H , T a y l o r L S , e t a l . P hy s i c a l f o und a t i o ns o f r a d i ol og y , 3 rd e d . N e w Y o r k : P a u l B . H o e b e r , 19 6 1 :2 41 . 9. Stanton L, Li g h t fo ot DA, M a nn S. A p e ne t r am e te r m et ho d for f ie ld kV c a l i b ra ti o n o f d i ag n o s ti c x - r a y m a c hi ne s . R a d i ol og y 1 96 6 ; 87 : 87 . 1 0 . A r d r a n G M , C r o o k s H E . C h e c k i ng d i a g no s ti c x - r a y b e a m q ua l it y . Br J R a d i o l 1 9 68 ; 4 1 :1 93 . 11. Nath R, Schulz RJ. On t he c ho i c e of m a t e ri a l for ha l f - v a l ue - l a y e r m e a s u r e m e n t s f o r meg a v o lt a g e x - r a y s . M e d P hy s 1 9 7 7 ; 4 : 13 2 . 1 2 . S c h i f f L I. E n e r g y -a n g l e d i st r ib ut io n o f t hi n t a rg et br e m s st r ahl ung . P hy s R e v 1 9 51 ; 8 3 :2 52 . 1 3 . S k a r s g a r d L D , Jo h n s H E . S p e c t r al f lux d e ns i t y o f s c at t er e d a nd p ri m a r y r a d i at io n g e n e r a te d a t 2 5 0 k V . R a d i a t R e s 19 6 1 ;1 4 : 23 1 . 1 4 . E p p E R , W e i s s H . E x p e r i m e nt al st udy o f t he p hot o n e ner g y s p e ct r um o f p r i m a r y d i ag n o st i c x - ra y s . P h y s M e d Bi o l 1 96 6 ; 11 : 2 25 . 15. Nath R, Schulz RJ. D e t e r m i nat io n of hi g h e ne r g y x-ray spectra by p h o to a c ti v a t io n . M e d P h y s 1 9 7 6 ; 3 : 13 3 . 1 6 . H o s p it a l P h y s i c i st ' s A s s o c i at io n. C e nt r a l a x i s d e pt h d o s e d a t a f o r us e i n r a d io t h e r ap y . B r J R a d i ol 1 9 83 ; 17 [ s up pl ] . 1 7 . N at h R , S c h u l z R J . P h o t o a ct i v at io n r a ti o s f o r sp e ci f i c a ti o n of hi g h- e ne r g y x r a y q u a l i t y : p a r t I a n d II. M e d P h y s 1 9 7 7 ; 4 :3 6 .
1

A v a i l a bl e R a di a ti o n M e a s u r e m e n t s , Inc . , M i d d le to n, W i s c o ns i n.

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part I - Abasic Ph ysics > 8 - Measurement of Absorbed Dose

8 Measurement of Absorbed Dose

8.1. RADIATION ABSORBED DOSE
discussed. It was then p oi n t ed o ut t ha t In C h a p t e r 6 , t h e qu a n t i t y e x po s ur e a nd i t s uni t , t he r oe nt ge n ( C / k g ) , w e r e e x p o s ure a pp li e s onl y to x a nd r a d i at io n s , i s a m e a su r e o f i o ni z a t io n i n a ir o nl y , a nd c a nno t b e us e d f o r p hot on e n e r g ie s a bo v e a bo u t 3 M e V . T he q ua nt i t y a b s o r be d do s e ha s b e e n d e fi ne d t o d e s c r ib e t h e q u a n t it y o f r a d i at io n f o r a ll t y p e s o f i o ni zi ng r a di a ti o n, i nc l udi ng c h a r g e d a n d u n c h a r g e d p a r t i cl e s ; a ll m a te r ia l s ; a nd a l l e ne r gi e s . A b s o r be d d o se i s a m e a s u r e o f t h e b io log i c a ll y s i g ni f i ca nt e f f ec t s p r od uc e d b y i o ni z ing r a d i a ti o n. T h e c u r r e n t d e f i ni ti o n o f a b s or b ed do s e , o r s i m pl y d o se , i s t he quo t ie nt d [ w it h b a r a b o ve ] / d m , w h e re d [ w i t h b a r a b o ve ] i s t he m e a n e ne rg y i m p a rt e d b y i o n i z i n g r a di a tio n t o m a t e ri a l o f m a s s d m ( 1 ) . T he o l d uni t o f d o s e i s r a d ( a n a c r o n y m f o r r a d i at io n a b s o r be d do s e ) a nd r e p r e se nt s t he ab s o rpt io n o f 1 0 0 e r g s o f e n e r g y p e r g r a m o f a b s o r bi n g m a t e ri a l .

T h e S I u n i t f o r a b s o r be d d o se i s t he gr a y ( G y ) a nd i s d e f i ne d a s :

T h u s t h e r e l a t io n s h i p b e t w ee n g r a y a nd r a d i s :

or

B e c a u s e g r a y i s a la rg e r u n i t t h a n r a d , t her e i s a p r a c ti c a l d i f f i cul t y i n s w i t c hi ng f r o m r a d to g r a y s . F or i n s t a n c e , i f a p a t ie nt r e c ei v e s t re a t me nt s o f 1 7 5 r a d /d a y , t h e d o s e w il l h a v e to b e r e co r d ed a s 1 . 75 g r a y s . Be c a us e m o s t p e op le p r e f e r n u m b e r s w i t h o u t de c im a l s a s w e l l a s a com m o n r e s i st a nc e to cha ng e t o t he S I u n i t s i n t h i s c o u n t r y , t h e a d op ti o n o f t he S I s y s t e m ha s b e e n d e l a y e d . H o w e v e r , f o r s o me , t h e c h a n g e i s i n e vi t a bl e a nd t he ra d i s r o uti ne l y co nv e rt e d i nto gr a y s . A s u b u n i t , c e n t i g r a y ( c Gy ) , h a s o f t e n b e e n us e d a s b e i ng e q ui v a le nt t o r ad .

8.2.

RELATIONSHIP

BETWEEN

KERMA,

EXPOSURE,

AND

ABSORBED DOSE A. Kerma

T h e q u a n t i t y ke r m a ( K) ( k i n e ti c e ne r g y r e le as e d i n t he m e di um ) i s d e f i ned a s t he q u o ti e n t o f d E t r b y dm , w h e r e d E t r i s t he sum o f t he i ni ti a l k i neti c e ne r gi e s o f a l l t h e c h a r g ed i o n i zi n g p a r t i cl e s ( el e ct r o ns and p o si t ro ns ) l i be r at ed b y unc ha r g ed p a r t i cl e s ( p ho to n s ) i n a m a t e r i al o f m a s s d m ( 1 ) .

WWW.MEDRAD.IR

P.107

T h e u n i t f o r k e r m a i s t h e s a m e a s f o r d o s e , t ha t i s , J / k g . T he na m e o f i t s S I uni t i s g r a y ( G y ) a n d i t s s p e c i al u n i t i s r a d . F o r a p ho to n b e am t ra v e r s i n g a me di um , k e r m a a t a po i nt i s d i re c t l y p r op o rt io nal t o t h e p ho to n e n e r g y f l u e n c e a nd i s g i v e n b y :

where

tr

/ i s t h e m a s s e n e rg y t r a n s f e r c o e f f i ci e nt f o r t he me di um a v e r a g ed o v e r t he

e n e r g y f l u e n c e s p e ct ru m o f p h o t o ns . A s d i sc us s e d i n s e c t io n 5 . 4 ,

where

en

/ i s t h e a v e r a ge d ma s s e n e r g y a b s o r pt io n c o e f f i c ie nt a nd

is

the

average

f r a c ti o n

of

an

e l e c t ro n

e ne r g y

l o st

to

r ad i at i v e

p ro c e s se s .

Therefore,

A m a j o r p a r t o f t h e i n i ti a l ki n e ti c e ne rgy o f e le c t ro ns i n low a t o mi c num b e r m a t e ri a l s ( e .g . , air, water, soft ti s s ue ) is e x p e nd ed by i ne l a s ti c c ol li s io ns ( i o n i z a tio n a n d e x c i t at io n ) w i t h a to m i c e le ct r o ns . O nl y a s m a ll p ar t i s e x p e nd ed i n t h e r a di at i v e c ol li s io n s w i t h at om i c nuc le i ( b r e m s st r a hl ung ) . K e rm a c a n t hus be d i v i de d i nt o t wo p a r t s:

w h e r e K c o l a n d K r a d a r e t h e c o ll i si o n a nd t he r a d i at io n p a r t s o f k e rm a , r e s p e c ti v el y . F r o m E q u a t io n s 8 . 8 a n d 8 . 9 ,

and

B. Exposure and Kerma

In C h a p t e r 6 , t h e q u a n t i t y e x po s ur e w a s d ef i ne d a s d Q / d m w he r e d Q i s t he t ot al c h a r g e o f t h e io n s o f o n e si g n p ro d uc ed i n a i r w he n a ll t he e le c tr o ns ( ne g at r o ns a n d p o si t ro n s ) li b er at e d b y p h ot o ns i n (d r y ) a i r o f m a s s d m a r e co m pl e te l y s t o pp ed i n a i r .

WWW.MEDRAD.IR

E x p o s u r e i s t h e io n i za t io n e q u i v a le nt o f the c o l li s io n k e r m a i n a i r . It c a n b e c a l c u l a te d f ro m K c o l by k n o w i n g t he io ni z a t io n c ha r g e p r od uc e d pe r uni t o f e ne r g y d e po s it e d b y p ho to n s . T h e m e a n e ne rg y r e qui r e d t o p r od uc e a n i on p a i r i n d r y a ir i s a l m o st c o n s t a nt f o r a l l e le c t ro n e ne r gi e s a nd ha s a v a l ue o f

= 3 3 . 9 7 e V / io n p a i r (2 ) . If e i s t he e l e c t ro ni c c ha r g e ( = 1 . 6 0 2 1 0 - 1 9 C ) , t he n

i s t h e a v e r a ge e n e r g y r e q u i r ed p e r uni t c har g e o f io ni z a ti o n p ro duc e d . S i nc e 1 e V = 1.602 10-19 J,

= 33.97 J/C. Exposure (X) is given by:

F r o m E q u a t io n s 8 . 1 0 an d 8 . 1 2 ,

T h e S I u n i t f o r e x po su r e i s C / k g a nd t he sp e c i al uni t i s r o e nt g en ( 1 R = 2 . 5 8 10-4 C/kg).

F I G . 8 . 1 . R e la ti o n s h ip b et w ee n a b s or b ed do s e ( D ) a nd c ol li s io n k e r m a ( K c o l ) f o r a m e g a v ol t ag e p h ot o n be a m . i s t he r a ti o o f a b s o r be d do s e to c ol lis i o n k e r m a . T he p o i nt de s ig n a t ed a s c. e . p . i s t h e c e nte r o f e le c t ro n p ro d uc tio n (s e e t e x t ) . ( F r om L o e v i n ge r R . A f o r ma l i s m f or c a l c ul at io n o f a b s o rb e d d o se to a m e di um f r om p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 8 1 ;8 : 1 , w i t h p e r mi s s io n. ) P.108

C. Absorbed Dose and Kerma

WWW.MEDRAD.IR

R e l a ti o n s h ip b et w e e n a b s o r be d d o se ( D ) a nd t he c ol li s io n p a r t o f k e r m a K c o l is i ll u s t r a te d i n F i g . 8 . 1 w h e n a b r o a d b e a m o f p ho to ns e nt e r s a m e d i um . W he r e as k e r m a i s m a x i m u m a t t h e s u r f a c e a nd d ec r e a s e s w i t h de p t h, the d o s e i ni ti a ll y b u i l d s u p to a m a x i mu m v a l u e a nd t he n d e c r e a s e s at t he s a m e r a t e a s k e r m a . B e f o r e t h e t wo c u r v e s m e e t , t h e el e ct r o n b ui l d up i s l e s s t ha n c o mp l et e , a nd :

w h e r e i s t h e q u ot ien t o f ab s o rb ed do s e at a g i ve n po i nt a nd t he c ol li s io n pa r t o f k e r m a a t t h e s a m e po in t . B e c a u s e o f t h e i n c r e a s i n g r a n g e o f t he e l e ct r o ns , c o m pl et e e le c t ro ni c e q uil i br i um does n ot exist w i th i n m e g a v o l t ag e p ho to n beams. However, c o nc e p t ua ll y e l e ct r o ni c e q u il i b ri u m w o u l d e x i s t i f i t w e re a s s um e d t ha t p ho ton a t t e nua t io n i s n e g l ig ib l e t h r o u g h o u t t h e r e gi o n o f i nte r e st . T he n:

A t d ep t h s g r e at e r t ha n t h e m a x i m um r a ng e o f el e ct r o ns , t he re i s a re g io n o f q u a s i e q u il ib r i u m c a ll ed t h e t r a n s i e nt e le c t ron e q ui l ib r i um i n w hi c h:

In t h e m o ti o n

t r a n s i e n t e q ui li b r i u m of the e l e ct ro n s .

re gi o n, i s g r e at e r t ha n uni t y b e c a us e o f t he t he d os e is b ei ng d ep o si ted by e l e ct r o ns

c o m bi n e d e f f e ct o f a tte n u a t i o n o f t he p hot on b e a m a nd t he p re dom i na nt l y f o r w a r d B e c a us e o r i gi n a ti n g u p s t re a m , o n e c a n t h i nk o f a p oint s o m e w he r e up st r e am a t a di s t a nc e l e s s t h a n t h e m a x i mu m e l e c t ro n r a ng e f r o m w he r e t he e ne rg y i s e f f e c t i ve ly t r a n s p o rt ed b y s e co n d a r y e le c t ro ns . T hi s p o i nt ha s b ee n c a l led t he c e nte r o f e l e ct r o n p ro d u c ti o n ( 3 ) . S i n c e t he e f f e c ti v e c e nt e r o f e l e ct ron p r o d uc t io n i s l o c at e d u p s t re a m re l at i v e t o t h e p oi nt o f i nt e r e st , t he do s e i s g re a t e r t ha n k e r m a i n t h e r e g io n o f t r a n s ie n t e le c t ro ni c e q uil ib ri um . T h e r e l a ti o n s h i p be t we e n a b s o r be d do s e a nd p ho to n e ne r g y f l ue nc e a t a p o i nt w h e r e a t r a n s i e n t el e ct r o n e q u il ib r i um e x i sts i s g i v e n b y :

S u p p o s e D 1 i s t h e do se a t a p oi n t i n s o m e m a t e ri a l i n a p hot o n b e a m a nd a no t he r m a t e ri a l i s s u b s ti t ut ed o f a t hi c k ne s s o f a t l e a st o ne m a xi m um e l e ct r o n r a nge i n a l l di r e ct io n s f r o m P.109 t h e p oi n t , t h e n D 2 , t h e d o s e i n t h e s e c o nd m a t e ri a l , i s r el a te d to D 1 b y :

T h e f a c t o r h a s b e e n c a l c u l a t ed f o r

60

C o a nd o t he r p hoto n e ne r g ie s f o r a i r , w a t e r ,

p o l y st y r e n e , c a r bo n , a n d a l u m i n um ( 4 , 5 ) . T he r e s ul t s s ho w t ha t t he v a l ue o f v a r i e s w i t h e n er g y , n o t me d i u m . A f i x e d va l ue o f = 1 . 0 05 ha s b e e n us e d f or
60

C o i n c o n j u n c t io n w i th i o n c h a m b e r d o s im et r y ( 6 ) .

F o r f u r t h e r d et a il s o f t h e r el at io ns hi p be t we e n a b so r be d d o se a nd k e r m a a nd it s s i g n i f i c a n c e i n do s i met r y , t h e r e a d e r i s r e f er r e d to a p a p e r b y Lo ev i ng e r ( 4 ) .

8.3. CALCULATION OF ABSORBED DOSE FROM EXPOSURE A. Absorbed Dose to Air

WWW.MEDRAD.IR

D e te r m i n at io n o f a b s o r b ed d o se f r o m e x po s ur e i s r e a di l y a c c om p l i s he d und e r c o n d it io n s o f e l e ct r on e q u i l i br i u m . H o w e v e r , f o r e ne r g ie s i n the m e g a v o lt a ge r a n g e , t h e e le c t ro n f lu e n c e p r o d u c i ng ab s or b e d do s e at a po i nt is c ha r a c t e r i st i c o f p h o to n e n e rg y f l u e n ce s om e d i st a nc e up st r e a m . Co ns e q ue ntl y , t he r e m a y b e a p p r e ci a bl e p h o to n att e n u a t io n i n t hi s d i st anc e . T he c a l c ul at io n of a b s o rb e d do s e f r o m e x p o s u r e w h e n r i g o ro u s e le c t ro ni c e qui l i br i um d oe s no t e x is t i s m uc h m o r e d i f f i c u l t , r e q u i ri n g e n e r g y - d ep e n d e nt c o r rec t io ns . T he r e f o r e , t he d e te r mi na t io n o f e x p o s u r e a n d i t s co n v e r s i o n to a b so r be d d o s e i s p r a ct i c al l y l im i te d to p ho to n e n e r g ie s up t o

60

Co .

In t h e p r e s e n c e o f ch a r g e d p ar ti c l e e q ui lib r i um ( C P E ) , d o s e a t a p oi nt i n a ny m e d i u m i s e q u a l t o th e c o l li s io n p a r t o f k e r m a , t ha t i s , = 1 . D o s e to a i r ( D a i r ) u n d e r t h e s e c o n d iti o ns i s g i v e n b y ( s e e E q ua t io n 8 . 1 2 ) :

In s e r t i n g u n i t s

Since 1 rad = 10-2 J/kg,

F r o m E q u a t io n 8 . 2 0 i t i s s e e n t h a t t he r oent g e n- to - r a d co nv e r s io n f a c t o r f o r ai r , u n d e r t h e c o n d it io n s of e l e c t ro n i c e q ui li b ri um , i s 0 . 8 7 6 .

B. Absorbed Dose to Any Medium

In t h e p r e s e n c e o f f u l l c h a r g ed p a rt i cl e equi l i br i um , t he a b so r be d do s e ( D ) t o a m e d i u m c a n b e c al c u l a t ed f r o m t he e ne r gy f l ue nc e a nd t he w e i g ht ed m e an m a s s e n e r g y a b s o rp tio n c o e f f i c ie nt ,

en

/ (i . e . , = 1 i n E q u a t io n 8 . 1 7 ) .

S u p p o s e a i r i s t h e e ne r g y f l u e n c e a t a po i nt i n a i r a nd m e d i s t he e ne r g y f l ue nc e a t t h e s a me po i nt w h e n a m at e ri a l ot he r tha n a i r ( m ed i um ) i s int e r po s e d i n t he b e a m . T h e n , u n d e r c o n d i t io n s o f e le c t ro ni c e q ui li b ri um i n e it he r ca s e , t he d o se to a i r i s r el a t ed to t h e do s e to t h e m ed i um b y t he f o ll o w i ng r el at io ns hi p :

w h e r e A i s a t r a n s m is s i o n f a c to r w hi c h e qua l s t he r at io m e d / a i r a t t he po i nt of i n t e re s t . P.110

F r o m E q u a ti o n s 8 . 1 9 a n d 8 . 2 2 , w e o bt a i n the r e l ati o ns hi p b et w ee n e x p o s ure t o a i r a n d a b s o r b ed d o se to a m e d i u m .

WWW.MEDRAD.IR

A g a i n , i f w e e x p r e s s X i n r o e n t g e ns a nd D m e d i n r a d , w e ha v e :

T h e q u a n t i t y i n b r a c k e t s h a s f r e q ue nt l y bee n r e p r e se nt ed b y t he s y m b ol f m e d so that:

where

T h e q u a n t i t y f m e d o r si m p l y t h e f f a c t o r i s s o m et i me s c a ll e d t he r o e nt ge n- to - r a d c o n v e r s i o n f a c t o r . A s t h e a b o ve eq ua t io n s ug g e s t s , t hi s f a c to r d e pe nd s o n t he m a s s e n e r g y a b s o rp tio n c o e f f i c ie nt o f t he m e d i um r el a ti v e to t he a i r . T hus t he f f a c t o r i s a f u n c t i o n o f t h e m e di u m c o m po s it io n a s w e l l a s t he p hoto n e ne r g y . A l i st o f f f a c to r s f o r w a t e r , bo n e , a nd m usc l e a s a f unc t io n o f pho t o n e ner g y i s g i v e n i n T a b le 8 . 1 . S in c e f o r m at e ri a l s w it h a n a to m i c num b e r cl os e to t ha t o f ai r, f o r e x a m p le , w a t e r a n d s o f t ti s s u e , t he r a tio (

en

/)med/(

en

/ ) a i r v a r ie s s lo w l y w i t h p h ot o n e ner g y (~ 1 0 % v a r i at io n f r o m 1 0 k e V a nd 10

M e V ) , t h e f f a c to r for t h e s e m a te r i al s do es no t v a r y m uc h o v er p r a c ti c a ll y t he w h o l e t h e ra p e u ti c r a ng e o f e n e r gi e s . H o w ev e r , b o ne w it h a hi g h e f f e c t i v e a to m i c n u m b e r n o t o n l y h a s a m u c h l a r g e r f f a ct or b et w e e n 10 a nd 1 00 k e V b ut t he f f a c t o r d r op s s h a r pl y fr o m i t s m a x i m um v alue o f 4 . 2 4 a t 3 0 k e V to a bo ut 1 . 0 a t 1 7 5 k e V . T h i s h i g h p ea k v a l u e a n d r a p i d d ro p o f t he f f a c t o r a r e t he r e s ult o f t he p h o to el e c tr i c p r o ce s s f o r w h i c h t he m a s s e ne r g y ab s o rp ti o n co e f f i c ie nt v a ri e s a p p r o xi m a te l y a s Z 3 a n d 1 / E 3 ( s e e C ha p t er 5 ) . A t hi g he r p ho ton e ne r g i e s w he r e t h e C o m pt o n P.111 p r o c e s s i s t h e o n l y mo d e o f i n t er a c ti o n p o ss i b le , t he f f a c to r s a re a pp r o x im a t el y t h e s a m e f o r a ll m a t eri a l s .

TABLE 8.1. f FACTORS FOR WATER, BONE, AND MUSCLE UNDER CONDITIONS OF CHARGED PARTICLE EQUILIBRIUM

WWW.MEDRAD.IR

f F a c t or Water P h ot on Energy (keV) (Gy kg/C) (rad/R) (Gy kg/C) (rad/R) (Gy k g/ C ) (rad/R) B on e M u sc l e

10

35.3

0.911

134

3.46

35.7

0.921

15

34.9

0.900

149

3.85

35.7

0.921

20

34.6

0.892

158

4.07

35.6

0.919

30

34.3

0.884

164

4.24

35.6

0.918

40

34.4

0.887

156

4.03

35.7

0.922

50

34.9

0.900

136

3.52

36.0

0.929

60

35.5

0.916

112

2.90

36.3

0.937

80

36.5

0.942

75.1

1.94

36.8

0.949

100

37.1

0.956

56.2

1.45

37.1

0.956

150

37.5

0.967

41.2

1.06

37.2

0.960

200

37.6

0.969

37.9

0.978

37.2

0.961

300

37.6

0.970

36.5

0.941

37.3

0.962

400

37.6

0.971

36.2

0.933

37.3

0.962

600

37.6

0.971

36.0

0.928

37.3

0.962

1,000

37.6

0.971

35.9

0.927

37.3

0.962

WWW.MEDRAD.IR

2,000

37.6

0.971

35.9

0.927

37.3

0.962

Data

f ro m

Wyckoff

HO.

( C o m m uni c a tio n . )

Med

P hy s

198 3 ; 10 : 7 15 .

C a l c u l a t io n s a r e b a s ed o n e n e rg y a b so r pt io n c o e f f i ci e nt d a t a f r o m H ub b ell J H . P h o t o n m a s s a t t en u a t i o n a nd e ne r g y - ab s o r pt io n c o e f f i ci e nt s f r o m 1 k e V t o 20 M e V . In t J A p p l R a d i a t Is ot 1 98 2 ; 33 : 12 6 9 .

S t r i c tl y s p ea k i n g , i n t h e C o m pt o n r a nge of e ne r g ie s , t he f f a ct o r v a ri e s a s a f u n c t i o n o f t h e n u m b er o f e l e ct ro ns p e r g r am . S i nc e t he num b e r o f e l e ct ro ns p e r g r a m f o r bo n e i s s li gh t l y l e s s t h a n f o r a i r , w a t e r , o r f a t , t he f fa c t o r f o r b o ne i s a l s o s li g h tl y lo w e r t ha n f o r t h e l a tt e r m ate r i al s i n t he C o mp ton r e g i o n o f t he m e g a v ol t ag e e n e rg ie s. O f c o u r s e , t he f f a c t o r i s no t d e f i ned b e yo nd 3 M e V s i nc e t h e r o e n tg e n i s n o t d ef i n e d b e y o nd t hi s e ne rg y .

C. Dose Calibration with Ion Chamber in Air

A s d i s c u s s e d i n C h a p te r 6 , a c a v i t y io n c ha m b e r i s e x p o s ur e c al ib r a t ed a g ai ns t a f r e e - a i r i o n c h a m b e r o r a s t a n d a rd c a v i t y cha m b e r , und e r c o nd it io ns o f e le c t ro nic e q u i li b ri u m . F o r l o w e r- e n e r g y r a di a ti o ns s uch a s x - r a y b e a m s i n the s up e r f i c i al o r o r t h o vo lt a g e r a n g e , th e c h a m b e r w a ll s a re us ua l l y t hi c k e no ug h t o p ro v i de t he d e s i re d e q u il ib r i u m , an d t h e r e f or e , t he c ha m b e r c al ib r a ti o n i s p ro v i de d w it ho ut a b u i l d - u p c ap . H o w e v e r , i n t h e c a s e o f hi g he r - e ne rg y r a d i at ions s uc h a s f r o m c o b a lt - 60 , a b ui l d - u p c a p i s u s e d o v e r t he s e ns it i v e vo l um e o f t he c ha m be r so t h a t t h e co m bi n e d t h ic k n e s s o f t h e c ha m b e r w a l l a nd t he b uil d - up c a p i s s uf f i c ie nt t o p ro v id e t h e r e q u ire d e q ui li b ri um . T hi s b ui l d - up c ap i s us ua ll y m a d e up o f acrylic (same as P l ex i g l a s , L u c it e , or P er s p e x ) a nd m us t be in place w he n m e a s u r i n g e x p o s u re . S u p p o s e t h e c h a m be r i s e x po s ed t o t he be a m ( F ig . 8 . 2 A ) a nd t he r e ad i ng M i s o b t ai n e d ( co r r e ct e d fo r a i r t em p e r at ur e and p r e s s ur e , s t e m l ea k a g e , c o l le c ti o n e f f i c i e n c y , e t c . ) . T h e e x p o s u r e X i s t he n g i ve n b y :

w h e r e N x i s t h e e xp o su r e c a l i br a ti o n f a c to r f o r t he gi v e n c ha m be r a nd t he gi v e n b e a m q u a l it y . T h e e x p o s u r e t h u s o b t ai ne d i s t he e x p o s ur e a t po i nt P ( c e nt e r o f t h e c h a m b e r se n s i ti ve v o l u m e ) i n f r e e ai r i n t he a b se nc e o f the c ha m b e r ( F ig . 8 . 2 B ) . In o t h e r w o r d s, t h e p e r t u r bi ng i nf l ue nc e o f t he c ha m b e r i s r e mo v e d o nc e t h e c h a m b e r c a li b r at ion f a c t o r i s a p p li ed . C o n s i d e r a sm a ll a m ou n t o f s o f t t i s s ue at p o i nt P t ha t i s j us t la r g e e no ug h to p r o v id e e le c t ro n i c e q ui li b r i u m a t it s c e nt e r ( F i g . 8 . 2 C ) . T he d o s e a t t he c e nt e r o f t h i s e q u il ib r i u m m a s s o f t i s s u e i s r e f e rr e d to a s t he d o s e i n f r e e s p a c e . T he t e rm d o s e i n f r e e sp a c e w as i n t r od u c e d b y J o hns a nd C unni ng ha m ( 7 ) w ho r e l at e d t hi s q u a n t i t y t o t h e do s e in a n e x t e n d e d ti s s ue m e d i um b y m e a ns o f t i s s ue ai r r at io s ( t o be d i s c u s s ed i n C h a p t e r 9 ) .

WWW.MEDRAD.IR

E q u a t i o n 8 . 25 c a n b e u s e d t o c o n v e rt e x p o sur e i nt o do s e i n f r e e sp a c e , D f . s . .

P.112

w h e r e A e q i s t h e t r a n sm i s s io n f a c t o r re p r e se nt i ng t he r a ti o o f t he e ne r g y f l ue nc e a t t h e c e n te r o f t h e e q u i li b ri u m m a s s o f ti s s ue t o t ha t i n f r e e a i r a t t he s a me p o i nt . T h u s , A e q r e p r es e n t s t h e r a t io o f t he e ne r g y f l ue nc e a t p o int P i n F i g . 8 . 2 C t o t h a t a t t h e s a me po i n t i n Fi g . 8 .2 B. F o r c o b a lt - 60 b e a m , A e q i s c l o se t o 0 . 99 ( 7) a n d i t s v a l u e a p p ro a ch e s 1 . 0 00 a s t he b e am e ne r g y d e c re a s e s to t he or t ho vo lt a ge range.

F I G . 8 . 2 . A : C h a m b er w i t h b u i l d - up c a p i s p l a c e d i n a r a d i at io n b e a m a t p oi nt P i n a i r a n d r e a di n g M is o bt a i n ed . B : E x p o s ur e i n f r ee ai r at P is c a l c ul a te d us i ng E q u a t i o n 8 . 27 . C : D o s e i n f r e e s p a c e a t P i s c a l c ul a t ed us i ng E q ua t io n 8 . 2 8 .

D. Dose Measurement from Exposure with Ion Chamber in a Medium

E q u a t i o n s 8 . 27 a n d 8. 2 8 p r o vi d e t he b a si s f o r a b s o r be d do s e ca l c ul a ti o n i n a ny m e d i u m f ro m e x po s u re m e a s u r e me nt i n a i r. S i m i l a r p ro c e d ur e i s v a l i d w he n t he e x p o s u r e m e a s u r e me n t i s m a de w it h t he c ha m b e r i m be d de d i n a m e d i um . Fi g ure 8.3A shows an a r r an g e m e n t in w hi c h the c ha m b e r w it h it s b ui ld - up cap is s u r r o u n d e d b y t h e me d i u m a n d e x po s ed to a p ho to n e ne r g y f lue nc e b a t t he c e n t e r o f t h e c h a m be r ( p oi n t P ) . If t he e ne r g y o f t he b e am i nc i d e nt o n t he c h a m b e r i s s u c h t h a t a s t a t e o f e l e ct ro ni c eq ui l ib r i um e x is t s w it hin t he a i r c a v i t y , t h e n t h e e x po s u r e at p o i nt P , w i t h t he c ham b e r a nd t he b uil d - up c a p r e mo v e d , i s given by: X = MNx T h e e x p o s u r e t h u s m e a s u r e d i s d e f i ne d i n f r e e a i r a t po i nt P d ue t o e ne rg y f l u e n c e c t h at w o u ld e x i s t at P i n t he ai r- f i l le d c a v it y o f t he si z e e q ual to t he e x t e r n a l d im e n s io n s of t h e b u il d up c a p ( Fig . 8 . 3 B) . T o c o nv e rt t hi s e x po s ur e to a b s o r be d d o se a t P i n t h e me d i u m , t he a i r i n t he c a v it y m us t b e r e pl a c e d b y t he m e d i u m ( F ig . 8 . 3 C ) a n d t h e f o l lo w i ng e q uati o n i s a p pl ie d :

WWW.MEDRAD.IR

Dmed = XfmedAm or

w h e r e A m i s t h e t r a n s m i s s io n f a c t o r f o r t he p ho t o n e ne rg y f l ue nc e a t po i nt P w he n t h e c a v i t y i n F i g . 8 .3 B i s r e p l ac e d b y t he med i um . If m i s t he e ner g y f l ue nc e a t P in the m e di u m , the factor Am is gi v e n by m/c a nd ha s been c a ll e d a d i s pl a c e me n t f a c t o r . T h e a b o v e e q u at io n i s s i m i la r to E q ua t io n 8. 2 8 e x c e pt t ha t A m i s us e d i ns t e ad o f A e q . Ho w e v e r , t h e di f f e r e n c e b e t we e n A m and A e q i s s m a ll f o r a t i s s ue e q ui v a le nt medium since P.113 t h e e q ui li b r i u m m a s s o f t i s s u e to w hi c h A e q a p p li e s i s o nl y s l ig htl y s m a l le r t ha n t h e m a s s o f t h e me di u m d i sp l a ce d b y a t y p i ca l s m al l io n c ha m b e r w i t h it s b ui ld - up cap.

F I G . 8 . 3 . A : C h a m b er w i t h b u i l d - up c a p w i t h i t s ce nt e r a t po i n t P i n a m e di um , e x p o s ed to a p h ot o n b e a m w h o s e e ne r gy f l ue nc e i s b at P . R e a d i ng M i s o b t ai n e d . B : E x p o s u r e a t P i n a i r c a vi t y o f s i z e eq ua l t o t he e x t er na l d i me ns io ns o f t h e b u i ld - u p c a p i s c a l c u l a te d . E ne r g y f lue nc e a t P i s c . C : A b s o r be d do s e at p o i nt P i n t h e m e di u m i s c al c u l a te d b y E q uat io n 8 . 29 . m i s t he ene r g y f l ue nc e at P. A n i n t e r e st i n g q u e st ion a r i s e s i n r eg a r d to the ne c e s s it y o f t he b ui l d - up c a p b ei ng l e f t o n t h e c h a m be r wh e n m a k i n g m e a s ur eme nt s i n a m ed i um . If the c ha m b e r ha s b e e n c a l ib r a te d f o r e xp o s u r e i n a i r w i t h it s b ui l d - up c a p o n ( t o a chi e v e e le c t ro ni c e q u i li b ri u m ) a n d i f a s i g n i f i c a nt p a rt o f the c a v i t y io ni z a ti o n i s t he r e s ult of e l e ct r o n s p ro d u c ed i n t h e b u i ld - up c a p , t he n r e p l a ci ng t he b ui l d- up c a p w i t h t he m e d i u m c o u ld , i n g e ne r a l , al te r t he c ha m be r r e ad i ng . T hi s s ub s ti t uti o n o f a l a y er o f m e di u m f o r t h e b u i l d - u p c ap c o uld c ha ng e t he e le c t ro ni c a nd p ho to n f l ue nc e i n c i d e nt o n t h e c h a m b e r w a ll b y v i rt ue o f d i f f e r e nc e s i n t he com p o si ti o n o f t he m e d i u m a n d t h e m a te r i al o f t h e b ui ld - up c a p . H o w e v e r , i n p r ac t i c al c a li b r at io n

WWW.MEDRAD.IR

m e a s u r e m e n t s , n o s i gn i f i c a n t d i f f e r e nc e s ha v e b e e n o b s e r ve d w he n e x p o s i ng t he c h a m b e r i n w a te r w ith a n d w i t h o ut t he L uc i t e b uil d - up c ap . D a y e t al . ( 8 ) ad de d P e r s p e x s h e a t h s u p t o 5 m m i n t hi c k ne s s t o a Ba l d w i n- F a r m e r i o ni z a t io n c ha m b e r i r r a di a te d at a de pt h o f 5 c m i n a w a te r p ha nt o m us i ng r ad i at io ns f r o m M V . T h e r e a d i n g s d i f f er e d b y l e s s t ha n 0 . 5 %.
137

C s to 6

8.4. THE BRAGG-GRAY CAVITY THEORY

A s d i s c u s s e d e a r li e r , c a l c u l a t io n o f a b s o rb e d do s e f r o m e x po sur e i s s ub j e c t to s o m e m a jo r li m it at io n s . F o r i n s t a nc e , i t m ay no t b e us e d f o r p ho to ns a b o v e 3 M eV a n d m a y n o t be u s ed i n c a se s w he r e el ec t r o ni c e q ui li b r i um do e s no t e x i st . In a d d it io n , t h e te r m e x p o s u r e a pp li e s o nl y to x a nd r a d i a ti o ns a nd f o r t hat r e a so n m e t h od s o f se c ti o n 8 . 3 a r e no t v al i d f o r p a rt i cl e d o si m et r y . T he Br a g g - G r a y c a v it y t h e o r y , o n t h e ot h e r h a n d , m a y b e us e d w i t ho ut s uc h r e s t ri c tio ns t o c al c ul at e d o s e di r e ct l y f r o m io n c h a m b e r m e a s ur e m e nt s i n a m e d i um . A c c o r d i n g t o t h e B r a gg - G r a y t h e o r y ( 9 , 1 0 ) , t he i o ni z a tio n p r o d uce d i n a g a s - f i ll ed c a v i t y pl a c e d i n a m ed i u m i s r el a te d t o t he e ne rg y a b so r b ed i n t he s ur ro und i ng m e d i u m . W h e n t h e ca v i t y i s s u f f i c ie nt l y sm a l l so t ha t i t s i nt rod uc t io n i nto t he m e d i u m do e s n o t al te r t h e n u m b e r o r d i st r i b ut io n o f t he e l e ctr o ns t ha t w o ul d exist in the me d i um w i t h o ut t he c a v it y , t he n t he f ol lo wi ng Br a g g - G r a y r e l at io n s h i p i s s a ti s f i ed :

w h e r e D m e d i s t h e a b so r b ed do s e i n t he m ed i um ( i n t he a b se nc e o f t he c a v it y ) , J g i s t h e io n i z a ti o n c h a r ge o f o n e s ig n p r od uc ed p e r uni t m a s s o f t he c a v i t y g a s , a nd (

/ ) g m e d i s a w e i g ht e d m e a n r a ti o o f t he m a ss s t op pi ng po w e r o f t he m ed i um t o t ha t o f t h e g a s f o r t h e el e ct r o n s c r o s si ng t he c a v i t y . T he p r o d uc t o f J g (

) i s t h e e n e r g y a b s o rbe d p e r u n i t m a s s o f t he c a v i t y g a s . The basic B r a g g - G ra y and r e l at io n s hi p ha s b ee n of t he c a r e f ul l y t heo r y e xa m i ne d ha v e been by m a ny i n v e s t ig a to r s s ev e r a l m od i f i ca ti o ns p ro po s ed

( 1 1 , 1 2 ,1 3 , 14 ) . T h e s e r e f i n e m e n t s r e s ult ed i n m o re de t ai le d c o ns i d er a ti o ns o f w h a t i s a p p r op r i at e to u s e f o r t h e m a s s s t o pp i ng p o we r r a t io i n E qua t i o n 8 . 30 .

A. Stopping Power
T h e t e r m st op p i n g po w e r r e f e r s to t he ene r g y l o s s b y e le c t rons p e r uni t p at h l e n g t h o f a m a t e ri a l ( f o r g r e a te r d et a il s , s e e s e c ti o n 1 4 .1 ) . A n e x t e ns i v e s et o f c a l c u l a te d values of mass s t o p pi ng po w e r s ha s been p ub li she d ( 1 5 , 16 ) . As m e n t io n e d e a rl ie r , t o u s e s t o p p i ng po w e r r a t io s i n t he Br a g g - Gr a y f o r m ul a , i t i s n e c e s s a r y t o d et e r min e a w e i g h te d me a n o f t he s to pp i ng p o we r r a ti o s fo r t he e l e ct r o n sp e ct r u m se t in m ot io n by t he p hot o n sp e c tr um in t he m at e ri a l s c o n c e r n e d . M et h o d s f or c a l c u l a ti n g a v e r a ge s t o pp i ng p o w e r s ( S ) fo r p hot o n b e am s h a v e b e e n p u b l i s h ed ( 1 7 ) . S e v e r a l a u t h o r s h a v e w o r k e d o u t t he t heor y o f t he s t op p i ng p ow e r r a t io f o r a n a i r - f i ll ed c a v it y i n a m e d i u m s u c h a s w a te r und e r el e ct r o n i r ra d i a tio n. A g oo d a p p r o xi m a ti o n

WWW.MEDRAD.IR

P.114 i s p r o v id ed b y t h e S p en c e r - A t t i x f o r m ula ti o n ( 1 1 , 1 8 ) :

w h e r e ( E ) i s t h e di s t ri b u ti o n o f el e ct r on f l ue nc e i n e ne r g y a nd r e s t ri c te d m a s s c o lli s io n s t o pp i n g po w e r w ith a s t he c ut o f f e ne r g y .

L / i s t he

T h e p r i m a r y e l e ct r on s ( o r i g i n a l el e ct ro ns o r e le c t ro ns g e ne ra t e d b y p ho to n s ) g i v e ri s e to i o n i z a tio n a s w e ll a s s e c o nd a ry e l e ct ro ns o r r a y s. T he e f f e c t s o f t h e l att e r ar e a c co u n te d f or i n t h e Sp e nc e r -A t t i x fo r m ul at io n b y us i ng a n a r bi tr a r y e n e r g y li mi t , , be lo w w h i c h e n e r g y t r a ns f er s a r e co ns id e r ed d i s si p a ti v e , t ha t i s , t h e s e co n d a r y el e ct r on o f e n e r g y l e s s t ha n is a s s um e d to di s si p a te i t s e ne r gy n e a r t h e s i t e o f i t s re l e a se . T h u s , w he n t he i nt e g r at io n i s p e r fo r m ed ( E q ua t i o n 8 . 3 1 ) to o bt a i n t h e en e r g y d e p o si te d i n t he c a v i t y b y t he e l e ctr o n f l ue nc e , t he l o w e r e n e rg y l i mi t s ho u l d b e , g re a te r t ha n z e r o . F o r i o n c ha m b e r s it m us t ha v e a v a l u e o f t h e o r de r o f t h e e n e r g y o f a n e l e c tr o n t ha t w il l j us t c r o s s t he c a v i t y. T h e v a l u e o f f o r m o s t c a v i t y a pp li c a ti o ns i n i o n c ha m b e r s w i ll l ie b e t we e n 1 0 and 20 keV. T h e S p e n c e r - A tt i x f o rm u l a t io n o f t he Br a gg- G r a y c a v i t y t heo r y us e s t he fo ll o w i ng r e l at io n s h i p :

where

[L

with

bar

above]

/ is t h e a v e r a g e r e s t ri c te d m a s s c o ll i si o na l sto p pi ng p o w e r o f
[L with bar above]

e l e ct r o n s . T a bl e s A . 1 t o A . 5 i n t he A pp e ndix g i v e a n d v a r i o u s p h o to n a n d e l e ct ro n e ne r g ie s .

/ fo r v a r io us m e di a

B. Chamber Volume
T h e q u a n t i t y J g i n E q u a t io n 8 . 3 2 c a n b e d et e r mi ne d fo r a cha m b e r o f k no wn v o l u m e or k n o w n m a s s o f a i r i n t he c a vit y i f t he c ha m b e r i s c o nne c t e d to a c h a r g e - m e a s u r i n g d e vi c e . H o w e ve r , t he c ha m b e r vo l um e i s us ua ll y no t k no w n to a n a c c e p t ab l e a c c u r a cy . A n i n d i r e c t m et ho d o f m e a s ur i ng J a i r i s to m a k e us e o f t he e x p o s u r e ca li b r at io n of t h e c h a m be r f o r the chamber volume. C o n s i d e r a n i o n c h am b e r t h a t h a s be e n c a l i b ra t ed w it h a b uild - up c a p f o r
60 60

Co r a y b e am . T hi s i n ef f e c t de t er m i ne s Co

e x p o s u r e . S u p po s e t he c h a m b e r w it h t hi s bui l d - up c ap i s e x p o sed i n f re e ai r to a
60

C o be a m a n d t h a t a t r a n s i e nt el e ct r o nic e q ui li b ri um e x i st s at t he c e nte r o f t he

c h a m b e r . A l s o a s s u m e i n i ti a ll y t ha t t he cha m b e r w a l l a nd t he b ui l d - up c a p a r e c o m po s e d o f t h e s a me m at e ri a l ( w a l l ) . N ow , i f t he c ha m b e r ( pl us t he b uil d - up c a p ) i s r e pl a c ed b y a h o m o g e n eo us m a s s o f w a l l m a te r i al w i t h o ut e r di m e ns io ns e q u a l to t h a t o f t h e c a p , t h e d o s e D w a l l a t t he c e nt e r o f t hi s m a s s c a n b e c a l c u l a te d a s f o ll o w s :

WWW.MEDRAD.IR

w h e r e ( c a v ) w a l l a i r i s t h e r a ti o o f e l e ct ro n f l uenc e a t t he re f e r e nc e po i nt P ( c e nte r o f t h e c a v it y ) w i t h c h am b e r c a v it y f il le d wi th w a l l m at e ri a l to t ha t w it h t he c a vi t y f i l le d w i t h a i r . T h i s c o r r e ct io n i s a p p li e d t o t he Br a g g - G r a y r el a ti o n ( E q ua t io n 8 . 2 9 ) to a c c o u n t f o r ch a n g e i n e l e c t ro n f l uenc e . A s d i s c u s s e d b y L oe v in g e r ( 4 ) 1 , i n t he ab o v e e q ua ti o n c a n b e r e pl a c e d b y , p r o v id e d a tr a n s i e n t el e c tr o n e q uil ib r i um e xi s t s t hro ug ho ut t he reg i o n o f t he w a ll from P.115 w h i c h s e c o n d a r y e l e c tr o n s c a n r e a c h t he c a v i t y . T he r e f o r e ,

If D a i r i s t h e a b s o rb ed d o s e t o ai r t ha t w o uld e x i s t a t t he r e f e re nc e p oi nt w it h t he c h a m b e r r e m o v ed a n d u n d e r c o n d i t io ns o f t r a ns i e nt e le c t ro ni c e qui l i br i um i n a i r , w e g e t f r o m E q u a ti o n 8 . 1 8 :

w h e r e ( c h a m b ) a i r w a l l i s t h e r at io t ha t c o r rec t s f o r t he c ha ng e in p ho t o n e ne r g y f l u e n c e w h e n a i r r e p l ac e s t h e c h a m b e r ( w a l l p l us c a p ) . F r o m E q u a t io n s 8 . 3 4 an d 8 . 3 5 , w e g e t :

A l s o D a i r ( u n d e r c o n d i ti o n s o f t r a ns ie nt e l e ct r o ni c e q ui li b ri um i n a i r ) c a n b e c a l c u l a te d f r o m e x po su r e m e a s u r e m e nt i n a
60

C o b e a m w i t h a c ha m b e r p l us b uil d 60

u p c a p , w h i c h b e a r s a n e x p o s u r e c a l ib r a ti o n f a c t o r N x f o r

Co rays.

w h e r e k i s t h e c h a r g e p e r u n i t m a s s p r od uc ed i n a i r p e r uni t e x p o sur e ( 2 . 5 8 1 0 4

C k g - 1 R - 1 ); M i s th e c h a m b e r re a di ng ( C o r s c al e d i v i si o n) no r m a li z e d to a tm o sp h e r ic under c o n d i tio ns , c a l i b r at io n Aion is t he a nd c o rr e c tion Pion is for t he i o ni z a ti o n i o ni z at io n c o nd it io ns ,

standard

r e c o mb i n a ti o n

r e c o mb i n a ti o n c o r re c tio n f o r t h e p r e s e nt m ea s ur e m e nt . S t a n d a r d c o n di ti o n s f o r N x a r e d e f i ned b y the s t a nd a r d s l ab o r at or i e s . T he N a t io nal In s t i t u t e o f St a n d a r ds a n d T e c h no lo g y ( NIS T ) s p e c i f i e s s t a nd ar d c o ndi ti o ns as t e m pe r a t u re a t 2 2 C a n d p r e s s u r e at 76 0 m m H g . S i nc e e x po s ur e i s d e f i ned f o r d r y a i r , h u m i d i t y c o r re c t io n o f 0 . 9 97 ( f o r cha ng e i n

w i t h h u m i d it y ) i s u s ed b y N IS T , w hi c h c a n b e a s s um ed c o ns t a nt i n t he r el a ti v e h u m i d i t y r a n g e o f 1 0% t o 9 0% f o r t he me as ur e m e nt c o ndi ti o ns wi t h m i ni ma l e rr o r

WWW.MEDRAD.IR

( 1 9 ) . T h u s t h e u s e r do e s no t ne e d to ap p l y a d di ti o na l hum i di t y co r r e ct io n a s l o ng as

is used for dry air. F r o m E q u a t io n s 8 . 3 6 an d 8 . 3 7 ,

T h e p r o d u c t ( c a v ) a i r w a l l ( c h a m b ) w a l l a i r eq ua l s ( w a l l ) w a l l a i r w hi c h r e p r e s ent s a c o r r e c t io n f o r t h e c h a n g e i n J a i r d u e to at te nua t io n a nd s c a tt e ri ng o f p ho to ns i n t he c ha m be r w a l l a n d b u i ld - u p c ap . T h i s f a c t o r ha s be e n d e si g na t ed a s A w a l l i n t he A A P M p r ot o co l ( 6 ) . T h u s , E q u a t i o n 8 . 38 b e co m e s :

N o w c o n s id e r a m o re r e a li s ti c si t ua ti o n i n w hi c h t he c ha m b e r w a l l a nd b ui ld - up c a p a r e o f d i f f e r e n t m a t e ri a l s . A c co r di ng to t he t wo - c o mp o ne nt m o d el o f A l mo nd a n d S v e n s s o n ( 2 0 ) , let b e t h e f r a c ti o n o f c a v i t y a ir io ni z a ti o n ow i ng to e l e ct ro ns g e n e r a te d i n t h e w a ll a n d t h e r em a i ni ng (1 - ) f r om t he b ui l d - up c a p . E q ua ti o n 8 . 3 9 c a n n o w b e w r i t te n a s :

or Jair = kMNxAwallwallAionAPion where A P.116 i s t h e q u a n t it y i n t h e b r a c k e t s o f E q ua t io n 8. 4 0 .

WWW.MEDRAD.IR

F I G . 8 . 4 . T h e f r a c t i on , , o f c a v i t y i o ni z a ti o n d ue to e le c t ro ns g e ne r a te d i n t he c h a m b e r w a l l , p lo tt ed a s a f u n c t i o n o f w a ll t hi c k ne s s . ( F r o m Le mp e r t GD , N a t h R , S c h u l z R J . F r a c t io n o f io n i z a t io n f r om el e ct ro ns a r i si ng i n t he w a ll o f a n i o ni z a t io n c h a m b e r . M e d P h y s 1 9 8 3 ; 10 : 1 , w i t h p e rm i s si o n. ) The f r a c t io n a h as b ee n d et e r mi ne d e x p e ri m e nt al l y by d o se b ui l d - up

m e a s u r e m e n t s f o r v ar i o u s w a ll t hi c k ne s s es ( F i g . 8 .4 ) . In a d d iti o n, it ha s be e n s h o w n ( 2 1 ) t h a t i s in d e p e n d e nt o f w a l l com p o si ti o n o r b uil d - up c a p , a s l o ng a s i t i s co m po s e d o f l o w a t o mi c n u m b e r m a t er ia l . S i n c e J a i r i s t h e c h a r g e p r o d u c e d pe r uni t m as s o f t he c a v i t y a i r , w e ha v e :

w h e r e V c i s t h e c h a m b e r v o l u me a nd a i r i s t he d e ns it y o f a ir no r m a l i z ed t o s t a n d a r d c o n di ti o n s . C o m p a ri n g E q ua t io ns 8 . 4 0 a nd 8 . 4 1 , w e ha v e :

C. Effective Point of Measurement C.1. Plane Parallel Chambers

S i n c e t h e f r o n t pl a n e ( t o w a r d t h e s o ur c e ) of t he a i r c a v i t y i s fl a t a nd i s e x p o se d t o a u n i f o rm f l u e n c e o f e le c t ro ns , t he po i nt o f m e a s ur e me nt i s a t t he f r o nt surface of the cavity. This w o ul d be s t r i ct l y t r ue if t he e l e ct r o ns w e re m o n o di r e ct io n a l a n d f o r w a r d di r e ct e d , p er p e nd i c ul ar to t he ca v i t y f a c e . If a s i g n i f i c a n t p a rt o f t h e c a v i t y io n i z a ti o n i s ca us e d b y b a c k - s c at t ere d el e ct r o ns , t he

WWW.MEDRAD.IR

p o i nt o f m e a s u r e m e n t w i l l s h i f t t o w a r d t he c e nt e r . If t he p l a ne - p a r a l le l c ha m b er h a s a s m a l l p l a te s e p ar a t io n a n d t he e l e ct r on f l ue nc e i s m o s t l y f o rw a r d P.117 d i r e ct ed , it i s re a s o na b l e to a s s um e t hat the p oi nt o f me a s ur em e nt i s t he f r o nt surface of the cavity.

C.2. Cylindrical Chambers

E l e c t ro n s (from an e l e ct r o n be a m or g ene r a t e d by p hot o ns ) t r a ns v e r s i ng a c y l i n d r i c al c h a m b e r of i n t e r n a l r a di us r w i l l e nte r t he se ns i ti v e v o l um e o f t he c h a m b e r ( a i r c a v i t y ) a t d i f f e r e nt di s t a nce s f r o m t he c e nt e r o f t he c ha m b e r . D u t r e i x a n d D u t re i x (2 2 ) s h o w ed t ha t t he or e ti c a ll y t he p oi nt o f m e a s ur e m e nt f o r a c y l i n d ri c a l c h a m b e r i n a u n i d i re c ti o na l b e a m i s d i sp l a c ed b y 0 . 8 5 r f r o m t he center and toward the source. De r i v at io n of t hi s v a l ue is i ns t r uc t i v e in u n d e r s t a n d i n g t h e co n c e p t a n d i s , t he re f o re , p r e s e nt ed he r e . F i g u r e 8 . 5 s h o w s a c ro s s - s e ct io n o f a c y li nd r i c a l c ha m b e r e x p o se d to a p a r a ll el, u n i f o r m , a n d f o r w a r d ly d i r e ct e d fl ue nc e o f e le c t ro ns . F o r a n el e c tr o n e nte r i ng t h e c h a m be r at p oi n t A , t h e po i nt o f m e a sur e m e nt i s at a di s t anc e X a bo v e t he c e n t e r . C o n s i de r i n g ele c t ro n s e n t e r i ng t he c ha m b e r a t p oi nt A , t he e f f e c t i v e poi nt o f m e a s u r e m e n t i s in f l u e n c e d b y t he nu m b e r o f el e ct r o ns e nt e ri ng t hr o ug h a s u r f a c e a r e a d s a t A o f t h e c h a m b e r a nd t he t r a c k l e ng t h o f t he s e e l e c t ro ns i n t he c a v i t y . T h u s t h e e f fe c t i ve po i n t o f me a sur e m e nt , X e f f , c a n be d et e rm i ne d b y w e i g h ti n g t h e di s p la ce m e n t X b y t he num b e r o f el e ct r o ns ( d s c o s ) e nt e ri ng t h e c h a m b e r a n d t h e tr a c k l e n g t h ( 2 X ) .

P.118

s u b s t it u t i n g X = r c o s a n d d s = r d ,

T h e a b o v e t h e o re ti c al r e s u lt i s m od i f ie d und e r a c t ua l i r r a di a tio n c o nd it io ns a s s o m e o f t h e el e ct ro n s e n t e r t h e c ha m be r a t o b li q ue a ngl e s .

WWW.MEDRAD.IR

FIG.

8.5.

D i a g r am

to

i ll u s t r at e

t he

d e te r m i nat io n

of

e f f e c t i ve

p oi nt

of

m e a s u r e m e n t f o r a c y li n d r i c al c h a m b e r e x pos e d to a uni d i r e ct io na l e l e ct r o n b e a m . T h e s h i f t i n t h e p o i n t o f m e a s u r e m e nt t a k e s p l a c e b e c a us e o f t he c y l i nd r i c al it y o f t h e c h a m b er c a v it y . If t h e r e i s a gr a d ie nt o f e le c t ro n f l ue nc e a c r os s t he c a vi t y ( a s i n t h e e x p o n e n ti a l fa l lo f f o f t h e de p t h d o s e c ur v e ) , a s hi f t i n t he po i nt o f m e a s u r e m e n t w il l re su l t i n a g r a d ie nt c or r e c ti o n t o t he d o se m e a s ur e d a t a p o i nt c o r r e sp o n di n g to t h e c e n t er o f t he c ha m b e r ( to b e di s c us s ed ) .

8.5.

CALIBRATION

OF

MEGAVOLTAGE

BEAMS:

TG-21

PROTOCOL A. Cavity-Gas Calibration Factor (N g a s )

T h e A A P M T G - 2 1 p r o to c ol ( 6 ) f o r a b s o rb e d d o s e c a li b r at io n i nt ro d uc e d a f a c t or ( N g a s ) to r e p r e se n t c a li b r a tio n o f t he c a v i t y g a s i n t e r m s o f a b s o rb e d do s e to t he g a s i n t h e c h a m be r p e r u n i t c h a r g e o r ele c t ro m et e r r e a di ng . F o r a n i o ni z a ti o n c h a m b e r c o n t ai n i n g a ir i n t h e c a v i t y a nd e x p o s ed t o a
60

Co r a y b e a m , 2

F r o m E q u a t io n s 8 . 4 0 an d 8 . 4 5 ,

WWW.MEDRAD.IR

A s s e e n i n E q u a t io n 8. 4 6 , N g a s i s de r i v ed f rom N x , t he e x po s ur e c al i b r at io n f o r t he chamber, and ot h e r c h a m b e r - r el a te d

60

pa r a m e te r s ,

a ll

de ter m i ne d

fo r

t he

c a l i b ra ti o n e n e r g y , e .g . ,

C o . O nc e N g a s i s d e te r m i ned , t he c ha mb e r c a n b e us e d

a s a c a l i b r at ed B r a g g- G r a y c a v i t y t o de te rm i ne a b s or b ed d o se f r o m p hot o n a nd e l e ct r o n be a m s o f a n y e n e r g y a n d i n p ha nt o m s o f a ny c o m p o s it io n. It m a y b e n o te d t h a t i n E q u a t i o n 8 .4 6 t he t e r m i n t he bi g b r a c ke t s i s p r e se nt ed d i f f e r e n tl y f r o m t h e AA P M p r o to co l . T hi s di f f e r e nc e re m a i ns une xp l a i ned , b ut t he t w o e x p re s s io n g i v e th e s a m e v a l ue to w it hi n 0 . 0 5% i n t he l i mi t o f = 0 a nd = 1 (24). N g a s i s u n i q u e t o e a c h i o n i z a ti o n c ha m be r , b e c a us e it i s re l at ed t o t he v o l um e of t h e c h a m b e r . F r o m E qu a t i o n s 8 . 42 a nd 8 . 4 6, us i ng

= 3 3 . 9 7 J / C a n d a i r = 1 . 1 9 7 k g / m 3 at s t a nda r d c o nd it io ns ( 2 2 C a nd 1 a t m ) ,

A s a n e x a m p l e , i f t h e v o l u m e o f t he c ha m be r i s 0 . 6 00 c m 3 , it s N g a s w il l b e 4 . 7 3 1 0 7 G y / C , a s c a l c u l ate d f r o m E q uat io n 8 . 47 . It m us t b e r e al i z ed , ho w e v e r , t ha t the volume is P.119 n o t e x a c t l y t h e no m i na l v ol u m e a s so c i at ed w i t h c o mm e r ci a l c ha m b e r s . T he l a tt er i s u s u a l l y a n a p p r o x im a t e v a l u e u s e d f o r de s i g na ti ng c ha m b e r s ens i t i v it y .

B. Chamber as a Bragg-Gray Cavity

In t h i s s e ct io n , w e w ill di s c u s s t he a p pl i c atio n o f t he S pe nc e r - A tt ix f o r m ul a ti o n o f t h e B r a g g - G r a y c a v i t y t h e o r y t o t he p r ob lem o f a b s o r be d do s e de t e rm i na ti o n to a m e d i u m u s i n g a h e ter o g e n eo u s c ha m b e r , tha t i s , a c ha m be r w it h w a l l m at e ri a l d i f f e r e n t f ro m t h e s u rr o u n d i n g m e di um . It w i l l be a s s um e d t ha t t he c ha m b e r w it h i t s b u i ld - u p c a p h a s be e n c a li b r at e d f o r co ba l t - 60 e xp o s ur e a nd thi s p r o vi d e s t he b a s i s f o r t h e de te r m i na t io n o f N g a s , a s d i s c us s e d i n t he p r e vi o us s ec t io n.

B.1. Photon Beams

S u p p o s e t h e c h a m b e r, w i t h i t s b ui l d - up c ap r e m o v ed ( i t i s r e com m e nd e d not to u s e b u i l d - u p c a p f o r in - p h a n t o m d o s im e tr y ) , i s p l a c e d i n a m e d i um a nd i r r a d i a te d b y a p h ot o n b e a m o f g i v e n e n e r g y . If M is t he c ha r ge me a s ur ed , t he ab s o rb e d d o s e ( D a i r ) to c a v i t y a ir , a t a p o i n t a t t he c ent e r o f t he c a v i t y ( P ) , i s g i v e n b y :

w h e r e P i o n i s a c o r r e ct io n f a c t o r f o r io n r e c om b i na ti o n lo s s e s . D o s e t o me di u m ( D m e d ) i s g i v e n b y t he Br a gg - G r a y r e l at io ns hi p us i ng t he S p e nc e r A t t i x f o r m u l at io n . U s i n g A A P M p r o t o co l (6) no t a ti o n a nd s ub s ti t uti ng a i r f o r gas in the chamber,

w h e r e P r e p l i s a r ep l a ce m e n t f a c to r t hat c o rr e c t s f o r p e rt ur b a ti o n i n t he e le c t ro n a n d p h o to n f l u e n c e s at po i n t P a s a r e s ul t of i ns e r ti o n o f t he c a v ity i n t he m ed i um

WWW.MEDRAD.IR

a n d P w a l l i s a f a c t o r w h i c h a c c o unt s f o r p e r t ur b at io n c a us e d by t he w a l l b ei ng d i f f e r e n t f r o m t h e m ed i u m . In g e n e r a l , E q u a t i o n 8 . 4 9 i s v a l id f o r a ny e ne r g y a nd a ny d e p th i n t he m e d i um ( i r r e s pe c ti v e o f t h e s t a t e o f e l e ct r o ni c eq ui l ib r i um ) p ro v i de d P r e p l a nd P w a l l a r e k n o w n f o r t h e m e a s u r e m e n t c o ndi ti o ns . A l t ho ug h t he s e co r r ec t io n f a c t o r s a re q u i t e s m al l ( u s u a ll y le s s t h a n 1 % ) f o r t y pic a l p ho to n d o si m et r y c o nd it io ns , t he i r d e te r m i n at io n i s c o mp l e x , e s p e ci al l y und e r c o nd i ti o ns o f no neq ui l ib r i um . T he A A P M v a l u e s f o r P r e p l a n d P w a l l ha v e b e e n d e r i v ed w i t h t he c ha m b e r i r r ad i at ed under factors the wi ll co n d it io n s i ni ti a ll y of tr a n s i e nt t he s e e le c t ro ni c eq ui li b ri um b ut l a te r (on wil l t he d e s c e ndi ng t he i r e x p o n e n ti a l p a rt o f th e d e p t h d o se c ur v e ) . T he f o l l o w i ng d e riv a t i o n o f t he s e assume co nd i ti o ns co ns i de r a p p li c a bi li t y to n o n e qu i l i br i u m s it ua t io ns . S u p p o s e t h e c h a m b er i s po s it io ne d at de pt h i n t he me di um a t w hi c h t r a ns i e nt e l e ct r o ni c e q u il i b ri u m e x i s t s . If t he c ha m b e r w a l l i s t hi c k e noug h s o t ha t t he e l e ct r o n s c ro s s i n g t h e c a v i t y a r i s e e nt i re l y f r o m p ho to ns i nt er a c ting w i t h t he w a l l m a t e ri a l , w e h a v e :

w h e r e D w a l l i s t h e d o se a t p oi n t P w he n c a v i t y a i r i s r e pl a c ed b y t he w a l l m a te r i al a n d ( c a v ) w a l l a i r i s t h e r a t io t h at c o r re c t s for t he di f f e r e nc e i n t he p hot o n e ne rg y f l u e n c e a t po i n t P w h e n a i r c a v i t y i s re pl a ce d b y t he w a ll m at e ria l . T he r a t io na l e f o r u s i n g ( c a v ) w a l l a i r as t h e p e rt ur b a ti o n cor r e c ti o n f a c to r i n t his c a s e ha s b e e n d i s c u s s e d b y Lo e v i n ger ( 4 ) . D o s e to po i n t P i f t h e c h a m b e r i s r e pl a c ed by t he m e d i um i s gi v e n b y :

or

P.120

w h e r e ( c h a m b ) m e d w a l l i s t h e r a ti o t ha t c o rr ec t s f o r t he c ha ng e in p ho t o n e ne rg y f l u e n c e w h e n m e d i u m r e p l a c e s t he w a ll m at e ri a l i n a v o l um e t hat c o r r e sp o nd s to t h e e n t i re c h a m b e r ( wa l l pl u s c a v i t y ) . N o w i f a l l t h e e le c t ron s c r o s s i n g t he c a v it y a r i s e f r o m t he m e di um , w e e f f e c t i v el y h a v e a c a s e o f a c h a m b e r w i t h m ed i um equi v a l e nt w a l l . T he n, und e r c o nd it io ns o f t r a n s i e n t el e ct r o ni c eq u i l ib r i u m ,

F o r a gi v e n c h a m b e r , s u p p o s e a f r a c ti o n o f t he c a vi t y io ni z a tio n i s co nt r ib ut ed b y e l e ct r o n s f r o m t h e c h a m b e r w a l l a nd t he r e m a i nde r ( 1 - ) by e l e c t ro ns f r o m t h e m e di u m , t h e n , d o s e t o a ir i n t he c ha m b e r i s g i v e n b y :

WWW.MEDRAD.IR

w h e r e D a i r ( w a l l ) a n d D a i r ( m e d ) a re d e ri v e d f ro m E q ua t io ns 8 . 5 2 a nd 8 . 5 3 . T hus ,

B y r e a r r a n g i n g E q u a t io n 8 . 5 5 ,

T h e p r o d u ct te r m ( c a v ) m e d w a l l ( c h a m b ) w a l l m e d ma y b e eq ua t ed to ( w a l l ) w a l l m e d , a f a c to r t h a t a c c o u n t s f o r c ha n g e i n p h o to n e ne rg y f l ue nc e w he n w a l l i s r ep l a ce d b y medium. T h e n f r o m E q u a t i o n s 8 . 4 8 , 8 . 49 , a nd 8 . 5 6 ,

where

and

P.121

S i n c e do e s no t c h a ng e si g n i f i c a nt l y w it h cha ng e i n m at e ri a l co mp o s it io n ( 4 ) , t he r a t io w a l l m e d c a n b e e qu a t e d to 1 . E q ua t io n 8 . 5 9 b e co m e s :

E q u a t i o n 8 . 60 a s a n e x p r e s s io n f o r P w a l l d i f fe r s f r o m t he o ne i n t he A A P M p r o t o col , s i n c e t h e co mp o n e n t s a n d ( 1 - ) a re a ppl i ed to D a i r b e fo r e c al cul a t i ng D m e d ( se e E q u a t i o n 8 . 5 2 ) . Ro ger s ( 2 4 ) h a s po i nte d out t ha t t he A A P M e x pr e s s io n f o r P w a l l , w h i c h a s s i g n s t h e t w o c o mp o n e n t s t o D m e d d i r e ct l y , i s not t heo re t i c al l y j us ti f ie d . H o w e v e r , t h i s d o e s n ot g i v e r i se t o a ny s i g ni f i c a nt d i f f e re nc e s i n t he r e s ul t s . A l s o, t h e p re v i o u s e x p r e s sio n i n c l u d e s ( w a l l ) w a l l m e d , w hi c h a p pe a r s f rom t he t he o re ti c a l c o n s i d er a ti o n s p r e se n t e d h e r e . T hi s f a c to r m a y a p p r o x i m at el y b e e q ua t e d t o

WWW.MEDRAD.IR

w h e r e x i s t h e w a l l t h ic k n e s s . A n a l t e r n at i v e a p p ro ac h t o d e ri v i ng P r e p l i s to de f i ne D a i r = M N g a s a s t he d o se t o ai r of an i n f i n it e si m a ll y s m a ll ai r c a v it y l oc a t e d in t he me di um at a poi nt P, c o r r e s po n di n g t o t h e c h a m b e r ' s e f f e c t i v e p o i nt o f m e a s ur e me nt ( s e e s e c tio n 8 . 4 C ) . B e c a u s e P r e p l f or t h i s s m a l l c a v it y c a n b e a s s um e d a s 1 , w e ha v e :

D o s e to me di u m a t po i n t P co r r e s po nd i ng t o t he c e nte r o f t he cha m b e r w il l t he n be:

T h e r e f o r e , P r e p l f o r t h e c h a m b e r u nd e r c o ns id e r a ti o n i s :

T h i s d e ri v a ti o n a s s um e s t h a t P r e p l a r i se s a s a r e s ul t o f t he d is p l a c e me nt o f t he e f f e c t i v e p oi n t o f m ea s u r e m e n t o f t he c ha m b e r , a nd it s v a l ue d e p e nd s o n t he d e pt h d o s e g r ad i e nt . T h i s p o i n t h a s b e e n d is c us s e d b y K ha n ( 2 5 ) . F o r a c y l i nd r i c al c h a m b e r , P r e p l c a n b e c a l c u l a te d f r o m t he f ol lo w i ng e q ua ti o n:

w h e r e D ( d ) i s t he do se a t de p t h d , r i s t he di s pl a c e m e nt co r r e ct io n, a nd r i s t he r a d i u s o f t h e c a v i t y . f o r p h ot o n b e a m s is t a k e n t o b e eq ua l to 0 .6 . E q ua t io n 8 . 6 4 s h o w s t h a t P r e p l d e p e n d s no t o nl y on e ne r g y b ut a l so on t he d e pt h o f measurement. T h e A A P M T G - 2 1 p r ot o co l r e co m me nd s P r e p l f a c t o r s b a se d o n the s e m i e mp i ri c a l v a l u e s o f C u n n i n g h a m a n d S o n t ag (2 6 ) . T he s e v a l ue s a re app l i c ab le o nl y i f a m e a s u r e m e n t i s m a d e a t a p o i n t o n t he d e sc e nd i ng e x po ne nt i al pa r t o f t he d ep t h d o s e c u r v e . M o r eo v e r, a s p o i n t ed o ut b y R o g e r s (2 4 ) , C unni ng h a m a nd S o nt a g ' s v a l u e s p e rt a i n t o t h e o u t e r d i a me te r o f t he c ha m b e r i ns te a d o f t he i nne r di a m et e r p r e s e n te d i n t h e p ro toc o l d at a . T h e u s e o f c h a m be r di s p l a ce m e n t c o rr e c tion t o d et e r mi ne P r e p l (E q ua t i o n 8 . 6 4 ) i s useful not only in c a l i b ra ti o n b ut al s o in c o r r e ct i ng t he e nt i re d ep t h- do s e d i s t ri b u tio n . In t h e l a t t er c a s e , i ns te a d o f c a l c ul a ti ng P r e p l a t i nd i vi d ua l po i nts , t he d e pt h - d o se (o r de pt h i o n i z a ti o n ) c ur v e a s a w ho l e i s s hi f te d to w a rd t he s ur f a c e b y a distance r.

B.2. Electron Beams

W h e n a c h a m b e r , w i t h i t s b u i ld - up c a p r e m o v ed , i s p l a c ed i n a m e d i um a nd i r r a di a te d b y a n e l e ctr o n b e a m , it i s us ua l ly a s s um e d t ha t t he cha m b e r w a l l do e s not i n t ro d u c e any p e r t u r b at io n of t he el e c tr o n f l ue nc e . T hi s a s s um p t i o n is c o n s i d er e d v a li d f o r th i n - w a l l e d P.122 ( 0 . 5 m m ) c h a m b e r s c o m po s e d o f l o w at om i c num b e r m a te r i al s ( e . g . , g r a p hi te ,

WWW.MEDRAD.IR

a c r y l i c ) ( 1 5 , 27 ) . T h u s t h e B r a g g - G r a y r e l a tio ns hi p c a n b e a p p li e d w i t ho ut t he w a ll p e r t u r b at io n c o r r e cti on , i . e . , P w a l l = 1 . F o r a n e l e ct r o n b e a m o f m e a n e n e r g y z a t d e pt h Z o f m e a s ur e m ent ,

o r i n t h e n o t at io n o f th e A A P M p r o t o c ol ( 6 ) ,

w h e r e P r e p l i s a r ep l a ce m e n t c o rr e c tio n f a c t o r t o a c co unt f o r t hr ee e f f e c t s : ( a ) t he i n - s c a t te r effect, w hi c h increases t he f lue nc e in t he cavity s i nc e e le c t ro n s c a t te r i n g o u t o f t he c a v i t y i s l e s s t ha n t ha t e x pe c te d i n t he i nta c t m ed i um ; (b ) t h e ob li q u it y e f f e ct , w h i c h d e c r e a s e s t he fl ue nc e i n t he c a vi t y be c a us e el e ct r o ns t r a v e l re l at i v el y s t r aig h t i n t h e c a v it y i nst e a d o f t a k i ng o bl iq ue p a t hs a s t he y w o u l d o w i n g t o l a rg er - a n g l e s c at te r i ng i n t he m ed i um ; a nd ( c ) d i sp l a ce m e nt i n t h e e f f e c t i ve p oi n t o f m e a s u r e m e nt , w hi c h g i v e s r i s e to a c o r r e ct io n i f t he p o i nt o f m e a s u r e m e n t i s o n t h e s l o pi n g p a r t o f t he d e pt h d o s e c ur v e . T he f i r s t t w o e f f e c t s m a y b e g ro u p e d i n t o a f l u e n c e c o r r e ct io n w hi l e t he t hi r d i s c al l ed t he g r a di e nt c o r r e ct io n . T h e A A P M T G - 2 1 p r o to c ol ( 6 ) r e c om m e nd s t ha t t he e le c t ro n b e am c a l i b r at io n b e m a d e a t t h e po i nt o f d e pt h d o se m a x i m um . Be c a us e t he r e i s no d o s e g r a di e nt at t h a t de p t h , t h e g r a di e n t co r r e ct io n i s i gno r e d . P r e p l , t he n, c ons t i t ute s o nl y a f l u e n c e c o r re c ti o n . T ab l e 8 . 2 g i ve s P r e p l fo r c y l i nd ri c a l c ha m b e r s a s a f unc t io n o f m e a n e l e ct ro n e n e r g y a t t h e de pt h o f m e a sur e m e nt a nd t he i nne r d i a m et e r o f io n c h a m b e r . T h e s e v a l u e s w e r e m e a s ur e d b y J o ha ns s o n e t a l . ( 2 7 ) . A s d i s c u s s e d i n a n A A P M r e p o r t (2 8 ) , a de p t h io ni z a ti o n c ur v e c a n b e c o nv e r t ed i n t o a de pt h d o se c u rv e u s i n g E q ua ti o n 8 .66 . T he p a r a me te r s ( [ L
with bar above]

/)medair

a n d P r e p l a re bo t h e n e rg y o r d ep t h de p e nde nt . T he g r a di e nt co r r e ct io n, ho w e v e r , is b e s t h a n d l ed b y s h i f t in g t h e p o i nt o f m e a sur e m e nt t o w a rd t he s ur f a c e t hr o ug h a d i s t a n c e o f 0 . 5 r ( 2 8 , 29 ) . F o r w e l l - de s ig ne d p l a ne - p a r al le l c ha m b er s w i t h a d e q ua te g u a r d r i n g s , b o t h f l u en c e a n d g r a d i e nt c o r re c t io ns a r e i g no re d , i .e . , P r e p l = 1 ; t he p o i nt o f m e a s u r e m e nt i s a t t h e f r o nt s ur f a c e o f t he c a v i t y .

C. Dose Calibration Parameters

A b s o r be d do s e c a li b r at io n o f a cl i ni c al r a dia t io n b e a m r e q uir e s tha t a na t io na l l y o r i nt e r n a ti o n a ll y a ppr o v e d p r ot o co l b e f o ll o w ed . T hi s i s i mp o rta nt no t o nl y t o e n s u r e a c c e p t ab l e P.123 d o s im e tr i c a c c u r a c y i n p a t i e n t t r e at m e nt s b ut a l s o to p ro v i d e c o ns i s t e nc y of d o s im e tr i c d at a a mon g i n s t it u t io ns t ha t p r o v id e r a di ot he r a p y . In t he p r e v i o us s e c t io n , d er i v a ti o n o f a d o se c a li b r at io n f o rm a l i s m r e co m m e nde d b y t he A A P M T G 2 1 p ro to c ol w a s p r e s en t e d . In t h e p r o c e s s , a f e w d i s c r e p a nc ie s or i nc o ns i s te nc i e s i n t h e p r ot o co l w e re n o t e d . H o w e ve r , t he i r o v e r a ll i m p a ct o n t he a c c ur a c y o f t he p r ot o co l i s n ot se r io u s e n o u g h to re c o m me nd v a r i a nc e f ro m t he pr o to c ol . A n A A P M t a s k g ro u p w a s fo r m ed w h i c h w a s c ha r g ed w i t h t he t a s k o f c a re f ul l y r e v ie w i ng t he

WWW.MEDRAD.IR

p r ot o co l a n d m a ki n g n e c e s s a r y r e v i si o ns or up d a t e s . In t he mea nt i m e t he us e r w a s a d v i s ed t o f o ll ow t h e p r ot o co l a s i t s to o d . A ne w p r ot oc o l , T G -5 1 , w as i n t r od u c e d b y t h e A A P M i n 1 9 9 9 ( to b e di s c us s e d l at e r ) .

TABLE 8.2. ELECTRON FLUENCE PERTURBATION FACTORS FOR ION CHAMBERS

Inner Diameter (mm) Ez(MeV) 3 5 6 7

0.977

0.962

0.956

0.949

0.978

0.966

0.959

0.952

0.982

0.971

0.965

0.960

0.986

0.977

0.972

0.967

10

0.990

0.985

0.981

0.978

15

0.995

0.992

0.991

0.990

20

0.997

0.996

0.995

0.995

F r o m Jo h a n s s o n K , M a t t s so n L , Li nd be r g L , S v e ns s o n H . A bs o r b ed - do s e d e te r m i n at io n w i t h i on i z a t i o n c ha m b e r s i n e l e ct r o n a nd p ho to n b e a m s ha v i ng e n e r g ie s b et w e e n 1 a n d 5 0 M e V . IA E A - S M - 2 2 2 /3 5 . V i e nna , 1 97 7 ; 24 3 : 27 0 , w i t h p e r mi s s io n .

A s a s u m m a r y to t h e p r e v io u s s e c tio n, p e rt ine nt c a li b r at io n p a r am e t er s o f t he T G 2 1 pr ot o co l a r e o u tl in e d b elo w w i t h a b ri e f de s c r ip ti o n o f t he i r f unc t io n a nd e v a l u a t io n .

C.1. Chamber Calibration Factor, N

is p r o v id e d by the N IS T or an A c c r e d i te d

x 60

Io n c h a m b e r e x p o s u r e c a l i b r at io n f a c t o r (R / C o r R / s c a l e d i v i s ion) f o r D o si m et r y C a l i b ra t io n

Co rays

L a b o r at o ry

( A D C L ) . T h i s f a c t o r w h i c h i s c h a r a c t e r i s tic o f t he c ha m b e r , i t s v o l um e , a nd i t s b u i l d - u p c ap i s d et e rm i n e d b y e x p o si ng it t o a factor for Co.

60

C o be a m o f k no w n e x p o s ur e r a te

a n d / o r c o m pa r i n g it s r e s p o n s e w it h a c ha m b e r o f k no w n e x p o s ur e c a l ib r a tio n
60

WWW.MEDRAD.IR

A t t h e N IS T , s p e c i a l l y c o n s t r u c t e d s p he ric a l , g r a p hi te i o ni z a t io n c ha m b e r s o f k n o w n v o l u m e a r e u se d to c al ib r a te t he c ob a l t b e am i n t e r m s of e x p o s ur e r at e . D e t ai l s o f t h e p r o ce d ur e a r e g i v e n b y L o ft us a nd W e a v e r ( 3 ) . N X p ro v i de d b y t h e U. S . c a l i b r at io n l ab o r at o ri e s i s no r ma li z e d to 22 C a nd 7 60 m m H g . C a l ib r a ti o n o f t h e el e ct ro m et e r (d ev i c e to me a s ur e i o ni za t io n c ha r g e ) , i f d e t a c h ed , i s p r o vi d ed s e p a r a te l y . E x p o s u r e m e a s u r e d i n a c o b a l t -6 0 be a m i s gi v e n b y :

w h e r e X i s t h e e x po su r e a t a poi nt c o rr e sp o nd i ng to t he ce nt e r o f t he c ha m be r w h e n t h e c h a m b e r i s n o t t h er e ; M i s t he re a d i ng co r re c te d f o r t e m pe r a t ure a nd p r e s s u r e a n d N e l i s t h e el e c tr o me te r c a lib r a t io n f a c to r , i f s ep a r a t e f r o m t he c h a m b e r . T h e a b o v e eq u a t io n f u n c t i o na l l y de f i ne s N x .

C.2. Cavity-Gas Calibration Factor, N

gas

C a v i t y - g a s c a li b r at io n f a c t o r ( G y / C o r G y / s ca l e d i v i si o n) i s c al c ul at e d f r o m N x a nd o t h e r p a r a me te r s a s d i s c u s s e d e a rl ie r . It i s d e f i ne d a s d o se t o t he g a s i n t he c h a m b e r p e r u n i t c h a rg e o r el e ct r o me te r r ea d i ng . D g a s i s s i mp l y giv e n b y J g a s (

) w h e r e J g a s i s t h e c h a r g e p e r u n i t m a s s o f c a v i t y g a s a nd

i s t h e a v e r a g e e n e r g y e x p e n d e d pe r uni t c ha r g e o f io ni z a t io n p r od uc e d i n t he g a s . S i n c e m a s s o f a i r i n th e c a v i t y o r c ha m be r v o l um e i s no t a c c ur at e l y k no w n, o ne h a s t o de te r m i n e t h i s v o l u m e i n di r e ct l y f rom N x ( E q ua t i o n 8 .4 6 ) . H o w e v e r , i t m a y b e p oi n te d o u t t h a t N g a s i s i n d e pe nd e nt o f a ll p r op e rt ie s o f t he c ha m b e r e x c ep t i ts c a v i t y v o l u m e ( E q u a tio n 8 . 4 7 ) . If N g a s i s n ot p ro v i de d b y t h e c a li b r at ion l a b o r at o r y , t he us e r i s re q ui re d to c a l c u l a te i t . T a b le 8. 3 g i v e s r a t io s o f a v a i l a bl e c h a m be r s . It is seen t hat N g a s / N x f o r a num b e r o f c o m m e r ci a ll y does not vary g r e a tl y b et w e en Ngas/Nx

c o m m o n l y u s e d c h a m be r s . H o w e v e r , t he us e r m us t f o l l o w t he p r oto c ol t o c a l c ul at e N g a s f o r t h e gi v e n c h a m b e r a n d u s e T a b l e 8. 3 f o r c o m p a ri s o n. N or m a l l y , c ha m b e r s a r e r e c al ib r a te d e v e r y 2 y e a r s a n d N g a s i s c al c ul a te d at e a c h ne w ca l i b r ati o n o f t he chamber.

C.3. Symbol
For dry air,

i s i n d e pe nd e n t o f e le ct r o n e n e r g y a b o v e a f e w k i l o el e ct r o n v o lt s a nd i t s c ur r e nt l y a c c e p te d v a l u e i s 33 . 97 0 . 0 6 J / C . T he T G - 2 1 p r oto c ol ( 6 ) us e s 33 . 7 J / C P.124 i n a l l it s e q u a ti o n s be c a u s e a t t he ti m e the p r ot o co l w a s w r it te n t he a c ce pt ed value of

f o r d r y a i r w a s 3 3 . 8 5 J / C a n d w a s c o r r e c t e d f o r 5 0 % r el a ti v e hum i d i t y to g i ve 3 3 . 7 J / C . W h e r e a s u s e r s o f t h e T G - 2 1 p ro to c ol m a y s t i c k to t he o r i gi na l p ro to co l

WWW.MEDRAD.IR

f o r c o n s i s te n c y r e a s on s , t h e c u r r e nt und e r s t a nd i ng i s t ha t , s inc e e x p o s ur e i s defined fo r dry air and Nx is a l r e ad y c o r r e ct e d fo r hum i d ity effect by t he s t a n d a r d s l ab o r at o r y ,

v a l u e i n t h e e q u a t io n s d i s c u s s e d e a rl ie r s houl d p e rt a i n t o d r y a i r , i . e . , 3 3 . 9 7 J / C .

TABLE

8.3.

RATIOS

OF

Ngas/NX

FOR

COMMERCIALLY

AVAILABLE CHAMBERS

Chamber: M od e l Up Cap) N o. Awall ( W a ll - B u i l d -

( L / ) w a l l a i r ( e n / )
l air wal

(L/)capair (en/)airca
p

Ngas/(NXAion ) ( Gy / R)

Capintec: PR06C, PR-06G (C552 p o l y st y r e n e )

0.99 1

0.4 6

1.000

1.032

8.51 10-3

Capintec: PR05 ( C 5 5 2 p o l y st y r e n e )

0.98 9

0.8 9

1.000

1.032

8.61 10-3

Capintec: PR05P ( C 5 5 2 A1, p o l y st y r e n e ) Exradin: Spokas ( C 5 5 2 C 55 2 )

0.98 8

0.8 9

1.000

1.032

8.60 10-3

2-mm build-up cap

0.98 5

0.8 6

1.000

1.00

8.61 10-3

4-mm build-up cap

0.97 6

0.8 6

1.000

1.00

8.53 10-3

Exradin: Spokas

T2,

0.98 5

0.7 3

1.037

1.037

8.30 10-3

( A 1 5 0 A1 5 0 )

WWW.MEDRAD.IR

Exradin: min

T1,

0.99 2

0.7 4

1.037

1.037

8.36 10-3

Shonka

( A 1 5 0 A1 5 0 )

Exradin: Shonka Wycoff (C552)

A3,

0.98 4

1.0 0

1.000

8.60 10-3

NEL 2 5 05 , 59

Farmer: 54 (Tufnol

0.99 2

0.5 9

1.021

1.020

8.49 10-3

acrylic)

NEL 2 5 05 , 67

Farmer: 59 (Tufnol

0.99 0

0.5 9

1.021

1.020

8.48 10-3

acrylic)

NEL 74

Farmer: (nylon

0.99 0

0.5 3

1.038

1.020

8.40 10-3

2 5 05 / A , 6 7 acrylic)

NEL

Farmer:

0.99 0

0.5 4

1.009

1.020

8.53 10-3

2 5 05 / 3 , 3 A , 7 1 7 9 ( g r a p h i te acrylic)

NEL

Farmer:

0.99 0

0.4 0

1.038

1.020

8.42 10-3

2 5 05 / 3 , 3 B , 7 4 ( n y lo n acrylic)

NEL 2 5 71 ,

Farmer: 79

0.99 0

0.5 4

1.009

1.019

8.54 10-3

( g r a p h i te D e l ri n )

WWW.MEDRAD.IR

NEL 2 5 81 ,

Farmer: 80

0.99 0

0.3 9

1.037

1.032

8.37 10-3

(A150 Lucentine)

NEL Standard: 2 5 61

NPL

0.98 4

0.6 5

1.009

1.019

8.49 10-3

Secondary

( g r a p h i te D e l ri n )

PTW: N 2 3 33 3 , 3 0 - 35 1 (acrylicacrylic) mm cap 3b u il d - u p NA

0.99 3

0.5 1

1.020

1.020

8.50 10-3

PTW: N 2 3 33 3 , 3 0 - 35 1 3 0 - 35 2 , 5 0 0 -1 0 4 (acrylicacrylic) mm cap 4.6b u il d - u p NA NA V IC

0.99 0

0.4 8

1.020

1.020

8.48 10-3

PTW: N 2 3 33 3 1 , N A 3 0 - 36 1 (acrylic acrylic)

0.99 0

0.7 9

1.020

1.020

8.48 10-3

PTW: M 2 3 3 32 Normal, 3 0 - 34 8 NA

0.99 3

0.5 1

1.020

1.020

8.50 10-3

WWW.MEDRAD.IR

(acrylic acrylic)

PTW: M 2 3 3 31 Transit, 3 0 - 34 9 (acrylic acrylic) NA

0.99 2

0.5 1

1.020

1.020

8.50 10-3

PTW: N 2 3 33 6 41 , NA 3 0 - 3 16 (acrylic acrylic)

0.99 2

0.6 5

1.020

1.020

8.50 10-3

V i c t o re e n : 5 5 5 -1 0 0 H A ( D e r li n )

0.99 0

1.0 0

1.019

8.49 10-3

V i c t o re e n : 5 5 0 -6 , acrylic) 6A ( p o l y st y r e n e

0.99 1

0.7 4

1.032

1.020

8.42 10-3

F a r W e s t : IC 1 7 ( A 1 50 )

0.98 3

1.0 0

1.037

8.28 10-3

F a r W e s t : IC 17A A150) ( A 1 5 0

0.98 4

0.7 9

1.037

1.037

8.29 10-3

F a r W e s t : IC 18 A150) ( A 1 5 0

0.99 1

0.8 6

1.037

1.037

8.35 10-3

F r o m G a s to r f R , H u m p h r i e s L , R o z e nf e ld M . C y l i nd r i c a l c ha m b e r d i m e ns io ns a n d t h e co r r e sp o n di n g v a l u e s o f A w a l l a nd N g a s / N X A i o n ) . Me d P hy s 1 98 6 ; 13 : 7 51 , w i t h p e r mi s s io n .

WWW.MEDRAD.IR

C.4. Ion Recombination Correction: A , P

ion

ion

A i o n i s a f a c t o r t h a t c or r e c t s f o r i nc om p le te c o ll e ct io n o f c ha r g e i n t he c ha m b e r at t h e t i me o f i t s c a li b r at io n a t t h e s t a nd a r d s l a b or a to r y . Be c a us e 1 f o r m o s t c h a m be r s w i t h a d e q u a te b i a s v ol t a ge . P i o n c o r r e ct s f o r io n r e c o mb i n a ti o n lo s s w he n t he c ha m b e r i s ir r a d i at e d i n t he u s e r ' s b e a m . T h i s f a c t o r de pe n d s o n t he do s e r at e (o r d o se pe r p ul s e ) , c ha m b e r g e o me t r y and the bi a s v ol t ag e . A me t ho d f or de te r m i ni ng

3 60

C o s o ur c e s us e d

f o r c h a m b e r c a l ib r a ti on u s u a l l y h a v e l o w d os e r a t e s , A i o n c a n b e a s s um e d e q ua l to

Pion

( t w o - vo lt a ge

t e c h n i q u e ) h a s b ee n d i s c u s s e d i n C ha p t e r 6 . F o r a 0 . 6 c m

F a rm e r t y pe c ha m b e r

o p e r at i n g a t a b i a s v o l t ag e o f a b o ut 30 0 V a nd e x p o s e d to do s e r a te s i n t he c l i n i c al r a n g e ( ~ 5 0 0 cG y / m i n o r l e s s ) , P i o n i s us ua l l y l e s s t ha n 1 . 0 0 5 . P.125

C.5. Wall-Correction Factors: A

wall

wall

, P

wall

T h e A w a l l c o r r e ct io n f a c t o r o c c u r s i n t he N g a s f o r m ul a a nd a c c o unts f o r a t te nua t io n a n d s c a t t e r o f p h ot o ns i n t h e w a l l a nd b ui ld - up c a p o f t he c ha m b e r w he n e x p o s e d in air to

60

C o r a y b e a m . In E q ua t i o n 8 . 3 6 , A w a l l a p p e a r s a s a r a t i o o f p hot o n

e n e r g y f l u e n c e a t t h e c e n t e r o f t he c a v i t y w i t h t he c ha m b e r a nd i t s b ui ld - up c a p i n p l a ce i n a ir to t h at w h e n t h e c ha m b e r i s r e m o v ed , i . e . , ( w a l l ) w a l l a i r . T hi s r a ti o i s a p p r o xi m a te l y g i ve n b y e - (

en

/)x, where

en

/ i s t h e a v e r a ge m as s e n e r g y a b so r pt io n c o e f f i c ie nt f o r t he

60

C o b e am a nd x is

t h e d e n s it y t h i c k n e s s , b o t h p e rt a i ni ng t o t he c ha m b e r w a l l a nd its b ui l d - up c a p . T h e A A P M p r o t o c ol ( 6) p r o v i de s a t a b le o f A w a l l v a l ue s f o r c y l i nd ri c a l c ha m b e r s a s a f u n c t i o n o f c h a m b er w a l l ( p l u s b ui ld - up c a p ) t hi c k ne s s a nd the l e ngt h o f t he c h a m b e r v o l u me . T h e s e v a l u e s a r e b a s ed on M o nt e - C a r lo c a l c ul at io n b y N a t h a nd S c h u l t z ( 3 0 ) . T a b l e 8. 3 g i v e s A w a l l f o r v a r io us c o m m e r ci a ll y a v a i l a bl e c ha m be r s , d e r i v ed f r o m t h e s a me d a t a ( 31 ) . w a l l i s t h e q u o ti e n t o f a b s o r b ed d o se t o c oll i si o n p a r t o f k e r m a in t he w a l l und e r t h e c o n di ti o n s o f t r an s i e n t el e ct r o ni c e q uil i b ri um . A s d i s c us se d i n s e c ti o n 8 . 2 C , w a l l a c c o u n t s f o r t h e d i f f e r e n c e b et w e e n t he p oi nt o f i nt e r a cti o n ( c e nt e r o f e l e ct r o n p r o d u ct io n ) a n d t h e po i nt o f e ne rg y d e po s it io n. It s v a lue i s t a k e n t o b e 1.005 for
60

Co.

A l t h o u g h t h e T G - 21 p ro to c ol u s e s w a l l i n a dd i ti o n t o t he A w a l l , i t i s no w und e r s t ood ( 2 3 , 2 4 ,3 2 ) t h a t t h e M o n t e - C a r lo c al c ul a ted v a l ue s o f A w a l l i nc l ud e w a l l . T hus t he u s e o f w a l l i n t h e A AP M p r o to c ol i s a n e r ro r . H o w e v e r , a s po i nt e d o ut e a r li e r , s o m e o f t h e e r ro r s in t h e T G - 2 1 p r oto c ol c a nc e l e a c h o t her and , t he r e f o re , no c h a n g e w a s r e c o m m e nd e d i n t h e p ro to co l unt il a r e v i s e d pr ot o co l w a s i nt r o d uc e d . Pwall is a co r r e ct io n in wall the factor that a c c o unt s T hi s t he fa c t o r for t he di f f e r e nc e on be a m be t w ee n e ne rg y , t he wall c o m po s it io n o f t h e c h a m b e r w a l l a nd t he pha nt o m a s i t p e rt a i ns t o p ho to n b e a m i n t e r a ct io n s thickness, user's beam. a nd d ep e nd s of c o mp o s it io n , f r a c t io n t he ca v i t y i o ni z at io n

c o n t r ib u t ed b y el e ct ro n s o r ig i n a ti ng i n t he c ha m b e r w al l . C a l cul a t io ns i nd i ca te

WWW.MEDRAD.IR

t h a t P w a l l [ a s y m pt ot i c al l y e q u al to ] 1 w he n < 0 . 2 5 . A s c a n b e d e duc e d f r o m T a ble 8 . 3 , P w a l l i s clo s e t o u n i t y f o r Fa r m e r t y pe c ha m b e r s ( w a ll t hi c k ne s s < 0 . 1 g / c m 2 ) a n d p h o t o n e n e rg i e s 6 M V . T h e e x p r e s s io n f o r t h e c a l c u l a ti o n o f P w a l l , g i v e n b y E q ua t i o n 8. 6 0 , i s d i f f e r e nt f r o m t h e o n e i n t h e T G - 2 1 p ro to c ol . T he re a s o ns f o r t he di s c r ep a nc y ha v e b e e n d i s c u s s e d e a rl i er . A g ai n , b e c a u s e t he d i f f e re nc e s a r e q uit e s m al l, no v a r i a nc e i s r e c o m me n d e d i f T G - 2 1 p r ot o co l i s f ol lo w e d .

C.6. Replacement Correction Factor, P

repl

F r o m t h e p re v i o u s dis c u s s i o n o f t hi s f a c t or , i t i s e v id e nt t hat P r e p l c or r e ct s f o r c h a n g e i n J a i r ( io n i z a tio n c h a r g e pe r uni t ma s s o f c a v i t y a ir ) c a us e d b y t he f i ni te s i z e o f t h e c a v it y . A c c o r d i n g t o E q uat io n 8 . 5 8 , i f t he me a s ur e m ent i s m a d e und er t h e co n d it io n s o f t r an s i e n t e l e ct ro ni c e q ui li b r i um , P r e p l i s t he r a t io o f p hoto n e n e r g y f l u e n c e a t t h e c e n t e r o f t he c a vi t y whe n t he c a v it y i s f il le d w i t h me di um to t h a t w h e n t h e c a v i t y i s f i l l ed w i t h a i r . T h i s r a t io i s a l so t h e r a t io o f el e c tr o n f l ue nc e s w i t h a nd w i t ho ut t he c a v i t y . O ne m a y c a l l t h i s a fl u en c e c o r r e ct io n f a c to r o r P f l . H o w e v e r , w he n t he el e ct r o n f l u e n c e i s m e a s u r e d w i t h a c y l i n d r i c al i o n c ha m b e r , t he r e i s a s hi f t i n t he p o i nt o f m e a s u r e m e n t de pe n di n g o n t h e r a d i us of t he c a v i t y ( s e e s ec t io n 8 . 4 , C . 2 ) . B e c a u s e o f t h i s s h i f t u p s t r e a m , t he io ni z a ti o n m e a s ure d i s g re at e r t ha n i f t he re w a s n o s h i f t o r c a v i t y r a d i u s w a s z e r o . T he c o m po ne nt o f P r e p l c aus e d b y t he s hi ft in the p o i nt of m ea s u r e m e n t is c a ll e d t he g r a d ie nt c o r rec t io n or Pgr. T he m a g n i t u de o f P g r i s dep e n d e n t o n t he g r a d ient o f t he d o s e a nd t he i nne r d i a m et e r o f t h e i o n c h a m b e r . Th u s P r e p l m a y b e t he tho ug ht o f ha v i ng t w o c o m po ne nt s , t he g r a d ie n t a n d f l u e n c e c o r r e ct io n f a c t o r o r P r e p l = P f l P g r . In the case of photon beams, f l ue nc e c o r r e c ti o ns are not ne e d ed if t he m e a s u r e m e n t s a re m a d e a t d m a x o r b e y o nd i n a b r o a d be a m be c a us e t r a ns i e nt e l e ct r o ni c eq u i li b ri u m e x i s t s t h e re ( 33 ) . Und e r t he se c o ndi tio ns , P f l = 1 b e c a use e l e ct r o n s pe c t r u m i s n o t c h a n g e d b y P.126 t h e p r e se n c e o f a i r c av i t y . P r e p l f o r p ho to n be a m s c a n t he r e f o re be e q ua te d to P g r o n l y i f t h e c h a m be r is p o s it io n e d o n t he d e s c e ndi ng p or ti o n o f t he d ep t h do s e curve. R e p l a ce m e n t c o r re c ti on f o r el e ct r o n b e a m ca l i b r ati o n i s mo r e c om p l e x . P re s e nce o f t h e c a v i t y a lt e r s th e p r i m a r y e le c t ro n f l ue nc e b e c a us e a i r s ca t t er s e le c t ro ns l e s s t h a n t h e m e di u m. G e n e r a l l y , t he f l ue nc e c o r r e ct io n f a c t o r is l e s s 1 a nd i ts v a l u e d e pe n d s o n t h e d ep t h i n t he m ed ium ( e ne r g y s p e ct r um a t t he d e pt h o f m e a s u r e m e n t ) a n d t h e s i z e o f t he c a v it y . T he g r a di e nt c o r re c ti o n f o r el e ct r on beam c al i b r ati o n is i g n o re d in T G - 21 b e c a us e t he r e com m e nd e d p oi nt of m e a s u r e m e n t i s a t t h e d e pt h o f do s e m a x im um , w he r e t he r e i s no s i g ni f i c a nt d ose g r a d ie n t . H o w e v e r , g ra d i e n t co r r e ct io n i s a p p li e d f o r t he m e a s ur e m e nt o f d ep t h d o s e di s t ri b u ti o n . In p r a c t i ce , t hi s i s a c com p l i s he d b y s hi f t i ng t he e nti r e de p t h d o s e c u r v e t h ro u g h a d i s t a n c e o f 0 . 5 r t o w a rd t he s o ur c e , w he r e r i s t he r a di us o f t h e c y l i n d r i c al c a v i t y . In t h e c a s e o f p l a ne- p a r a ll e l c ha m be r , P r e p l i s e q ua te d to u n i t y a n d n o s h i f t c o r r e c ti o n i s u s e d a s l o ng a s t he p o i nt o f m e as ur e m e nt i s t a k e n a t t h e p ro x i m a l s u r f a ce o f t h e c a v i t y .

WWW.MEDRAD.IR

C.7. Calibration Phantom

T h e T G - 2 1 p r o to c ol ( 6 ) r e c o m me nd s t ha t c a l i b ra ti o ns b e e x p res s e d i n t e r m s o f d o s e to w a t e r . W at e r, p o l y st y r e ne , o r a c ry l i c p ha nto m s m a y be us e d . S i nc e i n c l i n i c al do s i me t r y do se t o so f t t i s s ue o r mus c l e i s t he q ua nt it y o f i nt e re s t , o ne n e e d s to c o n v e r t D w a t e r t o D m u s c l e w he n d o s e i s s p e c i f ie d f o r p a ti e nt tr e a t me nt s . T hi s c o n v e r s i o n i s do n e b y t h e f o ll o w i ng r el at io ns hi p s : F o r p h o to n b e a m s ,

F o r e le c t ro n b e a m s ,

The factors (

en

/)musclewater and (

/ ) m u s c l e w a t e r v a r y o n l y s l i g ht l y w i t h e ne r g y a nd m a y b e e q ua t e d t o 0 . 9 9 f o r al l p h o to n a n d e l e ct r o n be a m s u s e d c l i ni c a ll y . A c a l i b r at io n p h a n t om m u s t p r o vi d e at l ea s t 5 c m m a rg i n l at er a l l y be y o nd f i eld b o r de r s a n d a t l e a st 1 0 c m m a r g i n i n d e pt h b e y o nd t he po i nt o f m e a s ur e m e nt. T h i s i s t o e n s u r e f u l l s c a t te r co nd it io ns . C a l i b r at io n d ep t hs for a m eg a v o lt a ge p h o to n b e a m s a r e re co m m e n de d t o b e b et we e n 5 - a nd 1 0 - cm de pt h, d e pe nd i ng o n e n e r g y . A l te r n a t i v el y , a s i n g l e d e pt h o f 10 c m m a y b e us e d fo r a ll e ne r gi es b e t w ee n data. F o r el e ct r o n be a m s , th e c a l ib r a ti o n de pt h r e c o m me nd e d b y T G - 21 i s t he de p t h o f d o s e m a xi m u m f o r t he r e f e r e n c e co ne ( e .g. , 1 0 1 0 c m ) a nd the g i v e n e ne r g y . F o r lo w e r - e n e rg y e le ct r o n be a m s ( < 1 0 M e V) , t he A A P M p r o to c ol r e c o m me nd s t he u s e o f pl a n e - p a r al le l c h a m b e r s . T he s e c ham b e r s m a y b e c a li b r at e d i n co m p a ri s o n w i t h c y l i n d r i c al c h a m b e r s , u s i n g a c a l i br a ti o n s e t up f o r a hi g h- e ne r g y e le c t ro n b e a m . T h e p ro c ed u r e i s s om e w ha t co m pl ic a t e d b y t he f a ct t ha t pl a ne - p a r al le l c h a m b e r s a r e u s e d i n p l a s ti c p h a nt o m s , t he r e b y c r e at i ng a d di ti ona l unc e r t a i nt ies i n t h e i n t e r co n v e r s io n o f d o s e to w a t e r a nd p l a s ti c m ed i a .
60

Co a n d 5 0 M V . D o s e r a te o r d o se p e r m o ni to r uni t i s t he n c a l c ul at e d f o r

t h e r e f er e n c e fi e ld siz e a t t h e re f e r e nc e de p t h b y us i ng de pt h- d o s e di s t ri b uti o n

C.8. Simplified Equations

T h e T G - 2 1 p ro to c ol (6 ) h a s w o r k s he e t s fo r c a l c ul a ti ng N g a s a nd d o s e t o w a t e r fo r p h o to n a n d e l e ct ro n b e a m c a li b r at io n. It i s i mp o rt a nt t ha t t he us e r o f t hi s p r ot o co l c o mp le te t h es e w o r k s h e et s fo r a ny ne w c ha m b e r a nd a ne w b e a m to b e c a l i b ra t ed . O n c e a ll t he r e le v a n t c a li b r at io n p a r a m et e r s ha v e be e n e s t a bl i s hed f o r the given chamber and the given b e a m, r o ut i ne c a li b r at io n c he c k s can be p e r f o r me d u s i n g s i mp li f i e d e q u a ti o ns a nd p re c a l c ul at e d t a bl e s .

TABLE BEAMS a

8.4.

CALIBRATION

PARAMETERS

FOR

PHOTON

WWW.MEDRAD.IR

Calib ratio n Ene rgy (MV ) Dept h (cm water ) Per cent Dep th D os e Prepl Fmus
cle

60

80 .4

1.134

0. 99 2

1. 11 4

Co

87 .0

1.127

0. 99 3

1. 10 8

10

91 .1

1.117

0. 99 4

1. 09 9

18

10

79 .9

1.100

0. 99 4

1. 08 2

24

10

84 .5

1.094

0. 99 5

1. 07 8

W a t er p h a n t o m , 1 0 1 0 - c m f i e l d at S S D = 1 0 0 c m , 0 . 6 - m L P T W F a r m e r N 2 33 3 3 ( see Table 8 .3 for c ha r a c t e ri s ti c s ) . T he mass e ne r g y

chamber

a b s o r pt io n
en

c oe f f i c ie n t

r a ti o ,

/)

muscle

water

, i s a s s u m e d to b e 0 . 99 0 f o r a l l e ne r gi e s ; P w a l l = 1 ; F m u s c l e i s

defined by Eq. 8.71.

P.127

F o r p h o to n b e a m s , dos e t o m u s c le i s g i v e n b y :

where

WWW.MEDRAD.IR

T a b l e 8 .4 g i v e s F m u s c l e v a l u e s f o r a s p e c i fi c c ha m b e r a nd a num b e r o f p ho t o n be am e n e r g ie s . T h i s t a b le i s r e p r od u c e d he r e a s an e x a m p l e a nd f o r r o ug h c o m p a r i so ns . F o r e le c t ro n b e a m s , D m u s c l e i s g i v e n b y :

where

T a b l e 8 . 5 g i v e s F m u s c l e v a l u e s f o r a gi v e n c ha m b e r a nd a num b e r o f el e ct r o n e n e r g ie s . A g a i n t h e se d a t a m a y be us e d f o r r o ug h c o m p a ri so ns i f t he us e r ' s c h a m b e r i s n ot v e r y d i f f e re n t f r om F a r me r t y pe i o n c ha mb e r us e d i n t he se c a l c u l a ti o n s . In a n S S D t y p e c a li b ra t io n o f a p ho to n b e am , a 1 0 1 0 - c m fi eld i s p l a ce d at a n S S D o f 1 0 0 c m a n d t h e c h a m b e r i s p o siti o ne d at t he r e c om me nd e d de p t h o f c a l i b ra ti o n (e . g . , 1 0 cm ) . D o se t o m us c l e 3 pe r mo ni to r unit i s c a l cul a t e d a nd t he n c o n v e r t ed to D m u s c l e a t t h e r e f e re n c e de pt h o f d o se m a x i m um ( d m ) by us i ng p e r ce nt d e pt h d o s e ( P ) a t t h e d e pt h o f m e a s ur e m e nt.

An

i s o c e nt r i c

c al i br at io n d ep t h of

involves c a li b r at io n

s et ti ng ( e . g .,

up 10

of

10 a nd

10-cm

field

at

t he

r e c o m me n d e d

cm)

so ur c e - to - c ha m b e r

d i s t a n c e ( S C D ) o f 1 00 c m . If T M R i s t he t i s s ue - m a xi m um r a tio ( di s c us s e d i n C h a p t e r 1 0 ) at t h e d ep t h o f m e a s ur e m e nt ,

8.6. AAPM TG-51 PROTOCOL

T h e T G - 5 1 p ro to c ol (3 4 ) r ep r e se nt s a m ajo r up g r ad e o f t he TG - 2 1 p ro to co l i n s e v e r a l r e s pe c t s : ( a ) it i s b a se d o n ab s or b e d -d o se - to - w a t e r ca l i b r ati o n f a c to r , N60
Co

D, W

, i ns t ea d o f e xp o s u r e o r ai r k e rm a ca l i b r ati o n o f t he io n cha m b e r ; ( b ) t he

u s e r d o e s n ot n e e d to P.128 c a l c u l a te a n y t h e o re ti c a l do s im e tr y f a c t o rs ; a nd ( c ) l a r g e t a bl e s o f st op p i ng p o w e r r ati o s a n d m a ss - e n e r g y a b so r pt io n co e f f i c ie nt s a re not nee d ed . A l t ho ug h t h e a d op ti o n o f T G - 5 1 r e s u l t s i n o nl y mo d e st i m p ro v e me nt i n d o sim e t ri c a c c ur a c y o v e r t h e T G - 21 p ro toc o l (1 % 2 % ) , t he g a in i n s i m pl i ci t y i s a si g ni f i c a nt f a c to r f r o m t h e u s e r ' s p oi n t o f v i e w .

TABLE BEAMS a

8.5.

CALIBRATION

PARAMETERS

FOR

ELECTRON

WWW.MEDRAD.IR

Energy (MeV) De pth dm (c m No min al E0 wa ter )

Me an En er gy (M eV ) at dm Pr
epl

Fm
uscl e

5. 6 6

1. 3

3. 2

1.077

0. 9 6 0

1. 0 2 0

8. 6 2

1. 9

5. 0

1.052

0. 9 6 5

1. 0 0 5

12

1 1. 5 3

2. 1

7. 5

1.025

0. 9 7 4

0. 9 8 5

15

1 4. 6 3

2. 1

10 .5

1.002

0. 9 8 2

0. 9 7 1

18

1 7. 5 9

1. 5

14 .7

0.979

0. 9 9 1

0. 9 5 8

22

2 0. 8 5

1. 5

18 .0

0.967

0. 9 9 3

0. 9 4 8

WWW.MEDRAD.IR

W a t er p h a n to m , f i el d s i z e , 10 1 0 c m c o ne , S S D = 10 0 c m , e ner g y d e ri v ed

f r o m b r o ad - b e am d e pt h d o s e di s t ri b uti o n (2 5 2 5 c m f i el d ) , 0. 6 - m l P T W F a r m e r c h a m b er N 233 3 3 ( se e T ab le 8 . 3 f o r c ha r a c te r i st i c s ) . ([ s w i t h b ar a b o v e ] / ) m u s c l e w a t e r i s a ss u m e d t o be 0 . 98 7 f o r a l l e ne r gi e s , F m u s c l e i s d e f i ne d by E q . 8 . 7 3 , E 0 i s t h e m ea n e l e c t ro n e ne r g y a t t he s ur f a c e .

T h e t h e o r et i c al a s p e ct s o f T G - 5 1 go b a c k t o t he T G - 21 f o r m al i sm , e s p e c i al l y in t h e c a l c u l at io n o f c o rre c t io n f a c t or s s uc h a s [ L w i t h b a r ab o v e ] / r a t io s , P w a l l , P r e p l , Pion, Ppolarity, Pgradient, Pfluence, et c . If t he s e factors

60

are

no r m al iz e d

to

re f e r e nce

c o n d it io n s o f a b s o r bed - d o se - to - w a t er i n a factor for a

C o b e a m , t he f o r m a li s m s i m pl i fi e s to

t h e a p pl i c at io n o f a q u a l i t y co nv e r s io n f a c t o r , w hi c h c o nv e r ts t he c a l ib r a tio n
60

C o be a m t o t h a t f o r t he us e r ' s b e a m .

T h e b a s i c T G - 5 1 e q u a ti o n f o r a b s o rb ed c a l ibr a t io n i s a s f o l lo w s :

w h e r e D Q w i s t h e a b s o rb e d do s e to w a t e r a t the r e f e r e nc e p oi nt o f m e a s ur e m e nt i n a b e a m o f q u a l it y Q ; M i s t h e e l e ct ro m et e r r e a d i ng t hat ha s b e en f ul l y c o r r e c t ed f o r i o n r e co m bi n a t ion , e n v i r o n m e nt a l tem p e r at ur e a nd p r e s sur e , e l e c tr o me te r c a l i b ra ti o n a n d c h a m b e r p ol a r it y e f f e c t s ; k Q i s t he q ua l it y c o nv e rs i o n f a c t o r t h a t c o n v e r t s t h e ab s o rb ed - d o se - to - w a t er c a li br a t io n f a c t o r f or a c a l i b ra ti o n f a c to r f o r a n a r b it r a r y be a m o f q ua l it y Q ; a nd N d o s e -t o - w at e r c al i br a ti o n f a c t o r fo r t he c ham b e r i n a c o n d it io n s . The reference p oi n t of m e a s u r e m e nt in E q ua t i o n (8.76) is s p e c i f ie d at t he r e f e r e n c e d e pt h c or r es p o n d i n g to t he c e nte r o f c a vi t y f o r a c y li nd r i c al c ha m b er a n d t h e f r o nt s u r f a c e o f t h e c a v i t y fo r a p l a ne p a r a ll el c ha m be r . A l t ho ug h t he e f f e c t i v e po i n t o f mea s u r e m e n t o c c ur s ups t r e a m f o r a c y l i nd ric a l c ha m b er , t he r e s u l ti n g g r a di e n t c orr e c ti o n h a s a l r e a d y b ee n t a k e n i nt o a c c o unt i n t he k Q f a c t o r .
60 60
Co

60

C o b e a m i nt o t he i s t he a b s or b ed -

D, w

C o b e a m und e r r e f e r e nc e

A. Beam Quality, Q 1. Photon Beams

The TG-21 p r o to co l s p e c i f ie s p ho to n beam e ne r g y in ter m s of no m i na l a c c e l e r at i n g p ot e n ti a l w h i c h i s s ho w n t o be r e l at ed to i o ni z at ion r a t i o ( 6 ) . T he i o n i z a ti o n r at io i s d e fi n e d a s t h e r a tio o f io ni z a t io n c ha r g e o r do s e me a s ur e d at 2 0 - c m de p t h to t h at m e a s u r e d a t 1 0 - c m de p t h f o r a c o nst a nt so ur c e to d et e ct or distance and a 10 10 cm2 field at the p l a ne o f t he c ha m b e r ( i so c e nt ri c g e o me t r y ) . T h i s i o n i za t io n r a t io i s t he s a me a s w ha t i s a l s o k no w n a s T P R 2 0 1 0 o r T P R 2 0 , 1 0 u s e d b y A n d re o a n d B r a hm e (3 5 ) a nd t he Int e r na t io na l A t om i c E ne r g y Agency ( IA E A ) p r o t oc o l (3 6 ) . T he AAPM TG-51 ( 34 ) p ro to co l ha s i ns te a d r e c o m me n d e d % dd ( 10) x a s t h e b e a m q ua li ty - s p e c i f ie r . T he q ua nt it y % dd ( 1 0) x i s

WWW.MEDRAD.IR

t h e p h ot o n c om po n e n t o f t h e p ho to n b e a m pe r c e nt a ge de pt h d o se a t 1 0 - cm d ep t h i n a 1 0 1 0 c m 2 f i e l d o n t h e s u r f a c e o f a w a t e r p ha nt o m a t a n S S D o f 1 0 0 c m . T h e p r o s a n d co n s o f u s i n g T P R 2 0 1 0 v e r s us % d d ( 10 ) x ha v e b e e n d i s c us s e d i n t he l it e r at u r e ( 3 7 , 38 ) .

F I G . 8 . 6 . A pl ot o f wa t e r to ai r st o pp i ng po w e r r at io s a s a f u nc ti o n o f %d d ( 10 ) x . ( F r o m K o s u n e n A , R o g e r s D W O . Be a m qua l i t y s p e ci f i c at io n f o r p hot o n b e a m d o s im e tr y . M e d P h y s 1 9 93 ; 2 0 :1 01 3 1 01 8 , w i t h p e r mi s s io n. ) P.129

T h e r a t i o n al e f o r %dd ( 1 0 ) x a s a p hot o n be a m q ua l it y s p e ci f i e r i s p r o v id e d b y K o s u n e n a n d R o ge r s (3 9 ) w h o s h o w ed t ha t f o r a ny x - r a y b e a m ab o v e 4 M V , t he re i s a l i n e a r r el a ti o n s hi p b et w e e n st o pp i ng p o w e r s r a ti o s a nd %d d ( 10 ) x f o r t he p h o to n c o m po n e n t o f t h e b e a m ( F ig . 8 . 6 ) . M a t he m a ti c a ll y ,

D e te r m i n at io n o f % dd ( 1 0 ) x r eq u i r e s t ha t t he p ho to n b e a m b e f r e e o f e le c t ro n c o n t a m i n at io n . Because it is i m po s si b le to r e mo v e el e ct ro n c o nt a m i na ti o n c o m pl e te l y f r o m cl i nic a l p ho to n b e am s , the T G - 5 1 p ro to c ol re c o m me nd s t ha t % d d ( 10 ) x be m e a s u r ed b y i n te r po s i ng a 1 -m m - t hi c k le a d ( P b ) foi l i n t he be a m a t a d i s t a n c e o f a b o u t 50 c m f r o m t he p ha ntom s ur f a c e . T hi s a r r a n g e m e nt mi ni mi z e s t h e e le c t ro n c o n t a m i na t io n i n c i d e nt at t he p ha nt o m s ur f a c e a s t he l e a d f o il a c t s a s a n e l e c t ro n f i l te r ( 4 0 ) . F o r p h ot o n be a m s o f en e r g y l e s s t ha n 1 0 M V , t he c o nt ri b uti o n o f do s e at d m a x f r o m i n c i d e nt el e ct r o n co n ta m i n a t io n i s m i ni m al f o r a 1 0 1 0 c m 2 . S o t he % dd ( 1 0 ) m e a s u r e d i n a n o p e n b e a m wi t h o ut le a d m ay b e e q ua te d t o t he %d d ( 10 ) x . T he us e

WWW.MEDRAD.IR

o f l ea d f oi l , h o w e v e r , i s re c o m me nd ed f o r % d d ( 10 ) x me a s ur e m ent f o r e ner g ie s o f 10 MV or higher. C a l c u l a t io n of %d d (1 0 ) x for v a r io us b ea m e ne r gi e s i nv ol v es t he f o ll o wi ng e q u a t io n s , a s r e c o m me n d e d b y T G - 5 1 :

It s h o u l d b e n ot ed th a t t h e P b f o il i s use d o nl y w he n d e te r mi ni ng t he be a m q u a l it y s p e c i f ie r , % dd ( 1 0 ) x , a n d m us t b e r e m o v e d at t he c onc l us i o n o f t hat d e te r m i n at io n . In a d d i ti o n , if t he m e a s ur e m e nt of d ep t h d os e s i nv o l v e s a c y l i n d r i c al c h a m b er , th e d e pt h d o se c ur v e m us t b e co r r e ct ed f o r g r a d ie nt e f f e c t s , t h a t i s , s h i f t o f t h e c u r v e u p s t r e a m b y 0 . 6 r c a v , w he r e r c a v i s the r a d i us o f t he chamber cavity. In case the l e ad f oi l is not a v a i l ab le , an a p p r o x i m at e r e la ti o ns hi p fo r t he d e te r m i n at io n o f % d d( 1 0 ) x o n a n i nt e r i m b as i s i s r e c om m e nde d by T G - 5 1 :

T h e p r e v i o u s e q u a ti o n i s b a s e d o n a g l o b al f i t t o d at a ( 3 3 ) a nd in e x t r e m e c a s e s m a y l e a d to a n e r r o r in k Q o r a b s o r be d do s e o f 0 . 4 % .

F I G . 8 . 7 . A t y p i c a l el e c tr o n b e a m de pt h d o s e c ur v e s ho w i ng d ep t h o f m a x i m um d o s e ( d m a x ) , d e pt h o f 5 0 % do s e ( R 5 0 ) a nd d e p t h f o r c li ni c r e f er e nc e d o si m et r y ( d r e f ) . ( F r o m A A P M . A A P M ' s T G - 5 1 p r o t o co l f o r c li ni c al r e f e r enc e d o s i me t r y of h i g h - e n e r g y p ho to n a n d e le c t ro n be a m s . M e d P hy s 19 99 ; 2 6 :1 8 47 18 70 , w it h p e r m i s sio n . ) P.130

2. Electron Beams
WWW.MEDRAD.IR

T h e b e a m q u a l it y f o r e l e ct r o n b e a m d o si me t r y i s s p e ci f ie d b y R 5 0 , t he d e pt h i n w a t e r (i n c e n ti m et e rs ) a t w h i c h t he pe r ce nt de pt h d o se i s 50 % f o r a b ro ad b e a m ( f ie l d s i z e a t th e p h a n t o m s ur f a c e 1 0 1 0 c m 2 f o r ene r g i e s up to 2 0 M e V o r 2 0 2 0 cm 2 fo r a ll e n e r gi e s i n t he c l i ni c al r a nge ) at a n S S D o f 10 0 cm . Figure 8.7 shows a t y p i c al el e ct ro n b ea m d ep t h do s e c ur ve with dmax, dref ( r e f e r e n c e de p t h o f c al i b r at io n ) a nd R 5 0 i nd ic a t e d . R 5 0 f o r a br o a d b e am ( e . g . , 2 0 2 0 cm 2 f i el d si z e ) m a y be d et e r mi ne d b y m e a s u r e m e n t o f do s e a t t w o p o i nt s o n c e nt r a l a x i s : o ne a t d m a x a nd t he o t he r a t d e pt h w h e r e t he do se f a l l s to 50 % o f t he m a x i m um d o s e . If a c y l i nd ri c a l i o n c h a m b e r i s u s e d fo r t h i s m e a s u r e me nt , t he p oi nt o f d m a x s ho uld c o r r e sp o nd t o w h e r e t h e c h a m b e r re a d s m a x i m um io ni z a t io n o n c e nt r a l a x i s . A p o i nt i s t he n l o c at e d do w n s t r e a m on c e n t r a l a x i s w he re the io ni z a t io n me a s ur ed i s 50 % o f t he m a x i m u m v a l u e . T h e d e pt h o f 5 0 % i o ni z a t io n ( I 5 0 ) i s d et e r mi ne d b y s ub t r a c ti ng 0 . 5 r c a v f r o m t h e d ep th i n d i c a t e d b y t he ce nt e r o f c ha m b e r c av i t y . T he b e a m q u a l it y s p e c i f ie r , R 5 0 , is t h e n c a l c ul a t ed f r o m I 5 0 ( 4 1 ) :

or

A l t e r n a ti v el y , R 5 0 m a y b e d et e r mi ne d f ro m t he de p t h i o ni z a t io n cur v e ( m e a s ur e d w i t h a c y l i n d ri c a l c ha m b e r ) , w h i c h ha s b e e n c o r re c t ed f o r g ra d i e nt e f f e c t s b y s h i f t i n g t he e n ti r e c u rv e u p s t r e a m b y 0 . 5 r c a v ( F i g . 8 . 8 ) a nd c o nv e r t i ng I 5 0 t o R 5 0 b y u s i n g t h e a b o v e E q u ati o n s . If a w a t e r p ha nt o m s c a nne r w i t h io n c ha m b e r i s us e d , m o s t s y s te m s a r e eq u i p pe d w i t h s o ft w a r e to c o nv e r t de pt h i o ni za t io n c ur v e s i nt o d e pt h - d o se c u r v e s u s i n g a p p r op r i at e f a c to rs ( e . g . , ( [ L w i t h b a r a b o v e ] / ) w a i r a nd P r e p l o r P f l P g r , a s a f u n c t i o n o f de pt h) . T hi s a l lo w s a q ui c k d e te r m i nat io n o f i m po r t a n t do s im et r y p a r a m e te r s s uc h a s d m a x , d r e f , R 5 0 , a nd R p .

F I G . 8 . 8 . S h i f t i n g o f d e pt h i o n i z at io n c ur v e s up s t r e a m b y 0 . 6 r c a v f o r p ho to ns a nd 0 . 5 r c a v f o r e le c t ro n s i n o r d e r to c o r r ec t f o r shi f t i n t he p o i nt o f m e a s ur e m e nt w he n u s i n g a c y l i n dr i c al io n c h a m b e r o f c a v it y r ad i us , r c a v . ( F r om A A P M . A A P M ' s T G - 5 1 p r ot o co l f o r cl i n i c al r e f e r e n c e do s i me t r y o f hi g h- e ne r g y p hot on a nd e l e c t ro n b e a m s . M e d P h y s 1 9 99 ; 2 6 : 18 47 18 70 , w i th p e r m i s s io n. )

WWW.MEDRAD.IR

If a d i od e o r f i l m i s u s e d t o d et e r mi ne d e pth- d o s e d i st r ib ut io n i n a w a t e r o r w a t er e q u i v a le n t p h a n to m , t h e de te c to r re s p o nse a s a f unc t i o n o f de p t h g i v e s d ep t h d o s e c u r v e d i re c tl y w i t h o u t f u r t he r co r r ec t io ns ( s e c ti o n 1 4 . 3 B) . H o w e v e r , i t i s i m po r t a n t t o e st a bl i s h P.131 first by s u it a bl e be n c h m a r k tests, t hat the s e d o si m et r y s y s te m s a g r ee w it h

c o r r e ct e d i o n c h a m b e r d o s i me t r y .

B. Quality Conversion Factor, k Q

B y d e f i n i t io n , k Q i s g i ve n b y :

F r o m T G - 2 1 E q u a t io n [ 8 . 5 7 ] :

A s d i s c u s s e d e a r li e r (s e c t io n 8 . 5 , C . 6 ) , P r e p l ha s t w o c o m p o ne nt s , t he g r a d ie nt a nd f l u e n c e c o r r e ct io n f a c t o r s :

E q u a t i o n 8 .8 4 m a y be f u r t h e r r e v i se d b y m ul t ip l y i ng t he ri g ht ha nd s i d e o f t he e q u a t io n b y t h e c e n t ra l e le c t ro de c o r re c ti on f a c t o r , P c e l . T hi s f a c t o r w a s i g no r ed b y t h e T G - 21 p r ot o col b u t it i s i ncl ud e d i n t he k Q v a l ue s o f t he T G - 5 1 p r ot o co l . T h e c e n t r a l e le c t ro de e f f e c t i s q ui t e s m a ll f o r el e ct r o n b e a m s (< 0 . 2 % ) , b ut fo r p h o to n b e a m s it h a s b e e n s h o w n t o be s igni f i c a nt . F o r e x a m pl e , P c e l f o r F a r me r l i k e c h a m be r s w i t h an a l u m i n u m e l e c tr o de o f 1 m m di a me t er v a r i e s b et w e e n 0.993 for

60

C o to 0 . 9 96 f o r 2 4 M V x - r a y s ( 4 2 ) .

F r o m E q u a ti o n s 8 . 8 3, 8 . 8 4 , a n d 8 . 85 a lo ng w it h t he us e o f P c e l w e ge t t he e x p r e s s io n f o r k Q :

1. k for Photon Beams

Q

U s i n g t h e a bo v e r el at io n s h i p , R og e r s (3 3 ) c a l c ul a te d k Q v a l ue s f o r a v a r ie t y o f c o m m e r ci a ll y a v a il a ble c y li n d r i c al i o n c ham b e r s a s a f unc t io n o f p ho to n be a m energy from

60

C o to 2 4 M V . T h e s e d a t a c o mp r i s e T a bl e I o f t he T G - 5 1 p r ot o co l a nd

a r e r e p ro d u c e d h e re i n T a b l e 8 . 6 . D a t a f o r p l a ne - p a r al le l cha m b e r s a r e no t i n c l u d e d b e c a u s e o f in s u f f i c i e n t i nf o r m a ti on a b o ut P w a l l i n p hot on b e a m s , o t her than

60

C o f o r w h i c h k Q = 1 b y d e f i ni t io n f o r a l l c ha m b e r s .

2. k for Electron Beams

Q

A l t h o u g h E q u a ti o n 8 .7 6 i s ge n e r a l f e l t t h at f o r e le c t ro n b e a m s P.132

a nd ca n b e

a pp li e d f o r bo t h p hoto n a nd

e l e ct r o n b e a m s ( se e IA E A P r o t o c ol , s e c ti on 8 . 7 ) , a ut ho r s o f t he T G - 5 1 P ro to col

t h e P Q g r f a c t o r i n E q u a t io n ( 8 . 8 6 ) a t t he r e f er e nc e p oi nt o f m e a s ure m e nt m a y v a r y f r o m o n e a c c e le r a to r t o a n o t h e r a nd t he re f o r e m us t b e me a s ur e d i n t he us e r ' s

WWW.MEDRAD.IR

b e a m . T h u s k Q h a s b e e n r e d e f i n e d f o r el e ctr o n b e a m s b y t he f o l lo w i ng e q ua ti o ns (43):

where

a n d P Q g r i s t h e g r a di en t c o r r e ct io n a t t he re f e r e nc e de p t h o f m ea s ur e m e nt . T he r e f e r e n c e d ep t h , c al le d d r e f , f o r e le c t ro n be a m s i s b a se d o n re co m m e nd at io n b y Burns et al. (44) and is given by:

T h e g r a d i e n t co r r e ct ion a t t h e r e f e r e nc e d ept h i s g i v e n b y :

w h e r e I ( d ) i s t h e io n iz a t i o n r e ad i ng o f t he c y l i nd r i c al c ha m b e r w it h t he c y l i nd ri c a l a x i s a t d e pt h d .

TABLE 8.6. k Q VALUES FOR ACCELERATOR PHOTON-BEAMS AS A FUNCTION OF %DD(10) x FOR CYLINDRICAL ION CHAMBERS

kq %dd(10)x I on C h a m b e r 58.0 63.0 66.0 71.0 81.0 93.0

Capintec 05/PR-05P

PR-

0.999

0.997

0.995

0.990

0.972

0.948

Capintec 06C/G Farmer

PR0.6cc

1.000

0.998

0.994

0.987

0.968

0.944

Exradin Shonka
a

A1

0.999

0.998

0.996

0.990

0.972

0.948

Exradin Farmer

A12

1.000

0.999

0.996

0.990

0.972

0.948

WWW.MEDRAD.IR

N E 2 5 0 5 /3 , 3 A 0.6cc Farmer

1.000

0.998

0.995

0.988

0.972

0.951

NE2561

0.3cc
b

1.000

0.998

0.995

0.989

0.974

0.953

NPL Sec. Std

NE2571 Farmer

0.6cc

1.000

0.998

0.995

0.988

0.972

0.951

N E 2 5 7 7 0 .2 c c

1.000

0.998

0.995

0.988

0.972

0.951

NE2581

0.6cc

1.000

0.994

0.988

0.979

0.960

0.937

r o b u s t F a r m er

PTW

N 3 0 00 1
c

1.000

0.996

0.992

0.984

0.967

0.945

0.6cc Farmer

PTW 0.6cc

N 3 0 00 2 a ll

1.000

0.997

0.994

0.987

0.970

0.948

Graphite

PTW

N 3 0 00 4

1.000

0.998

0.995

0.988

0.973

0.952

0 . 6 c c G r a p h i te

PTW 0.3cc

3 1 00 3

1.000

0.996

0.992

0.984

0.967

0.946

w a t e r p ro o f d

W e l l ho f e r 1 0 / IC - 5

IC -

1.000

0.999

0.996

0.989

0.971

0.946

For
a

60

Co

b e am s , c h a mb e r s N E 2 6 11 has is is

kQ w it h to to

1.000 a no t he r t he PTW PTW t he

by r ad i us e q ui v al e nt N 23 33 3 N 23 3 64 1 it it

d e f i nit io n . as A1. N E 2 5 61 . r e pl a c ed . r ep l a ce d .

T h e c a v i t y r a d i u s o f t h e A 1 h e r e i s 2 m m a l t ho ug h i n t he p a s t E x r a d i n ha s The PTW PTW r e p l a c ed t he

d e s ig n a t ed
b c d

N 30 00 1 N3 1 00 3

e q u i v al e nt e q u i v al e nt

F r o m A A P M . A A P M ' s T G - 5 1 p ro to co l f or c li ni c a l re f e r e nc e d o si m etr y o f hi g h-

WWW.MEDRAD.IR

e n e r g y p h ot o n a n d el e c tr o n b ea m s . M e d P hy s 1 9 9 9 ; 26 : 18 4 7 1 8 70 , w i t h p e r m i s sio n .

F u r t h e r , t h e a u t h o r s o f T G - 5 1 t ho ug ht t hat t he v a l ue s o f k R chambers vary c o n s id e r a bl y ( 43 ) a nd t ha t t her e was no

50

f o r d i f f e re nt io n p ro v i s io n in t his

f o r m a li s m f o r a f u t u r e p o s s ib il it y o f ha v i ng c ha m b e r c a li b r at io n f a c t o r s me a s ur e d d i r e ct l y f o r e le c t ro n be a m s . T h e s e d r a w b a ck s c o ul d be a v o id ed by a r r i v i ng a t k R i n t w o s te p s i n s t e ad o f t h e o n e d e ri v e d d i re c t l y b y q ua l it y c o m pa r i s o n w it h Thus, kR
50 50

60

Co.

is redefined as:

P.133

w h e r e k e c a l i s t h e q u ali t y co n v e r s i o n f a ct o r f o r a r e fe r e nc e e le c t ro n b e a m o f hig h e n e r g y w i t h a n a r b i t r ar y b e a m q u a l it y Q e o f R 5 0 = 7 . 5 c m , r e l a ti v e to
60

Co.

o r , f r o m E q u a t io n 8 . 88 :

and kR

50

i s t h e q u a li t y c o n v e r s i o n f a c to r f o r t he g i ve n e l e ct ro n b ea m o f q ua l it y Q

r e l at i v e to t h e r e fe r e nc e e l e ct ro n b e a m o f qua l i t y Q e , t hat i s ,

V a l u e s o f k e c a l f o r t he pl a n e - p a r al le l a nd c y l i nd ri c a l io n c ha m b e r s ha v e b ee n c a l c u l a te d u s i n g E q u a t io n 8 . 9 4 ( 4 3 ) a nd a re p r e s e nte d i n T a b le s II a nd I II o f t he T G - 5 1 p ro to c ol (3 4 ) . T h e s e a r e re p ro d uc e d i n T a b le s 8 .7 a nd 8 . 8 o f t hi s c ha pt e r. The values of are kR

50

for

Farmer-like by Ro ge r s

c y li nd r i c al (4 3 )

c ha m b e r s t he

a nd

p l a ne - p a r a ll el eq ua t io ns

chambers

c a l c ul a t ed

us i ng

f ol lo w i ng

r e s p e ct i v el y :

and

WWW.MEDRAD.IR

C. Calibration Phantom
T G - 5 1 r eq u i r e s t h a t th e c a l ib r a ti o n o f p ho to n a nd el e ct r o n b e a ms b e p e r fo r m ed in a w a t e r p h a n t o m . T h e r e c o m me n d e d d i me ns i o ns o f t he p ha nt o m ar e a t le a s t 3 0 3 0 3 0 c m 3 . If t h e b e a m e n t er s t he p ha nt o m f r o m t he s i de thr o ug h a p l a s t i c w a l l , a l l de pt h s m u s t b e s c a l ed to w a t e r equi v a l e nt d ep t hs us i ng a s c a l i ng f a c t o r of 1 cm acrylic = 1.12 cm H2O.

D. Chamber Waterproofing
A c y l i n d r i c a l io n c h a m b e r m a y b e w a t e r pr o o f ed us i ng a t hi n ( 1 - m m t hi c k ) a c r y l i c sl e e v e . T h e c h a m b e r s h o ul d sl ip i nto t he s le e v e wi t h li ttle r e si s t a nc e a nd w i t h m i n i m a l ai r g a p s P.134 a r o u n d t h e t h i mb le ( 0 . 2 m m ) . A no t he r o p ti o n i s to us e a l at e x c o ndo m b ut without any t al c u m powder b e c a us e t he t a l c um p o w de r c o uld leak i nto t he c h a m b e r c a v i t y . W a t er p r oo f c h a m b e r s o r cha m b e r s w i t h w a t e r pr o o f i ng k it s a r e a l s o c om m e r ci a ll y a v a i l a bl e .

TABLE 8.7. k e c a l VALUES FOR PLANE-PARALLEL CHAMBERS, ADOPTING A REFERENCE BEAM QUALITY Q e c a l OF R 5 0 = 7.5 cm

Chamber

kecal

Attix

0.883

Capintec

0.921

PTB/Roos

0.901

Extradin

0.888

Holt

0.900

Markus

0.905

NACP

0.888

WWW.MEDRAD.IR

F r o m A A P M . A A P M ' s T G - 5 1 p ro to co l f or c li ni c a l re f e r e nc e d o si m etr y o f hi g h e n e r g y p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 9 9 ; 2 6 :1 8 47 1 97 0 , w i t h p e r m i s sio n .

TABLE 8.8. R 5 0 = 7.5 cm

kecal

VALUES FOR CYLINDRICAL CHAMBERS,

ADOPTING A REFERENCE ELECTRON BEAM QUALITY Q e c a l of

Wall Cavity T h i c k n e ss Chamber kecal Material g/ c m

2

Al E l e c t r ode Diameter (mm) Radius rcav (cm)

F a r m e r - li k e

Exradin A12

0.906

C-552

0.088

0.305

N E 2 5 0 5 /3 , 3 A

0.903

G r a p hi t e

0.065

0.315

1.0

NE2561a

0.904

G r a p hi t e

0.090

0.370e

1.0

NE2571

0.903

G r a p hi t e

0.065

0.315

1.0

NE2577

0.903

G r a p hi t e

0.065

0.315

1.0

NE2581

0.885

A-150

0.041

0.315

Capintec 06C/G

PR-

0.900

C-552

0.050

0.320

WWW.MEDRAD.IR

PTW N23331

0.896

G r a p hi t e

0.012

0.395e

1.0

PMMA

0.048

PTW N30001b

0.897

G r a p hi t e

0.012

0.305

1.0

PMMA

0.033

PTW N30002

0.900

G r a p hi t e

0.079

0.305

PTW N30004

0.905

G r a p hi t e

0.079

0.305

1.0

PTW N31003c

0.898

G r a p hi t e

0.012

0.275

1.0f

PMMA

0.066

O t h e r c y l i n d ri c a l

Exradin A1d

0.915

C-552

0.176

0.200

Capintec 05/PR-05P

PR-

0.916

C-552

0.210

0.200

W e l l ho f e r IC 1 0 / IC - 5

0.904

C-552

0.070

0.300

a b c d

The PTW PTW

NE2611 N 3 0 00 1 N 3 1 00 3 is is

has

r e p l a c ed to to t he t he

t he PTW PTW

e q ui v a le nt N 2 3 3 33 N 2 3 36 4 1 r ad i us r ad i us it it

N E 2 5 61 . r e p l a ce d . r e pl a c ed . as A1. he r e .

e q u i v a l e nt e q u i v a le nt w it h t ha n

T h e c a v i t y r a d i u s o f t h e A 1 h e r e i s 2 m m a l t ho ug h i n t he p a s t E x r a d i n ha s c h a mb e r s is u s ed rather a no t he r t he r ea l cavity In e l e ct ro n b e a m s t he r e a re o nl y d a t a fo r c a v i t y r a di i up t o 0 . 35 c m a nd s o cm s ho w n E l e c t ro d e d i a me te r i s a c t u a ll y 1 . 5 m m, b ut o nl y d a t a f or 1 . 0 m m i s

d e s ig n a t ed
e

0.35
f

a v a i l a bl e F r o m A A P M . A A P M ' s T G - 5 1 p ro to co l f or c li ni c a l re f e r e nc e d o si m etr y o f hi g he n e r g y p h ot o n a n d e l e ct r o n b e a m s . M ed P hy s 1 9 9 9 ; 26 : 18 4 7- 1 9 70 , w i t h

WWW.MEDRAD.IR

p e r m i s sio n .

E. Charge Measurement
T h e f u l l y c o r r e c t ed c h a r g e r e a di n g , M , f r o m a n i o n c ha m b e r i s g i ve n b y :

w h e r e M r a w i s t h e r a w c h a m b e r r e a d i ng i n c o ul o mb s o r t he i ns t rum e nt ' s r e a d i ng; P i o n i s t h e i o n r e c o mbi n a t io n c o r r e ct io n; P T , P i s t he a i r t e mp e r at ur e a nd p r e s s u r e c o r r e ct io n ; P e l e c i s t h e e le c tr o me te r c a li b ra t io n f a c t o r ; a nd P p o l i s t he po l a ri ty c o r r e ct io n . R a t i o n al e f o r t h e s e co r r e ct io n f a c t o r s ha s b e e n di s c us s e d .

1. P

ion

T h e i o n r e c o m bi n a t io n c o r r e c ti o n ha s b e e n d i s c us s e d i n s e c tio n 6 . 8 . In o ne o f t he m e t h od s , t h e c h a m b er r e a d i n g s a re t a k e n w i t h f ul l v o lt a g e a nd w i t h ha l f - v o l t ag e . T h e r a t io o f t h e t w o r e a di n g s i s r el a te d t o P i o n w hi c h i s r e a d o f f f r o m a c ur ve c o r r e s po n di n g to the type of b ea m : p uls e d , p ul s ed s c a nni ng or c o nti nuo us r a d i at io n ( F i g . 6 . 1 7 ) . A l t e r n at i v el y , T G - 5 1 r e c o m me nd s m ea s ur e m e nt s at t wo v o l t ag e s : t h e n o r m a l o p e r at i n g v ol t ag e , V H a nd a pp r o x im a te l y ha l f - v o lt a g e V L . If t h e c o r r e sp o n di n g c h a m b e r r e ad i ng s a r e M H r a w a nd M L r a w , P.135 t h e n P i o n a t V H i s gi v e n b y :

or

2. P

T,P

In t h e U n i t e d S t a te s , t h e c a l ib r a ti o n l a bo r ato r ie s [ N a t io na l Ins t i t ut e o f S t a nd a r d s a n d T e c h n o l o g y ( N IS T ) a n d A c c r e d i te d Do s e C a li b r at io n L a bo ra t o ri e s ( A D C L s ) ] p r o v id e c h a m be r c al ib r a t io n f a c to r s f o r st a nd a r d e nv i r o nm e nta l To = 22C and p r e s s ur e Po = 760 mm Hg or c o ndi ti o ns o f kPa (1 t e m pe r a t u re 1 0 1 . 33

a t m o sp h e r e ) . T h e t e mp e r a t u r e a n d p re s s ur e c o r r e c ti o n, P T , P , i s gi ve n b y :

WWW.MEDRAD.IR

or

T h e r a t i o nal e f o r t h e u s e o f t e m pe r a t ure a nd p r e s s ur e c o r re c ti on f o r i o n c ha m b er r e a d i n g s h a s b ee n d i sc u s s e d i n s e c t io n 6 . 1 0.

3. P

elec

T h e e le c t ro m et e r c o r re c t io n f a c to r , P e l e c , dep e nd s o n w he t he r t he e le c t ro m et e r is d e t a c h ed or forms an integral uni t with t he ion c ha m b e r . If separate, t he e l e ct r om et e r m u s t bea r a c a l i b r at io n f a c t o r f o r c ha r g e m e a s ur e me nt . P e l e c c o r re c ts t h e el e ct r om et e r re ad i n g t o t r u e c o ul o mbs . It s uni t o f me a s ur e m e nt i s C / C o r C / r d g . If t h e e l e c t ro me t e r a n d io n c ha m b e r f o r m a s i ng l e uni t , P e l e c = 1 . 0 0 .

4. P

pol

C h a m b e r p o l ar it y e f f e c t s d e pe n d o n t he c ha m b e r d e si g n, c a b le p os i ti o n, a nd b e am q u a l it y ( s e e s e c tio n 6 . 9 ) . P p o l i s t he pol ar i t y co r r e ct io n f a c t or, w hi c h c o r r e c t s c h a m b e r ' s r e s po n s e f or p o s s ib l e p ol a r it y e f f e c t s . M e a s u r e m e n t o f P p o l i n v o l v e s t a k i ng c ha m be r r e a d i ng s w it h b o th p o l a r it ie s a nd d e te r m i ni n g P p o l f r o m :

w h e r e M + r a w i s t h e re a d i n g w h e n p o si ti v e c ha r g e i s c ol le c te d a nd M - r a w i s t he r e a d i n g w h e n n e g a ti v e c h a r g e i s c ol le c t ed , a nd M r a w i s t he r e a ding c o r r e s po nd i ng t o t h e po l a ri t y u s ed f o r b ea m c a li b r at io n (w hi c h i s r e c o m me nd ed to b e t he s a me a s u s e d f o r t h e c h a m b e r c a li b r at io n) . It s ho ul d b e no te d t ha t t he s i g n o f t he c h a r g e f o r M + r a w a n d M - r a w ( w h i c h w o ul d no r m a l l y b e op po s it e ) i s t o b e c a r r ie d i n E q u a t i o n 8 . 1 03 . A l s o s u f f i c i e n t t i me s ho ul d b e g i v e n b et w e e n p ola r i t y c ha ng e s t o s t a b il i z e t h e r e a di n g s . P.136

F. Chamber Calibration Factor, N w 6 0 C o

T h e T G - 5 1 p r o to co l i s b a s e d o n a b so r be d - dos e - to - w a t e r c al i b r ati on f a c t o r ,

where D

60C

i s t h e ab s o r be d d o se t o w a te r i n t he c al ib r a tio n l a b or a to r y ' s

60

Co

b e a m u n d e r r e f e re n c e c o n d it io n s , a t t he c ha m b e r ' s p oi nt o f m e as ur e m e nt i n t he a b s e n c e o f t h e c h a m be r . A s d i s c u s s e d e a r lie r , t he c a l ib r a ti o n f a c t o r a pp li e s und e r s t a n d a r d e n v i r o n m e n ta l c o n di ti o ns , v i z . 22 C , 1 0 1 .3 3 k P a , a nd re l a ti v e hum i dit y b e t w ee n 2 0 % a n d 80% . T h e c a l i b r at io n f a c t o r c a n b e ob t ai ne d f ro m A D C L s i n t he U n i t ed S t a te s ( t r a c e ab l e to N IS T ) . T h e N IS T ' s p r i m a r y st a n d a r d fo r t he ab s or b e d -d o se - to - w a t e r ca l i b r ati o n o f t he c h a m b e r i s c u r r e n t l y b a s e d o n a b so l ute d o si m et r y w i t h a c a l o ri me t e r . T r a ns f e r i o n c h a m b e r s a r e u s e d a t t h e A D C L s t o p ro v i de N IS T t r a c e a b l e c a li b r at io ns .

WWW.MEDRAD.IR

G. Photon Beam Calibration

The TG-51 p ro v id es worksheets to gui d e t he us e r in a s te p - b y - s tep i m p le m e nt a ti o n o f t he p ro to c ol . T he s e w or k s he e t s a r e hi g hl y re c o m me nd e d f o r t h e o ri gi n a l r e fe r e n c e c a l ib r a ti o n . S i mp l e r f o r m s o r wo r k s he e t s m a y b e de s i g ned f o r r o u t i n e c al i br a ti o n c h e c k s . T h e e s s e n ti a l e q ui p m en t f o r t h e re f e r e nc e ab s o r be d d o se c al ib r a tio n c o ns i st s o f a s u i t a bl e w a t er p h a n t om , a c h a m b e r ho l de r , a w a t e r p ro o f s le e v e ( if c ha m b e r i s not w a t e r p ro o f ) , a n io n c h a m b e r w i t h c al i b rat io n f a c t o r N
60

Co

D,w

, ele c t ro m et e r w it h

c a l i b ra ti o n f a c to r P e l e c , a c al i b ra t ed b a r o me te r a nd a c al i b r at ed t he r m o me te r . O ne m m t h i c k l e ad s h e et s h o u l d b e a v a i l ab le t ha t c a n be p l a ce d in t he be a m at a d i s t a n c e o f 5 0 5 cm f r o m t h e p ha nto m s ur f a c e . F o r us e a t s ho r t e r d i st a nc e s s u c h a s 3 0 1 c m , s e e T G - 5 1 p r oto c ol . A l t h o u g h f u l l d et a il s a r e a v a i l ab l e i n t he TG - 5 1 p ro to c ol a nd i t s w o r k s he e t s , t he c a l i b ra ti o n s t ep s a r e su m m a r i z e d b el o w a s a q ui c k r e v i e w :

S e t u p w a t e r p h a n t o m f o r c a l i b r at io n. D e te r m i n e be a m q u a lit y , i . e . % d d ( 10 ) x :

o o

S e t f i el d s i z e a t s u r f ac e , 1 0 1 0 c m 2 , a t S S D = 1 0 0 c m . M e a s u r e % d d ( 10 ) w i th o p e n b e a m ( no l e ad s he e t ) . F o r t he D m a x o r p e a k d o se m e a s u r e me nt , t he c ha m b e r s s ho ul d be p l a ce d w he r e t he reading for a s et num b e r of m o nit o r uni t s ( e .g . , 2 00 MU) is m a x i m u m o n t h e ce nt r a l a x i s . Fo r t he dos e a t 1 0 c m d e pt h, t he c e n t e r o f c h a m b e r s houl d b e pl a c e d at ( 1 0 + 0 . 6 r c a v ) cm . T h e r a t io o f io n i z a t io n a t 10 c m d e pt h to t ha t a t d m a x t i me s 10 0 g iv e s % d d ( 10 ) . If t h e b e a m e ne r g y i s < 1 0 M V , t he n % d d ( 1 0 ) x = % d d (1 0 ) . If t h e b e a m e n e r g y i s 1 0 M V , us e 1 - m m l e a d s he et i n t he b e am a t a d i s t a n c e o f 5 0 5 c m f r o m t he s ur f a c e . M e a s ur e % d d ( 10 ) P b a s i n (b) above. U s e E q u a ti o n 8 .7 9 t o d e te r m i ne % dd ( 10 ) x i f % d d (1 0 ) P b i s 73 %; o r E q u a t i o n 8 .8 0 i f t h e le a d i s no t us ed a nd % d d ( 10 ) i s g r ea t er tha n 7 5 % b u t n ot e x c e ed i ng 8 9 % . R e m o v e t h e l e a d s h eet .

o o

D e p e n di n g o n t h e c h am b e r mo de l , de te r m i ne k Q co r r e sp o ndi ng t o % d d (1 0 ) x ( T a b l e 8 . 6) . M e a s u r e t e mp e r at u r e a n d p r e s s ur e t o g e t P T , P ( E q . 8 . 1 01 o r 8 . 10 2) . M e a s u r e M + r a w a n d M - r a w t o de te r m i ne P p o l ( E q . 8 . 1 0 3 ) . M e a s u r e M h r a w a n d M L r a w t o de te r m i ne P i o n at V H ( E q . 8 . 1 0 0 ) . S e t 10 1 0 c m 2 f ie ld s i z e at t he s ur f a c e w i t h S S D = 1 00 c m ( S S D - t y p e c a l i b ra ti o n ) o r a t i s o ce n t e r w i t h S S D = 9 0 c m ( S A D - t y p e c a li b r at io n) . P o s i tio n t h e c h a m b e r w i t h i t s c e nte r o f c a v it y a t 1 0 c m d ep t h. Ir r a d i a te f o r a s et n u m b e r o f m o nit o r uni t s ( e . g . , 2 00 M U ). T a k e a n average of at l e a st three c o ns i s te nt i on c ha m b e r r e a d i ng s . T he f ul l y c o r r e ct e d re a d i n g M i s g i v e n b y P.137

WWW.MEDRAD.IR

E q u a t i o n 8 . 98 : M = MrawPT,PPionPelecPpol

D o s e to w a t er a t 1 0 cm d e p t h: DQw = MkQN
Co

60

D,w

D o s e pe r m o n it o r u n i t a t r e f e r e nc e d m a x 4

F o r S S D - t y p e c a li b r at io n,

F o r S A D - t y p e c a li b r at io n,

N o t e t h at t h e g r ad i e nt c o r r e ct io n f o r s hi f t i n t he c ha m be r p oi nt o f m e a s ur e m e nt i s i n c l u d e d a s p a rt o f k Q . S o t h e m e a s ur e m e nt d e pt h o f 1 0 c m f o r c a l i b ra ti o n i s s et a t t h e c e n t e r o f c h a m b e r c a v i t y . A l s o , t he v a l ue s o f % d d ( 10 , 10 1 0 ) a nd T M R ( 1 0 , 1 0 1 0 ) u s e d i n s t e p 1 1 a bo v e m us t b e d e ri v e d f r o m d at a t ha t ha v e b e e n c o r r e ct e d fo r s h i f t i n th e c h a m b e r ' s po i nt o f m e a s ur e m e nt i f a c y lind r i c a l c ha m be r h a d b e e n u s e d i n t h e a c q u i s it io n o f t he d a t a.

H. Electron Beam Calibration

B e c a u s e o f t h e se v e re de p t h d o se g r a d ie nt s a nd i nc r e a s ed pe rtur b a t io ns c a us e d by chamber c a vi t y in a low e ne r g y e le c t ro n be a m , t he TG-51 p ro to c ol r e c o m me n d s t h e u s e o f p l a n e - p ar a ll el c ha m b e r f o r e l e ct ro ns w i t h R 5 0 2 . 6 c m ( i n c i d e nt e n e rg ie s o f 6 M e V o r l e s s ) . It o f f e r s t w o m et ho d s o f o bta i ni ng k e c a l N for p l a n e - p ar a ll el chambers: o ne by cr o s s - c a li b r at io n a g a ins t
60
60Co

D,w

c a l i b r at ed

c y l i n d r i c al c h a m b e r ( pr e f e r r e d me t hod ) a nd t he o t he r b y us i ng

Co a b s o rb e d -d o se

c a l i b ra ti o n f a c to r f o r t h e p l a ne - p a r al l el c ham b e r . T he r e ad e r i s re f e r r e d to T G - 5 1 p r ot o co l f o r de t ai l s o n t h e u s e o f p l a ne - p a r al l el c ha m b e r f o r c al i b ra t io n. Although the use of p l a n e -p a r a ll el c ha m b e r for c a li b r at io n offers s ome a d v a n t a g e s , f o r e x am p l e , a b se n c e o f g ra d i e nt co r r e ct io n a nd m i ni m a l f l ue nce p e r t u r b at io n c or r e ct ion , t h e d i s ad v a nt a g e s i nc l ud e t he l a c k o f a bs o r b ed - do s e -t o water c a li b r at io n Because factor of by these the ADCLs, t he di f f i c ul t y us e r s of w a t e r p roo f i ng t he t he c h a m b e r , a n d el i mi n a ti n g w a t e r p r e ss ur e o n t he t hi n w i nd o w o f t he p la ne - p a r al l el chamber. d r a w b a c k s, some i g nor e p r ot o co l r e c o m me n d a ti o n a n d u s e F a r m e r - t y pe c ham b e r s f o r t he w hol e ra ng e o f c li ni c al l y u s e f u l e n e r g i e s , f o r ex a m p l e , f r o m 6 M e V to 2 0 M e V a nd hi g he r . In t h i s s e ct io n , t h e c al i b r at io n st e p s w it h c y l i nd ri c a l c ha m b e r s w i ll b e s um m a r i z ed for a quick review.

WWW.MEDRAD.IR

D e te r m i n e be a m q u al it y o r R 5 0 . T hi s p a r a met e r c a n b e d et e rm i ne d b y po i nt measurements or o bt a i n e d from t he p r e- m e a s ur e d de pt h d os e c ur v e , c o r r e ct e d f o r st op p i ng p o we r r a tio s a nd a l l t he pe r t ur b at io n e f f e c t s a s d i s c u s s e d i n s e c ti o n 1 4 . 3 B . A b r o a d b e a m ( e . g . , 2 0 2 0 c m 2 ) i s us e d f o r t h e s e m e a s u r e me n t s .

F o r t h e g i ve n c h a m b e r , d e t e r mi ne k e c a l ( T a b le 8 . 8 ) . F o r t h e g i ve n b e a m e ne r g y , d e te r m i ne k R
50

(Eq. 8.96).

S e t u p r e f e r e n c e co n d i ti o n s f o r c a li b r at io n:

P.138

Measure PT,P, Ppol, and Pion. Ir r a d i a te f o r a s e t n u m b e r o f m o ni to r uni t s ( e . g . , 2 0 0 M U ) a nd t a k e a n a v e r a g e o f at l e a st t h r e e co ns i st e nt r e a di ngs . T he f ul l y co r r e ct ed r e a d i ng M at dref is given by: M = MrawPionPT,PPelecPpol

D e te r m i n e g ra d ie n t c or r e c ti o n a t d r e f :

D o s e to w a t er a t d r e f : DwQ = MPgrQkecalkR ND,w

50

60

Co

D o s e pe r m o n it o r u n i t a t

D o s e pe r m o n it o r u n i t a t d m a x

N o t e t h a t t h e c al i br a tio n m e a s u r e m e nt i s ma d e w i t h t he c e nt e r o f c ha m b e r c a v i t y a t d r e f . T h e g r a d ie n t c o r r e ct io n a t d r e f d ue to s hi f t i n t he p o i nt o f m e a s ur e m e nt is d e te r m i n ed s ep a r at e ly a n d a p pl i ed e x p li c it l y ( unl i k e p hot o ns ) . T he % dd ( d r e f ) i s o b t ai n e d f ro m de pt h do s e d at a w hi c h ha v e b e e n c o rr e c te d fo r c ha ng e s i n ( [ L w it h

WWW.MEDRAD.IR

b a r a bo v e ] / ) w a i r a n d p e rt u r b a tio n e f f e c t s i f t he d a t a w e r e a cq ui r e d b y a n io n chamber.

8.7. IAEA TRS 398 PROTOCOL

T h e IA E A p u b l i s h e d its m o st r ec e nt c al ib r at io n p ro to c ol , T e c hni ca l R ep o rt S e ri e s ( T R S ) N o . 3 9 8 , i n 2 0 00 ( 3 6 ) . T h i s pr ot o co l s up e r s e de s t he p r e v ious IA E A T R S - 2 7 7 p r ot o co l ( 45 ) . T h e d ev e l op m e n t o f T R S - 3 9 8 ha s p a r a l l el e d t ha t o f t he A A P M T G - 5 1 p r ot o co l . C o n s eq u e n t ly , t h e t w o p r ot o co l s ar e v e r y s i mi l a r i n t heir f o r m a li s m s a nd b o t h a r e b a se d o n a b s o r be d - do s e -to - w a t er c a l i b r at io n o f t he io n c ha m b e r i n a c o b a lt - 60 b e am . H a v i n g p r e s e n te d T G - 2 1 and T G - 5 1 i n t he p r e vio us s e c t io ns , t he T R S - 3 9 8 w i ll be d i s c us s e d o n l y b ri e fl y , p r im a r i l y to hi g hli g ht i t s d i f f e r e nc e s f r om TG-51. The user of the T R S - 39 8 p ro to co l is a d v i s ed to f ol lo w t he p ro to c ol d o c u m e n t i n a ll it s d et a il s .

A. Formalism
T h e b a s i c eq u a t io n f o r t h e d et e r mi na ti o n o f a b s o r be d do s e to w a te r f o r a be a m o f q u a l it y Q i s t h e s a m e a s t h e T G - 5 1 e q ua ti o n ( E q . 8 . 7 6 ) . U s i ng IA E A ' s no t a t io n,

w h e r e D w , Q i s t h e a b so r b ed d o s e to w at e r in t he us e r ' s b e a m o f q ua l it y Q , N D , r e f e r e n c e b e am o f q u a l it y Q 0 ( e . g . , Co), kQ,

w, Q0

i s t h e c h a m be r c a li br a t io n f a c t o r i n t e rms o f a b s o rb e d d o se t o w a te r i n t he
60 Q0

i s t he f a c t o r t hat c o r r e ct s f o r t he

e f f e c t s o f t h e di f f e r en c e b e t w ee n t he re f er e nc e b e a m q ua li t y Q 0 a nd t he us e r q u a l it y Q a n d M Q i s t h e f u l l y c o r r e ct e d c ha mb e r r e a di ng . M Q i s gi v e n b y :

w h e r e M 1 i s t h e d o sim e t er r e a di ng a t t he no r m a l v o lt a ge V 1 , h p l i s t he p ha nto m d e pe n d e n t f l u e n c e s ca l i n g f a c to r t o co r r e ct f o r t he d i f f e r e nc e i n e l e ct r o n f l ue nc e i n p l a s ti c ( i f c a l ib r a tio n i s p e r f o r me d i n a p l a s ti c p ha nt o m ) w it h t ha t i n w a t e r a t a n e q u i v a l e n t d ep t h , k T P i s t h e te m p er a t ur e a nd p r e s s ur e c o r r e cti on f a c t o r :

P.139

( n o t i n g t h a t m a n y i n te r n a t io n a l P r i m a r y S ta nd a r d s L a b o r ato r i es s p e c i f y r e f e r e nc e a i r te m pe r a t u r e o f 20 C [ i n s te a d o f 2 2C i n t he U nit e d St a te s ] ) , k e l e c i s t he e l e ct r om et e r ca li b r at io n f a c to r , k p o l i s t he cha m b e r pol a r it y c o rr ec t io n f a c to r (t he s a m e a s E q . 8 . 1 0 3 ) , an d k s i s t h e io n r e c o mb i na ti o n c o r re c ti o n. In t h e T R S - 3 9 8 , k s i s d e t e rm i n e d b y t a k i ng c ha m b e r r e a di ngs M 1 a nd M 2 a t v o l t ag e s of V1 ( n o rm a l o pe r a ti ng v o lt a ge ) a nd V2 ( ha l f of V1 or less) a nd c a l c u l a ti n g k s b y :

w h e r e 0 , 1 , a n d 2 ar e c o n s t a n t s t ha t d e pe nd o n t y pe o f be a m ( p ul s e d o r p ul se s c a n n e d ) . In c o n t i n u o u s r a d i a ti o n ( e .g . , b e u s e d u s i n g t h e r el at io n s h i p :
60

Co ) , t he t w o v ol t ag e m e t hod m a y a l so

WWW.MEDRAD.IR

F o r p u l s ed a n d p u l s e- s c a n n e d b e a m s , v a l ue s o f 0 , 1 , a nd 2 a r e p r o v i de d b y T a b l e 9 o f t h e p r ot o col .

B. Beam Quality, Q 1. Photon Beams

A major difference b e t w ee n TG-51 a nd TRS-398 c o ns i s t s of beam q ua l it y s p e c i f i ca ti o n . W h e r e a s, T G - 5 1 r e c o m m e nd s % d d ( 10 ) x ( s e e s e ct io n 8 . 6 A ) , T R S - 3 9 8 s p e c i f ie s be a m q u a li ty b y T P R 2 0 , 1 0 . A lt ho ugh t he c ho i c e o f o ne o r t he o t he r ha s b e e n de b at e d i n t he lit e r at u r e ( 37 , 3 8 ) , t hi s d i f f e r e nc e ha s l itt l e e f f e c t o n t he e nd r e s u l t , n a m e l y , t h e ca l c u l a ti o n o f k Q o r a bs o r b ed d o se t o w a te r. In m y o p i ni o n, t h e T P R 2 0 , 1 0 me t h od i s s i m p le r to i mp l em e nt a s i t a v o id s t he us e of a l e a d f i lt e r o r d o s e me a s u r e m e n t at d m a x w h i c h i s s o m e wha t m e s s y ( e . g . , w i d t h o f d o s e pe a k r e l at i v e to chamber cavity d i a m e te r a nd t he q ue s t io n of r e s i d ua l el e ct r o n c o n t a m i n at io n a t d m a x i n s p it e o f t he l e a d f ilt e r ) . In a d di tio n, t he d e te r m i nat io n o f T P R 2 0 , 1 0 d oe s n ot re qu i r e di s pl a c e me nt cor r e c ti o n no r i s it s ens i t i v e to s m al l s y s t e m a ti c e r ro r s i n po s it io n i n g o f t he c ha m b e r a t e a c h d ep t h. H o w e v e r , t he us e r o f e it h e r p r ot o co l i s ad v i s e d to f ol lo w t he re s p e ct i v e m et ho d re co m m e nde d b y t he p r ot o co l . T h e e x p e ri m e n ta l se tu p f o r t h e d et e r mi na ti o n o f T P R 2 0 , 1 0 i s t he s a m e a s t ha t f or t h e io n i z a t io n r a ti o rec o m m e n de d b y t he T G - 2 1 p ro to c ol ( s ee s ec t io n 8 . 6 A ) . T he s o u r c e - to - c h a m b e r di st a n c e i s k ep t c o ns t a nt a t 1 00 c m a nd t he me a s ur e m e nt s a re m a d e w it h 1 0 cm a n d 2 0 cm o f w a te r o ve r t he c ha m be r . T he f i e l d s i z e at t he c h a m b e r po si ti o n i s 10 10 c m 2 . A s p re v i o us l y m e nti o ned , t he r e is no nee d to us e d i s pl a c e me n t c o rr e c tio n . T h e r a t io o f io ni za t io n a t 20 c m d ep t h t o t ha t a t 1 0 c m d e pt h g i v e s t h e T P R 2 0 , 1 0 . It h a s b ee n s h o w n (3 7 ) t h a t t h e re s t ri c te d st op p i ng po w e r r at io , ( [ L w i t h b a r a b o v e ] / ) w a i r , f or a ll cli n i c a l b e a m s d e c re a s es w i t h i nc r ea s e i n T P R 2 0 , 1 0 i n a si g mo id r e l at io n s h i p w h i c h h a s b e e n r e p re s e nte d b y a c ub i c p ol y no m i al , f i tt i ng t he da t a to b e tt e r t h a n 0 . 1 5% . T h e q u a l i t y c o nv e r s io n f a c t o r s , k Q , factors (Eq. 8.86).
Q0

( or k Q in t he no t a t io n o f

T G - 5 1 ) c a n t h e n b e c a l c u l a t ed us i ng s t o p pi ng p o w e r r at io s a nd p e r t ur b a ti o n

2. Electron Beams
T h e s p e c i f i c at io n o f be a m q u a li t y i n t he T RS - 3 9 8 p rot o co l i s t he s a m e a s i n t he T G - 5 1 p ro to c ol , n a m e ly , b y R 5 0 ( s e e s e ct io n 8 . 6 A . 2 ) . A b r o a d b e am ( e . g . , 2 0 20 c m 2 ) i s r e c o mm e n d ed f o r t h e m e a s ur e me nt o f R 5 0 .

C. Quality Conversion Factor, k Q , Q 1. Photon Beams

U s i n g T P R 2 0 , 1 0 a s t h e i n d e x o f b e a m q ua li t y , A nd r e o ( 4 6 ) ha s c a l c ul a te d k Q ,

Q0

v a l u e s f o r a v a r ie t y of c o m m e r ci a ll y a v a il ab l e io n c ha m b e r s a nd p ho to n be a m s o f T P R 2 0 , 1 0 , r a n gi n g f r o m 0 . 5 to 0 . 8 4 . T he s e v a l ue s a r e p r e se nt ed in T a b l e 1 4 o f t he T R S - 3 9 8 p ro to c ol . P.140

2. Electron Beams
WWW.MEDRAD.IR

T R S - 3 9 8 de v i a te s f r om t h e T G - 51 m et ho dol o g y i n t ha t i t d i re c tly c a l c ul a t e s k Q , E q . 8 . 8 6 ) i n s t e ad o f re d e f i n i n g k Q , the kQ,

Q0

Q0

f o r e le c t ro n s u s i n g r el e v a n t s to pp i ng po w er r a t io s a nd p e rt ur b at io n f a c t o r s ( s ee
Q0

i n te r ms o f k e c a l , k R

50

a nd P Q g r . In o t he r w o rd s ,
Q0

f o r m a li s m u s e d f o r e le c t ro ns i s t he s a m e a s f o r p ho t o ns . A t a b l e o f k Q ,

v a l u e s f o r e le c t ro n s i s p r o vi d ed b y t he p ro to c ol f o r v a r io us t y pe s o f i o n c ha mb e r s a n d b e a m q u a li t y R 5 0 . T h i s s i mp li f i e s t he ca l i b r ati o n p ro c e s s s om e w ha t s i nc e k e c a l a n d P Q g r do n o t n e ed t o be d et e r mi ne d . T he g r a d ie nt c o r re c ti o n a t d r e f (t he s a m e a s i n T G - 5 1 ) i s i m pl i cit i n t h e k Q , Q f a c to r f o r e l e ct r o ns a s i t i s f o r p ho to ns .
0

T R S - 3 9 8 d oe s p ro v i de t h e o pt io n o f c ha m b e r c a li b r at io n a t a s e r i e s o f e l ec t ro n b e a m q u al it ie s . T h e ca l i b r ati o n l ab o r ato r ie s c o ul d , i n t he f ut ur e , p r o v id e N D , f o r a r e f e r e n c e e le c t ro n b e a m o f q ua l it y Q 0 a nd k Q ,
Q0 w, Q0

f a c to r s c or r e s p o ndi ng to a
Q0

n u m b e r o f o t h e r b eam s o f q u al it y Q so tha t t he us er c o ul d de t e rm i ne k Q , D o s i me t r y L ab o r at o ri es ( P S D L s ) .

by

i n t e r pol a ti o n . C u r r e n tl y , t h i s o pt io n i s not a v a il a bl e b y t he P r i m a r y S t a nd a rd

D. Calibration
R e f e r e n c e co n d it io n s f o r t h e c a li b r at io n o f pho t o n a nd e le c t ro n bea m s i n t he T R S 3 9 8 a re t h e s a m e a s i n T G - 5 1 . T R S - 3 98 al s o p r o v id e s w or k s he e t s , w hi c h g ui de t h e u s e r i n a s t e p - b y -s t e p i m p le m e nt a ti o n of t he p r o to c ol . Comments: The TG-51 and TRS-398 p rot o co l s are si mi l a r , ex c e p t fo r mi no r d i f f e r e n c e s i n b e a m q u a l it y s p e ci f i c a ti o n a nd no t a ti o n. T he r e is no r e a s o n w hy o n e p r ot o co l co u l d n ot b e f o ll o w ed w o r ld w id e . In t hi s d a y a nd a g e , i t do e s not m a k e s e n s e t o pr o mo t e t h e s e mo r e o r le s s i d e nt i c al p r oto c ols p a c k a g e d w it h d i f f e r e n t n a m e s a n d n o t a ti o n s . A lt ho ug h it ' s to o l at e fo r t he se p r ot o co l s to be m e r g ed i nt o o n e , I h op e t h a t t h e ne x t re v i si o n o f e it he r o f t he se p r ot o co l s wi ll be c o m bi n e d a n d c a r r i ed o u t b y a n i nt e r na t io nal l y c o ns ti t ute d p a nel or a t a s k g r o up .

8.8. EXPOSURE FROM RADIOACTIVE SOURCES

E x p o s u r e r a t e f r o m a r a d io a c ti v e s o ur c e c a n b e d e te r mi ne d f r o m the k no w l e d g e o f its p ho to n e m i s si o n spectrum a nd t he r e l e v a nt mass e ne r g y a b s or p ti o n c o e f f i c ie n t s f o r a ir . A r e l a ti o n s h i p b et w e e n e x p o s ur e ( X ) a nd e ne r g y f l ue nc e ( ) m a y b e d e r i v ed b y c o m p a r i n g E q ua t io ns 8 . 1 9 a nd 8 . 2 1 . U nd e r the c o nd i ti o ns of c h a n g e d p a r ti c l e e q u ili b r i u m ,

Therefore,

S u p p o s e a r a di oi s ot op e em it s N p ho to ns o f d i f f e re nt e ne r g y and w i t h di f f e r e nt p r o b ab il it y pe r di s i nte g r a ti o n . Im a gi ne a sp he r e o f r a di us 1 m a r o und t hi s po i nt s o u r c e o f a ct i v it y 1 C i. B e c a u s e 1 C i und e r go e s 3 .7 1 0 1 0 d p s , and s i nc e a r e a o f a s p h e r e o f r a d i u s 1 m i s 4 m 2 a nd s i nc e 1 h = 3 , 6 0 0 s e c , w e h a v e :

w h e r e f i i s t h e n u m b e r o f p h ot o ns e m it ted / d e c a y o f e ner g y E i . F r o m E q uat io n 8.110,

WWW.MEDRAD.IR

P.141

where

i s t h e m a s s e n e r g y a bs o r pt io n c o e f f i c ie nt i n a i r f o r p ho to n o f e ne rg y E i . S u b s t i t u ti n g t h e v a l u es

0.00876

J/kgR,

MeV

1.602

10 -13

a nd

e x p r e s s ing

mass

e ne r g y

a b s o r pt io n c o e f f i ci e n t i n s q u a r e m e t er s p e r k i l og r a m , t he a bo v e eq ua t io n b e c o me s

or

A q u a n t i t y e x p o s u r e ra t e c o n s t a nt ha s b e e n d e f i ne d ( 47 ) a s :

where

i s t h e e x p o s u r e r a te f r o m p h o to ns o f e ne r g y g r e a t e r t ha n ( a s u i t a bl e c uto f f f o r

t h e e n e r g y s p e ct r u m ) a t a d i s t a n c e l f r o m a p o i nt s o ur c e o f a c ti v i ty A . If

i s i n R / h , l i s i n m , a n d A i s i n C i , t he d i m e ns i o ns o f b e c o me R m 2 h - 1 C i - 1 . It i s a l s o a pp a r e n t t h at i s n u m e r i c a l l y e q ua l t o

i n E q u a t i o n 8 . 1 11 . T h u s t h e e x p o s ur e r a t e co ns t a nt m a y b e w r i tt en a s :

w h e r e e n e r g y E i i s e x p r e s s e d i n M e V a nd

is in m2/kg.

Example
C a l c u l a t e t h e e x p o s ur e r a t e co n s t a nt f o r R/min from a 5,000-Ci source of
60 60

C o . D e te r mi ne t he e x p o s ur e r a te i n

C o a t a d is t a nc e o f 8 0 c m .

WWW.MEDRAD.IR

60

C o e m it s 2 - r a y s o f e n e r g y 1 . 1 7 a nd 1 . 3 3 M e V p e r d i s i nt e g r at ion

fi

Ei(MeV) (m2/kg)

1.00

1.17

0 . 0 0 27 0

1.00

1.33

0 . 0 0 26 1

P.142

T h e p r e v i o u s c a l c u l ati o n a p pl i e s o nl y v e r y a p p r o x i m at e l y to a n a c t ua l c o b a lt t e le t h e r ap y u n i t s i n c e e x p o s u re r at e wo ul d d e pe nd not o nl y o n t he s o ur ce a ct i v it y b u t a l s o o n t h e c o ll i ma t o r s c a tt e r , so ur c e s iz e , a nd s e l f - a b s o r pt ion i n t he s o ur c e .

8.9. OTHER METHODS OF MEASURING ABSORBED DOSE A. Calorimetry

C a l o r im e tr y i s a b a sic m et h o d o f d e te r mi ni ng a b so r be d d o se i n a m ed i um . It is b a s e d o n t h e p ri n c i pl e t h at t h e e ne r g y ab s o r be d i n a m e di um f r o m r a di a ti o n a p p e a r s u l ti m at e l y a s h e a t e n e r g y w hil e a s m a l l a m o unt m a y a pp e a r i n t he f o r m o f a c h e m i c a l c h a n g e . T h i s r e s ul t s i n a s m a l l i nc re a s e i n t em p e r at ur e o f t he a b s o r bi n g m ed i u m w h i c h , i f m e a s ur e d a c c ur a t el y , c a n b e r e l at ed t o t he e ne rg y a b s o r be d pe r u n i t m a ss o r t h e a b s o rb e d d o se . If a s m a l l v o l u me o f t h e m e di u m i s t he r ma l l y i so l at ed f r o m t he r e m a i nde r , t he a b s o r be d do s e D i n t h i s v o l u m e i s gi v e n b y :

w h e r e d E h i s t h e e n e rg y a p p e a ri n g a s he a t i n t he a b s or b e r o f m as s d m a nd d E s i s t h e e n e r g y a b s o rb ed o r p r od u c e d a s a r e s ul t o f c he m i c al c ha ng e, c a l l e d t he he a t d e f e c t ( w h i c h m a y b e p o s it i ve o r ne g at i v e ) . N e g le c ti ng t he l at te r fo r t he m o me nt , o n e c a n c al c u l a te t h e r i s e i n t e mp e r at ur e o f w a t e r b y t he ab s o rp t io n o f 1 G y o f dose:

WWW.MEDRAD.IR

w h e r e 4 . 18 i s t h e me c h a n i c a l e q ui v a le nt o f he a t ( 4 . 18 J o f ene r g y = 1 c a l o f h e a t ) . B e c a u s e t h e sp e c i f i c h e at o f w a te r i s 1 c a l / g / C o r 10 3 c a l / k g / C , t he i n c r e a s e i n te m p e ra t ur e ( T ) p r o d uce d b y 1 G y i s :

T o m e a s u r e s u c h a sm a l l t em p e r at ur e ri s e, t he r m i st or s a r e m o st c om m o nl y us ed . T h e r m i s to r s are sem i c o n d u c to r s w hi c h s ho w a large c hang e in e le c t ri c al r e s i st a n c e w i t h a s m a l l c h a n g e i n t e m pe ra t ur e ( a b o ut 5% p e r 1 C ) . T h us , b y m e a s u r i n g t h e c h a n g e i n r e s i st a n c e b y a n ap p a r a t us s uc h a s a Whe a t s to ne b ri d ge , o n e c a n c a l c u l a t e t h e a b s o r be d do s e . E x t e n s i v e li t er a t u r e ex i s t s o n r a di a tio n c a l or i m et r y to w hi c h t he re a d e r i s r e f e rr e d ( 4 8 , 4 9 ) . M o st o f t h es e a p p ar a t us e s a r e di f f i c ul t t o c o nst r uc t a nd , f o r v a r io us r e a s o n s , a r e c o n s i de re d i m p r a cti c a l f o r c lini c a l d o si m et r y . H o w e v e r , D o m e n ( 5 0 ) h a s d e s c r ib e d a s i mp le r w a t e r c a lo r i me te r fo r a b so l ute me a s ur e me nt o f ab s o rb e d d o s e . E s s e n ti a l f e a t u re s o f t h i s c a lo r i me te r a r e b r ie f l y d e s c ri b ed . F i g u r e 8 .9 i s a s c h em a t i c d r a w i ng o f Dom e n' s c a l o ri m et e r . A n ul t r a s m a ll ( 0 .2 5 m m d i a me te r ) b ea d th e r m i s to r i s s a nd wi che d b et w e e n t wo 3 0 - m p ol y e t hy l e ne f i l m s st r et c h e d o n po ly s t y r e n e r i ng s . T he the r m i s to r s a re c em e nt e d to o ne o f t he f i l m s to i n c r e a s e t h er m a l c o u pl i ng . T he f il m s p ro v i de t he ne ces s a r y hi g h a nd s t a b le r e si s t a n c e ( > 10 1 1 ) b e t w ee n t he t he r m i st o r le a d s a nd w a t e r . T h e f i l m s h e l d h o ri z on t a l l y i n a p l a st i c f r am e a r e t he n i m me r s ed i n a n i ns ul a t ed t a n k o f d i s t il le d w a te r . B e c a u s e o f t he l o w t he r m a l di f f us i v i ty o f w a t e r a nd i m p e r vi o u s n e s s o f p oly e t h y l e n e f il m to w a te r , ne a r l y ne gl i gi bl e c o nd uc t i v e he at t r a n s f e r o c c u r s at a p o i nt i n t h e w a t e r me d i um . T he r e fo r e , a the r m a l l y i s ol a te d v o l u m e e le m e n t o f w at e r i s n ot n e ce s s a r y . T hi s a p p a r at us m e a s ur e s do s e r a te s i n water of ab o u t 4 Gy/min with a pr e c i s io n (for t he re p r od uc i bi li t y of m e a s u r e m e n t s ) o f 0 . 5% .

WWW.MEDRAD.IR

F I G . 8 . 9 . S c h e m a ti c d i a g r a m o f D o me n' s ca l o ri m et e r . ( Re d r a w n f r o m Do m e n S R . A b s o r be d do s e w a t e r c a l o ri m et e r . M e d P hy s 1 9 8 0 ;7 : 15 7 . ) P.143

B. Chemical Dosimetry
T h e e n e r g y a b s o r b ed f r o m i o n i z i n g r a di a ti on m a y p r o d uc e a c he m i c a l c ha ng e , a nd i f t h i s c h a n g e c a n b e d e te r m i n ed , i t c a n b e us e d a s a m e a s ur e o f a b s o r b e d do s e . M a n y s y s t e m s o f c h e m i c a l do s im e tr y ha v e b e e n p r op o se d b ut the f e r r o us s ul f a t e o r t h e F r i c ke do s i me te r i s co n s i de r ed to be t he mo st de v e lo p ed s y s t e m f or t he p r e c i si o n m e a s u r e me n t o f a b so r be d d o se . The us e o f t hi s s y s te m ha s b ee n f ul l y d i s c u s s e d ( 51 ) . A b r i ef d e s c r i pt io n w i l l be pr o v i de d .

B.1. Ferrous Sulfate (Fricke) Dosimeter

The d o s i m et e r c o n sis t s of 1 m m o l /l f e r r o us s ul f a t e (or f e r r o us a m m o ni um s u l f a t e ) , 1 mm ol / l N aC l , a n d 0 . 4 mo l /l s ul fur i c a c i d . T he re a s o n f o r N a C l i n t he s o l u ti o n i s t o c o u n te ra c t t h e e f f e ct s o f or ga ni c i mp ur i ti e s p r e sent d e sp it e a ll t he n e c e s s a r y p r e c a u ti o n s. W h e n t h e s o l ut i o n i s i r r a d i at ed , t he f e r r o us i o ns , F e 2 + , a r e o x i di z e d by r a d i at ion by to ferric io ns , of Fe3+. t he T he ferric io n c o nc e nt r a ti o n w hi c h is d e te r m i n ed s p e ct r op h o to m et r y do s i me te r so l uti on, s ho w s

a b s o r pt io n p e a k s i n t h e u l t r a v io le t li g ht at w a v e l e ngt hs o f 2 2 4 a nd 3 0 4 nm .

B.2. G Value
The r a d i at io n c h e m i ca l y i el d ma y be e x p r e s s ed in terms of t he num b e r of m o le c u l e s p r od u c e d pe r 1 00 e V o f e ne r g y ab s o r be d . T hi s num b e r i s k no w n a s t he G v a l u e . T h u s , i f t h e y i e l d o f f e r r i c i o ns c an b e d e te r m i ned , t he e ne r g y a b s o rb ed c a n b e c a l c u l a t ed w h e n t h e G v a l ue i s k no w n. S u p p o s e a M ( m ol e s/ l ) c o n c e n t r at io n o f fe r r i c i o ns i s p r od uc e d b y a n a b s o r be d dose of D grays:

WWW.MEDRAD.IR

M o l e c u le s o f f e r r i c i o ns p r o d u c e d = M 6 . 0 2 1 0 2 3 mo le c ul e s /l it e r

w h e r e i s t h e d e n s it y o f t h e s o l u ti o n i n k i log r a m s p e r li te r . P.144

N u m b e r o f m o le c u l e s p r o d u c ed p e r e V o f e ne r g y a b s o rb e d :

or

Thus,

The

values

for T a bl e
137

the 8.9

Fricke gi v e s

d o si m et er t he v a l ues

ha v e

been

de te rm i ne d by N a hum

by

m a ny f or

i n v e s t ig a to r s . p h o to n s f r o m

r e c o mm e nd ed

(17)

C s to 30 M V . A c o ns t a nt G v a l ue o f 15 . 7 0 . 6 / 1 00 e V is

r e c o m me n d e d f o r el e ct r o n s i n t h e e ne r g y r a ng e o f 1 t o 3 0 M e V f o r 0 . 4 m o l /l it er H 2 S O 4 d o s i me te r s o l ut io n ( 2 9 ) .

TABLE 8.9. RECOMMENDED G VALUES FOR THE FERROUS SULFATE BEAMS DOSIMETER (0.4 mol/l H 2 SO 4 FOR PHOTON

WWW.MEDRAD.IR

R a d i a t i on

G V a l u e ( N o. / 1 0 0 eV )

137

Cs

15.3 0.3

2 MV

15.4 0.3

60

Co

15.5 0.2

4 MV

15.5 0.3

5 10 M V

15.6 0.4

1 1 3 0 M V

15.7 0.6

D a t a f r o m IC R U . R a d i a t io n d o s i me t r y : x r a y s a nd g a m m a r a y s w i t h m a x i m um p h o to n e n e rg i e s be tw e e n 0.6 a nd 50 MeV. R e po r t 14 . Bet he s d a , M D: In t e r n a t i o n al C o m mi ss i o n o n R a d i at io n U nit s a nd M e a s ur em e nt s , 1 9 69 , w it h p e r m i s sio n .

C. Solid State Methods

T h e r e a r e se v e r al s ol i d s t at e s y st e m s a va i l a bl e f o r t he do s ime t r y o f io ni z i ng r a d i at io n . H o w e v e r , n o n e o f t h e s y s t e m s i s a b s o l ut e e a c h ne e d s c a l i br a ti o n i n a k n o w n r a d i a t io n f i el d b e f o re it c a n b e use d f o r t he de te r m i nat io n o f a b so r b ed dose. T h e r e a r e t w o t y pe s o f s ol id s t at e do s i met e r s : ( a ) i nte g r at i ng t y p e d o si m et e r s ( t h e r m ol u m i n e s ce n t c r y s t a l s , r a d io p hot ol um i ne s c e nt gl a s s e s , o pt i c al d e ns it y t y pe d o s im e te r s s u c h a s gl a s s a n d f i l m ) , a nd (b ) e le c t ri c a l co nd uc tiv i t y d o si m et e r s ( s e m i co n d u c t o r j u n c t io n d et e ct o r s , i nd uc e d c o nd uc ti v i t y i n i ns ula t i ng ma t er i al s ) . O f t h e s e , t h e m o s t w i d el y u s e d s y s t e m s f o r t he m e a s ur e m e nt o f a b s o r b ed d o se are the t h e r mo l u min e s c e n t d o si m et e r (T L D ) , d i od e s , a nd film, w hi c h are d e s c r ib e d .

C.1. Thermoluminescence Dosimetry

M a n y c r y s t a l l i n e m a t er i a l s e x h i bi t t he p he no m e no n o f t he r mo l umi ne s c e nc e . W he n s u c h a c r y s t a l i s i r r ad i a te d , a v e r y mi nut e f r a c ti o n o f t he a b so r b ed e ne r g y i s s t o re d i n t h e c r y st a l la t ti c e . S o me o f t hi s ene r g y c a n b e re c o v e red l at e r a s v i s ib le l i g h t i f t h e m a t er i al i s P.145 h e a t e d . T h i s p h e n o m en o n o f t h e r el e a se o f v i s i bl e p ho to ns b y the r m a l m e a ns i s known as thermoluminescence (TL).

WWW.MEDRAD.IR

FIG.

8.10.

Schematic

di a g r a m

s ho w i ng

a p p a r at us

for

m e a s ur i ng

t h e r m ol u m i n e s c e n ce . T h e a r r a n g e m e n t f o r m e a s u r i n g t he T L o utp ut i s s ho w n s c he m a tic a l l y i n F i g . 8 . 1 0 . T h e i r r a d i at ed m a te r ia l i s pl a c ed i n a he a te r c up o r pl a nc he t , w he r e i t i s he a ted for a r e p r od u c i bl e heating cycle. T he e m it te d li g ht is m e a s ur e d by a p h o to m u l ti pl ie r t u be ( P M T ) w h i c h c o nv e r t s l i g ht i nto a n e l e ct r ic a l c ur r e nt . T he c u r r e n t i s t h e n a m p li f ie d a n d m e a s ur e d b y a r e c o r de r o r a c o unt e r. T h e r e a r e s e v e r a l T L p h o s p h o r s a v a i l a bl e b ut t he m o s t no te w o r t hy a r e l it hi um f l u o r i de ( Li F ) , li t hi u m b o r at e (Li2B4O7), a nd c a l ci um f l uo rid e (CaF2). T he ir d o s im e tr i c p ro p e rt ie s a r e l is t ed i n T a bl e 8 . 1 0 ( 5 2 ) . O f t he se p ho s p ho r s , L i F i s m o s t e x t e n s i v el y s t u di e d a n d mo s t f r eq ue nt l y us e d f o r cl i ni c al do s i me t r y . L i F i n i t s p u r e st f o r m e x h i bit s r e l at i v el y l it tl e t her m o l umi ne s c e nc e . But t he p r e s e nc e o f a t r a c e a m o u n t o f i mpu r i t ie s ( e . g . , m a g ne s ium ) P.146 p r o v id e s t h e r ad i at io n - i n d u c e d T L . T he s e im p ur i ti e s gi v e r i se to i m p e r f e ct io ns i n t h e l a tt i ce s t r u c t u r e of L i F a n d a p p e a r to be ne c e s s a r y f o r t he a p p e a r a nc e o f t he TL phenomenon.

TABLE 8.10. CHARACTERISTICS OF VARIOUS PHOSPHORS

WWW.MEDRAD.IR

Characteris tic

LiF

Li2B407:M n

CaF2:Mn

CaF2:nat

CaSo4:M n

Density (g/cc)

2.64

2.3

3.18

3.18

2.61

Effective a t o mi c n o .

8.2

7.4

16.3

16.3

15.3

T L e m i s s io n s p e ct r a ( A )

Range

3,500 6,000

5,300 6,300

4,400 6,000

3,500 5,000

4,500 6,000

Maximu m

4,000

6,050

5,000

3,800

5,000

T e m p e r at u re of main TL peak gl o w

1 9 5 C

2 0 0 C

2 6 0 C

2 6 0 C

1 1 0 C

Efficiency at 60 ( r e l at i v e t o Li F ) c ob a lt -

1.0

0.3

23

70

Energy response without added f i l te r -60) ( 30 k e V / c o b a lt

1.25

0.9

13

13

10

Useful range

Small, <5%/12 wk

mR106 R

mR3 105 R

mR104 R

R104 R

WWW.MEDRAD.IR

Fading

mR105 R

10%

in

10%

in

No d e te c t ab l e f a d i ng

5 0 6 0 % in first hr t he 24

first mo

first mo

Light s e n s i ti v i t y

Essentia lly none

E s s e nt i a l l y no ne

E s s e nt i a l l y no ne

Yes

Yes

Physical form

Powder, extruded , Teflone m b ed d ed, s i li c o n e m b ed d ed, glass c a p i ll a ri es

Powder, T e f l o ne m b ed d ed

Powder, T e f l o ne m b ed d ed, ho t p re s s ed c hi p s , glass c a p i ll a ri es

S p e c i al d o s im e t ers

Powder, T e f l o ne m b ed d ed

From

C a m e ro n

JR,

S u n t h a r a l i ng a m

N,

K e nne y

GN.

T he r m o l um i ne s c e nt

d o s im e tr y . M a d i s o n : Un i v e r s i t y o f W i s co ns i n P r e s s , 1 9 6 8 , w i t h p erm i s s io n.

F I G . 8 . 1 1 . A s i m pl i f ie d e n er g y - l e ve l d i ag ra m to il l us tr a t e t he rm o l um i ne s ce nce process.

C.2. Simplified Theory of Thermoluminescent Dosimetry

T h e c h e m i c a l a n d p h y s i c a l t h e o r y o f T L D i s no t e x a c tl y k no w n, b ut s i mp l e m od el s h a v e b e e n p ro po s e d to e x pl a i n t he p he no me no n q ua l it a ti v el y . F ig ur e 8 . 11 s ho w s

WWW.MEDRAD.IR

an

e n e r g y - l e ve l

d i agr a m

of

an

i no r g a nic

crystal

e x hi bi ti ng

TL

by

i o ni zi ng

r a d i at io n . In a n i n d i v i d u a l a tom , e l e c tr o n s o c c up y d i s c r et e e ne rg y l e ve l s . In a c r y s t a l l a tt i c e , o n t h e o t h e r h a n d , e l e ct ro ni c e ne r g y le v e l s a r e p e rtur b e d b y m ut ua l i n t e r a ct io n s b e t w ee n a t o m s a n d g i v e ri s e to e ne r g y b a nd s : t he a l l o w ed e ne r g y b a n d s a n d t h e f o r b i dde n e n e r g y b a nd s . In a d d it io n, t he p r e s e nce o f i m p ur it i e s i n t h e c r y s t al c re a te s en e r g y t r ap s i n t he f or b i dd e n re g io n, p ro v id i ng me t a st a bl e s t a t es f o r t h e e l e ct ron s . W h e n t h e m a t e r i a l i s i r r a di a te d , s om e o f t he e le c t ro ns i n t h e v a l e n ce b a n d ( g ro u n d s t at e ) re c ei v e s uf f i c i e nt e ne rg y to b e r ai s e d to t he c o n d u c t io n b a n d . T h e v a c a n c y t h us c r e a t e d i n t he v a l e nc e b a nd i s c a l l ed a p o s it i ve hole. The e l e c tr o n and t he ho l e move i nd e pe nd e ntly t hr o ug h t he i r r e s p e ct i v e b a n d s u n t il t h e y r e c o m b i ne ( el e ct r o n r e t ur ni ng to t he g r o und s t a te ) o r u n t i l t h e y f a l l i n t o a tr a p ( m e t a st a bl e s t at e) . If t he r e i s i ns t a nt a ne o us e m i s si o n of l i g h t o w i n g to t h e se t r a n s i ti o n s , t he p he no m e no n i s c a ll e d fl uo r e s c e nc e . If a n e l e ct r o n i n t h e t r a p re q u i r e s e n e rg y to g et o ut o f t he t r a p a nd fa l l to t he v a le nc e b a n d , t h e e m i s sio n o f l i g ht i n t hi s c a s e i s c a l le d s p e ed e d up s i g n i fi c an t l y with a m o d e r ate a m o unt p ho sp ho r es c e nc e ( d el a y ed of he a t i ng (~300C), t he f l u o r e s c e n c e ) . If p h o sp h o r e s c e n c e at r oo m t e m pe r a t ure i s v e r y s l o w , b ut c a n b e p h e n o m e n o n i s c a ll ed t h e r m ol u m i ne s c e nc e . A p l o t o f t h e r m ol u m in e s c e n c e a g a i ns t te mp e r a t ur e i s c a l le d a g lo w c ur v e ( F i g . 8 . 1 2 ) . A s t h e t e mp e ra t u r e o f t h e T L m at er i a l e x p o se d to r a di ati o n i s i nc r ea s e d , t h e p r ob a b il it y o f r e le a s i n g t r ap p ed e le c t ro ns i nc r e a s e s . T he l ig ht e m it te d ( T L) f i r s t i n c re a s e s , r e a c he s a m a x i m um v a l ue , a nd f a l l s a g ai n to z er o . Be c a us e m o st p h o s p h o r s co n t a i n a n u m b e r o f t r a p s at va r i o us e ne rg y l e v el s i n t he f o r bi dd e n b a n d , t h e g l o w c u r v e m a y c o n s i s t o f a n u m b e r o f g lo w p e a k s a s s ho w n i n F i g . 8 . 1 2 . T h e d i f f e r e n t pea k s c o r r e s p o nd t o di f f e r e nt t r a pp e d e ne rgy l e v e l s .

C.3. Lithium Fluoride

T h e T L c h a r a c t e r i s ti cs o f L i F h a v e b e e n s t ud i ed e x t e nsi v e l y . F o r d et a il s , t he r e a d e r i s r e f e r r ed to C a m e r o n e t al . ( 5 2 ) . L i t h i u m f l u o ri d e h a s an e f f e c t i v e a to m i c num b e r o f 8 .2 c om p a r ed w i t h 7 .4 f o r s o f t t i s s u e . T h i s m a k e s t h is m a t e ri a l v e r y s uit a bl e f o r cl i ni ca l do s im etr y . M a s s e ne r g y a b s o r pt io n co e f f i c ie n ts f o r t h i s m at e ri al hav e b ee n gi v e n b y G ree ni ng et al . ( 53 ) . T h e d o se a b so r be d i n L i F c a n b e c o nv e rt ed to do s e i n m us cl e b y c o ns i de r a tio ns s i m il a r to t h o s e d i s cu s s e d e a rl i er . F o r ex a m p l e , und e r e le c t ro ni c eq ui li b ri um c o n d it io n s , t h e r at io o f a b so r b ed do s e s i n t he t wo me d i a w il l b e t he s a me a s t he r a t io o f t h e i r m a s s e n e r g y a b so r p tio n c oe f f i c i e nt s . If t he dim e ns i o ns o f t he d o s im e te r a r e s m al le r t h a n t h e r a ng e s o f the e l e ct r o ns c r o s si ng t he d o si m et e r , t h e n t h e B r a g g - G r a y r e l a tio n s h i p c a n a l s o be us e d . T he r a t i o o f a b s o r be d do s e s i n P.147 t h e t wo m ed i a t h e n w i l l b e t h e s a me a s the r a t io o f m a s s st opp i ng po w e r s . T he a p p li c a bi li t y o f t h e B r a g g - G r a y c a v i t y t he o r y t o T L D ha s b ee n d i s c us s e d b y s e v e r a l a u t h o r s ( 54 , 55 ) .

WWW.MEDRAD.IR

F I G . 8 . 1 2 . A n e x a m p l e o f gl o w c ur v e o f L iF ( T L D - 1 0 0 ) a ft e r p ho s p ho r ha s b ee n a n n e a l e d at 40 0 C f o r 1 h a n d r e ad i m m ed ia t e l y a ft e r i r r a di a tio n t o 1 00 R . ( F ro m Zimmerman DW, Rhyner CR, Cameron JR. T he r m a l a nne a l i ng e f f e ct s on t h e r m ol u m i n e s c e n ce of L i F . H e a l t h P hy s 1 9 6 6 ; 1 2 :5 2 5 , w it h p e r m i ss i o n. )

C.4. Practical Considerations

A s s t a t e d p re v i o u s l y , t h e t h e r m ol um i ne s ce nt d o s im et e r m us t b e ca l i b r at ed b e f o re i t c a n b e u s e d f o r mea s u r i n g a n un k no w n d o s e . Be c a us e t he r e spo ns e o f t he T L D m a t e ri a l s i s a f f e c te d b y t h e i r p r e vi o us r a dia t io n hi s to r y a nd t he rm a l hi s to r y , t he m a t e ri a l m u s t be s u it a b l y a n n e al e d to r em o v e r e si d ua l e f f e c ts . T he s t a nd a rd p r e i r ra d i at io n a n n e a l in g p r o c ed u r e f o r Li F is 1 ho ur o f he a t i ng at 4 0 0 C a nd t he n 2 4 h a t 8 0 C . T h e s low h e a t i n g , na m el y 2 4 ho ur s a t 80 C , r e mo ve s p e a k s 1 a nd 2 o f t h e gl o w c u r v e ( F ig. 8 . 1 2 ) b y d e c re a s i ng t he t r ap pi ng e f f i ci e ncy . P e a k s 1 a nd 2 c a n a l so b e e li m i n at e d b y po st i r r ad i at io n a nne a l i ng fo r 1 0 minut e s a t 1 00 C . T h e n e e d f o r el i mi n a t in g p e a k s 1 a nd 2 ar i se s f r o m t he f a c t t ha t t he m a g nit ud e o f t h e s e pe a k s d e cr e a s es r e l at i v el y f a s t w it h t i me a f t er i r r ad i at ion. By r e m o v i ng t h e s e p e a k s b y a n n e a l i n g , t h e g lo w c ur v e b e c o m e s mo r e s t ab le a nd t he r e f o r e p r e di c t ab l e . The dose r e sp o n s e curve, cu r v e
3

f o r T L D - 1 00 5 i s s ho w n i n F i g . 8 . 1 3. T he d e pe nd s on m a ny c o nd i ti o ns tha t

c ur v e to

is be

g e n e r a ll y li n e a r u p to 1 0 response

c G y b ut b e y ond t hi s it be c o me s s up r a l i ne a r . T he ha v e

h ow e v e r ,

s t a n d a r d i ze d t o a c hi ev e r e a s o n a bl e a c c ur a c y w i t h T L D . T he c al i br a t io n s ho ul d be d o n e w it h t h e s am e TL D r e ad e r , i n a p p ro x im a t el y t he s a me q ua li t y be a m a nd to a p p r o xi m a te l y t h e s am e a b s o rb e d do s e l e ve l . T h e T L D r e sp o n s e i s de f i n e d a s TL o utp ut pe r uni t ab s o r be d d o se i n t he p ho s p ho r . Figure above 8 . 14 g i ve s th e energy r e s po ns e c ur v e for LiF ( T L D- 1 0 0 ) for p ho to n e n e r g ie s be lo w m e g av o l t ag e r a n ge . T he s tud i e s o f e ne r g y re s po ns e f o r p ho to ns

60

Co a n d h i g h e n e r g y e le c t ro ns ha v e y i e l de d so m e w ha t conf l i c t i ng re s ul t s .

WWW.MEDRAD.IR

W h e r e a s t h e d at a o f P i n k e r t o n et a l . ( 5 6) a nd C r o s b y e t a l . ( 5 7 ) s ho w s o me e n e r g y d e pe n d e n c e , ot h e r s t u d ie s ( 5 8 ) do no t s ho w t hi s e ne rg y d e p e nde nc e . W h e n c o n s i d e r ab l e c ar e i s u s e d , p r e ci s io n o f a p p ro x i m at e l y 3 % m a y b e ob t ai ned u s i n g T L D p o w d e r o r e x t r u d e d m a te r i al . A l t ho ug h no t a s p r ec i s e a s t he i o n c h a m b e r , T L D ' s m a i n a d v a n t a g e i s i n mea s ur i ng do s e s i n r egi o ns w he r e io n chamber P.148 b o d y c a vi ti e s . S i n c e TL D m at e ri a l i s a v ai l abl e i n m a ny f o r m s a nd s i z e s , i t ca n b e u s e d f o r s p e c i al d o sim e t r y s i t u at io ns s uc h a s f o r m e a s ur i ng d o s e d i s t ri b uti o n i n the b u il d - u p r eg io n , around b r a c hy t he r ap y s o ur c e s , a nd for p e r s o nnel do s e m o n i to r i n g . cannot be used. For e x a m p le , TLD is e x t re m el y us e f ul for pa ti e nt d o s im e tr y b y d i r e ct i n s e r ti o n i n to t i s s ue s o r

F I G . 8 . 1 3 . A n e x a m p l e o f T L v e r s us a b s o r b ed d o se c ur v e f o r T L D - 1 0 0 po w d er (schematic).

D. Silicon Diodes
S i l i co n p - n j u n c t io n d i od e s a re o f t e n us ed f o r re l at i v e d o si m et r y . T he i r hi g h er s e n s i ti v i t y , advantages i n st a n t a n e o u s over r e sp o ns e , s m all size a nd r ug g ed nes s offer s pe c i al for io ni z a t io n chambers. The y are p a r ti c ul a rl y well s uit ed

r e l at i v e me a s u r e m e n ts i n e l e ct r o n be a m s , o ut p ut co ns t a nc y c he c k s a nd i n v i v o p a t ie n t d o se mo n i to rin g . T h e i r m aj o r li m ita t io ns a s d o si m et e r s i nc l ud e e ne rg y d e pe n d e n c e in p h o to n beams, d i re c ti o na l d ep e nde nc e , t he rm a l e f f e ct s , a nd r a d i at io n - i n d u c e d d am a g e . M o de r n d i od e s f o r d o s i me t r y ha v e b e e n d e si g ne d t o m i n i m i z e t h e s e e f f e ct s.

1. Theory
A d o s i m et r y d i od e co n s i s t s o f a s i li c o n c r y s t a l w hi c h i s m i x e d o r d op e d w it h i m p u r it ie s to make pand n - t y pe s il i con. T he p-type si li c on is m a de by i n t r od u c i n g a s m a l l am o u n t o f

WWW.MEDRAD.IR

P.149 a n e l e me n t f r om g ro u p III o f t h e p er io d i c t a b le ( e .g . , b o ro n) , m a k i ng it i nt o a n e l e ct r o n re c ep to r . Wh e n s i l i co n i s m i x ed w i t h a m at e ri a l f r om g r o up V ( e . g . , p h o s p h o r us ) it re c e i ves a t o m s t h a t ar e c a r rie r s o f ne g at i ve c ha r g e, t hus m a k i ng i t i n t o a n e le c t ro n d o n o r o r n - t y p e s i li c o n. A p - n j unc t i o n d i od e i s de s i g ned w i t h o ne p a r t o f a p - si li c o n d i sc d op e d wi t h a n n- t y pe m a te r i al ( Fi g . 8 .1 5 ). T he p - r e gi o n o f t h e d io de i s d e f i ci e n t i n e l e ct ro n s ( o r co nt ai ns ho l e s ) w hi l e t he n- r e g io n ha s a n e x c e s s o f e le c t ro n s .

F I G . 8 . 1 4 . E n e r g y r e s p o n s e c u r v e f o r L i F (T L D - 1 00 ) , C a F 2 : M n a nd a p hot og r a p hic film. ( F r om C a m e ro n JR, S u n t ha r a l i ng a m H, K e nne y GN. T h e r m ol um i ne s c e nt d o s im e tr y . M a d i s o n : Un i v e r s i t y o f W i s co ns i n P r e s s , 1 9 6 8 , w i t h p erm i s s io n. )

WWW.MEDRAD.IR

F I G . 8 . 1 5 . A s c h e m a t i c di a g r a m s ho w i ng b a s i c d e si g n o f a s i l ic o n p - n j unc t i o n d i od e . ( F ro m At ti x FH. I n t r od uc t io n to r a d io lo gi c a l p hy s i cs a nd r a di a ti o n d o s im e tr y . N e w Y o r k : J o h n W i l e y & S o ns , 1 98 6 , w i t h p e r mi s s io n. ) A t t h e i n t e r f a c e be tw e e n p - a n d n- t y p e m a t e r i al s , a s m a l l r e g io n c a l le d t he d e pl et io n z o n e i s c rea t e d b e c a u s e o f i nit ia l di f f us i o n o f e le c t ro ns f r o m t he nr e g io n a n d h o l e s f r om t h e p - r e gi o n a c r os s t he j unc t i o n, unt i l e q ui li b ri um i s e s t a bl i s h ed . T h e de ple t io n z o n e d e v el op s an e l e ct r i c f i el d w hi c h o pp o se s f ur t he r d i f f u s i o n o f m a j o ri t y ca r r i e r s o n c e e q uil i b ri um ha s b e e n a c hi e v e d . W h e n a d i o de i s i r r a di a t ed el e ct r o n- hol e p ai r s a r e pr o d uc ed w it hi n t he d ep le ti on z o n e . T h e y a r e i m m edi a t el y s ep a r a te d a nd sw e p t o ut b y t he e x i st ing e le c t ri c f ie ld i n t h e de p le ti o n z o n e . T h i s g i v e s ri s e t o a ra d i a tio n- i nd uc e d c ur re nt . T he c ur r e nt i s f u r t h e r a u g m e nt e d b y t h e di f f u s i o n o f e l ec t r o ns a nd hol e s p r oduc e d o ut si de t he d e pl et io n z o n e w it h i n a d i f f u s i o n le ng t h. T he d i re c ti o n o f el e ct r o ni c c ur r e nt f lo w is f r o m t he n - t o t h e p- r e g io n ( w h i c h i s o p po s it e to t he di r e ct io n o f co nv e nt io na l current).

2. Operation
F i g u r e 8 .1 6 A s h o w s s c h e m a t i c al l y a r ad i at io n d io d e d et e ct o r , w hi c h e s s e nt i al l y c o n s i s t s o f a s il i co n p- n j u n c t i o n d io de c o nne c t e d to a c o a xi a l c ab l e a nd e nc a s ed i n e po x y p ot ti n g m ate r i al . T h i s de s i g n i s int e nd e d f o r t he r a di at io n b e a m to be i n c i d e nt p e rp e n d i c ul a rl y a t t h e l o ng a x i s o f t he d et e ct o r . A lt ho ug h t he c o ll e ct i ng

WWW.MEDRAD.IR

o r s e n s i ti v e v ol u m e (d e pl et io n z o ne ) i s no t k no w n p r e c i s e l y , i t is o n t he o r d er o f 0 . 2 t o 0 . 3 m m 3 . It i s l o c at e d w it hi n a d e pth o f 0 . 5 m m f r o m t he f r o nt s ur f a c e o f t h e d e te c to r , u n l e s s e l e ct r o ni c b ui ld up i s p r o v id e d b y e nc a s i ng t he d i od e i n a b u i l d u p m at e ri a l . Figure 8 .1 6 B shows the d io de c o nne ct e d to an op e r at io na l a m p li f i e r w it h a f e e d b a c k lo op to m ea s u r e r a d i a tio n i nd uc e d c ur r e nt . T he r e i s no b i a s v o lt a ge a p p li e d . T h e ci r c u i t ac t s a s a c u r r e nt - to - v ol t a ge t r a ns d uc er , w he r e b y t he v ol t age r e a d o ut a t p oi n t B i s d i r e ct l y p ro po r ti o na l to t he r a d ia ti o n i nd uc ed c ur r e nt . D i od e s a r e f a r mo r e s e n s i ti v e t h a n i o n c ha m b e r s . S i nc e t he e ne r g y r e q ui re d to p r o d u c e a n e le c t ro n -h o l e p ai r i n S i i s 3 .5 e V c o m p a re d to 34 e V r e q ui re d to p r o d u c e a n io n - p a i r i n P.150 a i r a n d b e c a u s e t h e de n s i t y o f S i i s 1 ,8 0 0 ti m e s t hat o f a i r , t he cur r e nt p r o d uc ed p e r u n i t v o l u m e i s abo u t 18 , 0 00 ti me s l a rge r i n a d io d e t ha n i n a n i o n c ha m b e r . T h u s , a d i o d e , e ve n w i t h a s m a ll c ol le c ting v o l um e , c a n p r o vid e a n a d eq ua t e signal.

WWW.MEDRAD.IR

F I G . 8 . 1 6 . S c h e m a ti c d i ag r a m s s ho w i ng ( a) s il i co n p - n j unc t i o n d io de , a nd ( b ) b a s i c e le c t ro n i c ci r c u it u s i n g o pe r a ti o nal am p l i fi e r w i t h a f e ed ba c k l oo p . ( F ro m G a g e r L D , W r ig h t A E , A l m o n d P R . S i l i co n di o de d et e ct or s us e d in r a d i o bi ol og i c al p h y s i c s m e a s u r e m e n ts . P a r t I: D e v e l op m ent o f a n e ne r g y c o m p e ns a t i ng s hi el d. M e d P h y s 1 9 7 7 ; 4 :4 94 4 98 , w i t h p e r mi s s io n. )

3. Energy Dependence
B e c a u s e o f t h e r e l at i ve l y h i g h a t om i c num be r o f s i li c o n ( Z = 1 4 ) c o m p a re d to t ha t o f w a t e r o r a i r , di od e s e x h i b i t s e ve r e e ne rg y d e p e nde nc e i n p ho ton b e a m s o f no nuniform q u a l it y . A l th o u g h some di od e s are d e si g ne d to p r o v id e e ne rg y c o m p e n s at io n t h r o u g h f i l t r at io n ( 5 9 ) , t he i ss ue o f e ne r g y de p e nde nc e ne v e r g oe s a w a y a n d t h e r e f o r e , th e i r u s e i n x - r a y b e am s i s li m it ed to r el ati v e do s i me t r y i n s i t u a ti o n s w h e r e s p e ct r a l q u a li t y o f t he be a m i s no t c ha ng ed s i g ni f i c a ntl y , f o r e x a m p le , p r o fi le m e a su r e m e n t s i n s m al l fi eld s , d o se c o ns ta nc y c he c k s . In e l e c t ro n

WWW.MEDRAD.IR

b e a m s , h o w e v e r , t h e d i od e s do no t s ho w e ne r g y d e pe nd e nc e a s t he s t op p i ng p o w e r r a ti o o f s i l i co n t o w a t e r do e s not v a r y s i g ni f i c a nt l y w i t h e le c t ro n e ne r g y o r d e pt h . T h u s d i o d e s a r e q u a l it a ti v e l y s i mi l a r to f i l m s so f a r a s t he i r e ne r gy d e pe n d e n c e i s c o n c ern e d . S o m e di od e s e x h ib it gr e a t er s t a bi li t y a nd l es s e ne r g y d ep e nd e nc e t ha n o t he r s . It i s t h e r e f o re i n c u m b e nt u p o n t h e us e r t o e st a b li s h d o si m et r i c a c cur a c y o f a d i o de b y c o m p a r a ti v e m e a s ur e m e n t s w it h a n i o n c ha m b e r .

4. Angular Dependence
D i od e s e x h ib it a n g u l a r d e p e n de n c e , w hi c h m us t b e t a k e n i nt o a c count i f t he a ng l e of beam i n c i de n c e is changed s i g ni f i c a nt l y . Again t he s e effects s ho ul d be a s c e r t ai n e d i n co m p ar a t i v e m e a s ur e me nt s w i t h a d et e ct o r w hi c h d oe s not s ho w a n g u l a r d e p e n de n c e . P.151

5. Temperature Dependence
D i od e s s h o w a s m a l l t e m pe r a t u r e de pe nde nc e t ha t m a y b e igno r e d unl e s s t he change i n t e mp e r at u r e during me a s ur e me nt s o r si nc e t he l as t c a li b r at io n i s d r a s t i c . T h e t e mp e r at u r e d e pe n d e nc e o f d i od e s i s s m a ll e r t han t ha t o f a n i o n c h a m b e r . M o r eo v e r , th e i r r e s po n s e i s i nde pe nd e nt o f p r e s s ure a nd hum i d i t y .

6. Radiation Damage
A d i o d e c a n s u f f e r p e r m a n e n t d a m a ge w he n i r r a d i a te d b y ul tr a hi g h d o s e s o f i o n i z i n g r a di a ti o n . T h e d a m a g e i s mo s t p rob a b l y c a us e d b y d i s pla c e m e nt o f s il i co n a t o m s f ro m t h ei r l at ti c e po s it io n s . T he e x t e nt o f d a m a ge w i ll d e pe nd up o n t he t y p e o f r a di a ti o n , e ne r g y a n d to t al do s e . Be c a us e o f t he p o s sib i li t y o f r a di a ti o n d a m a g e , e sp e ci a ll y a f t e r p ro lo n g e d us e , d i od e s e nsi ti v i t y s houl d be c he c k ed r o u t i n el y t o a s s u r e s ta b i li t y a n d a c c ur a c y o f c a l i b r a tio n.

7. Clinical Applications
A s p r e v io u s l y me n t ion e d , d io de s a re us e ful i n el e ct ro n b e am d o s im e tr y a nd i n l i mi te d s it u a t io n s i n ph o t o n b ea m m e a s ur em e nt s . M o s t o f t e n t hei r us e i s di c t at ed b y t h e re q u i re m e n t s o n t h e d et e ct o r s i z e . F o r e x a m p le , do s e pr o f i le s o r o ut p ut f a c t o r s i n a s m al l fi e ld m a y p o se d i f f i c ul ti es i n t he us e o f a n ion c ha m b e r . S o a f i l m o r a di od e r e s po n s e i s c he c k ed a g ai ns t a n i o n c ha mb e r und e r s uit a ble b e n c h m a r k c o n d i ti o n s . D i od e s a r e be c o mi n g in c r e a s i n g l y p op ul a r w i t h r e g a rd t o t hei r us e i n p a t ie nt d o se m o n i to r i n g . Si n c e di od e s do n ot r eq ui r e hi g h v o lt a ge bi a s , t hey c a n b e t ap ed d i r e ct l y o n t o t h e p a ti e n t at s u it a b le po i nt s to m e a s ure do s e . T he d io d e s ar e c a r e f u l l y c a li b r at ed to p r o v id e a c he c k o f pa t i e nt do s e at a re f e re nc e po i nt (e . g . , d o s e a t d m a x ) . D i f f e r e nt a mo u n t s o f b ui ld up m a t e ri a l c a n b e i nc o rp o r at e d to m a ke t h e di od e s a mp le t he do s e cl o se to t he p e a k do s e f or a gi v en e ne r g y b e a m . C a l i b r at io n f a c to r s a re a pp li e d to co nv e r t the d io de re a d i ng i nto e x p e c te d d o se at t h e r e f e r e n c e po i n t , t a k i n g i n t o a c co unt s o ur c e - to - de t e cto r d i sta nc e , f i e l d s i z e , a n d o t h e r p a r a me te r s u s e d i n t h e c a l c ul a ti on o f m o ni t o r uni t s . F o r f u r t h e r d et a il s o n d i od e s a n d t hei r c li ni ca l a p pl i c at io ns , t he r ea d i e r i s r e f e r re d t o s o me k e y a r t i cl e s in t h e l i te r a t ur e ( 59 , 60 , 6 1 , 62 ) .

WWW.MEDRAD.IR

E. Radiographic Film
A r a d i o g r ap h i c f i l m c o n s i s t s o f a t r a ns pa r e nt f i l m b a se ( c e llul o s e a c et a te o r p o l ye s t er r e s i n ) c o at ed w i t h a n e m ul s i o n co nt a i ni ng v e r y s m a ll c r y s t a l s o f s il v e r b r o mi d e . When the film is e x po s ed to io ni z i ng r a di a ti o n or v i s i b le l ig ht , a c h e m i c a l c h a n g e t a k es p l a ce w it hi n t he e x po s e d c r y s t a l s to f or m w ha t i s r e fe r r ed t o a s a l a te n t i m age . W h e n t h e f i l m i s d e v e lo p ed , t he a f f e c t e d c r y s t al s a r e r e d u c e d to s m a ll g r ain s o f m e t a ll i c s il v e r . T he f i l m i s t he n f i x e d . T he u na f f e c t e d g r a n u l e s a r e r e mo v e d b y t h e f i x i ng s o l ut ion, l e a v i ng a c l e a r f i lm i n t he i r p l a ce . T h e m e t a ll i c si l v e r , wh i c h i s n o t a f f e c t ed b y t he f i x e r , c a us e s d a r k e ni ng o f t he f i l m . T h u s t h e d e g r ee o f b l a c k e n i ng o f a n a r e a o f t he f i l m de pe nds o n t he a m o unt o f f r e e s i l v e r d e po s it ed a n d , c o n s e q ue nt l y , o n t he r a d i at io n e ne r gy a b s o r b ed . T h e d e g r ee o f b l a c k en i n g o f t h e f il m i s me a s ur e d b y de te r m i ning o p ti c a l d e ns it y w i t h a d e n s it o me te r . T h i s i n s t r u m e nt co ns is t s o f a li g ht so ur c e , a t i ny a p e rt ur e t h r o u g h w h i c h t h e li gh t i s di r e ct ed a nd a l ig ht d et e ct or ( p hot o ce ll ) to m ea s ur e t he l i g h t i n t e ns it y t r a n s m it t ed t h r o u g h t he f il m . T h e o p ti c a l de n s i t y , O D , i s d e f i n e d a s :

w h e r e I 0 i s t h e a mo u n t o f l ig h t co ll e ct ed w itho ut f i lm a nd I t i s t he a m o unt o f li g ht t r a n s m i tt ed t h ro u g h th e f i l m . A de ns i to m et e r gi v e s a d i re c t rea d i ng o f o pt i c al d e n s i t y i f i t h a s b een c a l i b r at e d b y a s t and a r d s t r ip o f f i lm ha v i ng r e g io ns o f k n o w n o p t i c a l de n s it y . P.152 In d o s i m e t r y , t h e q ua n t i t y o f i nte r e st i s us ua l l y ne t o p ti c a l de ns i t y w hi c h i s o b t ai n e d b y s u b t r a c tin g t h e r e a di ng f o r t he b a s e f o g ( O D o f une x p o s ed p r o ce s s ed f i l m ) f r o m t h e me a s u r e d o pt i c al d e nsi t y . A p lo t o f n e t op ti c a l de n s i t y a s a f unc t i o n of r a d i at io n e x po s ur e or d o se i s te r m ed the s e n s it o me t ri c cu r v e , or H-D c ur v e . 6 F i g ur e 8 . 17 s how s examples of c h a r a c t e r i st i c c u r v e s f o r t w o co m mo nl y us e d d o si m et r y f i lm s. F i l m s pe ed a nd l i n e a ri t y o f t h e s e n s it o me t ri c c u r v e a r e t he t w o m a i n c ha r a c t e ri s ti c s w hi c h a r e c o n s i d er e d i n s e le c ti n g a f i l m f or d o si me t r y. If a f i l m i s e x p o se d i n t he no nl i nea r r e g io n , c o r r e ct io n s a r e n e c e s s a r y t o c o nv e rt o pt i c al d e ns it y i nt o d o s e .

WWW.MEDRAD.IR

F I G . 8 . 1 7 . S e n s i to me t ri c c u r v e o f K od a k X V - 2 f i l m a nd Ko d a k R P M - 2 ( T y p e M ) film. Although film is w e ll - e s t ab li s h e d 14), it s as a m e t hod in of m e a s ur i ng e l ec t ro n is beam

d i s t ri b u tio n s

( C h a p t er

us e f ul ne ss

p ho to n

do s i me tr y

re l at i v el y

l i mi te d . Be c a u s e t h e p h o t oe l e ct ri c e f f e c t d e p e nd s o n t he c ub e o f t he a t o mi c n u m b e r , t h e s i l v e r ( Z = 4 5 ) i n t h e f i l m e m ul s io n a b s o r b s r a di a ti on b e l o w 1 50 k e V v e r y s t r o n g l y b y t h e p h o to el e c tr i c p ro c e s s . S i nc e m o s t cl i ni c al b e a m s c o nt a i n a s c a t te r c o m po n e n t o f l o w - e n e rg y p ho to ns , t he c o r r e l at io n b e t w een o p t i c al d e ns it y a n d d o se b e co m e s t e nu o u s . In a d d i ti o n, fi lm s uf f e r s f r o m s e v e r al po te nt i al e r ro r s s u c h a s c h a n g e s i n p r o c e s si n g co nd it io ns , i nt e r f il m e m ul s io n d i f f e r e nc e s , a nd a r t i f a c t s c a u se d b y a ir p o c k et s a d j a ce nt to t he f i l m . Fo r t he se re a s o ns , a b s ol ute d o s im e tr y r a d i at io n with f i e ld s , f il m is i mp r a c ti c a l . Ho w e v e r , field it is very us ef ul a nd for c he c k i ng a nd l ig h t - f i el d c oi nc i de nc e , fl a t ne s s , symmetry,

o b t ai n i n g q u i c k q u a li ta t i v e p at te r ns o f a r a d i a ti o n di s t ri b uti o n. In t h e m e g a v ol t ag e ra n g e o f p h oto n e ne rg i e s , ho w e ve r , f i l m ha s b e e n us e d to m e a s u r e i s od o se c u r v e s w i t h a c c e p t ab l e a cc ur a c y ( 3 % ) ( 6 3 , 6 4 , 6 5 ) . O ne o f t he t e c h n i q u e s ( 65 ) c o n s i s t s o f e x po s i ng t he f i l m p a c k e d ti g htl y i n a p o l y s t y r e ne p h a n t o m , p a r al le l t o t h e c e n t r al a x i s o f t he b e a m . T he f il m e d ge i s c a re f ul l y a l i g n ed w i t h t h e p h a n t o m s u r f a c e a nd a i r p o c k et s b et w e e n t he f i l m s ur f a c e a nd t h e s u r r o u n d i n g j a c k et a r e r e mo v e d b y p unc hi ng ho l e s ne a r t he c o r ne r s . O p ti c al d e n s i ti e s a r e co r r el at e d w it h d o s e b y us i ng a d e p t h- de pe nd ent s e ns i t om e tr i c c u r v e d e r i v ed f r o m k no w n c e n t r a l a xi s d ep th d o s e d a t a fo r a r e f er e nc e f i el d s uc h as 10 10 cm. Th e m et h o d is made p r a c ti c al by a com p ut e r - co nt r ol le d d e n s i to m et e r a n d a co m p u te r p ro g r a m t hat p e r fo r m s t he r e q uire d i so de ns i t y -t o i s o do s e c u r v e c o n v e r si o n .

WWW.MEDRAD.IR

P.153

F. Radiochromic Film
T h e u s e o f r a di o c h rom i c f il m s f o r r a d ia ti o n d o si m et r y ha s b ee n ev o l v i ng si nc e t he 1 9 60 s ( 66 , 6 7 ) . W it h t h e r e ce n t i mp r o ve me nt i n te c hno lo g y a s so c i at e d w i t h t he p r o d u c tio n o f t h e s e fi lm s , t h e i r u s e ha s b e co m e i nc r e a s i ngl y p opul a r e s p e ci a ll y i n brachytherapy Gy), r e l a ti v el y d o si me t r y . lo w Major ad v a nt ag e s of r a dio c hr o m i c (or film do s i me te r s i n c l u d e ti s s u e eq u i v a le n c e , h i g h s p a t ia l r e so l uti o n, l a rg e d y na m ic r a ng e ( 1 0 - 2 -1 0 6 s p e ct r a l of s e ns it i vi t y an ul t r a v a r i a ti o n t hi n (7to e ne rg y d e p e nd e nc e ) , c o l o r le s s , i n s e n s i ti v i t y to v i s ib le l i g h t a n d n o ne e d f o r c he m i c a l p ro c e s si ng . R a d i o c h ro m i c f i lm c on s i s t s 23-m thi c k ) , r a d io s e n s it i v e le u c o d y e bo n d ed o nt o a 1 0 0 - m t hi c k M y l a r b a s e (6 8 ) . Ot her v a r i e ti e s i n c l u de t h i n l a y e r s o f r a d io s e ns it i ve d y e s a nd w i c he d b e tw e e n t w o p i e ce s o f p ol y e st e r b a s e ( 6 9) . T h e u n e x p o s e d f i l m i s co lo r le s s a nd c ha ng e s t o s ha de s o f b l u e a s a r e s u l t o f a po l y m e ri z a ti o n p r o ce s s i nd uc e d b y i o ni zi ng r a d i a ti o n. N o p h y s i c al , c h e mi c a l, o r t h e r m al p r o ce s s ing i s r e q ui re d to b r i ng o ut o r st a bi li z e t h i s c ol or . T h e d eg r ee o f co lo r i n g i s us ua lly m e a s ur e d w it h a s pe c t ro p hot o me te r using a narrow s p ec t r a l w a v el e ng t h ( no m i na l 6 10 67 0 nm) . C o m m e r c i al l y a v a i l a bl e l a s e r s c a n n er s a n d C C D m i c r o de ns i to m et e r c a me r a s c a n a l s o be us e d to s c a n t h e f i l m s . T h e s e m e a s u r e m e nt s a r e ex p r e s s e d i n te r m s o f o p ti c a l de ns it y a s d e f i n e d b y E q u a ti o n 8. 1 1 5 . R a d i o c h ro m i c f i l m s a re a l mo s t ti s s ue e q ui va l e nt wi t h e f f e c t i v e Z o f 6 .0 to 6 . 5 . P o s t i r r ad i at io n c o lo r s t a b il it y o c c ur s a f t e r a b o ut 24 ho ur s . E ne r g y d e p e nde nc e i s m u c h l o w e r t h a n t h e s i l v e r h a l id e ( r ad iog r a p hi c ) f il m s . A lt houg h r a d i o c hro m i c f i l m s a re i n s e n s it i v e t o v i s ib le l i g ht , t he y e x hi b it so m e s e ns it i v it y to ult r a v io le t l i g h t a n d t em p e r at u r e. T h e y n e e d t o b e s tor e d i n a d r y a nd d a r k e nv i r o nm e nt at t h e t e mp e r at u r e a n d h u m i d i t y n o t t oo d i f f er e nt f r o m t ho se a t w hi c h t he y w i l l be u s e d f o r do s i me t r y . B e c a u s e r a d io c hr o mi c fi l m s a re s e ns it i v e t o ul t r a v io l et li g ht, t h e y s h o u l d n ot b e e xp o s ed to f l uo re s c e nt li g ht o r to s unl i g ht . T he y m a y b e r e a d a n d h a n d l e d i n n o r m a l i n c a n d e s c e nt li g ht . R a d i o c h ro m i c f il m s mu s t b e c a li b r at e d b e f or e t he y c a n b e us e d f o r d o si m et r y . T he s e n s i to m et r i c c u r v e sh o w s a li n e a r re l at io ns hi p up t o a c e rt a i n do s e l e v el be y o nd w h i c h i t s r e s p o n s e l e ve l s o f f w i t h i nc r e a s e in d o s e ( F i g . 8 . 18 ) . T h e m o s t c o m mo n l y u s e d r a d io c hr o mi c f i lms f o r d o s i me t r y t hat a r e c o m m er c i al l y a v a i l a bl e a re G a f C h r o m i c H D - 8 10 f il m ( Int e r na t io na l Sp e c i al ty P r o d uc t ( IS P ) , W a y n e , N J ) a n d D o u b l e - l a ye r G a f C hr o m i c M D - 5 5 2 f i l m ( IS P o r o t he r v e nd or ( s ) : N u c l e a r A s s o c i at e s , P.154 C a r l e P l a c e , N Y ) . W h e r e a s H D - 8 10 f i l m s a re m a i nl y us e d i n t he do s e r a ng e o f 5 0 t o 2 , 50 0 G y , M D - 5 5 - 2 a r e u s e f u l i n t he r a ng e o f 3 t o 10 0 G y .

WWW.MEDRAD.IR

F I G . 8 . 1 8 . A p l ot of n e t o p ti c a l de ns i t y a s a f u nc t i o n o f d os e f o r M D - 5 5 2 r a d io c h r o m i c f il m . ( F ro m A A P M . R a d io c hr o mi c f il m d o si m et r y : r e co m m e nd at io ns of A A P M R a d i a t i o n T h e r a p y C o m m i tt e e T a s k G r o up 5 5 . M e d P hy s 1 9 9 8 ;2 5 : 20 93 2 1 15 , w i t h p e r mi s s io n . ) F o r d et a il s o n r a d io c h r o m i c f il m a nd t he i r us e i n c l i ni c a l do s im et ry , t he r e a d e r i s r e f e r r e d t o t h e A A P M T G - 5 5 r e po r t ( 70 ) .

REFERENCES
1. IC R U . R a d i a t io n q u a n t i ti e s a nd uni t s. Report No. 33 . W a s hi ng t o n, DC: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 8 0 . 2 . B o u ti ll o n M , P er r o ch e - R o u x A M . R e - e v a l ua t io n o f t he W v a l ue f o r el e ct r o ns i n d r y a i r . P h y s M e d B i o l 1 9 8 7 ;3 2 :2 1 3 . 3 . L o f t u s T P , W e a v e r J T . S t a n d a r d i z a ti o n o f
60

C o a nd

137

C s g a mm a - r a y b e a m s i n

t e r m s o f e x po s u r e . J R e s N a t l B u r S t a nd 1 97 4 ; 78 A : 4 65 . 4 . Lo e v i n ge r R . A fo rm a l i s m f o r c a l c ul at ion o f a b so r be d d o se to a m e di um f r om p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 8 1 ;8 : 1 . 5 . M a c k i e T R , B i el a je w A F , R o g e r s D W O , e t al . G e ne r at io n of p ho to n e ne r g y d e po s it io n k e r n e l s u s in g t h e E G S M o nt e C a r l o c od e . P hy s M e d Bi o l 1 9 8 8 ;3 3 :1 . 6 . A m e r i c a n A s s o ci a tio n o f P h y s i c i s t s i n M ed i c i ne . R T C T a s k G r o up 2 1 . A p ro to c ol f o r t h e d e te r mi n a t io n o f a b so r b ed do s e f ro m hi g h e ner g y p hoto n a nd e le c t ro n b e a m s . M e d P h y s 1 9 83 ; 1 0 :7 4 1 . 7 . J o h n s H E , C u n n i n g h a m J R . T he p hy s i c s o f r a d io lo g y , 3 r d e d . S p r i ng f i el d , IL : Charles C Thomas, 1969.

WWW.MEDRAD.IR

8 . D a y M J , G r e e n e D , M a s s e y J B . U s e o f a P e r s p e x s he a t h f o r ioni z a t i o n c ha m b e r m e a s u r e m e n t s i n a w a t e r p h a n t om . P hy s M e d Bi o l 19 65 ; 1 0 :1 11 . 9 . B r a g g W H . S t u d i e s i n r a d i o a ct i vi t y . N e w Y o r k : M a c m i ll a n, 1 9 1 2. 1 0 . G r a y L H . A n i o n i za t io n m e t ho d f o r t he a b s o l ut e me a s ur e m e nt o f g am m a - r a y e n e r g y . P r o c R S o c 1 93 6 ; A 1 56 : 57 8 . 1 1 . S p e n c e r L V , A t ti x F H . A t h e o r y o f c a v i t y i o ni z a ti o n. R a d i at R es 1 9 5 5 ;3 : 23 9 . 1 2 . G r e e n i n g J R . A n e x p e r i me n t a l e x a mi na tio n o f t he o ri e s o f c a v i t y i o ni z a tio n. Br J R a d i ol 1 9 57 ; 30 : 25 4 . 1 3 . B u r l i n T E . A n e x p e r i me n t a l e x a m i nat io n o f t he o r i e s r el a ti ng the a b s o r p ti o n o f g a m m a - r a y e n e r g y i n m e d i u m to t he i o ni z a t io n p r o d uce d i n a ca v i t y . P hy s M e d B i o l 19 61 ; 6 : 33 . 1 4 . B u r l i n T E . F u r t h e r e x a m i n a t io n o f t heo ri e s r el a ti ng t he a b so rp t io n o f g a m m a r a y e n e r g y i n a m e d iu m t o t h e io ni z a ti o n p r o d uc ed i n a c a v i t y . P hy s M e d Bi o l 1 9 66 ; 1 1 :2 55 . 15. Nahum AE. Dosimetry in r a di ot he r a py . IA E A - S M - 2 9 8 / 8 1 . Proc Symp I nt A t o mi c E n e r g y A g e n c y 1 9 8 8 ;1 : 87 . 1 6 . IC R U . S t op p i n g pow e r s f o r el e ct ro ns a nd po s it r o ns . R ep o rt 37 . Be t he s d a , M D : In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 8 4 . 1 7 . N a h u m A E . W a t e r / a i r m a s s s t o pp i ng pow e r r a t i o s f o r m eg a v ol t a ge p ho to n a nd e l e ct r o n be a m s . P h y s M e d B i ol 1 9 78 ; 23 : 24 . 1 8 . B u r l i n T E . C a v i t y c h a m b e r t heo r y . In: A t t i x F H , R oe s c h W C , e d s . R a d i a t i on d os i m e t r y , V ol I , 2 n d e d . N e w Y o r k : A c a d e m i c P r e s s , 1 96 9 . 19. 20. IC R U . A l mo n d Average PR, energy r e q ui r e d H. to p ro d uc e c ha m b e r an io n pair. for R e po rt p ho to n 31. a nd W a s h i n g t o n , D C : IC R U , 1 9 7 9 . Svensson Io ni z a t i o n do s i me t r y e l e ct r o n be a m s . A c t a R a d i ol 1 97 7 ;1 6 : 17 7 . 2 1 . L e m pe r t G D , N a t h R , S c h u l z R J . F r a c t i on o f i o ni z a t io n f r o m e l e c tr o ns a r i s i ng i n t h e w a l l o f a n i o n i za t io n c h a m b e r . M e d P hy s 1 9 8 3 ; 10 : 1 . 2 2 . D u t re i x J , D u t re ix A . E t u d e c o m p a r d une s r i e d e c ha mb r e s d i o ni z at io n d a n s d e s f a i s c e a u x d l e ct r o n s de 2 0 et 1 0 M e V . Bi o p hy s i k 1 96 6 ;3 : 2 49 25 8 . 2 3 . S c h u l z R J , A l m o n d P R , K u t c h e r G , e t a l . C l a r i f i c a ti o n o f t he A A P M T a s k G r o up 2 1 p r oto c ol . M e d P h y s 1 9 8 6 ;1 3 :7 5 5 . 2 4 . R og e r s D W O . F u n d a m e n t a l s o f hi g h e ne r g y x - r a y a nd ele c t ro n d o si m et r y p r ot o co l s . A A P M S u m m e r S c h o o l , 19 9 0 . 2 5 . K h a n F M . R e pl a c em e n t co r r e ct io n ( P r e p l ) f o r i o n c ha m be r do s im e t r y . M ed P hy s 1 9 91 ; 1 8 :1 24 4 . 2 6 . C u n n i n g h a m J R , S o n t a g M C . D i s p l a c em e nt c o r r e ct io n us e d i n a b s o r b e d do se d e te r m i n at io n . M e d P h y s 1 9 8 0 ;7 : 6 72 6 7 6 . 2 7 . J o h a n s s o n K , M a tts s o n L , Li n d be r g L , et a l . A b so r be d - do s e d et e r mi na t io n w it h i o n i z a ti o n c h a mb e r s in e l e ct r o n a nd p hot o n b e a m s ha v i ng e ner g ie s be t w ee n 1 a nd 50 28. MeV. AAPM. I A E A - S M - 2 2 2 /3 5 . C l i n i c al e le c t ro n V ie nna : b e am In t e r na ti o na l do s i me t r y . A t om i c E ne r g y A g e nc y , P hy s 1 9 77 : 2 43 2 7 0 . T G - 25 R ep o rt . Med 1 9 91 ; 1 8 :7 3 1 09 . 2 9 . IC R U . R a d i a t i o n do s i me t r y : e le c t ro n b ea m s w i t h e ne r g i e s bet w e e n 1 a nd 5 0 M e V . R e p o rt 3 5 . W a s h i n g to n , D C : IC R U , 1 9 8 4 .

WWW.MEDRAD.IR

30.

Nath

R,

Schulz

RJ.

Calculated
60

re s po ns e

a nd

wall

co r r ec t io n

factors

f or

i o n i z a ti o n c h a m b e r s ex p o s e d t o P.155

Co g a m m a- r a y s . M e d P hy s 1 9 8 1 ; 8 : 8 5 .

3 1 . G a s to r f R , H u m p h r i e s L , R o z e nf el d M . C y l i nd r i c al c ha m b e r d im e ns i o ns a nd t he c o r r e s po n di n g v a l u e s o f A w a l l a n d N g a s / ( N x A i o n ) . M e d P hy s 1 9 8 6 ; 1 3 :7 5 1 . 3 2 . B i el a je w A F . Io n iz a t i o n c a v it y t heo r y : a f o r m al de r i v a ti o n o f pe r t ur b at io n factors fo r thick wa l l ed ion c ha mb e r s in p ho to n be a m s . P hy s Med Biol 1 9 86 ; 3 1 :1 61 . 3 3 . R o ge r s D W A . F u n d a m e n t al s o f do s i me tr y b a s e d o n a b so r be d d o s e st a nd a r d s . In : M a c k i e T R , P a l t a J R , e d s . T el et he r a py : p r e s e nt a nd f ut ur e . M a d i so n, W I: A d v a n c e d M e d i c al P u b l i s h i n g , 1 99 6 :3 1 9 35 6. 3 4 . A A P M . P r o to c ol f o r c li n i c a l r e f e re nc e d o s im e tr y o f hi g h- e ne r g y p hot o n a nd e l e ct r o n be a m s . M e d P h y s 1 9 9 9 ; 2 6 :1 84 7 18 7 0 . 3 5 . A n d r e o P , B r a h m e A . S t o p p i ng -p o w e r d a t a f o r hi g h- e ne r gy p ho t o n b e a m s. P h y s M e d B i o l 1 9 86 ; 31 : 8 39 85 8 . 3 6 . IA E A . A b s o r b ed do s e d et e r mi na t io n i n e x t e r na l b e a m r a di ot he r a p y . T e c hni c al R e p o rt s S e r ie s N o . 3 98 . V i e n n a : Int e r na t i o na l A t o mi c E ne r g y A g e nc y , 2 0 0 0 . 3 7 . A n d r eo P . O n t he be a m q ua l it y s pe ci f i c a ti o n o f hig h- e ne rg y p hot o ns fo r r a d io t h e r ap y d o s i me t ry . M e d P h y s 2 0 0 0 ; 2 7 :4 3 4 4 40 . 3 8 . Ro g e r s D W O . Com m e n t o n O n t he b ea m q ua li t y sp e ci f i c a tio n o f hig h- e ne r g y p h o to n s f o r r a d io t h e r ap y d o s i me t r y . M e d P hy s 2 0 0 0 ;2 7 : 44 1 4 44 . 39. Kosunen A, Rogers DWO. Be a m q ua l it y s p e c i fi c a ti o n f or p ho t o n be a m d o s im e tr y . M e d P h y s 1 9 93 ; 2 0 :1 18 1 1 18 8 . 4 0 . L i X A , R o ge r s D WO . R e d u c i n g e le c t ro n c o nt a m i nat io n f o r p hot o n- b ea m q ua li t y s p e c i f i ca ti o n . M e d P h y s 1 9 9 4 ;2 1 :7 9 1 79 8 . 4 1 . D i n g G X , R o ge r s D W O , M a c k i e T R . C a l c ul a t io n o f s t op pi ng - pow e r r a t io s us i ng r e a li s ti c c l i n i c al el e c tro n b e a m s . M e d P hy s 1 9 9 5 ;2 2 : 48 9 5 01 . 4 2 . M a C M , N a h u m A E . E f f e c t o f s i z e a nd c o m po s it io n o f c e nt r a l e l e ct r od e o n t he r e s p o n s e o f c y l i n d ri ca l i o ni z a t io n c ha m b e rs i n hi g h- e ne r g y p hot o n a nd e le c t ro n b e a m s . P h y s M e d B i o l 1 9 93 ; 3 8 :2 67 29 0 . 4 3 . R o ge r s D W O . A n e w a p p r o a c h to e lec t r o n- be a m r e f e re nc e d o s i me t r y . M e d P h y s 1 9 9 7 ; 2 5 :3 10 320 . 4 4 . B u r n s D T , D i n g G X , R o g e r s D W O . R 5 0 a s a b e a m q ua l it y s p e ci f i e r f o r s el e ct i ng s t o pp i n g -p o w e r r at io s a n d r e f e r e nc e de p ths f o r e l e ct r o n do s im e t r y . M e d P hy s 1 9 96 ; 2 3 :3 83 38 8 . 45. IA E A . Absorbed c o de dose of d e te r m i nat io n in p ho to n R e po r t a nd Se r ie s e l ec t r o n No. b e am s : an i n t e r n a ti o n al p r a c t i ce . T e c hni c a l 277. V ie nna :

In t e r n a t i o n al A t o mi c E n e r g y A g e n c y , 1 9 8 7 . 4 6 . A n d r eo P . A b so rb e d d o se be a m q ual it y f a c t o r s f o r t he dos i m et r y o f hig he n e r g y p h o to n b e a m s . P h y s M e d Bi o l 1 9 92 ; 37 : 2 18 9 2 21 1 . 47. IC R U . R a d i a ti o n q u a n t i ti e s a nd uni ts . R e p o rt No. 19. W a s hi ng t o n, DC: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 7 1 . 4 8 . L a u g h li n J S , G e n n a S . C a l o r i m et r y . In: A t ti x F H , R o e s c h WC , e d s . R a d i at io n d o s im e tr y , V o l I I . N ew Y o r k : A c a d e m i c P r es s , 1 9 6 7 :3 8 9 .

WWW.MEDRAD.IR

4 9 . G u n n S R . R a d i o me t ri c c a l o ri me t r y : a r e v i e w . N uc l I ns t M e tho d s 1 96 4 ; 29 : 1; 1 9 70 ; 8 5 :2 85 ; 1 97 6 ; 13 5 : 25 1 . 5 0 . D o me n S R . A b s o r b e d d o se w a t e r c a lo ri me t e r . M ed P hy s 1 9 8 0 ;7 : 1 57 . 5 1 . IC R U . R a d i at io n d o s im e tr y : x - r a y s gene r a t e d a t po te nt i al s o f 5 to 1 5 0 k V . R e p o rt No . 17 . W a s h in g t o n , D C : Int e r na tiona l C o m mi s s io n o n R ad i a ti o n U ni t s a nd M e a s u r e m e n t s , 1 97 0 . 5 2 . C a m e ro n J R , S u n t h a r a l i n g a m N , Ke nne y G N . T he r m o l umi ne sc e nt do s i me t r y . M a d i s o n : U n i v e r si t y o f W i s c o n s i n P r e s s , 1 9 68 . 53. Greening JR, La w J, Redpath AT. Mass a t t e nua t io n a nd mass e ne r g y a b s o r pt io n c oe f f i c ie n ts f o r Li F a nd L i 2 B 4 O 7 f o r p hot o ns f ro m 1 to 15 0 ke V . P hy s M e d B i ol 1 9 72 ; 17 : 58 5. 5 4 . P a li w a l B R , A l m on d P R . A p p li c at io n o f c a v i t y t he or i e s f o r e l e ct r o ns to Li F d o s im e te r s . P h y s M e d B i o l 19 75 ; 2 0 :5 47 . 5 5 . H o lt J G , E d e l st ei n G R , C l a r k T E . E ne r g y d e p e nde nc e o f t he r es p o ns e o f l it hi um f l u o r i de T L D r od s i n h i g h e n e r g y e l e ct r o n f i el d s . P hy s M e d Bi o l 1 97 5 ; 20 : 5 59 . 5 6 . P i n k e r t o n A , H o l t J G , L a u g h l i n J S . E n e r g y d e pe nd e nc e o f Li F d o si m et e r s a t h i g h e n e r g ie s . P h y s M e d B i ol 1 96 6 ; 11 : 12 9 . 5 7 . C r o s b y E H , A l m on d P R , S h a l e k R J . E n e r g y d e pe nd e nc e o f Li F d o si m et e r s at h i g h e n e r g ie s . P h y s M e d B i ol 1 96 6 ; 11 : 13 1 . 58. Suntharalingam N, Cameron JR. T he r m o l umi ne s c e nt re s po ns e of l it hi um f l u o r i de t o h i g h - e n e rgy e l e ct ro n s [ hi g h- e ne rg y r a d i at io n t he r a p y do s i me t r y i s s ue ] . A n n N Y A c a d S c i 1 9 6 9; 1 6 1 :7 7 . 59. G a ge r LD, W rig h t p h y s ic s AE, A l m o nd P R. Pa r t S i l i co n I: di o de de te c t or s of an us e d in r a d io b io lo gi c a l m e a s u r e me nt s . De v e lo p me nt e ne rg y

c o m p e n s at i n g s h i el d . M e d P h y s 1 9 7 7 ; 4 :4 94 4 98 . 6 0 . W r i g h t A E , G a g e r L D . S i l i co n d i od e d ete c t or s us e d i n r a d io b io lo g i ca l p hy s i c s m e a s u r e m e n t s . P a r t II: M e a s u r e m e nt o f d o s i m et r y d a t a f o r hi g h- e ne r g y p ho to ns . M e d P h y s 1 9 7 7 ; 4 :4 99 5 02 . 61. Dixon RL, Ekstrand 1 9 82 ; 3 3 :1 17 1 1 17 6 . 6 2 . R i k n e r G . C h a r a c te r i st i c s o f a s el e ct i v ely s hi e l de d p - S i de te c to r i n a n d 1 6 M V R o e n t g e n ra d i a tio n . A c t a R a d i ol O nc o l 1 98 5 ; 24 : 20 5 20 8 . 6 3 . J a c o b so n A . 4 M e V x - r a y f i l m d o s i m et r y . R a d i ol og y 1 9 72 ; 10 3 :7 0 3 . 6 4 . P a t te n L , P u r d y J , O l i v e r G . A ut o m a ted f i l m do s i me t r y [ A b st r a c t ] . M e d P hy s 1 9 74 ; 1 : 11 0 . 6 5 . W i ll i am s o n J F , K h a n F M , S h a r m a S C . F i l m do s im et r y o f m e ga v o l t ag e p ho to n b e a m s : a p r a c ti c a l me t h o d o f i s o de ns i t y -to - i so do s e c ur v e c o nv e r s io n. M e d P hy s 1 9 81 ; 8 : 94 . P.156
60

K E . S i l i c o n d io de

d o si m et r y .

I nt

J Appl

R a di a t

I sot

C o a nd 8

6 6 . M c L a ug h li n W L , C h a l k l e y L . L o w at o mi c num b e r ed d y e s y s te m s f o r i o ni z ing r a d i at io n m e a s u r e m e nt s . P h o t og r S c i E ng 1 96 5 ; 9 :1 5 9 16 5 . 6 7 . M c L a u g h l i n W L . M i c r o s co p i c vi s ua l i z a ti o n o f do s e di s tr i b uti o n. I nt J A pp l R a d i a t I s ot 1 96 6 ; 17 : 85 96 .

WWW.MEDRAD.IR

6 8 . Z h u Y , K i r o v A S , M i s h r a V , e t a l . Q ua nti t at i v e e v a l ua ti o n o f ra d i o c hro m i c f i lm r e s p o n s e f o r t w o - di m en s i o n a l d o si m et r y . M ed P hy s 1 9 9 7 ; 2 5 :2 23 2 3 1 . 6 9 . S o a r e s C G , M c L au g h l i n W L . M e a s ur e m e nt o f r a d i al do s e di st r i b ut io ns a r o und s m a l l be t a -p a r ti c le em i tt e r s u s i ng hi g h- r es o l uti o n r a di o c hr om i c f o i l do s i me t r y . R a d i a t P ro te c t D o s im 1 9 93 ; 4 7 :3 67 37 2 . 7 0 . A A P M . R a d i o c h r om i c f i l m d o si m et r y : r e c o m me nd a ti o ns o f A A P M R a d i a t io n T h e r a p y C o m m i tt ee T a s k G r o u p 5 5 . M e d P hy s 1 9 9 8 ;2 5 :2 0 93 2 1 15.

1

E l e c t ro n f l u e n c e at P w i t h t h e c a v it y f i ll e d w i t h w a ll m at e ri a l i s p r op o rt io na l to

w a l l a t P . W it h t h e a i r c a v i t y i n p la c e , t he el e c tr o n f l ue nc e at P i s p r o po rt io na l to t h e m e a n p ho to n e n e rg y f l u e n c e a t t he s ur f a c e o f t he c a v i t y , w hic h c a n b e t a k e n a s e q u a l t o a i r a t t h e c e n t e r o f t he c a v it y .
2

T h e T G - 2 1 p r ot o co l us e s

v a l u e o f 3 3 . 7 J / C w h ic h a s s u m e s a d r y a i r v a l ue o f 3 3 . 85 J / C a nd c o r r e ct s it f o r 5 0 % re l at i v e h u m i di ty ( 2 3 ) . In o ur d e r i v at io n w e w i l l a s s ume a d r y a i r v a l ue o f 3 3 . 9 7 J / C a n d n o h u m i d it y c o r r e ct io n, a s d is c us s e d e a r li e r i n r el at io n t o E q ua t io n 8.37.
3

A l t h o u g h t h e A A P M pr o to c ol r e co m me nd s ca l i b r ati o n i n t e r m s o f d o se to w a te r , D w a t e r to D m u s c l e a t t he ti m e o f

m a n y c o n s i d e r it m or e c o n v e n i e nt t o conv e r t

c a l i b ra ti o n a n d s e t t he a c c e l er a to r i n t e r m s o f d o s e to m us c l e pe r m o ni to r uni t .
4

R e f e r e n c e d m a x i s t h e f i x e d d m a x u s e d f o r nor m a l i z i ng p e r ce nt de pt h d o s e a nd T M R T L D - 10 0 ( H a r s h a w C h e m i c al C o . ) c o nt a i ns 7. 5 % L i a nd 92 . 5 % 7 Li.

d a t a f o r a ll f i el d s i z e s ( s e e C h a p t e r 1 0) .
5 6 6

T h e e x p r e s s io n H - D i s d e ri v e d f r o m t he na m e s o f H ur t e r a nd D r i f f i el d , w ho i n

1 8 90 u s e d s u c h c u r v e s t o c h a r a c t e ri z e t he re s p o ns e o f p ho to g r a phi c f i l m t o l ig ht .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Therapy > 9 - Dose D istribution and Scatter Analysis

9 Dose Distribution and Scatter Analysis

It i s se ld o m po s s i bl e to m ea s u r e do s e di s t rib ut io n d i re c tl y i n p a tie nt s tr e at e d w i t h r a d i at io n . Data on dose di s t ri b uti o n are a l m o st e nt i re l y d e ri v e d f r om m e a s u r e m e n t s i n p h a n t o m s ti s s ue e q ui v a le nt m at e ri a l s , us ua ll y l a r ge e no ug h in v o l u m e t o pr o v id e f u l l- s c a t te r c o ndi ti o ns f o r t he gi v e n b e a m . T he se b a s i c d a t a a re u s e d i n a d o s e c a l c u l at io n s y s t e m d e v i se d to p r e di c t do s e di s t ri but i o n i n a n a c t ua l p a t ie n t . T h i s c h a p te r d e a l s wi t h v a r io us q ua nt i ti e s a nd co nc e pt s t ha t a r e us e f ul f o r t h i s p u r p o se .

9.1. PHANTOMS
B a s i c d o s e d i st r ib u t ion d a t a a r e us ua l l y m e a s ur e d i n a w a te r p ha nt o m , w hi c h c l o s el y a p p ro x i m at e s t h e r a di a ti o n a b so r pt io n a nd s c a t te r i ng p r op e r ti e s o f m us c le a n d o t h e r so f t ti s s u es . A n o t h e r r e a s o n f or t he c ho i ce o f w a t er a s a p ha nt o m m a t e ri a l i s t h at i t i s un i v e r s a l l y a v a i l ab le w i t h r e p r od uc i bl e r a d ia tio n p r o pe r ti e s . A water phantom, h ow e v e r , poses s om e p r a c t i c al p r ob le m s w he n us e d in c o n j u n c t i o n w it h i o n c h a m b e r s a nd o t he r d e te c to r s t ha t a re a ff e c t e d b y w at e r , u n l e s s t h e y a r e d e s ign e d t o be w a t e r p roo f . In m o s t c a s e s , ho w ev e r , t he d e te c to r i s e n c a s ed i n a t h i n p l a s ti c ( w at e r e q ui v ale nt ) sl e e v e be f o r e i mm e r s io n i nto t he water phantom. S i n c e i t i s n ot a l w a ys p o s s ib le to p ut r ad i a ti o n de te c to r s i n w a t e r , s ol i d d r y p h a n t o m s h a v e b e e n d e v el op e d a s s ub st it ut e s fo r w a te r . Id ea l l y , f o r a gi v e n m a t e ri a l to b e ti s s u e o r w a t e r e q ui v al e nt , it m us t ha v e t he s a m e e f f e c t i v e a to m ic n u m b e r , n u m b e r o f e l e c tr o n s p e r g r a m , and m a s s d e ns i t y . H o w e v e r , s i nc e t he C o m p to n e f f e c t i s t he m o s t p re do m i na nt m o d e o f i nt e r a ct io n f o r m e g a v ol t ag e p h o to n b e a m s i n t h e cl i n i c al r a n g e , t he ne ce s s a r y c o nd it io n f o r w a t e r eq ui v a l e nce f o r s u c h b e a m s i s th e s a m e el e ct ro n d ens i t y ( num b e r o f e lec t r o ns pe r c ubi c c e n t i me te r ) a s t h a t o f w a t e r . T h e e l e ct r o n d e n s it y ( e ) o f a m at e ri a l m ay b e c a l c ul at ed f r o m i t s m a s s d e ns it y ( m ) a n d i t s a to m i c co m po s it io n a c c o r di ng t o t he f o rm ul a :

where

N A i s A v o g a d r o ' s n u m b e r a n d a i i s t he f r a c t io n b y w e i g ht o f t he i t h e l e me nt o f a t o mi c n um b e r Z i a nd a to m i c we i g ht A i . E l e c t ro n d e ns it ie s o f v a r i o us hum a n tissues and b od y fluids have been c a l c ul a t ed a c c o r di ng to E q ua t io n 9.1 by

WWW.MEDRAD.IR

S h r i m p to n ( 1 ) . V a l u e s f o r s o m e t is s ue s o f d o s im e tr i c i nte r e st a re l i st e d i n T a b l e 5.1. T a b l e 9 . 1 g i v e s t h e p r o pe r ti e s o f v a r io us p ha nt o m s t ha t ha v e b e e n f re q ue ntl y u s e d f o r r a di at io n d os i m et r y . O f t he c omm e r c i al l y a v a il a bl e pha nt o m m a te r i al s , L u c i t e a n d p ol y s t y r e ne a r e m o st f re q ue ntl y us e d a s d o si m et r y p hant o m s . A lt ho ug h t h e m a s s de n s i t y o f th e s e m a te r i al s m a y va r y d e p e ndi ng o n a gi v e n s a m p le , t he a t o mi c c o m po s it io n a n d t h e n u m b e r o f e l e c t r o ns p e r g r a m o f t he s e m a t er i al s a r e s u f f i c i e n t l y co n s t a n t t o w a r r a n t t he i r us e f o r hig h- e ne r g y p hot o n a nd el e c tr o n d o s im e tr y .

TABLE 9.1. PHYSICAL PROPERTIES OF VARIOUS PHANTOM MATERIALS

M a ss Chemical Material C om p os i t i on D e n si t y ( g/ c m 3 )

N u m be r (1023)

of Zeffa ( P h ot oe l e c t r i c )

E l e c t r on s/ g

Water

H2O

3.34

7.42

Polystyrene

(C8H8)n

1 0 3 1.05

3.24

5.69

P l e x i gl a s (Perspex, Lucite)

(C5O2H8)n

1.16 1.20

3.24

6.48

P o l y et h y l e n e

(CH2)n

0.92

3.44

6.16

Paraffin

CnH2n+2

0.87 0.91

3.44

5.42

Mix D

Paraffin: 60.8 P o l y et h y l e n e : 30.4

MgO: TiO2: 2.4

6.4

0.99

3.41

7.05

M 3

Paraffin: 100 MgO: 2 9 . 06

1.06

3.34

7.35

WWW.MEDRAD.IR

CaCO3: 0.94

S o l id w a t e r b

Expoxy resinbased mixture

1.00

3.34

a b

Zeff A v a il a b le

fo r f ro m

p h ot o el e ct r ic R ad i a ti o n

e f f e ct

is

given Inc .

by

Eq.

6.4.

Me a s ur e m e nts ,

( M i d d l eto n,

W i s c o ns i n) .

D a t a a re f r om T u b i a na M , D u t r ei x J , D ute r ix A , J o c k y P . Ba s e s phy s i q ue s de l a r a di ot h e r a pi e e t d e l a r a di ob io lo g ie . P a r i s : M a s s o n E T C ie , d i te ur s , 1 9 63 : 4 58 ; a n d S c h u l z R J , N a t h R . O n t he c o ns t a nc y i n c o m p o s it io n i n p o l y st y r e n e a n d p ol y m e t h y l m et ha c r y l a te p la s t i c s . M e d P hy s 1 9 7 9; 6 : 1 53 .

P.160

In

a d d i t io n

to

the

h o m o ge n e o us

p ha nt om s ,

a nt hr o p o mo r p hi c

p ha nt o m s

a re

f r e q u e n t l y u s e d f o r c li n i c a l do s i me t r y . O ne s uc h c o m m e r c i a ll y a v a i l a bl e s y s t em , k n o w n a s A l d e r s o n Ra n d o P h a n t o m , 1 i nc o rp o r at e s m at e ri a l s to s i m ul a te v a r io us b o d y ti s s u e s m u s c le , b o n e , l u n g , a nd a i r c a v i t ie s . T he p ha nt o m i s s ha p e d i nto a h u m a n t o r s o ( F ig . 9 .1 ) a n d i s se c ti o ned tr a ns v e r s e l y i nto s li c es f o r d o si m et ri c a p p li c a ti o n s . W h i t e e t a l . ( 2 ) h a v e de v e lo pe d e x t e nsi v e r e ci pe s f o r ti s s ue s ub s t it ut e s . T he m e t h od i s b a se d o n ad d i n g p a r ti c ul at e fi ll er s t o ep o x y r e si ns to f o r m a m i x t ur e w i t h r a d i a tio n p r o pe rt i e s cl o se l y a p p ro x i ma t i ng t ha t o f a p a r t i cul a r t i s s ue . T he m o s t im po r t a n t r ad i at io n p r o pe r ti e s i n t hi s r e g a rd a r e t he ma s s a t t e nua ti o n c o e f f i c ie n t , t h e m a s s e n e r g y a b so r pt io n c oe f f i c i e nt , e le c t ro n m as s s t op pi ng , a nd a n g u l a r s c a tt e ri n g pow e r r a ti o s . A d e ta il ed t ab ul a ti o n o f ti s s ue s ub s t it ut e s a nd their p ro pe r ti e s f or all the b od y t i s s ue s is i nc l ude d in a r e p o rt by t he In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s ( 3) . B a s e d o n t h e p r e v i o us m e t h o d , C o ns t a nti no u e t a l . ( 4 ) d e s ig ned a n e p o x y r e s i nb a s e d so li d s u b s ti t ut e f o r w a t e r , c a ll e d so lid w a t e r . T hi s m a te r i al c o ul d b e us ed as a d o s i m et ri c c a l ib r a t io n p h a nt o m for p ho t o n a nd e le c t ron beams in t he r a d i at io n t h e r a p y e n e r g y r a n g e . S ol id wa t e r p ha nto m s a re no w c o m me r c i al l y a v a i l a bl e f r o m R a di a tio n M e a s u r e m e nt s , Inc . ( M i d d le to n, W I) .

9.2. DEPTH DOSE DISTRIBUTION

A s t h e b e a m i s i n ci d en t o n a p a ti e nt (o r a p ha nt o m ) , t he ab s o rb e d do s e i n t he p a t ie n t v a ri e s wi t h d e pt h . T h i s v a r i at io n d e pe nd s o n m a ny co nd it io ns : b e am e n e r g y , d e pt h , f i e l d s i z e , d i s t a n c e f r om s o ur c e , a nd b e a m c o lli m a ti o n s y s t e m . T h u s t h e c a l c u l a t i o n o f d o s e i n t he p at ie nt i nv o l v e s c o nsi d e r at io ns i n r e g a r d to t h e s e p a r a me te r s a n d o t h e r s a s t he y a f f e c t d e pt h d o s e di s t ri b ution.

WWW.MEDRAD.IR

A n e s s e n t i al s te p i n t h e do s e c al c ul a tion s y s t e m i s t o e s t ab l i s h de pt h d o se v a r i a t io n a l o n g t h e c e n t r a l a x i s o f t he b ea m . A num b e r o f q ua nt i ti e s ha v e b ee n defined for this P.161 p u r p o s e , m a jo r a mo n g t h e s e be i ng pe r c e nt a g e d e pt h d o se ( 5 ) , t i s s ue - a ir r a ti o s ( 6 , 7 , 8 , 9 ) , t i s s u e -p h a n t o m r at io s (1 0 , 1 1 , 12 ) , a nd t i s s ue -m a x i m um r a ti os ( 1 2 , 1 3 ) . T h e s e q u a n t it i e s a re u s ua l l y d e ri v e d f r o m m e a s ure m e nts m a d e i n w a t er p h a n t o m s u s i n g s m a ll i o n i z at io n c ha m b e r s. A l t ho ug h o t he r do si m et r y s y s t e m s s u c h a s T L D , d i o d e s , a n d f i l m a r e o c c a si o na l l y us e d , i o n c ha m b er s a r e p r e f e r re d b e c a u s e o f t h ei r b et ter p r e c i si o n a nd s m a l ler e ne r g y d e pe nd e nc e .

F I G . 9 . 1 . A n a n t h r op o mo r p h i c p ha nt o m ( A l d e r so n R a nd o P ha nt o m ) se c ti o ned t r a n s v e r s e l y f o r do s i me t ri c s t u d ie s .

9.3. PERCENTAGE DEPTH DOSE

O n e w a y o f c h a r a c t e riz i n g t h e c e nt r a l a xi s d o s e d i st r ib ut io n i s to no r m a li z e do s e a t d e pt h w i t h r e s p e ct t o d o se a t a r e f e r e nc e d e pt h. T he q ua nt i t y p e r c e nt a ge ( o r s i m p l y p er c e n t ) d ep th d o s e m a y b e d e f ine d a s t he q uo t ie nt , e x p r e s s e d a s a p e r c e n t ag e , o f t h e a bs o r b ed do s e a t a ny de p t h d to t he ab s o rb ed do s e at a f i x e d r e f e r e n c e d ep t h d 0 , a l o n g t h e c e nt r al a x i s o f t he b e a m ( F i g . 9. 2 ) . P e r c e nt a g e d e pt h d o s e ( P ) i s t h u s:

WWW.MEDRAD.IR

F o r o r t h o vo lt a g e ( u p t o a b o ut 40 0 k V p ) a nd lo w e r - e ner g y x - r a ys , t he re f e r e nc e d e pt h i s u s u a l l y t h e su r f a c e ( d 0 = 0 ) . Fo r hi g he r e ne r gi e s , t he ref e r e nc e de pt h i s t a k e n a t t h e p o si tio n o f t h e p e a k a b so r be d d o s e ( d 0 = d m ) .

F I G . 9 . 2 . P e r ce n t a g e d e pt h do s e i s ( D d / D d ) 1 00 , w he r e d i s a ny d e pt h a nd d 0 i s
0

r e f e r e n c e de p t h o f m ax i m u m d o s e . P.162

In c l i n i c a l p r a c ti c e , th e p e a k a b s o r be d dos e o n t he c e nt r al a x i s i s s o me ti m es c a l l ed t h e m a x im u m do s e , t h e do s e m a x i m um , t he g i v e n d o se , or s i m pl y t he D m a x . Thus,

A n u m b e r o f p a r a m e te r s a f f e c t t he c e nt r al a x i s d e p t h do s e di st r i b ut io n. T he s e i n c l u d e be a m q u a li t y o r e n e r g y , de pt h, f i e l d si z e a nd s ha p e , so ur c e to s ur f a c e d i s t a n c e , a n d b e a m c o ll i m at io n . A d i s c us s i o n o f t he s e p a r a met e r s w i ll no w b e p r e s e n te d .

A. Dependence on Beam Quality and Depth

T h e p e r c e n t a ge d e pt h d o s e ( b e y o nd t he d ep t h o f m a x i m um d o s e) i nc r e a s e s w i t h b e a m e n e r g y . H i g h e r- e n e r g y b e a m s ha v e g r e a te r p e net r a ti ng p o w e r a nd t hus d e li v e r a h i g h e r p e r cen t a g e d ep t h d o se ( F i g. 9 . 3 ) . If t he e f f e c t s of i nv e r s e s q ua r e l a w a n d s c a t te r i n g a re n o t co n s i de r e d , t he p e r c e nt ag e d e pt h- d os e v a r i a ti o n w it h d e pt h i s g o v er n e d ap p r o xi m a te l y b y e x po ne nt i al at te nua t i o n. T hus t he b ea m q u a l it y a f f e c t s t h e p er c e n t a g e de pt h d o s e b y v i r t ue o f t he a v e r a g e a t te nua t io n c o e f f i c ie n t

WWW.MEDRAD.IR

.2 As the

d e c r e a se s ,

the

m o re

p e n e t r at i ng

t he

bea m

b e c o me s ,

r e s ul ting

in

hi g he r

p e r c e n t ag e de pt h d o se a t a n y g i v e n d e p t h b e y o nd t he b uil d - up re g io n.

A.1. Initial Dose Build-Up

A s s e e n i n F ig . 9 . 3 , th e p e r c e nt a g e d ep t h d o s e d e c re a s e s w it h d e pt h b e y o nd t he d e pt h o f m a x i m u m d o s e . H o w e v e r , t he r e i s a n i ni t i a l b uil d up o f d o s e w hi c h b e c o me s m o re a n d mo r e p ro n o u nc e d a s t he e ne r g y i s i nc r e a s e d. In t he c a s e o f t h e o r t h o vo lt a g e o r l ow e r - e n e r g y x - r a y s , t h e d o s e b uil d s up t o a m a x i m um o n o r v e r y c l o s e t o t h e s u r f a c e . B u t f o r hi g he r - e ne r g y b e a m s , t he po i nt o f m a x i m um d o s e l i e s de ep e r i n to t h e t i s s u e o r p ha nt o m. T he r e g i o n b et w e e n t he s ur f a c e a nd t h e p oi n t o f m a x i m u m d o s e i s c al l ed t he do se b ui l d - up re gi o n . The dose b u il d - u p ef f e c t of the hi g he r -e ne r g y beams gives rise to w ha t is c l i n i c al l y k n o w n a s t h e s k i n - s p a r i ng e f f e ct . F o r m eg a v o lt a ge b e a m s s uc h a s

c o b a lt - 60 a n d h ig h e r e n e r g ie s t he s ur f a c e d o s e i s m uc h s m a ll er t ha n t he D m a x . T h i s o f f e r s a d i st i n ct a d v a n t a g e o v e r t he lo w e r - e ne rg y b e am s fo r w hi c h t he D m a x o c c u r s a t t h e s k i n s u r f a c e . T h u s , i n t he c a s e P.163 o f t h e h i g h e r e n e r g y p h o to n b e a m s , hi g he r d o s e s c a n b e d el i v e re d t o de ep - s e at ed t u m o r s w it h o u t e x c e ed i n g t h e to le r a nc e o f t he s k i n. T hi s , o f c our s e , i s po s s i ble b e c a u s e o f bo t h t h e h ig h e r p e r ce nt d ep t h dos e a t t he t um o r a nd the l o w e r s ur f a c e d o s e at t h e s k i n . T h i s t o pi c i s di s c us s e d i n gr e a t er d et a il i n C ha p t e r 1 3 .

F I G . 9 . 3 . C e n t r a l a x i s d e p t h do s e di s tr i b ut io n f o r d i f f e r e nt q ua l ity p ho t o n b e am s . F i e ld s i z e , 1 0 1 0 cm ; S S D = 1 0 0 c m f o r a l l b e a m s e x ce p t f o r 3 . 0 m m C u H V L , S S D = 5 0 c m . ( D a t a fr o m H o s pi t al P hy s i c i sts A s s o c i a ti o n. C e nt r al a x i s d e pt h d o se d a t a f o r u s e i n r a d io th e r a p y . B r J R a d i o l 1 97 8 ; [ s up pl 1 1 ] ; a nd t he A p p e nd i x . )

WWW.MEDRAD.IR

T h e p h y s i c s o f d o s e b u i l d u p m a y b e e x p l ai ne d a s f o l lo w s : ( a ) A s t he hi g h- e ne r g y p h o to n b e a m e n te r s th e p a t ie n t o r t he p ha nt o m , hi g h- s p ee d el e ct r o ns a r e ej e c ted f r o m t h e s u r f a c e a n d t h e s u b s e q ue nt l a y er s ; ( b ) T he s e e l e ct rons d e p o si t t hei r e n e r g y a s i g n i f i c a n t d i s t a n c e a w a y f r o m the i r s i te o f o ri g i n; ( c) Be c a us e o f ( a ) a n d ( b ) , t h e el e ct r o n f l u e n c e a n d he nc e the a b s o r be d d o s e i ncr e a s e w it h d e pt h u n t i l t h e y r e a c h a m a x i m u m . H o w e v e r , t he p ho to n e ne r g y f l ue nc e c o nt i nuo us l y d e c r e a se s w i t h d e pt h a n d , a s a r e s ul t , t he p r o d uc tio n o f e le c tr o ns a l s o d e c r ea s e s w i t h d e pt h . T h e n e t e f f e c t i s t h a t b e yo nd a c e r t a i n de pt h t he d o s e e v e nt ua l l y b e gi n s t o d ec r e a s e w ith d e p t h . It m a y b e i n s t r u ct i v e t o e x pl a i n t he b ui l dup p he no m e no n i n t er m s o f ab s o rb ed dose and a q u a n ti t y known as kerma (from k i net i c e ne r g y r e l e a se d in t he m e d i u m ) . A s d i s c u s se d i n C h a p t e r 8 , t he k e r m a ( K ) m a y b e d e f i ne d a s t he q u o ti e n t o f d E t r b y dm , w h e r e d E t r i s t he sum o f t he i ni ti a l k i neti c e ne r gi e s o f a l l the charged i o ni z i n g p a r t i cl e s ( el e ct r ons ) l i b e r at e d by unc ha r g e d i o ni z i ng p a r t i cl e s ( p ho to n s ) i n a m a t e r i al o f m a s s d m ( 1 4 ) .

Because

kerma

re p re s e n t s

the

e ne r g y

tr a ns f e r r e d

f ro m

p hot o ns

to

di r e ct l y

i o n i z i n g el e ct r o n s , t he k e r m a i s m a x i m um a t t he s ur f a c e a nd d e c r e a s e s w it h d e pt h b e c a u s e o f t he d e c re a s e i n t he pho t o n e ner g y f l ue nc e ( F i g . 9 .4 ) . T he a b s o r be d d o s e , o n t he ot h e r h a nd , f i r s t i nc r e a s e s w it h d e pt h as t he hi g h- s pe e d e l e ct r o n s e j e ct ed a t v a r i o u s d ep t hs t r a ve l d o w ns t r e a m . A s a res ul t , t he re i s a n e l e ct r o ni c b u i l d - u p w it h d e p t h . H o w e v e r , a s t he d o s e d ep e nd s o n t he e l e ct r o n f l u e n c e , i t r e a c h e s a m a x i m u m a t a d e pth a p p r o x i m at el y e q ual t o t he r a ng e o f e l e ct r o n s in the m ed i u m . B e y o nd t hi s de p t h, t he do s e d e cre a s e s as kerma c o n t i n u e s to d e c re a s e, r e s u l t i n g i n a d e cr ea s e i n s e c o nd a r y el e ct r o n p ro d uc ti o n a n d h e n c e a n e t d e cr e a s e i n e le c t ro n f l ue nc e . A s s e e n i n F i g. 9 . 4 , t he k er m a c u r v e i s i n it i al l y h i g h er t h a n t h e d os e c ur v e b ut f a l l s b el o w t he d os e c ur v e b e y o nd t h e b u il d - u p r e gi o n . Th i s e f f e c t i s e x p l ai ne d b y t he f a c t t ha t t he a r e a s und e r t he t w o c u r v e s t a k e n t o i nf i n i t y m u s t b e t he s am e .

WWW.MEDRAD.IR

F I G . 9 . 4 . S c h e m a t i c pl ot o f a b s o rb e d do s e and k e r m a a s f u nc t i o ns o f d e p t h. P.164

B. Effect of Field Size and Shape

F i e ld s i z e m a y be s pec i f i e d e it h e r ge o me t ric a l l y o r d o si m et r i c al l y. T he g e o me t ri c a l f i e l d s i z e i s de f i n e d a s t h e p ro je c ti o n, o n a p l a ne p e rp e nd i c ul a r t o t he b e a m a x i s , o f t h e d i st a l e n d o f th e c o l li m a to r a s s e e n f r o m t he f r o nt c e nt er o f t he s o ur c e ( 1 5 ) . T h i s d e f i n i ti o n u s u a l l y c o r r e s po nd s to t he f i e ld d e f i ne d b y t he l i g ht lo c al i z e r , a r r a n g e d a s i f a p oin t s o u r c e o f l i g ht w er e lo c a te d a t t he c ent e r o f t he f ro nt s u r f a c e o f t h e r a d i a tio n s o u r c e . T he d o s i me t ri c , o r t he p hy s i c al , f i e l d si z e i s t he d i s t a n c e i n te r c e pt ed b y a g i v e n i so do s e c ur v e ( us ua l l y 5 0 % i sod o s e ) o n a pl a ne p e r pe n d i c u l a r t o t h e be a m a x i s a t a s t a te d di s t a nc e f r o m t he s o ur ce . U n l e s s s t at ed ot h e r w is e , t h e t e r m fi el d si z e i n t hi s bo o k w il l de no te g eo me t ri c f i e l d s i z e . In a d d it io n, t h e f ie ld si z e w il l be de f i ne d a t a p re d ete r m i ne d di s t a nc e s u c h a s t h e s o u r ce - s u r f a c e d i st a n c e ( S S D ) o r t he s o ur ce - a x i s d i st a nc e ( S A D ) . T he l a tt e r t e r m i s t h e di st a n c e f r o m t he so ur ce t o a xi s o f g a nt r y ro t at io n k no w n a s t h e i s o ce n t e r . F o r a s u f f i c i e n tl y s m al l f ie ld o n e m a y a s s um e t ha t t he de pt h d os e a t a p oi nt i s e f f e c t i v el y t h e r e s u lt o f t h e p ri m a r y r a di at io n, t ha t i s , t he p hot o ns w hi c h ha v e t r a v e r s ed the o v e r l yin g medium w it ho ut i nt e r a ct i ng . T he c o ntr i b uti o n o f t he s c a t te r e d p h o to n s to t h e d ep t h do s e i n t his c a s e i s ne gl ig ib l y sm a l l o r 0 . But a s t h e f i e ld s i z e i s i n c r e a s e d , t h e c o nt ri b utio n o f t he s c a t t e re d r a d i at io n t o t he a b s o r be d do s e i n c r e as e s . B e c a u s e t hi s i nc r e a s e i n s c a t te r ed d os e i s g r e at e r at

WWW.MEDRAD.IR

l a r g e r de p t h s t h a n a t t h e d e pt h o f D m a x , the p e r ce nt d e pt h do se i nc r e a se s w it h i n c r e a s i n g f i el d si z e . T h e i n c r e a s e i n pe r c en t d ep t h do s e c a us e d b y i nc r e a se i n f i el d s i z e de p e nd s on b e a m q u al it y . S i n c e t h e s c a tt e ri ng p ro b ab i li t y o r c ro s s - s e ct ion d e c r e a s e s w i t h e n e r g y i n c r e a s e a n d th e h i g h e r - e ne r g y p hoto ns a r e s c a t te r e d mo re p r e do m i na ntl y i n t h e f o r w a r d d i re c tio n , t h e f i e l d si z e d epe nd e nc e o f p e r ce nt de p t h do s e i s le s s p r o n o u n c e d f o r t h e h ig h e r - e n e r g y t ha n f o r the l o w e r - e ne rg y b e a ms . P e r c e n t d e pt h do s e da t a f o r r a di a ti o n t he ra p y b e a m s a r e us ua l ly t a b ul at ed f or square f i el d s . Si n c e the to m aj o ri t y of t he fi e ld t re a t me nt s s ha p e s is e nc o unt e r ed r e q uir e d. in c l i ni c a l p r a c t i ce r eq u i r e r e ct an g u l a r a n d i r r e g ul ar l y s ha p e d ( b lo c k e d ) f ie ld s , a s y s t e m o f equating square fi e ld s di f f e r e nt S e m i e mp i ri c al m e t h od s h a v e b e e n de v e lo p ed t o re l at e c ent r a l a x i s d e pt h d o se d a t a f o r s q ua r e , r e c t a n g u l a r , c i r c u l a r , a n d i r r e g ul a r l y s ha p e d f i el d s . A l t ho ug h g e ne r a l me t hod s (based on C l a r k s o n 's p r i n c ip le to be di s c us s e d l a te r in t hi s c ha p te r ) a re a v a i l a bl e , s i m pl e r me t h o d s h a v e b ee n d e v e lo p ed s p e ci f i c a ll y f o r i nt e r r el a ti ng s q u a r e , r e c t a n g u l a r , an d c i r c u l a r f i e ld d a t a . Day (16) and o t h e rs ( 1 7 , 18 ) ha v e s how n t ha t , for ce nt r al axis de pt h- d o se d i s t ri b u tio n , a r e ct a n g u l a r f ie l d m a y be app r o x i m at ed b y a n e q ui v a l e nt s q ua r e o r b y a n e q u i v a l e n t c i r cle . P.165 D a t a f or eq u i v a l e n t sq u a r e s , t a k e n f ro m Ho s p it a l P hy s i c i s t s A s so c i at io n ( 5 ) a re g i v e n i n T a b le 9 .2 . A s a n e x a m pl e , co ns i de r a 10 2 0 - c m f i el d . F r o m T a bl e 9 . 2 , t h e eq u i v a le n t sq u a r e i s 1 3 . 0 13 . 0 c m . Thus t he p er c e nt d ep t h d o se d a t a f o r a 13 13 - c m f i el d (o b t ai n e d f ro m st a nda r d t a bl e s ) may be a p p li ed as an a p p r o xi m a ti o n to t h e g i v e n 1 0 2 0 - c m f i eld .

TABLE FIELDS

9.2.

EQUIVALENT

SQUARES

OF

RECTANGULAR

L o n g A xi s (c m )

1 0

1 2

1 4

1 6

1 8

2 0

2 2

2 4

2 6

2 8

3 0

2 .

WWW.MEDRAD.IR

2 . 7

4 . 0

3 . 1

4 . 8

6 . 0

3 . 4

5 . 4

6 . 9

8 . 0

1 0

3 . 6

5 . 8

7 . 5

8 . 9

1 0 . 0

1 2

3 . 7

6 . 1

8 . 0

9 . 6

1 0 . 9

1 2 . 0

1 4

3 . 8

6 . 3

8 . 4

1 0 . 1

1 1 . 6

1 2 . 9

1 4 . 0

1 6

3 . 9

6 . 5

8 . 6

1 0 . 5

1 2 . 2

1 3 . 7

1 4 . 9

1 6 . 0

1 8

4 . 0

6 . 6

8 . 9

1 0 . 8

1 2 . 7

1 4 . 3

1 5 . 7

1 6 . 9

1 8 . 0

WWW.MEDRAD.IR

2 0

4 . 0

6 . 7

9 . 0

1 1 . 1

1 3 . 0

1 4 . 7

1 6 . 3

1 7 . 7

1 8 . 9

2 0 . 0

2 2

4 . 0

6 . 8

9 . 1

1 1 . 3

1 3 . 3

1 5 . 1

1 6 . 8

1 8 . 3

1 9 . 7

2 0 . 9

2 2 . 0

2 4

4 . 1

6 . 8

9 . 2

1 1 . 5

1 3 . 5

1 5 . 4

1 7 . 2

1 8 . 8

2 0 . 3

2 1 . 7

2 2 . 9

2 4 . 0

2 6

4 . 1

6 . 9

9 . 3

1 1 . 6

1 3 . 7

1 5 . 7

1 7 . 5

1 9 . 2

2 0 . 9

2 2 . 4

2 3 . 7

2 4 . 9

2 6 . 0

2 8

4 . 1

6 . 9

9 . 4

1 1 . 7

1 3 . 8

1 5 . 9

1 7 . 8

1 9 . 6

2 1 . 3

2 2 . 9

2 4 . 4

2 5 . 7

2 7 . 0

2 8 . 0

3 0

4 . 1

6 . 9

9 . 4

1 1 . 7

1 3 . 9

1 6 . 0

1 8 . 0

1 9 . 9

2 1 . 7

2 3 . 3

2 4 . 9

2 6 . 4

2 7 . 7

2 9 . 0

3 0 . 0

F r o m H o sp it a l P h y s i c i st s ' A s s o ci a ti o n. C e nt ra l a x i s d ep t h d o se d ata f o r us e i n r a d io t h e r ap y . B r J R a d i ol 1 9 78 ; ( s up pl 1 1 ) , w i t h p e r mi s s io n.

A s i m pl e r u l e o f t h u m b m et h o d ha s be e n d e v el op e d b y St e rl i ng et al . ( 19 ) f o r e q u a t i n g r e ct a n g u l a r a n d s q u a r e f i el d s . A c co r d i ng to t hi s r ul e , a r e c t a ng ul a r fi e ld i s eq u i v a l e n t to a squ a r e f i el d i f t he y ha ve t he s a m e a re a / pe r im e t er ( A / P ) . F o r e x a m p le , t h e 1 0 2 0 - c m f i e l d h a s a n A / P o f 3 . 3 3 . T he s q ua r e f i e l d w hi c h ha s t he s a m e A / P i s 1 3 . 3 1 3. 3 c m , a v a l ue v e r y c l o s e to t ha t gi v e n i n T a b l e 9 .2 . T h e f o l lo w i n g f o r m u la s a r e u s e f ul f o r q uic k c a l c ul a t io n o f t he e q ui v a l e nt f i eld p a r a m et e r s : F o r re c t an g u l a r f i e l d s ,

WWW.MEDRAD.IR

w h e r e a i s f i e l d w id t h a n d b i s f i e l d l e ngt h. F o r s q ua r e f i el d s , s i nce a = b ,

w h e r e a i s t h e si d e o f t h e sq u a r e . F ro m E qua t i o ns 9 . 5 a nd 9 . 6 , it i s e v id e nt t hat t h e s i de o f a n e q u i v a le n t s q u a r e o f a r e ct ang ul a r f i e l d i s 4 A / P . F o r e x a m p l e , a 1 0 1 5 - c m f ie l d h a s a n A / P o f 3 . 0 . It s e q ui v a l e nt s q ua re i s 12 1 2 c m . T hi s a g r e e s c lo s el y w i t h t he v a l u e o f 1 1 . 9 gi v e n i n T a b l e 9 . 2 . A l t h o u g h t h e co n c e pt o f A / P i s n o t b a s ed o n s o und p hy s i c a l pr i nc ip l e s , i t i s w i de l y u s e d i n c l i n i c al p r a c tic e a n d h a s b e e n e x t end e d a s a f i e ld p a r a me t e r t o a pp l y to o t h e r q u a n t it ie s s u c h a s b a c k s c a tt e r f a c tor s , t i s s ue - ai r r at io s , a nd e v e n be a m o u t p u t i n a i r o r i n p h a n t o m . T h e r e a d e r ma y , ho w e v e r , b e c a ut i o ne d a g a i nst a n i n d i s c ri m i n a te u s e o f A / P . F o r e x a mp l e , the A / P p a r a m et e r , a s s uc h, d o e s not a p p l y to c i r c u l a r o r irr e g u l a rl y s ha p e d f i e lds , a l t ho ug h r a d i i o f e q ui v a l e nt c i r cl e s m a y b e o b ta i n e d b y t he r e l at io n s hi p :

E q u a t i o n 9 .7 c a n be de r i v e d b y a s s um i ng t ha t t he e q ui v al e nt ci r cle i s t he o ne t h at h a s t h e s a m e a r e a as t h e e q u i v al e nt s q uar e . V a l i di t y o f t hi s ap p r o xi m a ti o n ha s b e e n v e r i f ie d f r o m th e t a b le o f e q ui v a le nt c i r c le s g i v e n i n H os p i t al P hy s i c i s t s A s s o c i a tio n ( 5 ) . P.166

C. Dependence on Source-Surface Distance

P h o t o n f l u e n c e e mi tt ed b y a p oi n t s o ur c e o f r a d i a tio n v a r i e s i nv e rs e l y a s a s q ua r e o f t h e d i st a n c e f r o m t h e s o u r c e . A l t ho ug h t he c l i ni c al s o ur c e (i so to p ic s o ur c e o r focal s po t ) for e x t e rn a l beam t he r a p y ha s a f i ni te size, t he s o ur c e - s ur f a c e d i s t a n c e i s u s u a l l y c ho s e n to b e l a r ge ( 80 c m ) so t ha t t he sour c e d i me ns io ns b e c o me u n i m po r t a n t in r e l a ti o n to t he v a ria t io n o f p ho to n f l ue nc e w i t h di s t a nc e . In o t h e r w o r d s , t h e so u r c e c a n b e co ns i de re d a s a po i nt a t l a r ge s o ur c e - s ur f a c e d i s t a n c e s . T h u s t h e ex p o s u r e r at e o r do s e r a t e i n f r ee s p a ce (C ha p t e r 8 ) f r om s u c h a s o u r c e v a r i e s i n v e r s e l y a s t he s qua r e o f t he d i st a nc e . O f c o ur s e , t he i n v e r s e s q u a r e l a w d ep e n d e n c e o f d o se r a te a s s um e s t ha t w e a r e d e a li ng w i t h a p r i m a r y b e a m , w i t h o ut s c a t te r . In a g i v e n c l i ni c al s i t ua ti o n, ho w e v e r , c o l li m at io n o r o t h e r s c at te r i n g ma t e ri a l i n t he b e am m a y c a us e d e v i a t io n f r o m t he i nv e r s e square law. P e r c e n t d ep t h d o se in c r e a s e s w i t h S S D b e c a us e o f t he e f f e c t s o f t he i nv e r s e s q u a r e l a w . Al t h o u g h t h e a ct u a l d o se r at e a t a po i nt d e c re a s e s w i t h i nc r e a s e i n d i s t a n c e f r o m t h e s o u r c e , t h e p e r c e nt de p th d o s e , w hi c h i s a r e l a ti v e d o se w i t h r e s p e ct t o a re f e r e n c e p oi n t , i n c r e a s e s w i t h S S D . T hi s i s il l us t ra te d i n F i g . 9 . 5 i n w h i c h r e l a t i v e do s e ra t e f r o m a p oi nt s o urc e o f r a d i at io n i s p lo tt e d a s a f unc t i o n o f d i st a n c e f r o m t h e so u r c e , f o ll o wi ng t he inv e r s e s q ua r e l a w . T he p lo t s ho w s t ha t t h e d r op i n d o se r a te b e t w ee n t w o p oi nt s i s m uc h g r e a t e r at sm a l le r d i st a nc e s

WWW.MEDRAD.IR

f r o m t h e so u r c e t h a n a t l a rg e di s t a nc e s . T hi s m e a ns t ha t t he pe rc e nt d ep t h do s e , w h i c h r e p r e s e n t s d ep th d o s e r e l at i ve t o a re f e r e nc e po i nt , de c r ea s e s m o r e r ap i dl y n e a r t h e s o u r c e t h a n f a r a w a y f r o m t he s o ur c e . In c l i n i c a l r a d i at io n t h e r a p y , S S D i s a v e r y i m p o rt a nt p a r a me te r . Be c a us e p e r c e nt d e pt h do s e d et e r mi n es h o w m u c h d o se c a n b e d el i v e re d a t d ep th r e l at i v e to t he s u r f a c e d o s e o r D m a x , th e S S D n e e d s t o b e as l a r g e a s p o s si b le . H o w e v e r , b e c a us e d o s e r at e de c r e a se s w i t h d i st a n c e , t he S S D , i n p r a c t i ce , i s s et a t a d i s t a nc e w hi c h p r o v id e s a c o m p ro m is e b e t w ee n d o s e r a te a nd p e r c e nt d e pt h d o s e . F o r t he t r e at m e n t of de ep - se a t ed l e s io ns w it h m e g a v ol t ag e beams, t he mi ni m um r e c o m me n d e d S S D i s 8 0 c m . T a b l e s o f pe r c e n t d ept h d o se f o r c li ni c a l us e a r e us ua ll y m e a s ure d at a st a nd a r d S S D ( 8 0 o r 1 00 c m f or m e g a v o lt a ge uni t s ) . In a g i v e n c l i ni c a l si tua t i o n, ho w e v e r , t h e S S D s e t o n a p a t ie n t m a y b e d i f f e r e nt f r o m t he s t a nd a r d S S D . F o r e x a m p l e , l a r g e r S S D s a r e r e q u ir e d f o r t re a t me nt t e chni q ue s t ha t i nv o l v e fi e ld s i ze s l a rg er t h a n t h e o n e s a v a i l a ble a t P.167 t h e s t a n d a rd S S D s . Th u s t h e p e r c e nt de p th d o s e s fo r a st a nd ar d S S D m us t b e c o n v e r t ed to t h o se a p p li c a bl e to t he a ct ua l t re a t me nt SSD. A l t ho ug h m o re a c c u r a t e m et h o d s a r e a v a i l a bl e (t o b e d i s c us s e d l at e r i n t hi s c ha pt e r ) , w e d i s c us s a n a p p r o x i m at e me t ho d i n t h i s se c ti o n: t he M a y ne o r d F F a c to r (2 0 ) . T hi s m e t ho d i s b a s e d o n a s t r i ct a p p li c a ti o n o f t he i nv e r s e s q ua r e l a w , w i tho ut c o ns i de r i ng c h a n g e s i n s c a t t e ri n g , a s t h e S S D i s c ha ng e d .

WWW.MEDRAD.IR

F I G . 9 . 5 . P l o t o f r ela t i v e do s e r at e a s i nv e r s e s q ua r e l a w f unc t io n o f d i s ta nc e f r o m a p o i n t so u r c e . R e f e r e n c e di s t a nc e = 80 c m .

F I G . 9 . 6 . C h a n g e o f p e r c e n t de pt h d o s e w i t h S S D . Ir r a d i a t io n c o nd it io n ( a ) ha s S S D = f 1 a n d c o n d i t i on ( b ) h a s S S D = f 2 . F o r b ot h c o nd i ti o ns , f i e ld s i z e o n t he p h a n t o m s u r f a c e , r r , a n d d e p t h d a r e t he s a m e . F i g u r e 9 . 6 s h o w s t wo i r r a d i at io n c o nd iti o ns , w hi c h d i f f e r o nl y i n r e g a r d to S S D . L e t P ( d , r , f ) b e t h e p er c e n t de pt h do s e at de p t h d f o r S S D = f and a f i el d s i z e r ( e . g . , a s q u a re f ie l d o f di m e n s io ns r r ) . S i nc e t he v a r i at io n i n d o se w it h de pt h i s g o v e r n ed b y t h r e e e f f e c t s i n v e r s e s q ua r e l a w , e x p o ne nti a l a t t e nua ti o n, a nd s c a t te r i n g

w h e r e i s t h e l i n e a r a t t e n u a ti o n co e f f i ci e nt f o r t he p r i m a r y a nd K s i s a f unc t io n w h i c h a c c o u n t s f o r t h e c h a n g e i n s c a tt e re d d o s e . Ig no ri ng t he c ha ng e i n t he v a l ue o f K s f r o m o n e S S D to a n o t h e r ,

D i v i di n g E q u a t io n 9 . 9 b y 9 . 8 , w e ha v e :

T h e t e r m s o n t h e r i gh t - h a n d s i d e o f E q ua t io n 9 . 1 0 a r e c a ll e d t he M a y ne o r d F factor. Thus,

WWW.MEDRAD.IR

It c a n b e s h o w n t h a t t h e F f a c t o r i s g r e at er t ha n 1 f o r f 2 > f 1 a n d l e s s t ha n 1 f o r f 2 < f 1 . T h u s i t m a y b e r e st a te d t ha t t he pe r c e nt d ep t h d o se i nc r e a se s w it h increase in SSD.

Example 1
T h e p e r c e n t d e pt h d os e f o r a 1 5 15 f i el d s i z e , 1 0 - c m d e pt h, a nd 8 0 - c m S S D is 5 8 . 4 ( 6 0 C o be a m ) . F i nd t h e pe r c e nt d ep t h do s e f o r t he s a me f ie ld s i z e a nd d e pt h for a 100-cm SSD. F r o m E q u a t io n 9 . 1 1 , as s u m i n g d m = 0 . 5 c m f o r
60

Co rays:

P.168

F r o m E q u a t io n 9 . 1 0 ,

T h u s , t h e d e s i r e d p er ce n t d e pt h d o se i s :

M o r e a c c u r a t e me t hod s t h a t t a k e s c at te r ing c ha ng e i nt o a c c o unt w o ul d y i el d a v a l u e c l o s e t o 60 . 6 . T h e M a y n e o r d F f a c tor m e t h od w o r k s re a so na b l y w e ll f o r s m a ll f i e ld s s i nc e t he s c a t te r i n g i s m i n i ma l u n d e r t h e s e c o nd it io ns . H o w e v e r , t he m e t ho d c a n g i v e r i s e t o s ig n i f i c a n t e r ro r s u n d e r e x t r e me c o ndi ti ons s uc h a s l o w e r e ne r g y , l a r g e f i el d, l a r g e d e pt h , a n d l a r ge S S D c h a ng e . F o r ex a m p l e , t he e r ro r i n d o s e at a 20 - c m d e pt h f o r a 30 3 0 - cm f i e ld a n d 16 0 - c m SS D ( 6 0 C o be a m ) w il l be a b o ut 3 % i f t he p e r c e n t de pt h d o s e i s c a l c u l a te d f r o m t he 80 - c m S S D t a b le s . In g e n e r a l , t h e M a y n e o r d F f a c t o r o ve r e sti m a te s t he i nc r e a s e in p e r c e nt d e pt h dose with increase in SSD. For e x a m pl e, for l a rg e f ie ld s a nd lo w e r e ne rg y r a d i at io n w h e r e t h e p r o po r tio n o f s c at te re d r ad i at io n i s r el a tiv e l y g re a t er , t he f a c t o r ( 1 + F ) /2 a pp lie s m o re a c c ur a t el y . F a c t o r s i nt e rm e di a te be t w e e n F a nd (1 + F ) / 2 h a v e a l s o b e e n u s e d f o r c e r t a i n c o ndi ti o ns ( 2 0 ) .

9.4. TISSUE-AIR RATIO

T i s s u e - a i r r a ti o ( T A R ) w a s f i r s t i nt r o d uc e d b y J o hns e t a l . ( 6 ) i n 1 9 5 3 a nd w a s o r i gi n a ll y c a ll e d t h e t u m o r - a i r r at io . A t t ha t ti m e , t hi s q ua ntit y w a s i nt e nde d s p e c i f i ca ll y f o r ro t at io n t h e r a p y c al c ul a tions . In r o t a t io n t he r ap y , t he r a di a ti o n s o u r c e m o v e s i n a c i rc l e a r o u n d t he a x i s o f r o t a tio n w hi c h i s us u a l l y p l a ce d i n t he t u m o r . A lt h o u g h t h e S S D m a y v a r y d e p e nd i ng o n t he s ha p e o f t he s ur f a c e c o n t o u r , t h e s o u r c e - ax i s d i s t a n c e re m a i ns co ns t a nt . S i n c e t h e p e r c e nt de p t h d o se d ep e nd s o n t he S S D ( s e c t io n 9 . 3 C ) , t he S S D c o r r e ct io n to t h e p e rc e n t de pt h do s e wi ll ha v e t o b e a pp li e d to co r r e ct f o r t he v a r y i n g S S D a p r o c ed u r e t h a t be c o me s c um b e r so m e to a pp l y r out i ne l y i n c li ni c al

WWW.MEDRAD.IR

p r a c t i ce . A s im p le r qu a n t i t y n a m e l y , T A R ha s b e e n de f i ne d to r e m o v e t he S S D d e pe n d e n c e . S i n c e t he t i me o f i t s i nt r od uc t io n, t he c o nc e pt o f T A R ha s b e e n refined to f a c il it a te c a l c u l a ti o n s no t o nl y for r o t ati o n t he r ap y b ut also fo r s t a ti o n a r y i s o ce n t r i c te c h n i q u e s a s w e l l a s ir r e g ul a r f i el d s . T i s s u e - a i r r a ti o m a y b e d e f i n ed a s t he r a t io o f t he d o s e ( D d ) a t a g i v e n p o i nt i n t h e p h a n to m t o t h e do s e i n f r ee s p a ce ( D f s ) a t t he s am e p oi nt . T hi s i s i ll us t r at ed in Fig. 9.7. P.169 F o r a g i v e n q u a l it y b ea m , T A R d e p e nd s o n d e p t h d a nd f i el d s i z e r d a t t ha t de pt h:

F I G . 9 . 7 . Il l u s t r at io n o f t h e d e f i n it io n o f t i ss ue - a i r r a ti o . T A R ( d , r d ) = D d / D f s .

A. Effect of Distance
O n e o f t h e m o s t i mp or t a n t p r op e rt ie s a t tr i but e d to T A R i s t ha t i t i s i nd e p e nde nt o f t h e d i s t a n c e f r o m t h e s o u r c e . T hi s , h o w e v e r , i s a n a p p r o xi m a ti o n w hi c h i s u s u a l l y v a l i d to a n a c c u r a c y o f b e t te r t ha n 2 % o v e r t he r a ng e of d i s t a nc e s us ed c l i n i c al l y . T h i s u s e f u l r e s u l t c a n b e d ed uc e d a s f o l l o w s . B e c a u s e T A R i s t h e r a t io o f t h e t wo d o se s ( D d a nd D f s ) a t t he s a m e p oi nt , t he d i s t a n c e de pe n d e n c e o f t h e p h o to n f l ue nc e i s r e m o v e d . T hus t h e T A R r e p r e s e nts m o di f i c a ti o n o f t h e d os e a t a p o i nt o w i ng o nl y t o a t te nua t io n a nd s c a t te r i ng o f t he beam in the p h a n t om c o m p a r ed with the dose at t he s am e p oi nt in t he m i n i p h a n t om (o r eq u i li b r i u m p h a nt o m ) pl a ce d i n f r e e a i r . Si nc e the p r i m ar y b e am i s a tt e n u a t ed e x po n en t i a ll y w i t h d ep t h, t he T A R f o r t he p ri m a ry b e a m i s o nl y a f u n c t i o n o f d e p t h , n o t o f S S D . T h e c a s e o f t he s c a t t e r c o mp o ne nt , ho w e v e r , i s no t o b v io u s . N e v e r t h e le s s, J o h n s e t a l . ( 2 1 ) ha v e s ho w n t ha t t he f r a c t io na l s c a tt e r c o n t r ib u t io n t o t h e de p t h d o se i s a l mo s t ind e p e nd e nt o f t he d iv e r g e nc e o f t he

WWW.MEDRAD.IR

b e a m a n d de p e n d s o nl y o n t h e d e pt h a nd the f i el d si z e at t ha t de p t h. H e nc e t he t i s s u e - ai r r a ti o , w h i ch i n v o l v e s bo t h t he p r i m a r y a nd s c at t er c o m po ne nt o f t he d e pt h d o s e , i s i n d e pen d e n t o f t h e s o ur c e dis t a nc e .

B. Variation with Energy, Depth, and Field Size

T i s s u e - a i r r a ti o v a r ies w i t h e n e r g y , d e p t h, a nd f i e l d s i z e v e r y m uc h l i k e t he p e r c e n t d ep t h do s e . Fo r t h e me g a vo lt a g e be a m s , t he t i s s ue - ai r ra t io b uil d s up t o a m a x i m u m a t t h e d ep t h o f m a x i m um do s e ( d m ) a nd t he n d e c rea s e s w i t h d ep t h m o r e or l e s s e x po n e n t i al l y . F o r a na r r o w b e a m o r a 0 0 f i e ld s i z e 3 i n w hi c h s c a t te r c o n t r ib u t io n to the d o se is ne g le c te d , t he TAR b e y o nd dm v a r ie s a p p r o xi m a te l y e x po n en t i a ll y w i t h d e pt h

where

i s t h e a v e r a g e at te n u a t io n c o e f f i c ie nt o f t he b e a m f o r t he gi v e n p ha nt o m . A s t he f i e l d si z e i s i n c r e a sed , t h e s c a t t er e d co mp o ne nt o f t he do s e inc r e a s e s a nd t he v a r i a t io n o f T A R w i t h d e p t h b e co me s m o re c o m pl e x . H o w e v e r , f o r hi g h- e ne r g y m e g a v ol t ag e b e a m s , fo r w h i c h t h e s c a tt e r is m i ni m al a nd i s d i re ct e d m o re o r l e s s i n t h e f o r w a r d di r e ct io n , t h e T A R v a r i a t io n w i t h d e pt h c a n s t i ll b e a p p ro x i m at ed b y a n e x p o n e n ti a l f u n c t io n , p r o v id e d a n e f f e c t i ve a tt e nua t io n c oef f i c i e nt ( e f f ) f o r t h e g i v e n f i el d s i z e i s u s e d .

B.1. Backscatter Factor

T h e t e r m b a c k s c a tt e r f a c t o r ( B S F ) i s s i m ply t he t i s s ue - a ir r a ti o a t t he d ep t h o f m a x i m u m d o s e o n c e n t r a l a x i s o f t he b e a m . It m a y b e d e f i ne d a s t he r a t i o o f t he d o s e o n c e n t r al a x i s at t h e d ep t h o f m a xi mum d o s e t o t he d o se a t t he s am e p oi nt i n f r e e s p a c e . M a t h e ma t i c al l y ,

or

w h e r e r d i s t h e f i el d si z e a t t h e de p t h d m o f m a x i m um d o s e .
m

WWW.MEDRAD.IR

F I G . 9 . 8 . V a r i a ti o n of b a c k s c a t t er f a c t or s w i t h b e a m q ua li t y ( ha l f - v a l ue l a y e r ) . D a t a a r e f o r ci r c u l a r f i e l d s . (D a t a f ro m H os p i t al P hy s i c i st s A s so c i at io n. C e nt r a l a x i s d ep t h d o se d at a f o r u s e i n r a di ot he ra p y . Br J R a di ol 19 78 ; [ s up p l 1 1 ] ; a nd J o h n s H E , H u n t J W , F e d o r u k S O . S ur f a c e b a c k - s c a t te r i n t he 10 0 k V t o 40 0 k V r a n g e . B r J R a d i o l 19 54 ; 2 7 :4 4 3 . ) P.170

T h e b a c k s c a tt e r f a ct or , l i k e t h e ti s s ue - a ir r a t io , i s i nde pe nd e nt o f di s t a nc e f r om t h e s o u r c e a n d de pe n d s o n l y o n t he b e a m q ua l it y a nd f i e ld s i z e . F i g ur e 9 . 8 s ho w s b a c k s c a t te r layer f a c to r s 0 .6 fo r an d v a r io u s 0.8 mm q ua l it y C u, be a m s a nd on f ie l d f ie l d a r e as . s i ze. W he r e a s T hus , for BS F t he i n c r e a s e s wi t h f ie ld siz e , i t s m a x i m um v al ue o c c ur s fo r b e a m s hav i ng a ha l f - v a l ue b e t we e n de pe nd i ng o r t h o vo lt a g e be a m s wi t h u s u a l f il t ra ti o n, t he b a c k s c a tt e r f a c to r ca n b e a s hi g h a s 1 . 5 f o r l a rg e f i el d s i z es . T h i s a m o unt s to a 5 0 % i nc r e a se i n do s e ne a r t he s ur f a c e c o m p a re d w it h t h e dos e i n f r e e s p a ce o r , in t e r m s o f e x po s ur e , 5 0 % i nc r e a s e i n e x p o s u r e o n t h e s k i n c o m p a re d w i t h t he e xp o s ur e i n a i r . F o r me g a v ol t ag e b e am s ( 6 0 C o a n d hig he r ene r g i e s ) , t he b a c k s c a tt e r f a ct o r i s m uc h s m a l le r . F o r e x a m pl e , B S F f o r a 1 0 1 0 - cm f i el d fo r dose is the r e s u lt of r a d i at io n s c a tt e r re a c hi ng
60

C o i s 1 . 0 3 6 . T hi s m e a ns po i nt of Dmax f ro m t he

t h a t t h e D m a x w i ll b e 3 . 6 % h i g h e r t ha n t he d o s e i n f r e e s p a c e . T hi s i nc r e a s e i n t he o v e r l y i n g a n d u n d e rl y i n g ti s s u e s . A s t he bea m e ne r g y i s i nc r e a s ed , t he s c at te r i s f u r t h e r r e d u c ed a n d so i s t h e b a c k s c a tt e r f ac t o r . A bo v e ab o ut 8 MV , t he s c a tt e r at

WWW.MEDRAD.IR

t h e d e pt h o f D m a x b e com e s n e g li g ib l y s m a ll a nd t he b a c k s c a t t e r fa c t o r a pp r o a c he s i t s m i n im u m v a l u e o f u n i t y .

C. Relationship between TAR and Percent Depth Dose

T i s s u e - a i r r at io a n d pe r c e n t de pt h d o s e a re i nt e r r el at e d . T he r ela t io ns hi p c a n b e d e r i v ed a s f o ll o w s : Co n s i d er i n g F ig . 9 . 9 A , l e t T A R ( d , r d ) be t he ti s s ue - a i r r at io at p o i nt Q f o r a f i el d si ze r d a t d e pt h d . L e t r b e t he f ie l d s i z e at the s ur f a c e , f b e t h e S S D , a n d d m b e th e r e f e r e n c e d e pt h o f m a x i m um d o se a t p oi nt P . L et D f s ( P ) a n d D f s ( Q ) b e t h e do s e s i n f r e e s p a ce at po i nt s P a nd Q , re s p e ct i v el y ( F i g. 9 . 9 B , C ) . D f s ( P ) a n d D f s ( Q ) a r e r e l at e d b y i nve r s e s q ua r e l a w .

P.171

T h e f i e l d s i z e s r a n d r d a r e r el a te d b y :

B y d e f i n i t io n o f T A R ,

or

Since

a n d , b y d e f i n i t io n , t h e p e r c e n t de p t h do s e P ( d , r , f ) i s g i v e n b y :

w e h a v e , f r o m E q u a t i on s 9 . 1 9 , 9 . 2 0 , a nd 9 . 21 ,

F r o m E q u a t io n s 9 . 1 6 an d 9 . 2 2 ,

WWW.MEDRAD.IR

F I G . 9 . 9 . R e l at io n s h ip b e t w ee n T A R a nd p e r c e nt d e pt h d o se . ( S e e t e x t . )

C.1. Conversion of Percent Depth Dose from One SSD to Anotherthe TAR Method
In s e c t i o n 9 . 3 C , w e d i s c u s s e d a m et ho d of c o nv e r t i ng p e r ce nt d e pt h d o se f r om o n e S S D t o a no t h e r . T h a t m e t h od us e d t he M a y ne o r d F f a c to r w hi c h i s d e r i v ed s o l el y f r o m i n v e r s e sq u a r e l a w c o ns i d e ra tio ns . A m o r e a c c ur a t e m e t ho d i s b a se d o n t h e i n te r r el a ti o n s hi p be t w ee n p e r c e nt de p t h do s e a nd T A R . T hi s T A R m e t ho d c a n b e d e r i v ed f r o m E q u a t io n 9 . 2 3 a s f o ll o ws . S u p p o s e f 1 i s t he S S D f o r w h i c h t he p er c e nt d e pt h do s e i s k no w n and f 2 i s t he S S D f o r w h i c h t h e p e r c e nt d e pt h do s e i s t o b e d e te r m i ned . Le t r b e t he f i el d s i z e at the surface and P.172 d b e t h e d ep t h , f o r bo t h c a s e s . R e f e r r i ng to F i g . 9 . 6 , le t r d , f a nd r d , f be t he f i el d
1 2

s i z e s p r oj e c te d at d e pt h d i n F i g . 9 . 6 A , B, r e s p e c ti v e l y .

F r o m E q u a t io n 9 . 2 3 ,

and

F r o m E q u a t io n s 9 . 2 6 an d 9 . 2 7 , t h e c o nv e r s io n f a c t o r i s gi v e n b y :

WWW.MEDRAD.IR

T h e l a s t t e rm i n t h e b r a c k e t s i s t he M ay ne o r d f a c to r . T hus t he T A R m et ho d c o r r e ct s t h e M a y n e o rd F f a c to r b y t he r a ti o o f T A R s f o r t he f ie l d s p ro j e ct ed at d e pt h f o r t h e t w o S S Ds . B u r n s ( 2 2 ) h a s d e v elo p ed t he f ol lo w i ng e qua t i o n t o c o nv e r t p erc e nt de p t h d o se f r o m o n e S S D t o a n oth e r :

where F is the Mayneord F factor given by

E q u a t i o n 9 .2 9 i s b a sed o n t h e c o nc ep t t ha t T A R s a r e i nde p e nde nt o f t he so ur c e distance. Burns's equation may be us e d i n a s i t ua t i o n w he r e TARs are no t a v a i l a bl e b ut i n s te a d a p e r c e n t d ep t h do s e t a b le i s a v ai l a bl e at a s t a nd a r d S S D a l o n g w it h t h e b a c k s c a t t er f a c t o r s f o r v a r ious f i e l d s i z e s . A s m e n t i o n e d e ar li e r , f o r h i g h - e ne r g y x - r a y s , t ha t i s , a b o v e 8 M V , t he v a r i a t i o n o f p e r c e n t de pt h d o se w i t h f i e ld s i z e i s sm a l l a nd t he b a c k s c at t er i s ne g li gi bl e . E q u a t i o n s 9 . 28 a n d 9 . 2 9 t h e n s i m pl i f y to a us e o f M a y ne o r d F f a c t o r .

Practical Examples
In t h i s s e c ti o n , I w i ll p r e s e n t e x a m pl e s o f ty p i c a l t r e at m e nt c a l c ul a ti o ns us i ng t he c o n c e p t s o f pe r c e n t de p t h do s e , b a c k s c a t ter f a c t o r , a nd t i s s ue - air r a t io . A lt ho ug h a m o r e g e n e r al s y s t em o f d o si m et r ic c a l c ul a ti o ns w i ll be p re s e nt e d i n t he ne x t c h a p t e r , t h e se e x a m pl e s a r e p r e se nt e d here t o i ll us t r at e t he c onc e p t s p re s e nte d thus far.

Example 2
A p a t i e nt i s to b e t r ea t e d w it h a n o r t ho v olt a g e be a m ha v i ng a ha l f - v a l ue l a y e r o f 3 m m C u . S u p p o s i n g t h a t t h e m a c hi ne i s ca l i b r at ed i n t e r m s o f e x p o s ur e r at e i n a i r , f i n d t he ti m e r eq u i r e d to de li v e r 20 0 c G y ( r a d ) a t 5 c m d e pt h, g i v e n t he f o l lo w i n g d at a : e x p o su r e r a t e = 1 0 0 R / m i n a t 5 0 c m , f i e l d si z e = 8 8 c m , S S D = 5 0 c m , p e r c e n t d e pt h d o s e = 6 4 . 8 , b a c k s c a t t er f a c t o r = 1 . 2 0 , a nd r a d / R = 0 . 9 5 ( c h e c k t h e s e d a t a i n re f e r e n c e 5 ) .

WWW.MEDRAD.IR

P.173

Example 3
A p a ti e n t i s to b e t re a t ed w it h
60

Co r ad i at io n. S up p o si ng t ha t t he m a c hi ne i s

c a l i b ra t ed i n a i r i n t e r m s o f d o s e r a te f r e e s p a c e , f i nd t he t re a t m e nt t i me to d e li v e r 20 0 c G y ( r a d ) a t a d e pt h o f 8 c m , g iv e n t he f o l lo w i ng d at a: d o s e r at e f r e e s p a c e = 1 50 c G y / m i n a t 8 0 .5 c m f o r a fi eld s i z e o f 1 0 10 c m, S S D = 8 0 c m , p e r c e n t de pt h d o s e = 6 4 . 1 , a n d b a c k s c a t te r f a c t o r = 1 . 0 3 6 .

Example 4
D e te r m i n e t h e t i me re q u i r ed to de li v e r 200 c G y ( r a d ) w i t h a
60

C o r a y b e a m at

t h e i s o ce nt e r ( a p oi n t o f i n t e r s e cti o n o f t he c o l li m at o r a x i s a nd the g a nt r y a x i s o f r o t at io n ) w h i c h i s p l a c e d a t a 1 0 c m d e pt h i n a p a t i e nt , gi v e n t he f o l lo w i ng d at a : S A D = 8 0 c m , f i e l d s iz e = 6 1 2 c m ( a t t he i s o c e nte r ) , d o se r at e f r e e s p a ce a t t h e S A D f o r t h i s f i e ld = 1 2 0 c G y / m i n a nd T A R = 0 . 6 8 1 .

WWW.MEDRAD.IR

Since TAR = Dd/Dfs

F I G . 9 . 1 0 . C o n t o u r of p a t i e n t w it h r a d i i d ra w n f r o m t he i s o c e nte r o f r o t at io n a t 2 0 - de g r ee i n t e r v a l s . L e n g t h o f e a c h r a di us r e p re s e nt s a d ep t h fo r w hi c h T A R i s d e te r m i n ed f o r t h e f i el d s i z e a t t he i s o ce nt er . ( S e e T a b l e 9 . 3 . ) P.174

D. Calculation of Dose in Rotation Therapy

T h e c o n c e p t o f t i s s u e -a i r r a ti o s i s mo s t us e ful f o r c a l c ul a ti o ns i nvo l v i ng i s o c e nt r i c techniques of i r r ad ia t io n . R o t a ti o n or arc t he r a p y is a type of i s o ce nt ri c i r r a di a ti o n i n w h i c h t h e s o u r c e m o v e s co nt i nuo us l y a r o und t he a x i s o f r o t a ti o n. T h e c a l c u l a t io n o f d ep t h d o se i n r ot a ti o n t he r a p y i nv o l v e s t he d e te r m i nat io n o f a v e r a g e T A R a t t h e is o c e n te r . T he c o nt o ur o f t he p a ti e nt i s dr a w n i n a p l a ne c o n t a i n i n g t h e a x i s of r o t a ti o n . T he i s o c e nt e r i s t he n pl a c e d w it hi n t he c o nt o ur ( u s u a l l y i n t h e m i d d le o f t h e t u m o r o r a f e w c e nt i m e te r s b e y o nd i t ) a nd r a d i i a r e d r a w n f r o m t h i s po i n t a t s e le c te d a ng ul a r i nt e r v a l s (e . g . , 2 0 de g re e s ) ( F ig . 9 . 1 0 ). E a c h r a d i u s r e p re s e n ts a d e pt h f o r w hi c h TA R c a n b e ob t ai ne d f ro m t he T A R t a bl e , f o r t h e g i v e n be a m en e r g y a n d f i el d si z e de f i ne d at t he i so c e nter . T he T A R s a r e t h e n s u m m e d a n d a v e r a g e d to d et e rm i ne

WWW.MEDRAD.IR

, a s i l l u s t r at e d i n T a b le 9 . 3 .

Example 5
F o r t h e d a ta gi v e n i n T a b l e 9 . 3 , de te r m i ne t he t re a t me nt t i me t o d e li v e r 2 00 c G y ( r a d ) a t t h e c e n te r o f r o t a tio n , g i v e n t he da t a : d o se r a t e f r ee s pa c e f o r 6 6 - c m f i e l d at t h e S A D i s 8 6 .5 c G y / m i n .

TABLE 9.3. DETERMINATION OF AVERAGE CENTER OF ROTATION a

TAR AT THE

Angle

Depth Radius

a l on g

TAR

A n gl e

D e pt h Radius

a l on g

TAR

16.6

0.444

180

16.2

0.450

20

16.0

0.456

200

16.2

0.450

40

14.6

0.499

220

14.6

0.499

60

11.0

0.614

240

12.4

0.563

80

9.0

0.691

260

11.2

0.606

100

9.4

0.681

280

11.0

0.614

120

11.4

0.597

300

12.0

0.580

140

14.0

0.515

320

14.2

0.507

160

15.6

0.470

340

16.0

0.456

WWW.MEDRAD.IR

60

Co be a m , f ie l d s i z e a t t h e i s o ce nt e r = 6 6 c m . A v e r a ge t i s sue - a i r r atio

) = 9 . 6 9 2 / 1 8 = 0 . 538 .

P.175

9.5. SCATTER-AIR RATIO

S c a t t e r - ai r r a ti o s a re u s e d f o r t he p ur p o se o f c a l c ul a ti ng s c a tte r e d do s e i n t he m e d i u m . T h e c o m p u ta t io n o f t h e p r i m a r y a nd t he s c a t t e r ed d o s e s e p a r at el y i s p a r t i c ul a r l y u s e f u l i n th e d o s i me t r y o f i r re g ul a r f i e ld s . S c a t t e r - ai r r at io m a y b e de f i n e d a s t he ra t io o f t he s c at t er e d d o s e a t a g i ve n p o i nt i n t h e p h a n t o m t o t h e do s e i n f r e e s pa c e a t t he s a m e p oi nt. T he s c a t t e r - a i r r a t io l i k e t h e ti s s u e - ai r r at io i s i nd e pe nd e nt o f t he so ur c e - to - s ur f a c e di s t a nc e b ut d e pe n d s o n t h e b e a m e n e r g y , d e pt h, a nd f i e l d s i z e . B e c a u s e t h e s c a tt e re d d o se at a po i nt i n t he p ha nto m i s eq ua l to t he tot a l d o se m i n u s t h e p r i m a r y d os e a t t h a t p oi nt , s c a t te r - a i r r a ti o i s m at he ma t i c al l y g i v e n b y t h e d i f f e r e n c e b e t we en t h e T A R f o r t he g i v e n f i e l d a nd t he T A R f o r t he 0 0 f i e l d .

H e r e T A R ( d , 0 ) r e p re s en t s t h e p r i m a r y c o mpo ne nt o f t he b e am . B e c a u s e S A R s a r e p r im a r i l y u s e d i n c a l c ula t i ng s c a tt e r i n a f i e ld o f a ny s ha p e , S A R s a r e t a b u l at e d as f u n c t i o n s o f d ep t h a nd r a d i us o f a c ir c ul a r f i el d at t ha t d e pt h . A l s o , b e c a u s e S A R d a t a a r e d e r i ve d f r o m T A R d a t a f or r e c t a ng ul a r or s q u a r e f i el d s , r ad ii o f e q u i v al e nt ci r c le s m a y b e o bt a i ned f ro m t he t ab l e i n r e f e r e n c e 5 or b y E q u a t io n 9 . 7 .

A. Dose Calculation in Irregular FieldsClarkson's Method

A n y f i e l d ot h e r t h a n t h e r e c t a n g ul a r , s q ua r e , o r c i r c ul a r f i e ld m a y b e t e r m ed i r r e g ul a r . Ir r e g u l a rl y s h a p e d fi el d s a re enc o unt e r e d i n r a di a tio n t he r ap y w he n r a d i at io n s e n s i ti v e s tr u c t u r e s a r e s hi el d ed f r o m t he p ri m a r y b ea m o r w he n t he f i e l d e x te n d s be y o n d t h e i rr e g u l a rl y s ha pe d p at ie nt bo d y co nto ur . E x a m p l e s o f s u c h f i e l d s a r e t h e m a n t l e a n d i nv e r t ed Y f i e l d s us ed f o r the t r e at m e nt o f H o d g k i n ' s di s e a se . S in c e t h e b a si c d at a (pe r c e nt d e pt h do s e , t i ss ue - a i r r at io s , o r t i s s u e - m a x im u m r a t io s to be di s c us s e d later) are a v a il a bl e us ua l l y for r e c t a n g u l a r f i el d s , me t h o d s a r e r eq ui r ed to us e t he s e d at a f or g e ne r a l c a s e s o f i r r e g ul a r l y s h a pe d fi eld s . O n e s u c h m et ho d , o ri g i nal l y p r op o s ed by C l a r k s o n ( 23 )

WWW.MEDRAD.IR

a n d l a t e r de v e lo p ed by C u n n i n g h a m ( 2 4 , 2 5 ) , ha s p r o v e d t o b e t he m o s t g e ne r al i n i t s a p pl i ca ti o n . C l a r k s o n ' s m e t h od i s b a s e d o n t he p r i nc ip le t ha t t he s c at t er e d co m po ne nt o f t he d e pt h d o se , which depends on t he f ie l d size a nd s ha p e , c an be c a l c ul at ed s e p a r a te l y f ro m t h e pr i m a r y c o mp o ne nt w hi c h i s i nd ep e nd e nt o f the f i e ld s i z e a nd s h a p e . A s p e c i al q u an t i t y , S A R , i s us e d to c a l c ul at e t he s c a tte r e d d o se . T hi s m e t h od h a s be e n di sc u s s e d i n de t ai l i n the l it e r at ur e (2 6 , 27 ) a nd o nl y a b ri e f d i s c u s s io n w i l l be p r e se n t e d h e re . L e t u s co n s i d er a n i rr e g u l a rl y s ha p e d f ie ld a s s ho w n i n F i g . 9 .1 1 . A s s um e t hi s f i e l d c r o s s - se c ti o n to b e at de pt h d a nd p e rp e nd i c ul a r to t he be am a x i s . Le t Q be t h e po i nt o f c a l c u l at io n i n t h e p l a ne o f t he f i el d c r o s s - se c ti o n. R a d ii a re d r a w n f r o m Q t o d i v id e t h e f ie l d i n to e le m e nt a r y s e c t o r s . E a c h s e c t o r i s cha r a c t e r i z ed b y i t s r ad i u s a n d c a n b e c o n s i de r ed a s p a r t of a c i r c ul a r f i el d o f tha t r a d i us . If we s u p p o s e t h e s e ct or a n g l e i s 1 0 de g r ee s , the n t he s c a t t e r c o nt ri b ut io n f r o m t hi s s e c t or w i l l b e 1 0 / 36 0 = 1 / 3 6 o f t ha t c o nt ri b ut ed b y a P.176 c i r c u l a r f i el d o f t h a t ra d i u s a n d c e nt e r e d at Q . T h us t he s c a t t e r c o nt r ib ut io n f r o m a l l t h e s e ct o r s c a n b e c a l c u l a t e d a nd s um m e d b y c o ns i d e ri ng e a ch s e c t o r t o be a part of its own ci r cl e the s c att e r - ai r r at io of w hi c h is a l rea d y k no w n a nd t a b u l at e d .

WWW.MEDRAD.IR

F I G . 9 . 1 1 . O u t l i n e o f m a n t l e f ie ld i n a p l ane p e r pe nd i c ul a r t o the b e a m a x i s a nd a t a s p e ci f i ed d e pt h . R a d ii a re d r a w n f r om po i nt Q , t he po i nt o f c al c ul a tio n. S e c t o r a n g le = 10 deg r e e s . ( Re d r a w n f r o m A m e r i c a n A s s o ci at io n o f P hy s i c i st s i n M e d i ci n e . D o si m et r y w o r k s h o p : H o d g ki n' s d i s e a se . C hi c a g o , IL , M . D . A nd e r s o n H o s p it a l , H o u s to n , T X , R a d i ol og i c al P hy s i c s C e nt e r , 1 9 70 . ) Using an SAR t a b le for circular f ie ld s , t he SAR v a l ue s for t he s e ct o r s a re

c a l c u l a te d a n d t h e n s u m m e d t o gi v e t he a ve r a g e s c at t er - a i r r at io (

) f o r t h e i r r eg u l a r f iel d at po i n t Q . Fo r s ec t o r s p a s s i ng t hr o ug h a b lo c k e d a re a , t h e n e t S A R i s d et e rm i n e d b y s u b t r a ct i ng t he s c a tt e r c o nt r i b ut io n b y t he bl o c k ed p a r t o f s e ct o r . F o r e x a m p l e , n e t ( S A R ) Q C = ( S A R ) Q C - ( S A R ) Q B + ( S A R ) Q A . T h e c o m p u t ed

i s c o n v e r te d to a v e r a ge t i s s u e - ai r r a ti o (

WWW.MEDRAD.IR

) b y t h e e q u a t io n :

w h e r e T A R ( 0 ) i s t h e t is s u e - a i r r a ti o f o r 0 0 f i e ld , t ha t i s ,

where

i s t h e a v e r a ge l i n e a r a t t e n u a ti o n co e f f i ci e nt f o r t he b e a m a nd d i s t he de pt h o f p o i nt Q . T h e p e r c e n t d ep t h dos e ( % D D ) a t Q m a y b e c a l c ul a te d re l at i v e t o D m a x o n t he c e n t r a l a x i s u s i n g E q u a t io n 9 . 2 3 .

w h e r e B S F i s t h e b a ck s c a t t e r f a c t or f o r t he i r re g ul a r f i el d a nd c a n b e c al c ul a te d b y C l a r k s o n ' s m e t hod . T h i s i n v o l v e s d et er m i ni ng T A R a t t he d e pt h d m o n t he c e n t r a l a x i s , u s i n g t h e f i e l d c o nt o ur o r r a di i p r o je c te d a t t he d e pt h d m . P.177

In c l i n i c a l p r a ct ic e , ad d it io n a l co r r e ct io ns a r e us ua l l y ne c e s s a r y s uc h a s f o r t he v a r i a t io n o f S S D w i th i n t h e f i e l d a nd t he p r i m a r y b e a m p ro f ile . T he d e t a il s o f t h e s e c o r re c ti o n s w i ll b e d i s c u s s ed i n t he nex t c ha p t e r .

REFERENCES
1 . S h r i m p to n P C . E le c t ro n d e n s it y v a l ues o f v a r io us hum a n t i s s ue s : i n v i tr o C o m p to n s c a t te r measurements a nd ca l c ul a te d r a ng e s . P hy s Med Bi o l 1 9 81 ; 2 6 :9 07 . 2 . W h i t e D R , M a r t i n R J , D a r l i s o n R . E p o xy r e s i n b a s e d ti s s ue s ub s t it ut e s . Br J R a d i ol 1 97 7 ;5 0 : 81 4 . 3. In t e r n a t io n a l Com m i s s io n on R a di at io n U ni t s a nd M e a sur e m e nt s . T i s s ue s u b s t it u t e s i n r a d i at io n d o si m et r y a nd m ea s ur e m e nt . R e po r t No . 4 4 . Bet he s d a , M D : In t e r n a t i o n a l C om m i s s io n o n R a d i a ti o n U ni t s a nd M e a s ur e m ent s , 1 9 8 9 . 4 . C o n s t a n ti n o u C , A tt i x F H , P al i w a l BR . A s ol i d p ha nto m m at e ri a l f o r r ad i at io n t h e r a p y x - r a y a n d - r a y b e a m c a l i br a ti o ns . M e d P hy s 1 9 8 2 ; 9 :4 36 . 5. H o s p i ta l P h y s i c i s ts A s s o c i a ti o n. C e nt r a l axis d e pt h dose data for us e in r a d io t h e r ap y . B r J R a d i ol 1 9 78 ; [ s up p l 1 1 ] . 6 . J o h n s H E , W h i t m o re G F , W a t so n T A , e t a l . A s y s t e m o f do s ime t r y f o r r ot a ti o n t h e r a p y w i t h t y pi c a l ro t at io n d i s tr i b utio ns . J C a n A s s o c R a d i o l 1 95 3 ; 4 :1 . 7 . J o h n s H E . P h y s i c a l a s p e c t s o f r o t at io n t he r a p y . A J R 1 9 5 8 ;7 9 : 37 3 . 8 . C u n n i n g h a m J R , J o h n s H E , G u p t a S K . A n e x a m i na ti o n o f t he de f i ni ti o n a nd t he m a g n i t u de 9. Gupta of SK, for b a c k - sc a t t er Cunningham l a r ge field f a c t or JR. for cob a l t 60 of gamma t i s s ue - ai r r a ys . r a t io s Br J R a d i ol s c a t t er J Radiol 1 9 65 ; 3 8 :6 37 . M e a s ur e m e nt for co b alt 60 a nd Br functions si z e s gamma r a di a tio n.

1 9 66 ; 3 9 :7 . 1 0 . K a r z m a r k C J , De w b e r t A , Lo e v i nge r R . T i s s ue - p ha nto m r a t io s a n a id to t r e at m e n t pl a n n i n g . B r J R a d i o l 19 65 ; 3 8: 1 58 .

WWW.MEDRAD.IR

1 1 . S a u n d e r s J E , P r i c e R H , H o r s l e y R J . C e nt r a l a x i s de p t h do s es f o r a c o ns t a nt s o u r c e - t u mo r d i st a n c e. B r J R a d i o l 1 9 68 ; 41 :4 6 4 . 1 2 . H o lt J G , L a u g h li n J S , M o r o n e y J P . E x t e ns i o n o f co nc e pt o f t i s s ue - ai r r a ti os ( T A R ) t o h i g h e n e r g y x - r a y b e a m s . R a d i ol ogy 1 9 7 0 ; 96 : 43 7 . 1 3 . K h a n F M , S e w c h a n d W , L e e J , et al . R e v i s io n o f ti s s ue - m ax i m um r a t io a nd s c a t te r - m a x i m u m r a tio c o n c e pt s f o r c o b al t 6 0 a nd hi g he r e ne r g y x - r a y b e a m s . M e d P h y s 1 9 8 0 ; 7 :2 30 . 1 4 . In t e r n a t io n a l C om m i s s io n o n R a d i a ti on U ni t s a nd M e a s ur e m e nt s . R a d i a tio n q u a n t i ti e s a n d u n i t s . R e p o rt N o . 3 3 . W a s hi ng t o n, D C : U . S . N a t io na l Bur e a u o f S t a n d a r d s , 1 98 0 . 15. In t e r n a t io n a l C o m m i s si o n on R ad i a ti o n U nit s a nd M e a s ur e m e nt s . D e t e r mi n a t io n o f a b sor b e d d os e i n a p a ti e nt ir r a d ia t ed b y b ea m s o f x o r g a m m a r a y s i n r a d io t h e r ap y p r o c ed u r e s . R e po rt No . 2 4 . W a s hi ngt o n, DC : U . S . N a t i o na l B u r e a u o f S t a n d a r d s , 1 9 76 . 1 6 . D a y M J . A n o t e o n t h e c a l c ul at io n o f d o s e i n x - r a y f i e ld s . 1 9 50 ; 2 3 :3 68 . 1 7 . J o n e s D E A . A n o t e o n b a c k - s c a t te r a nd d e p t h do s e s f o r el o ng a t ed r e c t a ng ul a r x - r a y f i e l d s . B r J R a d i o l 19 4 9 ;2 2 :3 4 2 . 1 8 . B a t h o H F , T h e i mer O , T h e i m e r R . A co ns i d e r at io n o f eq ui v a lent c i r c le m et ho d of c a l c u l at i n g d e pt h doses for r e ct a ng ula r x-ray fields. J Ca n Assoc R a d iol 1 9 56 ; 7 : 51 . 1 9 . S t e rl i n g T D , P e r r y H , K a t z I. D e r i v a ti o n o f a m a t he m a ti c a l e xp r e s s io n f o r t he p e r c e n t de pt h d o s e su r f a c e o f c o b a l t 60 be a m s a nd v i s ua l i z a t ion o f m ul t i p le f i e ld d o s e di s t ri b u tio n s . B r J R a d i ol 1 9 64 ; 37 : 54 4 . 20. Mayneord WV, La m e r to n LF. A s ur v e y of depth do s e d ata . Br J Radiol 1 9 44 ; 1 4 :2 55 . 2 1 . J o h n s H E , B r u c e W R , R e i d W B. T he d e p e nd e nc e o f d ep t h d os e o n f o c a l s k i n d i s t a n c e . B r J R a d i ol 19 5 8 ;3 1 : 25 4 . 2 2 . B u r n s J E . C o n v e r s i o n o f d e pt h d o s e s fr o m o ne F S D t o a nothe r . Br J R a d i o l 1 9 58 ; 3 1 :6 43 . 2 3 . C l a r k so n J R . A n o t e o n d e pt h do s e s in f i e l d s o f i r r eg ul a r sha p e . Br J R a diol 1 9 41 ; 1 4 :2 65 . 2 4 . Jo h n s H E , C u n n n i n g h a m J R . T he p hy s i cs o f r ad io lo g y , 3 r d e d. S p r i ng f ie l d , IL : Charles C Thomas, 1969. 2 5 . C u n n i n g h a m J R . S c a t t er - a i r r at io s . P hy s M e d Bi o l 19 72 ; 1 7 :4 2 . 26. American A s s o ci a ti o n of P hy s i c i s t s in M e d i c i ne . D o sim e t r y w o r k s ho p : H o d g k i n ' s di s e a se . C h i c a g o , IL : M D A nd er so n H o s pi t al , H o us to n, T X , R a d i ol og i c al Physics Center, 1970. 2 7 . K h a n F M , L e v i t t SH , M o o r e V C , e t a l . C o m p ute r a nd a p p r o x im a t io n m e t hod s o f c a l c u l a ti n g d ep t h d o se i n i r r e g u l a rl y s ha p e d f i e l d s . R a di ol og y 1 97 3; 1 0 6 :4 3 3 .
1 2

Br J R a d i o l

A l d e r so n R e s e a r c h L ab o r at o ri e s , Inc . , S t a m f o r d , C o nne c t i c ut .

i s t h e a v e r a g e at te n u a t io n c o e f f i c ie nt f o r t he he t e ro g e neo us b e am .
3

A 0 0 f i e l d i s a h y p o t h et i c al f i el d i n whi c h t he d e pt h d o s e is e nt i r el y d ue to

p r i m a r y p h ot o n s .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II Classical Radiation Therapy > 10 A System of Dosimetric

Calcu lations

10 A System of Dosimetric Calculations

S e v e r a l me t h od s a r e a v a i l a bl e f o r c a l c ul at ing a b s o r be d d o se i n a p a ti e nt . T w o o f these m et h o d s u s i n g p e r c e n t de pt h d o s es a nd t i s s ue - a i r r at io s (TARs) were d i s c u s s e d i n C h a p t e r 9 . H o w e v e r , t he r e a re s o m e li mi t at io ns t o t he s e m e t ho d s . F o r e x a mp le , t h e d ep en d e n c e o f p e r ce nt d e pt h d o se o n s o ur ce - to -s ur f a c e d i st a nc e ( S S D ) m a k e s t hi s q u an t i t y u n s u i t a bl e f o r i so c e nt ri c t e c hni q ue s . A l t ho ug h ti s s ue air r at io s (TAR) a nd s c a tt e r - ai r r at io s (SAR) e l im i na te
60

t hat

p r ob le m ,

t hei r

a p p li c a ti o n t o b e a m s o f e n e r g y hi g her t ha n t ho s e o f beam e n e rg y the i n c r e as e s , has do s e to in be free the size of f r om t he it suc h c ha m b e r b e co m e s

C o ha s b e e n s e ri o usl y cap In for i n- a ir to t he

q u e s t io n e d ( 1 , 2 ,3 ) a s t h e y r eq u i r e m e a s ure m e nt o f do s e i n f r ee s p a ce . A s t he b uil d - up measurements c a l c u l a te i n c r e a se d s p a ce a nd i nc re a s ing l y d i f f i c ul t

m e a s ur e m e nt s .

a d d it io n,

m a t e ri a l o f t h e b ui l d -u p c a p i s u s ua l l y d i f f e r e nt f r o m t ha t o f t he p ha nt o m a nd t his i n t r od u c e s a b i a s o r un c e r t a i n t y i n t he T A R m e a s ur e m e nt s . In o r d e r to o v e r co m e t h e l im it a ti o ns o f t he T A R , K a r z m a r k e t a l . ( 1 ) i nt ro d uced t h e c o n c ep t o f t i s s u e -p h a n t o m r at io ( T P R ) . T hi s q ua nt i t y r e ta i ns t he p ro pe r ti e s o f t h e T A R b u t li m it s t he m e a s u r e me nt s t o the p ha nt o m r a t he r t ha n i n a i r . A f e w y e a r s l a te r , H o lt et a l. ( 4 ) i n t r od uc e d y et ano t he r q ua nt it y , t i s s ue - m a x i m um r a ti o ( T M R ) , w h i c h a l s o l i mit s t h e m e a s ur e me nt s t o t he p ha nto m . In this c h a p te r , I de v e lo p a do s i me t ri c s y s t e m based o n t he TMR co nc e pt , a l t h o u g h a s i m il a r s y s t e m c a n a l s o be d e ri v e d f r o m t he T P R c o nc ep t ( 5 ) .

10.1. DOSE CALCULATION PARAMETERS

T h e d o s e to a po i n t i n a m e d i u m m a y b e a na l y z e d i nt o p r i m ar y a nd s c a t t e red c o m po n e n t s . T h e p r im a r y d o s e i s co nt ri but e d b y t he i ni ti a l o r o r i gi na l p hot o ns e m it t ed f r o m t h e s o ur c e a n d t h e s c a t te r ed d o s e i s t he r e s ult o f t he s c a t te r ed p h o to n s . T h e s c a tt e red do s e c a n b e f ur t he r a na l y z e d i nt o c ol li m at o r a nd p ha nto m c o m po n e n t s , because the two can be v ar i e d i nd e pe nd e ntl y by b l o c k i ng . For e x a m p le , b l o c ki n g a p o r ti o n o f t he f i el d doe s no t s i g ni fi c a nt l y cha ng e t he o ut p ut o r e x po s u r e i n t h e o pe n p o r tio n o f t he b e am ( 6 , 7 ) b ut m a y s ubs t a nt i al l y r ed uc e t h e p h a n t o m s c a tt e r . T h e a b o v e a n a l y s i s p r e s e n t s o n e p r a ct i c al di f f i c ul t y , na m e l y , t he d e te r m i nat io n o f p r i m a r y do s e i n a ph a n t o m w h i c h e x c l ude s b ot h t he co ll i m ato r a nd p ha nt om s c a t te r . H o w e v e r , f o r m e g a v ol t ag e p hot o n b e a m s , it i s r e a so na b l y a c c ur a t e t o c o n s i d er c o ll i m at o r sc a t t er a s p a r t o f t he p r i m a r y b e a m s o t ha t t he p ha nt o m s c a t te r c o ul d b e c al c u l a t ed se p a r at e l y . We , t he r e f o re , de f i ne a n ef f e c t i v e p r i m a r y d o s e a s t h e do s e d u e t o t h e p r i m a r y p hot o ns a s w e ll a s t ho se s c at t er e d f r o m t he c o ll i m at i n g s y s te m . Th e e f f e c t i v e p r i m a r y in a p ha nt o m m a y b e t ho ug ht o f a s t he

WWW.MEDRAD.IR

d o s e a t d ep t h mi n u s t h e p h a n t o m s c at te r. A l t e r nat i v el y , t he ef f e c t i v e p r i m a r y d o s e m a y be de f i n e d a s t h e d ep t h do s e e x p e c te d i n t he f i el d w he n s c a t t e r i ng v o l u m e i s r ed u c e d to z e r o w h i l e k e ep i ng t he c o ll i m at or o pe ni ng c o ns t a nt . R e p r e se n t a ti o n o f p r im a r y d o se b y t he dos e i n a 0 0 f i el d p o s e s c o nc ep t ua l p r o bl e m s b e c a u s e o f t h e l a c k o f l a te r a l e lec t r o ni c eq ui li b ri um i n na r r o w f i e l d s i n m e g a v ol t ag e p h ot o n beams. T hi s i s s ue ha s been debated in t he l i t e r at ur e ( 8 , 9 , 1 0 ) , b u t p r a ct i c al s o l u t io n s a r e s t il l not a g r e e d o n. S y s t e m s t ha t us e e l e c t ro n t r a n s p o rt i n t h e c a l c u l a ti o n o f p r i m a r y a nd s c a t t e re d c o m po ne nts o f d o s e w o ul d b e a p p ro p ri a te b u t a re n o t a s y e t f ul l y d e ve l op ed a nd P.179 i m p le m e nt e d . U n t il t he n , t h e co nc e pt o f 0 0 f ie ld t o r e pr e s e nt p ri m a r y b e a m s w i t h t h e i m pl i ci t a s s um p ti o n t h a t l at e r al e le c t ro ni c e q uil ib r i um ex i s t s a t a ll p oi n t s w i l l c o nt i n u e to b e u s e d f o r r o u ti ne d o si m etr y .

F I G . 1 0 . 1 . A r r a n g e m e n t f o r me a s ur i ng S c a nd S c , p . A : C ha m b e r w i t h b ui ld - up c ap i n a i r t o m e a s u r e o u tp u t r e l at i v e to a r e f e r e nc e f i e l d , f o r d et e rm i ni ng S c v e r s us f i e l d s i z e . B : M e a s u re m e n t s i n a p ha nt o m a t a f i x ed d ep t h f o r d e te r m i ni ng S c , p v e r s u s f i e l d si z e . ( F r o m K h a n F M , S e w c ha nd W , L e e J , e t al . R e v i s io n o f t i s s ue m a x i m u m r a ti o a n d s c a t te r - m a x i m um r at io c o nc ep t s f o r co b alt 60 a nd hig he r e n e r g y x - r a y b e a m s . M e d P h y s 1 9 8 0 ; 7 :2 30 , w i t h p e r m i s si o n. )

A. Collimator Scatter Factor

WWW.MEDRAD.IR

T h e b e a m o u tp u t (e x po s u r e r at e , d o se r at e i n f r e e s p a c e , o r e ne rg y f l ue nc e r at e ) m e a s u r e d i n a i r d e pen d s o n t h e f i e ld s i z e. A s t he f i e l d s i z e i s i nc r e a s e d , t he o u t p u t i n c r e a s e s b e c au s e o f t h e i nc r e as e d c o ll i m at o r s c at te r , 1 whi c h i s a d d ed to t h e p r i m a r y be a m . T h e c o l li m a to r s c a tt e r f a c t o r ( S c ) i s c o m mo nl y c a l l ed t he o utp ut f a c t o r a nd m a y b e d e f i n e d a s t h e r a t io of t h e o u t p u t i n a i r fo r a g i v e n f i e ld t o t ha t f o r a r e f e r e nc e f i e l d ( e . g . , 10 1 0 cm ) . S c m a y b e m e a s ure d w it h a n i o n c ha m be r w i t h a b ui ld - up c a p o f a si z e l a rg e e n o u g h t o p ro v i d e ma x i m um d o se b uil d - up f o r t he g i ve n e n e r g y b e a m . T h e me a s u r e m e n t se t up i s s ho w n i n F i g . 1 0 . 1A . R e a d i ng s a re p l ot te d ag a i n s t f i el d si z e ( s id e o f e q ui v a l e nt s q ua r e o r a re a / pe r im e t er [ A / P ] ) a nd t h e v a l u e s a r e n o r m a liz e d t o t h e re f e r e nc e f ie l d ( 10 1 0 c m ) . In t h e m e a s u r e m e n t of S c , t h e f i el d m us t f ul l y c o v e r t he b ui l d - up c a p f o r a ll f i el d s i z e s i f m e a s u r em e n ts a r e to r e fl e ct re l at iv e p hot o n f l ue nce s . F o r s m al l f i el d s , o n e m a y t a k e t h e m ea s u r e m e n t s a t l a r ge d i s t a nc e s f ro m t he sour c e s o t ha t t he s m a l le s t fi e ld co v e r s b u i ld - u p c a p . No r m al l y , t he co ll im a to r s ca t t er f a c to r s a r e m e a s u r e d at t h e so u rc e - to - a x i s d i st a nc e ( SA D ) . H o w e v e r , l a r g e r d i s t a nc e s c a n be u s e d p r o v id e d t h e f i e ld s i z e s a r e a ll d e f i ned a t t he S A D .

B. Phantom Scatter Factor

T h e p h a n t o m s c a t te r f a c t o r ( S p ) t a k e s i nto a c c o unt t he c ha ng e i n s c a t te r r a d i at io n o r i gi n a ti n g i n t h e p h a n t o m a t a r e f e re nc e d e pt h a s t he f i e l d si z e i s c ha ng e d . S p m a y b e d e f i n ed a s t h e r a t io o f t h e do s e r a te f o r a g i v e n fi el d at a r e f e r e nc e d ep t h ( e . g . , d e p t h o f m a x im u m d o s e ) to t he do s e r a te a t t he s a me d e pt h f o r t he r e f e r e n c e f i el d si z e ( e. g . , 1 0 1 0 c m ) , w i t h t he s a m e c o ll i m at o r o p e ni ng . In t hi s d e f i n it io n , i t s h o u l d be n o t e d t h at S p i s r e la t e d to t he c ha ng e s in t he v o l um e o f t h e p h a n t o m i r r ad i at ed f o r a f i x e d c o ll i m ator o p e ni ng . T hus o ne P.180 could de te r m i ne Sp, at le a s t i n c o nc e pt , b y us i ng a l a r ge fi e ld i nc id e nt o n

p h a n t o m s o f v a r i o u s cr o s s - s e ct io na l s i z e s . F o r p h ot o n b e a m s fo r w h i c h b a c k s c a t t e r f a c to r s c a n b e a c c ur a t el y m e a s ur e d (e . g . ,
60

C o a n d 4 M V ) , S p f a c t o r a t t h e de pt h o f m a x i m um d o s e m a y b e de f i ne d s i mp l y a s

t h e r a ti o o f b a c k s c at te r f a c t or ( BS F ) f o r t he g i v e n f ie ld to t ha t fo r t he re f e r e nc e f i e l d ( se e A p pe n d i x , s e c t io n A ) . M a t he m a t i ca l l y ,

w h e r e r 0 i s t h e s i de o f t h e r e f e r e nc e f i el d s iz e ( 1 0 1 0 c m ) . A m o r e p r a ct i c al m et h o d o f me a s ur i ng d e r i v at io n , s e e A p p e nd i x , s e c t io n A ) : S p , w hi c h c a n be us ed f o r a ll b e am e n e r g ie s , c o n s i s t s o f i n d i r e c t de te r m i nat io n f r o m t he f o l lo w i ng e q ua t io n ( f o r

w h e r e S c , p ( r ) i s t h e to t al s c a t te r f a c t o r d ef i ne d a s t he d o s e r a te a t a r e f e r e nc e d e pt h f o r a g i v e n f i e l d s i z e r d i v i de d b y t he d o s e r at e a t t he s a m e p o i nt a nd d ep t h f o r t h e r e f e r e n c e f i el d s i z e ( 1 0 1 0 c m ) ( F i g . 1 0 . 1 B) . T hus S c , p ( r ) c o nt a i ns b o th t h e c o ll i m ato r a n d p h a n t o m s c a tt e r a nd w he n d i v i de d b y S c ( r ) y i el d s S p ( r ) .

WWW.MEDRAD.IR

S i n c e S p a n d S c , p a r e d e f i n e d a t t he r e f e renc e d e pt h o f D m a x , a ctua l m e a s ur e me nt o f t h e s e f a c t o r s at t h i s d e pt h m a y c r e a t e p ro b le m s b e c a us e o f t he p o s s i ble i n f l u e n c e o f c o n t a mi na n t el e c tr o ns i nc i de nt o n t he p ha nto m . T his c a n b e a v oi d ed b y m a k i n g m e a s u r e me n t s a t a g re a te r d ep t h ( e . g . , 1 0 c m ) a nd c o nv e r ti ng t he readings to the r e f er e n c e d ep t h of Dmax by us i ng p e r c e nt de p t h do s e data, p r e s u m a b l y m ea s u r e d w i t h a s m a l l - di a m et e r c ha m b e r . T he r at io na l e f o r t hi s

p r o c ed u r e i s t h e s a me a s f o r t h e r e c o m m e nd e d de p t hs o f c a li b r ati o n ( 1 1 ) .

C. Tissue-Phantom and Tissue-Maximum Ratios

T h e T P R i s d e f i n ed as t h e r a ti o o f t he d os e a t a gi v e n po i nt in p ha nt o m to t he dose at the in s a me Fig. point 10 . 2 . at The a fixed r e f er e nc e d e pt h, us ua l l y for t he 5 cm. T hi s is i ll u s t r a te d c o r r e s po nd ing q ua nt i t y s c a t t e re d do se

c a l c u l a ti o n i s c a ll ed th e s c a t t e r -p ha nt o m r at io ( S P R ) , w hi c h i s a n a l o go us i n us e t o t h e s c a tt e r - ai r r a ti o di s c u s s e d i n t he p r e vi ous c ha p t e r . D et a il s o f t he T P R a nd S P R c o n c e p t s h a v e b ee n d is c u s s e d i n t he l it e r at ur e ( 1 , 3 , 5 ) . T P R i s a g e n e r al f u n c t io n w h i c h m a y b e no r m a l i z ed to a ny r e f e re nc e d ep t h. But t h e r e i s no g e n e r al ag r e e me n t c o nc er ni ng t he d ep t h to b e us ed f o r t hi s q ua nti t y , a l t h o u g h a 5 - c m d ep th i s t h e u s ua l c ho i c e f o r m o s t be a m e ne r gie s . O n t he o t he r h a n d , t h e po i n t o f cen t r a l a x i s D m a x ha s a si m p li c it y t ha t i s v e r y d e s i r ab le i n d o se c o m p u t at io n s . If a d o p t e d a s a f i x e d P.181 r e f e r e n c e de pt h , t h e q u a n t i t y T P R g i v e s ris e t o t he T M R . T hus T M R i s a s p e c i a l c a s e o f T P R a n d m a y b e d e fi n e d a s t he ra t io o f t he d o se a t a g i v e n p oi nt i n p h a n t o m t o t h e d o se a t t h e s a m e po i nt a t t he r e f er e nc e d e pt h of m a x i m um do se (Fig. 10.2).

F I G . 1 0 . 2 . D i a g r a m i ll u s t r a ti n g t he d e fi ni tio ns o f t i s s ue - p ha nto m r a t i o ( T P R ) a nd t i s s u e - m a x im u m r a t io ( T M R ) . T P R ( d , r d ) = D d / D t 0 , w he r e t 0 i s a r e f e r e nc e de pt h. If t 0 i s t h e r e fe r e n c e de pt h o f m a x i m um d o s e , t he n T M R ( d , r d ) = T P R ( d , r d ) . F o r m e g a v ol t ag e b e am s i n t h e r a ng e o f 2 0 t o 4 5 M V , t he d e p t h o f m a x i m um d o se ( d m ) h a s b e e n f o u n d t o de p e n d s ig ni f i c a ntly o n f i e l d s i z e ( 1 2 ,13 ) a s w e l l a s o n SSD (14,15). F or th e c a l c u l a ti v e f unc t io ns to be i nde p e nde nt of m a c hi ne

WWW.MEDRAD.IR

p a r a m et e r s ,

they

should

n ot

i nv o l v e

mea s ur e m e nt s

in

t he

b ui l d - up

re gi o n.

T h e r e f o r e , t h e r e f e re n c e d e pt h m us t b e e q ua l t o o r g re a te r t ha n t he l a r g e st ( d m ) . S i n c e ( d m ) t e n d s t o dec r e a s e w it h f i e ld s i z e ( 1 2 ) a nd i nc r e a se w i th S S D ( 1 4 ) , o ne s h o u l d c h o o se ( d m ) f or t h e s m a ll e st f ie l d and t he l a rg e st S S D . In p r a c t i ce , o ne m a y p l ot [ (D D ) ( SS D + d ) 2 ] a s a f unc t io n o f de p t h d to f i nd ( d m ) (1 5 ) . T hi s e l im i n a te s de pe n d e n ce o n S S D . T he m a x im um ( d m ) c a n t he n b e o bt a i ne d b y p l ot ti n g ( d m ) a s a f u n c t io n o f f i e l d si z e a nd ex t r a p ol a ti ng to 0 0 f i e l d si z e . T h e r e f e r e n c e de pt h of m a x i m u m d o s e ( t 0 ) , a s d e te r m i ned a bo v e , s ho ul d b e us ed f o r p e r c e n t d e pt h d o se , T M R , a n d S p f a c t o r s , i r r e s p e ct i v e o f f i e ld s i z e a nd S S D .

C.1. Properties of TMR

The c o n c e pt of ti s su e - m a x i m u m r a ti o is b a s ed on t he a s s um p ti o n t ha t t he f r a c t i o n al s c a t te r c o n tr i b u ti o n to t he de p t h d o s e at a p oi nt i s i nde p e nde nt o f t he d i v e r ge n c e o f t h e b e am a n d d ep e nd s o nl y o n t he fi e ld si z e at the p oi nt a nd t he d e pt h o f t h e o v e r l yi n g t i s s u e . T h i s ha s b ee n s ho w n t o b e e s s e nti a ll y t r ue b y J o hns e t a l . ( 1 6 ) . T h i s p r i n c i p le , w h i c h a l s o und e r l ie s T A R a nd T P R , m a k e s a l l t he se f u n c t i o n s p r a ct i c al l y in d e p e n d e nt o f s o ur c e- s ur f a c e d i st a nc e . T hus a s i ngl e t a ble o f T M R s c a n b e u s e d f o r a l l S S D s f o r e a c h ra d i a tio n q ua l i t y . F i g u r e 1 0 . 3 s h o w s T M R d a t a fo r f o r 10 - M V x - r a y b e a m s a s a n e x a m p l e . T he c ur v e f o r 0 0 f i e l d s i z e s h o w s t h e s t e ep e st d r op w i t h d e p t h a nd i s c a us e d e nt i re l y b y t h e p r i m a r y be a m . F or m e g a v o lt a ge b e a m s , t he p r i m a r y b e a m at te nua t i o n c a n b e a p p r o xi m a te l y r e p re s en t e d b y :

w h e r e i s t h e e f f e ct i v e l i n e a r a tt e nua t ion c o e f f i c ie nt a nd t 0 is t he r e f e re nc e d e pt h o f m a x i m u m dos e . c a n b e de te r m ine d f r o m T M R d at a by p l ot ti ng a s a f u n c t i o n o f f i e l d s i z e ( s i d e o f e q u i v al e nt s qua r e ) a nd e x t r a p o l at ing i t b a c k t o 0 0 f i e ld . T M R a n d p e r c e n t de pt h d o s e P a re i nte r r el a t ed b y t he fo ll o w i ng e q ua ti o n ( s ee A p p e n d i x , s e ct io n B , f o r d e ri v a t io n) .

where

H e r e t he pe r c e n t d ept h d o se i s re f e r e nc e d a g a i ns t t he do s e at d e pt h t 0 s o t h at P ( t 0 , r , f ) = 1 0 0 f o r a l l f i e ld s i z e s a nd S S D s . Although TMRs can be m e a s u re d di r e ct l y, t he y can also

60

be

c a l c ul a te d

f r om

p e r c e n t d ep t h do s e s , a s s h o w n b y E q ua t io n 1 0 . 4 . Fo r d a t a i n t h o se c a s e s , s u c h a s

C o , E qua t i o ns 1 0 . 2 a nd

1 0 . 4 c a n b e u s e d t o c a l c u l a te T M R s . In a d d i ti o n, T M R s c a n b e de r i v e d f ro m T A R
60

C o , w he r e T A R s a r e a c c ur a t e l y k no w n:

WWW.MEDRAD.IR

F I G . 1 0 . 3 . P l o t o f T M R f o r 1 0 - M V x - r a y s a s a f unc t i o n o f de p t h fo r a s el e ct io n o f f i e l d si z e s . P.182

D. Scatter-Maximum Ratio
The s c a t te r - m a x i m um r a ti o (SMR), li k e t he SAR, is a q ua nt i t y d e si g ned s p e c i f i ca ll y f o r t h e c al c u l a ti o n o f s c a tt e re d d o se i n a m ed i um . It m a y b e d e fi ned a s t h e r a t io o f t h e sc a t t er e d d o s e at a g iv e n p o i nt i n p ha nto m t o t he e f f e c t i ve p r i m a r y do s e a t t h e s a m e po i n t a t t he ref e r e nc e de p t h o f m a xi m um do s e (5 ) . M a t h e m a ti c a ll y ,

WWW.MEDRAD.IR

F o r d e ri v a t io n o f t h e ab o v e e q u at io n, s e e A pp e nd i x , s e c ti o n C . F r o m E q u a t io n s 1 0 . 1 , 1 0 . 5 , a n d 1 0 . 6 , i t c a n b e s ho w n t ha t f o r b e c a l c u l at e d f ro m T M R s b y u s i n g E q ua t i o ns 9 . 7 a nd 1 0 . 6 . Another b e c o me s : i nt e r e sti n g r e l at io n s h i p can be o b t ai ne d at t he r e f er e nc e de p t h of m a x i m u m d o se ( t 0 ) . S i n c e T M R a t d ep t h t 0 i s unit y b y de f i ni tion, E q ua t i o n 10 . 6

60

Co rays, SMRs

a r e a p p ro x i m at el y t h e s a m e a s S A R s . H o w e v e r , f o r hi g he r e ne rg ie s , S M R s s ho ul d

T h i s e q u a t io n w i l l be u s e d i n s e c t io n 1 0 . 2 C . P.183

10.2. PRACTICAL APPLICATIONS

R a d i ot h e r a p y i n s t it u ti o n s vary in t he i r tr e a t me nt te c hni q ue s a nd c a l i b r at io n p r a c t i ce s . F o r e x a m ple , s o m e r el y e x c l us i ve l y o n t he S S D o r t he S A D ( i s o ce nt r i c ) t y p e te c h n i q u e s , w h i le o t h e r s u s e bo t h. A c c o r d i ngl y , uni t s a r e ca l i b r at ed i n a i r o r i n p h a n t o m a t a s u ita b l e re f e r e nc e d e pt h. In a d d i t io n, c l i ni c al f i e l d s , al t ho ug h b a s i c a ll y re c t a n g u l a r o r s q u a re , a r e o ft e n sha p e d i r r eg ul a r l y to pr o te c t c r it i c al o r normal re gi o n s of th e b od y . T hus a c al c ul a ti o n s y st e m m us t be ge ne r a ll y a p p li c a bl e to t h e a bo v e p r a c ti c e s , w it h a c c e p t ab le a c c ur a c y a nd s i m p li c it y f o r routine use.

A. Accelerator Calculations A.1. SSD Technique

Percent d e pt h do s e is a s u i t ab le q uant i t y fo r c al c ul a ti o ns
-2

i nv o l v i ng

SSD

t e c h n i q u e s . M a c h i n e s a r e u s u a l l y c a l ib r a te d t o de li v e r 1 r a d (1 0

G y ) p e r m o ni to r

u n i t ( M U ) a t t h e re f e re n c e d ep t h t 0 , f o r a re f e r e nc e f ie ld s i z e 1 0 1 0 c m a nd a s o u r c e - to - c a li b r at io n p o i nt d i st a n c e o f S C D . A s s um i ng t ha t t he S c f a c t o r s r el a te to c o ll i m at o r f ie ld s i z e s d e f i n e d at t he S A D , the m o ni to r uni t s ne c es s a r y t o d el i v e r a c e r t ai n t u m o r d o se ( T D ) a t de pt h d f o r a fi el d s i ze r a t t he s ur f a c e a t a ny S S D a re given by:

w h e r e K i s 1 r a d p e r M U , r c i s t h e c o ll im a tor f i e l d s i ze , g i v e n b y :

and:

It m u s t b e re m em b e re d t h a t , w he r e a s t he f i e l d s i z e f o r t he S c is d e f i ned at t he S A D , S p r e l a te s t o t h e f i e l d i rr a d i at i ng t he pa t i e nt .

WWW.MEDRAD.IR

Example 1
A 4 - M V li n e a r a c ce l era t o r i s c al ib r a te d to gi v e 1 r a d ( 1 0 - 2 G y ) per M U i n p ha nt o m a t a re f e r e n c e d ep t h o f m a x i m u m do s e o f 1 c m , 10 0 - c m S S D , and 1 0 1 0 cm f i e l d s i z e . D et e r mi n e t h e M U v al ue s to d el iv e r 2 00 r ad s to a p at i e nt at 10 0 - cm S S D , 1 0 - c m d e pt h , a n d 1 5 1 5 c m f i el d si z e , g i v e n S c ( 15 1 5 ) = 1 . 0 2 0 , S p ( 15 1 5 ) = 1 . 0 1 0 , %D D = 6 5 . 1 . F r o m E q ua ti o n 10 . 8 ,

form

for

t re a t men t

c a l c u l a ti o ns

is

sho w n

in

Fig.

10.4

with

t he

a bo v e

c a l c u l a ti o n s f i ll ed i n .

Example 2
D e te r m i n e t h e M U f o r t h e tr e at m e nt c o ndi ti ons g i v e n i n E x a m pl e 1 e x c e pt t ha t t he t r e at m e n t S S D i s 1 2 0 c m , g i v e n S c ( 1 2 . 5 1 2 . 5 ) = 1 . 0 10 a nd % D D f o r t he ne w SSD is 66.7.

WWW.MEDRAD.IR

F I G . 1 0 . 4 . A c c e l e r at or c a l c u l a ti o n s he e t .

P.184

F r o m E q u a t io n 1 0 . 8 ,

A.2. Isocentric Technique

T M R i s t h e q u a n t i t y o f c h o i c e f o r do s ime t ri c c a l c ul at io ns i nv o l v i ng i s o ce nt r i c techniques. Since t he unit is c a li b r at e d to gi v e 1 rad ( 10 - 2 Gy)/MU at t he r e f e r e n c e d e pt h t 0 , cal i b r at io n di s t a nc e S C D, a nd f o r t he r e f e re nc e f i el d (1 0 1 0 c m ) , t h e n t h e mo n i tor u n i t s n e ce s s a r y to d e li v e r i s o ce nt e r do s e ( ID ) a t d ep t h d are given by:

where

Example 3
A t u m o r d o s e o f 2 00 r a d s i s t o b e de li v e r e d a t t he i s o c e nte r w hi c h i s l o c a t ed a t a d e pt h o f 8 c m , g i v e n 4 - M V x - r a y b e am , f ie l d s i z e a t t he i s o ce nt e r = 6 6 c m , Sc(6 6) = 0.970, P.185 S p ( 6 6 ) = 0 .9 9 0 , ma c h i n e c a l ib r a te d at SC D = 1 0 0 c m , T M R ( 8 , 6 6 ) = 0 . 78 7 . S i n c e t h e c al i b ra ti o n p o i nt i s at t he S A D , S A D f a c t o r = 1 . T hus , us i ng E q ua t i o n 10.9,

Example 4
Calculate MU v al u e s for the case in Example 3, if t he uni t is c al i br a te d n o n i s o c e n t ri c al l y , i . e . , s o u r c e t o c a li b r at io n p o i nt d i st a nc e = 1 0 1 c m .

Thus,

WWW.MEDRAD.IR

B. Cobalt-60 Calculations
T h e a b o v e c a l c u l at io n s y s t e m i s s uf f i c ie nt l y g e ne r al t ha t i s c a n be a p pl ie d to a ny r a d i at io n c a l i b ra t ed g e n e r at o r , including
60

Co.

In

t he

l at t er

case,

t he

m a c hi ne

can

be

ei t h e r i n a i r o r i n p ha nto m

pr o v i de d t he

f ol lo w i ng i nf o r m a ti o n i s

a v a i l a bl e : ( a ) do s e r at e D 0 ( t 0 , r 0 , f 0 ) i n p ha nt o m a t d e pt h t 0 o f ma x i m um d o s e fo r a r e f e r e n c e f i el d si z e r 0 a n d s t a nd a r d S S D f 0 ; ( b ) S c ; ( c ) S p ; ( d ) p e r c e nt d ep t h d o s e s ; a n d ( e ) T M R v a l u e s . If u ni v e r s a l d ep t h d o se d a t a fo r
60

Co ( 1 6 ) a re us e d ,

t h e n t h e S p a n d T M Rs c a n b e ob t ai ne d by us i ng E q ua t io ns 10. 1 a nd 10 . 5 . In a d d it io n , t h e S S D u se d i n t h e s e c al c ul a tions s ho ul d b e co nf i ned to a r a ng e fo r w h i c h t h e o u t p u t i n a i r o be y s a n i nv e r s e s q ua r e l a w f o r a c o ns t a nt c o ll i m at o r opening. A f o r m f o r c o b a lt c a l cu l a t io n s i s p r e se nt e d in F i g . 1 0 . 5 .

F I G . 1 0 . 5 . C a l c u l a ti on s h e e t c o b al t -6 0 . P.186

WWW.MEDRAD.IR

Example 5
A t u m o r d o se o f 2 0 0 r a d s i s to be de li v e r ed a t a 8 - c m d ep t h, us i ng 15 15 - c m f i e l d s i z e , 1 0 0 - cm S S D , a n d p e n u m b r a t r i mm e r s up . T he uni t i s ca l i b r at ed to g i ve 1 3 0 r a d s / mi n i n p h a n to m at a 0 .5 - c m de pt h f o r a 1 0 1 0 - c m fi eld w i t h t r i mm e r s u p a n d S S D = 8 0 c m . D e te r m i n e t he tim e o f i r ra d i at io n, g i ve n S c ( 1 2 12 ) = 1 . 0 1 2 , S p (1 5 1 5 ) = 1 . 0 1 4 , a n d % DD ( 8 , 15 1 5 , 1 0 0 ) = 6 8 . 7 .

C. Irregular Fields
D o s i me t r y o f i r re g u l ar f i e l d s u s i ng T M R s a nd S M R s i s a na l o g o us t o t he m et hod u s i n g T A R s a n d S A R s ( s e c t io n 9 . 5 ) . S i nce t he m a t he m a ti c a l r a t io na l e o f t he m e t h od h a s b e e n d i s cu s s e d i n d e t ai l i n t he l it e r at ur e ( 5 ) , o nl y a b r i e f o utl i ne w ill b e p r e se n t ed h e r e to il l u s t r at e t h e p r o ce d ure . A n i r r e g u l ar f ie l d a t de p t h d m a y b e di v i d ed i nto n e le m e nt a r y se c t or s w it h r a dii e m a n a t i n g f r o m po i n t Q o f c a l c ul at io n ( Fig . 9 . 10 ) . A C l ar k s o n t y p e i nt e g r at io n ( C h a p t e r 9 ) m a y b e pe r f o r m ed to g i v e a v e ra g e d s c a tt e r -m a x i m um r a t io (

( d , r d ) ) f o r t h e i r r e g ul ar f i e l d r d :

w h e r e r i i s t h e r a d i u s o f t h e i t h s e ct o r a t d e pt h d a nd n i s t he t ot a l num b er o f s e c t or s ( n = 2 / , w h e r e i s t he s e cto r a ng l e ) . T h e c o m p u t ed

( d , r d ) i s t h e n c o n v e rt ed t o

( d , r d ) b y u s i n g E q u a t io n 1 0 . 6 .

P.187

WWW.MEDRAD.IR

where

, ( r d ) i s t h e a v e r ag ed S p f o r t h e i r r eg ul a r f i e ld a nd S p (0 ) i s t he S p f o r t he 0 0

a r e a f i e ld . T h e a b o v e e q u a t io n i s s t r i ct l y v a l i d o nl y f o r p oi nt s a l o ng t he c e nt r al a x i s o f a b e a m t h a t i s n o r m a l l y i nc i de nt o n a n i nf i ni t e p ha nt o m w i t h f l a t s ur f a c e . F o r o f f - a x i s po i nt s i n a b e a m w it h no nuni f o r m p ri m a r y do s e pr of i l e , o ne s ho ul d write

w h e r e K p i s t h e o f f - a x is r a t io r ep r e se nt i ng pr i m a r y do s e at po i nt Q r e l at i v e t o t ha t a t t h e c e n t r al a x i s .

( d , r d ) m a y b e c o n v e rte d i n to p e r ce nt d ep t h d o s e P ( d , r , f ) b y us i n g E q ua t i o n 1 0 .4 .

F r o m E q u a t io n s 1 0 . 7 an d 1 0 . 1 3 w e g et t he f ina l e x p r e s s io n:

T h u s t h e c a l c u l a tio n o f pe r c e n t d ep t h do s e fo r a n i r re g ul a r f i e ld re q ui r e s a C l a r k s o n i n te g r at io n o v e r t h e f u nc t io n S M R b ot h a t t he po i nt of c a l c ul a ti o n Q as w e l l a s a t t h e re f e r e nc e d e pt h ( t 0 ) a t c e ntr al a x i s .

C.1. SSD Variation Within the Field

T h e p e r c e n t de p t h dos e a t Q i s n o r m al i z e d w i t h r e s p e ct to t he D m a x o n t he c e nt r al a x i s a t d ep t h t 0 . L e t f 0 b e t h e no mi na l SS D a lo ng t he c e ntr a l a x i s , g b e t he v e r t i c al g ap d i st a n c e , i . e . , g a p b et w e e n s k i n s ur f a c e o v e r Q a nd t he no m i nal S S D p l a n e , a n d d b e th e d e pt h o f Q f r om s k i n s ur f a c e . T he p e r c ent d e pt h do s e i s then given by:

T h e s i g n o f g s h o u l d b e se t p o si ti v e o r nega t i v e , d e pe nd i ng o n i f t he S S D o v e r Q i s l a r ge r o r s m a ll e r t h a n t h e n o m i na l S S D .

C.2. Computer Program

A c o m p u t e r a lg o ri t h m e m b o d yi n g t he C l a r ks o n' s p r i nc i pl e a nd sc a t t er - a i r r at io s w a s d e v e l op ed b y C u n n i n g h a m e t a l . ( 1 7 ) a t t he P r i nc e s s Ma r g a r e t Ho s p it a l , T o r o n to , and was pu b l i s h e d in 1 97 0 . Ano t he r p ro g r a m , b a se d on t he sa m e p r i n c i pl e , w a s d e v el op e d b y K h a n ( 1 8 ) at t he U ni v e r si t y o f M inne s o t a . It w a s

WWW.MEDRAD.IR

o r i gi n a ll y w r i tt e n fo r t h e C D C - 3 30 0 c o mp ute r us i ng S A R s a nd l ate r r e w ri tt e n f o r t h e A r t ro n i x P C - 1 2 an d P D P 1 1 /3 4 c o mput e r s . T he l att e r v ers i o ns us e S M R s instead of SARs. T h e f o l lo w i n g d at a a re p e r m a n e n tl y s to r e d i n t hi s c o m p ut e r p rog r a m : ( a ) a t a bl e o f S M R s a s f u n c t i o n s o f r a di i o f ci r c ul a r f i e l d s a nd ( b ) t he o ff - a x i s r a t io s K p , d e r i v ed f r o m d o se p ro f i le s a t s e le c te d de pt hs . T he s e d a t a a r e the n s t o r e d i n t he f o r m o f a t ab le o f K p a s a f u n c t i o n o f l / L w he r e l i s t he l a te r a l d is t a nc e o f a po i nt f r o m t h e c e n t ra l a x i s a n d L i s t h e di s t a nce a l o ng t he s a m e li ne to t he ge o me t ric e d ge o f t h e b e a m . U su a l l y l a r g e f ie ld s a r e us e d f o r t he s e m e a s ure m e nt s . T h e f o l l o wi n g d a t a a r e p r o v i de d f o r a p a rt i cul a r p a t ie nt :

C o n t o u r p oi n t s : t h e o u t li n e o f t he i r r eg ula r f i e l d c a n b e d r a w n f r o m t he p o rt ( f i el d ) f il m w i t h a c t u a l bl o c k s o r ma r k e r s i n p l a ce to de f i ne t he f i el d . The field co n t o u r is then d i g iti z e d a nd t he c o or d i nat e s s to re d in t he c o m p u te r .

The

c o o r di n a t e s

(x,

y)

of

t he

p oi nt s

of

c a l c ul a ti o n

are

a ls o

e nt e r ed ,

i n c l u d i n g t h e re f e r e n ce po i nt , us ua ll y o n t he c e nt r al a x i s , ag a i ns t w hi c h t he p e r c e n t de pt h d o s e s ar e c a l c ul a te d .

P a t i e n t m e a s u r e me n ts : p a ti e nt t hi c k ne s s a t F i g . 1 0 . 6 f o r a m a n tl e f i e l d a s a n e x a m p le .

v a r io us p oi nt s of i nt e r e st ,

S S D s , a n d s o u r c e - t o - fi l m di s ta nc e a r e me a sur e d a nd r e c or d ed a s s ho w n i n

F i g u r e 1 0 .7 s h o w s a d a i l y t ab le c a l c ul at e d b y t he c o m p ut e r fo r a t y p i c a l m a ntl e f i e l d . S u c h a t a b le is u s e f u l i n p r o g r a mm i ng t r ea t me nt s s o t ha t t he do s e to v a r i o u s r e gi o n s o f t h e P.188 f i e l d c a n b e a d j u s te d . T h e a r e a s t ha t r e c e iv e t he p r e s c r ib e d do se a f t e r a c e r t ai n n u m b e r o f t r e a tm e n t s a r e s h i e ld e d f o r t he r em a i ni ng s e s s io ns .

WWW.MEDRAD.IR

F I G . 1 0 . 6 . F o r m f o r r e c o r di n g p at ie nt a nd d o s im e tr i c d at a f o r ma nt l e f ie l d . No te t h a t t h e m e a s u r e me n t p o i n t s a re s t a nd a r di z e d b y a na t o mi c l a nd ma r k s .

D. Asymmetric Fields
M a n y o f t h e m o de r n l i n e a r a c c el e r at o r s a re eq ui p pe d w i t h x - r ay c o ll i m at or s (o r j a w s ) t h a t c a n b e m o v e d i n de p e nde nt l y to a l lo w a s y m m e t ri c f i e ld s w i t h f i el d c e n t e r s p o si ti o n ed a wa y f r o m t h e t r ue ce ntr a l a x i s o f t he b e a m . F o r e x a m pl e , a n i n d e pe n d e n t j a w c a n b e mo v e d t o b lo c k o f f ha l f o f t he fi e ld a lo ng c e nt r al a x i s t o e l im i n a te b e a m d i v e rg e n c e . T h i s f e a t ur e is us e f ul f o r m a t c hi ng a d j a c e nt f ie ld s .

WWW.MEDRAD.IR

A l t h o u g h t h i s f u n c t ion c a n a l s o b e pe r f o rm e d b y be a m s pl it ter s o r s e co nd a r y b l o c ki n g o n a s h a d o w t r a y , a n i nd e p e nd e nt j a w f e a t ur e r ed uc e s t he s e t up t i me a n d s p a r e s t h e t h e r api s t f r o m h a nd li ng he a v y b l o c k s . The effect of a s y mm e t ri c b e am c ol li m at io n on d o se di s t ri but i o n ha s b ee n d i s c u s s e d i n t h e l it e r at u r e ( 19 , 2 0 ) . W he n a f i e l d i s c ol li m at e d a s y m m e t ri c a ll y , o ne n e e d s t o ta k e i n t o ac c o u n t c h a n g e s i n t h e c o ll i m at o r s c a tt e r , p ha nt o m s c a t te r , a n d o f f - a x i s b e a m q u a l it y . T h e P.189 l a tt e r e f f e c t a ri s e s a s a c o n s e q u e nc e o f usi ng b e am - f l a tt e ni ng f il t er s ( t hi c k er i n t h e m i dd le a n d t h i n n e r i n t h e p e r ip he r y ) , w hi c h r e s ul t s i n g r e at e r b e a m ha r d e ni ng c l o s e t o t h e c e n t r a l a xi s c o m p a re d w it h t he p e r ip he r y o f t he b e a m ( 2 1 , 2 2 ) .

F I G . 1 0 . 7 . C o m p u t e r o u t p u t s h ee t s ho w i ng c um ul a t i ve m id t hi c kne s s d o s e s f o r a m a n t l e f i el d . T ot a l dos e t o v a r i o us po i nt s is p r o g r a m me d b y a l ine d r a w n t hr o ug h t h e t ab le . A s s oo n a s a g i v e n a re a r e a c he s it s p re s c r ib e d d o se , i t i s s hie ld ed d u r i n g s u b s e q u e nt t re a t m e nt s . It i s not ne c e s s a r y to r e c al c ul ate t he t a bl e w it h t h i s c h a n g e i n b l o c ki n g s i n c e o n l y a f e w t r ea t m e nt s a r e a f f e ct e d . A d o s e c a l c u l at io n f o r m a l i s m f o r a s y m m et r ic f i e l d s ha s b e e n d e ve l op ed w hi c h i s d e s c r ib e d b e lo w . F o r a po i n t at t h e cen t e r o f a n a s y m m e tr ic f i e l d a nd a l at e r al d i s t a nc e x a w a y f r o m t h e b e a m c e n t r al a x i s , t h e c o l li m a to r s c a t te r f a c t o r m a y b e a p p r o x i m at ed t o a s y m m e t ri c f i el d o f th e s a m e c ol li m at o r o pe ni ng a s t hat o f t he gi v e n a s y m m e t ric field. In ot h e r w o rds , the Sc w il l d ep e nd on t he a c t ua l c ol li m a to r o p e ni n g , i g n o ri n g s m a ll c h a n g e s i n t h e s c a t t er e d p ho to n f l ue nc e t ha t m ay r e s ul t o w i ng to t h e c h a n g e i n t h e an g l e o f t h e a s y m m etr i c j a w s r e la ti v e t o t he be a m . T hi s

WWW.MEDRAD.IR

a p p r o xi m a ti o n i s r e a so n a b l e a s lo ng a s t he p o i nt o f d o s e c al c ul at io n i s c e nt r a ll y l o c at e d , t h at i s , a w a y f r o m f i e ld e d ge s . T h e p h a n t o m s c at te r c a n a l s o b e a s s um ed to be t he s a m e fo r a n a s y m m e t r ic f i el d a s f o r a s y m m e t r i c f ie l d o f t h e s a me d i mens i o n a nd s ha p e , p r ov i d e d t he p oi nt o f c a l c u l a ti o n i s lo c a te d a w a y f r o m t he f i e l d ed g e s to a v o id p e num br a l e f f e c t s . T h e p r i m a r y do s e d i str i b u ti o n h a s b ee n s how n t o v a r y w i t h l at e ra l di s t a nc e f ro m central axis because of the c ha ng e in beam q ua li t y , as me nt io ne d e a rl ie r . T h e r e f o r e , t h e pe r c e nt d e pt h d o s e o r T M R d i s t ri b utio n a l o ng t he c e nt r a l r a y o f a n a s y m m e t r ic f ie l d i s n ot t h e s a m e a s al o ng the c e nt r al a x i s o f a sy m m e t r i c f i el d o f t h e s a m e s i z e a n d s h a p e . In a d d i ti o n, t he i nc i d e nt p r i m a r y be am f l ue nc e a t o f f a x i s po i n t s v a r i e s a s a f u n c t i o n o f di s t a nc e f r o m t he ce nt r al a x is , d e pe nd i ng on t h e f l a tt e n i n g fi lt e r de s i g n . T h e s e e f f e ct s ar e no t e m p ha s i z ed i n t he d o si m et r y o f s y m m e t r i c f ie ld s , b e ca u s e t a r g et d o se s a r e us ua l l y s p e c i f i ed a t the b e a m c e nt r a l a x i s a n d t h e o f f - a x i s d o s e d i st r ib ut io ns a r e v i e w e d f r o m t he i so d o se c ur v e s . In a s y m m e t r ic f i el d s , h ow e v e r , t h e t a r ge t o r the p o i nt o f i nte r e st do e s not li e o n t he b e a m ce n t r a l a x i s ; t he r e f o re , a n o f f - a x i s do s e co r r e ct io n m a y be r e q ui r e d i n t he c a l c u l a ti o n o f t a r ge t d o s e . T h i s co r r e ct ion w i l l de p e nd o n t he d ep t h a nd t he d i s t a n c e f ro m t h e c e nt r a l a x i s o f t he po i nt o f i nt e re s t . S i n c e b e a m f l a t n e s s w i t h i n t h e c e nt r a l 80 % o f t he m a x i m um f i e l d s i z e i s s p e c i fi e d w i t h i n 3 % a t a 1 0 -c m d ep t h , i g no ri ng of f - a x i s d o s e co r r e ct ion i n a s y m m et r i c f i e l d s w il l i n t r od u c e e r r o r s o f t h at m a g nitud e und e r t he s e c o nd i ti o ns . T hus t he off-axis dose P.190 c o r r e ct io n w i l l fo ll o w c h a n g e s i n t he p r i ma ry b e a m f l a t ne s s a s a func t i o n o f d ep t h a n d d i s t a nc e f r o m c e nt r a l a x i s . In v i e w o f t h e a b o v e d i s c u s s io n , t he f o ll ow i ng e q ua ti o ns a r e pr o po s e d fo r t he c a l c u l a ti o n o f m o n ito r u n i t s f o r a s y m m e t r i c f i e l d s . F o r S S D t y p e o f t re a tm e n t s , E q u a t i o n 10 . 8 i s m o di f i ed to :

w h e r e O A R d ( x ) i s t h e p r i m a r y o f f - a x i s r a tio a t de p t h d , t hat i s , r a t io o f p r im a r y d o s e at t h e o f f - a x i s p o i nt o f i n te r e st to the p r i m a r y do s e at the c e nt r a l a x i s at t h e s a m e d ep t h f o r a s y m m e t ri c a ll y w i de op e n f i el d . P ri m a r y o f f- a x i s r a ti o s m a y b e e x t r a c te d f r o m d ept h d o se p r o fi l e s o f t he l a r ge s t f i el d a v a i l ab le b y s ubt r a c ti ng s c a t te r . A di r e ct m et h o d co n s i s t s o f me a s ur i ng t r a ns mi tt e d do s e p r o f il e s t hr o ugh d i f f e r e n t t h i c k n e s s e s o f a n a b s o rb e r und e r g o o d g eo m et r y c o ndi ti o ns ( a na r r ow beam and a l a r ge d e te c to r - to - a b so r be r d i s t a nc e ) (2 3 ) . A no t he r di r e ct b ut a p p r o xi m a te m et h o d is t o m e a s ur e p r o fi l e s a s a f unc t i o n o f d e pt h f o r a na r r o w e l o n g at ed f ie l d ( e . g . , 5 4 0 cm ) . S i nc e t he p r i m a r y d o se p ro f i le is c r e a te d b y t he f l a t te n i n g f i lt e r , w h i c h h a s a r a d i a l s y m m et ry , p r i m a r y O A R d a t a ca n b e t a b ul at ed a s a f u n c t i o n o f d e pt h a n d r a d i a l d is t a nc e f ro m c e nt r al a x i s . F o r i s o ce n t ri c t y p e o f t r e at m e n t s , E q ua t io n 1 0 . 9 i s mo d i fi e d t o :

WWW.MEDRAD.IR

T h e a b o v e f o r m al i s m i s g e n e r al a nd c a n b e us e d f o r a n o f f - a x i s p o i nt d o se c a l c u l a ti o n i n s y m m etr i c or a s y m m et r i c f i eld s g e ner a te d b y bl o c ks o r co ll im a to r s , i n c l u d i n g m u l ti le a f c ol li m a to r s . F o r i r r eg ula r l y s ha p e d f i e ld s t he p a r a m e te r r d i s the e q u i v al e n t f ie ld size d et e r mi ne d by C l a r k s o n' s t e c hni que or g eo me t ri c a p p r o xi m a ti o n ( se c ti on 1 0 . 3 ) . T he p a r a met e r r c i s t he co ll i ma to r op e ni ng si z e p r o je c te d a t t h e st a n da r d S S D .

10.3.

OTHER

PRACTICAL

METHODS

OF

CALCULATING

DEPTH DOSE DISTRIBUTION A. Irregular Fields

C l a r k s o n ' s t e c h n i q u e is a g e n er a l me t ho d o f c a l c ul at i ng d e pt h do se di s t ri b uti o n i n a n i r r e g u l a rl y s h a p e d f i e l d , b ut i t i s no t p r ac t i c al f o r r o uti ne m a nua l c a l c ul a ti o ns . E v e n w h e n c o m p u t e r iz e d , i t i s t i me - c o ns um i ng s i nc e a c o ns id er a b l e a m o unt o f i n p u t d at a i s re q u i re d b y t h e c o mp ut e r p rog r a m . H o w e v e r , w it h t he e x c e pt io n o f mantle, i n v e r t ed Y, and a few o t he r c o m pl e x f i el d s , re a so na b l y a c c ur a te c a l c u l a ti o n s c a n b e m a d e f o r m o st b l o c ke d f i e ld s us i ng a n a p p r o x i m at e m et hod ( 1 8 ) , t o b e d i s c u s se d . Figure 10.8 shows a number of b lo c k e d f i e ld s e nc o unt e r ed in r a d iot he r a p y . A p p r o x i ma t e re c t a n gle s m a y b e d r a w n c o nt a i ni ng t he p oi nt o f c a l c ul a ti o n to i n c l u d e mo s t o f t h e i rr a d i at e d ar e a s ur r o und i ng t he po i nt a nd e xc l ud e o nl y t ho se a r e a s t h a t a r e re m ot e t o t h e p oi nt . In s o do i ng , a b lo c k e d a re a m a y b e i ncl ud ed i n t h e re c t a n gl e , p r ov i d e d t h i s a r e a i s s ma l l a nd i s r e mo te l y l oc a t e d r el a ti v e to t h a t p oi n t . T h e r e c t a ng l e t h u s f o r m ed m a y b e c a l le d t he e f f e c t i ve f i e ld , w hi l e t he u n b l o c k e d f i el d , de f i n e d b y t h e c ol li m a to r , m a y b e c a l l ed t he c ol li m a to r f i el d . O n c e t h e e f f e ct i v e f ie l d h a s be e n de te r m ine d , o ne m a y p ro c eed w i t h t he us ua l c a l c u l a ti o n s a s d i s c u ss e d i n se c ti o n 10 . 2 . H o w e v e r , it i s i m po rta nt t o r e me m be r t h a t , w h e r e a s t h e S c i s r e l at e d to t he c ol lim a t o r f i el d , t he p er ce nt d e pt h d o s e , T M R , o r S p c o r r e s po n ds t o t h e e f f e ct i v e f i el d.

B. Point Off-Axis
It i s p o s si bl e to c a l c ula t e d e pt h do s e di s t ri but i o ns at a ny po i nt w it hi n t he f i el d o r o u t s id e t h e f ie ld u s i ng C l a r k s o n ' s t e c hni q ue . H o w e v e r , a s st at e d e a r li e r , i t i s no t p r a c t i ca l f o r m a n u a l c a l c u l a ti o n s . D a y ( 2 4) ha s p r o p o s e d a p ar t i c ul a rl y s i m pl e c a l c u l a ti o n m et h o d f o r P.191 r e c t a n g u l a r f i el d s . In t h i s m et h o d , p e r ce nt d ep t h d o se c a n b e ca l c ul a te d a t a ny p o i nt w i t h i n t h e m ed iu m u s i n g t h e c e nt r a l a x i s d a t a .

WWW.MEDRAD.IR

F I G . 1 0 . 8 . E x a m p l e s o f i r r eg u l a r l y s ha pe d f i e l d s . E q ui v al e nt r e c ta ng l e s f o r d o se at p oi n t s of i n t e re st are shown by d a s he d l i ne s . P o i nt s v er s us e q ui v a l e nt r e c t a n gl e s a re ( A ) 1 , G H K L ; 2 , A BE J ; ( B ) 1, A G H D; 2 , L I J K ; ( C ) 1 , E F G H ; ( D ) 1 , K L G H . F r o m L e v it t S H , K h a n F M , P o t i s h R A , e d s . Te c hno l og i c al ba s i s o f r a di a ti o n t h e r a p y : pr a c ti c a l a nd c li n i c a l a p pl i c at io ns , 2 nd ed . P hi l ad e lp hi a: L e a & Fe bi g e r , 1 9 92 : 7 3 , w it h p e r m i s si o n . T o c a l c u l at e do s e at a n y p o i n t Q , t he f ie ld i s i m ag i ned to b e d i v i de d i nt o f o ur s e c t io n s ( F i g . 10 . 9 ) an d t h e i r c o nt ri b utio n i s c o m p ut ed s e p a r at ely . T h us t he d o s e a t d e pt h d a l o n g t he a x i s t h r o u g h Q i s g i v e n b y ( s um o f c e n t r a l a x i s do s e a t d e pt h d f o r f i e ld s 2 a 2 b , 2 a 2 c , 2 d 2 b , a nd 2 d 2 c ) . S u p p o s e t h e do s e i n fr e e s pa c e o n t he ce ntr a l a x i s t hr o ug h P at S S D + ( d m ) i s 10 0 c G y ( r a d ) a n d i t s v a l u e a t a c o r r e sp o ndi ng p o i nt o v e r Q i s K Q 1 0 0 , w he r e K Q is t h e o f f - a x i s r a t io de ter m i n e d i n a i r f ro m t he p r i m a r y b e a m pr o f il e. If t he B S F a nd c e n t r a l a x i s %D D f o r r e c t a n g u l a r f ie ld s a r e a v a i l a b le , t he do s e at d e pt h d a lo ng t h e a x i s t h r o u g h Q w i ll b e gi v e n b y :

WWW.MEDRAD.IR

F I G . 1 0 . 9 . D a y ' s m eth o d o f c al c u l at i ng d o se a t a ny p oi nt Q i n a r e c t a ng ul a r f i el d . ( S e e t e xt . ) P.192

S i n c e t h e D m a x a t P i s 1 0 0 B S F [ ( a + d ) ( b + c ) ] , t he p e r c ent d e pt h d o se a t d e pt h d a l o n g t h e a x i s t h r o u g h Q , r e l a t i v e to D m a x a t P , w i ll b e gi v e n b y :

Example 6
S u p p o s e i n Fi g . 1 0 . 9 t h a t t h e o v e r a ll fi e ld s i z e i s 15 1 5 c m . F i nd t he pe r c e nt d e pt h d o se a t po i nt Q a t 1 0 c m d e pt h, g i v en a = 1 0 , b = 5 , c = 1 0 , a nd d = 5 . Assume
60

C o b e a m w ith K Q = 0 . 9 8 a nd S S D = 8 0 c m .

U s i n g t h e a b o ve p r o ce d u r e a n d c o ns ul t i ng T a b l e A . 9 . 1 i n t he A p p e nd i x to t he b o o k , t h e r eq u i r ed p e rc e n t d e pt h d o se i s g i ve n b y :

or

WWW.MEDRAD.IR

In t h e a b o v e e x a mp l e, i f t h e p ri m a r y b e am p r o f il e w e re f l at , t hat i s , K Q = 1 , t he p e r c e n t d ep t h do s e a t Q w o u l d b e 5 6 . 9 , w hi c h i s st il l l e s s t ha n 58 . 4 , t he p e r ce nt d e pt h d o s e at P . T h i s o f f - a x i s d e c r e a se i n d o s e i s d ue to t he r ed uc e d s c a tt e r at p o i nt Q c o mp a r ed w i th p o i n t P . S i mi l a rl y , it c a n b e s ho w n t ha t the m a g ni t ude o f t h e r e d u c ti o n i n s c at te r d e pe n d s o n t he d is t a nc e o f Q f r o m P as w e l l a s de p t h. T h u s t h e d ep t h d o se p r o f il e a c r o s s t he f i eld i s a f unc t io n not onl y o f t he be a m f l a t n e s s i n a i r b u t a l so t h e d ep t h i n t he p hant o m . F o r h i g h e r - e n e rg y b e am s ( 8 M V ) , t he a b o v e p r o c ed ur e m a y b e f ur t he r s i m p li f ie d b y a s s u m i n g B S F = 1 f o r a ll f i el d s i z e s . A l s o , D a y ' s p r o ce d ur e c a n b e a d o pt ed u s i n g S p v a l u e s i n s t ea d o f B S F , s i nc e t he t w o q ua nti ti e s a re r ela t e d b y E q ua t io n 10.1.

F I G . 1 0 . 1 0 . C a l c u l a t io n o f d e pt h d o s e o ut s id e a r e c t a ng ul a r f ie ld . ( S e e t e x t .)

C. Point Outside the Field

D a y ' s m e t h o d c a n b e e x t e n d ed a l so t o t he c a s e o f d e te r mi ni ng do s e di s t ri b uti o n a t po i n t s o u t si d e t h e f i e l d li m it s . In F i g . 1 0. 1 0 , a r e ct a ng ul a r f ie ld o f di m e ns io ns a b i s s h o w n w i t h t h e c e n t r al a x i s p a ss i ng t hr o ug h P . S up po s e Q i s a po i nt o u t s id e t h e fi e ld at a d i st a n c e c f r o m t he f i el d bo r d e r . Im a g ine a r e ct a ng le a d j a c e n t to t h e f ie ld s u c h t h a t it co nt ai ns p oi nt Q a nd ha s d i me ns i o ns 2 c b . P l a c e a n o t h e r re c t a n gl e o f di m e n s io ns a b o n t he ot he r s i de o f Q s uc h t ha t t he f i e l d o n t h e ri g h t o f Q i s a m i r ro r i m a ge of t he f i el d o n t he le f t, a s s ho w n i n t he f i g u r e . T h e d o se a t p oi n t Q a t d ep t h d i s t hen g i v e n b y s ub t r a ct i ng t he d ep t h do se a t Q f o r f i e ld 2 c b f r o m t h a t f o r f i el d (2 a + 2 c ) b a nd d i v i d i ng b y 2 . T he p r o c ed u r e i s il l u s t ra t ed b y t h e f o l lo w i ng e x am p l e . P.193

Example 7
WWW.MEDRAD.IR

S u p p o s e i t i s r e q u i re d t o de te r m i ne p e r ce nt d e pt h d o s e at Q ( r el at i v e t o D m a x a t P ) o u t s id e a 15 1 0 - cm f i e ld a t a d i st a nc e o f 5 c m f r o m t he f iel d bo r de r . In F i g . 1 0 . 1 0 , t h e n , a = 15 , b = 10 , a n d c = 5 . S up p o se Q i s a t t he c e nte r o f t he m id dle r e c t a n gl e o f d im e n s ion s 2 c b . T he n t he d o s e D Q a t 10 - c m d ep t h i s g i v e n b y : [ D Q ( 4 0 1 0 ) - D Q ( 10 1 0 ) ] If D Q i s n o r m a l i z e d to D m a x a t P , o ne g et s t he p e r c e nt de p t h do s e at Q o r % D Q .

Thus for a

60

Co beam at SSD = 80 cm,

A g a i n f o r h i g h e r -e n e rg y b e a m s , t he ab o v e p r o c ed ur e i s si m pl i fie d b y a s s um i ng B S F = 1 . A l so , i f S p v al u e s a r e k n o w n i ns te ad o f BS F , t he ab o v e ca l c ul a ti o n c a n b e p e r f o r me d b y s u b s ti t ut i n g S p f o r BS F .

D. Point Under the Block

A s d i s c u s s e d e ar li e r , th e d o s e d i st r ib ut io n in a b l o c k ed f i el d i s b es t d et e r mi ne d b y C l a r k s o n ' s m e t h od o f i r r e g ul a r f i el d do s i me tr y . H o w e v e r , i f t he b lo c k e d po r ti o n o f t h e f i el d i s a pp r o x i ma t e d t o a r e ct a ng le , a s i m pl e r me t hod k no w n a s ne g a ti v e f i e l d m et h o d m a y b e u s e d . T h e c o nc e pt o f ne g a ti v e f ie l d ha s be e n d e s c ri be d i n t h e li te r a t u r e (2 5 , 26 ). In t h i s m e t ho d , t he d o s e at a ny p oi nt i s eq ua l to t he d o se f r o m t h e o v e r al l ( u n b lo c k e d ) fi e ld mi nus t he d o se e x pe c te d i f t he e nt i re f i el d w e r e b l o c ke d , le a v i n g t h e sh i e l de d v ol um e o p e n. In o t he r w o r d s , t he b lo c k e d po rt io n o f t h e f i e ld i s c o n s i de r e d a n e g a t i v e f i e ld a nd i t s c o nt r ib ut io n i s s ub tr a c t e d f r o m t he o v e r a ll f i el d do s e di s tr i b u ti o n . A c o m p u te r i z ed n eg a ti v e f ie l d m et ho d no t o nl y i s a f a s t m et hod o f c al c ul at i ng i s o do s e d i st ri b u t io n i n b lo c k e d f ie ld s b ut i s v e r y c o nv e ni e nt f o r ma nua l p o i nt do s e c a l c u l a ti o n . It s p r a c ti ca l u s e f u l n e s s i s i ll us t ra t e d b y E x a m p le 8 .

Example 8
A p a ti e n t i s t r e at ed w i t h a s pl it f ie ld o f ov e r a l l s i z e 1 5 1 5 cm , b lo c k e d i n t he m i d dl e t o s h ie l d a re gi o n o f s i z e 4 1 5 c m o n t he s ur f a c e ( F i g . 1 0 . 1 1 ) . C a l c ul at e ( a ) t h e t re a t me n t t i me to d el i v e r 20 0 c G y (r a d ) a t a 1 0 - c m de p t h a t p oi nt P i n t he o p e n po r ti o n o f t h e f ie l d P.194 a n d ( b ) w h a t p e r c e n ta g e o f t h a t do s e i s r ec e i v e d at p oi nt Q i n the m i d dl e o f t he b l o c ke d a re a , gi v e n
60

C o b ea m , S S D = 8 0 cm , d o se r at e f r e e s p ac e f o r a 1 5 1 5 -

c m f i e ld at 80 . 5 c m = 1 2 0 r ad s / m i n, l e a d b lo c k t hi c k ne s s = 5 c m w i t h p ri m a r y b e a m t r a n s mi s s io n o f 5 % , a n d s h a d o w t r a y ( o r b lo c k t r a y ) t r a ns mi s s io n = 0 . 9 7 .

WWW.MEDRAD.IR

F I G . 1 0 . 1 1 . E x a m p l e o f c a l c u l a ti ng d ep t h do s e und e r a b lo c k .

A p p r o x i ma t e e q ui v a l en t f i e ld at po i nt P [ a sy m p t ot i c al l y e q ua l t o] 5 . 5 15 , a s s u m i n g n e g l ig i bl e sc a t t er c o nt r ib ut io n t o P f r o m t he o t he r o pe n p o r ti o n o f t h e f i e ld a c r o s s t h e b l o c k ed a r e a .

DQ = DQ(15 15) - DQ(4 15) (1 - T) w h e r e T i s t h e t r a n s m i s s io n f a c t o r f o r t he lea d b lo c k .

WWW.MEDRAD.IR

Thus,

Since Dp = 200 cGy (given)

Alternative
L e t u s p r oj e c t al l f ie l ds a t d e pt h = 1 0 c m .

P r o j e ct e d f ie ld s . (15 15) cm 1.125 = 17 17 cm ( 4 1 5 ) c m 1 . 1 2 5 = 4 . 5 1 7 c m = 7 7 c m e q ui v a l e nt s q ua r e ( 5 . 5 1 5 ) c m 1 . 1 25 = 6 . 2 1 7 c m = 9 9 c m e q ui v a l e nt s q ua r e

P.195

Alternative
Since

S u b s t i t u ti n g v a l u e s f r o m T a b le A . 9 . 2 i n t he A p p e nd i x to t he bo o k

WWW.MEDRAD.IR

A l t h o u g h t h e p ri m a r y t r a n s m i s s io n t hr o ug h t he l e ad b lo c k i s o nl y 5 % , t he do s e at a 1 0 - c m de p t h u n d e r th e b lo c k i n t he mi dd le i s ab o ut 20 % o f t he d o s e i n t he o p e n p o rt io n . T h i s i n c r e a s e i n d o s e i s a r e s ult o f t he i nt e r nal s c a t te r c ont r i b ute d b y t he o p e n a r e a s o f t h e f ie ld t o po i n t Q . O f c o ur s e , t he d o s e und e r t he b lo c k d e p e nds o n t h e e xt e n t o f t h e b l o c ke d a r e a , o v e r al l f i e l d s i z e , bl o c k t hi c kne s s , d e pt h, a nd l o c at io n o f p o i nt Q .

Appendices

APPENDIX TO CHAPTER
A. Derivation of Sp
S p ( r ) , a s d e f i n ed i n s ec t io n 1 0 . 1 B, i s t he r at io o f d o se r a te f o r t he g i v e n f i el d ( r ) a t a r e f e r e n c e d e pt h t o t h e do s e r a te a t the s a m e p o i nt f o r t he r e f e r e nc e f i el d s i z e ( r 0 ) , w i t h t h e s am e co ll i m at o r op e ni ng . T hi s i s il l ust r a te d in F i g . 1 0 . 12 . T he g i v e n f i el d i n F i g . 1 0 .1 2 A i s b lo c k e d d o w n to t he si z e o f t he re f e re nc e f i el d i n F i g . 1 0 . 1 2 B w it h o u t c h a n g i n g t h e co ll i m at o r op e ni ng . T hus b o t h a r r a ng e m e nt s ha v e t h e s a m e c ol li m a to r sc a t t er f a c t o r , S c ( r ) , P.196 b u t d i f f e re n t p h a n to m s c a t te r . L et D f s a nd D m a x be t he f r ee s p a ce d o se r a te a nd D m a x d o se r a t e , r e sp e ct i v el y . T h e n , a t t he r e f e r e nc e d e pt h o f m a x im um d o s e ,

w h i c h i s t h e s a m e a s E q u a t i o n 1 0 .1 . E q u a t i o n A 1 c a n a l s o b e w r i tt e n a s :

w h e r e S c , p ( r ) i s t h e t ot a l s c a tt e r co r r e ct io n f a c t o r d e fi ne d a s t he r a t io o f D m a x do se r a t e f o r a g i ve n f i e l d to t h e D m a x do s e r at e f or t he r e f e r e nc e f i el d (F i g . 1 0 . 1 B) .

WWW.MEDRAD.IR

F I G . 1 0 . 1 2 . D i ag r am s to i ll u s t r a te d e f ini t io n o f S p . A : D o se i n p ha nt o m at r e f e r e n c e d ep t h f o r a g i v e n f ie l d . B : Do s e at t he s a m e po i nt f o r a r e f e r e nc e f i eld w i t h t h e s a me c ol li ma t o r o pe n i n g . ( F r o m K ha n F M , S e w c ha nd W , L e e J , et al . R e v i s io n o f t i s s u e - m ax i m u m r a t i o a nd s c a tte r - m a x i m um r a t io c o nc e p t s f o r c ob a lt 6 0 a n d h i g h e r e n e r g y x - r a y b e a m s . M e d P hy s 1 9 8 0 ;7 : 23 0 , w i t h p er m i s s io n. )

B. Derivation of TMR
In F i g . 1 0 . 2 , l e t D 1 an d D 2 b e t he d o se s a t d e pt hs d a nd t 0 ( r ef e r e nc e d e pt h o f m a x i m u m d o se ) , re s pe c t i ve l y . Le t r , r t 0 , a nd r d be t he f i el d s i z e s a t d i st a nc e s f , f + t 0 , a n d f + d f r o m t h e s o u r c e , r e s p e ct i v ely . T he n, b y d e f i ni t io n:

and

w h e r e D ( t 0 , r t 0 , f ) i s t h e d o s e a t de pt h t 0 , f ie l d s i ze r t 0 a nd S S D = f .

C o m b i n i n g E q u a ti o n s A 4 , A 5 , a n d A 6 ,

C. Derivation of SMR
R e f e r r i n g t o F ig . 1 0 .2, l et D 1 ( d , r d ) b e t he d o s e a t p oi nt 1 a nd D 2 ( t 0 , r d ) be t he d o s e a t po i nt 2 f o r f i e l d s i z e r d . L e t D 1 ( d , 0 ) a nd D 2 ( t 0 , 0 ) b e the c o r r e s po nd i ng d o s e s f o r 0 0 f i el d w i t h t h e s a m e c ol li m at o r op e ni ng . T he n:

P.197

WWW.MEDRAD.IR

or

w h e r e r 0 i s t h e r e f e r en c e f i e l d ( 10 1 0 c m) f o r no r m a l i z i ng S p . S i nc e :

and

E q u a t i o n A 9 b e co m e s :

REFERENCES
1. Karzmark CJ, Deu b e r t A, L oe v i ng e r R. T i s s ue - p ha nt o m ra t io s a n a id to t r e at m e n t pl a n n i n g . B r J R a d i o l 19 65 ; 3 8: 1 58 . 2 . H o l t J G . L et te r t o th e e d it o r . A m A s s o c P hy s M e d Q B ul l 1 9 72 ;6 : 1 27 . 3 . S a u n d e r s J E , P r i c e R H , H o r s l e y R J . C e n t r a l a x i s d ep t h d o se s f o r a c o ns t a nt s o u r c e - t u mo r d i st a n c e. B r J R a d i o l 1 9 68 ; 41 :4 6 4 . 4 . H o lt J G , L a u g h li n J S , M o r o n e y J P . T he e x t e ns io n o f t he c o nce p t o f ti s s ue - ai r r a t io s ( T A R ) t o h i g h en e r g y x - r a y b e a m s . R a d i olo g y 1 97 0 ; 96 : 43 7. 5 . K h a n F M , S e w c h a n d W , L e e J , e t a l . R e v i s io n o f t i s s ue - m ax i m um r a t io a nd s c a t te r - m a x i m u m r a tio c o n c e pt s f o r c o b al t 6 0 a nd hi g he r e ne r g y x - r a y b e a m s . M e d P h y s 1 9 8 0 ; 7 :2 30 . 6 . K h a n F M . D o s e d i s tr i b u ti o n p r ob le m s i n c o b a lt te l et he r a p y [ T he s i s ] . U ni v e r s it y o f M i n n e s o t a , 1 96 9 :1 06 . 7 . C u n d i f f J H , C u n n i n g h a m J R , G o l d e n R , e t a l . R P C / A A P M , c o m p i le r . Do s i me t r y w o r k s h o p o n H o dg k i n 's d i s e a s e . H o us to n, T X : M D A nd e r s o n H o s p it a l , 1 97 0 . 8 . M o h a n R , C h u i C . V a l i di t y o f t he co nc e p t o f s e p a r at i ng p rim a r y a nd s c a t t e r d o s e . M e d P h y s 1 9 85 ;1 2 : 72 6 . 9. Bjarngard BE, Cunningham JR. C o m m e nt s on V a li di t y of t he co nc e pt of s e p a r a ti n g p ri m a r y a n d s c a t te r d o se . M e d P hy s 1 9 8 6 ; 13 : 7 60 . 1 0 . M o h a n R , C h u i C . R e p l y t o co m m e nt s b y Bj a r ng a r d a nd C unni ng ha m . M e d P hy s 1 9 86 ; 1 3 :7 61 . 11. A m e ri c a n A s s o ci a ti o n of P hy s i c i s t s in M e di c i ne . A pr o to c ol for t he d e te r m i n at io n o f a b s o r b ed d o se f r o m hi gh e ne r g y p ho t o n a nd e l e ct r o n b e a m s. M e d P h y s 1 9 8 3 ; 10 : 741 . 1 2 . A l m o nd P , R o o sen b e e k E V , Br o w ne R , e t a l . V a r i a ti o n i n the p o s it io n o f t he c e n t r a l a x i s m a x i m u m b u i l d - u p po i nt w it h f ie l d si z e f o r hi g h- e ne rg y p ho t o n be a m s [ L e tt e r t o t h e E di to r ] . B r J R a d i o l 1 97 0 ; 43 :9 1 1 .

WWW.MEDRAD.IR

1 3 . D a w s o n D J . P e r ce n t a g e d e pt h d o se s f o r hi g h e ne r g y x - r a y s . P hy s M e d Bi o l 1 9 76 ; 2 1 :2 26 . 14. Bagne F. Physical aspects of s upe r v o lt a ge x-ray t he r a p y . Med P hy s 1 9 74 ; 1 : 26 6 . 1 5 . S u n t h a r a l i n g a m N , S t e b e n D J . P hy s i c a l c ha r a c t e ri z a t io n o f 4 5 - M V p hot o n b e a m s f o r u s e i n t r e atm e n t p l a n n i ng . M e d Phy s 1 9 7 7 ; 4 :1 3 4 . 1 6 . J o h n s H E , B r u c e W R , R e i d W B. T he d e p e nd e nc e o f d ep t h d os e o n f o c a l s k i n d i s t a n c e . B r J R a d i ol 19 5 8 ;3 1 : 25 4 . 1 7 . C u n n i n g h a m J R , S h r i v a s t a v a P N , W i l k i ns o n J M . C o m p ut e r ca l c ul a ti o n o f d o se w i t h i n a n i r r e g u l a rl y s h a p e d b e am . R P C / A A P M , c o m p i le r . Do s i met r y w o r k s ho p o n H o d g ki n ' s d i s e a se . H o u s t o n , T X : M D A nd e r s o n H o s p it a l , 1 97 0 . 1 8 . K h a n F M , L e v i t t SH , M o o r e V C , e t a l . C o m p ute r a nd a p p r o x im a t io n m e t hod s o f c a l c u l a ti n g d ep t h d o se i n i r r e g u l a rl y s ha p e d f i e l d s . R a di ol og y 1 97 3; 1 0 6 :4 3 3 . 1 9 . K h a n F M , G e rb i B J , D e i be l F C . Do s i me t r y o f a s y m m et r i c x- r a y c o ll i ma to r s . M e d P h y s 1 9 8 6 ; 13 : 936 . 2 0 . Lo s h e k DD . A n a ly s i s o f t i s s ue -m a x i mum r a t io / s c a tt e r -m a x im um r a t io m o de l r e l at i v e to t h e p re d i ct io n o f t i s s ue - m a xi mum r a t io i n a s y m m etr i c a ll y c ol li m a te d f i e l d s . M ed P h y s 1 9 8 8; 1 5 : 67 2 . P.198

2 1 . H a n s o n W F , B e r k l e y L W . O f f - a x i s b e a m q ua l it y c ha ng e i n l i nea r a c c e l e r at or x r a y b e a m s . M e d P h y s 1 9 80 ; 7 : 14 5 . 2 2 . K ep k a A G , J o h n s on P M , D a v i d J . T he e f f e c t o f o f f - a x i s q ua l it y c ha ng e s o n z e ro a r e a T A R f o r m e g a v o lta g e b e a m s . P hy s M e d Bi o l 19 85 ; 3 0 :5 89 . 2 3 . G i bb o n s J P , K h a n F M . C a l c u l a t io n o f do s e i n a s y m m et ri c x - r a y c o l li m at o r s . M e d P h y s 1 9 9 5 ; 22 : 145 1 1 4 57 . 2 4 . D a y M J . A n o t e o n t h e c a l c ul at io n o f d o s e i n x - r a y f i e ld s . 1 9 50 ; 2 3 :3 68 . 2 5 . S u n d b o m L . M e th o d o f d o se p l a nni ng o n a p p l i c at io n o f s hi e ld i ng f il te r s i n c o b a lt 6 0 t el et h e r a p y . A c t a R a d i ol T he r P hy s Bi o l 1 96 5 ;3 : 2 10 . 2 6 . K h a n F M . C o mp u te r do s im e tr y o f p a r ti al l y b lo c k e d f i el d s i n co b a lt t el et he r a p y . R a d i ol og y 1 97 0 ; 97 : 405 .

1

Br J R a d i o l

C o ll i m at o r s c at t er i n c l u d e s p h ot o ns s c a tt er e d b y a l l c om p o ne nts o f t he m a c hi ne

h e a d i n t h e p a t h o f t he b e a m .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Par t II - C lassical Radiation Therapy > 11 - Treatment Plannin g I: Isodose Distr ibutions

11 Treatment Planning I: Isodose Distributions

In order to r e p re se n t v o l u m et r i c or p l a na r v a r i a ti o n in a b s o r be d

T h e c e n t r a l a x i s d e pt h d o s e di s t ri b uti o n b y it s e l f i s not s uf f i c i e nt to c ha r a c t e ri z e a r a d i at io n b e a m t h a t pr o d u c e s a d o se d i st r ib ut io n i n a t hr e e - d i me ns i o na l v ol um e . do s e , d i s t ri b u tio n s a r e d e pic t e d b y m ea ns o f i s od o s e c ur v e s , w hi c h a r e l i ne s pa s s i ng t h r o u g h p oi n t s o f e q ua l d o se . T h e c ur v e s a re us ua l l y d r a w n a t r eg ul a r i nte r v a l s o f a b s o r be d do s e a n d ex p r e s s e d a s a p e r c e nt a g e o f t he do s e at a r e f e r e nc e po i nt . T h u s t h e i s o do s e c u r v e s r e p re s e nt l e v el s o f a b s o rb ed do s e i n the s a m e m a nne r t h a t i s ot h e r m s a r e u se d f o r h e a t a nd i so b a rs , f o r p r e s s ur e .

11.1. ISODOSE CHART

A n i s o d o s e c h a r t f o r a g i v e n b e a m c o ns i sts o f a f a m i l y o f i s o d os e c ur v e s us ua l l y d r a w n a t e q u a l i n c r em e n t s o f p e r ce nt d ept h d o s e , r ep r e s e nt i ng t he v a r i a t io n i n d o s e a s a f u n c t i o n o f d e p t h a n d t r a ns v e r s e d i s t a nc e f r o m t he c e nt r a l a x i s . T he d e pt h - d o se v a l u e s o f t h e c u r v e s a r e no r m al i z e d ei t he r at t he poi nt o f m a xi m um d o s e o n t h e c e n tr a l a x i s o r a t a fi x e d dis t a nc e a lo ng t he c e nt r a l a x i s i n t he i r r a di a te d m ed i u m . Th e c h a r t s i n t he f i r st c a te g or y a r e a pp lic a b l e w he n t he p a t ie n t i s t r e at ed at a c o n s t a n t s o ur c e -to -s ur f a c e d i st a nc e ( S S D) i r re s p e ct i v e o f b e a m di r e ct io n . In t h e s e c o n d c at eg o r y , t he i s od o se c ur v e s a r e no r m a l i z ed a t a c e r t ai n d e pt h b e y o n d t h e d e pt h o f m a x i mum d o s e , c o r re s po nd ing t o t he a x i s o f r o t at io n o f a n i s o c e nt r i c t he r a p y uni t . T hi s t y p e o f r ep r e se nt a ti o n i s e sp e ci a ll y useful in r ot a ti o n th e r a p y but can al so be us e d for st a tio na r y
60

i s o ce nt r i c

t r e at m e n t s . F ig u r e 1 1. 1 s h o w s b o t h t y p e s of i s o d o se c ha r t s f o r a d o s e di s t ri b u tio n s .

Co ray beam.

E x a m i n a t i o n o f i so dos e c h a r t s r e v e al s s om e g e ne r al p ro p e rti es o f x - a nd - r a y

T h e d o se at a n y de pt h i s g r e at e st o n t he c e nt r al a x i s o f t he b e a m a nd g r a d u a l l y d e c re a s e s to w a r d t he ed g es o f the b e a m , wi t h t he e xc e p ti o n o f s o m e L i n a c x - r a y be am s , w hi c h e x hi b i t a r ea s o f hi g h do s e o r ho r ns ne a r t h e s u r f a c e i n t h e per i p h e r y o f t he fi e ld . T he s e ho r ns a r e c r e at e d b y t he f l a t te n i n g f il te r , w h i ch i s us ua l l y de s i g ned to o ve r c o mp e ns a te ne a r t he s u r f a c e i n o r d e r to o bt a i n f l a t i so do s e c ur v es a t g r e a te r d ep t hs .

Near

the

e dg e s

of

the

beam

(t he

p e num b r a

r e gi o n) ,

t he

do s e

r a te

d e c r e a se s r ap i dl y a s a f u n c t i o n o f l at e ra l d i s t a nc e f r o m t he be am a x i s . A s d i s c u s s e d i n C h a p t e r 4 , t he w i d t h o f ge om e t ri c p e num b r a , w hi c h e x i s t s b o t h i n s id e a n d o ut s id e t h e ge o me t ri c a l bo und a r i e s o f t he b e am , d e p e nd s on source si z e , di st a n c e from t he so ur c e , a nd s o ur c e -t o -d i a p hr a gm distance.

WWW.MEDRAD.IR

Near

the

beam

ed g e,

falloff

of

t he

b e am

is

c a us e d

no t

o nl y

by

t he

g e o me t ri c pe n u m b r a b u t a l s o b y t he r ed uc e d s id e s c a tt e r . T her e f o r e , t he g e o me t ri c p e n u m b r a is n o t t he b e s t m e a s ur e o f b e a m s ha r p ne s s ne a r t he e d ge s . In s t e a d t h e te r m p hy s i c a l p e num br a m a y b e us e d . T he p hy s i c a l p e n u m b r a w i d t h i s de f i n e d a s t he l at e r al d i s t a nc e b e t we e n t w o s p e c i f ie d i s o do s e c u r v e s a t a s p e c i f ie d de p t h ( e . g . , l a t e r al d i st a nc e b e tw e e n 9 0 % a n d 2 0 % i so do s e li n e s a t t he d e pt h o f D m a x ) . P.200

O u t s i d e t h e g eo m et r ic l i mi t s o f t he be a m a nd t he p e num b r a , t he do s e v a r i a t io n i s t h e r e s u lt o f si d e s c a tt e r f r o m t he f ie l d a nd b ot h le ak a g e a nd s c a t te r f r o m t h e c ol lim a t o r s y s t e m . Be y o nd t hi s c ol li m at o r z o ne, t he d o s e d i s t ri b u tio n is go v e rn e d by t he l a te r a l s c a t te r from t he m ed i um a nd l e a k a g e f ro m t h e h e ad o f t he m a c hi ne ( o f te n c a l l ed t he r a pe ut i c ho us i ng o r source housing).

F I G . 1 1 . 1 . E x a m p l e of a n i s o d o s e c ha r t . A : S S D t y p e , f i e l d si z e = 1 0 1 0 cm a t s u r f a c e . B : S A D t y p e ,
60

60

C o b e a m, S S D = 8 0 c m ,

C o b e a m , S A D = 1 0 0 c m , d ep t h

WWW.MEDRAD.IR

o f i s o c e nt e r = 1 0 c m , f i e l d s i z e at i s o ce nt er = 1 0 1 0 c m . ( D a t a f r o m U ni v e r s i t y o f M i n n e s o t a H o s pit a ls , E l d o r a do 8 C o b al t Uni t , s o ur c e s i z e = 2 c m . ) F i g u r e 11 . 2 s h o w s t h e d o s e v a r i a tio n a c r o s s t he f i el d at a sp e ci f i ed d ep t h. S uc h a r e p r e se n t a ti o n o f t h e b e a m i s k no w n a s the b e a m p ro f i le . It ma y b e no t ed t ha t t h e f i e ld P.201 s i z e i s de f i n e d a s th e l at e r al di s t a nc e b e t w ee n t he 50 % i so d o se l i ne s a t a r e f e r e n c e d ep t h . T h i s d e f i n it io n i s p r a ct i c all y a c hi e v ed b y a p ro ce d ur e c al le d t he b e a m a li g n m e nt i n w h i c h t h e f i el d - de f i ni ng li g ht i s m ad e t o co i nc id e w i t h t he 5 0% i s o do s e l i n e s o f t h e r a d i at io n b e a m p ro jec t e d o n a p l a ne pe r pe nd i c ul a r t o t he b e a m a x i s a n d a t t h e s t a n d a r d S S D o r s o ur ce - to - a x i s d i st a nc e ( S A D ) .

F I G . 1 1 . 2 . D e p t h d os e p r o f il e s ho w i ng v a r i a ti o n o f d o se a c r o ss t he f i e l d . l i n e i n di c a te s g eo m et ri c f i e ld b o u nd a r y a t a 1 0 - c m d ep t h.

60

Co

b e a m , S S D = 8 0 c m , d e pt h = 1 0 c m , f i e ld s i z e a t s ur f a c e = 1 0 1 0 c m . D o tt ed

WWW.MEDRAD.IR

F I G . 1 1 . 3 . C r o s s - s e c t io n a l i s od o se d i st r i but i o n i n a p l a ne p e r pe nd i c ul a r to t he c e n t r a l a x i s o f t h e bea m . Is o d o se v a l ue s a re no r m al i z ed t o 1 00 % a t t he ce nt e r o f t h e f i e ld . A n o t h e r w a y o f d e p i ct i n g t h e do s e v a r i a tio n a c r o s s t he f i e l d i s t o p lo t i so do s e c u r v e s i n a pl a n e pe rp e n d i c u l a r to t he c e ntr a l a x i s o f t he b e am (F i g . 11 . 3 ) . S uc h a r e p r e s e nt a ti o n i s u s e f u l f o r t r e a tm e nt pl a nni ng i n w hi c h t he f i e l d s i z e s a re d e te r m i n ed o n t h e b as i s o f a n i s o d o s e c urv e ( e . g . , 9 0 % ) t ha t a d e q ua te l y c o v e r s t h e t a r ge t v ol u m e .

11.2. MEASUREMENT OF ISODOSE CURVES

Is o d o s e c h a r t s c a n b e m e a s u r e d b y me a ns o f io n c ha m b e r s , so li d s t a te d e te c to r s , o r r a di og r a p h i c f il m s ( C h a p t e r 8 ) . O f t he se, t he i o n c ha m be r i s the m o s t re li a bl e m e t h od , m a i nl y b e c au s e o f i t s r el a ti v e l y f l a t e ne r g y r e s po nse a nd p r e ci s io n. A l t h o u g h a n y o f t h e p h a n t o m s d e s cr i be d in C ha p t e r 9 m a y b e us e d f o r i s od o se m e a s u r e m e n t s , w at e r i s t h e me d i um o f c ho i c e f o r io no m et r i c me a s ur e m e nt s . T he c h a m b e r c a n be m ad e w a t e r pr oo f b y a t hi n p l a s ti c sl ee v e t ha t cov e r s t he c ha mb e r a s w e l l a s t h e po r ti o n o f t h e c a b le i m m e r se d i n t he w a t e r . A s m e a s u r e m e n t o f is o d o se c h a r t s ha s b e e n d i s c us s e d i n s om e d e t ai l i n t he In t e r n a t i o n al C o m mi ss i o n o n R a d i at io n U nit s a nd M e a s ur em e nt s ( IC R U ) ( 1 ) , o nl y a f e w i m p o r t a nt p oi n t s w i l l be d i s c us s ed he r e . T he i o ni z a t io n c ha m b e r us e d f o r i s o do s e m e a s u r e me n ts s h o u l d b e s m a ll s o t ha t m e a s ur em e nt s c a n b e m a d e i n r e g io n s of high d o se g r a di e n t , s uc h as ne a r t he e d ge s o f t he beam. It is

WWW.MEDRAD.IR

r e c o m me n d e d t h a t t he s e n s it i v e vo l um e o f t he c ha m b e r b e l e s s t ha n 1 5 m m l o ng a n d h a v e a n i n s i d e d i a m et e r o f 5 m m or l e s s . E ne r g y i nd e pe nd e nc e o f t he c h a m b e r i s a n ot h e r im p o rt a n t r eq ui r e me nt. Be c a us e t he x - r a y b e a m s pe c t r um c h a n g e s w i t h p o si ti o n i n t h e p h a nto m o w i ng to s c at te r , t he e ner g y r e s po ns e o f t h e c h a m b e r s h o u l d be a s f l a t a s p o s s i bl e . T hi s c a n b e c he c k e d b y o b t ai ni ng t he e x p o s u r e c a li b r at io n o f t h e c h a m b e r f o r or t ho v ol t a ge ( 1 to 4 m m C u) a nd i s a c c e pt a b le .

60

Co

b e a m s . A v a r i a t io n o f a p p r o xi m a te l y 5 % i n r e s p o ns e t hr o ug ho ut thi s e ne r g y r a ng e

F I G . 1 1 . 4 . S c h e m a t i c d i a gr a m o f a n a uto ma t i c i s od o se pl ot te r sy s t e m , T he r a do s RFA-3. ( R e p r i n te d wi t h p er m i s si o n from Ins t r um e nt AB T he r a d o s , U pp s a l a , Sweden.) P.202

A u t o m a ti c de v i ce s f o r m e a s u r i n g i so do s e cur v e s ha v e b ee n d e ve l op ed f o r r a pid m a p p i n g o f t h e i so dos e c u r v e s . T he s e s y st e m s a re de s ig ne d t o b e e it he r st a nd a l o n e o r c om p u t er d ri v e n . B a s i c a l l y , t he ap p a r a t us ( Fi g . 11 . 4 ) c o ns i s t s o f t w o i o n i z a ti o n c h a m be r s , r e f e r r e d to a s t he d e te c t or A ( o r pr o be ) a nd t he mo ni to r B. W h e r e a s t h e p ro b e i s a r r a n g e d to m o ve i n t he t a nk o f w a t e r to s a m p le t he do s e r a t e a t v a ri o u s p oi n t s, t h e m o n i to r i s f i x ed a t s o m e poi nt i n t he f i e l d t o mo ni to r t h e b e am i n te n s i t y w it h t i me . T he r a ti o o f t he d et e ct o r to t he mo ni to r r e sp o nse ( A / B ) i s r e c o r de d a s th e p r o be i s m o ve d i n t he p ha nt o m . T hus t he f i na l r e s po ns e A / B i s i n d e p e n d e nt o f f l u c t u a t io n s i n o ut p ut . In t he s t a nd - a l o ne s ys t e m , t he p ro b e s e a r c h e s f o r p oi n t s a t w h i c h A / B i s e q ua l t o a p r e s et p e r ce nta g e v a l ue o f A / B m e a s u r e d at a r e fe r e nc e de p t h o r t he d ep t h o f m a xi m um do s e . The m ot io n o f t he p r o be i s t r a n s mi tt e d to t h e p lo tt e r w hi c h r ec o r d s it s p a t h, t he i sod o s e c ur v e . In t h e c o mp u t e r -d r i v en m o de l s , t he c ha mb er m o v e me nt o f t he p ro b e i s c o ntr ol le d b y a c o mp u t e r p ro g ra m . T h e p ro b e -t o -m oni t o r r a ti o i s s a m pl ed a s t he p ro be

WWW.MEDRAD.IR

m o v e s a c r o s s t h e f ie ld a t p r e s et i nc r e me nt s . T he s e b e a m p r o fi l e s a r e m e a s ur e d at a n u m b e r o f de pt h s , d e te r m i n ed b y co m p ut e r p r og r a m . T he d ata t hus m e a s ur e d a r e s to r e d i n t h e co mp u t e r i n t h e f o r m o f a m a t r i x t ha t c a n t he n b e t ra ns f o r m e d i n t o i so do s e c u r v e s o r o t h e r f o r m at s a l lo w ed b y t he c o m p ute r p r og r a m .

A. Sources of Isodose Charts

A c q u i s i ti o n o f i so do se c h a r t s h a s be e n d is c us s e d ( 1 ) . A tl a s e s o f p re m e a s ur ed i s o do s e c h a r t s f o r a w i d e r a n g e o f r a d i a ti o n t he r a p y e q ui p me nt a re a v a i l a bl e f r o m t h e s o u r c e s li s t ed i n th e l it e r at u r e ( 2 ,3 , 4 ) . In a d d i ti o n, i so do s e di s t ri b uti o ns m a y also be o b t ai n e d having f r om th e m a n u f a c t ur e r s same uni t . of r a d i a ti o n t he g e ne r at o rs us e r is or from o t her i n s t it u t io n s Ho w ev e r , c aut i o ned a g ai ns t

a c c e p ti n g i s od o se c ha r t s f r om a ny s o ur c e a nd us i ng t he m a s b a s i s fo r p at ie nt t r e at m e n t wi t h o u t a d eq u a t e v e ri f i c at io n. T he f i r s t a nd m o st i m po rt a nt c he c k to be p e r f o r me d i s t o v er i fy t h a t t h e c e nt r al ax i s d ep t h- do s e d a t a c o r r e s po nd w it h p e r c e n t d ep t h - do s e d at a m e a s u r ed i nde p e nde nt l y i n a w a te r p ha nto m . A d e v i ati o n o f 2 % o r l e s s i n l o ca l d o s e i s a c ce p t ab le up t o d e pt hs o f 2 0 c m . T he e d ge s o f t he d i s t ri b u tio n s h o u l d b e c h e c k e d b y m e a s uri ng be a m p r o f il e s f o r s el e c te d f i el d s i z es a n d d e p t h s . A n a g r e em e n t w i t h i n 2 m m i n the p e num b r a r e g io n i s a c c e p t a bl e . Besides di r e ct m e as u r e m e n t s , i s od o se c ha r t s can also be g e ne r at ed by c a l c u l a ti o n s u s i n g v ar i o u s a lg o ri t hm s fo r t r e at m e nt p l a nni ng (5 , 6 , 7 , 8 , 9 ) . Mo r e c u r r e n t a l g or it h m s a r e d i s c u s s e d i n P.203 P a r t III o f t h i s b oo k . S o m e o f t he s e p ro gr a m s a r e c o m me r c i al ly a v a i l a bl e w i t h t r e at m e n t p l a n n i n g c om p u t e r s . A g ai n, t he ap p li c a bi li t y o f t he c o mp ut e r - ge ne r a ted i s o do s e c u r v e s to t h e u s e r ' s m a c hi ne m us t b e c a r e f ul l y c he c k e d .

11.3. PARAMETERS OF ISODOSE CURVES

A m o n g t h e p a r am et e rs t h a t a f f e c t t he s i ngle - b e a m i s od o se di s t rib ut io n a r e b e am q u a l it y , source size, beam c ol li m a ti o n, field si z e , SSD, a nd t he s o ur c e - to d i a p h r a g m d i st a n c e (S D D ) . A d i s c us s i o n o f t he s e p a r a me te r s w i ll b e p re s e nte d i n t h e c o n t e xt o f t r e at me n t p l a n n i n g .

A. Beam Quality
A s d i s c u s s e d p r e v io u s l y , t h e c e n t r al a x i s de p t h do s e d i st r ib ut io n d e pe nd s o n t he b e a m e n e r g y . A s a r es u l t , t h e d ep t h o f a g iv e n i s o do s e c ur v e i nc re a s e s w it h be a m q u a l it y . B e a m e n e r g y a l s o i n f l u e nc e s i so do se c ur v e s ha p e ne a r t h e f i e l d bo r de r s . G r e a t e r l at e r al s c at ter a s s o ci a te d w it h lo we r - e ne r g y b e a m s c a us e s t he i so do s e c u r v e s o u t s i d e t h e f iel d t o b ul g e o ut . In o t he r w o r d s , t he a b s o rb e d do s e i n t he m e d i u m o ut s i de t h e pr i m a r y b e a m i s g r e at er f o r l o w - e ne rg y b e a ms t ha n f o r t ho s e of higher energy. Physical penumbra de p e n d s on beam q ua l it y as i ll us t r at e d in Fig. 11.5. As e x p e c te d , t h e i so do s e c u r v e s o u t s i d e t he pr i m a r y b e a m ( e . g . , 10 % a nd 5 % ) a re g r e a tl y d i st e n d ed i n th e c a s e o f o r t ho vo lt ag e r a d i ati o n. T hus o n e d i s a d v a nt ag e o f t h e o r t ho v o lt a ge b e am s i s t h e i nc r e a s ed s c a t te r e d do s e to ti ss ue o ut s i de t he t r e at m e n t re gi o n . F o r m e g a v ol t ag e be a m s , o n t he ot he r ha nd , t he s c a t te r o ut s i de the f ie l d is mi n i m i ze d as a re s ul t of pr e d om i na nt l y fo r w a r d s c a tt e ri ng a nd b e c o me s m o re a f u n c t i o n o f c o ll im a ti o n t han e ne r g y .

WWW.MEDRAD.IR

B. Source Size, Source-to-Surface Distance, and Sourceto-Diaphragm DistanceThe Penumbra Effect

S o u r c e s i z e , S S D , a n d S D D a f f e c t t he s ha p e o f i s od o s e c ur v e s b y v i r t ue o f t he g e o me t ri c pe n u m b r a , d i s c u s s e d i n C ha p t er 4 . In a d d i ti o n, t he S S D a f f e c t s t he p e r c e n t de pt h d o s e a nd t h e r e f o re t he de p t h o f t he i s od o se c ur v e s . A s d i s c u s s e d p r e vi o u sl y , t h e d o s e v a ri a ti o n a c r o s s t he f i el d bo r de r i s a c o m pl e x f u n c t i o n o f g e o m et r i c p e n u m b r a , l a t e r al s c a t t er , a nd c o l li m a ti o n. T he r e f o r e , t he f i e l d s h a r p n e s s a t de pt h i s n o t s i m pl y d e t erm i ne d b y t he s o ur c e or f o c a l s p o t si z e . F o r e x a mp le , b y u s i ng pe n u m b r a t ri m me r s o r s e co nd a r y bl o c k ing , t he i s od o se s h a r p n e s s a t de pt h f o r
60

C o be a m s w it h a so ur c e s i z e l e s s t ha n 2 c m i n d i am et e r

c a n b e m a d e c o mp a r ab l e w it h h i g he r - e ne rgy L i na c b e a m s , a l t ho ug h t he f o c a l s po t s i z e o f t h e se be a m s is u s u a l l y le s s t ha n 2 m m . C o m p a ri s o n o f i so d o se c ur v e s f o r
60

C o , 4 a nd 1 0 M V i n F i g . 1 1 . 5 il l us tr a te s t he p oi nt t ha t t he p hy s i c a l p e num b ra

w i d t h f o r t h e s e be a m s i s m o r e o r l e s s s i mi l ar .

WWW.MEDRAD.IR

F I G . 1 1 . 5 . Is o d o se d is t r i b ut io n s f o r d i f f e rent q ua li t y r ad i at io ns . A : 2 0 0 k V p , S S D

WWW.MEDRAD.IR

= 50 cm, HVL = 1 mm Cu, field size = 10 10 cm. B: 1 0 - M V x - r a y s , S S D = 1 0 0 c m , f i el d s i z e = 10 1 0 c m .

60

Co, SSD = 80 cm, field

s i z e = 1 0 1 0 c m . C: 4 - M V x - r a y s , S S D = 1 0 0 c m , f i el d si z e = 1 0 1 0 c m . D :

C. Collimation and Flattening Filter

T h e t e r m c ol li m a ti o n is u s e d h e r e t o d e si g na t e not o nl y t he co ll im a t o r b lo c k s t ha t g i v e s h a p e a n d s i z e to t h e b e a m b ut a l so the f l a t te ni ng f il te r a nd o t he r a b so r b e rs o r s c a t te r e r s i n t h e b e a m b et w e e n t he ta r g e t a nd t he p at ie nt . O f t he s e , t he f l a t te n i n g f i lt e r , w h i c h i s u s e d f o r m e g a v o lt a g e x - r a y b e a m s , ha s t he g r e a t e st i n f l u e n c e i n d e te r mi n in g t h e s h a pe o f t he is o d o se c ur v e s . Wi t hout t hi s fi lt e r , t he i s o do s e of the curves w il l be co n i c a l in s ha pe , s ho w i ng m a r k ed l y i nc r e a s e d x-ray i n t e n s it y a l o n g t h e c en t r a l a x i s a nd a r a p i d r e d uc t io n t r a ns v e r s e ly . T he f unc t i o n f l at te n i n g f i lte r i s t o m a k e t he b e a m i nt e ns it y d i st r ib ut io n r e l at i v el y u n i f o r m a c r o s s t h e f i e ld (i . e . , f l a t ) . T he r e f o re , t he f il t er i s t hi c k e st i n t he m i d dl e a n d t ap e r s o f f t o w a r d t he e d ge s . T h e c r o s s - s e ct io n a l va r i a ti o n o f t he f il te r t hi c k ne s s a l so c a us e s v a r i a t io n i n t he p h o to n s p e c t r u m o r be a m q u a l it y a c r o s s t he f i e l d o w i ng t o s el e ct i v e ha r d e ni ng of t h e b e a m b y t h e f i lt er . In g e n e r a l , t he a v e r a g e e ne rg y o f t he bea m i s s o me w h a t l o w e r f o r t h e p e ri p h e ra l a r e a s P.204 c o m p a re d w it h t h e c en t r a l p a rt o f t he b e am . T hi s c ha ng e i n q ua l it y a c r o s s t he b e a m c a u s e s t h e f l atn e s s t o c h a ng e w i t h d e pt h. H o w e v e r , t he c ha ng e i n f l a t ne s s w i t h d ep t h i s c a u s ed b y n o t o nl y t he s el e cti v e ha r d e ni ng o f t he b e a m a c ro s s t he f i e l d b u t a l so t h e c h a n g e s i n t h e d i st r ib ut io n o f r a d i a tio n s c a t t e r a s t he de p th increases. B e a m f l a t n e s s i s u s u al l y s pe c i f ie d at a 1 0 - cm d e pt h w it h t he m a xi m um li m it s s et a t t h e d ep t h o f m a x i m u m d o se . By c a r e ful d e si g n o f t he f il te r a nd a c c ur a te p l a c e me n t i n t h e b e am , i t i s p o s si bl e t o ac hi e v e f l a t ne s s to w i thi n 3 % o f t he c e n t r a l a xi s do s e v a l u e a t a 10 - c m de pt h. T hi s d e g re e o f f l at ne ss s ho ul d e x t e nd o v e r t h e c e n tr a l a re a b o u n d ed b y at l e a st 8 0 % o f t he f ie ld dim e ns i o ns at t he s p e c i f ie d d ep t h o r 1 c m f r o m t he e d ge o f t he f ie ld . T he a bo v e s p e ci f i c a ti o n i s s a t i s f a c to r y f o r t h e p re c i s io n r e q ui re d i n r ad i a ti o n t he r ap y . T o o bt a i n a c c e pt a bl e f l a t n e s s a t 1 0 - c m de p t h, a n a r e a o f hi gh d o s e ne a r t he s u r f a c e m a y h a v e to b e a c ce pt e d . A l t ho ugh t he e xt e nt o f t he hig h d o se re gi o ns , o r h o r n s , v a r ie s w it h t h e de s i g n o f t he f i lt er , l o w e r -e ne r g y b e a ms e x hi b it a l a r ger v a r i a t io n t h a n h i g h e r- e n e r g y b e am s . In p r a c t i c e , i t i s a c ce p t ab le to ha v e t he se s u p e r f l a t i s od o se c u r v e s n e a r t he s ur f a c e P.205 p r o v id e d n o p oi n t i n a n y p l a n e p a r a ll el to t he s ur f a c e r e c ei v e s a d o s e g r e at e r t h a n 1 0 7 % o f t h e c e ntr a l a x i s v a l ue ( 1 0 ) .

D. Field Size
F i e ld si z e i s o n e o f t he mo s t i mp o rt a nt p a r am e t er s i n t re a t me nt pl a ni ng . A d eq ua t e d o s im e tr i c c o v e r ag e o f t h e t u m o r r e q uir es a d e t e r mi na t io n o f a p p r o p ri a te f i el d

WWW.MEDRAD.IR

size.

This

d et e r mi n a t io n

must

al w a y s

be

m a de

d o si m et r i c all y

r a t he r

t ha n

g e o me t ri c a ll y . In ot h er w o r d s , a c e rt a i n i sod o s e c ur v e ( e .g . , 9 0% ) e nc lo s i ng t he t r e at m e n t v ol u m e s h o u l d b e t h e g ui d e i n c ho o s i ng a f i e ld s i z e r a t he r t ha n t he g e o me t ri c di m e n s io n s o f t h e f i e ld . G r e a t c a u ti o n s h o ul d a l s o b e e x e r c i se d i n us i ng f i e ld si z e s s m all e r t ha n 6 c m i n w h i c h a r e l at i v el y l a rge p a rt o f t he fi el d i s in t he pe num b r a r e gion. D e p e ndi ng o n t h e s o u r c e si z e , c o ll ima t io n , a n d d e s i g n o f the f l a t te ni ng f i lt e r , t he i s od o se c ur v e s f o r s m a l l f ie ld s i z e s , in g e n e r a l , t e nd t o be b e ll - s ha p e d . T hus t r ea t m e nt pl a nni ng w i t h i s o do s e c u r v e s sh o u l d b e m a nd at o r y f o r s m a ll f i e ld s i z e s . T h e i s o do s e c u r v a t u r e f o r
60

C o i nc re a s e s a s t he f i el d si z e b e c om e s o v e rl y l a rge

u n l e s s t h e b e a m i s f l at t e n ed b y a f l a t te ni ng f i l t e r . T he r e a s o n f o r t hi s e f f e c t i s t he p r o g re s s i v e r ed u c t io n o f s c at t er e d r a di a tio n w i t h i nc r e a s i ng dis t a nc e f r o m t he c e n t r a l a x i s a s w e ll a s t h e o bl i q ui t y o f the p r i m a r y r a y s . T he e f f e c t b e co m e s p a r t i c ul a r l y s e v e re w it h e l o n g at ed f i el d s s uc h a s c r a ni a l s p i na l f ie l d s us e d i n t he t r e at m e n t o f me d u ll ob l a s to m a . In t he se ca s e s , o ne ne e d s to ca l c ul a te do s e s at s e v e r a l o f f - a x i s po i n t s o r u s e a b e a m - f l a tt e ni ng c o m pe ns a t o r .

11.4. WEDGE FILTERS

F r e q u e n t l y , s p e ci a l f i lt e r s o r a b so r bi ng b l o ck s a r e p l a c e d i n t he p a t h o f a b e a m to m o di f y i t s i s o do s e d i st r i b ut io n . T he m o s t co m m o nl y us ed b e am -m o di f y i ng d e v i ce i s t h e w ed g e fi lt e r . Th i s i s a w e dg e - s ha p ed a b s o rb e r t ha t c a use s a p r og r e s si v e d e c r e a se i n t h e i n t e n si t y a c r o s s t he b e a m , re s ul ti ng i n a t i l t o f t he i s o do s e c ur v e s f r o m t h e i r n o rm a l po si ti o n s . A s s ho w n i n F i g . 1 1 . 6 , t he i so do s e c ur v e s a r e t i lt ed t o w a r d t he t h i n e n d , th e d e g r ee o f t il t d e pend s P.206 o n t h e s lo p e o f t h e we d ge f il te r . In a c t ua l w e d g e f i lt e r d e si g n, the s l op i ng s ur f a c e i s m a d e e it h e r s t r ai g ht o r si g mo i d i n s ha p e; t he l at t er d e si g n i s us e d t o p r od uc e s t r a i g ht e r i so do s e c u rv e s .

WWW.MEDRAD.IR

FIG.

11.6.

Is o d o s e

curves

for

wedge
60

f i l te r .

A:

no r m a liz e d

to

Dmax.

B:

n o r m a l i z ed to D m a x w i th o u t t h e w e dg e . = 8 10 cm, SSD = 80 cm.

Co , w e d g e a ngl e = 4 5 d eg r e e s , f ie l d si ze

T h e w e d ge i s u s u a l l y m a d e o f a de ns e ma t e ri a l , s uc h a s l e ad o r s t ee l , a nd i s m o u n t e d o n a t r a n s pa r e n t p l a st i c t ra y w hi c h c a n b e i ns e r t e d i n t he b e a m a t a s p e c i f ie d d i st a n c e f r om t h e s o u r ce ( F i g . 1 1 .7 ) . T hi s d i st a nc e i s a rr a ng e d s uc h t h a t t h e w e d ge t r a y i s al w a y s a t a d i s t a nc e o f a t l e a st 15 c m f r o m t he s k i n s ur f a c e , s o a s t o a v o id d e st r o yi n g t h e s k i n - s p a r i ng e f f ec t o f t he m e g a vo lt a g e b e a m .

WWW.MEDRAD.IR

F I G . 1 1 . 7 . P h o t og r a ph o f a 4 5 d eg r e e w e dg e f il te r f o r a 4 - M V x- r a y L i na c ( A T C 400). A n o t h e r c la s s o f w e dg e s ( n ot d i s c us s e d he r e ) a re t he d y na m i c w e d ge s . T he se w e d g e s a r e g e n e ra t ed el e ct r o n i c al l y b y c re a t i ng w e dg e d be a m p r o f il e s t hr o ugh d y n a m i c m ot io n o f an i n d e p e n de nt j a w w i t hi n t he t r e at m e nt b e a m . D y na m i c w e d g e s d o n ot o f f e r s i g n i fi c a n t cl i ni c al ad v a nt a g e s o v e r t he tr a d i tio na l me t al w e d g e s . M o re o v e r , a ll w e d g e s a n d c o m pe ns a t o r s a r e no w s up e r se d ed b y t he ne w t e c h n o lo g y u s i n g d y n a m i c m u lt il e a f col li m at o r s i n co nj unc t i o n wit h t he i nte ns i t y m o d u l at e d r ad i at io n th e r a p y ( IM R T ) .

A. Wedge Isodose Angle

T h e t e r m w e d g e i sod o s e a n g le ( o r s i m ply w e d g e a ng l e ) r e f er s t o t he a ng l e t h r o u g h w h i c h a n i so d o se c u r v e i s ti tl ed a t t he c e nt r al r a y o f a b e am a t a s p e c i f ie d d e pt h ( 1 1 ) . In t h i s d e f i ni ti o n, o ne s ho ul d not e t ha t t he w e d ge a ng le i s t h e a n g le be t w ee n t h e i s od o se c u r v e a nd t he no r m a l to t he c e nt ra l a x i s , a s s ho w n i n F i g . 1 1 .6 . In a d d i tio n , t h e s p e ci f i c a ti o n of d e p t h i s i m po r t a nt si nc e , i n g e ne r al , t h e p r e se n c e o f s c a t te r e d r ad i at io n c a us e s t he a ng le o f i s od o se t il t t o d e c re a s e w i t h i n c r e a si n g de p t h i n t h e p h a nto m . H o w ev e r , t he r e i s no g e ne ra l a g re e me nt as t o t h e c h o i ce o f r e f e re n c e d e pt h . S o m e c ho o se d ep t h a s a f unc t io n o f f i e ld s i ze ( e . g . , 1 / 2 o r 2 /3 o f t h e b e a m w i dt h) w hi l e ot he r s d e f i ne w e dg e a ng l e a s t he a ng le b e t w ee n t h e 5 0 % i sod o s e c u r v e a nd t he no r m a l to t he ce nt r al a x i s . T he l a tt e r c h o i c e , h o w e v e r , b e co m e s i mp r a c ti c a l w hen hi g he r - e ne r g y b e am s a r e us e d . F o r e x a m p le , t h e c e n t r a l a x i s d e pt h o f t he 5 0% i s o do s e c ur v e f o r a 1 0 - M V b e a m li e s a t a bo u t 18 c m f o r a 1 0 10 - c m f i el d a nd 1 0 0 - c m S S D . T hi s d e pt h i s too l a rg e i n t h e c o n t e x t o f m o s t w e d ge f i l te r a p pl i c at io ns . A s w i l l b e di s c us s e d i n s e c t i o n 1 1 . 7, t h e w e d ge f i lt e r s ar e m o s tl y u s e d f o r t r e at ing s up e r f i c i al t um or s , f o r e x a m p le , n ot

WWW.MEDRAD.IR

m o r e t h a n 10 c m d eep . T h e r e f o re , t he c ur re nt r e co m me nd a ti o n is t o us e a s i ngl e r e f e r e n c e de p t h o f 10 c m f o r w e d g e a ng le s pe c i f i c at io n ( 1 1 ) . P.207

B. Wedge Transmission Factor

T h e p r e s e n c e o f a w ed g e f il te r d e c re a s e s the o ut p ut o f t he m a chi ne , w hi c h m us t b e t a k e n i n to a c co u n t i n t r e at me nt c al c ula t io ns . T hi s e f f e ct i s c ha r a c t e ri z e d b y t h e w e dg e t r a n s m i s sio n f a c t o r (o r si m pl y w e d g e f a ct o r ) , d e f i ned a s t he r ati o o f d o s e s w it h a n d w i t h o u t t h e w e d g e , a t a p oi nt i n p ha nt o m a l o ng t he c e nt r a l a x i s o f t h e b e a m . T h i s f a c t o r s h o u l d b e m e a s ur e d in p ha nt o m a t a s ui t a b l e d ep t h b e y o nd t h e d e pt h o f m a x i m u m d o s e ( e . g . , 1 0 c m ) . In c o b a l t -6 0 t el et h e ra p y , t h e w e dg e f a c t or i s so m et i me s i nc o rp o r at e d i nto t he i s o do s e c u r v e s , a s s h o w n i n F i g . 1 1 . 6 B. In t hi s c a s e , t he d e p t h d o s e di s t ri b uti o n i s n o r m a li z e d r el a ti v e t o t h e D m a x w i t ho ut t he w e d ge . F o r e x a mp l e , t he i s od o se c u r v e a t d e p t h o f D m a x i s 7 2 % , i ndi c a ti ng tha t t he w e d g e f a c to r i s a l r e ad y t a k e n i n t o a c c o u n t i n t h e i s o do s e di s t ri b uti o n. If s uc h a c ha r t i s us e d f o r i so do se p l a n n i n g , n o f u r t h e r c o r r e ct io n s ho ul d b e a p p li e d to t he o ut p ut. In o t he r wo r d s , t h e m a c h i n e o u t p u t cor r e s p o n di n g to t he ope n b e a m s ho ul d b e use d . A m o r e co m mo n a p pr o a c h i s t o no r m a li ze t he i s od o se c ur v e s r e l at i v e to t he c e n t r a l a x i s D m a x w it h t h e w e dg e i n t he be am . A s s e e i n Fi g . 1 1 . 6A , t he 10 0 % do s e i s i n di c a te d at t h e d ep t h o f D m a x . W it h t hi s a p p r o a c h, t he o utp ut o f t he be a m m ust b e c o r re c te d u s i n g t h e w e d g e f a c t or .

C. Wedge Systems
W e d g e f il te r s a re o f t w o m ai n t yp e s . T he f i r s t m a y b e c a ll ed the i nd i vi d ua li z e d w e d g e s y s te m , w h i c h r e q u i r e s a s ep a r a te w e d g e f o r ea c h b e a m w i d t h, o p ti m al l y d e s ig n e d to m i n i mi z e t h e l o s s o f b e am o ut put . A m e c ha ni s m i s p r o v i de d to a l ig n t h e t h i n e n d o f t h e w e d g e w it h t he bo r de r o f t he l ig ht f i el d ( F i g . 1 1 .8 A ) . T he s e c o n d s y s t e m u s e s a u n i v e r s a l w e d ge , t ha t i s , a s i ng l e w e dg e s e rv e s f o r a l l b e am w i d t h s . S u c h a f i l t e r is f i x e d c e n t r al l y i n t he b e a m w hil e t he f i eld c a n b e op e ne d t o a n y s i z e . A s i l l u str a t e d i n F i g . 1 1 .8 B, o nl y a s m a l l p a rt o f t hi s w e d ge , i . e . , A B C , i s e f f e c t i ve i n p r o d u c i n g t he g i ve n w e d g e a ng l e . T he r es t ( A C DE ) , b e i ng u n w e d g e d , d oe s n o t c o n t r ib u t e to t he i so do s e ti lt b ut unne c e s s a r i l y r e d uc e s t he b e a m i nt e n s it y . S i n c e t h e i n di v i d ua li z e d s ys t e m e co no mi z e s o n the b e a m o ut p ut , i t i s p r e f e r re d fo r u se i n co b al t t el et he r a py . T he uni v e r s a l w e dg e , o n t he o t her h a n d , i s u s e f u l f o r l in e a r a c c e le r a to r b e am s w he r e t he o utp ut i s pl e nti f ul . F r om t h e s e t- u p a n d t r ea t me n t p l a n n i n g poi nt s o f v i e w , t he uni v e r s a l w e d g e i s s i mp le r t o u s e t h a n t h e i n d i v id u a l i z e d f il te r .

D. Effect on Beam Quality

In g e n e r a l , t h e w e d ge f i l te r a lt e r s t he b e am q ua l it y b y p r e f e re nt i al l y a tt e nua t i ng t h e l o w e r -e n e r g y p h o to n s ( b e a m ha r d e ni ng ) a nd , t o a l e s s e r e x t ent , b y C o m p t o n s c a t te r i n g , w h i c h r e s u l t s i n e n e r g y d e g r ad a t io n ( b e a m s o f te ning ) . F o r t he
60

Co

b e a m , b e c a u s e t h e pr i m a r y b e a m i s e s s e nt i al l y m o noe ne r g et i c , t he p r e s e nc e o f t h e w e d ge f i lt e r d oe s n o t s i g ni f i c a nt l y al ter t he c e nt r al a x i s pe rc e nt d ep t h do s e d i s t ri b u tio n . F o r x - r a y s , o n t h e o t he r ha nd , t he r e c a n b e s o me b e a m ha r d e ni ng

WWW.MEDRAD.IR

( 1 2 ) , a n d co n s e q u e n tl y , t h e d e pt h do s e di s t ri b uti o n c a n be som e w ha t a lt e re d , e s p e ci a ll y a t l a r ge d ep t h s . A l t h o u g h t h e we d ge f il t er s p ro d u c e so m e c ha ng e i n be a m q ua li t y , a s no t ed a bo v e , t h e e f f e c t i s n o t l a rge e n o u g h t o a l te r ot he r c a l c ul a ti o n p a r a met e r s s uc h a s t he b a c k s c a t te r f a c to r o r t h e eq u i v a le nt s q uar e , w hi c h m a y b e a ss um e d to be t he s a m e a s f o r t h e c o rr e s p o n di n g o pe n b e am s . E v e n c e nt r a l a x i s p e r c e nt de p t h d o s e s , ti s s u e - a i r r at ios o r t i s s u e m a x i m al r a t io s m a y b e a s s um e d unc ha ng e d f o r s m a l l d e pt h s ( e . g . , le s s t h a n 1 0 cm ) . T he e r ro r c a us e d b y t hi s a s s um p ti o n i s m i n i m i z ed i f t h e w e dg e t r a n s m i s si o n f a c tor ha s b e e n m e a s ur e d a t a r e f e r e nc e d e pt h c l o s e t o t h e p oin t o f i n t e r e st .

E. Design of Wedge Filters

T h e d e s ig n o f w e d ge f i l te r s f o r me g a v ol t age b e a m s ha s b e e n des c r i b ed b y m a ny a u t h o r s ( 13 , 1 4 , 15 , 1 6 ). H e r e I w i ll b r ie f l y p re s e nt t he de s ig n o f a uni v e r s a l w e dge f i l te r f o ll o w i n g t h e P.208 technique of Aron an d S c a p i c c hi o (16). T he p r i nc i pl e of t hi s m et ho d is to

d e te r m i n e t h e r a ti o o f p e r c e n t d e pt h d o se s a t v a r i o us po i nt s f o r w e d g e d a nd n o n w e d g e d f ie l d s . T h e t h i c k n e s s o f t he w e d ge f i l te r m a t e ri al a t t he s e p oi nt s is t h e n d et e r mi n e d f ro m t h e s e r a ti o s a nd t he k no w l e d ge o f t he ha l f - v a l ue l a y e r or t h e a t te n u a t io n c o e f f ic i e n t o f t h e gi v e n b e am f o r t he f i l te r m a te r ia l .

WWW.MEDRAD.IR

F I G . 1 1 . 8 . S c h e m a t i c r e p re s e n t at io n o f ( A ) a n i nd i vi d ua li z e d w edg e f o r a sp e c i fi c f i e l d wi dt h i n w h i c h t h e t h i n e n d o f t he we d ge i s a l w a y s a li g ned w i t h t he f ie ld b o r de r a n d ( B ) a u n i ve r s a l w e dg e i n w hi c h t he c e nt er o f t he w edg e f i lt e r i s f i x ed a t t h e b e a m a x i s a n d t h e f i e ld c a n b e o pe ned t o a ny w i d t h. F i g u r e 11 . 9 il l u st r a te s t h e d e si g n o f a w ed ge f i lt e r . A li ne i s d r aw n a t a s e l e ct ed d e pt h a c r o s s t h e n o nw e d g ed f i el d a t ri g ht a ng l e s t o t he ce nt r a l a x i s . T hi s d ep t h s h o u l d c or r e s po n d t o t h e r e f e re n c e d e pt h us e d f o r t he we d ge a ngl e d e f i nit io n. F a n l i n e s , r e p re s e n ti n g r a y s f r o m t h e s o ur c e , a r e d r a w n a t f i x e d i nt e rv a l s ( e . g . , 1 c m ) o n bo t h si d e s o f t h e c e n t r a l a x i s . A se r ie s o f p a r a ll el l i ne s i s dr a w n m a k i ng a n a n g l e w i t h t h e c e n t r al a x i s e q u a l t o t he co mp l e me nt o f t he gi v e n w e d g e a ng le a nd i n t e r se c ti n g t h e ce n t ra l a x i s a t t he s a me po i nt s o f i nte r s e ct io n a s t he no nw e d ge d i s o do s e l i n e s . A t a b le i s c o n s t r u c te d t ha t inc l ud e s t he pe r c e nta ge d ep t h do s e s at t h e p oi n t s o f i n t e r se ct io n o f t h e f a n l i ne s a nd t he r e f e re nc e d ep t h l i ne fo r t he

WWW.MEDRAD.IR

n o n w e d g e d i so do s e c ur v e s a n d t he we d ge d is o d o se l i ne s ( sl op i ng li ne s ) . T he r a ti o o f t h e w ed ge d t o n o n w e d g ed v a l ue s i s c al cul a t e d a s s ho w n i n Ta b l e 1 1 .1 . T he s e r a t io s are n o r m a li z ed to the hi g he st v a l ue w i t hi n t he f i eld ( e x c l ud i ng t he p e n u m b r a r e gi o n ) to g i v e t h e r el at i v e t ra ns m i s s io n r a t io a lo ng t he d e s ig na t ed f a n l i n e s . A w e dg e f il te r o f a g i v e n m at e ri a l ca n t he n b e de s ig ne d t o p r o v id e t he s e t r a n s m i s s io n r a t io s .

F I G . 1 1 . 9 . N e w 4 5 de g r ee l i n e s c o ns t r uct ed p a r al le l to o ne a no the r , i nt er s e c ti ng the c e n tr a l a xi s at same po i n t s of i nte rs e c t io n as no nw e d g e i s od o se l i ne s . ( R e d r a w n f r o m A r o n BS , S c a p i c c h i o M . De s ig n o f uni v e r s a l w ed g e f i l te r s y s te m f or a c o b a lt 6 0 u n i t . A m J R o e n t ge n o l 19 66 ; 9 6 :7 0 . ) P.209

11.5. COMBINATION OF RADIATION FIELDS

T r e a t m e nt b y a s i n gl e p h o to n b e a m i s s el dom us e d e x c e pt i n so me c a s e s i n w hi c h t h e t u mo r i s s u pe r f i c ia l . T h e f ol lo w i ng cr it er i a o f a c c e pt a bi li t y ma y b e us ed f o r a s i n g l e f i el d t re a t me n t : ( a ) t h e d o se di s tr i b uti o n w it hi n t he tum o r v ol um e is r e a s o n a bl y u n i f o r m ( e. g . , w i t h i n 5 % ) ; (b ) t he m a x i m um d o se to t he t i s s ue s i n t h e b e a m is n o t e x c es s i v e ( e . g . , no t m or e t ha n 1 1 0 % o f t he pr e s c r i be d do s e ); a n d ( c ) n o r m al c ri ti ca l s tr u c t u r e s i n t he b e a m d o no t r e ce i v e d o se s ne a r o r b e y o n d t ol e r a n c e . W h e r e a s si n g le f ie ld s o f s up e r f i ci a l x - r a y s a re r o ut i nel y us ed f o r t r e at i n g s k i n c a n c e r s w h i c h a r e c o nf i ne d t o a de p t h o f a f e w m i l l im et e r s ,

WWW.MEDRAD.IR

s i n g l e m eg a v o lt a ge be a m s a re u s e d o nl y i n r a r e c as e s fo r w hi c h a c o mb i na ti o n o f beams is ei t h e r t e ch n i c a l l y d i f f i c ult or r e s ul t s in unne c e s s a r y or e x c e s si v e i r r a di a ti o n o f t h e n o rm a l ti s s u e s . E x a m p l es o f a f e w t re a t me nts t ha t us e si ng le m e g a v ol t ag e be a m s in c l u d e t h e s up r a cl a v ic ul a r r e gi o n, i nte r na l m a m m a r y no d e s ( a n t e r io r f i el d ) , a n d th e s p i n a l P.210 c o r d ( po s te r io r f i el d ) . A l t h o u g h t he do s e dis t r i b ut io n i s no t i d e al, t he s i ng l e- f i el d t e c h n i q u e i n t h e s e ca s e s r e s u lt s i n s i mp li c it y o f s e t- up w i t hout v i o l at i ng t he a b o v e c r it e ri a o f a c c ep t a bi li t y .

TABLE

11.1.

TRANSMISSION

RATIOS

FOR

THE

CONSTRUCTION OF WEDGE FILTER

Non wed ge isod ose

4 0

5 5

6 2

6 5

6 7

6 8

6 8

6 8

6 7

6 5

6 2

5 5

4 0

Wed ge isod ose

3 5

3 9

4 1

4 7

5 3

6 0

6 8

7 6

8 6

9 5

1 0 5

1 1 0

1 1 5

Rati o (we dge /no nwe dge )

0 . 8 7 5

0 . 7 1 0

0 . 6 6 0

0 . 7 2 0

0 . 7 9 0

0 . 8 8 0

1 . 0 0

1 . 1 2

1 . 2 8

1 . 4 6

1 . 7 0

1 . 2 0

2 . 8 8

Tran smi ssio n rati o

0 . 3 8 7

0 . 4 2 5

0 . 4 6 2

0 . 5 1 5

0 . 5 9

0 . 6 6

0 . 7 5

0 . 8 6

1 . 0

WWW.MEDRAD.IR

mm Pb

1 5 . 2

1 3 . 6

1 2 . 2

1 0 . 5

8 . 3

6 . 5

4 . 5

2 . 3

F r o m A ro n B S , S c a p i cc h i o M . De s ig n o f univ e r s a l w e dg e f i lt e r s y s t e m fo r a c o b a lt 6 0 u n i t . A J R 1 96 6 ; 96 : 7 0 , w it h p e r m i ss i o n.

F o r t re a t me n t o f m o st t u m o rs , h o w e v e r , a c o m bi na t io n o f t wo o r m o re be a m s i s r e q u i r ed for an a c ce p t ab le di s t ri b uti o n of d o se w it hi n t he t um o r a nd t he s u r r o u n d i n g n o r m al t is s u e s . A l t h o ug h r ad i at io n f i el d s m a y be com b i ne d i n m a ny w a y s , t h e d i s c u s s i o n h e r e w i ll b e co nf i ne d t o t he b a s i c p r i nci p les t ha t a r e us e f ul i n t r e a ti n g t u m o r s i n v o l v i n g di f f e r e nt s it e s .

A. Parallel Opposed Fields

T h e s i m p l e st c o m bi n at io n o f t w o f i e l d s i s a p a i r o f f i e l d s di r e ct ed a l o ng t he s a m e a x i s f r o m o pp o si te si de s o f t h e t r e at me nt vo l um e . T he a d v a nt a ges o f t he p a ra ll e l o p po s ed f i el d s ar e t h e s i m pl i ci t y a nd re p ro duc i b i lit y o f s et - up , hom o g e neo us do s e to the tumor, and le s s c h a n c e s o f g e om e t ri c a l mi s s ( c o m pa r e d w i t h a ng le d b e a m s ) , g i ve n t h a t th e f i e l d si z e i s l a r g e e no ug h t o p ro v i de a d e q ua te l at e r al c o v e r a ge o f t h e t u m or v o l u m e . A d i s a d v a nt a g e i s t he e x c e s si v e d o s e to no r m al t i s s u e s a n d c r it i c al o rg a n s a b o v e a nd b e lo w t he t um o r . A c o m p o si te i so do s e d i s t ri b u ti o n f o r a pa i r o f p a r al le l o p po se d f i el d s m a y be o b t ai n e d b y ad d i n g th e d ep t h do s e c o nt r ib ut io n o f e a c h f i el d (F i g . 11 . 1 0 ) . T he m a n u a l p r o c ed u r e c o ns i s t s o f j oi ni ng t he po i nt s o f i nte r s e ct io n o f i s od o se c ur v e s f o r t h e i n di v i d u a l f i eld s w h i c h s um to t he s a m e t ot a l do s e v al ue . T he r e s ul t a nt d i s t ri b u tio n s h o w s t h e c o m b i n ed i s od o se P.211 d i s t ri b u tio n n o r m a l i z ed t o t h e i ndi v i d ual be a m w e i g ht s . T he b ea m s a r e us ua l l y w e i g h te d i n do s e u n its o f 10 0 at t he d e pt h o f D m a x i n t he c a se o f S S D t e c hniq ue s o r a t t h e i so c e n te r f or t h e i s o ce nt r i c te c hni q ue s . F o r t he e x a mp le s ho w n i n F i g . 1 1 . 1 0 A , t h e m i n i m u m p e r c e n t i s od o se s ur r o und i ng t he t um o r i s 1 1 0 . T hi s m e a ns t h a t t h e mi n i m u m d o se to t h e t u m o r ( w i t h a g e ne ro us m a rg i n) i s 1 10 r ad s i f 1 00 r a d s a r e d el i v er e d at t h e d e pt h o f D m a x b y ea c h f i e l d . T hus , i f t he t um o r do s e w e re t o b e sp e c i fi e d a t t h is i s od o se le v e l , o ne c o ul d c al c ul a te t he D m a x d o se a nd t he t r e at m e n t t im e f o r e ac h f i e l d . Fo r t he i so ce nt r i c p l a n s ho w n i n F i g . 11 . 1 0 B, t he b e a m w ei g h t s r e f er to do s e s d el i ve r e d to t he i so c e nt e r . T hus the 1 90 % i s od ose c u r v e r e p r e s e n t s t h e s p e c i f ie d mi ni m um d os a g e l e v el i f e a c h b e am d e li v e r e d 1 00 r a d s to it s i s o ce n t e r . O n c e t h e i s o ce nt e r d o s e i s c al c ul a te d , one c a n d e te r m i ne t h e t r e at m e nt t i me o r m o n i to r u n i t s a s d e s c ri b ed i n s e c ti o n 1 0 . 2 .

WWW.MEDRAD.IR

F I G . 1 1 . 1 0 . C o m p o s it e i so d o se d i st r ib ut ion f o r a p a i r o f p a r a l le l o pp o se d f i el d s . A : E a c h b e a m i s g i v en a w e i g h t o f 1 00 a t t he d e pt h o f D m a x . B: Is o c e nt r i c pl a n w i t h e a c h b e a m w e i g ht e d 10 0 a t t he i so c e nte r .

A.1. Patient Thickness Versus Dose Uniformity

O n e a d v a n t a g e o f eq u a l l y w e ig ht ed p a r al l el op po s e d b e a m s is t ha t t he do s e d i s t ri b u tio n w i t h i n t h e i r r a di a te d v o l ume c a n b e m a d e uni f o r m . H o w e v e r , t he u n i f o r m i t y o f di s t ri b ut io n d ep e n d s o n t he p a t ie nt t hi c k ne s s , b ea m e ne r g y , a nd b e a m f l at n e s s . In g e ne r a l , a s t h e p at ie nt t hi c k ne s s i nc r e a s e s o r the b e a m e ne r g y d e c r e a se s , t h e c e n t r al a x i s m a x i m um d o s e ne a r t he s ur f a c e i nc r e a s e s r e la ti v e t o t h e mi d po i n t do s e . T hi s e f f e ct , c a ll ed ti s s ue l a te r a l e f f e ct , i s s how n i n F i g . 1 1 . 1 1 i n w h i c h t w o op po s i ng be a m s a re p l a ce d 2 5 c m a p a rt wi t h t he mi d po i nt do se n o r m a l i z ed to 1 00 . T h e c u r v e s f o r c o b a lt - 60 a nd 4 M V s ho w t ha t f o r a p a t ie nt o f t h i s t h i c k n e s s p a r al lel op po s e d b ea m s w o ul d g i v e r i s e to a n e x c e s s i v el y hi g he r d o s e to t he s u b c u t a n eo u s t i s s u e s c o mp a r ed w i t h t he t um or do s e a t t he m id po i nt . A s t h e e n e r g y i s i n c r ea s e d t o 1 0 M V , t he dis t r i b ut io n b e co me s a lm o s t uni f o r m a nd a t 2 5 M V it s h o w s s ig n i f i c a n t s p a ri ng o f the s up e r f i c i al ti s s ue s r e l a ti v e t o t he m i d li n e s t r u c t u re s .

WWW.MEDRAD.IR

T h e r a t io o f m a x im u m p e r ip h e r a l d o se to mid p oi nt do s e i s pl ot te d i n F i g . 11 . 1 2 a s a f u n c t i o n o f p a ti e n t t h i c k n e s s f o r a num b e r o f be a m e ne rg ie s. S uc h d a t a a re u s e f u l i n c h o o s i n g t he a p p ro p ri a te b e a m e ne r g y f o r a gi v e n pa t i e nt t hi c k ne s s w h e n u s i n g p a r a ll e l op p o se d fi e ld s . F or e xa m p l e , a c c e pt a bl e unif o r m it y o f do s e, t h a t i s , w i t h i n 5 % , i s a c h i e v a b le w i t h c o b a lt - 60 o r 4 - t o 6 - M V b e a m s f o r t h i c k n e s s e s o f a b o u t 1 5 c m o r l e s s (e . g . , he a d , ne c k , a nd e x t r e m i ti e s ) . H o w e v e r , f o r t h i c k n e s s e s o f 2 0 c m o r g r e at e r ( e . g . , tho r a x , a b d o m e n, a nd p e l v i s ) , 10 - M V o r h i g h e r e n e r gi e s m u s t b e u s e d to s p a r e t he no r m a l s ub c ut a ne o us t i s s ue s .

F I G . 1 1 . 1 1 . D e p t h d os e c u r v e s f o r p a r a l l el o p p o se d f i el d no r m ali z e d to m i d po i nt v a l u e . P a t i e n t t hi c k n e s s = 2 5 c m , f i e l d s i z e = 1 0 1 0 c m , S S D = 1 0 0 c m .

WWW.MEDRAD.IR

F I G . 1 1 . 1 2 . R a t i o o f m a x i m u m p e r ip he r a l d o s e t o t he m i dp oi nt d o s e p lo tt e d a s a f u n c t i o n o f p at ie n t t h ic k n e s s f o r d i f f e re nt be a m q ua li ti e s . P a r al lel op po s e d f i el d s , f i e l d si z e = 1 0 1 0 c m S S D = 1 0 0 c m . P.212

A.2. Edge Effect (Lateral Tissue Damage)

W h e n t r e a ti n g w i t h mu l t i pl e b e a m s , t he q ue s t io n a r i se s w he t he r o ne s ho ul d t r e at o n e f i el d pe r d a y or a l l f ie l d s p e r d a y . W i ls o n a nd H a l l ( 17 ) ha v e d i s c us s e d t his p r o bl e m in t er m s of cell s u r v i v al c ur v e s a nd Ellis's t i me - do s e - f r a c ti o nat io n f o r m u l a ( 18 , 1 9 ) . Fo r p a r a l le l op p o se d b e am s , t he y ha v e s ho w n t ha t tr e a ti ng w it h o n e f i e ld p e r d a y p r odu c e s g r e a t e r bio lo g i c d a m a g e to no r m al s ub c ut a ne o us t i s s ue t h a n t r e a ti n g w i t h t w o f i e ld s p e r d a y , d e sp i te t he f a c t t ha t t he t o t al d o se i s t he s a m e . A p p a re n t l y , t h e b io lo gi c e f f e ct i n t he no r m a l ti s s ue i s g re at e r i f it re c ei v e s a l t er n a t i n g h ig h - a n d l o w - do s e f r a c ti o ns co m p a re d w it h t he e qua l b ut m e di um s i z e d o se f r a c ti o n s r es u l t i n g f r om t re a ti ng b o t h f ie ld s d a il y . T hi s p he no m e no n ha s b e e n c a ll e d t h e e dg e e f f e c t , o r t he ti s s ue l a te r a l d a m ag e (20 ) . T he p r o b le m b e c o me s mo r e s e v e re w h e n l a r g er t hi c k ne s s e s ( e . g . , 20 c m ) a r e tr e a te d w i t h o n e f ie l d pe r d a y u s in g a lo w e r -e ne r g y bea m ( e . g . , 6 M V ) . In s uc h c a s e s , t he d o s e p e r f r a ct io n to t h e s u b c u t a ne o us t i ss ue s , a l t ho ug h de li v er e d o n al te r na t e d a y s , b e c o m e s p r o h ib it i v el y h i g h .

A.3. Integral Dose

One way of c o mp a r in g d o se di s t ri b uti o ns for di f f e r e nt q ua lit y beams is to c a l c u l a te t h e i n te g r al d o s e f o r a gi v e n t um or d o se . Int e g r al d o s e i s a me a s ur e o f t h e t ot a l e n e r g y a b sor b e d i n t h e t r e at ed vo l um e . If a m a s s o f ti s s ue r e ce i v e s a

WWW.MEDRAD.IR

u n i f o r m d o s e , t h e n th e i n t e g r al do s e i s si m p l y t he p ro d uc t o f m a s s a nd d o s e . H o w e v e r , i n p r a c ti c e , t h e a b so r b ed do s e in t he t i s s ue i s no nuni f o r m s o r at he r c o m pl e x m a t h e m at i c al f o r m u l a s a r e r e q ui re d t o c a l c ul at e it . F o r a si n g le be a m o f x - o r r ad i at io n, M a y ne o r d ( 21 ) f o rm ul at e d t he fo ll o w i ng e x p r e s s io n :

w h e r e i s t h e i n te g ra l do s e , D 0 i s t he p e ak d o s e alo ng t he ce ntr a l a x i s , A i s t he g e o me t ri c a re a o f t h e f i e ld , d i s t he t ot a l thi c k ne s s o f p a ti e nt i n t he p at h o f t he b e a m , d 1 / 2 i s t h e h a l f -v a l u e d e p t h o r t he dep t h o f 5 0 % d ep t h d o se a nd S S D i s t he s o u r c e - s u r f a c e d i st a n c e . T h e t e r m

i s a c o r r e ct io n f o r g e om e t ri c d i v e rg e nc e o f the b e a m .

F I G . 1 1 . 1 3 . In t e g r a l d o s e a s a f unc t io n o f p ho to n b e a m e ne r g y , w he n 1 , 0 0 0 r ad a r e d el i v e re d at a mid p oi n t o f a 2 5 - c m t hic k p a t ie nt . F i el d si z e , 1 0 - c m di a m et e r a t a n S S D o f 1 0 0 c m . ( R e d r a w n f r o m P o d go r s a k E B, R a w l i ns o n J A , J o hns H E . X r a y d e pt h do s e s f o r lin e a r a c c el e r at o r s i n the e ne r g y r a ng e f ro m 1 0 to 3 2 M e V . A m J R o e n t g e n ol 1 97 5; 1 2 3 :1 8 2 . ) P.213

B e c a u s e i n t e g r al d o se i s b a s i c a ll y t he p r oduc t o f m a s s a nd d o s e, i t s uni t i s t he g r a m - r a d o r k il og r a m- g r a y o r s i m pl y j o ul e ( s i nc e 1 G y = 1 J / k g ) . F i g ur e 1 1 . 13 s h o w s t h e i n t eg r a l dos e a s a f u n c t i o n o f t he e ne rg y o f r a d ia ti o n f o r a t um o r d o se o f 1 , 00 0 r a d (1 r ad = 1 0 - 2 G y ) a t a de pth o f 12 . 5 c m i n t he p a t ie nt o f 25 - c m t h i c k n e s s t r e at e d wi th p a r a l l el op p o se d be a m s ( 2 2 ) . T he c ur v e s ho w s a us e f ul r e s u l t , n a m e l y , t h e h ig h e r t h e p h o to n e ne r gy t he l o w e r t he i nt e g ra l d o se . A l t h o u g h i t i s g e n er a ll y b e li e v ed t ha t t he pr o b a bi li t y o f d a m a g e t o no r m al ti s s ue i n c r e a s e s w it h t h e i n c r e a s e i n t he i nte g r al d o se , t hi s q ua nt it y i s s el d om us ed c l i n i c al l y to pl a n d o s ag e s o r pr e di c t t r e at me nt o ut co m e . H o w e v e r, i t d oe s p ro v i de

WWW.MEDRAD.IR

q u a l it a ti v e g u id e li n e s f o r t r e at me nt pl a nni ng f o r s el e ct i ng b e am e ne r g y , f i el d s i z e s , a n d m u lt ip li c it y o f f ie l d s . A s a ge ne ra l r ul e , o ne s ho ul d ke e p t he i nt eg r al d o s e to a m i ni m u m , pr o v i de d t h e ad eq ua c y o f t umo r i r r a di a ti o n and t he sp a r i ng of c r i ti c a l o rg a n s a r e n o t c o m p r om i s ed .

B. Multiple Fields
O n e o f t h e mo s t im p or t a n t o b je c ti v e s o f t r ea t m e nt pl a ni ng i s t o de l i v er m a x im um d o s e t o t h e t u m o r an d m i n i m u m do s e t o t he s ur r o und i ng t i s sue s . In a d d i t io n, d o s e u n i f o r m it y w i t hi n t h e t u m o r v ol um e a nd s p a r i ng o f c ri ti c a l o r g a ns a re i m po r t a n t co n s id e r at io n s i n j u d gi ng a pl an. S o m e o f t he s t r at e gi e s us e f ul i n a c h i e v i n g t h e s e g oa l s a r e ( a ) u s i ng fi el d s o f a p pr o pr i at e si z e ; (b ) i nc r e a si ng t he number of f ie l d s or p o rt a l s ; (c) s el e ct ing a p p ro p ri a te be a m d i re c ti o ns ; ( d) adjusting be a m w e igh t s ( d o s e co nt r ib ut ion f r o m i nd i v i d ua l fi el d s ) ; ( e ) us i ng

a p p r op r i at e be a m e n er g y ; a n d ( f ) us i ng b e a m m o d i fi e r s s uc h a s w e d ge f i lt e r s a nd c o m p e n s at o r s . Al t h o ug h o bt a i n i n g a co m bina t i o n o f t he se p a r am e t er s t hat y ie l d s an o p ti m a l plan is t i me - c o n s um i ng if d o ne m a nua ll y , t re a t m e nt - pl a nni ng c o m p u te r s a re n o w a va i l a bl e t h a t c a n do t he jo b q ui c k l y a nd a c cur a t e l y . S om e o f t h e s e s y s te m s a r e h i gh l y i n t e r a c ti v e s o t ha t t he us e r c a n a l m o st ins t a nt l y m o di f y , c a l c u l a te , a n d e x a m i n e v a r i o u s p l a ns to s e le c t o ne t hat i s c li ni c a ll y s up e r i o r . In s e c t i o n 1 1 . 5 A , I d i s c u s s e d t h e c a s e o f t w o p a r a ll el o p po s ed f i e ld s . A l t ho ug h t he t e c h n i q u e r e s ul t s i n un i f o r m i r r ad i at io n o f the t um o r , t he re i s li ttl e s p a ri ng o f t he s u r r o u n d i n g n o r m al ti s s u e . In f a c t , t he do s e t o t he pe r ip he r a l t i s s ue s c a n be s i g n i f i c a n tl y h i g h e r th a n t h e m i d li ne d o se. R e d uc t io n o f d o se t o s ub c ut a neo us t i s s u e a n d n o r m al t is s u e s u r r o und i ng t he t um o r c a n b e a c hi ev e d b y us i ng a c o m bi n a t io n o f t h r ee o r mo r e f i el d s . Fi g ur e 1 1 . 14 i ll us t r at e s v a rio us m ul ti pl e - f ie ld a r r a n g e m e n t s i n w h i ch t h e b e a m P.214 e n t e r s t h e p at ie n t f r om v a r i o u s di r e ct io ns , a l w a y s d i r e ct ed a t t he t um o r . T hus , b y u s i n g m u l ti pl e fi e ld s , t h e r at io o f t he t umo r do s e to t he no r mal ti s s ue d o se i s i n c r e a s e d . Fi g u r e 11 .1 5 A , B s h o w s t y p i c a l e x a m p le s o f m ul ti pl e f i e l d s , o ne us e d f o r t r e at m e n t o f t h e e s o p h a g u s a nd t he o t he r , f o r t he p r o st at e gl a nd . F i g ur e 1 1 . 1 5 C i ll u s t r at e s a f i x e d S S D - t yp e t e c hni q ue i n w hi c h t he b ea m w e i g ht s a re d e li v e r ed to D m a x poi n ts . In a c t u a l p r a c ti c e , o ne m a y us e a co m bi na t io n o f p a r al le l o p po s ed f i e ld s a n d m u l ti p le f i el d s to a c hi e v e t he d e s i re d do s e di s tr i b uti o n.

WWW.MEDRAD.IR

F I G . 1 1 . 1 4 . S c h e m a t i c di a g r a m s ho w i ng e x a m p l e s o f m ul ti ple f i e ld s . A : T w o o p po s i n g p a i r s at r igh t a n g l e s . B : T w o o pp o s i ng p a i r s at 12 0 de g r ee s . C : T hr e e f i e l d s : o n e a n t e ri o r a nd t w o p o st e rio r o bl iq ue , a t 4 5 d eg r ee s w i t h t he v e r t i ca l . A l t h o u g h m u l t ip le f i e ld s c a n p r o v i d e go od di s t ri b uti o n, t he r e a r e s o m e c li ni c a l a nd t e c h n i c a l l i mi t at io n s t o t h e s e me t hod s . Fo r e x a m pl e , c er t ai n b e a m a ng le s a r e p r o h i bi te d be c a u s e o f t h e p r e s e n c e o f c r i t i c al o r g a ns i n t ho s e di r ec t io ns . A l s o , t he s e t - u p a c c u r a c y o f a t r e a t me n t m a y b e b et te r w i t h p a r a ll el o pp o se d t ha n w i t h t he m u l t ip le a n g l ed b e am a r r a n g e m e nt . It i s , the r e f o r e , im p or t a nt to r e a li z e t hat t he a c c e p t ab il it y o f a t rea t m e n t p l a n d e pe nd s no t o nl y o n t he d o se di s t ri b uti o n o n p a p e r b u t a l so o n t h e p r a c ti c a l f e a si bi li t y , s e t - up a c c ur a c y , a nd r e p r od uc i bi li t y o f t h e t r e at m e nt t e c h n i qu e .

11.6. ISOCENTRIC TECHNIQUES

M o s t mo de r n m a c h i n es a r e c o n st r uc t ed s o tha t t he so ur c e o f r a d ia t io n c a n r o ta te a b o u t a h o ri z o n t al a x is . T h e g a n t r y o f t he m a c hi ne i s c a p ab l e o f r o t at i ng t hr o ug h 3 6 0 d eg r ee s w it h t h e c o ll i m at o r a x i s m o v i ng i n a v e r ti c a l pl a ne . T he i s o ce nt e r i s t h e p oi n t o f i n te r s e ct io n o f t h e c o ll i m at or a x i s a nd t he g a nt r y a x i s o f r o t a ti o n.

A. Stationary Beams
WWW.MEDRAD.IR

T h e i s o c e n t ri c t e c h n iq u e o f i r r a d i at io n c ons i s t s o f p l a c i ng t he i s o c e nte r o f t he m a c h i n e a t a d ep t h w i t h i n t h e p a ti e nt a nd d i re c ti ng t he be a ms f r o m di f f e r e nt d i r e ct io n s . T h e d i s t a nc e P.215 o f t h e s o u r c e f r o m t he i so c e n te r , o r t he S AD , r e m ai ns c o nst a nt i rr e s p e ct i v e o f t he b e a m d i re c ti o n . H o w ev e r , t h e S S D i n t hi s c a s e m a y c ha ng e , d e p e ndi ng o n t he b e a m d ir e c tio n a n d t h e s h a p e o f t he p a ti e nt c o nt o ur . F o r a ny b e a m d i r e ct io n, t he f o l lo w i n g r el a ti o n s h i p h o l d s :

where

is

the

de pth

of

the

i s o ce nt e r . K no w i ng

t he

d ep t h

a nd

p o si ti o n

of

i s o c e nt e r f r o m o n e di r e ct io n s u c h a s t he a nt e r i or p o st e ri o r , t he S S D c a n b e c a l c u l a te d a c c o rd i n g to E q u a t io n 1 1 . 2 P.216 a n d s e t u p f r o m t h at d i r e ct io n . T he n t he p o s it io ni ng o f s ub s e q ue nt f i el d s s i mp ly r e q u i r e s mo v i n g t h e ga n t r y a n d n o t t he p a t ie nt .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

F I G . 1 1 . 1 5 . E x a m p l e s o f m u lt ip l e f i el d pl a ns . A : T hr e e - f i el d i so c ent r i c t e c hni q u e . E a c h b e a m d el i v e r s 10 0 u n i t s o f d o se a t the i s o ce nt e r ; 4 M V , f i e l d si z e = 8 8 c m a t i s o c e nt e r , S A D = 1 0 0 c m . B : F o ur - f i e l d i s o ce nt r i c te c hniq ue . E a c h b e a m d e li v e r s 1 00 u n i t s o f d o s e a t t he i so c e nte r ; 1 0 M V , f i e l d s i z e = 8 8 c m a t i s o c e nt e r , S A D = 1 0 0 c m . C : F o ur - f i e l d S S D t e c hni q ue i n w hi c h a l l b e a m s a r e w e i g h te d 10 0 u n it s a t t h e i r r e s pe c ti v e po i nts o f D m a x ; 1 0 M V , f i e ld s i z e = 8 8 c m at surface, SSD = 100 cm. A l t h o u g h a ll te c h n i q ue s f o r w h i c h S S D S A D c a n b e c a r r ie d out i s o ce nt r i ca ll y , t h e m a j o r a d v a n t a ge o f t h i s m e t hod i s t he e a s e w i t h w hi c h m ul t ip l e f i el d s et - up s ( t h r e e o r m o re ) c a n b e t r e at e d w he n a ll fi e ld s a re t r e at e d t he s a m e d a y . T hi s t e c h n i q u e no t o n l y dis p e n s e s w it h t he s et ting up o f S S D fo r e a ch b e a m d i re c ti o n b u t r e li e s p r i m a ri l y on t h e a c c u r a c y o f m a c hi ne i s o ce nt r i ci t y a nd no t o n t he s ki n m a r k s w h i c h a r e u n r e l i a b le p oi n t s o f r e f e re nc e i n m o s t c a s e s . The t r e at m e n t c a l c u la t io n s f o r i s o ce nt r i c t r e at m e nt s ha v e bee n p r e se nt e d i n s e c t io n 10 . 2 A . 2 . F igu r e 1 1 . 15 A , B s ho w s e x a m p le s o f i s od o se d i st ri b uti o n f o r i s o c e nt r i c te c h n i q u e s .

B. Rotation Therapy
R o t at io n t h e r a p y i s a s p e c i a l c a se o f t he is o c e nt ri c t e c hni q ue i n w hi c h t he b e a m m o v e s c o nt i n u o u s l y ab o u t t h e p at i e nt , o r the p a t ie nt i s r ot a te d w hi l e t he b e a m i s h e l d f i xe d . A lt h o u g h t h i s t e c h n i q ue ha s be e n us e d f o r t r e at i ng t umo r s o f t he e s o p h a g u s , bl a dd e r , pr o s t at e g l a nd , c e r v i x , a nd b r ai n, t he t e c hniq ue o f f e r s li tt le a d v a n t a g e o v e r t h e is o c e n t ri c t e c hni q ue us i ng m ul t ip le s t a ti o na r y b e a m s . F o r e x a m p le , o p po s ed the e s op h ag u s and the can be t r e at ed w it h e q ua ll y or w e ll w it h f ie ld s thr e e or f i el d s ; t he p r o st a t e gl a n d a n d bla d d e r , wi t h fo ur f i el ds ( s o me ti m e s c o mb i ne d w it h p a ra ll e l f i el d s ) ; br a i n, t wo t hr ee with w e dg e s , d e pe n d i n g o n t h e si ze a n d l o c at io n o f t he t um o r . M a ny t i m e s it i s a m a tt e r o f i n d i v id u a l pr e f e re n c e , a l t ho u g h o ne te c hni q ue m a y o f f e r p a rt i cul a r a d v a nt a ges o v e r t h e o t h e r i n re ga r d to p a ti e nt po s it ioni ng , b lo c k i ng , a nd t he s i z e o f v o l um e t o b e i r r a di a te d . E s p ec i a ll y w h e n i nt r i c at e b l o c ki ng i s re q ui re d , r o t at io n t he r ap y s h o u l d n o t be a t te m pte d . R o t at io n t h e r a p y i s be s t s u i te d f o r s m a ll , d e ep - s e a te d t umo r s . If t he t um o r i s c o n f i n e d w it h i n a r e gio n e x t e n di ng no t m o re t ha n ha l f w a y f r o m the c e nt e r o f t he c o n t o u r c r o s s - se c ti o n , r o t a ti o n t h e r ap y m a y b e a p r o pe r c ho i c e . Ho w e v e r , r o t ati o n t h e r a p y i s n o t i n d i c at e d i f ( a ) v ol um e t o b e i r r a di a te d i s to o l a r ge , ( b ) t he e x t e r n a l s u r f a c e d i f f e rs m a r k e d l y f r o m a c y l i nd e r , a nd ( c ) t he t um o r i s to o f a r o f f center. C a l c u l a t io n for r o t at io n therapy can be made in t he same way as for t he s t a ti o n a r y i so c e n t ri c b e a m s , e x c ep t t ha t a r e a s o na bl y l a rg e num b e r o f b e a ms s h o u l d b e po s it io n e d a r o u n d t h e p a ti e nt c ont o ur a t f i x e d a ng ul ar i nt e r v a l s . T he d o s e r at e a t t h e i s o cen t e r i s g i ve n b y :

w h e r e [ D w i t h d o t ab ov e ] r e f i s t h e re f e r e nc e d o s e r at e r el a te d to the q ua nt i t y

WWW.MEDRAD.IR

w h i c h m a y b e a v e ra ge ti s s u e - to - ai r r at io ( T A R ) o r t i s s ue m a x im a l r at io ( T M R ) ( a v e r a g e d o v e r a ll d ep t h s a t t h e s el e ct e d a ng l e s ) . In t he c a s e o f T A R s , [ D w it h d o t ab o v e ] r e f i s t h e d os e r a t e i n f r e e sp a c e f o r t he g i v e n f i el d a t t he i s o ce nt e r . A m e t h od o f m a n u a l c al c u l a ti o n s b a se d o n thi s s y s t e m w a s di s c us s e d i n se c ti o n 9 . 4 D . If t h e T M R s a r e u s e d , [ D w i t h d o t a b o v e ] r e f i s t he D m a x d o s e r at e f o r t he g i v e n f i e ld a t t h e S A D. U s i n g t h e T M R s y s t e m d i s c us s e d i n C ha p t er 1 0 ,

w h e r e [ D w i t h do t ab ov e ] 0 i s t h e D m a x do s e ra t e f o r a 1 0 10 - c m f i e l d a t t he S A D , a n d S c a n d S p a r e t h e c ol li m a to r a nd p ha nt o m s c at t er c o r re c tio n f a c t o r s fo r t he g i v e n f i e ld s i z e a t t h e i s o c e n te r . In t he c a s e o f a l i ne a r a c c e l e r at o r , [ D w i t h d ot a b o v e ] 0 i s t h e m o ni to r u n i t ( M U ) ra t e ( as s um i ng 1 M U = 1 ra d ( c G y ) at t he i s o c e nt e r f o r a d ep t h o f D m a x f o r a 1 0 1 0 -c m f i e l d ) .

Example
A p a ti e n t i s to re c ei v e 2 50 r ad at t he i s o ce nt e r b y ro t at io n t her a py , us i ng 4 - M V x r a y s , 6 1 0 - c m f i e l d a t t h e i so c e nte r , a nd a S A D o f 1 0 0 c m . If

c a l c u l a te d a c c or d i n g t o t h e p r o ce d ur e i n s e c t io n 9 . 4 D i s 0 . 746 , c a l c ul a te t he n u m b e r o f m o n i to r u n i t s t o be s e t o n P.217 t h e m a c h i n e i f t h e m ac h i n e o u t p ut i s s et a t 2 0 0 M U / m i n a nd g i ven S c ( 6 1 0 ) = 0 . 9 8 a n d S p ( 6 1 0 ) = 0 . 9 9 . F r o m E q ua t ion 1 1 . 4 ,

or

G a n t r y r o t at io n s p ee d i s s et s o t ha t 3 45 M U a r e de li v e r e d a t t he c o nc l us i o n o f t he r o t at io n . S o m e m a c h in e s p e r f or m o nl y o ne r o t at io n, w he r e a s o t he r s c a n pe r f o r m a s p e c i f ie d n u m be r of arcs or r ot a ti o ns in a p e nd ul um m a nne r . Most m od e r n m a c h i n e s a l lo w f o r au t o m a ti c a dj us t m e nt o f r o ta ti o n s pe e d t o d e li v e r a p re set n u m b e r o f m o n i to r u n i t s b y t h e e nd o f a s i ng l e ro t at io n. T h e d e te r m i n at io n o f c o m pl et e i s o do s e c ur v e s f o r r ot a tio n t her a p y b y m a nua l m e a n s i s v e r y ti m e - co n s u m i n g . It i s e s se nt i al l y t he s am e p ro c ed ur e a s us e d in m u l t ip le f i x e d b e a m s , b u t w i t h a l a r g e num b e r o f b e a m s . T he is o c e nt ri c i s od o se c h a r t ( F i g . 1 1 . 1 B ) i n w h i c h i s o d o s e s a r e no r m a l i z ed t o a po i nt a t d e p t h o n t he c e n t r a l a x i s i s u s e d w i t h t h e i so c e nte r p la c e d a t t he p oi nt o f no r m a l i z at io n. By s u m m i n g t h e i so do s e v a l u e s a t s el e ct ed p o i nt s w hi l e t he c har t i s p l a c ed a t different angles, t he do s e di s tr i b ut io n can be de te r m i ned r e l at i v e to t he i s o c e nt e r . B e c a u s e o f t h e t e di u m i nv o l v ed i n t he p r o c ed ur e , t hi s t a s k i s i de a ll y

WWW.MEDRAD.IR

s u i t e d f or c o m p u te r a p p li c a ti o n . S uc h p r o g r a m s a r e a v a i l ab le w i t h c o m m e r ci al t r e at m e n t pl a n n i n g c om p u t e r s . F i g u r e 11 . 1 6 s h o w s th r e e e x a m p le s o f i sod o s e d i st r ib ut io n f o r r o t at io n t he r a p y: ( a ) 1 00 de g r ee a r c rot a ti o n ; ( b ) 1 80 de g ree a r c ro t at io n; a nd ( c) f ul l 36 0 d e g re e r o t at io n . It s h o u l d b e n o t e d t h a t w he r e a s the m a x i m um d o s e f o r t he 3 6 0 - de g re e r o t at io n o c c u r s a t t he i so c e n te r , f o r t he p a r t ia l ar c s it i s d i spl a c e d to w a r d t he i r r a di a te d s e ct or . T h i s i ll u s t r a te s a n i mp or t a nt p ri nc i pl e t ha t in a r c t he r a p y or w h e n o b l i q u e f ie ld s ar e d i re c te d t hro ug h o ne s i d e o f a p at ie nt , t he y s ho ul d b e a i m e d a s u i t ab le di s ta n c e b e y o n d t he t umo r a r e a . T hi s i s so m et i me s r e f e r re d to a s p a s t po i n ti n g . T h e e x t e n t o f p a s t p oi nt i ng r e q ui re d t o b r i ng t he m a x i m um do s e t o t h e t u m o r si t e d ep e n d s o n t he a r c a ng l e a nd s ho uld b e de t e rm i ne d fo r a n i n d i v id u a l c a s e b y a c tu a l i s o do s e pl a nni ng .

11.7. WEDGE FIELD TECHNIQUES

R e l a ti v e l y s u pe r f i ci a l t u m o r s , e xt e nd i ng f r om t he s ur f a c e t o a de p t h o f s e v e ral c e n t i me te r s , c a n be ir r a d i at e d b y t w o w ed g e d b e a m s di r e ct e d f r o m t he s ame s i d e o f t h e pa ti e n t . Fig u r e 11 . 1 7 A s ho w s i so d o se d i st r ib ut io n o f tw o a ng le d b e a m s w i t h n o w ed g e i n t h e b e a m s . It i s se e n t ha t i n t he r e gio n o f o v e r la p o f t he b e a m s , t h e d o se di s t ri b u ti o n is q u i t e no n uni f o r m . T he d o s e i s hi g he st i n the s up e r f i c i al o r p r o x i m al r e gio n o f o v e r l a p a n d f a ll s o f f t o l o w e r v a l ue s t o w a r d the d e e pe r a r e a s . B y i n s e r t i n g a p p ro p ri at e w e d ge f i lt e r s i n t he b e a m a nd p o si ti o ni ng t he m w i t h t he t h i c k e n d s a d j a ce n t t o e a c h o t h e r , t he a ng led f i el d di s t ri b uti o n c an b e m a d e f ai r l y u n i f o r m ( F i g . 1 1 . 17 B ) . E a c h w e d g e d be a m in t hi s c a s e ha s a r e d uc e d d o s e i n t he s u p e r f i c i al re g io n re l at i v e to t h e de ep e r r eg i o n so t ha t t he do s e g r a di e nt i n t he o v e r l ap r eg io n i s m in i m i z e d . T he do s e fa l l s o f f r a pi dl y be y ond t he re gi o n o f o v e r l ap o r t h e p l at e au r e g i o n , w hi c h i s c l i ni c a l l y a d e si r a bl e f e at ur e . T h e r e a r e t h r ee p a r am e t er s t h a t a f f e c t t he p l at e a u r eg io n i n t er m s o f i t s d e pt h, s h a p e , a n d d o se di s t ri b u t io n : , , a nd S , w he r e i s t he w e dge a ng l e ( se c ti o n 1 1 . 4 A ) , is t h e h i n g e a n gl e , a nd S i s the s e p a r at io n. T he s e p a r a m et e r s a r e i ll u s t r a te d i n F i g . 11 . 18 . T h e h i n g e a ng l e P.218 i s t h e a n gl e b et w e e n t h e c e n t r al a x e s o f t he t w o b e a m s a nd t he s e p a r at io n S i s t h e di s t a n c e b et w e e n t h e t h i c k e nd s o f the w e d ge f il t er s a s p r o je c te d o n t he s u r f a c e . C o h e n a n d M a r t i n ( 3 ) h a v e di s c us s e d i n d et ai l ho w , , a nd S c a n b e a d j u s t ed t o a c h ie v e a d e s i re d pl a te a u.

WWW.MEDRAD.IR

WWW.MEDRAD.IR

F I G . 1 1 . 1 6 . E x a m p l e s o f i s o d o se d i st r ib ut ion f o r r o t a t io n t he r a p y. A : A r c a ng l e = 1 0 0 de g re e s . B : A r c a n g l e = 1 8 0 de g re e s . C : F ul l 3 6 0 de g re e r ot at io n; 4 M V , f i e l d s i z e = 7 1 2 c m a t i s o c e n te r , S A D = 1 0 0 c m . T h e r e i s a n o pt i m u m re l a tio n s h i p b et w e e n the w e d g e a ngl e a nd t he hi ng e a ng le w h i c h p r o v i d e s t h e m o s t u n i f o r m di s t ri b uti o n o f r a d i at io n d o se in t he p l a t e a u:

T h i s e q u a t io n i s b a s ed o n t h e p r i nc i pl e t ha t f o r a g i v e n hi ng e a ng l e t he w e dg e a n g l e s h o u ld b e s u c h t h a t t h e i s od o se c ur v e s f r o m e a c h f i el d ar e p a r a ll el to t he b i s e ct o r o f t h e h i n ge angle ( F i g . 1 1 . 18 ). U nd e r t he se c o ndit io ns , w he n t he i s o do s e s a re c o m bi n ed , t h e r e s u l t a nt di st r ib ut io n i s uni f o r m . T h e E q u a t i o n 1 1 . 5 , a l t h o u g h h el p f ul i n tr e a t me nt pl a nni ng , m a y no t y ie l d a n o p ti m u m pl a n f o r a g i v e n p a ti e nt co nto ur . T he r e l a ti o ns hi p a ss um e s t ha t t he w e d g e i so do s e c u r v es a r e n o t m o di f i ed b y t he s ur f a c e c o nt o ur . In p r a c t i c e , however, contours are usually curved P.219 o r i r r eg u l a r i n s h a p e a n d t h u s m o d i f y t h e i s o do s e di s tr i b ut io n f o r t he w e d g ed b e a m s . A s a r e s u lt , t h e i so do s e c ur v e s fo r t he i nd i v id ua l f ie ld s a r e no l o nge r p a r a l le l to t h e b i se c to r o f t h e hi ng e a ng l e , t hus g i v i ng r i s e t o a no nuni f o r m d i s t ri b u tio n in the o v e r l ap re g io n. T hi s p r ob le m can be so l v ed by usi ng c o m p e n s at o r s ( di s c u s s e d i n C h a p t e r 1 2 ) , w hi c h m a k e t he s k i n s u r f a c e e f f e c t i v el y f l a t a n d p e r pe n d i c u lar t o e a c h be a m . A n a l t er na t i v e a p p ro a c h i s to mo di f y t he w e d g e a n gl e ( u s i n g a d i f f e r e n t we d ge a ng le f i lt e r f ro m t hat g i ve n b y E q ua t i on 1 1 . 5 ) s o t h a t a p a r t of t h e w e d g e a ng le a c ts a s a c o m p e ns a to r a nd t he r e s t a s a t r u e w e dg e f ilt e r . T h e m a i n ob j e ct i v e i s t o m a k e t he i s od o se c ur v e s p a r al le l t o t he hinge P.220 o p ti m u m w ed ge a n gl e m a y n ot be e a s y i f pl a nni ng i s do ne m a nua l l y . T he fo r m e r m e t h od , o n t h e o t h e r h a n d , i s w el l - s uit ed f o r m a nua l c al c ul a ti ons s i nc e a ll yo u n e e d i s a co m pe n s a tor a n d a n a t l a s o f p r ec a l c ul a te d i s o do s e d i st r i b ut io ns f o r a v a r i e t y o f , , a n d S v a l u e s . T h i s m e t hod , ho w e v e r , b e co m e s t e chni c a l l y d i f f i c ult t o im p le m e n t i f c o mp l i c at ed s e c o nd ar y b lo c k i ng i s r eq ui r ed i n a d d it io n t o t he c o m p e n s at o r a n d t h e w e d g e f il te r . angle bi s e ct o r . A l t h o u g h t he l at te r a p p r o a c h ob v i a te s t he ne e d for a c o m p e n s at o r , t h e de ter m i n a t io n o f a n

WWW.MEDRAD.IR

F I G . 1 1 . 1 7 . Is o d o s e d i st r ib u t io n f o r t w o a ng l e b e a m s . A : W it ho ut w ed g e s . B: W i t h w e d ge s ; 4 M V , f i e ld s i z e = 10 1 0 cm , S S D = 1 0 0 c m , w e d ge a ng l e = 45 d e g re e s .

WWW.MEDRAD.IR

F I G . 1 1 . 1 8 . P a r a m e ter s o f t h e w ed g e be a ms , i s w e dg e a ng l e , i s hi nge a ngl e , a n d S i s s e p a r a t i o n . Is o d o s e c ur v e s f o r e a c h w e d g e f i e ld a r e p a r a l l el to t he b i s e ct o r . E q u a t i o n 11 . 5 s u g ges t s t h a t fo r e a c h hing e a ng l e o ne s ho uld us e a d i f f e re nt w e d g e a n gl e . H o w e v er , i n p r a c t i ce , s e le c ted w e d g e a ngl e s , i .e . , 1 5 d eg r ee s , 3 0 d e g re e s , 4 5 de g r ee s , a n d 6 0 d e g r ee s , a r e a d e q ua t e o ve r a w i d e r a ng e o f hi ng e angles. In m o d e r n r a d i a ti o n th e r a p y , c o m p le x t r e atm e nt t e c hni q ue s a re f r e q ue nt l y us e d , which such may cases. involve For this wedge fi lt e r s , in c om p e ns a to r s , ins t i t uti o ns , c o m p ute r f i el d al l as a blo c k i ng , c om pl e x m at t er a nd f i eld r e d u c t io n s , a l l fo r t he s a m e p at ie nt . M a nua l t r e at m e nt p l a nni ng i s di f f i c ul t f o r r e a so n , are m a ny by t r e at m e nt s , of s ta nd a rd including p r a c t i ce . w ed g ed f i el d s , p l a nne d

A. Uniformity of Dose Distribution

B e c a u s e w e d g e p ai r te c h n i q u e s a r e no r m a ll y us e d f o r t r e at i ng sm a l l , s up e r f i ci al t u m o r v o l u m e s , a h i gh - d o s e r e gi o n ( ho t s po t ) o f up t o + 1 0% w i thi n t he t r e a t me nt

WWW.MEDRAD.IR

v o l u m e i s u s u a l l y a c ce p t ab le . T h e s e ho t s po t s o c c ur und e r t he thi n e nd s o f t he w e d g e s a n d t h ei r m a gn i t u d e i n c r e a se s w i t h f i e l d si z e a nd w e d g e ang l e . T hi s e f f e c t i s r el a te d to t h e di f f e r e n t i al a tt e nua ti o n o f t he b e am und e r t he thi c k e nd r e l at i ve to the thin end. G e n e r a l l y , t h e w ed ge f i l te r t e c h n i q ue i s s ui ta b l e w he n t he t um o r is a p p ro x i m at el y f r o m 0 to 7 c m de e p a n d w h e n i t i s ne c e ssa r y t o i r r ad i at e f ro m o ne s id e o f t he s k i n s u r f a c e . T h e m o st de s i r ab le f e at ur e o f t hi s t e c hni q ue i s t he ra p i d do s e f al lo f f b e y o n d t h e re g io n o f o v e rl a p . T hi s f al lo f f c a n b e e x plo it e d to pr o te c t a c r it i cal organ such as the spinal c o rd . A l t houg h wedge f i lt e r s ar e i nv a l ua b le in r a d io t h e r ap y , s o m e of t h e s e te c hni q ue s ar e b ei ng r ep l a ce d b y e l e ct ro n b e a m t e c h n i q u e s ( C h a p t er 14 ) .

B. Open and Wedged Field Combinations

A l t h o u g h w e dg e f il te rs w e r e o r i gi na ll y d e sig ne d f o r us e i n co nj unc t i o n w i t h t he w e d g e -p a i r a r ra n g e me n t , i t i s p o s si b le t o c o m bi ne op e n a nd w e d g ed b e am s to o b t ai n a p a r t i c u l ar d os e d i s t ri b u tio n. O ne s uc h a r r a ng e m e nt w hi c h us e s a n o p e n f i e l d a nt e ri o rl y a n d w e d g ed f i el d l at e ra ll y i n t he t re a t me nt o f s o m e t um o r s is s h o w n i n F i g . 1 1 . 1 9 A. T h e a n t e r i o r f i el d i s w e i g ht ed to d el i v e r 1 0 0 uni t s t o t he l a t er a l 1 5 u n it s to t h e i s o ce n t e r ( t he se be am s c o ul d b e w e ig ht e d i n te r m s o f D m a x i n t h e S S D t e c h n i q u e ). T h e w e i g ht s a nd wed g e a ngl e a re us ua l l y a d j us t ed f o r a n i n d i v id u a l case to ob t a i n an a c ce pt a bl e d i st r ib ut io n. T he pr i nc i pl e of t hi s t e c h n i q u e i s t h at a s th e d o s e c o nt ri b utio n f r o m t he a nt e ri o r fi e ld d e c re a s e s wi th d e pt h , t h e l a te r a l b e am p r o v id e s a bo o st to o f f s e t t hi s d e c r e a se . A s s e e n i n F i g . 1 1 . 1 9 A , a w e dg ed bea m w i t h t he t hi c k e nd po s it io ne d s up e ri o rl y p ro v i de s t he d e s i re d co m pe n s a ti o n f o r t h e do s e d ro p o f f . T hus s uc h a c o m b i nat io n o f o p e n a nd w e d g ed be a m s g i v e s r i s e to a di s t ri b uti on w hi c h r e m a i ns co ns t a nt w it h de pt h w i t h i n c e r t ai n l i mi t s . F i g u r e 11 . 1 9 B s h o w s a n o t h e r te c hni q ue in w hi c h t he a nt e r i o r o p e n be a m is c o m bi n e d w it h t h e t w o l at e r al w e dg e d b e am s . A g a i n, t he be a m w e i g ht s a nd w ed ge angles are chosen to make t he op e n beam d i s tr i b ut io n remain c o ns t a nt throughout the tumor volume.

11.8.
The

TUMOR
of

DOSE
can

SPECIFICATION
be me a ning f ul l y

FOR

EXTERNAL
if s uf f i c i e nt

PHOTON BEAMS
results t re a tm e n t s i nt e rp r et e d onl y i n f o r m a ti o n i s p ro v i ded r e g ar d i n g t he i r r a dia t io n t e c hni q ue a nd the d i st r ib ut io n o f d o s e i n sp a c e a n d ti me . In t h e a b se nc e o f thi s i nf o r m at io n, r e co rd i ng o f o nl y t he s o - c a ll e d t u mo r d o se s e r v e s l it tl e p ur p o se . U nf o r t una t e l y , t hi s i mp o rt a nt p r ob l em i s o f te n i g n or e d . Mor e o f te n t h a n no t , tr e a t me nt s um m a r ie s a nd r e c o rd s a r e a m b i g uo u s a n d e v e n i n c o m p r e h e ns ib le P.221

P.222 to o t h e r p eo pl e . T h e r e f o re , one c a nno t o v e r e mp ha s i z e t he ne e d for a d o se

WWW.MEDRAD.IR

r e c o r di n g

system

which

is

s u f f i c i e nt l y

e x p l i ci t

a nd

d e t ai le d

to

e na bl e

ot he r

c e n t e r s to r e p ro d u c e th e t r e a t me nt .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

F I G . 1 1 . 1 9 . T r e a t m en t p l a n s us i ng o p e n a nd w e d g e d f i e ld c o m bi na t io ns . A : Is o c e n t r i c p l a n w it h a n t e r io r o p e n f ie ld we i g hte d 1 00 a nd l a t er a l w e dg e d f i el d w e i g h te d 15 at t h e i so c e n te r . B : A c o mb i na t io n o f a nt er io r op en b e a m a nd t w o l a t er a l w e dg e d be a m s; 4 M V x - r a y b e a m f r o m A T C - 4 0 0 L i na c .

F I G . 1 1 . 2 0 . S c h e m a t i c i ll u s t r at io n o f IC R U v o l um e s . ( F r o m IC R U . P r e s c r i b i ng, r e c o r di n g , and r ep o rt i n g p ho to n beam the r a p y . IC R U Report 50. Be t he sd a , M a r y l a n d . In t e r n a t i o na l C o m m i s si o n o f R a d ia t io n U ni t s a nd M e a s ur e m e nt s , 1 99 3 . ) In 1 9 7 8 , t h e IC R U ( 2 3 ) r e c og n i z e d t he ne e d f o r a g e ne r al do s e - s pe c i f i ca ti o n s y s t e m w h i c h c o u l d be a d op te d u ni v e r s al l y . A l t ho ug h t he s y st e m p r o po s ed b y t he IC R U h a s n o t be e n un i v e r s a l l y i m pl em e nt ed , t he re i s a s ub s t a nt i al a d v a nt ag e i n a d o pt i n g a c o m mo n m e t h od o f d o s e s pe c if i c a t io n. In t hi s s e c t i o n, I p r e s e nt t he h i g h l i g ht s o f t h e IC RU p r op o s al . F o r de t ail s , t he r e ad e r i s r e fe r r e d t o c ur re nt d o c u m e n t s : R ep o rt N o. 5 0 a n d 6 2 ( 2 4 , 25 ) . F i g u r e 1 1 . 20 i s a s ch e m a t i c r e p re s e nt at ion o f v a r i o us vo l um e s t ha t t he IC R U R e p o rt n o . 5 0 (2 4 ) rec o m m e n d s t o b e i de nt i f ie d i n a t re a t me nt p l a n. D el i ne at io n of these v o l u me s is g r e a tl y f a c i l it a te d by 3-D i m a gi ng b ut t he c o nc e p t is i n d e pe n d e n t o f t h e met h o do lo g y us e d f o r t he i r d et e rm i na ti o n.

A.1. Gross Tumor Volume

T h e g r o s s t u mo r v ol u m e ( G T V ) i s t he g ro ss d e mo ns t r a bl e e x te nt a nd l o c at io n o f t h e t u m or . It m a y co n s i s t o f p ri m a r y t um o r , m et a s t at i c l y m pha d e no p a t hy , o r o t h e r m e t a st a s e s . D eli n e a ti o n o f G T V i s pos s i b le i f t he t um o r i s v i s i bl e , p al p ab l e o r de m o n st r a b le t h r ou g h i m a g i n g . G T V c anno t b e d e fi ne d i f t he t umo r ha s be e n s u r g i c a ll y r e m o v e d , al t h o u g h a n o ut l i ne o f t he t um o r b ed m a y b e s ub s t i t ut e d b y e x a m i n i n g p r eo pe r a ti ve a n d p o s to pe r a ti v e im a g e s .

A.2. Clinical Target Volume

WWW.MEDRAD.IR

T h e C T V c o n s i s t s o f t h e d e m o n s t r at ed t umo r ( s ) i f p r e se nt a nd a ny o t he r t i s s ue w i t h p re s u m e d t u m or . It r ep r e se nt s , t he r e f or e , t he t r ue e xt e nt a nd lo c a tio n o f t he t u m o r . D el i n e at io n o f C T V a s s u m e s t ha t the r e a r e no t um o r ce l l s o ut si d e t hi s v o l u m e . T h e C T V m u s t r e c e i v e a de q ua te d o se t o a c hi e ve t he t he r ap e ut i c ai m .

A.3. Internal Target Volume

IC R U R e p o r t n o . 6 2 (2 5 ) r e co m me nd s t hat a n i nt e r na l m a r gi n ( IM ) b e a d de d t o C T V t o c om p e n s at e fo r i n te r n a l p hy s i ol o gic a l m o ve m e nt s a nd v a r i a ti o n i n s i z e , s h a p e , a n d p o si tio n o f t h e C T V d ur i ng t he r ap y i n r e la ti o n to a n i nt e r na l re f e r e nc e p o i nt a n d i t s c o r re s pon d i n g P.223 c o o rd i n a te s y s t em . T h e v o l u m e t ha t i nc l ud es C T V w i t h t he s e m arg i ns i s c al le d t he i n t e r n a l t a r g et v ol u m e ( IT V ) .

A.4. Planning Target Volume

T h e v o l u m e t h a t i n c lu d e s C T V w i t h a n IM a s w e l l a s a se t - up m a r g i n ( S M ) f o r p a t ie n t m o v e me n t a nd s et - u p u n c e r t ai nti es i s c al le d t he p l a nning t a rg et v ol um e ( P T V ) . T o d el i n e at e t h e P T V , t he IM a nd S M a r e not ad d ed l i ne a rl y b ut a r e c o m bi n e d r at h e r s u b je c t i ve l y . T h e m a r gi n a r o und C T V i n a ny d i r e c ti o n m us t be l a r g e e no u g h t o c o mpe n s a t e f o r i nte r na l m ov e m e nt s a s w e l l a s p at i e nt - m ot io n a nd s e t - u p u n c e r t a i nt i e s .

A.5. Planning Organ at Risk Volume

T h e o r g a n ( s ) a t r i s k ( O R ) n e e d s a d e q ua te pr o te c ti o n j us t a s C T V ne e d s a d eq ua t e t r e at m e n t . O n c e t h e OR i s id e n ti f i ed , m a r gi ns ne e d t o b e a d de d t o c o m pe ns a t e for i t s mo v e m e nt s , i n t e r na l a s w e ll a s s et - up . T hus , i n a na l o g y t o t he P T V , o ne ne e d s t o o ut li n e p l a n n i n g o rg a n a t r i s k v o l um e ( P R V ) t o p r ot e ct O R e f f e c t i v el y . F i g u r e 11 . 2 1 sc h e m a ti c a ll y i ll u s t r at e s t he pr o c e s s o f o utl i ni ng P TV a nd P R V . T hi s p r o c e s s i s i n te n d ed t o m a k e t he r a di a ti on o nc o l og i st t hi nk me t ho di c al l y a nd a n a l y t i c a ll y w h e n o u tl i n i n g t a r g et s a nd o rg a ns a t r i s k i nst e a d o f t a k i ng a w il d g u e s s . A l t ho u g h a b s olu t e a c c u r a c y i n e it he r c a s e c a nnot be a s s ure d , t he ob j e ct i ve o f t h i s a p p ro a c h i s t o m i n i m i z e e r r o r s b y p ay i ng a t t e nt io n t o d et ail s . It is al s o i m po r ta n t to p oi n t o ut t ha t t he r e is a co m mo n t e nd e nc y a mo ng p r a c t iti o n e r s t o dr a w t a r g et v ol u m e s b a s ed o n G T V w i t h l i tt le ma r g i ns to a c c o unt f o r s u b c l i n i c al P.224 d i s e a se , o r g a n m ot io n , o r s e t - u p unc e r t a i nti e s . T he s o - c a l le d c o nf o r m a l r a di a ti o n t h e r a p y i s a d o u bl e -ed g e d s w o rd a hig h de g r ee o f pl a n c o nf o rm i t y c a n c re a te a h i g h p r o b ab il it y o f ge o g r ap h i c a l m i s s . T hus g r e a t c a uti o n m us t b e e x e r c i se d in d e s ig n i n g P T V a n d P R V . It i s j u s t a s i m p o r t a nt to k no w t he l im i t at io ns o f t he s y s t e m a s i t i s t o k n ow i t s c a p a b il it ie s .

WWW.MEDRAD.IR

F I G . 1 1 . 2 1 . S c h e m a t ic r e p r e s e nt a ti o n o f IC R U v o l um e s a nd m a r g ins . ( F r o m IC R U . P r e s c r i bi n g , r e co r di n g a n d r e po r ti ng p ho ton b e a m t her a p y [ s upp l e me nt t o IC R U R e p o rt 5 0 ] . IC R U R ep o rt 62 . B e t he sd a , Ma r y l a nd . Int e r na t io na l C o m m i s si o n o n R a d i a ti o n U n it s a n d M e a s u r e m e n t s , 19 9 9 . )

A.6. Treated Volume

A d d it io n a l m a rg i n s m u s t b e p ro v i d ed a ro und t he t a r ge t vo lum e t o a ll o w fo r l i mi t at io n s o f t h e t r ea t m e n t te c h ni q ue . T hus t he m i ni m um t a r ge t do s e s ho ul d be r e p r e se n t ed b y a n i so d o se s u r f a c e w hi c h a d e q ua te l y co v e r s t he P T V t o p r o vi de t h a t m a r gi n . T h e v o lu m e e n c l o se d b y t hi s i s o do s e s ur f a c e i s ca l l ed t he t r e at ed v o l u m e . T h e t r e a te d v o l u m e i s , i n g e ne r al , la r g e r t ha n t he p l a nning t a r g e t v ol um e a n d d e p e nd s o n a p a rti c u l a r t r e at me nt t e c hni q ue .

A.7. Irradiated Volume

WWW.MEDRAD.IR

T h e v o l u m e o f ti s s u e r e c ei v i n g a si g ni f i c ant d o se ( e . g . , 50 % o f t he sp e ci f i ed t a r g et do s e ) i s c al le d t h e i r ra d i at ed v ol um e . T he i r r a di a te d vo l um e i s l a r ge r t ha n t h e t r e at ed v o l u m e a nd d e pe n d s o n t he t r e at m e nt te c hni q ue us e d .

A.8. Maximum Target Dose

T h e h i g h e s t do s e i n th e t a r g et a re a i s c al le d t he m a x i m um t a rge t do s e , p r o v id ed t h i s do s e c o v er s a m in i m u m a r e a o f 2 c m 2 . H i g he r d o se a re a s o f l e s s t ha n 2 c m 2 m a y b e i g n o re d i n d e si g n a ti n g t h e v a l ue o f m a x i m um t a r g et d o se .

A.9. Minimum Target Dose

T h e m i n i m u m t a r g et do s e i s t h e l o w e st a b sor b e d do s e i n t he t a r g et a r e a .

A.10. Mean Target Dose

If t h e d o s e i s c a l c u l a te d a t a l a r g e num b e r o f d i s c r et e po i nt s uni f o r m l y d i st r ib ut ed i n t h e t a r ge t ar e a , t h e m e a n t a r ge t d o se i s t he me a n o f t he a b sor b e d d o se v a l ue s a t t h e s e po i nt s . M a t h e m a t i c al l y :

w h e r e N i s t h e n u m b er o f po i n t s i n t he m a tr i x a nd D i , j i s t he d o se a t l a tt i ce po i nt i , j l o c at ed i n s i de t h e ta r g e t a re a ( A T ) .

A.11. Median Target Dose

T h e m e di a n t a rg e t do s e i s si m pl y t he va l ue be t w ee n t he ma x i m um a nd t he m i n i m u m a b s o rb e d d os e v a l u e s w i t hi n t he ta r g e t .

A.12. Modal Target Dose

T h e m o d a l t a r ge t do se i s t h e a b so r be d dos e t ha t o c c ur s mo s t fr e q ue nt l y w it hi n t h e t a r ge t a re a . If t h e d o se d i st r ib ut io n o ve r a g r id o f p oi nt s cov e r i ng t he ta r g et a r e a i s p lo tt ed a s a f r e q u e n c y hi s t og r a p h, t he do s e v al ue s how i ng t he hig he st f r e q u e n c y i s c a l l ed t h e m o d al d o se . In F i g . 1 1 . 2 2 t he mo d al d o se c o r r e sp o nd s to t h e p e a k o f t h e f r e q u en c y c u r v e .

WWW.MEDRAD.IR

F I G . 1 1 . 2 2 . T a r g e t v o l u m e - do s e f r eq ue nc y c ur v e . ( R e p r i nt e d w i t h p e r m i s si o n f r o m E l l i s F , O li v e r R . T h e s p e c i f i c at io n o f t um o r d o se . Br J R a d i o l 1 9 61 ; 3 4 :2 58 . ) P.225

A.13. Hot Spots

A h o t s p ot i s a n a r ea o u t s i de t he t a r ge t t ha t r e c ei v e s a hi g her d o s e t ha n t he s p e c i f ie d t a r ge t do s e . L i k e t h e m a x i m um ta r g e t d o se , a ho t spo t i s c o ns id e r ed c l i n i c al l y m e a n i n g f u l on l y i f i t c o v e r s a n a r ea o f a t l e a s t 2 c m 2 .

B. Specification of Target Dose

T h e a b s o r b ed d o se d i s t ri b u tio n i n t he t a r g e t v ol um e i s us ua l l y no t uni f o r m . A l t h o u g h a co m pl et e d o s im e tr i c sp e ci f i c a tio n i s not p o s si b le w it ho ut t he e nti re d o s e di s t ri b u tio n , t h e r e i s v a l u e i n ha v i ng o ne f i g ur e a s t he ma i n s t a t em e nt o f t a r g et do s e . T h e u s e o f t h e t e r m t um o r do se i s no t r e co m m e nde d ( 2 3 ) . T h e q u a n t i t y m a xi m u m t a r ge t d o se al o ne c a nno t b e us e d f or re p o rt i ng , si nc e it c a n c o n c e a l s e r io u s u n d e r d o s ag e s i n s o me p a r t s o f t he ta r g et v o l um e . A lt ho ug h l o c al t u m o r co n t ro l de p e n d s o n t he m i ni mum t a r g et d o se , t hi s q ua nt i t y a lo ne is n o t r e co m m e n de d b y th e IC R U ( 2 3 ) , b e c a use it i s d i f f i c ult to de ter m i ne t he e x t e nt o f t h e t u mo r , a n d t h e r e f o re , t h e s el e ct io n o f t he mi ni m um t a r ge t d o se be c om es d i f f i c u l t i f n o t a rb it r ar y . M o r e o v e r , i f mo s t o f t he t a rg et v o l um e r e c e i v e s a d o se t h a t i s ap p re c i ab l y dif f e r e n t f r o m t he m i nim um , t hi s m a y a l so re d uc e it s cl i ni c al s i g n i f i c a n c e . A s t at e me n t o f b ot h t he m a x i mum a nd m i ni m um v a l ue s i s us e f ul , b ut i t i s n o t a l w a y s r e p res e n t a ti v e o f t he do s e d i s tr i b ut io n. F ur t he r m o r e , t hi s w o uld d o a w a y w i t h t h e s i m pl i ci t y o f h a v i ng o ne q ua nt i t y f o r r ep o rt i ng t ar g e t do s e .

WWW.MEDRAD.IR

T h e m e a n , m e d i a n , a n d m o d a l do s e s a re no t g e ne r al l y r e co mm e nd e d , be c a us e t h e y u s u a l l y r e q u i re e l a bo r a te c a l c ul a ti o ns f o r t he i r a c c ur a t e de t e rm i na ti o n a nd m a y n o t b e f e a s i bl e by i n s t i t u ti o n s ha v i ng l im i te d c o mp ut a ti o n f a ci li ti e s .

B.1. The ICRU Reference Point

T h e t a r g et d o se s h ou l d b e s pe c i f ie d a nd r e c o r de d a t w ha t i s c a l l ed t he IC R U r e f e r e n c e po i n t . T h i s p o i nt s h o u l d s a ti s f y t he f o l lo w i ng ge ne r a l c rit e ri a ( 2 5 ) :

T h e p oi n t s h o u ld be s e l e ct ed s o t hat t he d o s e a t t hi s p oi nt i s c l i ni c al l y r e l e v a n t a n d r ep r e s e nt a ti v e o f t he do s e t hro ug ho ut t he P T V ; T h e p o i n t s h o u ld b e ea s y t o d e f i ne i n a c l e ar a nd una m b i g uo us w a y ; T h e p o i n t s h o u ld b e se l e ct ed w he r e t he d o se c a n b e a c c ur a t e l y c al c ul a te d ; T h e p o i nt s h o u ld n o t l i e i n t he p e num b r a re g io n o r w he re t he re i s a s te ep d o s e g r ad ie n t .

P.226

In m o s t c a s e s t h e IC R U r e f e r e n c e po i nt s houl d li e w el l w i t hi n t he P T V , p r o v i de d i t g e n e r a ll y me et s t h e ab o v e m e n ti o ned c ri te ri a . R e co m m e nd at io ns f o r s i mp le b e a m a r r a n g e m e n t s a r e d i s cu s s e d b e lo w a s e x a m pl e s .

B.1.1. Stationary Photon Beams

F o r a s i n g le b e a m , th e t a r g et a b s o rb ed do s e s ho ul d be s p e ci f ie d o n t he c e n t r a l a x i s o f t h e bea m p l a c ed w i t hi n t he P T V . F o r p a r a ll el o pp o s ed , e q u a l l y w e i g hte d bea m s , t he p o i nt o f t ar g e t do s e s p e c i f i ca ti o n s h o u l d b e o n t he c e nt r al a x i s m i d w a y b e t w ee n t he b e a m entrances.

F o r p a r al le l o pp o se d , u n e q ua l l y w e i g ht e d be a m s , t he t a r ge t d o se s ho ul d be s p e c i f ie d o n t h e c e n t ra l a x i s p l a c ed w i t hi n the P T V . F o r a n y ot h e r a r r a n gem e n t o f t w o o r m o re int e r s e ct i ng b e a m s , t he po i nt o f t a r g et do s e s pe c i f i c ati o n s ho ul d be a t t he i nt e r se c ti o n o f t he c ent r a l a x e s o f t h e b e a m s pl a c ed w i t h i n t he P T V .

B.1.2. Rotation Therapy

F o r f u l l r ot a ti o n o r a r c s o f at l e a st 27 0 d e gr e e s , t he t a r ge t d o se s ho uld be s p e c i f ie d at t h e c e n te r o f r o t at io n i n t he p r i nc i p al pl a ne . F o r sm a l le r a r c s , t he t a r g et do s e s h o u ld b e s t a t ed i n t he p ri nc i p al p l a ne , f i r st , a t t he ce nt e r o f ro t at io n a n d , s e c o n d , a t t h e ce n t e r o f t h e ta r g et vo l um e . T hi s d ual - po i nt s p e ci f i c at io n i s r e q u i r ed b e c a u s e i n a s m a l l a r c t he r a p y , pa s t - po i nti ng t e c hni q ue s a r e us e d t h a t g i v e m a x im u m a b s or be d do s e cl o se t o t he c e nt e r o f t he t a r ge t ar e a . T he d o se at t h e i s o ce n t e r i n t h e s e c a s e s , a l t h o ug h i m por t a nt to s p e ci f y , i s s o m e w ha t l e s s .

B.2. Additional Information

T h e s p e c i f i c at io n o f ta r g e t do s e i s m e a ni ng f ul o nl y i f s uf f i c i e nt i nf o r m a t io n i s p r o v id e d r eg a r di n g t h e i r r a di a ti o n t e c hniq ue . T he d e s c r i pt io n o f t e c hni q ue s ho uld i n c l u d e r ad i at io n q u al it y , S S D o r S A D , f ie l d s i z e s , be a m - mo dif i c a t io n d e vi c e s

WWW.MEDRAD.IR

(wedges

and

s h i el din g

b lo c k s ,

et c . ) ,

b ea m

w e i g ht i ng ,

co r r ec t io n

for

t i s s ue

h e t e ro g e n ei ti e s , do s e f r a c t i o n a ti o n, a nd pa t i e nt p o si ti o ni ng . M a ny o f t he a b o v e t r e at m e n t p a r a m et e r s a r e l i st ed w i t h t he t r e at m e nt p l a n ( i so dos e p a tt e r n) a nd c a n b e a tt a c h e d t o th e p a t ie n t c ha r t . In v i v o a b s o rb ed do s e m e a s ur e m e nt s c a n a l s o p ro v i de u s e f u l i n f o r m a ti o n a nd s ho ul d be r e c o rd e d i n t he c ha r t . F i n a l l y , t he m a i n o b je c t i ve s o f a d o s e s p ec i f i c a ti o n a nd r e p or ting s y s t e m a r e t o a c h i e v e u n i f o r m i t y o f d o s e r e po r ti ng a m ong i ns t i t uti o ns , t o p ro v i de m e a ni ng f ul d a t a fo r a s se s s i n g t he r e s u lt s o f t r e at m e nt s , a nd t o e na bl e t he t r e at me nt t o b e r e p e at ed e l s e w h e re w i t h o u t h a v i ng r e c o ur se t o t he or i gi na l i ns tit ut io n f o r f ur t he r i n f o r m a ti o n .

REFERENCES
1 . In t e r n a t io n a l C o mm i s s io n o n R ad i at io n U ni t s a nd M e a s ur e ment s . M e a s ur e m e nt o f a b s o r be d do s e i n a p h a n t o m i r r a di a te d by a s i ng l e b e a m o f x o r g a m m a r a y s . R e p o rt N o . 2 3 . W a s h i ng t o n , D C : N a t io na l Bur e a u o f S t a nd a r d s , 1 97 3 . 2 . W e b s te r E W , T s i e n K C , e d s . A t l a s o f r a d i at io n d o s e di s tr i but i o ns . V o l . I o f S i n g l e - f ie ld i s od o se c h a r t s . V i e n n a : Int e r na t io na l A t o mi c E ne r g y A g e nc y , 1 9 6 5 . 3 . C o h e n M , M a r ti n S M , e d s . A tl a s o f rad i a ti o n d o se di s t ri b uti o ns . V ol . II o f M u l t i pl e - fi e ld i so d o se c h a r t s . V i e nna : Int e r n a t io na l A t om i c E ne r g y A g e nc y , 1 9 6 6 . 4. Tsien KC, Cunningham JR, W r i g ht DJ, et al. Atlas of r a d i a ti o n d o se d i s t ri b u tio n s . V o l . III o f M o v i n g f ie ld i so do se c ha r t s . V ie nna : Int e r na t i o na l A to m i c Energy Agency, 1967. 5 . S t e r li n g T D , P e r r y H , K a t z I. A ut o m a t io n o f r a d i a ti o n t re a tm ent p l a nni ng . IV . D e r i v at io n o f a m at h e m a ti c a l e x p r e s si o n fo r t he p e r ce nt de pt h d o s e s ur f a c e o f c o b a lt 6 0 be a m s a n d v i s u a l i z a ti o n o f m ul t ipl e f i el d d o se d i st r ib ut io ns . Br J R a d i o l 1 9 64 ; 3 7 :5 44 . 6 . K h a n F M . C o m p u ter d o si m et r y o f p a rt i al ly b lo c k e d fi el d s i n c ob a l t te le t he r ap y . R a d i ol og y 1 97 0 ; 97 : 405 . 7 . V a n d e G ei j n J . A c o m p u te r p r og r a m f o r 3 - D p l a nni ng i n e x t er na l b e a m r a d i at io n t h e r a p y , E X T D T S . C o m p ut P r o g Bi o m e d 19 70 : 1 4 7 . P.227

8 . C u n n i n g h a m J R , S h r i v a s t a v a P N , W i l ki ns o n J M . P r o g r a m IR R E G c a l c ul a t io n of d o s e f r om i r r eg u l a r l y s h a p e d r a d i ati o n b e am s . C o m p ut P r o g Biom e d 1 97 2 ;2 : 1 92 . 9 . W e i n k a m J J , K o l d e R A , S t e r l i n g T D . E x t e nd i ng t he ge ne r a l f iel d e q uat io n t o f it t h e d o se d i st r ib u t io n s o f a v a r i e t y o f t he r a py uni t s . Br J R a d i o l 197 3 ; 46 : 9 83 . 1 0 . N o rd i c A s so c i at ion o f C l i n i c al P hy s i c s . P r o c e d ur e s i n e x te r nal b e am r a di a ti o n therapy 11. do s im et r y with el e ct r o n a nd on p ho to n b e am s w it h ma x i m um e ne r gi e s b e t w ee n 1 a n d 5 0 M eV . A c t a R a d i o l O nc ol 19 8 0 ;1 9 : 58 . In t e r n a t io n a l C o m m i s si o n R ad i a ti o n U nit s a nd M e a s ur e m e nt s . D e te r m i n at io n o f ab so r b ed d o s e i n a p at ient i r r ad i at e d b y b e a ms o f x o r g a m m a r a y s i n r a di ot h e r a p y pr o c e d u r e s . R e po r t N o . 2 4 . W a s hi ngt o n, D C : N a t io na l Bur e a u o f S t a n d a r d s , 1 97 6 . 1 2 . S e w c h a n d W , K h a n F M , W i l l i a m s o n J . V a r i a t io n i n d e pt h d os e d a t a b et w ee n o p e n a n d w e d ge f i e ld s f o r 4 M V X - r a y s . R a d i o lo g y 1 97 8 ;1 2 7 :7 89 .

WWW.MEDRAD.IR

1 3 . C o h e n M , B u r n s J E , S e a r s R . P h y s i c a l a s p e c t s o f c o b al t 6 0 te l et he r a p y us i ng w e d g e f il te r s . I. P h y s i c a l i n v e st i g at io n. A c ta R a d i ol 1 96 0 ; 53 : 40 1. II . D o s i m e tr i c c o n s i d er a ti o n s . A c t a R a d i ol 1 96 0 ;5 3 : 48 6 . 1 4 . T r a n t er F W . De s i gn o f w e d ge f il te r s f or us e w i t h 4 M e V l i ne a r a c c e l e r ato r . Br J R a d i ol 1 95 7 ;3 0 : 32 9 . 1 5 . V a n d e G ei j n J . A s i m p le w e dg e f il te r tec hni q ue f o r c o b al t 6 0 t e le t he r ap y . Br J R a d i ol 1 96 2 ;3 5 : 71 0 . 1 6 . A r o n B S , S c a p i c c h i o M . D e s ig n o f uni v e r s a l w e d g e f il te r s y s t em f o r a c o b a l t 6 0 u n i t . A m J R o e n t g e n ol 1 9 6 6 ;9 6 :7 0 . 17. W il s o n CS, H a ll EJ. On t he a d v i s ab i li t y of t re a ti ng al l f i e ld s at each r a d io t h e r ap y s e s s i o n . R a d i ol og y 1 97 1 ; 98 : 419 . 1 8 . E l l i s F . N o mi n a l s ta n d a r d d o s e a nd t he re t . Br J R a d i o l 1 9 71 ; 44 : 1 01 . 1 9 . O r to n C G , E l l i s F . A s i m p l i f i c at io n i n t he us e o f t he N S D c o nc e p t i n p r a ct i c al r a d io t h e r ap y . B r J R a d i ol 1 9 73 ; 46 : 52 9 . 2 0 . T a pl e y N . P a r a ll el o pp o si n g p o rt a l s te chni q ue . In: F l e t c her GH , e d . T e xt bo ok o f r a d io t h e r ap y , 3 r d ed . P h i l a d el p hi a : Le a & F e b i ge r , 1 9 80 : 60 . 2 1 . M a y n e o r d W V . T h e m e a s u r e m e nt o f r a di a ti o n f o r m ed i c al p urp o s e s . P r o c P hy s S o c 1 9 42 ; 54 : 4 05 . 22. P od g or s a k in EB, the Rawlinson energy JA, J o hns from HE. 10 X-ray to 32 depth MeV. a nd doses Am J for l i ne a r a c c e l e r ato r s 23. r a nge on R oe nt ge nol D ose

1 9 75 ; 1 23 : 18 2 . In t e r n a t io n a l C om m i s s io n R a d i at io n U ni t s M e a sur e m e nt s . s p e c i f i ca ti o n f o r r ep or t i n g e xt e r na l be a m t he r a p y w i t h p hot o ns a nd e l e ct r o ns . R e p o rt N o . 2 9 . W a s h i ng t o n , D C : N a t io na l Bur e a u o f S t a nd a r d s , 1 97 8 . 24. IC R U . P r e s c ri b i ng , r e co r di n g , a nd rep o rt i ng p hot o n beam t he r ap y . IC R U R e p o rt 50 . B e t h e sd a , M a r y l a n d : Int e r na t io na l C o m mi s s io n o n R a di a ti o n U nit s a nd M e a s u r e m e n t s , 1 99 3 . 2 5 . IC R U . P r e s c r i bi n g , r e c o rd i n g , a nd re po r ti ng p hot o n be a m t he ra p y ( s up p le m e nt to IC R U R ep o rt 5 0) . IC R U R e p o rt 62 . Be t he s d a , M a r yl a nd : Int e r na t io nal C o m m i s si o n o f R a d i at io n U n i t s a n d M e a s ur em e nt s , 1 9 99 .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Par t II - C lassical Radiation T herapy > 12 - Treatment Plann ing II: Patient Data, Corrections, and Set-Up

12 Treatment Planning II: Corrections, and Set-Up

Patient

Data,

B a s i c d e pt h - d o se d a t a a n d i s o d o se c ur v e s a r e us ua l l y m e a s ur e d in a c ub i c w a t e r p h a n t o m h a v i n g d i me n s i o n s m u c h l a r g e r t ha n t he f i e l d si z es us e d c l i ni c al l y . P h a n t o m i r r a di a ti o n s f o r t h i s p u r p o se a r e ca r r i e d o ut und e r s t a nd a r d c o ndi ti o ns , f o r e x a m p l e , be a m s in c i d e n t n o r m al l y o n the f l a t s ur f a c e a t s p e c i f i e d di s t a nc e s . T h e p a t ie n t ' s bo d y , h o w e v e r , i s nei t he r hom o g e neo us no r f l at i n s ur f a c e c o nt o ur . T h u s t h e d o s e d i st ri bu t i o n i n a p at i e nt m ay d i f f e r s ig ni f i c a ntl y f r o m t he s t a nd a rd d i s t ri b u tio n . This chapter di s c us s e s s e ve r a l a s pe c t s of t re at m e nt pl a nni ng , i n c l u d i n g a c q u i sit io n o f p a ti e n t d at a , c o r rec t io n f o r c o nto ur c ur v a t ur e , a nd t i s s ue i n h o m o ge n e it ie s a n d p a t i e nt p o si ti o ni ng .

12.1. ACQUISITION OF PATIENT DATA

A c c u r a t e p a ti e n t do s im e t r y i s o nl y po s s i ble w he n s u f f i c i e nt l y ac c ur a t e p a ti e nt d a t a a re a v a il a b le . S u c h d a t a i nc l ud e bo d y c o nto ur , o utl i ne , a nd d e ns it y o f relevant p e r f o r me d i n te r n a l s tr u c t u r e s , or with a l o c at io n, a nd e x t e nt of t hi s t he t a r ge t vo l um e . a s pe c t of A c q u i s i ti o n o f t h e s e d a t a i s n e ce s s a r y w he t he r t he d o si m et ri c c a l c ul a ti o ns a re m a n u a ll y co m p ute r . However, i m por t a nt t r e at m e n t pl a n n i n g i s o f te n e x e c ute d p oo rly . F o r e x a mp l e , i n a b us y d e p a rt m e nt t h e r e m a y be a n i n o rd i n a t e a m o unt o f p r es s ur e t o b e gi n t he p at i e nt ' s t re a t me nt w i t h o u t a d eq u a t e do si m et r i c pl a nni ng . In o t he r c a s e s , l a c k o f s uf f i c i e nt p hy s i c s s u p p o r t a n d / o r eq u i pm e n t i s t h e c a us e o f thi s p r ob le m . In s uc h a c a s e , it m ust be r e a li z e d t h a t t h e f i n a l a c c u r a c y o f t he t r ea t m e nt p l a n i s s t ro ngl y d e pe nd e nt o n t h e a v a il a bi li t y o f t h e p a ti e n t d at a a nd t hat g re a t e f f o rt i s nee de d t o i mp r o ve i t s q u a l it y .

A. Body Contours
A c q u i s i ti o n o f b od y c o n t o u r s a nd i nt e r nal s t r uc t ur e s i s b e st a c c o m pl i s he d b y i m a gi n g ( c o m p u te d tom o g r a p h y [ C T ] a nd m a g ne t i c re s o na nc e i ma g i ng , e t c . ) . T he s c a n s a r e pe r f o r me d sp e c i f i ca ll y f o r t r e at m ent p l a nni ng p ur p o se s , w i t h t he p a ti e nt p o s it io n e d t h e sa m e w a y a s f o r a ct ua l tr e a t me nt . In 3 - D t r ea t m e nt p l a nni ng ( C h a p t e r 19 ) t h e s e da t a a r e al l i m a g e -b as e d a nd a r e a cq ui r ed a s p a r t o f t he t r e at m e n t pl a n n i n g p ro c e s s . H o w e v e r , f o r c a s e s i n w hi c h 3 - D t r e a t m e nt pl a nni ng is n ot co n s i d e re d of the necessary or if b od y c o nto ur s are o bt aine d or m a nua l l y fo r v e r i f i c a tio n i m a g e -b a s ed c o nt o urs , m e c ha ni c a l e le c t ro m e c ha ni c a l

m e t h od s a r e u s e d f o r c o n t o u r i n g . A n u m b e r o f d e v i c e s h a v e b e e n m a d e to ob t a i n p at ie nt c o nto ur s . S o m e o f t he se a r e c o m m e r ci a ll y a v a i l a bl e w h i le o t he r s ca n b e f a b r i c a t ed i n t he d e p a rt m e nt m a c h i n e s h o p . T h e mo s t co m mo n a nd t he si m p le s t o f t he de v i c e s i s a so ld e r w ire o r a l e a d w i re e m be d de d i n p l a st i c . Be c a us e t he w i r e m a y no t f a i thf ul l y r e t a i n t he

WWW.MEDRAD.IR

c o n t o u r d i me n s io n s w h e n t r a n s f e r r i ng i t f r om t he p a t ie nt t o t he p a p e r , o ne m us t i n d e pe n d e n tl y m e a s u r e a n t e r op o st e ri or a nd / o r l at e r al d i a me te r s o f t he c o nto ur w i t h a c a l i pe r .

F I G . 1 2 . 1 . P h o to g r ap h o f a co nto ur pl ott e r . ( C o urt e s y o f R ad i a ti o n P ro d uc t s D e s ig n , B u f f a l o , M N . ) A n o t h e r k i n d o f si m ple de v i c e ( 1 ) co ns i st s o f a n a r r a y o f r od s , the t ip s o f w hi c h a r e m a d e t o t o u c h th e p a t ie n t ' s s k i n a nd t he n p l a c ed o n a s he e t o f p a pe r f o r c o n t o u r d r a wi n g . P e rh a p s t h e m o st a c c ura t e o f t he m e c ha ni ca l d e v i ce s i s a p a n t o gr a p h t y p e ap p ar a t u s ( F ig . 12 . 1 ) i n whi c h a r od c a n b e m ov e d l at e ra ll y a s w e l l a s u p a n d do w n . W h e n t h e r o d i s mo v ed o v e r t he p a ti e nt cont o ur , i t s mo ti o n i s f o l lo w ed b y a p e n t h a t r e c o r d s t he o utl i ne o n p a p e r . P.229

C l a r k e ( 2 ) h a s d e s c r i b e d a n e l e ct r o me c ha ni c a l d e vi c e i n w hi c h m o ti o n o f t he r od o v e r t h e p at ie n t co n to u r i s re a d b y a s e ns i ng d e vi c e a nd t r a nsf e r r e d t o a n X - Y r e c o r de r . S u c h a d e v i c e c a n b e us e d f o r d ig i ti z i ng t he p at ie nt co nt o ur f o r di r e ct i n p u t to t h e t re a tm e nt p l a n n i n g c om p ut e r . O p t i c al ( 3 ) a nd ult r a so ni c ( 4 ) m et ho d s h a v e a l s o b e e n de v i s ed t o ob t ai n t he c o nto ur i nf o r m a t io n.

WWW.MEDRAD.IR

A l t h o u g h a n y o f t h e a b o v e me t hod s c a n b e us e d w it h s uf f i c i e nt a c c ur a c y i f c a r e f u l l y u s e d , s o m e i m p o rt a n t po i nt s m us t b e c o ns id e re d i n r e g a r d to m a nua l contour making.

T h e p a t ie n t c o nt o u r mu s t b e ob t ai ne d w it h the p a t ie nt i n t he s a me p o si ti o n a s u s e d i n t h e a c t u al t r e at m e nt . F or t hi s re a s o n, p r ob a bl y t he b e s t p l a ce for ob t ai n i n g the co n t o ur i nf o r m a ti o n is with t he p at ie nt p r op e rl y p o s it io n e d o n t h e t r e at m e n t s im ul a to r c o uc h.

A l i n e r e p re s e n ti n g th e t a b le to p m us t be ind i c a t ed i n t he c o nt our s o t h a t t h i s h o r i z o n ta l li n e c an b e us e d a s a r e f e r e nc e f o r b e a m a ng l e s . Im p o r t a n t b o n y l a n d ma r k s a s w e l l a s be a m e nt r y p oi nt s , i f a v a i l ab l e , m ust b e i n d i c at ed o n t h e c on t o u r . C h e c k s o f b o d y c o n t ou r a r e r e c o m m e nde d d ur i ng t he t r ea t me nt c o ur s e i f t h e c o n to u r i s e x p e cte d to c ha ng e d ue to a r e d uc ti o n o f t um o r vo l um e o r a c h a n g e i n p a t i e nt w e ig h t .

If b o d y t h i c k n e s s v a r i e s s i g ni fi c a nt l y w i t hin t he t r e a t m e nt f ie l d, c o nt o u r s s h o u l d b e de te r m i n ed i n m o r e t ha n o ne p l a ne .

P.230

B. Internal Structures
L o c a li z a ti o n of i n te rn a l s t r u c t ur e s for t r e at m e nt inf o r m a t io n pl a nni ng can be s ho ul d p r o vi d e f ro m q u a n t i t at i v e i n f o r m a tio n i n r e g a r d to t he si z e a nd l o c at io n o f c r i ti c a l o rg a ns o r i n h o m o ge n e it ie s . A l th o u g h q u a l i t at i v e o b t ai ne d d i a g n o st i c r ad io g r ap h s o r a t l a se s o f c r o s s - se c t io na l a na to m y , t hey c a nno t b e us e d d i r e ct l y f o r p re c i se lo c a li z a t io n o f o r g a ns r e l a ti v e to t he e xt er na l c o nt o ur . In o r d e r f o r t h e c o n to u r a n d t h e i nt e r na l s t ruc t ur e d at a t o b e r e al i st i c f o r a gi v e n p a t ie n t , t h e lo c a li z a tio n m u s t b e o bt a i ned und e r c o nd i ti o ns s i mi la r t o t ho se o f t he a c t u a l t r e at me n t p o si ti o n a n d o n a c o uc h s i m i l a r to t he t r e at m e nt c o uc h. T h e f o ll o w i n g de v i c e s a r e u se d fo r t he l o c al i z a ti o n o f i nt e r na l s truc t ur e s a nd t he t a r g et v ol u m e . A b ri ef d i s c u s s i o n r eg a r di ng t he ir o pe r at io n a nd f unc t i o n w i l l be p r e s e n te d .

B.1. Transverse Tomography

Conventional to mo g ra p h y p r e - d at e s t he i nt ro d uc ti o n of CT . A t r a ns v e r s e a nd a film t o mo g r ap h y u n i t ( F i g. 1 2 . 2 ) co ns i s t s o f a d i a g no s ti c x - r a y tub e

c a s s e tt e t h a t ro t at e s s i m u l t a n eo u s l y w i t h the x - r a y t ub e . T he t u b e i s s et i n s uc h a p o s it io n t h a t t h e c e n tr a l a x i s o f t he be a m m a k e s a n a ng l e o f a bo ut 2 0 d e g re e s w i t h t h e f i l m s u r f a c e. T h e p a t i e nt i s p o si ti o ne d o n t he t a bl e so t ha t t he x - r a y b e a m c a n p a s s t h r ou g h a d e s i re d b o d y c r o s s - s e ct io n. A s t he g a nt r y r ot a te s , s t r u c t u r e s i n o nl y o ne t r a n s v e r se pl a ne are i n f o c us . T he st r uc t ur e s i n r e gio ns o t h e r t h a n t h a t p l a n e a r e bl u r r e d b e c a us e of t he m ot io n o f t he x -r a y t ub e a nd t he f i l m c a s s et t e . T h e d i f f e r e n c e b et w ee n c o n v e n t io na l t o mog r a p hy a nd t r a ns v e r se to m og r a p hy i s t h e o ri e n t at io n o f t h e p l a n e i n f o c us . W he re a s a c o nv e nt io na l t om o g r a p hi c i m ag e

WWW.MEDRAD.IR

i s p a r a ll el to t h e l o ng a x i s o f t he p at ie nt , t he t r a ns v e r s e t o mog r a m p r o vi d e s a c r o s s - s e ct io n a l i m ag e p e r pe n d i c u l a r t o t he bo d y a x i s . T r a n s v e r s e t o mo g r a ms h a v e b e e n us e d i n r a d i a ti o n t he r ap y t o p r o v i de c r o s s s e c t io n a l i n f o r m at io n o f i n te r n a l st r uc t ur es i n r el a ti o n t o t he e x t e r na l co nto ur (5,6). Although the P.231 m e t h od c a n b e u s e d f o r l o c a l i zi ng b o ne , l ung , a i r c a v i t i e s , a nd o r g a ns w i t h c o n t r a s t m e di a , t h e t o mo g r a m s ha v e po or c o nt r a st a nd sp a tia l r e so l utio n. In a d d it io n , t h e i m a ge s a r e m a r r e d b y a r ti f a c t s a nd r e q ui r e i nte r p re ta t io n.

F I G . 1 2 . 2 . P h o t og r a ph o f a c o n v e nt i o na l tr a ns v e r s e t o mo g r ap hy uni t ( r i g ht ) i n c o m bi n a t io n w i t h a t re a t m e nt s i m ul at o r . (C o ur t e s y o f T o s hi b a M e d i c al S y s t e m s , C h i c a g o , IL . )

WWW.MEDRAD.IR

F I G . 1 2 . 3 . Il l u s t r a ti on o f s c a n m o ti o ns i n C T . A : A n e a r l y d e s i gn i n w hi c h t he x ray source and the d e t e cto r p e r f or m e d a c o m b i na ti o n of t r a ns l a ti o nal a nd r o t at io n a l mot io n . B : A m o de r n s c a nne r i n w hi c h t he x - r a y t ub e r o t at e s wi t hi n a s t a ti o n a r y c i r c u l a r a r ra y o f d e t e ct o r s .

B.2. Computed Tomography

T h e m a i n d i s a d v a n t a ge o f c o n v e n t io na l t r a ns v e r s e t om o gr a p hy i s t he p r e se nc e o f b l u r r e d i m a ge s r e s u lt in g f r o m s t r uc t ur e s o ut s i de t he pl a ne o f i nte r e s t . In C T , t he x - r a y s u s e d f o r r e c o ns t r u c t i n g t h e im a g e ent e r o nl y t he l a y e r und e r e x a mi na t io n, s o t h a t u n w a n t e d p l an e s a r e c o m p le te l y om i tt e d . Ba s i c al l y , a na r r o w b e a m o f x r a y s s c a n s a c r o s s a p a t i e nt i n s y nc hr o ny w i t h a r a d i a t io n d et e ct or o n t he o p po s it e s i d e o f t h e p a ti e n t . If a s u f f i c i e nt num b er o f t r a ns m i s si o n mea s ur e m e nt s a re t a k e n a t di f f e r e n t o rie n t a ti o n s o f t he x - r a y s o ur c e a nd de te c to r ( F i g . 12 . 3 A ) , t he d i s t ri b u tio n o f a tt e n u a t io n c o e f f i ci e nt s w ithi n t he l a y e r m a y be d e te r m i ned . By a s s i g n i n g di f f e r e n t lev e l s t o d i f f e r e nt at tenua t i o n c o e f f i ci e nt s , a n i m a g e c a n b e r e c o n s t r u c te d that re p r e se n t s v a r i o us s tr uc t ur e s with d i f f e re nt a t te nua t i o n

WWW.MEDRAD.IR

p r o pe r ti e s . S u c h a r e p r e se n t a ti o n o f a t tenua t i o n c o e f f i c ie nt s c o ns t it ut e s a C T image. S i n c e C T s c a n n i n g w a s i n t r od u c e d ab o ut 3 0 y e a r s ag o , t he r e ha s b e e n a r a pi d d e v e lo p me n t i n b ot h t h e s o ft w a r e a nd ha rd w a r e . M o st o f t he im p r o v e me nt s i n h a r d w a r e h a d to do w i t h t h e s c a nne r mot io n a nd t he m ul ti pl i ci ty o f d et e ct o r s to d e c r e a se t h e s c a n t i me . F i g u r e 1 2 . 3 B s ho w s a m o d e r n s c a nne r i n w hi c h t he x - r a y t u b e r ot a te s w i t h i n a c i r c u l a r P.232 a r r a y o f 1 , 00 0 o r mo re d et e ct o r s . Wi t h s uch s c a nne r s , s c a n t i m es a s f a s t a s 1 s e c o r l e s s a r e a c h ie v a b le. F i g u r e 1 2 . 4 s ho w s a t y p i c al C T i m a g e .

FIG. 12.4. Typical CT image. S p i r a l o r h el i c al C T s c a n n e r s w e r e i nt ro d uce d i n t he e a rl y 1 99 0 s i n w hi c h t he x r a y t u b e ro ta t e s c o n tin u o u s l y a s t he p ati e nt i s s lo w l y tr a ns l a te d t hr o ug h t he C T a p e r t u r e . H e li c al C T s a r e f a s t e r a nd p r o v i de b e tt e r v i s ua li z a t io n o f a na t o m y a nd t a r g et v o l u me s . T h e r e c o n s t r u c ti o n o f a n i m a g e b y C T i s a m a t he m a ti c a l p r o ce ss o f c o ns i d er a b le c o m pl e x it y , g e n e r a ll y p e r f o r me d by a c o m p ute r . For a r e vi e w of v a r i o us m a t h e m a ti c a l a pp r o a ch e s f o r i m a g e r e co ns t r uc t io n, t he r e a de r is r e f e r r ed t o a p a p e r b y B r oo k s a n d D i C h i r o (7 ) . T he r e c ons t r uc t i o n al g o rit hm ge ne r a t e s w ha t i s k n o w n a s C T n u m b e r s , w h i c h a r e r e l at ed to a tt e nua ti o n c oef f i c i e nt s . T he C T n u m b e r s r a n g e f r o m -1 , 0 0 0 fo r a i r to + 1 , 00 0 f o r b o ne , w it h t ha t f o r w a t e r se t at 0 . T h e C T n u m b e r s n o r m a l i z ed i n t hi s m a nne r a r e c a l le d H o uns f i el d num b e r s ( H ) .

w h e r e i s t h e l i n e a r a t t e n u a ti o n c oe f f i c i e nt . T hus a H o uns f i e l d uni t r e p r e se nt s a c h a n g e o f 0 . 1 % i n t h e a t t e n u a ti o n c o e f f i ci e nt o f w a t e r . Because the CT numbers be a r a l i ne ar r e l at io ns hi p w it h t he a tt e nua ti o n c o e f f i c ie n t s , i t i s po ss i b le t o i n f e r e l e ct r o n d e ns i t y ( e le c t ro ns c m - 3 ) a s s ho w n i n F i g . 12 . 5 . A lt h o u g h C T n u m b e r s c a n b e c o r r el a te d w it h el e ctr o n d e ns it y , t he

WWW.MEDRAD.IR

r e l at io n s h i p i s n ot l i ne a r i n t h e e nti r e r a nge o f ti s s ue de ns i ti e s . T he no nl i ne a ri t y i s c a u s e d b y t h e c h a n g e i n at o mi c num b e r o f t i s s ue s , w hi c h a f f e ct s t he p r op o rt io n o f b e am a tt e n u a ti o n b y C o m pt o n v e r s us pho t oe le c t ri c i nt e r a ct ions . F i g ur e 12 . 5 s h o w s a r el a ti o n s h i p t h a t i s li n e a r b et w e en l ung a nd s o ft ti s s ue b ut no nl i ne ar b e t w ee n s o f t ti s s u e a n d b o n e . A t o mi c n um b e r i n f o rm a t io n c a n a l so b e ob t a i ned i f a tt e nua ti o n c o e f f i ci e nt s a r e m e a s u r e d at t w o d i f fe r e n t x - r a y e ne r gi e s ( 8 ) . It i s p o s si bl e to t r a ns f o r m t he a t t e n u a ti o n co e f f i ci e nt s m e a s u r ed b y C T a t di a g no st i c e ne r gi es t o t he r ap e uti c e n e r g ie s (9 ) . H o w e v er , f o r l o w ato m i c num b e r m a te r i al s s uc h a s f a t , ai r , l un g , a n d m u s c l e , t h i s t r a n s f o r m a ti o n i s not ne ce s s a r y f o r t he p urp o se o f c a l c ul at i ng d o s e di s t ri b u tio n s a n d i n h o m o g e n ei t y c or r e ct io ns ( 9 ) . A p p li c a ti o n o f C T i n ra d i a tio n t h e r ap y t re a tm e nt p l a nni ng ha s b ee n t he s ub j e ct o f many papers ( 9 , 10 , 11 , 1 2 , 13 , 1 4 , 15 , 1 6 ,1 7 ,1 8 , 1 9 ,2 0 , 21 ) . T he CT i nf o r m a ti o n is u s e f u l i n t w o a s p e ct s o f t r e at m e nt p l a nni ng: ( a ) d e li ne a ti o n o f t ar g e t v ol um e a nd t h e s u r r o u n d i n g s t r u ct u r e s i n r el a ti o n t o t he e x te r na l co nto ur ; and ( b ) p r o v id i ng q u a n t i t at i v e d at a ( i n th e f o r m o f C T n um b e r s ) f o r t i s s ue P.233 h e t e ro g e n ei t y c o r re c tio n s . F r o m a pr a c ti c a l p o i nt o f v i e w , t he fi r st a s pe c t i s m or e i m po r t a n t t h a n t h e s e c o n d . A c c ur a t e d eli ne a ti o n o f s ur f a c e c o nt o ur , i nt e r nal s t r u c t u r e s , a n d t a r g et v o l u m e i s no t o nly c r uc i a l f o r o p t i mi zi ng a t r e a t me nt t e c h n i q u e b u t a l so n ec e s s a r y f o r a c c ur a te c a l c ul a ti o n o f d o se dis t r i b ut io n. E v e n t h e ti s s u e h e te r og e n ei t y c o rr e c tio ns f o r m eg a v o lt a g e p hot o n be am s c a n b e m a de w i t h a c c e pt a bl e a c c u r a c y b y u s i n g t he C T cr o s s - s e ct io na l i m a ge to de te r m i ne t he e x t e n t o f t h e i n h o mog e n e it y a n d e mp lo y i ng p ub li s he d v al ue s o f e le c t ro n d e ns it y . T o q u ot e S o nt a g e t a l . ( 1 2 ) , T he mo s t s e v e r e e r r o r s i n c o mp ut i ng t he do se d i s t ri b u tio n a r e c a u s e d b y i n a c c ur a t e de line a t io n o f t he g eo me t ri c o ut li ne s o f t i s s u e i n h o m og e n ei ti es . L e s s se v e r e e r ro r s i n t he d o se c a lc ul a ti on a r e c a us e d b y u s i n g a n i n a c c u r a t e re l a ti v e e le c t ro n d e ns it y f o r t he i nho mo g e ne i t y , pr o v id e d t he o u t li n e is accurate. Similar ob s e r v a ti o ns were also made by Geise a nd McCullough (11).

WWW.MEDRAD.IR

F I G . 1 2 . 5 . C T n u m b e r s p l ott e d a s a f unc t i on o f e l e ct r o n d e ns it y r e l a ti v e t o w at e r . ( F r o m B a tt i st a J J , R ide r W D , V a n D y k J . C o m p ute d t om og r a p hy f o r r a di ot he r a p y p l a n n i n g . I n t J R a d i at O n c o l B i ol P hy s 1 9 8 0 ;6 : 9 9 , w i t h pe r m i s si o n. ) From these i n v e st i ga t io n s , it seems t ha t more s op hi s ti c at ed i nho m o ge ne it y

c o r r e ct io n a l go ri t h m s s u c h a s t h o s e us i ng p i x e l -b y - p i x el C T da t a p ro d uc e o nl y s m a l l im p ro v e m e n t s i n d o s e a c c ur a c y c om p a r e d w it h t he t r ad i ti o nal m e t ho d s u s i n g e q u i v a le n t d ep th , p r o v i d ed t he e xt ent o f t he i nho mo ge nei t y i s a c c ur a te l y k n o w n . H o w e v e r , g r e a t e r p r ec i si o n i n t he i nho m o g e nei t y o utl ine a nd e l e c t ro n d e n s i t y m a y b e r e q ui r e d i n r e gi o ns w he r e s e v e r e d o se g r a di ent s e x i s t i n t he d i r e ct io n o f t h e be am . F o r e x a mp le , t he e le c t ro n d e ns it y i nfo r m a ti o n m a y b e c r i ti c a l f o r s o me c a s es o f e l e c t ro n b e a m t he r a p y a nd , f o r hi g h e ne r g y p ho t o ns , i n r e g io n s where el e ct ro n i c e q ui li b ri um is no t e st a bl i s he d . In s uc h i ns t a nc e s , m e t h od s us i n g p i x el - by - p i x e l c or r e ct io n m e tho d s m a y b e r e q ui re d ( 1 6 , 2 2 ,2 3 ) .

WWW.MEDRAD.IR

P.234

T h e r e a r e s e v e r al com m e r c i al l y a v ai l ab l e c o m p ute r t r e at m e nt p l a nni ng s y s te m s t h a t a ll o w d i sp l a y a nd u s e o f C T i m ag e s f o r t re a t me nt pl a nni ng . O nc e t he C T i m a g e h a s b e e n p ro d uc e d , t h e d a t a c a n be t r a ns f e r r e d t o t he t r ea t m e nt -p l a nni ng c o m p u te r ei t h e r d i re c tl y o r t h e o utl i ne s o f the c o nt o ur a nd i nt e r na l s t r uc t ur e s c a n b e tr a c e d b y h a n d a n d t h e n e n te r ed i nto the c o m p ute r . In d i r e ct s y s t e m s , t he C T s c a n i s d i s p l a y e d i n g r a y - s c a l e m od e o n the c o m p ut e r m o ni to r o f t he t r e a tm e nt p l a n n i n g s y s t e m a n d r e l e v a n t s t r uc t ur e s c a n b e o ut l i ned o n t he b a s i s o f C T n u m b e r d i st r ib u t io n . A f t e r t h e t r ea t me nt pla n i s f i na l i z ed , it c a n b e s up e ri m po s ed o n t h e C T i m a g e f o r v is u a l d i s pl a y . T h e u s e o f C T s c a n s i n t r ea t me nt pl a nning i s no w a n e st a bl is he d p ro c e d ur e . C o m p a r a ti v e st u d ie s of t re a t me nt pl anni ng with a nd w it ho ut CT ha v e d e m o n st r a te d si g n i f i ca n t l y i m pr o v ed a c c ur a c y o f t a r ge t d e li ne at io n, f i e ld s ha p i ng a n d n o r m a l ti s s u e e x c l u s i o n f ro m t he f ie ld w he n t r e a t me nt s a r e d e s ig ne d wi t h t he a i d o f C T s c a n s . A re v i e w o f C T a p pl i c at io ns i n r a dio t he r ap y is p r e se nt ed i n a b o o k e dit e d b y L i n g et a l . ( 2 4 ) . M o r e c ur r e nt a p p li c a ti o ns a r e di s cus s e d i n p a r t III o f t h i s b oo k . A l t h o u g h e x te r n a l co n t o u r a n d i n t e r na l s t r uc t ur e s a r e we ll - d el i nea t e d b y C T , t he ir u s e i n t r e at m e nt pl a n n i n g r e q u i re s t ha t t hey b e lo c a li z e d a c c ur ate l y w i t h re s p e ct t o t h e t re a t me n t ge om e t r y . D ia g no st i c C T s c a ns o b t ai ne d t y p i ca l l y o n a c ur v ed t a b le to p w it h p a ti e nt p o s it io n d i f f e re nt f r om t ha t to be us e d i n t r e at m e nt ha v e l i mi te d u s e f u l n e s s i n d e s ig n i n g te c hni q ue and d o s e d i st r ib ut io n. S p e c i al t re a t me nt p l a n n i n g C T s c a n s a r e r e q u i r ed w it h f ul l a tte nt io n t o p a ti e nt p o si ti o ni ng a nd o t h er d e t ai l s a f f e c ti n g t re a tm e n t p a r a m et e r s . S o m e o f t h e c o m mo n c o n s i d er a ti o ns i n o bt ai ni ng t r e at m e nt pl a nning C T s c a ns a r e t h e f o ll o wi n g : ( a ) a f la t t ab l eto p s ho uld be us e d , us ua l l y a f l a t wo o de n bo a r d c a n b e d e si g n e d t o p ro v id e a r e m o v a bl e i ns ert f o r t he d i ag no s ti c C T c o uc h; ( b ) a l a r g e d i am et e r C T a pe r t u r e (e . g . , 7 0 cm ) c a n b e us e d to a c com m o d at e unus ua l a r m p o si ti o n s a n d o t he r b od y c o n f i g ur at io ns e nc o unt e r ed i n r a di a ti o n t he r ap y ; ( c ) c a r e s h o u l d b e t a k e n t o u s e p a ti e nt -p o si ti oni ng o r i m m o bi li z a ti on d e v i c e s t ha t do n o t c a u s e i m ag e a rt if a c t s ; ( d ) p a ti e nt -p o si ti o ni ng , l e v el i ng , a nd i m mo bi li z a ti on should be do n e in accordance with the e x p e ct e d t re a t me nt te c hni q ue or s i m u l a ti o n i f d o n e be fo r e C T ; ( e ) e x t e r na l c o nt o ur l a nd m a r k s c an b e d e l i ne at ed , u s i n g r a d io p aq u e m ar k e r s s u c h a s p l a st i c c a t he te r s ; ( f ) s uf f i ci e ntl y m a g ni f ied i m a g e s f o r d i gi ti z a ti on c a n b e ob t ai ne d i f r a d io g r a p hs o n f i l m ar e to be us e d f o r d r a w i n g t ar g et a n d o th e r s t r u c t u r e s ; a nd ( g) i m a ge s c al e s ho ul d b e a c c ur a te bo th i n t h e X a n d Y d i r e c t ion s .

Three-dimensional Treatment Planning

A d d it io n a l c o n s id e r ati o n s go i n to CT s c a nni ng for 3-D t re at m e nt pl a nni n g . B e c a u s e t h e 3 -D a n a to m y i s de r i v ed f r o m ind i v i d ua l t r a ns v e r s e sc a ns ( w hi c h a r e i m a g ed i n 2 - D ) , t h e in t e r s li c e d i st a nc e m us t be s uf f i c i e ntl y s m al l t o r e co ns t r u c t t h e im a g e i n t h r e e di m e n s io n s . D ep e nd i ng o n t he t umo r si te or t he e x t e nt of c o n t e mp l at e d t r e at m en t v o l u m e , c o nti g uo us s c a ns a r e t a k e n w i t h s l i c e t hi c k ne s s

WWW.MEDRAD.IR

r a n g i n g f r o m 2 t o 1 0 m m . T h e t o t al num b e r o f s l i c e s m a y r a ng e f r o m 3 0 t o 80 m m . T h i s r e q u i r e s f a s t s c a n c a p a b i li t y to a v o i d pa ti e nt m o ve m e nt o r d i s c om f o r t . D e li n e a ti o n o f t a r ge t a n d c r i ti c a l o r g a ns o n e a c h o f t he s c a ns i s ne c e s s a r y f o r t he 3 - D r e co n s t r u c ti o n of t h e s e s tr uc t ur e s . Thi s i s a n e x t re m el y t i me - c o ns um i ng p r o c ed u r e , w h i c h h a s b e e n a d et e r re nt t o the a d op ti o n o f 3 -D t re a t m e nt pl a nni ng o n a r o ut i n e b a s i s . Ef f o r t s h a v e be e n di r ec t e d to w a r d m a ki ng thi s p r o ce s s l e ss c u m b e r s o me c o m p u te r d e li n e a ti o n is such as a u t o m a ti c a c o nt o uri ng , t he basic process. p a tt e r n A l t ho ug h r e co g nit io n, r e m ai ns a nd t ha t o t he r t a r get v i s i ble m a n i p u l at io n s . i n h e r en t l y However, m a nua l p ro b le m

r a d i o g ra p hi c a ll y

t u m o r b o u n d a r ie s c a n b e re c og n i z e d b y ap p ro p r ia t e c om p ute r so f tw a r e , t he e x te nt o f t a rg et v ol u m e d epe n d s o n g r a de , st a g e, a nd p at te r ns o f t umo r s pr e a d to t he surrounding not yet. B e s i d e s t h e t i me - c o ns u m i n g p r o ce s s o f t ar g e t lo c a li z a t io n, 3 - D c o m p ut at io n o f d o s e d i st r ib u t io n a n d d i s pl a y r e q ui re s m uc h m o r e po w e r f ul co m p ut e r s i n t e r m s o f s p e ed a n d P.235 s t o r ag e c ap a c it y t h an t h e co n v e nt io na l tr e a t me nt - pl a nni ng s y s t e m s . Ho w e v e r , w i t h t h e p h e n o m e n al g r o w t h o f c o mp ut e r te c hno l og y t hi s i s no t p e r c ei v e d to b e a s i g n i f i c a n t b a r ri e r to th e a d o p ti o n o f r o uti ne 3 - D p l a nni ng . T he b i g g e st d e te r r e nt , h o w e v e r , i s g oi n g t o be t h e c o s t o f t r e at m e nt , i nc l ud i ng eq ui p me nt a nd p e r s o nne l . W h e r e a s 3 -D pl a n n i n g f o r e v e r y p a ti e nt m a y no t b e p re s e ntly r e a li s ti c , it ha s a l r e a d y b ee n f o u n d t o b e q u i te us e f ul a nd p r a c t i c al f o r c e r t ai n t um o r s o r t um or s i t e s ( h e a d a n d n e c k , l u n g , p r o st r a te ) . T r ea t m e nt o f w el l -l o c al i ze d s m al l l e si o ns ( e . g . , l e s s t h a n 4 c m i n di a m et e r ) i n t he b r a i n b y st e re ot a c ti c r a d io s ur g e r y ha s g r e a tl y be n e f i te d b y 3- D p l a n n i n g . In t hi s pr o c e d ur e , t he t a r ge t vo l um e i s us ua l l y based on the e xt e n t of r a d io g r ap hi c a ll y v i s i bl e t um o r ( w it h c o nt r a s t ) , t hus o b v i at i n g t h e n ee d fo r m a n u a l t a r ge t de li ne a ti o n o n e a c h C T s l i c e . T he 3 - D d i s pl a y o f do s e d i st r ibu t i o n to a s se s s c o v e ra g e o f t he t ar g et v ol um e c o nf i ne d to a r e l at i v el y s m a ll number of s l i ce s is both us e f ul a nd pra c t i c al . S i m il a rl y , b r a c h y t h e r a p y i s a me n a b l e to 3 -D pl a nning b e c a us e o f t he lim i te d num b e r o f s l i c e s i n v o l v i n g t h e t ar g e t . T h e n e x t b e st t hi n g t o f u ll - f l ed g ed 3 -D p l a nni ng ( e . g . , 3 -D c o m p ut at io n a nd d i s pl a y ) i s t o do 2 - D p l a n n i n g , us i ng a l i m i te d num b e r o f C T s c a ns , s e l e c t ed to o b t ai n a r e a so n a b l y a d e q u a te p er s p e ct iv e of t he do s e d i str i b uti o n in t hre e d i m e n si o n s . F o r e x a mp l e , t ar g et s a nd ot he r c r i t i ca l s t r uct ur e s m ay b e d r a w n o n 5 t o 1 0 C T c u t s , s p a nn i n g t h e v ol um e o f int e r e st . T hi s c a n b e d o ne ei t he r b y d r a w i n g t a rg e t s a n d st r u c t u r e s o n t he C T f i lm s o r d i re c tl y o n t he c o m p ute r s c r e en by using a cursor After or a light pe n. f ie l d T r e a tm e nt - pl a nni ng m a rgi ns , beam s o f t w ar e a nd is a v a i l ab le pl a n w h e r e b y m a r g i n s a r ou n d t h e t a r g e t v ol um e c a n b e s p e c i fi e d t o s e t t he f i el d b o u n d a r ie s . op t im i z i n g a ng l e s , o t he r p a r a m et e r s r e l ati v e t o t h e ce n t r al C T c ut , the d o se d i st r ib ut io ns c a n b e vi e w e d i n o t h e r s li c e s e it h e r i n di v i d u a ll y o r s i m ul t a neo us l y b y se r i al d i s pl ay o n t he s c r ee n. B e a m ' s e y e vi e w ( B E V ) d i s pl a y i n w hi c h t he p l a n i s v i e we d f r om the v a nt a g e p oi nt s t r u c t u re s . Clinical j udg m e nt is r e q ui re d in d e fi ni ng t he t a rg e t v o l u m e . O b v io u s l y , a c o m p u te r c a nno t re pla c e t he r ad i at io n o nco lo g i st! A t l e a st ,

WWW.MEDRAD.IR

o f t h e r a d i at io n so u r c e ( i n a p l a ne p er p e ndi c ul a r t o t he ce nt r a l ax i s ) i s us e f ul i n p r o v id i n g t h e s a m e pe r s p e ct i v e a s a s i m ula t o r o r po rt f i l m . In a d d it io n, a BE V o u t li n e o f t h e f i el d c an b e o bt a i n ed to a id in t he d r a w i ng o f c us to m bl o c k s o n t he s i m u l a to r f il m . M o re d i s c u s s io n o n C T - b a s e d t re a tm e nt pl a nni ng i s p ro v i de d i n Chapter 19.

B.3. Magnetic Resonance Imaging

Magnetic resonance im a g i n g ( M R I) ha s de v e lo p ed , in p a r al le l to CT, i nto a p o w e r f u l i m a gi n g mod a l it y . Li k e C T , it pr o v i de s a na to m i c i ma g e s i n m ul ti pl e p l a n e s . W h e r e a s C T p r o v id e s b a s ic a ll y t r a ns v e r s e a x i a l i m a ges ( w hi c h c a n b e f u r t h e r p r o ce s s e d to r e c o n s t r u c t i m ag e s i n o t he r pl a ne s or i n thr e e di m e ns io ns ) M R I c a n b e u s e d to s c a n d i r e ct l y i n a x i al, s a g i tt a l , co r o nal , o r o bl i q ue p l a ne s . This makes it p o ss i b le to o bt a i n o pti m a l vi e w s to e nha nc e d i ag no s ti c i n t e r pr e ta ti o n o r t a r ge t de li n e a ti o n f o r r a di ot he r a p y . O t he r a d va nt a g e s o ve r C T i n c l u d e n o t i n v o l v i n g t h e u s e o f i o ni z i ng r a d i at io n, hi g he r c o ntr a s t , a nd b e tt e r i m a gi n g o f s o f t ti s s u e t u mo r s . S o me d i s ad v a nt a g e s co m p ar e d w i t h C T i nc l ude l o w e r sp a ti a l r e so l u tio n ; i n a b il it y to i m a ge bo ne o r c a l ci f i c a tions ; l o ng e r s c a n a c q u i s it io n t im e , t h e re b y i n c r e a si ng t he p os s i b il it y o f mo ti o n a rti f a c t s ; te c hni c al d i f f i c u l ti e s d u e to sm a l l h ol e o f t he m ag ne t a nd m ag ne ti c int e r f e r e nc e wi t h m e t al li c agents. T h e p r e v io u s c u r s o r y c o m p a ri s o n be t w ee n C T a nd M R I s ho w s t ha t t he t wo t y pe s o f i m a gi n g a r e c o m pl e men t a r y . Basic physics of MRI involves a p he no m e no n k no w n as nuc l e a r m a g net ic r e s o n a n c e ( N M R ) . It i s a r e s o n a nc e t r a ns it io n b e t we e n nuc l e a r s p i n s t a te s o f c e r t ai n a to m i c n u c l e i w h e n s u b j e c t ed to a ra d i o f re q ue nc y ( R F ) s ig na l o f a s pe c i f i c frequency in the presence of an e x t e rna l m a g ne t i c f ie l d . T he nuc l e i that p a r t i ci p at e i n t h i s p h e n o m e n o n a r e t he o ne s t ha t i nt ri ns i c al l y po s s e s s s pi nni ng m o ti o n , i .e . , h a v e a n gu l a r m o me nt um . T he se r ot a ti ng c ha r ge s a c t a s ti ny m a g ne t s w i t h a s s o ci a te d m a g ne t i c di po le mo m e nt , a p r op e rt y t hat gi v e s a m e a s ur e o f ho w q u i c k l y t h e m a g n e t w i ll a li g n it s el f a lo ng an e x t e r na l ma g ne ti c fi e ld . Be c a us e o f t h e s p i n n i n g m ot io n or t h e m a g n e ti c d ip ol e m o m e nt , nuc l e i al i g n t he i r s p i n a x e s a l o n g t h e e xt e r n a l ma g n e t i c f i el d ( H ) a s w e l l a s o rb it o r p re c es s a r o und it ( F ig . 12.6). P.236 T h e f r e q u e n c y o f p r e c e s s i o n i s c al le d t he La r m o r f r e q ue nc y . A s e c o nd a lt e r na ti ng f i e l d i s ge n e r a te d b y a p p l y i n g a n a l te r na t i ng v o l t ag e ( a t t he L a rm o r f r e q ue nc y ) t o a n R F c o i l . T h i s f i e l d i s a p p l ie d pe r p e ndi cul a r t o H a nd r o t a te s a r o und H a t t he L a r m o r f r eq u e n c y . T h i s c a u s e s t he nuc l e i to p r e ce s s a ro und t he ne w f i e l d i n t he t r a n s v e r s e di r e ct io n . W h e n t h e R F s ig na l i s t ur ne d o f f , t he nuc l ei r et ur n t o t hei r o r i gi n a l a li g n m e nt a r o u n d H . T hi s t r a ns i t io n i s c a l le d r el a x a t ion. It i nd uc e s a s i g n a l i n t h e re c ei v i n g R F c o il ( t une d to t he L a r m o r f r eq ue nc y ) w hi c h c o ns t i t ute s the NMR signal. o b je c t s ; a nd current una v a i l a b i li t y of m a ny approved MRI c o nt r a s t

WWW.MEDRAD.IR

F I G . 1 2 . 6 . A l i g n m e nt a n d p r e ce s s io n o f p ro to ns i n a st r o ng m a gne t i c fi e ld . ( F r om H a l v e r s o n R A , G r i f f i th s H J , L e e BC P , e t a l . M a g ne ti c r e so na nc e i m a gi ng a nd c o m p u te d to mo g r a p h y i n t h e d et e r mi na t io n o f t um o r a nd t re a t me nt v o l um e . In: L e v i tt S H , K h a n F M , P o ti s h R A , e d s . T e c hnol og i c al b a si s o f r ad i at io n t he r a p y , 2 nd e d . P h i l a de l p h ia : L e a & F e bi g e r , 19 9 2 :3 8 , w i t h p e r mi s s io n. )

WWW.MEDRAD.IR

T h e t u r n i n g o f f o f t h e t r a n s v e r s e R F f i e l d ca us e s nuc l e i t o r el a x i n t he t r a ns v e r s e d i r e ct io n ( T 2 r el a x a t ion ) a s w e l l a s to r et ur n t o t he o r ig i na l l o ngit ud i na l di r e ct io n o f t h e m a g n e ti c f i el d ( T 1 r e l a x a ti o n) . T hi s i s s c he m a t i c a ll y i ll us t ra t e d i n F ig . 1 2 . 7 . T h e r e l a x at io n ti m e s , T 1 a n d T 2 , a r e a ct ua l l y t i me co ns t a nt s ( l i k e t he d e c a y c o n s t a n t i n r a d io a ct i ve d e c a y ) fo r t he e x pone nt i a l f unc t io n t hat g o v e r ns t he t wo t r a n s i ti o n s . T h e s i g n a l s o u r c e i n M R I c a n b e a n y n uc l e us w i t h no nz e r o s p i n o r a ng ul a r m o m e n t u m . H o w e v e r , c e r t ai n n u c l e i gi v e l ar g e r s ig na l t ha n t he ot he r s . H y d r o ge n n u c l e i ( p ro to n s ) , b e c au s e o f t h ei r hi g h i nt r ins i c s e ns i ti v it y a nd hig h c o nc e nt r at io n i n t i s s u e s , p r od u c e si g n a l s o f s uf f i c i e nt str e ng t h f o r i m a gi ng . W o r k w i t h o t he r p o s s ib le c a n d i d at e s , P.237 C, and H i s co n ti n u i n g . C u r r e nt l y , r o uti ne M R I i s b a se d e x c l us i v e l y o n p r ot o n
31

P,

23

Na,

19

F,

13

d e n s i t y a nd p ro to n r e la x a t i o n c h a r a c t e ri s ti cs o f d i f f e r e nt ti s s ue s .

WWW.MEDRAD.IR

F I G . 1 2 . 7 . E f f e c t s o f r a d io f r e q u e nc y a p p li ed a t r i g ht a ng l e s to t he m a g ne t i c f ie l d . ( F r o m H a l v e r s o n R A , G r i f f i t h s H J , L e e BC P , e t a l . M a g ne ti c r e so na nc e i m a g i ng a nd c o m p u te d to mo g r a p h y i n t h e d et e r mi na t io n o f t um o r a nd t re a t me nt v o l um e . In: L e v i tt S H , K h a n F M , P o ti s h R A , e d s . T e c hnol og i c al b a si s o f r ad i at io n t he r a p y , 2 nd e d . P h i l a de l p h ia : L e a & F e bi g e r , 19 9 2 :3 8 , w i t h p e r mi s s io n. ) L o c a li z a ti o n o f p ro ton s i n a 3 - D s p a c e i s a c hi e v e d b y a p pl y i ng m a g ne ti c f i el d g r a d ie n t s p r od u c e d b y g r a d i e n t R F c oi l s i n thr e e o r t hog o nal p l a nes . T hi s c ha ng e s the p re c e s s io n f r e q ue n c y of p r ot o ns sp at i al l y , be c a us e t he MR f r e q ue nc y is l i n e a rl y p r o po r ti o n al t o f i el d s t re ng t h. T hu s b y t he a p p r o p r ia t e i nt e r pl a y o f t he e x t e r n a l m ag n e ti c f i el d a n d t h e R F f ie ld g r a d ie nt s , p ro to n d i st r i b ut io n c a n b e l o c al i z ed . A b o d y sl i ce i s im a g ed b y a pp l y ing f i e l d g r a di e nt alo ng t he a x i s o f t he s l i c e a n d se le c ti n g a f r e q u e n c y r a ng e f o r a r e a d o ut . T he s t r eng t h o f t he f i el d

WWW.MEDRAD.IR

g r a d ie n t d et e r mi n e s th e t h i c k n e s s o f t he s li c e (t he g r e at e r t he gr a d i e nt , t hi nne r t h e s l i ce ) . L o c a li z a ti on w i t h i n t h e s l i c e i s ac c o m pl i s he d b y p ha s e e nc o d i ng ( us i ng b a c k - t o - f ro n t Y - g r ad ie n t ) a n d f r e q ue nc y enc o d i ng ( us i ng t r a ns v e r s e X - g r ad i e nt ) . In t h e p r o ce s s , t h e com p u t e r st or e s p ha s e (a ng l e o f p re c e s s io n o f t he p rot o n at a p a r t i c ul a r ti m e ) and frequency i nf o r m a tio n a nd r e c o ns tr uc t s t he i m ag e by m a t h e m a ti c a l m a n ip u la t io n o f t h e d a t a . M o s t M R i m ag i n g u s es a s p i n e c ho te c hni que i n w hi c h a 1 8 0 - d eg r e e R F p ul s e is a p p li e d a f t e r t h e i n i tia l 90 - d eg r ee p ul se , and t he r e s ulti ng s ig na l i s re c ei v e d at a t i me t h a t i s e q u al t o tw i c e t h e i n te r v a l b et w e e n t he t w o p ul se s . T hi s t i m e i s c al le d t h e e c h o ti m e ( T E ) . T h e t im e b e t we e n e a c h 9 0 - de g re e p ul se i n a n im a g i ng s e q u e n c e i s c al le d th e r e pe ti ti o n t im e (T R ) . By a d j us t i ng T R a nd T E , i m age c o n t r a s t c a n b e a f f e c te d . F o r e x a m pl e , a long T R a nd s ho r t T E p ro d uc e s a p ro to n ( s p i n ) de n s i t y - w ei g h te d i m a ge , a s ho r t T R a nd a s ho rt T E p r od uc e s a T 1 - w e i g ht ed i m a g e , a n d a l o n g T R a n d a l o n g T E p r o d uc es a T 2 - w e i g ht e d P.238 i m a g e . T h u s d i f f e r e n c e s i n p r o to n d e ns i t y , T 1 , a nd T 2 b e t w e e n d i f f e r e nt ti s s ue s c a n b e e n h a n c e d b y a m a n i p u l a ti o n o f T E a nd T R i n t he s p i n e c ho t e c hni q ue .

WWW.MEDRAD.IR

F I G . 1 2 . 8 . E x a m p l e s o f M R i m a g e s o f t he he a d . A : T r a ns v e r s e p l a ne . B : S a g i tt al p l a n e . C : C o r o n a l p la n e . F i g u r e 1 2 .8 s h o w s e x a m p l e s o f M R i m a g e s o b t ai ne d i n t he a x i al , s a g i tt a l , a nd c o r o n a l pl a n e s . B y c o n v e n t i o n , a s t r o ng M R s i g na l i s d i sp l a y ed a s w hi t e a nd a w e a k s i g n a l i s d i sp l a ye d a s d a r k o n t he c a tho d e r a y t ub e o r f il m .

B.4. Ultrasound
U l t r a so n i c b e c o mi n g i m ag i n g w id e l y fo r d el i n e at i ng as p at ie nt an c o nto ur s a nd in i nt e rna l s t r uc t ur e is rec o g n i z e d i mp o rt a nt to ol r a d i a ti o n t he r a p y .

T o m o gr a p h i c vi e w s p ro v i de c r o s s - se c ti o nal i nf o r m a ti o n t ha t i s a lw a y s he l p f ul f or t r e at m e n t pl a n n i n g . A l t h o u g h i n m o s t c a s e s t he i m a g e q ua li t y o r c l i ni c al r e li a bi li t y i s n o t a s go o d a s t h a t o f t h e C T , ul t r a s o nic p r o c ed ur e d oe s no t i nv o l v e io ni z i ng r a d i at io n , usefulness. is less e xp e n s i v e , a nd in s ome cases, y i el d s d at a of c o m p a r ab le

WWW.MEDRAD.IR

P.239

U l t r a so u n d c a n p r o v id e u s e f u l i nf o r m at io n i n l o c al i z i ng m a ny m a l ig na nc y - p r o ne s t r u c t u r e s i n t h e low e r p el v i s , re t ro pe r it o ne um , up pe r ab dom e n, b r e a st , a nd c h e s t w a l l (2 5 ) . A d eta i l ed r e v ie w o f t he se t e c hni q ue s i n t he c o nt e x t o f r a d i at io n t h e r a p y p l a n n i n g h a s b e e n p r e se nt ed b y C a r s o n e t a l . ( 2 5 ,2 6 ) . A n u l t r a s o u n d ( o r u l tr a s o n i c ) w a v e i s a s o und w a v e ha v i ng a f r e q ue nc y g r e a te r than 2 0 , 00 0 cycles per se c or he rt z ( Hz ) . At t hi s f r e q ue nc y , t he so und is i n a u d i b le to t h e h u m a n e a r . U l t r a so und w a v e s o f f r e q ue nc i e s 1 t o 2 0 M H z a r e u s e d i n d i a g n o st i c r adi ol o g y . U l t r a so u n d m a y b e us e d to p ro d uc e i m a g es e i t he r b y m e a ns o f t r a ns m i s s io n o r r e f l e ct io n . H o w e v e r , in m o s t c li n i c a l a p pli c at io ns , us e i s m a de o f ul t r a s o ni c w a v e s r e f l e ct e d f r o m d i f f e r en t t i s s u e i n te r f a c e s . The s e r e f le c ti o ns o r echo e s a r e c a us e d by v a r i a ti o n s in a cou s t i c i mp ed a nc e of m a t e ri a l s on op po s ite s i de s of t he i n t e r f a c e s . T h e a c o u s ti c i m pe d a n c e ( Z ) o f a m e d i um i s d e f i ned as t he p r od uc t o f t h e d e n s it y o f t h e m e d i u m a n d t he v e lo c it y o f ul t r a s o und i n the m e d i um . T he l a r g e r t h e d i f f e re n c e i n Z b e t w e e n t he t w o m e d i a , t he g re a te r is t he f r a c t i o n of u l t r a s o u n d e n e r g y re f l e c te d a t t he i nte r f a c e . F o r e x a m pl e , st rong r e f l e cti o ns o f u l t r a s o u n d o c c u r a t t he a i r -t i s s u e , ti s s ue - bone , a nd c he s t w al l -l ung i nte r f a c e s d ue t o h ig h i mp e da n c e mi s m a t c h . H o w e v e r , be c a us e l ung co nt a i ns m i ll io ns o f ai r t i s s u e i n te r f a c e s , s t ron g r e f l e c ti o ns a t t he num e r o us i nt e r f a c e s p re v e nt s i t s us e i n lung imaging. A t t e n u a ti o n o f t h e ult r a s o u n d b y t he me di um a l so pl a y s a n im p o rt a nt ro le i n u l t r a s o u n d i m ag i n g . Th i s a t te n u a t i o n t a ke s p l a c e a s t he e ne r g y i s r e mo v e d f r o m t h e be a m b y a b s or p tio n , s c a t te r i ng , a nd r ef l e c ti o n. T he e ne r g y re m a i ni ng i n t he b e a m d e c re a s e s a p p ro x i m a te l y e x po ne nt i all y w i t h t he d e p t h o f p e ne t r at io n i n to the m e di u m , a l lo w i ng a t te n u a t io n in d i f f e r e nt m ed i a t o be c ha r a c t e r i z ed by a t t e n u a ti o n c oe f f i c i e nt s . A s t h e a t t e nua ti o n c o e f f i c ie nt o f ul t r a sound i s v e r y hi g h f o r b o n e c o mp a r e d w it h s o f t t i s s ue , to g et he r w i t h t he l a r ge r e f le c t io n c o e f f i ci e nt o f a t i s s u e -b o n e i n t er f a c e , i t i s di f f i c ul t t o vi s ua l i z e st r uc t ur e s l y ing b e y o nd bo n e . O n t h e ot h e r h a n d , w a t e r , bl oo d , f at , a nd m us c l e a r e ve r y g oo d t r a ns m it t er s o f ultrasound energy. U l t r a so n i c w a v e s a re g e n e r at e d a s w e ll as d e te c te d b y a n ul tr a s o ni c p ro be o r t r a n s d u c e r . A t r a n s du c e r i s a d e v i ce t hat c o nv e rt s o ne f o r m o f e ne rg y i n to another. energy, An and u l t r a so ni c vice effect. transducer This effect is is c o nv e rt s e x hi b it e d C o nv e r s e l y , el e ct r i c al by a by e ner g y p ro c e s s i nt o ul t r a so und as t he a a in w hi c h across v er s a . This a c c o mpl i s he d k no w n

p i e z oe le c t ri c thus

c e r t ai n

crystals

v a r i a t io n o f a n el e ct r ic f i e ld a c ro s s t he cr y s t a l c a us e s it to o s c il l at e me c ha ni c a l l y, g e n e r a ti n g a c ou s t i c waves. p r e s s ur e v a ri at io ns p i e z oe le c t ri c m at e ri a l ( i n r e s po n s e to a n inc i d e nt ult r a s o und wa v e ) r e s ul t i n a v a r y i n g e l e ct r i c al p ot en t i a l a c ro s s o pp o si te s ur f a c e s o f t he c r y s t a l . A l t h o u g h t h e pi e z oe lec t r i c e f f e ct i s e x hi b ite d b y a num b e r o f nat ur a l l y o c c ur ri ng crystals, most co m mo n c r y s t a l s us e d c l ini c a l l y a r e made a rti f i c i al l y s uc h a s b a r i u m t it a n a t e , l e ad z i r c o n i u m t it a na t e , a nd le a d me t a ni o ba t e . T he p ie z o el e ct r ic

WWW.MEDRAD.IR

e f f e c t p ro d u c ed b y t he s e m at e ri a l s i s m ed ia t e d b y t hei r el e c tr i c d i po le m om e nt , t h e m a g n i t u de o f w h i c h c a n b e v a r i e d b y a d d i ti o n o f s ui t ab le i m pur i t ie s . As the u l t r a so u n d wave r e f l e ct e d f ro m ti s s ue i nte r f a c e s is re c e i v ed by t he t r a n s d u c e r , v ol t a ge pu l s e s a r e p ro d uc e d t ha t a r e p ro c e s s ed a nd d i s pl a y e d o n t he c a t h o d e r a y t u be ( C R T ) , u s u a l l y i n o ne o f t hr e e d i sp l a y m od e s: A ( a m p l i t ude ) m o d e , B ( b ri g h t n e s s ) m o d e , a n d M ( mo tio n) m o de . A m o de c o ns is t s o f di s pl a y i ng t h e s ig n a l am p li t u de o n t h e o rd i na te a nd ti m e o n t he a b s ci s s a . T he t i me , i n t his c a s e , i s re l at e d to di s t a n c e o r t i s s ue d e pt h, g i v e n t he s p ee d o f s o und i n t he m e d i u m . In t h e B m od e , a s ig n a l f r o m a po i nt i n t he me d i um i s d i s pl a y e d b y a n e c h o do t o n t h e C R T. T h e ( x , y ) p o si ti o n o f t he do t o n t he CR T i nd i c at e s t he l o c at io n o f t h e r e f le ct i n g po i n t at t he i nte r f a c e a nd i t s p r op o rt io na l b ri g ht ne s s r e v e a l s t he a mp li t u de o f t h e e c ho . By s c anni ng a c r o s s t he p at ie nt , t he B- m o de v i e w e r s ee s a n a p p are n t c r o s s - se c ti o n t hr oug h t he p a ti e nt . S uc h c r o s s - s e ct io na l i m a g e s a re c a l le d u lt ra s o n i c to m og r a m s . In t h e M mo d e o f pr e s e n t at io n , t he ul t ra s o und i m ag e s d i sp l ay t he mo ti o n o f i n t e r n a l st r u c t u r e s o f t h e p a t ie n t ' s a na t o my . T he m o s t f r e q ue nt a p p l i c ati o n o f M mode scanning is e c h o c a r di o gr a p hy . In r a d i ot he r a p y , t he c r o s s - s e c ti o na l i n f o r m a ti o n u s e d f o r t r e at m e n t p l a nni ng i s e x c l us i v e l y d e ri v e d fr o m t he B s c a n i m a g e s ( Fi g . 12 . 9 ) . T h e u s e o f ul t r a s o und i n b r a c hy t he r a p y (e . g . , ul t r a s o und g u i d ed p r o st a te i m pl an t s ) i s d i s c us s e d i n C ha p t e r 23 .

F I G . 1 2 . 9 . U l t r a s o n i c t o mo g r a m s ho w i ng che s t w a l l t hi c k ne s s ( r i g ht ) co m p a red w i t h t h e C T i m a g e ( le f t ) . P.240

12.2. TREATMENT SIMULATION

A t r e a tm e n t si m u l at o r ( F i g . 12 . 1 0 ) i s a n ap p a r a t us t ha t us e s a d i a g no st i c x - r a y tube b ut d u pl i c at e s a r a d i at io n t re a t me nt uni t in terms of it s g eo me t ri c a l , m e c h a n i c a l , a n d op ti ca l p ro p e rt ie s . T he m a in f unc t i o n o f a s i m ul at o r i s to di s pl a y t h e t re a t me n t f ie l d s s o t h a t t h e t a r g et v ol um e m a y b e a c c ur ate l y e nc o mp a s s ed without d el i v e ri n g ex c e s s i v e i r r a di a ti o n to s ur ro und i ng no rm a l t i s s ue s . By

WWW.MEDRAD.IR

r a d io g r a p h i c v i s u a li z at io n o f i n t e r na l o rg ans , c o r r e c t p o si ti o ni ng o f f i e l d s a nd s h i e l di n g b lo c k s can a be o bt a i ned copy in is r el a ti o n o b t ai ne d to in e x te r na l te r m s la nd m a r k s . by t he of Most c o m m e r ci a ll y v i s u a l i z a ti o n r a d io g r a p h y . S p e c i f i c at io n s o f a t r ea t m e n t si m ul at o r m us t c lo s el y m a t c h t ho s e o f t he t r e at m ent unit. Several a u t h o rs ( 2 7 ,2 8 , 29 , 3 0 , 31 ) ha v e d i s c us se d t he s e a s p e ct s . Fo r a c o m p re h e n s i v e di s c u s s i o n , t h e re a d er i s re f e r r e d t o t he p a p e r b y M c C ul l o ug h a nd Earl (31). a v a i la bl e be f o r e si m u l a to r s hard ha v e f l uo r o s co pi c c a p ab il it y d y na m i c si m ul a to r

F I G . 1 2 . 1 0 . V a r i a n ( T E M ) X i m a t r o n 5 t re at m e nt si m ul at o r . ( Cour t e s y o f V a ri a n A s s o c i a te s , P a l o A lt o , C A . ) P.241

The

n e e d f o r si m u l at o r s a r i se s f ro m

f o ur f a c t s : ( a ) ge o me t ri c a l r el a ti o ns hip

b e t w ee n t h e r a d ia ti o n b e a m a n d t he e x te r na l a nd i nt e r na l a na t om y o f t he p a ti e nt c a n n o t b e d u pl i c at e d b y a n o rd i na r y di a gno s t i c x - r a y uni t ; ( b) a l t ho ug h f i eld l o c al i z a ti o n c a n be a ch i e v e d d i re c tl y w i t h a t he r a p y m a c hi ne b y t ak i ng a po r t fi l m, t h e r a di og r a p h i c q u al it y i s p oo r b e c a us e o f v e r y hig h be a m e ne r g y , a nd f o r c o b a lt - 60 , a l a r ge sou r c e s i z e a s w el l ; ( c ) f i el d l o c al i z at io n i s a t im e - co ns um i ng p r o c e s s w h i c h , i f c a rr i e d o u t i n t he t re a tm e nt ro o m , co ul d e ng a g e a t he r ap y m a c h i n e f o r a p r o h i b it i v e le n g t h o f t i me ; ( d ) unf o r e s e e n p r o bl em s w i t h a p a t i e nt s e t - u p o r t re a t me n t te c h n i q u e c a n b e so l ve d d ur i ng s i m ul at io n, t hus c o ns e r v i ng t i me w i t h i n t h e t re a tm e n t r oo m . Although the p ra c ti ca l use of s i m ul ato rs varies w i de l y f r om i ns t it ut io n to i n s t it u t io n , t h e s i m u la t o r ro o m i s i nc r e a sing l y a s s um i ng t he r ole o f a t r e at m e nt p l a n n i n g r oo m . B e s i de s l o c al i zi n g t r ea t ment v o l um e a nd s et ti ng up f i e ld s , o t her

WWW.MEDRAD.IR

n e c e s s a r y d a t a c a n a l s o be ob t ai ne d at t he ti m e o f s i m ul at io n. Be c a us e t he s i m u l a to r t ab le i s s u pp o s ed to b e s im il a r to t he t re a t me nt t ab le, v a r i o us p a t ie nt measurements c o m p e n s at o r a c c o m pl i s h e d shadow tray. S o m e si m u l a to r s h a ve a to mo g r a p hy at t ac hm e nt i n w hi c h t he i m a ge f r o m t he i m a g e i n t e n s i fi e r i s an a l y z e d a n d r e c o ns t r uc t e d us i ng e it he r a na lo g ue 1 o r d ig it a l 2 p r o c e s si n g . B e c a u s e o f t h e po o r i m a g e q ua l it y , t hi s t e c hnol og y c a nno t c o m pe te w i t h C T - b a s e d v i r t u a l s i m u l a ti o n . A n e x c i t i n g de v e lo p me n t i n t h e a re a o f sim ul a t io n i s t ha t o f co nv e r t i ng a C T s c a n n e r i n t o a s im u la t o r . A co m me r c i al d e v i c e 3 k no w n a s C T - S IM us e s a C T s c a n n e r t o lo c a li z e t h e t r e at me n t f i el d s o n t he b a s i s o f t he p a ti ent ' s C T s c a ns . A c o m p u te r p r og r a m , s p e c i f i c al l y w r i tt e n f o r s i m ul a ti o n, a ut o m at i c all y p o s it io ns t he p a t ie n t c o u c h a n d t he l a s e r c ro s s ha i r s to d e f i ne t he s c a ns a nd t he t r e at m e nt f i e l d s . T h e s o f t w a r e pr o v i de s a u t o m at i c o utl i ni ng o f e x te r na l c o nto ur s a nd c r i t i c al structures, i n t e ra c ti v e p o rt a l di s pl a y s a nd p l a c e m e nt , d i s pla y of i s o d o se d i s t ri b u tio n , a n d r e v i ew o f m u l t ip le t re a t ment p l a ns . S uc h a n i nt e g r a t ed a pp r o a c h t o t re a t me n t p l a n n i n g h a s t h e p ot e nt i al o f be c o mi ng t he si m ul a to r c um t re a t me nt p l a n n i n g s y s t e m o f t he f u t u r e . such or as contours design, s i m u l at o r . a nd can To t hic k ne s s e s , be o b t ai ne d i nc l ud i ng und e r tho s e r el a te d to bo lu s a a p p r op r i at e s et - up mo de r n

c o n d it io n s . F a b r i c a ti on a n d t e s t i ng o f i nd i vi d ua li z e d s hi e ld i ng blo c k s c a n a l s o b e w it h f a c i li t at e s uc h me a s ur e m e nt s , s i m u l a to r s a r e e q ui p pe d w i t h a c c e s s o ri e s suc h a s l a s e r l i g ht s , c ont o ur m a k e r , a nd

12.3. TREATMENT VERIFICATION A. Port Films

T h e p r i m a r y p u r po s e o f p o rt f i l mi ng i s to v e r i f y t he t r e at m ent v o l um e und e r a c t u a l c o n d it io n s o f tr e a t me n t . A l t ho ug h t he i m a ge q ua l it y w i t h t he m e g a v ol t ag e x - r a y b e a m i s p oo r e r t h a n w i t h t he d i a g no st i c o r t he s i m ul ato r f i lm , a p o r t f il m i s c o n s i d er e d m a n d at o r y n o t o n l y a s a g o od c l ini c a l p r a c ti c e b ut a s a l e g al r e c o rd . A s a t re a t me n t re c o rd, a p or t fi l m m us t b e o f s uf f i c i e ntl y go od qua l i t y so t ha t t he f i e l d bo u n d a r i e s ca n be d e s c ri be d a nat o mi ca l l y . H o w e v e r , t hi s ma y no t a l w a y s b e p o s s ib le d u e t o ei t h er v e r y h i g h b e a m e ne r g y ( 1 0 M V o r hi g he r ) , l a r g e s o ur c e s i z e ( c o b a lt - 60 ) , l a rg e p ati e n t t h i c k n e s s ( > 2 0 cm ) , o r p oo r r a di og r a phi c t e c hni q ue . In s u c h a c a s e , t h e a v a i l a b i li t y o f a s i m ul a to r f i l m a nd / o r a t r e at m ent d i a g r a m wi t h a d e q u a te a n a to m i c d es c r i p tio n o f t he f ie ld is he l p f ul . A na t o mi c i nt e r p re t at io n o f a p o rt f i l m i s h e l pe d b y o b t ai n i n g a f ul l - f ie ld e x p o s ur e o n t o p o f t he t r e at m e nt p o rt exposure.

WWW.MEDRAD.IR

F I G . 1 2 . 1 1 . S c h e m a t ic d i a g r a m o f v i de o -b as e d e le c t ro ni c po r t al im a g i ng d e vi c e . P.242

R a d i og r a p h i c t ec h n i q u e s ig n i f i c a ntl y i nf l ue nc e s i m ag e q ua l it y o f a p o rt f il m . T he c h o i c e o f f i lm a n d s c r e e n a s w e l l a s t he e xp o s ur e te c hni q ue i s im p o rt a nt i n t hi s r e g a r d . D ro e ge a n d B j r n g a r d ( 3 2 ) ha v e a na l y z e d t he f i l m s c r ee n c o m b i na ti o ns commonly used fo r p o rt f il mi ng at m e g a v ol t ag e x-ray e ne r g ie s . T he i r i n v e s t ig a ti o n s ho w s th a t t h e u s e o f a si ng l e e m ul si o n f i l m w ith t he e m ul s io n a d j a c e n t to a si n g le lea d s c r ee n 4 b et w e e n t he f i lm a nd t he p at ie nt i s p re f e r a bl e to a d o u bl e e m u l s io n f ilm o r a fi l m w i t h mo re t ha n o ne s cr e e n. Thus , f o r o p ti m um r e s ol u t io n , o n e n e e d s a s i n g l e e m ul s io n f i lm w i t h a f r o nt l e a d s c r e e n a nd no r e a r s c r e e n . C o n v e n t i o n a l n o n m e t a ll i c s c r ee ns a r e no t r e c o mm e nd ed a t m e g a v ol t ag e e n e r g ie s . A lt h o u g h th i c k e r m e ta ll i c s c ree ns p r o d uce a be tte r r e s po ns e , an i n c r e a s e i n t h i c k n e s s b e y o n d t h e m a xi m um e le c t ro n r a ng e p r od uc e s no f ur t h er c h a n g e s i n r e s o l u ti o n ( 3 2 ) . C e r t a i n sl o w - s pe e d fil m s , r e a d y p a c k e d but w i t ho ut a s c r ee n, c a n b e e x po s ed d u r i n g t h e e n ti r e t rea t m e n t d u r a ti o n. A the r a p y v e r i f i c at io n f ilm s uc h a s K o d a k X V - 2 i s s u f f i c i e n tl y s lo w t o a ll o w a n e x po sur e o f up to 20 0 c G y w i t ho ut re a c hi ng s a t u r a t io n . In a d d i t ion , s u c h f i l m s c a n b e u s e d t o co ns t r uc t c o mpe ns a t o r s f o r bo t h t h e c o n to u r s a n d t i s s u e h e t e ro g e neit y ( 3 3 ) .

B. Electronic Portal Imaging

M a j o r l i mi t at io n s o f p o rt f il m s a re ( a ) v ie w i ng i s de l a y ed be ca us e o f t he t i me r e q u i r ed for p r o ce s s in g ; (b) it is i mp r a ct i c al to do po r t f ilm s before each t r e at m e n t ; a n d ( c ) f ilm i m a ge i s o f p oo r qua l i t y e s p e ci a ll y f o r p ho to n e ne r gi es g r e a te r t h a n 6 M V . Ele c t ro n i c p o rt a l i m ag i ng o v er c o me s t he f i r st t w o p r ob l em s b y m a k i n g i t p o s si bl e to v i e w t h e po r t al i m ag es i ns t a nt a ne o usl y , i . e. , i m a g e s c a n b e d i s pl a y e d o n co m p u ter s c r e e n b e fo r e i nit i ati ng a t r e at me nt o r i n r e a l -t i me d uri ng

WWW.MEDRAD.IR

t h e t re a tm e n t . Po r t al i m a ge s c a n a l so b e s t o re d o n c om p ute r d i s c s fo r l a te r viewing or archiving. O n - l i n e e l e ct ro n i c p or t a l i m ag i n g d e vi c e s ( E P ID s ) a r e c ur r e ntl y b ei ng cl i ni c al ly u s e d i n s e v e r a l i n s t itu t i o n s , a n d s o m e o f the m a r e c o m m er c i al l y a v a i l a b le . M a ny o f t h e s y st e m s a r e v ide o b a s e d ; t he b e a m t ra ns m i t te d t hr o ug h t he p a ti e nt e x c it e s a m e t al f l uo r e s ce n t s cr e e n , w h i c h i s v ie w e d b y a v id eo c a m e ra us i ng a 4 5 d e g ree m i r r o r (3 4 , 35 , 3 6 , 37 ) ( F i g . 1 2 . 11 ) . P.243 T h e c a m e r a i s i n t e r f ac e d to a m i c r o co m p ute r t hr o ug h a f r a m e - gr a b b e r bo a r d f o r d i gi ti z i n g t h e v id eo im a g e . T h e i m a ge s a re a c q ui r ed a nd d i gi tiz e d a t t he v id e o r a t e o f 3 0 f r a m e s p er s e c o n d . A n a p p r o p ri a t e num b e r o f f r a m es i s a v e r a g e d to p r o d u c e a f i n a l i m a ge. D e p e n di n g o n t he co m p ute r s o f t w a re , t he i m a ge d a t a c a n b e f u r t h e r m a n i p u l at ed t o i mp r o ve t he i m age q ua l it y o r p e r fo r m a s p e c i al s t ud y . O n e p r o bl em w i t h mi rr o r - b a se d E P ID s i s t he l a r ge s i ze o f t he mi r r o r , w hi c h c a n p o s e p r a ct i c al p ro b lem s . W o n g e t a l . ( 3 8 ) ha v e d e v e l op e d a s y s t e m t ha t re p l a ce s t h e m i r ro r w it h a f i be r o pt i c s s y st e m t o dir e c t t he fl uo r e s ce nt li g ht to t he v i d eo camera. The f i b e r o pt i c s channels c o ns i s t of t hi n clear p o l y st y r e ne c o l um ns e n c a s e d b y a t hi n a c r y l i c c l ad di ng . Be c a us e o f t he d i f f e r e nc e i n t he r e f r a ct i ve i n d i c e s o f t h e t w o pl as t i c s , i t i s po s s ib l e to c o nd uc t li g ht w i t ho ut s i g ni fi c a nt l o s s o f i n te n s i t y . T h i s li gh t p ip i n g i s a c c om p lis he d b y t he p ro c e s s o f to t al i nt e r nal r e f l e ct io n a t t h e c l a ddi n g i n t e r f a c e . A n o t h e r cl a s s o f E P ID s c o n s i st s o f a m at r i x o f li q uid i o n c ha m b e r s us ed a s d e te c to r s ( 39 , 4 0 ) . T he s e de v i c e s a re m uc h m o r e co m p a ct t ha n t he v i de o - ba s e d s y s t e m s a n d a r e c o mp a r a b le i n s i z e to a f i l m c a s se tt e , al be it a l itt l e he a v ie r . F i g u r e 1 2 . 12 s h o w s a s y s t e m d e v e lo p ed a t T he N e d e r l a nd s K a nk e r Ins t i t ut e . T he s y s t e m c o n s i st s o f a m a t r i x o f 2 5 6 2 56 i o n c ha m b e r s c o nta i ni ng a n o r g a ni c f l u i d a n d a mi c r o co mp u t e r f o r i m ag e pr o ce s s i ng . F ig ur e 12 . 1 3 s ho w s a n i m a ge o b t ai n e d w it h s u c h a d e v i c e . B e si d e s i m a ging , a no t he r p ot e nti a l us e o f t hi s d e vi c e is o n - li n e pa ti e n t do s e mo n it o ri ng . F ur the r work is nee d ed to d e v el op t hi s a p p li c a ti o n . Y e t a no t h e r t y pe o f E P ID u s e s s o li d - st a te d et e ct o r s . O ne a pp ro a c h e mp lo y s a s c a n n i n g l i n e a r a r r a y o f s i l i c o n d io de s . A no t he r us e s a l i nea r a r r a y o f z i nc t u n g s t a te ( Z n W O 4 ) s c i n t il l at i n g c r y s ta l s at t a c he d to p hot od io de s . A n e x c e l le nt r e v i e w o f t h e s e de v e lo p m e nt s i s p ro v i d ed by Bo y e r e t a l . ( 4 1 ) .

WWW.MEDRAD.IR

F I G . 1 2 . 1 2 . V a r i a n P o r t al v i s io n s y s t em c ont a i ni ng a m at r i x o f l i q uid io ni z a ti o n c h a m b e r s , mo u n t e d o n t h e a c c el e r at o r ga nt r y . T he m o unt i ng a r m s w i ng s i nto p o s it io n f o r i m a gi n g a n d o u t o f t he w a y w he n no t ne e d ed . ( C o ur t e s y o f V a r i a n A s s o c i a te s , P a l o A lt o , C A . )

WWW.MEDRAD.IR

F I G . 1 2 . 1 3 . E x a m p l e o f a p o rt a l im a g e . ( C our t e s y o f V a r i a n A s s o ci a t e s , P al o A lt o , CA.) P.244

A v a r i e t y o f te c h n o l og i e s a re b ei ng e x pl o re d to d e v elo p ne w E P ID S o r r e f i ne t he e x i s ti n g o n e s . F o r ex a m p l e , V a r i a n M e d ic a l S y s t e m s ha s r e c e nt l y i nt ro d uc ed P o r t al V i s io n a S 5 00 f ea t u r i n g a n a r r a y o f im a g e de te c to r s b a s ed o n A m or p ho us S i l i co n ( a - S i ) t e c h n o lo g y . W i t h i n t hi s uni t a s c i nt i l l at or c o nv e r t s t he r a d i at io n b e a m i nt o v i si bl e p ho to n s . T h e l i g ht i s d e te c te d b y a n a r r ay o f p ho to d io de s i m p la n t e d o n a n a m orp h o u s s i li c o n p a ne l . The p ho to di od e s i nt eg ra t e t he li g ht i nto c h a r g e c a p t u r e s . T h e s e n s i ti v e a r e a o f t he E P ID i s 4 0 3 0 c m 2 w i t h 5 1 2 3 84 p i x e l s , s p a ti a l r e so l u ti o n i s 0 . 78 m m a nd the r e a d -o ut i m a ge ha s a b o ut 2 00 , 000 p i x e l s . T h i s s y s te m of f e r s b et te r i m a ge q ua l it y t ha n t he p re v ious s y s t e m us i ng l i q u id io n c h a m b e r s .

12.4. CORRECTIONS FOR CONTOUR IRREGULARITIES

A s m e n t io n e d at t h e b e gi n n i n g o f t hi s c hap t e r , b a s i c d o se d i st ri b ut io n d at a a re o b t ai n e d u n d e r s t a nd a r d co n d it io ns , w hi c h i nc l ud e ho mo ge neo us uni t de ns i t y phantom, pe r p e n di c u la r beam i nc i de nc e , a nd flat s ur f a c e . D ur i ng t re a t me nt ,

WWW.MEDRAD.IR

h o w e v e r , t h e be a m ma y b e o bl iq ue l y i nci d ent w i t h r e s pe c t t o t he s ur f a c e a nd , i n a d d it io n , t h e s u r f a c e m a y b e c u r v e d P.245 o r i r re g u l a r i n s h a p e. U n d e r s u c h c o nd i t io ns , t he s t a nd a r d dos e d i st r ib ut io ns c a n n o t b e a p pl ie d w i th o u t p r o pe r m od i f i c at io ns o r c o r r e ct io ns . C o n t o u r c o rr e c tio n s m a y b e a v oi de d b y us i ng a bo l us o r a com p e ns a to r ( to b e d i s c u s s e d i n s e c ti o n 1 2 . 4 ) b ut und e r s o me c i r c um s t a nc e s , i t is p e r m i s si bl e o r e v e n d e si r a bl e , t o de t e rm i n e t he a ct ua l d o s e di s t ri b uti o n b y c a l c ul a ti o n. T he f o l lo w i n g t h r ee m et h o d s a r e re c o m me nd ed f o r a ng l e s o f i nc i de nc e o f up t o 45 d e g re e f o r m eg a v o lt ag e b e a m s a nd o f up t o 30 d e gr e e f r om t he s ur f a c e no r m a l for o rt h o v ol t ag e x -r a y s (42). A lt ho ugh all co m p ute r t re a t m e nt - pl a nni ng a l g or it h m s a r e ca p a ble o f co r r e ct i ng f o r cont o ur i r re g ul a ri ti e s , the s e m et ho d s a r e d i s c u s s e d be lo w t o il lu s t r a t e t h e b a s i c p ri nc i p le s .

A. Effective Source-to-Surface Distance Method

C o n s i d e r Fi g . 12 . 1 4 in w h i c h s o ur c e - t o - s ur f a c e i s a n i r r eg ul a r ly s ha p e d p a ti e nt c o n t o u r . It i s d e si r e d t o c al c u l a te t he p e r cent d e pt h d o se a t p oi nt A ( i . e . , d o se a t A a s a p e r c e n t a g e o f D m a x d o s e at p oi nt Q ) . T he d i a g r a m s ho w s t ha t t he t i s s ue d e f i c it ab o v e po i n t A i s h c m a nd t he d ep t h o f D m a x i s d m . If w e no te t ha t t he p e r c e n t de p t h d o se do e s no t c h a ng e r a pi dly w i t h S S D (p r o v id e d t ha t t he S S D is l a r g e ) , t h e r el a ti v e de p t h d o se d i st r ib ut io n a l o ng t he l i ne jo i ni ng t he s o ur c e w i t h p o i nt A i s u n c h a n g e d w h e n t h e i so do s e c ha r t i s mo v e d do w n b y t he di s t a nc e h a nd p o s it io n e d w i t h i t s su r f a c e l i n e at S S . S up p o s e D A i s t he d o s e a t p oi nt A . A s s u m i n g b e a m t o b e i n c i d e nt o n a f l a t s ur f a c e l o c at ed a t : S S ,

w h e r e P i s p e r ce n t de p t h d o se a t A re l at i ve to D m a x at poi nt Q . S up p o s e P c o r r i s t h e c o r r e ct p e r ce n t d ep t h d o se a t A r e l at i v e t o D m a x a t p oi nt Q . T he n,

P.246

F r o m E q u a t io n 1 2 . 2 an d 1 2 . 3 ,

B e c a u s e , w h e n t h e dis t r i b ut io n i s m o v ed , the S S D i s i nc r e a s ed b y a di s t a nc e h , we have:

Therefore,

WWW.MEDRAD.IR

F I G . 1 2 . 1 4 . D i a g r a m i ll u s t r a ti n g me t hod s of c o r r e ct i ng d o se di s t ri b ut io n und e r an i r r e g ul a r s u r f a c e s u c h a s S S . T h e so li d i sod o s e c ur v e s a r e f r o m a n i s o do s e c ha r t w h i c h a s s u m e s a f l a t s u r f a c e l o c a te d at S S . T he d a s he d i s o do se c ur v e s a s s um e a f l a t s u r f a c e a t S S w i t h o u t a ny a i r g a p . T h u s t h e e f f e c ti v e S SD m et h o d c o ns i st s o f s l i di ng t he i s od o se c ha r t do w n s o t h a t its surface li n e is at SS, re a di ng off t he p e r ce nt d o se v a l ue at A a nd m u l t ip l y i n g it b y t h e in v e r s e s q u a r e l a w f a c t o r to g i v e t he c or r e cte d p e r ce nt d e pt h dose value. T h e a b o v e m et h od ap p li e s t h e s a m e w a y w he n t he r e i s e x c e ss t i s s ue a bo v e A i n s t e a d o f t i s s u e de f i ci t . In s u c h a c a s e , t he i s o do s e c ha r t i s mo v e d up s o t ha t it s s u r f a c e l i n e p a s s e s t hr o u g h t h e p oi nt o f i nte r s e c ti o n o f t he c o nto ur li ne a nd t he r a y l i n e t hr o u g h A . T h e v a l u e o f h i s a s s i g ned a ne g a t i v e v a l ue i n t hi s c a s e .

B. Tissue-air (or Tissue-maximum) Ratio Method

T h i s m e t h od d ep e n d s o n t h e p r i nci p le t hat t he ti s s ue - ai r , o r ti s s ue - m a x i m um , r a t io do e s n o t de p e n d o n t h e S S D a nd i s a f unc t i o n o nl y o f t he dep t h a nd t he f ie ld s i z e a t t h a t de pt h . S u p p o se , i n F i g . 1 2 . 14 , the s ur f a c e i s l o c a t ed a t S S a nd t he a i r s p a c e b et w e e n S S a n d S S i s fi ll ed w i t h ti s s ue - li k e m at e ri a l . N o w , i f a s t a n d a r d i so do s e c h a rt f o r t h e g i v e n b e am a nd S S D i s p l a c ed w ith i t s s ur f a c e a t S S , t h e p e r ce n t d ep t h do s e v al ue at A wi ll c o rr e s po nd t o t he d e pt h d + h. B ut t h e a c t u a l v a l u e a t A i s g r e at e r t ha n t hi s a s t he re i s a t i s sue d e f i c it . T he

WWW.MEDRAD.IR

c o r r e ct io n f a c t o r c a n b e o b ta i n e d b y t he r a t io o f t i s s ue - ai r o r t i s s ue - m a xi m um r a t io s f o r d ep t h s d a n d d + h .

w h e r e T s t a n d s f o r t i ss u e - a i r r a ti o o r t i s s ue- m a x i m um r a t io a nd r A i s t he f ie l d si ze p r o je c te d a t po i n t A ( i. e . , a t a d i s t a nc e o f S S D + d + h f r o m t he s o ur c e ) . T h u s i f t h e u n c o r r e c t ed v a l u e o f p e r c e nt d ep t h d o s e at A w i t h t he s ur f a c e l i ne o f t h e i s od o se c h a r t a t S S i s P , t he n t he co r r e ct e d v a l ue P c o r r i s g i v e n: Pcorr = PCF

C. Isodose Shift Method

T h e p r e c e di n g m et h od s a r e u s e f ul f o r m a ki ng i nd i vi d ua l po i nt do s e c a l c ul a ti o ns . H o w e v e r , f o r m a n u a l t r e at m e nt pl a nni ng , i t i s co nv e ni e nt t o co r r e ct t he e nti r e i s o do s e c h a r t f o r co n to u r i r re g u l a ri ti e s . T his c a n b e do ne b y a n em p i ri c a l m et ho d , k n o w n a s t h e i s o do se s h i f t m et ho d . T he p r o c ed ur e i s i ll us t r ate d i n F ig . 1 2 . 15 . S u p p o s e S S i s t h e pa t i e nt c o n to ur d r a w n o n a t r a ns p a r e nt p a pe r a nd S S i s a f l a t s u r f a c e li n e p a s sin g t h r o u g h t he p oi nt o f i nt e rs e c ti o n o f t he c e nt r a l a x is w i t h t h e co n t o u r . F ro m t h e l i n e S S , d r a w v e r ti c a l g r id l i ne s , p a r a ll el to t he ce nt r al a x i s a n d s p a c e d a b o u t 1 c m a p a r t , t o c o v e r t he f ul l f i e ld w i d t h. P la c e t he s t a nd a r d i s o do s e c h a r t u n d e r ne a t h t hi s p ap e r a nd al i g n t he ce nt r a l li ne o f t he c ha r t w it h t h a t o f t h e g ri d . M a r k t h e p e r c e nt d e pt h d os e v a l ue s o n t he c e nt ra l a x i s . F o r e a c h g r i d li n e , s li d e t h e is o d o se c h a r t up o r d o w n, d e pe nd i ng o n w he t he r t he re i s tissue P.247 e x c e s s o r d e f i ci t a lo n g t h a t l i n e , b y a n a m o unt k h w he r e k i s a f a c t o r l e s s t ha n 1 ( g i v e n i n T a b l e 12 . 1) . T h e n m a r k t he i s o do s e v a l ue s a t po i nt s of i nt e r s e c tio n o f t h e g i v e n g r id l i n e a nd t h e s h i f t e d i s o do s e c ur v e s . A f t e r a l l t he is o d o se p o si tio ns a l o n g al l t h e g r id li n e s h a v e b e e n m a r k ed , ne w i s o do s e c ur v es a r e d r a w n b y j o i n i n g t h e m a r k e d poi n t s h a v i n g t he s a m e is o d o se v a l ue s .

WWW.MEDRAD.IR

FIG. 12.15.

Diagram

i l l u st r a ti n g

i so d o se

s hi f t

m e t ho d

of

co r r e ct i ng

i so do se

c u r v e s f o r s u r f a c e c o n t o u r i r re g u l a ri t y . T h e f a c t o r k de p e n d s o n t h e r a di a ti o n q ua l it y , f i e ld si z e , de pt h o f i nt e r e st , a nd S S D . T a b l e 1 2 .1 gi v es a p p ro x i m at e v al ue s r e c om m e nd ed f o r c lini c a l us e w he n m a n u a l c o r r e c ti o n s a re n e e d ed . O f t h e t h r e e m et h o ds d i s c u s s ed a bo v e , the t i s s ue- a i r o r ti s s ue - m a x i m um r at io m e t h od g i v e s t h e m os t a c c u r a t e r e s ult s . T he f i r s t t w o m et hods a r e e s p e ci a ll y u s e f u l i n c o m p u t e r t rea t m e n t pl a nni ng .

TABLE

12.1. ISODOSE

SHIFT FACTORS

FOR DIFFERENT

BEAM ENERGIES

WWW.MEDRAD.IR

P h ot on E n e r g y ( M V )

A p p r o x i m a t e F a c t or k

Up to 1

0.8

60

Co-5

0.7

5 15

0.6

1 5 3 0

0.5

Above 30

0.4

Data

f ro m

Gi e s s e n

PH.

m e t hod

of

ca l c ul a ti ng

t he

i s od os e

s hi f t

in

c o r r e ct i n g f o r ob li q u e i n c i d e n c e i n r a d i ot he ra p y . Br J R a d i o l 1 97 3 ;4 6 : 97 8 .

P.248

Example 1
F o r p oi n t A i n F i g . 12. 1 4 , h = 3 c m a nd d = 5 c m . C a l c ul a t e t he p e r c e nt d ep t h d o s e a t po i nt A u s i n g ( a ) t h e e f f e c t i v e S S D m e t ho d a nd ( b ) t he t i s s ue - ai r r a t io m e t h od . Given
60

C o b e a m , T A R( 5 , 1 1 1 1 ) = 0 .9 1 0 a nd T A R ( 8 , 1 1 11 ) = 0 . 7 9 5 a nd S S D

= 80 cm:

u s i n g s o l id i so d o se c u r v e l i ne s i n F i g . 12 . 1 4,

F i e ld d i me n s io n p r o j e ct e d at

c m . T h u s f i e l d s i z e at A = 1 1 1 1 c m :

WWW.MEDRAD.IR

U s i n g d a s h ed i so do s e l i n e s i n F i g . 1 2 . 14 , unc o r r e ct e d p e r ce nt de pt h d o se = 65.2.

C o m p a r i n g t h e r e s ul ts f o r ( a ) a nd ( b ) , t he a g r e e me nt b et w e e n t he t w o m e t h od s i s w i t h i n 3 % .

12.5. CORRECTIONS FOR TISSUE INHOMOGENEITIES

A p p li c a ti o n s h o m o ge n e o u s of s t a nd a r d de n s i t y i so do s e m e di um . c ha r t s In a a nd d e pt h do s e t a b le s t he a s s um e may unit p a t i e nt ho w e v e r , beam

t r a n s v e r s e l a y er s o f f a t , b o n e , m us c l e , l ung , a nd a i r . T he p r es e nc e o f t he se i n h o m o ge n e it ie s w il l p r o d u c e c h a ng e s i n the d o se di s t ri b uti o n, d e pe nd i ng o n t he a m o u n t a n d t y p e o f ma t e ri a l p re s e nt a nd o n t he q ua l it y o f r a d i a tio n. The effects of t i s s ue i n h o mo ge ne it ie s may be cl a s si f i e d int o two g e ne r al c a t e go r ie s : ( a ) c h a n g e s i n t h e ab s o rp ti o n of t he pr i m a r y b e a m and t he a s so c ia t ed p a t te r n o f s c a tt e re d p h o to n s a n d ( b ) c ha ng e s i n t he s e co nd a r y e l e ct r o n f l ue nc e . T h e r e l a ti v e i mp o rt a n c e o f t h e s e e f f e ct s d ep e nd s o n t he r eg io n of i nt e r e st w he r e a l t er a ti o n s i n a b so r be d do s e a re c o nsi d er e d . F o r p oi nt s t ha t l ie b e yo nd t he i n h o m o ge n e it y , t h e pr e d om i n a n t e f f e ct i s t he a tt e nua ti o n o f t he p ri m a r y be a m . C h a n g e s i n t h e a s s o c ia t e d p ho to n s c a t te r di s t ri b uti o n a lt e r s t he d o s e di s tr i b ut io n m o r e st ro n g l y n e a r t he i n h o mo g e nei t y t ha n f a r t he r be y o nd i t . T he c ha ng e s i n t he s e c o n d a r y el e ct ro n f lu e n c e , o n t he ot he r ha nd , a f f e c t s t he tis s ue s w i t hi n t he i n h o m o ge n e it y a n d a t t h e b o u n d a r ie s . For x-ray beams in the m eg a v ol t a ge ra ng e , w he r e C o mp to n effect is a p r e do m i n a n t mo d e o f i n t e r a c tio n , t he a t tenua t i o n o f t he b e am in a ny m e d i um i s g o v e r n e d b y el e ct r o n d e n s i t y ( n um b e r o f e l e ct r o ns p er c m 3 ) . T hus a n e f f e c t i v e d e pt h can be used for c a l c u la ti ng tr a ns m i s s io n t hro ug h no nw a t e r - eq ui v a l e nt m a t e ri a l s . H o we v e r , cl o s e to t h e bo und a r y o r i nte r f a c e , t he di s t ri b ut io n i s m o re c o m pl e x . F o r e x a m pl e, f o r m e g a v o lt a ge b ea m s , t he r e m a y b e lo s s o f e le c t ro nic e q u i li b ri u m c lo s e to th e b o u n d a r ie s o f lo w- d e ns i t y m a te r i al s o r a i r c a vi ti e s . Fo r o r t h o vo lt a g e a n d s u pe r f i c i al x - r a y s , t he m a j o r p r ob le m i s t he b o ne . Ab s o rb e d d o s e w it h i n t h e b o n e o r i n t h e i m m e di a t e v i c i ni t y o f i t m a y b e s e v e r a l ti m es h i g h e r t h a n t h e d o s e i n t h e s o f t t i s s ue i n t he a b s e nc e o f b o ne. T hi s i nc r e a s e d e n e r g y a b s o rp ti o n i s ca u s e d P.249 b y t h e i n c r e a se i n t he e le c t ro n f l ue nc e a r is i ng f r o m t he p ho to ele c t ri c a b s o rp ti o n i n t h e m i n e r a l co n t e n ts o f t h e b o ne .

WWW.MEDRAD.IR

F I G . 1 2 . 1 6 . S c h e m a t i c d i ag r a m s ho w i ng a w a t e r e q ui v a l e nt p ha nt o m c o nt a i ni ng a n i n h o m o g e n ei t y o f el e c tr o n d e n si t y e r el at i v e t o t ha t o f w a t e r . P i s t he po i nt o f d o s e c al c u l a ti o n .

A. Corrections for Beam Attenuation and Scattering

Figure 1 2 .1 6 is a sc h e m a t i c di a g r a m s ho w i ng an i nho m o ge ne i t y of el e ct r o n d e n s i t y e r e l at i ve t o t h a t o f w a t e r . T he m a t e ri a l p re c e di ng and f o l lo w i ng t he i n h o m o ge n e it y i s w a t e r e q u i v a le nt ( r e l at i ve e = 1 ) . L a t e r a l dim e ns i o ns o f t hi s c o m po s it e p h a n to m a r e a s s u m e d i nf i ni te o r m uc h l a r ge r t han t he f i e ld s i z e . C a l c u l a t io n i s t o be m a d e a t p oi nt P , w hi c h i s l o c at e d at a di st a nc e d 3 f r om t he l o w e r b o u n d a r y , di s t an c e ( d 2 + d 3 ) f ro m t he f r o nt b o und a r y o f t he i nho m og e nei t y , a n d d i s t a nc e d = d 1 + d 2 + d 3 f r o m t he s ur f a c e . T h r e e m e t ho d s o f co rr e c ti n g f o r i nho mo g e ne i ti e s a re il l us t r at ed w i t h r e f e r e nc e t o F i g . 1 2 . 16 .

A.1. Tissue-air Ratio Method

T h e f o l l o w i n g C F a pp l ie s t o t h e do s e a t P i f t he e nt i r e p ha nt o m w a s w a t e r e q u i v a le n t :

w h e r e d i s t h e e q u i va l e n t w a t e r d ep t h, i . e. , d = d 1 + e d 2 + d 3 , a nd d i s t he a c t u a l d ep t h o f P f r o m t h e s u r f a c e ; r d i s t he f i e l d si z e p r oj e ct e d at p o i nt P . T h e a b o v e c o r re c ti o n m e t h o d d oe s no t ta k e i nt o a c co unt t he p o s it io n o f t he i n h o m o ge n e it y r el a ti ve to p oi n t P . In ot he r w o r d s , t he co r r e ct ion f a c t o r w il l not c h a n g e w i t h d 3 a s l o ng a s d a n d d r e m a i n c o ns t a nt .

WWW.MEDRAD.IR

A.2. Power Law Tissue-air Ratio Method

B a t h o ( 43 ) a n d Y o u n g a n d G a y lo r d ( 44 ) ha v e p ro po s e d a me t ho d i n w hi c h t he r a t io o f t h e ti s s u e - ai r r a ti o s i s r a i se d to a p o w e r . Re f e r r i ng a g ain t o F i g . 12 . 1 6 , t h e c o r r e ct io n f a c t o r at P.250 p o i nt P i s :

H e r e e i s t h e e le c t ro n d e n si t y ( num b e r o f el e ct r o ns / c m 3 ) o f t he het e ro g e nei ty r e l at i v e to t h a t o f w a t e r . A s s e e n i n E q u a t i o n 12 . 9 , t h e c o r re c ti o n f a ct o r do e s d e pe nd o n t he l o c at io n o f t he i n h o m o ge n e it y r e l at i ve t o p oi n t P b ut no t r e l a ti v e to t he s ur f a c e . T hi s f o r m ul a t i o n i s b a s ed o n t h e o re tic a l c o n s id e r at io ns a ss um i ng C o m pt o n i nt er a c t io ns o nl y . It d o e s n ot a pp l y to po i n t s i n s i de t he i nho m o g e nei t y o r i n t he b ui l d - up re gi o n. E x p e r i m e n t al (43,44). A more g e n er a l fo rm of the po w e r law m e t ho d is pr o v id e d by S o nt ag a nd C u n n i n g h a m ( 4 5 ) t ha t a llo w s f o r co r r e cti o n o f t he do s e t o p o i nt s w it hi n a n i n h o m o ge n e it y a s w e l l a s b e l o w it . T hi s i s g iv e n b y : v e r i fi c at io n of the m od el ha s been p ro v i de d f or
60

Co

beams

w h e r e 3 i s t h e d e n sit y o f t h e m a te r ia l i n w hi c h p o i nt P li e s a nd d 3 i s i t s d ep t h w i t h i n t h i s m a te r i al . 2 i s t h e d e ns it y o f the o v e r l y i ng m at e r ia l , a nd ( d 2 + d 3 ) i s t h e de p t h b el o w t h e u p p e r s u r f a c e o f it . It m a y b e p oi nt ed out t ha t E q uat io n 1 2 . 1 0 r ed u c e s t o E q u at io n 1 2 . 9 i f P l i e s i n a uni t d e ns i t y m e d i um a s s ho w n i n F i g . 12.16.

A.3. Equivalent Tissue-air Ratio Method

T h e u s e o f w a t e r e q u i v a l e n t d ep t h i n E q ua t io n 1 2 . 8 a p p ro p ri a te l y c o r r e c t s f o r t he primary c o mp o n e n t of dose. However, the c ha ng e in s c a t t er e d d o se is not c o r r e ct l y p re d i ct ed be c a u s e t h e e f f e ct o f s c a t te r i ng s tr uc t ur e s d e pe nd s o n t hei r g e o me t ri c a r r a n g e men t w i t h r e s p e ct t o po i nt P . S o nt a g a nd C unni ng ha m ( 2 1 ) accounted fo r these g eo m et r i c f a c t or s thr o ug h t he s c al i ng of t he f i el d si ze p a r a m et e r . T h e i r m eth o d u s i n g e q ui v a l e nt t i s s ue - a i r r a ti o s ( E TA R s ) i s g i v e n b y :

w h e r e d i s t h e w a ter e q u i v a l e nt d ep t h, d i s t he a c t ual d ep t h, r i s t he be a m d i m e n si o n a t d ep t h d, r = r ~ = s c a l e d f i e l d s i z e di m e ns io n, a nd ~ i s t he w e i g h te d d e n s it y o f t he i r r a di a te d v o l ume . T h e w e i g h t e d d e n s it y ~ c a n b e d e t e r mi ne d b y t he a v e r a g i ng p r oc e d u r e :

WWW.MEDRAD.IR

w h e r e i j k a r e t h e r el at i v e el e ct r o n de ns i ti e s o f s c a t t e r e le m e nt s (e . g . , p i x e l s i n a s e r i e s o f C T i m a ge s of t h e i rr a d i at ed v ol um e ) a nd W i j k a re t he w e i g hti ng f a c to r s a s s i g n e d t o t h e s e e l em e n t s i n te r m s o f t he ir r e l at i v e co nt r ib ut io n t o t he s c a tt e r ed d o s e at t h e p oi n t o f ca l c u l a ti o n . T h e w e i g h t i n g f a c to r s a r e c a l c u l a t ed us i ng C o m p t o n s c a tt e r c ros s - s e c t io ns a nd i n t e g ra ti n g s c a tt e r ov e r t h e e nt i re i r r ad ia t e d vo l um e f o r e a ch p o i nt o f do se c a l c u l a ti o n . A more p r a c t i c al a p p ro a c h is to c o al e s c e a ll of t he d e ns it y i n f o r m a ti o n f r o m i n d iv i d u a l s li c e s i nt o a s ing l e e q ui v al e nt s li ce , t hus r e d uc i ng t h e v o l u me i n te g r at ion t o a n i n te g r at io n ov e r a p l a ne . De t ai l s o f t hi s p ro c ed ur e a r e d i s c u s s e d b y S o n t a g a n d C u n ni ng ha m ( 2 1 ) . An a l t e r n a ti v e a pp r oa c h to the ETAR me t ho d is to c al c ul a te s c a tt e r ed do se s e p a r a te l y f r o m t h e pr i m a r y d o s e b y s um m a t io n o f t he s c a t t e r co nt r ib ut io n f r o m i n d i v id u a l s c a tt e r el em e n t s i n t h e i r r ad i at ed he t e ro g e ne o us v o l um e . T hi s m e t hod is known as the di ff e r e n t i al s c at t er - a i r r a t io (DSAR) m et hod ( 4 6 , 47 ) . More a d v a n c e d c o m p u te r - ba s e d m et h o d s s uc h P.251 a s d e l ta v o l u m e ( D V) ( 4 7 , 4 8 ) , d o se s p r ea d a r r a y ( D S A ) ( 4 9 ) a nd d i f f e r e nt i al pencil b ea m (DPB) (5 0 ) of me t h od s ha v e be e n p ro po s e d t r a ns po r t us i ng to to do s e take i nto a c co unt mo re (e . g . , m u l t ip le s c a tt e ri n g of photons a nd e le c tr o n p r ed i c t d o se

a c c u r a t e l y a s w e ll a s in t h e r e g io ns w he r e el e c tr o ni c eq ui li b ri um d o e s not e x i st . A d i s c u s s io n Chapter 19. mod e l -b a s e d a lg o ri t hm s k e r ne l s c o n v o l u ti o n / s u p e rp o sit io n a l go r it hm s ) a nd M o nt e C a rl o t e c hni q ues i s p re s e nte d i n

TABLE

12.2.

ISODOSE

SHIFT

FACTORS a

FOR

INHOMOGENEITIES

I n h om og e n e i t y

S h i f t F a c t or n a

Air cavity

-0.6

Lung

-0.4

Hard bone

0.5

Spongy bone

0.25

A p p ro x i m at e f a ct o rs , d e te r m i ned e mp i ric a l l y f o r

60

C o a nd 4 -M V x - r a y s .

F r o m G r e e n e D , S te wa r t J R . Is o d o s e c ur v es i n no n- uni f o r m p ha nt o m s . Br J R a d i ol 1 96 5 ;3 8 : 37 8 ; S u n d b l o m L . D o se p la nni ng f o r i r r a d i a tio n o f t ho r a x

WWW.MEDRAD.IR

w i t h c o b al t i n f i x e d bea m t h e r a p y . A c t a R a d io l 19 6 5 ;3 : 34 2 ; w i t h pe r m i s si o n .

A.4. Isodose Shift Method

This method, p ro po se d by G r e e ne a nd Stewart ( 51 ) c ha r t s a nd f or S und b l o m t he ( 52 ) , is of convenient for m a nu a l l y c o r r e ct i ng i s od o s e p r e s e nc e

i n h o m o ge n e it ie s . T h e i s o do s e c u r v e s b e yo nd t he i nho m og e nei t y a r e m o v e d b y a n a m o u n t e q u a l to n t im e s t h e t h i c k ne s s o f t he i nho mo g e nei t y a s m e a s ur e d al o ng a l i n e p a r a ll el to t h e ce n t r a l a xi s a nd p a s sing t hr o ug h t he p oi nt o f i nte r e st . T he s h i f t i s to w a r d t h e s kin f o r b o n e a nd a w a y f r o m t he s k i n f o r l ung o r a i r c a v it ie s . T a b l e 1 2 . 2 gi v e s e xp e r i me n t al l y d et e rm ine d v a l ue s o f n w hi c h a p p l y to size.
60

Co

r a d i at io n a n d 4 - M V x - r a y s . T h e f a c t o r s a re b el ie v e d t o b e i nd ep e nd e nt o f f i eld

A.5. Typical Correction Factors

N o n e o f t h e m e t h o d s d i s c u s s e d a b o v e c an c l a i m a n a c c ur a c y o f 5 % f o r a l l i r r a di a ti o n e l e ct r o n bulk c o n d it io n s ar e encountered e x p e ct ed in to r a d i ot he r a p y . a c hie v e t ha t are T he g o al ne w b ut g e ne r a t io n are al o ng s ti ll ray of a l g or it h m s t h a t t a k e a c c o u n t o f t he 3 - D sha p e o f t he i r r a di a ted v o l um e a nd t he t r a n s p o rt und e r l i ne s , d e v e lo p me n t . M o st c o m m e r ci a l s y s te m s us e o ne - di m e ns io na l m e t hod s i n w hi c h d e n s i t y - b a se d in h o m o g e n ei t y c o r re ct io ns a p p li e d d i s r eg a r di n g t h e e x ten t o f i n h o m o ge ne it ie s i n t he o t he r di m e ns ions . T a n g e t a l . (5 3 ) h a v e c o m p a re d a f e w c om mo nl y us e d m et ho d s , na m e l y , t he T A R , the ETAR, and the g e n e r al i z e d Ba t ho a g a i ns t m e a s ur e d data us i ng a h e t e ro g e n eo u s p h a n t om c o n t a i n i ng l a y e r s of p o l y s t y r e ne a nd c o rk . T he i r r e s ul t s s h o w t h a t fo r t h e geo m et r ie s co ns i d e re d (a ) t he T A R me t ho d ov e r e s ti m a te s t he d o s e f o r al l e n e r gi e s , ( b ) t h e E T A R i s b e s t sui t e d f or t he lo w e r - e ne r g y b e a m s ( 6 M V ) , a n d ( c ) t h e g e n e r a li z e d B a t ho me t hod i s t he be s t i n t he hi g h- e ne r g y r a nge ( 1 0 M V ) . T h u s t h e a c c u r a c y o f d i f f e r e nt m et ho d s d ep e nd on t he i r r a di at io n c o n d it io n s , e . g . , e n e rg y , f i e ld si z e , lo c a ti on a nd e x t e nt o f i nhom o g e nei t y , a nd l o c at io n o f p o i nt o f c a l c u l a ti o n . T a b l e 1 2 .3 gi v e s som e e x a mp l e s o f i nc re a s e i n do s e b e y o nd he a l t hy l ung f o r v a r i o u s b e a m e n e r gi es . T h e s e c o r r e ct io n f a c t o r s ha v e be e n c a lc ul a t e d b y us i ng E q u a t i o n 12 . 1 0 , a s s um i n g d 1 = 6 c m , d 2 = 8 c m , a nd d 3 = 3 cm , r e l a ti v e e f o r l u n g = 0 . 2 5 , a n d f i el d si z e = 10 10 c m . T he v a l ue s w e re r o und e d o f f to r e p r e se n t ap p ro x i m a te f a c to r s f o r t y pi c a l l ung c o r r e ct io ns . M o re d e t ai le d t a bl e s o f

WWW.MEDRAD.IR

t h e be y o n d - l u n g a n d in - l u n g c o r r e ct io n f a c to r s ha v e b e e n c al c ul at e d b y M c Do na ld e t a l . ( 54 ) f o r s e v e r a l r e p r e s e nt a ti v e b e a m e ne r g ie s a nd f i e ld s i z es .

TABLE

12.3.

INCREASE

IN

DOSE

TO

TISSUES

BEYOND

HEALTHY LUNG a

Beam Quality

C or r e c t i on F a c t or

O r t h o v ol t a ge

+ 1 0 % / c m o f l ung

60

Co rays

+ 4 % / c m o f l ung

4-MV x-rays

+ 3 % / c m o f l ung

10-MV x-rays

+ 2 % / c m o f l ung

20-MV x-rays

+ 1 % / c m o f l ung

A p p ro x i m at e

values

c a l c u l a te d

w it h

E q ua t i o n

12 . 1 0

for

t yp i c a l

cl i ni ca l

s i t u a ti o n s .

P.252

T a b l e 12 . 4 g i v e s t h e d e c r e a se i n d o s e be y o nd b o ne t ha t mi g ht b e e x p e ct ed w i t h b e a m s o f d i f f e re n t e ne r g ie s . T h e s e a re a ppr o x i m at e v a l ue s b e c aus e t he s hi el di ng e f f e c t o f b o n e d e pe n ds o n t h e s i z e o f t he bo ne , f i e ld s i z e , a nd ot he r p a r a m et e r s t h a t a f f e c t s c a t te r i n g . T h e s h i e l d i ng e f f e c t o f b o ne d i mi ni s he s q ui t e r a pi dl y a s t he b e a m e n er g y i n c r e a ses . T h e s h i e l di ng e f f e ct o f b o ne f o r x - r a y s g ene r a t e d b et w e e n 5 0 0 k V a n d 4 M V i s e n t i re l y d u e to it s g re a t e r e le c t ro n d e ns ity ( e l e c t ro ns p e r c m 3 ) , a s a l l t h e a t te n u a t i o n i s d ue to t he C o m p to n p r o c e s s . In t he m e g a v ol t ag e r a n g e , t h e co r r e ct io n s f o r bo n e a tt e nua ti on i n m o s t cl i ni c a l si tua t i o ns a re s m all a n d a r e u s u a ll y n e gl ec t e d . Ho w e v e r , a s t he x - r a y e ne r g y i nc r e a se s be y o nd 1 0 M V , the s h i e ld i n g effect begins to i nc r e a s e b e c a us e pair p ro duc t i o n b e co m es s i g n i f i c a n t . R e c al l t h at t h e a b s o rp ti o n o f r ad i a ti o n a s a r e s ul t o f p a i r p r od uc t io n d e pe n d s o n t h e a t om ic n u m b e r .

B. Absorbed Dose within an Inhomogeneity

A s m e n t io n e d e a rl ie r , t h e a b s o rb ed d o se wi t hi n a n i nho m og e nei ty o r i n t he s o ft t i s s u e s a dj a c e n t t o it i s s t ro n g l y i nf l ue nc e d b y a lt e r at io ns in t he s e c o nd a r y e l e ct r o n f l u e n c e . F o r e x a m p le , f o r x - r a y s g e ne r a t ed a t po te nt i als l e s s t ha n 2 5 0 k V p , t h e r e i s a s u b st a n t i al i n c r e a se i n a b s o r be d do s e i ns i d e b o ne be c a us e o f i n c r e a s e d e le c tr o n f l ue n c e a r i si n g f r o m p ho to el e c tr i c ab s o rp ti o n. S p i e r s (5 5 , 56 )

WWW.MEDRAD.IR

h a s m a d e a co m p re h en s i v e s t u d y o f a b so r be d do s e wi t hi n mi ne r al bo ne a s w e ll a s w i t h i n s o f t ti s s u e c om p o n e n t s o f b o ne . T he i nt e r e st ed r e a de r i s r e f e r r ed to t he o r i gi n a l wo r k o r to Joh n s a n d C u n ni ng ha m ( 5 7 ) f o r de t ai l s . So m e p r a c t i ca l a sp e ct s o f t h e p r ob l em w i ll b e d i s c u s s e d i n t hi s s e cti o n.

B.1. Bone Mineral

U n d e r t h e c o n di tio n s o f el e ct r o ni c eq ui li br i um , t he ra ti o o f abs o r b ed do s e s i n d i f f e r e n t m ed i a , f o r a g i v e n p h o t o n e ne rg y f l ue nc e , i s g i v e n b y t he r a t io o f t he ir e n e r g y a b so r pt io n c o ef f i c i e n t s ( se e C ha p te r 8 ) . Be c a us e t he r a d /R o r t he f f a c t or i s p r op o rt io n a l to t h e e n e r g y P.253 a b s o r pt io n c o e f f i ci e n t r e l a ti v e t o a i r , t he r a t i o o f f f a c t o r s a l s o r e f le c t s t he r e l at i v e a b so r be d d os e . Thus, for a given q ua l i t y r a di a ti o n a nd t he e ne r g y f l u e n c e , t h e a b s o r b ed d o s e i n b o ne m i ne r al r e l a ti v e t o a b so r be d d o s e i n m us c l e i s t h e r a t io :

u n d e r e l e ct r o n i c eq u i lib r i u m c o n d it io ns .

TABLE 12.4. REDUCTION IN DOSE BEYOND 1 CM OF HARD BONE a

Beam Quality

C or r e c t i on F a c t or ( % )

1 mm Cu HVL

-15b

3 mm Cu HVL

-7

60

Co

-3.5

4 MV

-3

10 MV

-2

A p p ro x i m at e

v a l u es

c a l c u l a te d

w it h

E q ua t i o n

12 . 8

for

t y p ic a l

c li ni c al

s i t u a ti o n s . A s s u m e d e l e ct r o n d e nsi t y o f b o ne r el a ti v e t o w a te r = 1 . 6 5 .
b

E s t i m at ed f r o m m e as u r e d d a t a b y H a a s L L , S a nd b e r g G H . M o di f i c a ti o n o f

t h e de pt h do s e c u r v e s o f v a r i o us r a d i a t io ns b y i nt e r p o s ed b o ne . Br J R a d i ol 1 9 57 ; 3 0 :1 9 .

WWW.MEDRAD.IR

F i g u r e 1 2 .1 7 A s h o w s a p l o t o f a b so r b ed d o s e a s a f unc t i o n o f d e p t h f o r a n o r t h o vo lt a g e be a m i n c i d e n t o n a c o mp o si te p ha nt o m c o nt ai ni ng 2 - c m t hi c k bo n e . B e c a u s e f o r t h i s q u al it y r a d i at io n f b o n e / f m u s c l e = 1 . 9 / 0 . 9 4 = 2 . 0 , t he d o s e i n t he f i r st l a y e r o f bo n e w il l b e a b o u t t w i ce a s m uc h a s i n so f t t i s s ue . In t he s ub se q ue nt l a y e r s , t h e d o s e w i ll d r o p f ro m t hi s v a l ue d ue to i nc r e a se d at tenua t i o n b y bo ne ( T a b l e 12 . 4 ) . F i g u r e 12 . 1 7 B c o m p ar e s t he P.254 s i t u a ti o n w it h C o bea m . S i n c e f b o n e / f m u s c l e = 0 . 9 5 5 /0 . 9 57 = 0 . 96 f o r t hi s e ne r g y ,

60

60

t h e d o se to b o n e mi n er a l f o r a

C o be a m i s s l i g ht l y l e s s t ha n t ha t e x p e c te d i n t he

s o f t t i s s u e . B e yo n d th e b o n e , t h e d o se i s r e d uc e d d ue t o t he shi e l di ng e f f e c t o f b o n e b e c a u s e t h e ele c t ro n d e n si t y o f bone i s hi g he r t ha n t ha t o f t he m us c l e tissue.

WWW.MEDRAD.IR

FIG.

12.17.

Percentage

de p t h

do s e

as

f unc t i o n

of

d ep t h

in

p ha nt o m

WWW.MEDRAD.IR

c o n t a i n i n g 2 c m o f b on e . A : H V L = 1 m m C u ; S S D = 5 0 c m ; f i eld s i z e = 10 1 0 cm. B:
60

Co ray beam; SSD = 80 cm; field size = 10 10 cm.

TABLE 12.5. ABSORBED DOSE TO BONE RELATIVE TO SOFT TISSUE FOR DIFFERENT ENERGY BEAMS

R a d i a t i on Q u a l i ty A p p r o x i m a t e E f f e c t iv e HVLa Energy B on e Mineralb S of t T i ssu e

i n B on e

1 mm Al

20 keV

4.6

5.0

3 mm Al

30 keV

4.8

5.3

1 mm Cu

80 keV

2.1

3.8

2 mm Cu

110 keV

1.4

2.4

3 mm Cu

135 keV

1.2

1.6

10.4
60

mm

Pb

1.25 MeV

0.96

1.03

( Co rays)

11.8 mm Pb (4MV x-rays)

1.5 MeV

0.96

1.03

14.7 mm Pb (10MV x-rays)

4 MeV

0.98

1.05

13.7 mm Pb (20MV x-rays)

8 MeV

1.02

1.09

12.3 mm Pb (40MV x-rays)

10 MeV

1.04

1.11

HVL,

ha l f - v a l ue

layer.

WWW.MEDRAD.IR

HVL

and

a p p ro x im a t e

e f f e ct i v e

e ne rg i e s ( c ha p t e r

c al c ul a te d

us i ng

a t te nua t io n 7).

c o e f f i c ie n t s
b

D e r i ve d f r o m d a t a g i v e n i n J o hns H E , C u nni ng ha m J P . T h e p hy s i c s o f

r a d io lo g y . 4 t h e d . S p ri n g f i el d , IL : C ha r l e s C T ho m a s , 1 9 8 3 .

T a b l e 12 . 5 , c o l u m n 3 , g i v e s t h e c ha ng e i n d o s e e x pe c te d i n t he b o ne m i ne r al f o r d i f f e r e n t e n e rg y b e a ms . T h e s e c a l c ula ti o ns a r e m a de o n t he b a s is o f t he f f a c tor r a t io s o f bo n e t o mu s c l e o r t h e r at io of e ne r g y ab s o rp ti o n c o e f f i c ie nt s . Fo r o r t h o vo lt a g e be a m s , t h e s e v a l u e s r e pr e s ent t he m a x i m a l e nha nc e m e nt i n d o se o c c u r r i n g j u s t i n s id e bo n e o n t h e e nt r a nc e s id e o f t he b ea m .

B.2. Bone-tissue Interface Soft Tissue in Bone

T h e b o n e d i s c u s s e d i n s e c ti o n B. 1 i s t he i no rg a ni c bo ne (bo ne m i ne ra l ) . O f g r e a te r i m po r t a n c e b io lo g i ca ll y , ho w e v e r , is t he do s e to s o ft ti ss ue e m be d de d i n b o n e o r a dj a c e n t t o b o n e . T h e so f t ti s s ue e l em e nt s i n bo ne ma y i nc l ud e bl oo d v e s s e l s ( t h e H a v e r s i an c a n a l s ) , l i v i ng c e l l s c a l l e d o s te o c y te s a nd b o ne m a r ro w . T h e s e s t r u c t u r e s m a y h a v e v e r y s m a l l t hi c kne s s e s , r a ng i ng f r o m a f e w m i c r o ns t o a m i ll i me t er . W h e n t h e t h i c k n e s s o f a s of t t i s s ue st r uc t ur e i n b o ne i s s m al l c o m p a re d wi t h t h e r an g e o f t h e e le c t ro ns tr a v e r s i ng i t , i t m a y be c o ns id e re d a s a B r a g g - G r a y c a v i t y ( s ee C h a p t e r 8) , c o nt ai ni ng s o f t t i s s ue e m be dd e d i n t he bo ne m e d i u m . U n d e r t h e se c o n d it io n s p ho to n i nt e r a c ti o ns i n t he c a v i ty c a n b e i g no r ed a n d t h e io n i z a ti o n i n t h e c a v i t y i s c o nsi d e re d e nti r el y d ue t o e le c t ro ns ( p ho to -, C o m p to n - , or p ai r -p r o d u c tio n e l e ct ro ns ) o r i gi na ti ng from t he s ur r o und i ng m a t e ri a l . T h e do s e D S T B to a v e r y s m al l vo lum e o f so f t t i s s ue e mb e d de d i n bo n e, a s s u m i n g n o p e r t u r b at io n o f t h e p ho to n o r e l e ct r o n f l ue nc e s , i s gi v e n b y :

w h e r e D B i s t h e d o s e to t h e s u r r o und i ng bo ne m a t r i x a nd (

/ ) S T B i s t h e r a tio o f av e r a g e m a s s c ol li s io n s t o pp i ng p o we r o f so ft ti s s ue t o b o ne f o r t h e e le c t ro n s . A s d i s c u s s e d ea r li e r in s e c t io n B. 1 , t he d os e a t a po i nt i n t he b o ne mi ne r a l i s r e l at e d to the d o se (DST) at t he s a me p oi nt if t he bo ne is r ep l a ce d by a h o m o ge n e o u s m e di u m o f s o f t t i s s ue :

P.255

WWW.MEDRAD.IR

F r o m e q u a ti o n s 12 . 1 3 a n d 1 2 . 1 4 , w e g et :

T h e r a t io o f d o se to a s o f t ti s s ue e le m ent e mb e dd e d i n b o ne to t he do s e i n a h o m o ge n e o u s me di u m o f so f t t i s s ue , fo r t he s a m e p ho to n e ne rg y f l ue nc e , i s g i v e n by:

C a l c u l a t ed v a l u e s o f f o r di f f e r e nt e ne r g y b e a m s a re gi v e n i n co l um n 4 o f T a ble 1 2 . 5 . T h e s e d a t a s ho w t h a t f o r t he s a me p hot o n e ne rg y f l uenc e , s o f t ti s s ue s t r u c t u r e s i n s id e t h e b o n e w i ll r e c ei v e hig he r d o s e t ha n t he d o s e t o t he bo ne m i n e r a l or t h e d o se to s o f t ti s s u e i n t he a b s e nc e o f b o ne . T he re a r e t w o r e a so ns f o r t h i s i n c r e a s e i n d os e : ( a )

en

/ i s g re a te r f o r b o ne t h a n s o f t t i s s ue i n the v e r y l o w e ne r g y r a ng e b e c a us e o f

t h e p h ot oe le c t ri c pr o ce s s a n d i n t he v e r y hi g h e ne rg y r a ng e b e ca us e o f t he p ai r p r o d u c tio n . H o w e v e r , i n t h e C o m p to n r a ng e o f e ne r g ie s ,

en

/ f o r bo n e i s s li g h tly l e s s t h a n t ha t f o r s of t t i s s ue ; ( b )

/ i s g re a te r f o r so f t t i s s u e at a ll e ne rg ie s b e c a us e it co nt a i ns g re a t e r num be r o f e l e ct r o n s pe r u n i t ma ss t h a n t h e b o ne ( T a b le 5 . 1 ) . T he c om b i ned e f f e c t o f ( a ) a nd ( b ) g i v e s r i se t o a h i g h e r d o se to t he s o ft t i s s ue e mb e dd ed i n b o ne t ha n t he s u r r o u n d i n g b o n e m i ne r a l o r t h e ho m og e neo us s o f t t i s s ue i n t he a b s e nc e o f b o ne . In a c l i n i c a l si t u a ti o n, t h e d o se t o a s ma ll ti s s ue c a v it y i ns i de a b o ne m a y b e c a l c u l a te d b y t h e f o llow i n g e q u a t io n:

w h e r e t S T a n d t B a r e th i c k n e s s e s o f so f t ti ss ue a nd bo ne , r e sp e ct i v el y , t r a v e r se d b y t h e b e a m be f o re r e a c h i n g t h e po i nt o f i nt e r e st ; B i s t he re l a ti v e el e ct r o n d e n s i t y o f bo n e ; a n d T M R i s t h e t i s s ue - ma x i m um r a t io (o r s i mi l a r at te nua t io n f u n c t i o n ) f o r t h e g i v en f i e l d s i z e .

Soft Tissue Surrounding Bone

O n t h e e n t r a n c e s id e o f t h e p h ot o n be a m , the r e i s a do s e e nha nc e m e nt i n t he s o ft t i s s u e ad j a ce n t t o t h e b o n e . In t he m eg a v ol t a ge r a nge o f e ne rg ie s , t hi s i nc r e a se i n d o se i s p r i m a ri l y du e to t h e el e ct r o n b ac k s c a t t e ri ng . D a s a nd K ha n ( 5 8 ) ha v e s h o w n t h a t t h e m a g n i t u d e o f t h e b a c k s c a tt e r i s ne a r l y t he s a me f o r a l l p hot o n e n e r g ie s f r om
60

Co to 2 4 M V . F o r bo ne , t he d o s e e nha nc e m e nt d ue to b a c k s c at te r

i s a p p ro x i m at el y 8 % in t h e a b o v e e ner g y ra ng e . Be c a us e o f t he v e r y s ho r t r a ng e o f t h e b a c k s c a tt e r ed e l e ct r o n s , t he e nha nc e m e nt e f f e c t i s l i mi ted o nl y t o a f e w m i ll i me te r s ( Fi g . 1 2 . 18 ) . F o r i n s t a nc e t he d o s e e nha nc e m e nt d ro p s f ro m 8 % to l e s s t h a n 2 % w i t h i n 2 m m u p s t r e a m f r o m t he i nt e r f a c e . O n t h e t r a n s m i s s io n s i d e o f t h e b e a m , t he fo r w a r d s c a tt e r o f el e ct r o ns f r o m bo ne a n d t h e b u il d u p o f ele c t ro n s i n so f t ti s s ue g i v e r i s e to a do s e per t ur b a ti o n e f f e c t which depends on p h o to n energy ( 59 ). F i g ur e 12 . 1 9 s how s t hi s e ne r g y d e pe n d e n c e . F o r e n e rg i e s u p to 1 0 M V , t he d o s e a t t he i nte r f a c e i s i ni t i al l y le s s

WWW.MEDRAD.IR

t h a n t h e d o se i n a h om o g e n eo u s s o ft ti s s ue m e d i um b ut t he n b uil d s up to a d o se t h a t i s sl ig h t l y g re a ter t h a n t h a t i n t he hom o g e neo us c a s e . F or hi g he r e ne r gi e s , t h e r e i s a n e n h a n c e m e n t o f d o se a t t he i nt e r f a c e b e c a us e of t he i nc r e a s e d e l e ct r o n fl u e n c e in bone due to pair p ro d uc ti o n. T he e f f e ct d e c re a s e s wi t h d i s t a n c e a n d l a st s u p t o t h e r a n ge o f t he e le c t ro ns . M o s t p a ti e n t s a re t r ea t e d w i t h p ar a ll e l -o pp o s ed be a m s . A l so do s e d i st r i b ut io ns a r e n o r m a ll y n o t co rr e c t ed f o r t he p r e senc e o f b o ne w he n us i ng m e g a vo lt a g e p h o to n b e a m s . T h e f o ll o w i n g d i s c us s io n a na l y z e s t he b o ne d o sa g e p ro bl e m i n a p r a c t i ca l c li n i c a l si t u at io n . F i g u r e 12 . 2 0 s h o w s ex a m p l e s o f d e pt h do se d i st r ib ut io ns e x p e cte d i n a p at ie nt t r e at e d w i t h p a r al l el -o p po s ed be a m s . Do s es a r e no r m a li z e d to the m i dp oi nt d o se e x p e c te d i n a h o m oge n e o u s s o f t ti s s ue me d i um . T he d i st r i b ut io n c o r r e ct e d f o r increased to the bo n e at ten u a t i o n ( s hi el di ng b o ne ef f e c t ) a lo ne s ho w s d o se re d uc ti o n a c t ua l t h r o u g h o u t . T h e m a gn i t u d e o f t h i s re d uc tio n d e pe nd s o n bo ne thi c k ne s s r e l a ti v e so f t tissue thickness, d e ns i t y a nd beam e ne rg y . T he d i s t ri b u tio n i n t h e p re s e n c e o f bo ne i nc l ud e s bot h b o ne a tt e nua t io n a nd bo ne t i s s u e i n t e r f a c e e f f e c ts d i s c u s s e d e a rl i er . T he s e e f f e c t s i n t he me g a v ol t a ge r a nge of P.256

P.257 e n e r g ie s c a u s e a n i n c r e a s e i n d o se t o so f t t i s s ue a d j a c e nt t o bo ne , b ut t he ne t i n c r e a s e i s n ot s ig n i fi c a n t a t lo w e r e ne r gie s ( 1 0 M V ) . H o we v e r , a s t he p a ir p r o d u c tio n p r o c e s s b ec o m e s si g n i f i c a nt at hi g he r e ne rg ie s a nd t he e le c t ro n r a ng e i n c r e a s e s , a p p re c i ab le e n h a n c e m e nt i n d o s e o c c ur s a t t he b o ne t is s ue i nt e r f a c e s . T h i s i s s e e n i n F i g . 1 2. 2 0 a n d T a b l e 12 . 6 .

WWW.MEDRAD.IR

F I G . 1 2 . 1 8 . B a c k s c a t t er do s e f a ct o r ( BS D F ) f o r v a ri o us e nerg y p ho to n be a m s p l ot te d a s a f u n c t io n o f d i st a n c e , t o w a r d the s o ur c e , f ro m t he b o ne - po l y st y r e ne i n t e r f a c e . B S D F i s t h e r a t io o f d o s e a t t he i nt e r f a c e w i t h b o ne t o t ha t w i t ho ut b o n e . ( F ro m D a s IJ , K h a n F M . Ba c k s c a t te r do s e pe r t ur b at io n a t hi g h at o mi c n u m b e r i n t e r f a c e s i n m e g a v o lt a ge p hot o n b e a m s . M e d P hy s 1 9 8 9 ;1 6 : 36 7 , w it h p e r m i s sio n . )

WWW.MEDRAD.IR

F I G . 1 2 . 1 9 . F o r w a r d d o s e pe r t u rb a ti o n f a c t o r ( F D P F ) f o r v a r io us e ne r g y p ho to n b e a m s pl ot te d a s a f u n c t i o n o f d i st a nc e , a w a y f r o m t he s o ur c e , f r o m b o ne p o l y st y r e n e i n te r f a c e . F D P F i s t h e r at io o f d o s e at t he i nt er f a c e w i t h b o ne t o t ha t w i t h o u t b o n e f o r t h e s a m e p h oto n e ne r g y f l ue nc e . ( F r o m D a s IJ. S t ud y o f do se p e r t u r b at io n at bo n e- t i s s u e i n te r f a c e s i n m e g a v o lt a ge p ho to n b e a m t he r a p y . [ D i s s e rt a ti o n . ] U n i v e rs i t y o f M i n n e s ot a , 1 9 88 : 1 19 , w i t h p e r mi s s ion. )

WWW.MEDRAD.IR

FIG.

12.20.

Percent

depth

do s e

d i st ri but i o n

in

2 0 - c m thi c k

p o l y s t y r e ne

p h a n t o m c o n t ai n i n g a b o n e s u b s ti t ute m a ter i a l . Do s e s a r e no rm a li z e d to m id po i nt d o s e i n t h e h o mo ge n e o u s p ol y s t y r e ne p ha nt o m o f t he s a m e t hic k ne s s . P a r a l l e l -

WWW.MEDRAD.IR

o p po s ed b e a m s , f ie l d s i z e = 1 0 1 0 c m , S S D = 1 0 0 c m . T he s y m b ol * s i g ni f i es d o s e t o a s m a ll ti s s u e c a v i t y i n bo ne . A : 6 M V p ho to n b e a m . B : 2 4 M V p ho to n b e a m . ( F r o m D a s IJ , K h a n F M , K a s e K R . D o s e p e rt ur b a ti o n a t high a t o m i c num b e r i n t e r f a c e s i n p a r a ll el o p po s ed m e g a vo lt a g e p ho t o n be a m i r r ad i ati o n [ a b s t . ] . P hy s M e d B i ol 1 9 88 ; 33 [ s u pp l 1 ] : 12 1 , w i t h pe r m i ss i o n. )

B.3. Lung Tissue

D o s e wi t h i n t h e l u n g t i s s u e i s p ri m a ri l y gov e r ne d b y it s d e ns it y . A s d i s c us s e d i n s e c t io n 1 2 . 5 A , lo w e r lu n g d e n s i t y g i v e s ri s e t o hi g he r do s e w it hi n a nd b e y o nd t he l u n g . F i g u r e 1 2 . 21 P.258 g i v e s t h e i n c r e a se i n l u n g d o se a s a f unc t io n o f d ep t h i n t he lung f o r s e l e ct ed e n e r g ie s u s i n g a 1 0 1 0 c m f i e ld . But i n t he f i r s t l a y e r s o f s o f t t i s s ue b e y o nd a l a r g e t h i c k n e s s o f l u n g , t h e re i s so m e lo s s o f s e co nd a r y el e ct r o ns ( 6 0 ) . T hi s gi v e s r i s e to a s l ig h t d e c rea s e i n d o s e r el a ti v e to t ha t c a l c ul at ed o n the b a s i s o f l ung t r a n s m i s s io n .

TABLE

12.6.

DOSE

ENHANCEMENT

AT

BONE-TISSUE

INTERFACE FOR PARALLEL-OPPOSED BEAMS a

T h i c k n e s s of B on e ( c m )

6 MV

10 MV

18 MV

24 MV

0.5

1.01

1.02

1.03

1.04

1.0

1.01

1.02

1.03

1.05

2.0

1.00

1.01

1.03

1.05

3.0

0.99

1.00

1.03

1.05

D o se

to

so f t

tissue

adjacent =

to

bo ne

r e l at i v e 100

to

m id p oi nt

dose

in

h o m o ge n e o u s s o f t ti s su e ; t o t al t hi c k ne s s = 2 0 c m ; f i e ld s i z e = 1 0 1 0 c m ; SSD interfaces in p a r al le l cm. be a m i r r a di a ti o n F r o m D a s IJ , K h a n F M , K a s e K R . Do s e p er t ur b a ti o n at hi g h ato m i c num be r o p po s ed m eg a v o lt a g e p ho to n [ a b s t r a ct ] . P h y s M e d B i o l 19 88 ; 3 3 [ S upp l 1 ]: 1 2 1 , w i t h pe r m i s si o n.

K o r n e l so n a n d Yo u n g ( 6 1 ) h a v e di s c us s e d the p r ob le m o f lo s s o f l a t er a l e le c t ro nic e q u i li b ri u m w h e n a h i g h - e n e r g y p ho to n b e am t r a v e r s e s t he l ung . Be c a us e o f t he l o w e r d e ns it y o f l u n g , a n i n c r e a s i ng num b e r o f el e c tr o ns tra v e l o ut s i de t he g e o me t ri c a l l i mi t s o f th e b e a m . T hi s c a us e s t he d o s e p ro f il e to b ec o m e le s s s ha r p .

WWW.MEDRAD.IR

F o r t h e s a me r e a so n t h e r e i s a g r e at e r l o s s o f l a te r a ll y s c a tt e r ed el e ct r o ns , c a u s i n g a re d u c ti o n in d o s e o n t he b e am a x i s . T he e f f e ct i s si gni f i c a nt f o r s m al l f i e l d s i ze s ( < 6 6 cm ) a n d h ig h e r e ne r gie s ( > 6 M V ) . Cl i ni c al l y, w he n t r e at i ng a t u m o r i n t h e l u n g t he r e i s a po s s i bi li t y o f und e r d o s a g e i n t he p e r ip he r y o f t he t u m o r i f s m a ll f ie ld s a n d h i g h - e ne r g y b e am s a r e us ed . H o w e v er , c o ns i de r i ng t he fact that m o st p r otoc o l s i n t h i s co unt r y r e q ui r e no l ung c or r e c ti o n i n d o se p r e s c r ip ti o n , c o n s id e ra t io n o f t h i s e f f e c t i n d o s im e tr y b e c o me s r at he r a c a d e mi c .

B.4. Air Cavity

T h e m o s t i mp o rt a n t ef f e c t o f ai r c a v it ie s in m e g a v ol t ag e b e a m d o s im e tr y i s t he p a r t ia l l o s s o f el e c tro n i c eq u i li b ri um a t the c a v i t y s ur f a c e . T he a c t ua l d o se to t i s s u e b e y o n d a n d i n f r o n t o f t h e c a v it y m ay b e a pp r e ci a bl y lo w er t ha n e x p e ct ed . T h i s p h e n o m e no n o f do s e b u i ld u p at t he a i r c a v i ti e s ha s b ee n e x te ns i v e l y st ud ie d b y E p p e t a l . ( 6 2 , 6 3 ) . T h e m o s t s i g ni f i c a nt d e c r e a se i n d o s e o c c ur s a t t he s ur f a c e b e y o n d t h e c a vi t y , f or l a r ge c a vi ti e s ( 4 cm d ee p ) a nd t he s m al l e st fi el d (4 4 c m ) . E p p e t a l . (6 2 ) ha v e e s t im a te d t hat i n t he c a s e o f P.259 r e s p i r ato r y a i r p a s s a ge s , w i l l n o t be g r e at er t ha n 1 0 % unl e s s f i e l d s i z e s s m a ll er t h a n 4 4 c m a r e u s e d . T h e u n d e r d o s ag e i s e x p e ct e d t o b e g rea t e r f o r hig he r e n e r g y r a d i at io n ( 6 3 ) .
60

Co t he re d uc t io n i n d o se

i n p r a c t i c al c a s e s , s u c h a s t h e l e s i o ns lo c a ted i n t he up p e r

F I G . 1 2 . 2 1 . P e r c e n t ag e i n c r e a s e i n l ung d o s e a s a f unc t i o n o f d e pt h i n t he l ung f o r s el e ct e d e n e rg ie s . F i el d s i z e = 10 10 c m . ( F ro m M c D o na ld S C , K el le r BE , R u b i n P . M e t h o d f o r ca l c u l a ti n g d o se w he n l ung t i s s ue li e s i n t he t r e a t me nt f i el d . M e d P h y s 1 9 7 6 ; 3 :2 10 , w i t h p e r m i s si o n. )

12.6. TISSUE COMPENSATION

A r a d i a ti o n be a m i n c id e n t o n a n i r r e g ul ar o r s lo pi ng s ur f a c e p rod uc e s s k e w i ng o f t h e i s od o se c u r v e s . C o r r e ct io n s f o r t hi s e f f e c t w e r e di s c us s e d i n s e c t io n 1 2 . 2 . In

WWW.MEDRAD.IR

c e r t ai n

t r e a tm e n t

s itu a t i o n s ,

however,

t he

s ur f a c e

i r r e g ul a ri ty

gives

rise

to

u n a c c e p t a b le n o n u n i f or m i t y o f d o se w it hi n the t a r ge t v ol um e o r ca us e s e x c e s s i v e i r r a di a ti o n o f s e n si ti v e s t r u c t u r e s s uc h a s the s p i na l co r d . M a ny t e c hni q ue s ha v e b e e n d e v i se d t o o v erc o m e t h is p r ob l em , inc l ud i ng t he us e o f w e d g ed f i e ld s o r m u l t ip le f i el d s a n d t he a d di ti o n o f bo l us m at e ri a l o r c o mp e ns a to rs . A r e a s ha v i ng a s m a l le r t hi c k n e s s o f t i s s u e c a n al s o b e blo c k e d fo r t he l a st f ew t r e at m e nt s to r e d u c e t h e do s e i n t h es e a r e a s . B o l u s i s a t i s s u e - e q uiv a l e n t m a t er i al p l a c ed d i r e ct l y o n t he s k i n s ur f a c e t o e v e n o u t t h e i r r eg u l a r c o nt o u r s o f a p at ie nt to p r e s e nt a f l at s ur f a c e no r m a l t o t he b e a m . T h i s u s e o f bo lu s s h o u l d be di s ti ng uis he d f r o m t ha t o f a bo l us l a ye r , w hi c h i s t h i c k e n o u g h to p rov i d e a de q u a te d o se bui l d up o ve r t he s k i n sur f a c e . T he l a t t e r s h o u l d b e te r m ed t h e b u i l d - u p bo l us . Placing bo l u s di r e ct ly on the skin s ur f a c e is s at i s f a c to r y for o rt ho v o lt a ge r a d i at io n , b u t f o r h i gh e r - e n e r g y b e a ms r es ul t s i n t he l o s s o f the s k i n s p a r i ng a d v a n t a g e . Fo r s u c h r a d i at io n s , a c o m pens a t i ng f il te r s ho ul d b e us e d , w hi c h a p p r o xi m a te s t h e e f f ec t o f t h e b ol us a s w ell a s p r e se r v e s t he s k in- s p a r i ng e f f e ct . T o p r e s e r ve t h e s k i n - s p a r i n g p ro p e rti e s of t he m e g a v o lt a ge p ho to n b e a m s , t he c o m p e n s at o r i s pl a c ed a s u i t a b l e di s t a nc e ( 2 0 c m ) a w a y f r o m t he p a t i e nt ' s s k i n. Y e t t h e co m p e n s at o r is s o d e s ig n e d t ha t it s i nt ro d uc ti o n i n t he be a m gi v e s ri s e to i s o do s e c u r v e s w i t hi n t h e p ati e n t t ha t d up li c a t e , a s c lo s el y a s po s s i bl e , t ho se f or t h e b ol u s .

A. Design of Compensators
F i g u r e 1 2 . 22 i ll u s t r ate s s c h e m at i c al l y t he us e o f a c o mp e ns a tor to pr o v id e t he r e q u i r ed b e a m a tt e nu a t i o n t h a t wo ul d othe r w i s e o c c ur i n t he m i s s i ng t i s s ue when the body surface is P.260 i r r e g ul a r o r c u r v e d . B e c a u s e t h e c o m p e nsa t o r i s de s ig ne d to be p o s it io ne d at a d i s t a n c e f ro m t h e s u r fa c e , t h e d im e ns io ns a nd s ha p e o f t he c om pe ns a t o r m us t b e a d j u s t ed be c a u s e o f (a ) t h e b e a m di v e r ge nc e , ( b ) t he r e l ati v e l ine a r a tt e nua t io n c o e f f i c ie n t s o f t h e f il te r m a te r i al a nd s o ft tis s ue s , a nd ( c ) t he r e duc t i o n i n s c at te r a t v a r i o u s de p t h s w h e n t h e c o m pe ns a to r is p l a c ed a t a di s t a nce f r o m t he s k i n r a t h e r t h a n i n co n t a c t w i t h it . T o co m pe ns a t e f o r t hi s s c at te r , t he c o mp e ns a to r is d e s ig n e d s u c h t h a t th e a t te n u a t io n o f t he f i lt e r i s l e s s t ha n t ha t r eq ui r ed f o r p r i m a r y r a d ia ti o n o n ly . T h e s e c o ns i d e r a ti ons a nd o t he r s ha v e b e e n d i s c us s e d i n t h e l it e r at u r e ( 6 4 ,6 5 ,6 6 , 6 7 ,6 8 , 69 , 7 0 ) .

WWW.MEDRAD.IR

F I G . 1 2 . 2 2 . S c h e m a t ic r e p r e s e nt a ti o n o f a c o m p e ns at o r de s ig ne d f o r a n i r r e g ul a r s u r f a c e . ( F r o m K h a n F M , M o o r e V C , Bur ns D J . T he c o ns t r uc ti o n o f c o m pe ns a to r s f o r c o b al t te le t h e r ap y . R a d i ol og y 1 9 70 ; 96 : 18 7 , w i t h p e r mi s s io n. ) M i n i f i c a ti o n o f t h e c om p e n s a ti n g m a t e ri a l fo r g eo m et r i c di v e r genc e o f t he b e a m h a s b e e n a c h ie v e d in m a n y w a y s . O ne m e t hod ( 64 , 6 6 ,6 7 , 68) c o ns t r uc t s t he c o m p e n s at o r o u t o f a lu m i n u m o r b r a s s b lo ck s , us i ng a m a t r i x o f s q ua r e c o l um ns c o r r e s po n di n g to t h e i r r e g ul a r s u r f a c e . T he d i me ns i o n o f e a c h col um n i s mi ni f i ed a c c o r di n g t o t h e g eom e t ri c d i v e rg e nc e co rr e c ti o n, w hi c h i s c a l c ul a t e d f ro m t he S S D a n d t h e f i lt e r - s u rf a c e d i s ta n c e . K ha n e t a l . ( 71 ) d e s c ri be d an a p p a r a t us t h a t u s e s t h i n r o d s d u pl i ca t i n g t h e d i v e rg i ng ra y s o f t he t he r a p y be a m ( F i g . 12 . 2 3 ). T h e r o d s mo v e f r ee l y i n r ig i d s h a f t s al o ng the d i v er g i ng p at hs a nd c a n be l o c ked o r r el e a se d b y a lo c k in g d e v i c e . T he a p p a ra t us i s po s it io ne d o ve r t he p a ti e nt so t h a t t h e l o we r e n d s o f t h e r od s to uc h t he s k i n s ur f a c e . W he n t he r o d s a re lo c k e d, t h e u p p er e n d s o f t h e r o d s g e n e r at e a s ur f a c e t ha t i s si m il a r t o t he s k i n s ur f a c e b u t c or r e ct e d f o r d i ve r g e n c e . A p la s ti c c om p e ns a to r c a n t he n b e b ui lt o v e r t hi s s u r f a c e ( 6 9 ) . B e c k e t a l . ( 7 2 ) a nd Bo g e e t a l . ( 7 3 ) ha v e d e s c r i b ed S t y r o f o am c u t t e r s ( F ig . 1 2 . 2 4 ) t h a t w o r k o n a p a nt o g r a p hi c pr i nc i pl e a nd us e a he a t i ng e l e me n t o r a ro u t i n g t o ol m e c h a ni s m f o r t he ho ll o w i ng o f t he S t y r o f o a m . T he c a v i t y t h u s p r o d u c e d i s a m i n i f i ed v e r s io n o f t he p a ti e nt s ur f a c e , w hi c h c a n b e f i l le d w i t h t h e co m p e ns a t o r m at e ri a l .

WWW.MEDRAD.IR

F I G . 1 2 . 2 3 . A n a p p a r a t u s f o r t h e co ns t r uc ti o n o f 3 - D c om p e ns ato r i n o ne p ie c e . (From Khan FM, Moore V C , B u r ns D J . A n a p p a r a t us f o r t he c o ns t r uc ti o n of i r r e g ul a r s u r f a c e c o mp e n s a t or s f o r us e i n r a d io t he r ap y . R a d i olog y 1 9 68 ; 90 : 59 3 , w i t h p e r mi s s io n . )

WWW.MEDRAD.IR

F I G . 1 2 . 2 4 . S c h e m a t i c d i ag r a m o f a S t y r of o a m c ut te r f i tt ed w i th a r o ut i ng t ool f o r c o n s t r u c ti n g co m pe n s a t o r s . ( Re d r a w n f r o m Bo ge R J , E d l a nd R W , M a t he s D C . Tissue c o m pe n s a t o r s for m e g a v o lt a ge r ad i ot he r a p y f a b ri c a t ed from ho l lo w e d S t y r o f o a m f il l ed w i t h w a x . R a d i o l og y 1 97 4 ;1 1 1 :1 9 3 , w it h p e r m i s si o n. ) P.261

A t i s s u e eq u i v a l e n t com p e n s a to r d e si g ned w i t h t he s a m e t hi c k nes s a s t ha t o f t he m i s s i n g t i s s u e w il l o ve r c o mp e n s a te , i . e . , the d o s e t o t he und e rly i ng t i s s ue s w il l b e le s s t h a n t h a t i n dic a t e d b y t h e s t a nd a rd i s o do s e c ha rt . T hi s de c r e a s e i n d e pt h d o s e , w h i c h i s d u e to t h e r e d u ct io n i n s c a tte r r e a c hi ng a p oi nt at d e pt h, d e pe nd s o n t h e d i s t a n c e o f t h e c o m p e n s a to r f r o m t he p a t ie nt , f i el d s i z e , d e pt h, a nd b e a m q u a l it y . T o co m pe n s a te f o r t h i s d e c re a s e i n s c a t te r , o ne m a y r ed uc e t he t hi c k ne s s o f t h e c o mp e n s a to r to i n c r e a se t he p ri m a r y b e a m t ra ns m i s s io n. T he c o m pe ns a to r t h i c k n e s s s h o u l d b e s u c h t h a t t h e d o s e a t a g i v e n d e p t h i s t he sa m e w he t he r t he m i s s i n g t i s s u e i s re pla c e d w it h t he b ol us in c o nt a c t o r w it h t he c o m pe ns a t o r a t t h e gi v e n d i st a n c e f ro m t h e s k i n s ur f a c e . T he r e q ui re d t hi c k ne s s o f a t i s s ue e q u i v a le n t c o mp e n s a to r a lo n g a r a y di v i de d b y t he m i s si ng ti s s ue t hi c k ne s s a lo ng t h e s a m e r a y m a y b e c a l l ed t h e de ns i t y r at io o r t hi ck ne s s r a ti o (6 9 ) ( h / h i n F i g . 1 2 . 2 2 ) . F ig u r e 1 2 .2 5 P.262 g i v e s a p lo t o f t h i c k ne s s r a t io , , a s a f un c t io n o f c o m p e ns a to r -s ur f a c e d i s t a nc e , d . i s u n i t y a t t h e s u r f a c e a n d d e c r e a s e s a s d i nc r e a s e s .

WWW.MEDRAD.IR

FIG.

12.25.

plot

of

d e n s it y

r a t io

or

t hi c k ne s s

r a ti o
60

as

f unc t i o n

of

c o m p e n s at o r di s t a n c e f o r a u n i f o r m l y t hi c k c o m p e ns a to r .

Co rays, field size =

1 0 1 0 c m , S S D = 8 0 c m , c o m p e ns a ti o n de p t h = 7 c m , a nd t i s s ue d e f i c it = 5 . 0 c m . ( F r o m K h a n F M , M o o r e V C , Bur ns D J . T he c o ns t r uc t io n o f c o m p e ns at o r s f or c o b a lt te le t h e r ap y . R a d i ol og y 1 97 0 ; 96 : 18 7 , w i t h p e r mi s s io n. ) T h i c k n e s s r a t i o d ep en d s , i n a c o m pl e x wa y , o n c o m p e ns a to r -s ur f a c e d i s t a nc e , t h i c k n e s s o f m i s s i n g t i s s u e , f i e ld s i z e , de p t h, a nd b e a m q ua li t y . H o w e v e r , a d e t ai le d st u d y o f t h i s p a r a m et e r ha s s ho w n t ha t i s p r i m a ri l y a func t i o n o f d ( f or d 2 0 c m ) a n d t h a t it s d e pe n d e nc e o n o t he r p a r a m et e r s i s r el a ti v e l y le s s c r it i c al ( 6 9 , 7 4 ) . T h u s a f i x e d v a l u e o f , b a s e d o n a g i v e n d ( us ua l l y 2 0 cm ) , 1 0 1 0 c m f i e l d , 7 - c m d ep t h , a n d a t i s s u e d e f i ci t o f 5 c m c a n b e us e d fo r m o s t c o mp e ns a to r work. The c o n c e pt of t hi ck n e s s r a t io s al s o r ev e a l s t ha t a c o mp e ns a t o r c a nno t be d e s ig n e d t o p ro v i de a b s o r be d d o se co m pens a t i o n e x a c t l y a t al l d e pt hs . If , f o r g i v e n i r r ad i at io n c o nd i ti o n s , i s c ho s e n fo r a ce r t ai n c o mp e nsa t io n d ep t h, t he c o m p e n s at o r o v e r com p e n s a t e s at s ha l low e r d ep t hs a nd unde r c o mp e ns a te s at g r e a te r d e pt h s . C o n s id e r i n g t h e li m it a tio ns o f t he t he o r y a nd too m a ny v a r i ab le s a f f e c t i n g , w e h a v e fo u n d t h a t a n a v e r a ge v a l ue o f 0 . 7 fo r m ay b e us ed f o r a ll i r r a di a ti o n co n d it io n s p r o vi d ed d 2 0 c m. T he s a m e v a l ue ha s b e e n t e st ed to y i e l d s a ti s f a c to r y r e su l t s ( e rr o r s i n de pt h d o s e w i t hi n 5 % ) f or 10-MV x-rays (74). In t h e a c t u a l d e s i g n o f t h e c o m p e ns at o r , the t hi c k ne s s r a t i o i s us e d t o c a l c ul at e c o m p e n s at o r t h i c k n e s s ( t c ) a t a g i ve n p o i nt i n t he f i e ld :
60

C o , 4 - M V a nd

w h e r e T D i s t h e t i s s ue d e fi c it a t t he p oi nt c o ns i d er e d a nd c i s the d e ns it y o f t he c o m p e n s at o r m at e ri a l .

WWW.MEDRAD.IR

A d i r e ct de te r m i n at io n o f t h i c k n e s s ( / c ) for a c o mp e ns a to r s y s tem m a y b e m a d e b y m e a s u r i n g do s e a t a n a p p ro p ri a te d e pt h a nd f ie l d s i z e i n a t is s ue e q ui v al e nt p h a n t o m ( e . g . , p ol y s ty r e n e ) w i t h a s l a b o f c o m p e ns a to r m a te r i al p l a c ed i n t he b e a m at t h e p o si tio n o f t h e co m pe ns a to r t r a y . P i e c e s o f p ha nto m m at e ri a l a re r e m o v ed f r o m t h e su r f a c e u n t i l t he d o se e q ua l s t hat m e a s ur e d i n t he i nt a ct p h a n t o m , w it h o u t t h e c o m pe n s a t or . T he ra t io o f co m pe ns a to r t hi c k ne s s to t he t i s s u e de f i c it g i v e s t h e t h i c k n e s s r a t io . It m a y b e m e n t i o n ed t h a t a t e r m c o mp e nsa t o r r a tio ( C R ) ha s a l s o b e e n us e d i n t h e l it e r at u r e to r el a te t i s s u e de f i ci t to t he r e q ui r ed c o m pe ns a tor t hi c k ne s s ( 7 5 ) . It i s d e f i n ed a s t h e r a t io o f t h e m i s si ng t i s s ue t hi c k ne s s t o the c o m p e ns at or t h i c k n e s s n e c e s s a r y to g i v e t h e d o se f o r a p a r t i c ul ar f i e ld s i z e a nd d e p t h. T he c o n c e p t s o f c o m p e n s at o r r a ti o a nd t he t hi ck ne s s r a t i o a r e t he sa m e , e x c e p t t h at t h e t w o q u a n t it ie s a r e i n v e r s e o f e a c h o t he r, i . e . , C R = T D / t c = c / .

B. Two-dimensional Compensators
D e s ig n i n g a 3 -D c om pe n s a t o r i s a t i me - c o ns um i ng p r o ce d ur e . In a w e l l -e q uip p ed m o ld or machine sh o p , a t r a i ned t e c hni c i a n can p ro b a bl y c o ns t r uc t s uc h c o m p e n s at o r s ro u t i n ely w i t h a r e a s o na b l e ex p e nd i t ure o f t i me . In t he a b s e nc e o f s u c h f a c i l i t ie s a n d p er s o n n e l , h o w e v e r , m os t s i t uat io ns r e q ui ri ng c o m pe ns a t ion c a n b e h a n d l e d s at i s fa c t o ri l y w it h s i m pl e 2- D c o m pe ns a t o r s . In m a ny t r e a t m e nt s i t u a ti o n s , t h e c o nt o ur v a r i e s s i g ni fi c a nt l y i n o nl y o ne d i re c ti o n: a l o ng t he f ie l d w i d t h o r l e n g t h . In su c h c a s e s , a c o mp e ns a t o r c a n b e c o ns t r uct e d i n w hi c h t he t h i c k n e s s v a r ie s o n l y a l o n g t h i s di m e ns io n. F o r e x a mp le , i f a nt e rio r a nd po s t er io r f i e l d s a r e i n c i d e nt o n a s l op i n g me d i a sti num , c o m p e ns at io n i s us ua l l y not c ha ng e d i n t h e l a te r a l di r e ct io n b u t o n l y i n t he c r a ni oc a ud a l d i re c ti o n. O n e s i m p le w a y o f c o n s t r u c t i n g a t w o - dim e ns i o na l co m pe ns a to r i s to us e t hi n s h e e t s o f le a d ( w it h k n o w n t h i c k ne s s r a t i o o r e f f e ct i v e a tt e nua t io n c o e f f i c ie nt ) a n d g l u i n g t h e m t og et h e r i n a s t e p w i s e f a s hi o n t o f o r m a l a m ina t e d f i lt e r . T he t ot a l t h i c k n e s s o f t h e f i l te r at a ny p oi nt i s c a l c ul a te d t o c o mp ens a t e f o r t he a ir g a p at t h e p oi n t b e low i t . A n ot he r m et ho d, us e d ro ut i nel y at the U ni v e r s it y o f M i n n e s o t a , i s t o co n st r u c t t h e co m p e ns at or i n o ne pi e c e f r o m a b lo c k o f L uc i te . T h e p a ti e n t c o nt o u r is t a k e n s h o wi ng bo d y t hi c k ne s s at at l e a st t hr ee r e fe r e nc e p o i nt s : c e n tr a l a xi s , i n f e r i o r m a r gi n, a nd s up e r io r m a r gi n o f the f i e ld . T i s s ue d e f i c it s , t , a r e c a l cu l a t e d b y s ub t r a c ti ng t hi c k ne s s e s a t t he r e f e r e nc e po i nt s f r o m t h e m a x i m u m th i c k n e s s . A t hi c k ne s s m i ni f i c a tio n f a c t o r is c a l c ul a te d b y d i v i di n g t h e P.263 t h i c k n e s s r a t io b y th e e l e ct r o n de ns i t y (e - p e r c m 3 ) o f L uc i te re l a ti v e t o t ha t o f t i s s u e . T h e g eo m et r i c m i n i f i c at io n f a c to r i s c a l c ul at e d b y ( f - d )/ f w he r e f i s t he S S D a t t h e p oi n t o f m a x i m u m t h i c k ne s s and d i s t he fi lt e r - s ur f a c e di s t a nc e . T he c o m p e n s at o r d i me n s i on s c a n n o w b e d r a w n b y m ul t ip l yi ng t he t v a l ue s w i t h the t h i c k n e s s m i n i f i c at io n f a c t o r a n d t he sp a c ing b e t w ee n t he r e fe re nc e p oi nt s w it h t h e g eo m et r i c mi n i f i ca t io n f a c t o r . A L uc i t e b l o c k i s t he n m a c hi ne d a nd g l ue d o n a t h i n L u c it e p l at e fo r p l a c e me n t i n t he b e am . T he s a m e me t hod m a y b e us ed t o c o n s t r u c t a c om p e n sa t o r b y s t a c k i ng L uci t e p l at e s i n a s t epw i s e f a s hi o n a nd a t t a c h i n g t h em t og et h e r f i r m l y w i t h p ie c e s of S c o t c h t a p e .

WWW.MEDRAD.IR

C. Three-dimensional Compensators
Early 3-D c o mp e n s a to r systems w e re m ec ha ni c a l d e v i ce s to m e a s ur e ti s s ue d e f i c it s wi t h i n t h e f iel d i n bo t h t he t ra ns v e r s e a nd t he l o ngi t udi na l bo d y c ro s s s e c t io n s . E x a m p l e s o f t h e s e s y s t e m s i nc l ude E l l i s t yp e f i lt e r s ( 64 , 6 6 ) , r o d b o x es ( 6 8 , 6 9 ) a n d p a n t og ra p h i c de v i c e s ( 72 , 7 3) . M o r e r e ce nt de v i ce s i nc l ude Mo i r c a m e r a , 3 - D m a g n et i c d i gi ti z e r s , C T - b a s ed c o m p e ns at o r p r og r a ms a nd e le c t ro ni c c o m p e n s at io n u s i n g M u l t il e a f c ol li m a to r s ( C ha p t e r 20 ) .

C.1. Moir Camera

A s p e c i al l y d e si g n ed c a m e r a s y s t e m al lo ws t o po g r ap hi c m a pp i ng o f t he p at ie nt b o d y s u r f a c e a n d pr ov i d e s t i s s u e de f i c it da t a ne c e s sa r y f o r t he d e si g n o f a 3 - D c o m p e n s at o r . T h e p rin c i p l e o f o pe r a ti o n of t he c a m er a ha s bee n d i s c us s ed b y B o y e r a n d G o i te i n ( 76 ) . T h e c a m e r a c a n b e m o unt ed o n a s i m ul a t o r w it ho ut i n t e r f e ri n g w it h the s i m u l at o r ' s no r m al us e . M oi r f ri ng e s o b se r v e d on t he p a t ie n t ' s s u r f a c e re p re s e n t i s o - S S D l i ne s f r o m w hi c h t he t i s s ue de f i c it d at a c a n be d e d u c e d . T h e d at a c an b e u s e d to d ri v e a pa nt o g r ap hi c c utt i ng uni t . A c o mm e r ci a l v e r s i o n o f t h i s s y s t em i s m a n u f a c t ur e d b y D C D , S & S P A R S c i e nt i f i c ( Br oo k l y n, NY).

C.2. Magnetic Digitizer

A h a n d h e l d s t y l u s c on t a i n i n g a m a g net i c f i e l d se ns o r i s us e d t o di g it i ze t he p o s it io n o f t h e se n s o r a s it i s s c a nne d o v e r t he pa ti e nt ' s s ur f a c e i n t he p r e se nc e o f a l o w - s t r e n gt h , l o w- f r e q u e n c y m a g ne t i c f i e ld . T i s s ue d e f i ci t d ata a r e c a l c ul a t ed b y t h e c o mp u t e r f rom t h e s e n s o r c oo r dina t e s a nd us e d t o dr i v e a S t y r o fo a m cutter. C a v it ie s c o rre s p o n di n g to t he to t is s ue d es i g n d e f i ci t a are t hen A f i l l ed w it h an a p p r op r i at e ( B r i s t ol , R I) . co m pe n s a t o r m at e ri a l c o m pe ns a to r . c o m m e r c i al ly

a v a i l a bl e s y s te m , k n ow n a s C o m p uf o r m e r i s m a nuf a c t ur e d b y H ue s t i s C o rp o r ati o n

C.3. Computed Tomographybased Compensator Systems

T h r e e - d i me n s i o n al r ad i ot h e r a p y tr e at m e nt p l a nni ng s y s t e m s t ha t us e m ul ti l e ve l C T s c a n s h a v e s u f f i c i e n t d a t a a v a il a bl e to p r o v id e c o mp e ns a ti o n no t o nl y f o r t he i r r e g ul a r s u r f a c e co n to u r s b u t al s o f o r t he t i s s ue i nho m og e nei ti es . T he r e a r e t w o c o m m e r ci a l s y s t em s th a t p ro v i de so f t w a r e f o r t he d e s ig n o f c o mpe ns a t i ng f i lt e r s : the Target (G.E. Medical S y s t em s , M i l w auk e e , W I) a nd t he T he r a c o m p / H E K ( T h e r a t r o n i c s Lt d . , On t a r i o , C a n a d a ) . T he s e s y s t e m s e x t r a ct the t i s s ue d e f i ci t d a t a f r o m t h e C T s c a n s , w h i c h a r e t he n us e d to c ut t he S t y ro f oa m m o ld us i ng a d r i ll bi t o r a h e at e d w i r e l oo p . A lt ho ug h a ny c o m p e ns a t o r ma t e ri a l o f k no w n c o m p e n s at o r ra ti o ma y b e c a s t i nto t he f i l te r mo ld s , i t i s d e s i r ab le to use m e d i u m -d e n s it y m a t er i a l s r a t h e r t ha n he a v i e r m a t e ri a l s s uc h a s C e r r o b e nd . T he m a i n r e a so n f o r t hi s i s to mi n i m i z e e r ro r in d o s e d i st r ib ut io n w he n s m a l l e r r o rs a r e m a d e i n c u t ti n g t he m o ld . T h e r e a r e s e v e r al ot h e r c o m pe n s a to r s y s t em s t ha t ha v e no t be en d i s c us s e d he r e. F o r a d e t ai le d r e vi e w o f t h i s t op i c t he r e a der i s r e f e r r e d t o R ei ns te i n ( 7 7 ) . P.264

D. Compensating Wedges
WWW.MEDRAD.IR

F o r o bl iq u e b e am i nc i d e n c e o r c ur v e d s ur f a c e s f o r w hi c h t he c o nt o ur c a n b e a p p r o xi m a te d convenient with a straight li ne , s t a nda r d w e dg es c o m p e ns at i ng a re w e d ge s are very a ( 69 , 7 0 ) . C o m p e n s a ti ng (C-wedges) f ab r i c a te d f ro m

m e t al s u c h a s c o p p e r , b r a s s , o r l e a d . T he y a r e d e s i g ne d t o c om p e ns a t e f o r a m i s s i n g w e d ge o f t i s s u e , u s i n g t he sam e d e si g n p ri nc i pl e s a s d i s c us s e d i n s e c t io n 1 2 . 4 B . D i s ti n c t io n n e ed s t o be m a de be t w ee n a w ed g e fi lt e r a nd a co m pe ns a t i ng we d ge . A l t h o u g h a w e d g e f il te r c a n b e u s e d e f f e c tiv e l y a s a c o m p e ns a tor , i t i s p ri m a r il y d e s ig n e d to ti lt t h e s t a n d a r d i so do s e c urv e s t hr o ug h a c e r t ain w e d g e a ng le i n c o n j u n c t i o n w i t h t h e w e d g e -p a i r te c hni q ue ( C ha p t e r 1 1 ) . T he w e d g e f i lt e r i so do se c u r v e s m u s t b e a v a i l ab l e a n d u s e d t o ob t ain t he c o m p o si te i so dos e c ur v e s b e f o r e t h e f i lt e r i s u s e d i n a t r e at m e n t se t - up . T he C - w e d g e , o n t he o t he r ha nd , i s us e d j u s t a s a c o m p e n s a tor , s o t h a t t he s t a nd a rd i s od o se c ha r t s c a n b e us e d w i t ho ut m o di f i c a ti o n . In a d d i ti o n , n o w e d g e t r a ns m i s s io n f a c t o r s a r e r equi r e d f o r t he C wedges. A n i m p o rt a n t a d v a n t ag e o f C - w e dg e s o v e r w e d g e f il te r s us e d a s c o m p e ns at o r s i s t h a t t h e C - w e dg e s ca n b e u s e d f o r p a rt ia l f ie l d c o mp e ns a ti o n, t ha t i s , t he C w e d g e i s u s e d t o c om p e n s a t e o nl y a p a r t o f t he co nt o ur , w hi ch i s ir r e g ula r i n s h a p e . A w e dg e fi lt e r , i n t hi s c a s e , c o uld not be us e d a s a c o mp ens a t o r b e c a us e it i s d e s ig n e d to b e p l a ce d i n t h e f i el d i n a f i x e d p o si ti o n.

E. Other Applications
C o m p e n s a ti n g f i lt e r s c a n b e d e s i g ned t o c o m p e ns at e f o r ti s s ue he t e ro g e nei t y . M o s t o f t h i s w o r k w a s d o n e b y E l l i s a nd hi s c o w o r k e r s ( 3 3) i n w hi c h c o m p e ns a t o r s w e r e d e si g n e d f ro m th e k n o w l e d g e o f c r o ss - s e c t io na l a na to m y us i ng t r a ns a x i a l t o mo g r ap h y lungs. C o m p e n s a to r s h a v e a ls o b ee n u s e d t o im p rov e d o s e uni f o r mi t y i n t he f i e ld s w he r e n o n u n i f o r m i t y o f t h e d o s e di s t ri b uti o n a ris e s f r o m so ur c e s o t he r t ha n c o nto ur i r r e g ul a r it y : r ed u c e d s c a tt e r n e a r t he f iel d e d ge s a nd una c c e p t a bl e hi g h d o se r e g io n s o r h o r n s i n t h e b e a m p r o fi le . Le ung e t a l . (7 9 ) ha v e d i s c us s ed t he d e s ig n o f fi lt e r s f o r t he m a n tl e te c hni q ue i n w hi c h t he co m p e ns at or i s d e si g ned o n t h e b a s i s o f c a l c u l at ed d o s e di s t ri b uti o n i n t he a b s e nc e o f a c o mp e ns a t or . Bo g e et a l . ( 8 0 ) h a v e d e s c r ibe d a s pe c i al c om p e nsa t o r f ilt e r t o re d uc e the ho r ns p r e s e nt i n l a r g e f ie l d s o f a 4 - M V l i n e a r a c c e le r a to r . or a p h o to g r a p hi c film. M o re r e c e ntl y , K ha n et al. (78) ha v e d e s c r ib e d co m pe n s a to r s f o r to t al bo d y ir r a d i at io n i nc l ud i ng c o m p e ns at io n f o r

F. Compensator Set-up
A s m e n t io n e d e a r li e r , t h e c o mp e n s a to r s ho ul d be pl a c e d a t a d i sta nc e o f 2 0 cm o r m o r e a w a y f r o m t h e s k i n s u r f a c e t o p re s er v e t he s ki n- s p a r i ng p r o pe r ti e s o f t he m e g a v ol t ag e be a m s . B e c a u s e t he di m e ns io ns o f t he co m pe ns a t o r a re r ed uc ed ( c o m p a re d to t h e b olu s ) i n t h e p l a ne p e r pe nd i c ul a r to t he b e a m a x i s t o a l lo w f o r b e a m di v e r g e n ce , t h e f i l te r m u s t b e pl a c ed a t t he f i lt e r - s ur f a c e dis t a nc e f o r w hi c h i t i s de s ig n e d . In a d di ti o n , t h e no m i nal S S D s ho ul d b e m e a s ur ed f r o m t he p l a ne p e r pe n d i c u l a r t o the beam axis, c o nt a i ning t he most el e v at ed p oi nt on t he c o n t o u r i n c l u d e d i n th e f i e ld ( F ig . 1 2 .2 2 ) . F o r i so c e nt r i c t r e atm e nt s , it i s m o st c o n v e n i e n t t o u s e fie l d d i me n s i o ns p r o jec t e d at t he i so c e nte r i n c o m pe ns a to r

WWW.MEDRAD.IR

d e s ig n . A c c o r di n g l y , th e d e pt h o f t he i s o c ent e r i s m e a s ur ed f r om t he l e v el o f t he m o s t el e v a te d po i nt on t h e c o n t o ur t o be c om p e ns a t ed .

12.7. PATIENT POSITIONING

A v a i l a b il it y of i s o cen t r i c tr e a tm e nt ma chi ne s , s i m ul a to r s , CT s c a nne r s , a nd c o m p u te r s h a s m a d e it p o s si bl e to a c hi e ve a hi g h d e g r ee o f p re c is i o n i n r a di a ti on t h e r a p y . H o w e v e r , o ne o f t h e w e a k e st l i nk s i n t he t re a t me nt - pla nni ng p r o c e s s i s t h e p r ob l em o f p a ti e n t p o s it io n i n g P.265 and i m m o bi li z a t io n . It is f r e q ue nt l y o b se r v e d t ha t s o me of t he t r e a t me nt

t e c h n i q u e s i n c u r r e n t p r a c ti c e a re o ut d ate d o r do not ta k e ad v a nt a g e o f t he a c c u r a c y a v a i l a b l e w it h t h e m o de r n e q uipm e nt . F o r e x a m pl e , t he p a ti e nt s a re t r e at e d i n l e s s t h a n a s t a b le po s it io n, a r e mo v e d be t w ee n d i f f e r e nt f i el d s , a nd s e t up p r i m a r il y by m a rk s inked or t at to oe d on t he skin s ur f a c e . But , as a ny e x p e r ie n c e d o b s e r ve r k n o w s , s u c h p r a c t i ce s a r e p ro ne t o se r io us e r r o r s . S k i n m a r k s a r e v u l n e r a bl e t o v a ri a ti o n i n s k i n s ag a nd bo d y po s it io n on t he t r e at me nt t a b le .

F I G . 1 2 . 2 6 . B i t e bl oc k s y s t e m f o r he ad and ne c k i m m ob il i z a tio n. ( C o ur t e s y o f R a d i a ti o n P r od u c t s D es i g n , B u f f a l o , M N . ) T h e p r o bl e m o f p r e ci se p a ti e n t p o si ti o ni ng a nd i m m ob il i z a ti o n has b e e n a dd r e s s ed b y a n u m b e r o f i n v e st i g ato r s ( 81 , 8 2 , 83 , 8 4, 8 5 , 8 6 ) , i nc l ud i ng a re c e nt re v i e w b y R e i n s t ei n ( 8 7 ) . B u t t h i s p r o bl e m s ti ll r e ma i ns t he a r e a o f g r ea t e s t v a r i a nc e i n a c t u a l t re a tm e n t . T h e f o ll o wi n g i de a s a re p r e s e nte d t o f o c us a t t e nt io n o n t hi s i m po r t a n t a re a a n d o f f e r s o m e g u id e li ne s f or p r e c i se p a ti e nt po s iti o ni ng .

A. General Guidelines

T r e a t m e nt s s h o u l d be s e t up i s o c e nt r i c all y . T he p r i nc i p a l a d va nt a g e o f i s o c e nt r i c t e c h n i q ue o v e r S S D t e c hni q ue is t ha t t he p at ie nt i s no t mo v e d b e t w ee n f i e ld s . O n c e t h e i s o c e nte r i s pos i ti o ne d a c c ur a te l y w i t hi n t he

WWW.MEDRAD.IR

p a t ie n t , t h e re m a i ni n g f i el d s a r e a r r a ng ed s i m pl y b y g a nt r y r ot a ti o n o r c o u c h m o v e m e n t , n o t b y d i s p la c i ng t he p at ie nt r e l at i v e t o t he co uc h.

Is o c e n t e r

po s it io n

within

t he

p at ie nt

can

be

e s t ab li s he d

us i ng

t he

t r e at m e n t si m u l at o r . T h i s i s us ua l l y a c c omp l i s hed b y a nte r io r and l a te r a l r a d io g r a p h s , u s i n g th e r a d i og r a p hi c al l y v i s i bl e s t r uct ur e s t o d e f i ne t he t a r g et v o l u me .

T o a c c u r a t e l y d e fi n e th e p a t i e nt ' s p o si ti o n, t hi c k p a d s o r m a tt r e ss e s s ho ul d n o t b e u s e d o n t h e s im u l a t o r t a bl e o r t he tr e a t me nt t a bl e . T hi s is e s s e nt i al f o r a c c u r a t e m e a s u r em e n t o f s e t - up p a ra me t e r s a s w e ll a s r e p rod uc i b il it y .

F o r h e a d a n d n e c k t r e a t me nt s , f l e x i bl e he a d r e s t s , s uc h a s p i ll o w s or s p o n g e s , s ho u l d b e av o i de d . T he he ad s houl d r e st o n a r ig id s ur f a c e s uc h a s a b l o c k o f h a r d S t y r o f o a m o r a pl a s ti c he a d - ne c k s up p o r t ( Fig . 1 2 . 2 6 ) .

M a n y m e t h o d s o f h e ad i m mo b il i z at io n a r e a v a i l a bl e s uc h a s p a r t i al b od y c a s t s ( 85 ) , bi te b lo c k s y s t e m ( 8 8 ) , 5 no s e br i d ge s , 5 he ad c l am p s , 5 o r si m ple m a s k i n g t a pe . C h o i c e o f a n y o f t he a bo v e w il l de pe nd o n t he lo c a tio n o f t he t r e at m e n t f ie l d s .

A s f a r a s po s s ib le , t he p at ie nt s ho ul d b e t re a t ed i n t he s up i ne po s it io n. A n overhead P.266

s a g i tt a l l a s e r l i n e i s us e f u l i n a l i g ni ng t he s a g i tt a l a x i s o f t he p ati e nt w it h t h e a x i s o f g a n t r y r o ta t io n .

For

head

and

neck

t r e at m e nt s ,

t he

c hi n

e x t e ns io n

s ho ul d

be

d e f i ned

a n a t o m i c al l y , f o r e x a m p l e , di s t a nc e b et w e en t he s t e r na l no t c h a n d t he c hi n b o n e . T h i s m e a s u r e me n t s ho ul d be a c c ur a te l y m a d e a f te r t he hea d p o si ti o n h a s b e e n e s t a bl i s h ed o n t h e b a s i s o f s t ab il it y a nd f i e l d lo c a li z a ti on.

D u r i n g s i m u l at io n a s w e l l a s t re a tm e nt , t he d e pt h o f i so c e nte r s ho ul d b e defined by ei t h e r th e s e t - up SSD ( us ua l l y m e a s ur e d a nte r io r l y or p o s te r io rl y ) o r b y s ett i n g t he d i st a nc e be tw e e n t he t a bl et op di st a nc e a nd l a t er a l be a m a x i s . S id e l a s er l ig ht s m a y a l s o be us e d f o r t hi s pur p o s e . In t h e l att e r c a se , t h e l as e r li g ht s s ho ul d be che c k e d f r e q ue nt l y f o r a l i g nme nt a c c u r a c y , b e c a u s e t h es e li g ht s a re k no w n to d ri f t p r e s um a bl y b y e x p a ns i o n a n d c o n t r a c ti o n o f t h e w a l l s o n w hi c h t he y a r e m o unt e d .

S k i n m a r k s s h o u l d n o t b e re li e d o n f o r d ail y l o c al i z a tio n o f t he t r e at m e nt field. The f ie l d b o un d a r i e s s ho uld be d e f i ne d re l at i v e to t he b o ny l a n d m a r k s e s t a bl i s h ed d u r i ng s i m ul a ti o n. Do no t f o r c e t he f i el d t o f it t he skin marks!

F o r l at e r al po rt a l s , t h e M y l a r s e ct io n o f t he c o uc h o r t e nni s ra ck e t s ho uld b e r e mo v e d a n d t h e p a t ie nt pl a c e d o n a s o li d s ur f a c e t o a v oi d s a g . T he s e s h o u l d be u s e d o n l y f o r a nt er o po st e r io r ( A P ) t r e at m e nt s fo r w hi c h s k i n s p a r i n g i s to b e a c h iev e d . F o r e x a m p le , i f the f o ur - f i e l d pe l v i s t ec hni q ue i s u s e d , o n e c a n u s e t w o f i e ld s a d a y i n w hi c h c a s e A P t r e a t m e nt s a r e g i v e n i s o c e nt r i c al l y o n a M y l a r w i ndo w us i ng a nt e ri o r o r po s te r io r set - up S S D ,

WWW.MEDRAD.IR

a n d l a t e r al f i e ld s a r e t r e at e d o n a f l a t t a b le t op s e c ti o n us i ng t he t a b le to p d i s t a n c e t o l a te r a l b ea m a x i s . O r i f f o ur f i e l d s a re t re a te d t he s a m e d a y , t h e po s te r io r fi e ld c a n b e t r e at ed t hr o ug h the r i gi d Pl e x ig l a s s e cti o n o f t he c o u c h i n s t e a d o f t h e M y l a r w i nd o w . O r A P t r e at m e nt s c a n b e gi ve n o n t he M y l a r w i n d o w a n d t h en t h e w i nd o w ca n b e re p l a ce d b y t he P l e x ig la s s e c ti o n f o r t h e l a te r a l t re a t me n t s . T he l a st a lt e r nat i v e i nv o l v e s t w o s e pa r a t e se t u p s , o n e f o r t h e A P an d t he o t he r f o r t he la t e r al f ie l d s . It s ho uld b e us e d o n l y w h e n s k i n d o se f r o m t he minimum. po s te r io r f i e ld s i s to b e re duc e d to a

F o r i so c e n tr i c t e c h n iq u e s , f i el d si z e s m us t be de f i ne d at t he i s o ce nt e r w h i c h w i l l , i n m o st c as e s , b e a t t he c e nte r o f t he t re a t me nt v ol um e a nd n o t o n t h e s ki n s u r f a c e . P h y s i c i a ns w ho a r e a c cus t o m ed to us i ng s t a nd a r d f ie ld sizes (e.g., pe l v i c f i e ld s ) de f i ne d at t he skin s ur f a c e s ho ul d m a ke a d j u s t m e n t s i n f ie ld si z e s s o t ha t t he fi el d s e nc o m p a s s t he s am e i r r a di a te d volume.

S o m e i n s t it u ti o n s h av e d e v el op e d el a bo ra t e c a st i ng te c hni q ue s to i m m ob il i z e p a t ie n t s d u ri n g t re a tm e n t s . T h i s r e q uir e s a w e l l -e q ui pp ed m ol d r o o m a s we ll a s p e r s o n n el t r a i n ed i n m o ld t e c h n o lo g y . S o me o f t he s e te c hni q ue s ha v e b e e n s ho w n t o b e q u it e e f f e ct i v e in m i n i m i z i n g p a ti e nt m o ti o n ( 8 5 , 87 ) . H o w ev e r , p a t i e nt s a r e k n o w n t o m o v e w it h in a c a s t e s p e ci a ll y i f t he f i t i s no t go od o r i f t he re i s a c h a n g e i n t h e s u r f a c e s c o n t o u r d ue to r e g res s i o n o f t he t um or o r w e i g ht lo s s . D e te c ti o n o f p at i e nt m o ti o n i s po s s ib le b y us i ng s m a l l d ot s o f re f l e ct i v e t ap e o n t h e p a ti e n t w it h a p e n c i l l ig h t r a y a nd p ho t o c el l de v i c e . L a se r lo c a li z a t io n l ig h t s c a n a l s o b e u s e d f o r t h i s p u rp o s e . T he si gna l r e ce i v e d f r o m t he p hot o c el l c a n be f u r t h e r p r o ce s s e d to a c t i v at e a n i nt e rl o ck t o i nt e rr up t t r e at me nt o r s o und a n a l a r m i f pe r ti n e n t mot io n e x c e e d s a p r e se t l i mi t . T hus a g oo d m o ti o n de te c ti o n s y s t e m c a n c o m p le me n t p a ti e n t po s it io ning a nd i m m o bi li z a t ion t e c hni q ue s b y m o n i to r i n g the st a bil it y of p at ie nt po s it io n as w e ll as t he e f f e c t i v e ne s s of i m m ob il i z a ti o n .

B. The XYZ Method of Isocenter Set-up

In t h e i s o c e n t r i c te c h n i q u e , t h e i s o ce nt e r is p l a c e d i ns i d e t he pa t i e nt , us ua l l y a t t h e c e n t e r o f t h e t a rge t v ol u m e . O nc e t hi s p o i nt ha s b e e n lo c a li z e d b y s i m ul at io n, a g oo d t r e at m e n t se t -u p s h o u l d r ep r od uc e it q ui c k l y a nd a c c ur at el y . T he f o l lo w i ng s t e p s o u tl i n e a p r o ced u r e , h e r e b y c al l ed the X Y Z m e t ho d , f o r the l o c al i z a tio n o f t h i s i m po rt a n t p oi n t . P.267

B.1. Simulation Procedure

T h e p a t i e n t i s po s itio n e d o n t he s i m ul ato r c o uc h f o l l o wi ng the g e ne r a l g u i d el i n e s di s c u s s e d in s e c t i o n 1 2 .7 A . T h e p a t i e nt i s le v e led u s i ng t he s i de l a s er s ( o r a b ub b le l e v el) a nd t he s a g i tt a l l a s er b e a m to d e f i ne t he s a g itt a l a xi s o f t he p a ti e nt . T he p a t ie nt i s t h e n c o n s t r ai n e d f r om m o v em e nt b y a s uit a b le i m mo b il i z at io n d e v i c e . F o r

WWW.MEDRAD.IR

h e a d a n d n e c k p o s i t ion i n g , c hi n e x t e ns i o n ( d i s t a nc e be t w ee n c hi n b o ne a nd t h e s t e r n a l n ot c h ) s h o u l d b e a c c ur a t el y m e as ur e d .

T h e t r e a tm e n t f ie ld s a r e s i m ul at ed us i ng ant e r io r a nd l at e r al r ad i og r a p hs a n d t h e i s o c e nt e r i s es t a b li s he d a c co r di ng to t he t re a t me nt p l a n. A r e f e r e n c e a n a t o mi c p o i n t i s c ho se n o n t he s a g i tt a l a x i s , s o me w he r e i n t h e n e i g h bo r h o od o f t h e t r e at m e nt a r e a , to r e p re s e nt a s t ab l e a na t o m i c l a n d m a r k . F o r e x a m p le , n a s i o n f o r he ad a nd ne c k , s t e r na l no t c h f o r ne c k a n d t h o r a x , t i p o f x i p h o i d f o r t ho r a x a nd a b d o m e n, a nd b o tt om o f p ub i c r a m u s o r t ip o f c o c cy x f o r p e l v i s , c a n b e c ho s e n a s r e a s o nab l y s t a ble r e f e r e n c e po i n t s .

T h e c o o r di n a t e s o f t h e t r e at m e nt i s o ce nt e r a r e r e p r e se nt ed b y ( X , Y , Z ) w h e r e X i s t h e l a t er al di s t a nc e a nd Y i s the l o ngi t udi na l d i st a nc e ( a lo ng p a t ie n t a x i s ) o f t h e i so c e n te r f r o m t he r e f e re nc e p o i nt a nd Z i s t h e t a b le top t o i so c e n te r d i st a n c e ( F i g . 1 2 . 27 ) . Be a m a ng l e i s re c o rd e d .

B.2. Treatment Set-up

P o s i tio n a n d l e v e l t h e p a t ie nt o n t he t re a tme nt c o uc h a s i n s i m ul a t io n. W i t h t h e g a n t r y v e r tic a l , p l a c e t he c e nt r al a x i s a t t he r e f e r e nce a na t o mi c p o i nt a n d m a r k i t w i t h i n k . M o v e t h e c o u c h : u p o r do w n t o ob t ai n Z us i ng t he si de l a s e r; l a te r a ll y through X and P.268

l o n gi t u di n a l l y t h r o u g h d i st a nc e Y . R ot a te t he g a nt r y t hr o ug h a ng le . T his g i v e s t h e r eq u i r ed c e n t r a l a x i s o f t he f ie ld a nd t he i s o c e nt e r lo c a tio n.

WWW.MEDRAD.IR

F I G . 1 2 . 2 7 . A d i a g r am t o il l us t r at e X , Y , Z c o o r di na t e s t o a p at ie nt s e t - up .

Make

secondary

c h ec k s

a c c o r d i ng

to

t he

f i el d

di a g r am

s uc h

as

SSD,

l o c at io n o f f i e l d b o rd er s , e t c . F o r is o c e nt r i c s et - u p , o t h er f ie l d s a r e po si ti o ne d b y si m pl y r ota t i ng t he g a n t r y a n d p o s it io n i n g i t a t p re d et e r mi ne d ang l e s . O n e p ot e nt i al a d v a n t ag e o f t h i s me t hod i s tha t t he s et - up p ar a m et e r s X , Y , Z , a nd c o u ld be co m p ute r c o nt r ol le d , t he r eb y d e c re a s i ng t he s e t - up t im e a nd m i n i m i zi n g h u m a n e r r o r s . T h e t h e r a p i st , i n t hi s c a s e , w i l l p o si tio n t he p a t ie nt a s u s u a l a n d p l a c e t h e c e n t r a l a x i s v e rt i c al l y a t t he r e f e re nc e p oint . T he n, w i t h a s w i t c h o n t h e h a n d p e n d a n t , t h e c o m p ute r c o nt r o l co ul d b e i nitia t e d to m o v e t he c o u c h a n d t h e g a n t r y t o t h e X , Y , Z , a nd c o o r di na t e s . S uc h a m e t hod c o ul d be a d o pt ed b y s o m e o f t he e x i s ti n g t r e at m e nt m o ni to r i ng s y s te m s t ha t a r e c a p a bl e o f moving the couch and the gantry.

WWW.MEDRAD.IR

E v e n m a n u a l l y , t h e X Y Z m e t h o d c a n g r e atl y e c o no mi z e s et - up t i me a s w e l l a s e n h a n c e s e t - u p p r e cis i o n . M o s t m o de r n c ouc he s a r e m o to r d ri ve n a nd e q ui pp e d w i t h m oti o n - s e n s i n g de v i c e s . Vi d eo g r ap hi c d i s pl a y o f t he c o uc h m o ti o ns co ul d be c o n v e n i e n t l y u s ed to p o s it io n t he co uc h. A r e s e t s w it c h f o r t he X , Y , a nd Z c o o rd i n a te s w o u l d ma k e i t e a s ie r t o mo v e t he c o uc h t hr o ug h t he X , Y , a nd Z distances.

REFERENCES
1 . K u i s k H . C o n t o u r m a k e r e li m i nat i ng b o d y c a st i ng i n r a di ot he r a p y pl a nni ng . R a d i ol og y 1 97 1 ; 10 1 :20 3 . 2 . C l a r k e H C . A c o n to u r i n g d e v i ce f o r us e i n r ad i at io n t re a t ment p la nni ng . Br J R a d i ol 1 96 9 ;4 2 : 85 8 . 3 . C l a y t o n C , T h o m p so n D . A n o p t i c al a pp ar a t us f o r r e p ro d uc i ng s ur f a c e o ut l i ne s o f b o d y c r o s s - se c ti o n s. B r J R a d i o l 1 9 70 ; 43 :4 8 9 . 4 . C a r s o n P L , W e n z el W W , A v e r y P , e t al . Ul t r a so und i m ag i ng a s a n a i d t o ca nc e r t h e r a p y p a rt I. I n t J R a d i at O n c o l Bi ol P hy s 1 9 75 ; 1 : 11 9 . P a rt II. I nt J R a d i at O n c o l B i ol P h y s 1 9 7 6 ;2 : 3 35 . 5 . T a k a h a s h i S , M a t s u d a T . A x i a l t r a ns v er s e l a mi no g r ap hy a p p l ie d t o ro ta ti o n t h e r a p y . R a d io lo g y 1 96 0 ; 74 : 6 1 . 6. Pierquin B. La t o mo g r ap hi e tr a ns v e r s a l e : t e c hni q ue de r o uti ne en r a d io t h e r ap i e . J R a d iol E l e c t ro l 1 9 61 ; 42 : 1 31 . 7 . B r o o k s R A , D i C h i r o G . P r i n c i pl e s o f com p ut e r a s si s t ed to m og r a p hy ( C A T ) i n r a d io g r a p h i c a n d r a dio i so to pi c i m a gi ng . P hy s M e d Bi o l 19 76 ; 2 1 :68 9 . 8. 9. Rutherford K i je w s k i RA, Pullan BR, Is he r w o o d T he us e I. of M e a s ur e m e nt c o mp ut ed of e f f e c ti v e at o mi c for n u m b e r a n d e l e c tr o n d e n s i t y u s i n g a n E M I s c a nne r . N e ur o r a d i ol og y 1 9 76 ; 1 1 :1 5 . PK, B j r n g a r d BE. t o mog r a p hy data r a d io t h e r ap y d o s e c alc u l a t io n s . I nt J R a d i a t O nc o l Bi o l P hy s 1 9 78; 4 : 4 29 . 1 0 . M u n z e n r i d e r J E , P i l ep i c h M , F e r r e ro J BR , e t a l . U s e o f bo d y s c a nne r s i n r a d io t h e r ap y t r e at m e nt p l a n n i n g . C a nc e r 1 97 7 ; 40 : 1 70 . 1 1 . G e i se R A , M c C u l l o u g h E C . T he us e o f C T s c a n ne r s i n m e g a v o l t ag e p hot o nb e a m t h e r ap y p l a n n i n g . R a d i ol og y 1 9 77 ; 124 : 1 33 . 12. Sontag MR, B a tt i st a JJ, Br o ns k i l l MJ , et al. Im p li c a ti o ns of c o m p ute d t o mo g r ap h y f o r i n h o m o g e n ei t y c o r re c ti o ns i n p ho to n b e am do s e c al c ul at io ns . R a d i ol og y 1 97 7 ; 12 4 :14 3 . 1 3 . C h e r n a k E S , A n t u n e z R A , J e l d e n G L , e t a l . T he us e o f c o m put e d to mo g r a p hy f o r r a d i at io n t h e r a p y tr e a t me n t p l a nni ng . R ad i ol og y 1 97 5 ; 11 7 :6 1 3. 1 4 . S te r n i c k E S , L a ne F W , C u r r a n B. C o mp a r i so n o f co m p ut e d t o mo g r ap hy a nd c o n v e n t i o n al t r a n s v e rs e a x i a l to mo g r a p hy i n r a d i ot he r a p y t rea t m e nt pl a nni n g . R a d i ol og y 1 97 7 ; 12 4 :83 5 . 1 5 . F u ll e rt o n GD , S ew c h a n d W , P a y ne J T , e t a l . C T d et e rm i na tio n o f p a r a m et e r s f o r i n h o m og e n ei t y c or r e c ti o n s i n r a di at io n t he r a p y o f t he e so pha g us . R a d i o lo gy 1 9 78 ; 1 24 : 16 7 . 16. Parker RP, Hobday PA, Cassell for KJ. T he direct us e of CT num b e r s Med in Bi o l r a d io t h e r ap y 1 9 79 ; 2 4 :8 02 . d o s a ge c a l c u l a t io n s i nho m o ge ne o us m e di a . P hy s

WWW.MEDRAD.IR

1 7 . H ob d a y P , Ho d son N J , H u s b a nd J , et a l . C o mp ut e d to mo g ra p hy a p p li ed t o r a d io t h e r ap y 1 9 79 ; 1 33 : 47 7 . 18. Ragan DP, P e rez CA. Efficacy of C T - a s s i s t ed t w o - di m e ns i o na l t re a t me nt p l a n n i n g : a n a l y s i s o f 4 5 p a ti e n t s . A m J R o ent g e nol 1 97 8 ; 13 1 :7 5 . 1 9 . G oi te i n M . T h e u t i li t y o f c o m p ut e d t o mo g r ap hy i n r a d i ati o n t he r ap y : a n e s t im a te o f o u t co m e . I n t J R a d i a t O nc ol Bi ol P hy s 1 9 7 9 ; 5 : 17 9 9 . P.269 t r e at me n t p l a n ni ng : t e chni q ue s a nd r e s ul t s . R a di ol og y

2 0 . G o it ei n M . C o m p u t e d to mo g r ap hy i n p l a nni ng r a d i a t io n t he ra p y . I nt J R a d i a t O n c o l B i ol P h y s 1 9 7 9 ;5 : 4 45 . 2 1 . S o n ta g M R , C u n n i n g h a m J R . T he e q ui v al e nt t i s s ue -a i r r a ti o me t ho d f o r m a k i ng a b s o r be d do s e c a l c ul at io n s i n a h e t e r o ge ne ous m e d i um . R a d i ol og y 1 9 7 8 ;1 29 : 7 87 . 2 2 . H o g s t ro m K R , M i ll s M D , A l m o nd P R . E l e c t ro n b e a m d o se c a lc ul a t io ns . P hy s M e d B i ol 1 9 81 ; 26 : 44 5. 2 3 . C a s s e l l K J , H o b d ay P A , P a r k e r R P . T he i m p l em e nt at io n o f a g e ne r a li z e d Ba t ho i n h o m o ge n e it y c o r r ec t io n for r a d i ot he r ap y p l a nni ng with d ir e c t us e of CT n u m b e r s . P h y s M e d B i o l 19 8 1 ;2 6 :8 2 5 . 2 4 . L i n g C C , R o g e r s C C , M o r t o n R J , e d s . C o m p ut e d to m og r ap hy i n r a d i a t io n therapy. New York: Raven Press, 1983. 2 5 . C a r s o n PL , W e n z el W W , H e n d ee W R . Ult r a s o und i m a gi ng a s a n a i d t o c a nc e r t h e r a p y I. I n t J R a d ia t O n c o l B i ol P hy s 1 9 75 ; 1 : 11 9 . 2 6 . C a r s o n P L , W e n z e l W W , A v e r y P , e t a l . U l t r a so und i m a gi ng a s a n a i d to c a nc e r t h e r a p y II. I n t J R a d i a t O n c o l B i ol P hy s 1 9 76 ; 1 : 33 5 . 2 7 . G r ee n D , Ne l so n K A , G i b b R . T he us e o f a l i ne a r a c c el e r at or s i m ul a to r i n r a d io t h e r ap y . B r J R a d i ol 1 9 64 ; 37 : 39 4 . 2 8 . O v a d i a J , K a r z ma r k C J , H e nd r i c k s o n F R . R a d i a ti o n t he r a py s i m ul a ti o n a nd t r a n s v e r s e t o mo g r ap h y : a p p a r a t us b i bl io gra p hy a nd t um o r l o c al iz a t i o n . H o us to n: A m e r i c a n A s s o c i at io n o f P h y s i c i s t s i n M e d i cine R a d i ol og i c al P hy s i c s C e nt e r , 1 9 71 . 2 9 . K a r z m a r k C J , R u s t D C . R a d i ot he r a p y s i m ul a to r s a nd a ut o ma t io n. R a d i ol og y 1 9 72 ; 1 05 : 15 7 . 3 0 . B o m f o r d C K , C r a i g L M , H a n n a F A , e t a l . T r e a t m e nt s i m ul at o rs . R e p o r t no . 1 0. L o n d o n : B r it i s h In s t i tu t e o f R a d io lo g y , 1 9 76 . 3 1 . M c C u l l o u g h E C , E a r l J D . T h e s e l e ct io n, a c c e p t a nc e t e st i ng , and q ua l i t y c o nt rol o f r a d io t h e r ap y t r e a tm e n t s i m u l at o r s . R a dio lo g y 1 97 9 ;1 3 1 :2 21 . 3 2 . D ro e ge R T , B j r ng a r d B E . M e t al s c r een- f i l m d et e ct or M T F at m eg a v o lt a ge x r a y e n e r g i e s . M e d P h y s 1 9 7 9 ;6 : 51 5 . 3 3 . E l li s F , L e s c r e ni e r C . C o m b i n e d c o mp e ns a t io n f o r c o nto ur s a nd he t e ro ge ne it y . R a d i ol og y 1 97 3 ; 10 6 :19 1 . 3 4 . B a i l y N A , H o r n R A , K a m p p T D . F l uor o s c op i c v i s ua li z a ti o n o f m e g a v ol t ag e t h e r a p e ut i c x - r a y b e am s . I n t J R a d i a t O nc ol Bi o l P hy s 1 9 8 0 ;6 : 9 35. 35. Le o n g J. U se of d ig it a l f l uo ro s c op y a s an o n- li ne v e ri f i ca t io n d e vi c e in r a d i at io n t h e r a p y . P h y s M e d B i o l 19 86 ; 3 1 :98 5 . 3 6 . S h a l e v S , L e e T , L e s z c z y n s k i K , e t a l. V i d e o t e c hni q ue s for o n- l i ne p o rt a l i m a gi n g . C o m p u t M e d I m a gi n g G r a p h 1 9 89 ;1 3 : 21 7 .

WWW.MEDRAD.IR

37.

V i s se r

AG,

Huizenga

H,

A l t ho f

VGM,

et

al.

P er f o r m a nc e

of

p r ot ot y pe

f l u o r o s co p i c i m a gi n g s y s t e m . I n t J R a d i at O nc o l Bi ol P hy s 1 9 9 0 ; 18 : 4 3 . 3 8 . W o n g J W , B i n n s W R , C h e n g A Y , e t a l . O n- l i ne r ad io t he r ap y i m a gi ng w it h a n a r r a y o f f i b e r - op ti c i ma g e r e d u c e r s . I nt J R a d i a t O nc ol Bi ol P hy s 1 9 9 0 ;1 8 : 14 77 . 3 9 . V a n H e r k M , M e e r t e n s H . A m a t r i x i o ni za t io n c ha m b e r i m a g i ng d e v i c e f o r o nl i n e p at ie n t s e t u p v e ri f i c a ti o n d u r i ng r a di othe r a p y . R a d i ot he r O nc o l 19 8 8 ;1 1 :3 6 9 . 4 0 . M e e r te n s H , V a n H e r k M , B i j h o l d J , e t al . F i r s t c li ni c a l e x pe r ienc e w i t h a ne w l y d e v e lo pe d e le c t ro n i c p o rt a l i m ag i ng d ev i c e . I nt J R a di a t O nc o l Bio l P hy s 1 9 90 ; 1 8 :1 17 3 . 4 1 . B o y e r AL , A n t n u k L , F e n s t er A , et a l . A r e v i e w o f e le c t ro nic p o rt a l i m ag i ng d e v i c e s ( E P ID s ) . M e d P h y s 1 9 9 2 ; 1 9 :1 . 42. In t e r n a t io n a l C om m i s s io n on R a d i at io n U ni t s a nd M e a s ur e m e nt s ( IC R U ) . D e te r m i n at io n o f ab so r b ed d o s e i n a p at ient i r r ad i at e d b y b e a ms o f x o r g a m m a r a y s i n r a d iot h e r a p y p r o c ed u r e s . R ep o rt No . 2 4 . W a s hi ng to n, DC : U ni t ed S t at e s N a t io n a l B u r e a u o f S t a n d a r d s , 1 9 76 . 4 3 . B a t h o H F . L u n g c o r r e ct io n s i n c ob a lt 6 0 be a m t her a p y . J C a n A s s n R a d i o l 1 9 64 ; 1 5 :7 9 . 44. Young MEJ, Gaylord JD. E x p e ri me nt a l t e st s of c or r e cti o ns for t i s s ue i n h o m o ge n e it ie s i n r a d i ot h e r a p y . Br J R a d i ol 1 9 70 ; 43 : 3 49 . 4 5 . S o n t ag M R , C u n n i n g h a m J R . C o r r e ct ions t o a b so r be d d o se c a l c ul a ti o ns f or t i s s u e i n h o mo ge n e it i es . M e d P h y s 1 9 7 7 ; 4 : 43 1 . 4 6 . C u n n i n g h a m J R . S c a t t er - a i r r at io s . P hy s M e d Bi o l 19 72 ; 1 7 :4 2 . 4 7 . W o n g J W , H e n k elm a n R M . A ne w a p p r o a c h t o C T p i x el - b a se d p hoto n d o se c a l c u l a ti o n i n h e t e ro ge n e o u s m e di a . M e d P hy s 1 9 8 3 ;1 0 : 19 9 . 4 8 . K ri p p n e r K , Wo n g J W , H a r m s W B, e t a l . T he us e o f a n ar r a y pr o c e s so r f o r t he d e lt a v o l u m e do s e c om p u t a ti o n a l go r it hm . In: P r o c e e d i ng s o f t he 9 t h i nt e r na t io na l c o n f e r e n c e o n t h e u s e o f c om p ut er s i n r a d i at io n t he r a p y , S che v e ni ng e n, T he N e t h e r la n d s . N o r t h H ol l a n d : T h e N e t he rl a nds , 1 9 8 7 :5 3 3 . 4 9 . M a c k i e T R , S c r i m ge r J W , B a t ti s ta J J . A co nv o l uti o n me t hod o f c a l c ul a ti ng do se f o r 1 5 - M V x - r a y s . M e d P h y s 1 9 8 5 ; 1 2 :1 8 8 . 5 0 . M o h a n R , C h u i C , L i do f s k y L . Di f f e r e nti al pe nc i l be a m d o se com p ut a ti o n mo de l f o r p h o to n s . M e d P h y s 1 9 8 6 ;1 3 :6 4 . 5 1 . G r ee n e D , St e w a rt J R . Is o do s e c ur v e s i n no n- uni f o r m p ha nto m s . Br J R a di ol 1 9 65 ; 3 8 :3 78 . 5 2 . S u n d b lo m I. Do s e p l a n n i n g fo r i rr a d i atio n o f t ho r a x w it h c oba l t i n f i x e d be a m t h e r a p y . A c t a R a d io l 19 6 5 ;3 : 3 42 . P.270

5 3 . T a n g W L , K h a n F M , G e r b i B J . V a l id it y o f l ung c o r re c ti o n a lgo r it hm s . M e d P hy s 1 9 86 ; 1 3 :6 83 . 5 4 . M c Do n a l d S C , K el l e r B E , R ub i n P . M et ho d f o r c al c ul at i ng d o s e w he n l ung t i s s u e li e s i n t h e t r e atm e n t f i el d . M e d P hy s 1 9 76 ; 3 : 21 0 . 55. S p i re s SW. Dos a g e in i r r a di a te d soft ti s s ue a nd b one . Br J R a d i ol 1 9 51 ; 2 4 :3 65 .

WWW.MEDRAD.IR

56.

In t e r n a t io n a l

C om m i s s io n

on

R a d i at io n

U ni t s

a nd

M e a s ur e m e nt s

( IC R U ) .

C l i n i c a l d o si m et r y . R e p o rt N o . 10 d . W a s hi ng to n, D C : U ni t e d St a t e s Bur e a u o f S t a n d a r d s , 1 96 3 . 5 7 . J o h n s H E , C u n n i n g h a m J R . T he p hy s i c s o f r a d io lo g y , 2 nd e d . S p r i ng f i el d , IL: C h a r l e s C T h o m a s , 1 9 6 9 : 45 5 . 5 8 . D a s IJ , K h a n F M . B a c k s c a t t e r d o se p e rt ur b a ti o n a t hi gh a t o mi c num b er i n t e r f a c e s i n m eg a v ol ta g e p h ot o n b e a m s . M ed P hy s 1 9 8 9 ; 1 6 :3 67 . 5 9 . W e r n e r B L , D a s IJ , K h a n F M , e t a l . D o s e p e r t ur b ati o n a t i nter f a c e s i n p ho t o n b e a m s . M e d P h y s 1 9 87 ; 1 4 :5 8 5 . 6 0 . L e u n g P M K , S e a ma n B , R o b i n s o n P . L o w - d e ns i t y i nho m o ge ne ity c o r r e c ti o ns f o r 2 2 - M e V x - r a y t h e r a p y. R a d i o lo g y 19 7 0; 9 4 :44 9 . 6 1 . K o r n el s o n R O , Y ou n g M E J . C h a ng e s i n t he d o s e -p r o fi l e o f a 10 M V x - r a y b e a m w i t h i n a n d b e y o n d lo w d e n s i t y m a te r i al . M e d P hy s 1 9 8 2 ; 9 : 11 4 . 6 2 . E p p E R , Lo u g h e ed M N , M c K a y J W . Io ni z a t io n b ui ld up i n upp er r e s pi r a to r y a i r passages during te le t h e r a p y uni t s with c o b al t 60 r a di a tion. Br J Radiol 1 9 58 ; 3 1 :3 61 . 6 3 . E p p E R , B o y e r A L, D o pp k e K P . U nde r do s i ng o f le s io ns r e s ult i ng f ro m l a c k of e l e ct r o ni c e q u il ib r i u m i n u p p e r r e sp i r at o r y a i r c a v i ti e s i r r a di a te d b y 1 0 M V x - r a y b e a m . I n t J R a d i at O n c o l B io l P h y s 1 9 7 7 ;2 :6 1 3 . 6 4 . E l li s F , H a ll E J , O li v e r R . A c o mp e ns a to r f o r v a r i at io ns i n ti s sue t hi c k ne s s f o r h i g h e n e r g y b e a m . B r J R a d i ol 1 9 59 ; 32 : 42 1 . 6 5 . C o h e n M , B u r n s J E , S e a r R . P hy s i c a l as p e c t s o f co b a lt 6 0 te l et he r a p y us i ng w e d g e f il te r s . II. D o s i m e t ri c c o n s i de r a ti o ns . A c t a R a d i ol 1 96 0 ; 53 :4 8 6 . 6 6 . H a l l E J , O l i ve r R . T h e u s e o f s t a nd a r d i s o do s e d i st r ib ut io ns w i t h hi g h e ne r g y r a d i at io n b e a m s t h e a c c u r a c y o f a c o m p e ns a t o r t e c hni q ue i n c o rr e c ti ng f o r bo d y c o n t o u r s . B r J R a d i ol 1 9 61 ; 3 4 :4 3 . 6 7 . S u n d b l o m I. In d i v i d u a ll y d e s ig ne d f il te rs i n c o b a lt - 60 te l et he ra p y . A c t a R a d i ol T h e r P h y s B i o l 1 96 4 ;2: 1 8 9 . 6 8 . V a n D e G ei j n J . Th e c o n s t r u c ti o n o f i ndi v i d ua li z e d i nte ns i t y m o di f y i ng f i lt e rs i n c o b a lt 6 0 t e le t h e rap y . B r J R a d i o l 1 9 65 ; 38 : 8 65 . 6 9 . K h a n F M , M o o r e V C , B u r n s D J . T he c o ns t r uc t i o n o f co m p e ns a t o r s f o r co b alt t e le t h e r ap y . R a d i ol ogy 1 9 7 0 ; 96 : 18 7 . 70. Sewchand W, Bautro N, Scott RM . Ba s i c data of t i s s ue - eq ui v a le nt c o m p e n s at o r s f o r 4 MV x - r a y s . I n t J R a d i a t O nc o l Bi ol P hy s 1 9 8 0 ;6 : 3 27 . 7 1 . K h a n F M , M o o r e V C , B u r n s D J . A n a p p a r a t us f o r t he c o ns t r uct io n o f i r r eg ul a r s u r f a c e c o m p e n s a to r s f o r u s e i n r a d i ot he r a py . R a d i o lo g y 1 96 8 ;9 0 :5 9 3 . 7 2 . B e c k G G , M c Go n n a g l e W J , S u l li v a n C A . U s e o f S t y r o fo a m b lo ck c ut t e r to ma k e t i s s u e - eq ui v a le n t c o mp e n s a t or s . R a d i olo g y 1 9 71 ; 1 00 : 69 4 . 7 3 . B og e R J , E dl a n d R W , M a t t he s D C . Ti s s ue c om p e ns at o r s f o r me g a v ol t ag e r a d io t h e r ap y f a b r i c ate d f r om h ol lo w e d St y r o f o a m f i ll ed w it h wax. R a d i ol og y 1 9 74 ; 1 11 : 19 3 . 7 4 . K h a n F M , S e w c h a n d W , W i l l i am s o n J F . U np ub l i s he d d at a . 7 5 . H e n d e r so n S D , P u r d y J A , G e r b e r R L , e t a l . Do s i me t r y c o ns i d e r at io ns f o r a L i po w i t z m et a l ti s s u e c o m p e n s at o r s y s te m . I nt J Radiat O nc o l Bi o l P hy s 1 9 87 ; 1 3 :1 10 7 .

WWW.MEDRAD.IR

76.

Boyer

AL,

G oi tei n

M.

S i m ul a t o r

m ount e d

M o i r

to po g r ap hy

camera

for

c o n s t r u c t i n g co m pe n s a t o r f il te r s . M e d P hy s 1 9 80 ; 7 : 19 . 7 7 . R e i n s te i n L E . N ew a p p r o a c h e s to ti s sue c o m p e ns a tio n i n r a d i a tio n o nc o lo g y . In : Purdy JA, ed. Advances in r a d i at ion o nc o l og y p hy s i c s . M e d i c al P hy s i c s M o n o g r a p h N o . 19 . W o o db u r y , N Y : A m e r i c a n I ns t i t ute o f P hy s i c s , Inc . , 1 9 9 2 : 53 5 . 7 8 . K h a n F M , W i l l i a m so n J F , S e w c ha nd W , e t a l . Ba s i c d a t a f o r d os a g e c a l c ul at io n a n d c o m p e n s a ti o n . I n t J R a d i a t O nc o l Bio l Phy s 1 9 8 0 ; 6 :7 4 5 . 79. Le u n g PMK, Van Dyke J, Ro bi ns J. A m et ho d for l a rge i rr e g ul a r f ie ld c o m p e n s at io n . B r J R a d i ol 1 97 4 ;4 7 : 80 5 . 8 0 . B o g e R J , T ol be r t D D , E d l a n d R W . A c c e s s o r y b e am f l a tt e ning f i l te r f o r t he V a r i a n C l i n a c - 4 l i n e a r a c c e l e r ato r . R a d io lo g y 1 9 7 5 ;1 15 : 4 75 . 8 1 . C h u n g - B i n A , K a r t h a P , W a c ht o r T , et a l . D e v el o pm e nt a nd e x p e ri e nc e i n c o m p u te r m o n it o ri n g a n d t h e v e r i f i c a tio n o f d a i l y p a ti e nt t r e at me nt p a r a m et e r s . In : S t e r n i c k E S , e d . P r o c e ed i n g s o f t he 5 th i nt e r na ti o nal co nf e r e nc e o n us e of c o m p u te r s i n r a di a ti on t h e r a p y . H a no v e r , N H : U ni v e r s it y P r e s s o f N e w E ng l a n d, 1 9 76 : 5 51 . 8 2 . H a u s A , M a r k s J . D et e c tio n a nd e v a l ua t io n o f l o c al i z at io n e r r o r s i n p at ie nt r a d i at io n t h e r a p y . I n v e s t R a d iol 1 9 73 ; 8 :3 8 4. 8 3 . K a r t h a P K I, C h u n g - B i n A , W a c ht o r T , e t a l . A c c ur a c y i n p a t i ent s e t - up a nd it s c o n s e q u e nc e i n d o si me t r y . M e d P hy s 1 9 7 5 ;2 : 3 31 . 84. W il li a m so n TJ. Im p r o v i n g t he r ep r od uc i b il it y of l at e r al t he r a p y p o rt al p l a c e me n t . I n t J R a d ia t O n c o l B i ol P hy s 1 9 79 ; 5 : 40 7 . P.271

8 5 . V e r h e y L J , G oi te in M , M c N u l t y P , e t al . P r e c i se p o si ti o ni ng o f p at ie nt s fo r r a d i at io n t h e r a p y . I n t J R a d i a t O n c ol Bi o l P hy s 1 9 8 2 ;8 : 2 89 . 8 6 . H e n d r i c k so n F R . P r e c i s io n i n r ad i at io n onc o l og y . I nt J R ad i at O nc o l Bio l P hy s 1 9 81 ; 8 : 31 1 . 8 7 . R ei n s t ei n L E . P a t ie n t po s it io ni ng a nd im m o bi li z a t io n. In: K ha n F M , P o t i s h R A , e d s . T r e at m e n t p l a n ni n g i n r a di at io n o nc ol og y . Ba l t im o re : W il lia m s & W il k i ns , 1 9 98 : 5 5 88 . 88. Huaskins LA, T h o m s o n R W . P a t i e nt p o s it io ni ng d e vi c e f or e x t e r na l - be a m r a d i at io n t h e r a p y o f th e h e a d a n d ne c k . R a d i ol og y 1 97 3 ; 10 6 :7 0 6.

1 2 3

O l de l f t C o rp o r at io n o f A m e r i c a , F a i r f a x , V i r g i ni a . V a r i a n A s s o c i a te s , P a l o A lt o , C a l i fo r ni a . T h e r a t r o ni c s In t e r n a t io n a l L td . , K a na t a , O nt a r i o , C a na d a . Also, Picker

In t e r n a t i o n al , In c . , S t . D a v i d s , P e nns y l v a ni a .
4

S u c h a s h e e t o f l e a d a c t s a s a n i nt e ns i f y i ng s c r e e n b y m e a ns o f e l e ct r o ns ej e c ted which reflects th e v a r i a t io n of b e am i nt e ns it y t r a ns m i tt e d t hr o ug h t he

f r o m t h e s c r ee n b y ph o t o n i n te r a c tio ns . T h e s e el e ct r o ns p ro v i de a n i m a g e o n t he film p a t ie n t .
5

S u c h d e v i c e s a r e c om m e r c i al l y a v a il a b le , f o r e x a m p l e , f r om R a d i a tio n P r o d uc t s

D e s ig n , In c . , B u f f a l o , M i n n e s o t a a nd M e d - T ec , O r a ng e C i t y , Io w a .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Par t II - C lassical Radiation Therapy > 13 - Treatment Plann ing III: Fie ld Shaping, S kin Dose, and Field Separation

13 Treatment Planning III: Field Shaping, Skin Dose, and Field Separation

S h i e l di n g o f v i t al o r ga n s w i t h i n a r a d i a t io n f i e l d i s o ne o f t he ma j o r c o nc e r ns o f r a d i at io n t h e r a p y . C o n s i d e r a bl e ti m e a nd e f f o r t a r e s pe nt i n s ha p i ng f i e ld s no t o n l y to p r ot e ct c ri ti ca l or g a n s b ut a l so t o a v o i d unne c e s s a r y i rr a d i at io n o f t he s u r r o u n d i n g n o r m al t is s u e . A t te nd a nt t o t hi s p ro bl e m i s it s e f f e c t o n s k i n do se a n d t h e b u i l d u p o f d os e i n t h e s ub c ut a ne o us t i s s ue . S k i n s p a r i ng i s a n i m p o r t a nt p r o pe r t y o f m eg a v ol ta g e p ho to n b e am s , and e v e r y e f f o rt s ho uld b e di r e ct e d to m a i n t a i n i n g t h i s e f f e ct w h e n i r r a d i a ti ng no rm a l s k i n. A n o t h e r p ro b le m f r equ e n t l y e n c o unt e re d i n r a d i at io n t he r a p y i s t he m a t c hi ng o f a d j a c e n t f ie l d s . T h i s s i t u a t io n a r i s e s w he n r a d i a ti o n f i el d s av a i l a bl e w i t h t he e q u i p me n t a r e n o t l a rg e e n o u g h t o e nc o mpa s s t he e nt i r e t a rg et v o l um e . In s o m e c a s e s , t h e t a r g et v ol u m e i s d i v id e d i nto t wo p a r t s so t re a tm e nt t o t he s e co nd p a rt does n ot c o mm e n c e until the tr e at m e nt c o ur s e to t he f i r st part ha s been c o m pl e te d . S u c h a sc h e m e i s de s ig ne d to a v oi d to x i c it y d ue t o i r r ad i at i ng a n e x c e s s i v e v o l u m e o f t i s s u e . M u lt ip le a dj a ce nt f ie l d s a r e a l so us e d w he n t umo r d i s t ri b u tio n o r p a t ie n t a n a t o m y d o e s no t al lo w c o p l a na r f i el d s ( f ie l d s w it h c e nt r a l axes in the of same pl a n e ) . d o se The main p r ob l e m in with t he t he s e t e chni q ue s r e g io n. is t he p o s s ib il it y e x t re me i n h o mo g e nei ty j unc t i o na l Be c a us e

r a d i at io n b e am s a re di v e r g e nt , a d ja c e nt f i eld s c a n o v e r l ap at de pt h a nd gi v e r i se t o re g io n s o f e x c e s si v e d o se o r h ot s po t s . O v e r l a p s c a n b e a vo ide d b y s e pa r a ti ng t h e f i e ld s , b u t t h i s i n t u r n c a n g i v e r i s e t o ar e a s o f r e d uc e d do s e o r c o l d s pot s . T h i s c h a p t e r o n t re a tm e n t pl a n n i ng f o c us es o n t he ab o v e p ro bl em s a nd d i s c us s es t h e i r po s s ib le s o l u ti o ns .

13.1. FIELD BLOCKS

T h e s h a p i n g o f t r e atm e n t f ie ld s i s p ri m a ril y di c t at e d b y t um o r d i s t ri b utio n l o c al e x t e n s io n s a s w e l l as r e g io n a l m et a st a s es . N o t o nl y s ho uld the d o s e t o v it al o r g a n s n ot e x c ee d th e i r to le r a n c e b ut t he do s e t o no r m al ti ss ue , i n g e ne r al , s h o u l d b e mi n i m i z ed. A s l o n g a s t he t ar g e t v ol um e i nc l ude s, w i t h a d e q ua t e margins, the de mo n s t r a te d t u mo r as we l l as i ts p r e s um ed o c c ul t sp r e a d , s i g n i f i c a n t i r r a di a ti o n o f t h e n o r m a l t i s s ue o ut s i de t hi s v o l ume m us t b e a v o id e d a s m u c h a s po s s ib le . T h e s e re s t ri c ti o ns ca n g i v e r i se t o c o mpl e x f ie ld s ha p e s , w h i c h r e q u i r e i n t ri c a te b lo c k i n g . T h e f r e q u e n c y a n d c o m p l e xi t y o f f i el d s ha ping v a r y f r o m i ns t i t utio n t o i ns t it ut io n. H o w e v e r , i f c o mp le x te c h n i q u e s i nv o l vi ng ela b o r at e bl o c ki ng a r e us e d o f te n, i t i s n e c e s s a r y t o e st a bl i s h a r a t i o n a l s y s te m o f f i e ld s ha p i ng .

A. Block Thickness
WWW.MEDRAD.IR

S h i e l di n g bl o c k s a re m o s t c o m mo nl y m a de o f le a d . T he t hi c k ne ss o f le a d re q ui re d t o pr o v id e a de q u a te pr o te c ti o n o f t he s hi el de d a r e a s d e pe nd s o n the b e a m q ua li t y a n d t h e a l lo w e d t r a n sm i s s io n t h r o ug h t he P.273 b l o c k . A p r i m a r y b ea m a c h i e v e t h i s t r a n s mi s si o n , t r a n s m i s s io n o f 5 % t hr o ug h t he b loc k i s c o ns i d e r ed

a c c e p t ab le f o r mo s t cl i n i c al s it u a ti o ns . If n i s t he num b e r o f ha lf - v a l ue l a y e r s t o

or

or

or

T h u s a t h i c k n e s s o f l e a d b et w e e n 4 . 5 a nd 5 . 0 ha l f - v a l ue l a y e r s w o ul d g i v e le s s t h a n 5 % p r i m a r y b e am t r a n s m i s s io n a nd i s , t he r e f o r e , r e co m me nd e d f o r m o st c l i n i c al s h i e ld i n g . S h i e l di n g a g ai n s t p rim a r y r a d i a tio n f o r sup e r f i c i al a nd o rt ho vo lt a g e b e a m s i s r e a d il y a c c o mp li s h e d b y t h i n s h e e t s o f le ad t ha t c a n be pl a c e d o r m ol de d o n to t h e s k i n s u r f a c e . How e v e r , a s t he be a m e ne r g y i nc re a s e s to t he me g a v ol t ag e r a n g e , t h e t h i c k n e s s o f le a d re q ui re d fo r s hi e l di ng i nc r e a s e s sub s t a nt i al l y . T he l e a d b lo c k s a re t he n p l a ce d ab o v e t he pa t i e nt s up po r te d i n t he be a m o n a transparent pl a s ti c tray, c a ll e d t he s ha d o w tray. T a b le 13.1 gives t he r e c o m me n d e d l e a d s h ie l d t hi c k n e s s e s f o r v a r i o us q ua l it y b e a m s . A l t h o u g h t he p ri m a r y b e a m t r a n s mi s s io n ca n b e re d uc e d f ur t her b y us i ng e x t r a t h i c k b l o c k s , t h e r ed u c t io n i n d o s e i n the s hi e l d ed r e gi o n m a y no t b e t ha t s i g n i f i c a n t d u e to t he p r ed o mi n a nc e o f sc a t t er e d r ad i at io n f r om t he a d jo i ni ng o p e n a r e a s o f t h e f ie ld .

B. Block Divergence
Id e a l l y , t h e bl o c k s sh o u l d b e s ha p ed o r ta p e r ed s o t hat t he i r s i d e s f ol lo w t he g e o me t ri c d i v e rg e n c e of the be a m . T hi s m i ni mi z e s t he b lo ck t r a ns m i s si o n p e n u m b r a ( p a rt i al t r an s m i s s i o n o f t he be am a t t he e dg e s o f t he b lo c k ) . H o w e v e r , d i v e r ge n t b lo c k s o f f e r l i tt le a d v a nt a g e f o r be a m s w i t h l a r ge g eo me t ri c p e num b r a . F o r e x a m pl e , i n t h e ca s e o f
60

Co , t he s ha rp ne s s o f t he b e am c ut o f f a t t he bl o ck

e d ge i s no t s ig n i f i c an t l y i mp r o v ed b y using d i v e rg e nt b lo c k s . A l s o , fo r so m e c l i n i c al s it u a t io n s t h is s h a r p n e s s i s no t cr i ti c a l o r w o r t h t he ti m e r eq ui r ed f o r m a k i n g d i v e rg e n t b lo ck s , w h i c h h a v e t o b e inv a r i a b l y c us t o m d e sig ne d f o r a gi v e n t r e at m e n t s et - u p . T h er e f o r e , mo s t i nst it ut ions k e e p a s t o c k o f s t ra i g ht - c ut bl o c k s o f v a r i o u s s h a p e s a n d d i m e n s io n s .

WWW.MEDRAD.IR

TABLE

13.1.

RECOMMENDED

MINIMUM

THICKNESS

OF

LEAD FOR SHIELDING a

Beam Quality

R e q u i r e d L e a d T h i c kn e ss

1.0 mm Al HVL

0.2 mm

2.0 mm Al HVL

0.3 mm

3.0 mm Al HVL

0.4 mm

1.0 mm Cu HVL

1.0 mm

3.0 mm Cu HVL

2.0 mm

4.0 mm Cu HVL

2.5 mm

137

Cs

3.0 cm

60

Co

5.0 cm

4 MV

6.0 cm

6 MV

6.5 cm

10 MV

7.0 cm

25 MV

7.0 cm

A p p ro x i m at e v a l u e s to g i v e 5 % p ri m a r y t ra ns m i s s i o n .

HVL, half-value layer.

P.274

D i v e r ge n t bl o c k s a re m o s t s u it ed f o r b e a m s ha v i ng s m a l l f o c al s po t s . Be c a us e t he sides of t h e se b lo c ks f o l lo w b e am d i ve rg e nc e , o ne can r educ e t he l at e r al

WWW.MEDRAD.IR

d i m e n si o n s b y d e s i g nin g t h e s h i e l d s f o r s ma l l er s o ur c e - to - bl o c k d i s t a nc e s w it ho ut i n c r e a s i n g t h e bl oc k t ra n s m i s s i o n p e num b r a .

13.2. FIELD SHAPING A. Custom Blocking

A l t h o u g h a n u m b e r o f s y s t e m s h a v e b ee n us e d f o r fi e ld s ha p i ng ( 1, 2 , 3 , 4 , 5 , 6 , 7 , 8 ) , t h e o n e i n t ro d u c ed by P o w e r s et al . ( 1 ) i s m o st co m mo nl y us e d i n r a d i at ion t h e r a p y . T h i s s y s t e m u s e s a l o w m el ti ng poi nt a ll o y , Li p o wi t z m et a l ( br a nd na m e , C e r r o be n d ) , w h i c h h a s a d e n s it y o f 9 .4 g /c m 3 a t 2 0 C ( ~ 83 % o f l e ad de ns i t y ) . T h i s m a t e r i al c o n s i sts o f 5 0 . 0 % bi s m ut h, 2 6 . 7 % le a d , 13 . 3 % t i n, a nd 1 0 . 0 % c a d m i u m ( 1 ) . T h e m a in a d v a n t a g e o f C e r r obe nd o v e r l ea d i s t hat it m el t s a t ab o ut 7 0 C ( co m p a re d wi t h 3 2 7 C f o r l e ad ) a nd , t he r e f o re , c a n be e a sil y c a s t i nto a ny s h a p e . A t r o o m t e m per a t u r e , i t i s ha r de r t ha n l e a d . The minimum t hi c k n e s s of C e r ro be nd blo c k s r e q ui re d fo r blo c k i ng may be c a l c u l a te d f ro m T ab l e 1 3 . 1 u s i n g i t s d e nsi ty r a t io re l at i v e to l e ad ( e . g . , m ul ti p ly l e a d t h i c k n e s s b y 1 . 21 ) . In t h e m e g a vo lt ag e r a ng e o f p ho to n be a m s , t he mo st c o m m o n l y u s ed t h i c kn e s s i s 7 . 5 c m , w hi ch i s e q ui v a le nt to a bo ut 6 c m o f p ur e lead. The procedure for constructing C e r ro bend blocks starts w it h a s i m ul a t o r r a d io g r a p h o r a po r t f i l m o n w hi c h t he ra d i ot he r a pi s t d r a w s the o utl i ne o f t he t r e at m e n t f i el d i n d i c at i n g a re a s t o be s hi eld e d . T he f i l m i s t he n us e d to co ns t r uct d i v e r ge n t c a v i ti e s i n a S t y r o f o a m bl o c k t ha t a r e us e d to c a s t Ce r r o be nd b lo c k s . F i g u r e 1 3 . 1 s h o w s a S t y r o f o a m - c ut ti ng de v i c e t ha t c o ns i st s of a n e l e c t ri c a ll y h e a t e d w i r e w h i c h pi v o t s a b o ut a p oi nt s i mul a t i ng t he s o ur c e o r t he x - r a y ta r g et . T h e f i l m , t h e S t y r o f o am b l o c k , a n d t he w i r e a p p a r a t us a r e so a d j us t e d P.275 t h a t t h e a c t u al t re a tm e n t ge o me t r y ( s ame s o ur c e to f il m a nd s o ur c e t o b lo c k d i s t a n c e s ) i s o bt a i n ed. T h e l o w e r e nd o f t he w i r e t r a c e s t he o ut li ne o n t he f i l m .

WWW.MEDRAD.IR

F I G . 1 3 . 1 . P h o t og r ap h o f bl o c k c utt e r . ( C o ur t e s y o f H ue st i s M a c hi ne C o r p . , B r i s t ol , R I. )

WWW.MEDRAD.IR

F I G . 1 3 . 2 . A : C e r r o be n d b l o c k s f o r l ung s hi e ld i ng . B : C us t o m b loc k s f o r he a d a nd neck. If p o s i t i ve b lo c k s su c h a s l u n g b l o c k s a re to be m a de , c a v i ti es a r e c ut i n t he S t y r o f o a m wi t h t h e h e a t e d s e gm e nt o f the w i r e a nd s ub s eq ue nt l y f il le d wi t h m e lt e d C e r r ob e n d . If a n e g a ti v e b lo c k w i t h c e nt r al a re a op en a nd p e r ip he r al a r e a s bl o c k ed i s d e si re d , a n i n n e r c ut i s fi rs t m a de t o o utl i ne t he f i el d o pe ni n g . A n o u t e r r e c ta n g u l a r c u t i s t h e n m ad e to de f i ne t he co ll i m at o r f ie l d w i t h 1 - t o 2 c m m a r g i n . T h e t h r e e S t y r o f o a m p ie c e s t hus m a d e a r e p l a ce d on a L uc i t e p l ate and carefully a l i g ned r e l at i v e to t he ce nt r a l axis. T he i nte r m e di a te p ie c e , c o r r e s po n di n g to t h e a r e a s to be s hi el ded , i s t he n re m o v ed a nd C e r r o be nd i s p o u r e d i n t o t h e c a v i t y. It i s i m p o rt a n t t h a t th e C e r r o b e nd i s po ur e d s l o wl y t o p r e v e nt f o r m a ti o n o f a ir b u b b le s . A l s o , t h e S t yr o f o a m bl o c k s ho ul d be p r e s s ed t ig ht l y a g ains t a r ub b e r p a d a t t h e b ot to m t o a v oid l e a k a ge o f t he li q uid m e ta l . T he i ns id e wa l l s o f t he c a v it y m a y b e s p r a y e d w i t h s i li c o n e f o r e a s y r e lea s e o f t he S t y r o f o a m p i e c e s f r o m t he block.

WWW.MEDRAD.IR

T h e b l o c k s c a n b e m ou n t e d o n a L uc i t e pl a te o r b lo c k i ng t r a y , w hi c h i s p r e m a r k ed w i t h t h e c e nt r a l a xi s c r o s s h a i r s . Blo c k s c a n a l s o be pl a c e d o n a t e mp l at e m ad e o n a c l e a r f i l m b y t r a ci n g t h e o u t li ne o f t he f i e l d at t he s ha d o w t ra y p o s i ti o n w hi l e t h e p o rt f i l m o u t li n e is p l a c e d at t he d i st a nc e a t w hi c h t he r a d i ogr a p h w a s t a k e n. F i g u r e 1 3 .2 s h o w s e x a m p l e s o f C e r r o be nd b l o c k s , o ne co ns t r uc te d f o r s hi el d i ng l u n g s a n d t h e o t h e r f or a h e a d a n d ne c k f i e l d .

B. Independent Jaws
A s y m m e t r i c f i el d s a re s o me ti m e s us e d t o b lo c k o f f a p ar t o f t he f i el d wi t ho ut changing g e n e r a te P.276 j a w s . T h i s f e a t u r e i s v e r y c o n v e ni e nt w he n m a t c hi ng f i el d s o r be a m s pl it ti ng . In t h e l att e r c a se , t h e be a m i s bl o c k ed o f f a t t he c e nt r a l a x i s t o r em o v e d i v e rg e nc e . W h e r e a s h a l f - b e a m blo c k s h a v e b e e n us e d a s b e a m s pl it t er s i n the p a s t , t hi s c a n n o w b e d o n e s i mp l y by m o v i n g i n t he i nd e pe nd e nt j a w s . M o s t mo d er n m a c h i n e s a r e eq u i pp e d wi th i nd e p e nde nt l y mo v a b l e j a w s . S o me m a c h i n e s h a v e o n e in d e p e n d e nt j a w , o t he r s ha v e t wo i nde p end e nt p ai r s , a nd s o m e h a v e a l l f o u r j a w s a s i n d e p e nd e nt . O p e r a ti o na ll y , t he i nd e p e nd e nt j a w o p ti o n i s i n te r lo c k e d t o a v o id e r r o r s i n t he s e t ti ng o f s y m m e t r i c f i e l d s , i n w hi c h c a s e t h e o pp o si te j a w s o p e n o r c lo s e s y m me t ri c a ll y . One of the e f f e ct s o f a s y m m et r i c c ol li ma t io n i s t he c ha ng e in t he p hy s i c al p e n u m b r a ( d e fi n e d i n s e c t io n 1 1 .1 ) a nd t he t il t o f t he i s od o se cur v e s t o w a r d t he b l o c ke d ed g e ( F i g . 13 . 3 ) . T h i s e f f e c t i s s i m p l y t he r e s ult o f b l o c ki ng , w hi c h e l im i n a te s p ho to n a n d el e ct r o n s c at te r f ro m t he bl o c ke d p o rt io n o f t he f ie ld , t h e r e b y r ed u c i n g t h e d o s e n e a r t he ed g e . T he s a m e e f f e c t w o ul d o c c ur o n t he i s o do s e c u r v e s i f t h e b l o c k i n g w e re do ne w i t h a l e a d o r C e r r ob e nd b lo c k o n a tray. the p o si ti on f ie l d of the i so c e nte r . A l t ho ug h b lo c k i ng ca n is be o f te n e a s il y us e d d o ne to by ir r e g u la r s h a pe s , r e ct a ng ul a r bl o c k i ng

i n d e pe n d e n tl y m o v a b le c o ll i m at or s , o r

WWW.MEDRAD.IR

F I G . 1 3 . 3 . C o m p a r i son o f i s o d o se d i st r i b ut io n w i t h ha l f t he b e a m b l o c k ed b y a n i n d e pe n d e n t j a w v e r su s a b l o c k o n a t r a y . N o ti c e c lo s e a g r ee m ent a s w e l l a s t he t il t o f t h e i s o do s e c u rv e s t o w a r d t he bl o c ked e d ge .

WWW.MEDRAD.IR

FIG.

13.4.

Varian

m u l t il e a f

c ol li m a to r :

(top)

at t a c hed

to

a c c e l e r at o r

a nd

( b o tto m ) w i t h a n e n d - o n v i e w . ( C o ur t e s y o f V a r i a n A s s o c i a te s , P a lo A l to , C A . ) P.277

W h e n a s y m m e t r i c f i e ld s a r e u s e d , s p e c i a l c o ns i d er a ti o ns m us t b e g i v e n t o t he b e a m f l a t n e s s a n d t h e d o s i me t ri c p a r a me te r s us e d t o c a l c ul at e m o ni t or uni t s . K h a n e t a l . ( 9 ) h a v e p r o po s e d a s y s t e m o f do s e c a l c ul at io n f o r f i e ld s g e ne r a te d b y a s y m m e t r ic c o ll i m ato rs , w h i c h w a s d i s c us s e d i n C ha p t e r 1 0 .

C. Multileaf Collimators
A m u l t il e a f c ol li m a tor ( M L C ) f o r p hot o n b e a m s co ns i st s o f a l a r ge num b e r o f c o ll i m at i n g b lo c k s o r le a v e s t h at c a n be d r i ve n a ut o m at i c al l y , i nd ep e nd e nt o f e a c h

WWW.MEDRAD.IR

o t h e r , to ge n e r a te a f i e l d o f a n y s ha p e ( Fig . 1 3 .4 ) . T y p i c al ML C s y s t e m s c o ns i st o f 8 0 l e a ve s ( 4 0 p ai r s) o r P.278 m o r e . T h e i n di v i d u al le a f h a s a w i d t h o f 1 cm o r le s s a s p ro j e ct ed a t t he i s o ce nt e r . T h e l e a v e s ar e m ade o f t u n g s t e n al lo y ( = 1 7 . 0 to 18 . 5 g / c m 3 ) a nd ha v e t h i c k n e s s a l o n g t h e be a m d i r e ct io n r a ng i ng f r o m 6 c m t o 7 . 5 c m , d e p e nd i ng o n t h e t y pe o f a c ce l er a to r . T h e l e a f t hi c k ne s s i s s uf f i c i e nt to p ro v id e p ri m a r y x - r a y t r a n s m i s s io n t h r o u g h t h e l e a v e s o f l e s s tha n 2 % ( c o m p a r ed w i t h a b o ut 1 % f o r j a w s a n d 3 . 5 % f o r C e r r o b e n d blo c k s ) . T he i nt e r le a f ( b e t w ee n s i de s ) t r a ns m i s si o n i s u s u a l l y le s s t h a n 3% . T h e p r i m a r y b e a m t r a ns m i s s io n m a y b e f ur t he r m i ni mi z ed b y c o m b i n i n g j a w s w ith t h e M L C i n s hi e l d i ng a r e a s o ut s id e t he M LC f i e l d op e ni ng . S o m e M L C s y s te m s h av e d o u bl e - f o c us ed le av e s , t ha t i s , t he le a v es f o r m a c o ne o f i r r e g ul a r c r o s s - se c ti on d i v e r gi n g from t he s o ur c e p o si ti o n and move on a s p h e r i c a l s h el l c e n te re d a t t h e so ur c e . T he r a t io na l e be hi nd a d oub l e - f o c us ed M L C i s t o p ro v id e a s h a r p b e a m c u t o f f a t t he ed g e . H o w e v e r , f o r hi gh- e ne r g y b e a m s t h i s o b je c ti v e i s a c h i ev e d o n l y t o a l i mi te d e x t e nt , b e c a us e t he do s e f a l lo f f a t t he e d ge i s l a rg e l y d et e rm i n e d b y s c a tt e re d pho t o ns a nd e le c t ro ns . Be c a us e do ub le f o c u s e d M L C s a r e d i f f ic u l t to m a n uf a c t ur e , s o m e s y s te m s ha v e b ee n d e s i g ned w i t h r o u n d e d l ea f e d g e s an d d i r e c ti o n s o f t r a v el p e r pe nd i c ul a r to t he c e nt r a l r a y . T he p u r p o s e o f r o u n d e d e dg e s i s to p r o v id e c o nst a nt b e a m tr a ns m i s s ion t hr o ug h a l e a f e d ge , r e g a r dl e s s o f it s p o s it io n i n t he f i e ld . An i m p o rt a n t co n s i de r a ti o n in t he us e of MLCs for s t at io na r y f i e ld s is t he c o n f o r m it y b et w e e n th e p l a n n e d f ie ld bo und a r y , w hi c h i s c o nt inuo us , a nd t he j a g g ed s te p w i se b o u nd a r y c r e a te d b y t he ML C . T he d e g r ee o f c o nf o r m it y b e t w ee n t h e t w o d ep e n d s n ot on l y o n t h e p ro j e ct ed le a f w i d t h b ut a l so o n t he s ha p e o f t he t a r g et v o l u m e a n d t he a n g l e o f r ot a ti o n of t he c o l li m a to r . O p tim i z a t io n o f M L C r o t at io n a n d s e t ti n g h a s b e e n d i s c us s e d b y Br a hm e ( 1 0 ) . H i s a na l y s i s s ho w s t h a t t h e be s t o r ie n t at io n o f t h e co ll i ma to r i s w he n t he d i re c ti o n of m o ti o n o f t he l e a v e s i s p ar a ll e l w i t h t h e di r e ct io n i n w hi ch t he t a rg et v ol um e ha s t he s m a ll e st c r o s s - s e ct io n . T h e p h y s i c a l p e n u m b ra ( s e c ti o n 1 1 . 1 ) w it h M L C i s l a rg e r t ha n tha t p ro d uc e d b y t h e c o ll i m ato r j a w s o r t h e C e r r o b e nd blo ck s ( F i g . 1 3 . 5 ) . T hi s i s us ua l l y no t a s e r io u s d r a w b a c k e x c e p t f o r t h e t re a t me nt o f s m a ll f i el d s o r w he n b l o c k i ng is r e q u i r ed c l o se t o c r it ic a l s t r u c t u r e s . A l s o , ja g g e d ne s s o f t he f i e ld e d g e s m a k e s it d i f f i c u l t t o m at c h a d j ac e n t f i e ld s . T h e u s e o f M L C i n bl o c k i n g a n d f ie l d s ha p i ng i s i d e al l y s ui t ed f o r t r e at m e nts r e q u i ri n g l a r ge n u m b er s o f m u l ti p le f i el d s be c a us e o f a ut om a ti o n o f t he p ro c ed ur e t h u s r e s u l t i n g i n a s i g n i f i c a n t re d uc ti o n o f s e t - up t im e . M LC c a n p r a c t i c a l l y e l im i n a te t h e u s e o f C e r r o be n d blo c k i ng e x ce p t f o r s ha pi ng s m al l f i e l d s o r i s l a nd b l o c ki n g i n w h i c h a n a r e a w i t h i n t he op en p o r t io n o f t he f ie ld s ne e d s to be b l o c ke d . T h e i m po r t a n c e o f ML C i s n ot j us t t he rep l a c e me nt o f C e r ro b end b lo c k i ng . T he g r e a te r i m p a ct o f t hi s t e c h n o lo g y i s i n the a ut o m a ti o n o f f i el d s ha p i ng a nd m o d u l at io n conformal of be a m i n t e n s it y . therapy M o de r n ra d i ot he r a p y 19) a nd t e c hni q ue s s uc h as 3-D r a d i ati o n ( C ha p te r i nte ns i t y - mo dul a t e d r a di a ti o n

WWW.MEDRAD.IR

t h e r a p y ( C h a p t e r 2 0 ) a r e d e p e n de nt o n the d y na m i c a l l y c o nt ro ll e d M L C . O t he r a p p li c a ti o n s i n c l u d e d y n a m i c w e dg e s a nd e le c t ro ni c co m pe ns a t io n. F o r f ur t her d e t ai l s o n M L C d e s ign s a n d a p p l i c at io ns , t he r e a de r i s re f e r r ed t o a re v i e w b y Boyer (11).

13.3. SKIN DOSE

W h e n a p a t i e n t i s t re at e d w it h a m e g a v o lt a ge b e a m , t he s ur f a c e d o s e o r s k i n d o se can be s u b s t a n ti a ll y lower than t he m a x i m um d o se t hat o c c ur s in t he s u b c u t a n e o u s t i s s u e s . In c o n t r a s t t o lo w e r e ne r g y b e a m s ( e . g . , s up e r f i c i a l a nd o r t h o vo lt a g e x - r a y s ) , w h i c h g i v e r i s e to m a x i m um i o ni z a tio n a t o r c lo s e t o t he s k i n s u r f a c e , t h e meg a v o lt a g e be a m s pr od uc e a n i nit i al e le c t ro ni c b ui l d up w i t h d e pt h , r e s u l ti n g i n a r e d u c e d d o se a t t he s ur f a c e a nd m a x i mum d o s e at t he e q u i li b ri u m d e pt h . T h i s p h e n o m e no n o f d o se b ui l d up w a s d i s c us s ed i n C ha p t e r 9 . S k i n s p a r i n g i s o n e o f t h e m o s t d es i r a bl e fe a t ur e s o f hi g h- e ne rgy p ho t o n b e a m s . H o w e v e r , t h i s e f f e ct m a y b e r e d uc ed o r e v e n l o st i f t he b e am i s e x c e s si v e l y c o n t a m i n at e d P.279 with secondary el e ct r o n s . In t he f o l l ow i ng s e c t io ns , t he s o ur c e s of t his

c o n t a m i n at io n a n d t h e m e t h o d s u s e d t o r ed uc e i t w il l be d i s c us s e d.

WWW.MEDRAD.IR

WWW.MEDRAD.IR

FIG.

13.5.

C o m p a r i so n n o r m a l i ze d

of to

physical 10 0% at

pe num b r a c e nt r a l

a s s o ci a te d axis. (From

w ith

MLC

(A) et

a nd al.

c e r r o be n d bl o c k s ( B ). F i e ld s i z e 15 1 5 , d e pt h 1 0 c m , a nd ene r g y 6 M V . D o s e d i s t ri b u tio n G al v i n JM, E v a l u a t i o n o f m u l ti le af c o l l im a to r d e si g n f or a p ho t o n b e a m . I nt J R a d i a t O nc o l B i o l P h y s 1 9 9 2; 2 3 :7 89 80 1 , w i t h p e rm i s si on. )

A. Electron Contamination of Photon Beams

S u r f a c e d o s e i s t h e re s u l t o f el e ct r o n c o nta m i na t io n o f t he i nc i de nt b e a m a s w e ll a s t h e b a c k s c a tt e re d r a d i at io n ( bo t h e le c t ro ns a nd p ho to ns ) f r om t he m ed i um . It i s w e l l - k n o w n t h a t al l x - r a y a nd r a y b e a m s us e d i n r a d i at io n t he r a p y a r e c o n t a m i n at e d P.280 a n d i n a n y o t h e r s c a t t e ri n g m a t e ri a l i n t he p a t h o f t he b e a m . If a s ha d o w t r a y i s u s e d t o s u p po r t b e am - s h a p i n g b lo c k s , s e c o nd a r y e l e ct ro ns p r od uc e d b y p ho to n i n t e r a ct io n s i n t h e t r ay a n d t h e a i r c ol um n b e t w ee n t he t ra y a nd t he s k i n s ur f a c e s i g n i f i c a n tl y i n c r e a s e s k i n d o s e . T he s ha d o w t r a y i s us ua l l y t hi c k e no ug h t o a b s o r b mo s t o f t h e e le c t ro n s i n c i d e nt o n t he t r a y . There has been a co n t r o v er s y as to t he r e l at i v e co nt ri b utio n of s e c o nd a r y e l e ct r o n s v s . lo w e n e rg y s c a t te r e d p hot o ns t o t he do s e i n t he b uil d - up r eg io n. It i s w el l k n o w n t h a t as t h e f i el d si z e i nc r ea s e s , t he de p t h d o se i n t he b ui l d - up r e g io n i n c r e a s e s re s u l ti n g i n a s hi f t i n t he d e pt h o f m a x i m um d o s e , d m a x , to i n c r e a s i n gl y s h a l l o we r d e pt h s ( 1 2 , 1 3 ,1 4 ) . Sp e c i f i ca ll y , t he c a us e o f t he d m a x s hi f t w i t h f i e ld s i z e h a s be e n s t u d ie d b y s e v er a l i nv e s ti g at o r s (1 5 ,1 6 , 1 7 ) . C ur r e nt e v i d e n c e f a v o r s t h e h y p o t h e s i s t ha t t he e f f e c t i s p re do m i na ntl y c a us e d b y t he s e c o n d a r y e le c t ro n s . w it h secondary e le c t ro ns . T he s e e l e ct r o ns a r i se from p ho to n i n t e r a ct io n s i n t h e a i r, i n t h e c o l li m a to r ,

B.

Measurement

of

Dose

Distribution

in

the

Build-up

Region
B e c a u s e o f t h e st eep d o se g r ad ie nt i n the b ui l d- up r e gio n, t he s i z e o f t he d o s im e te r a lo n g t h e be a m d i re c ti o n s ho ul d b e a s s m a ll a s p o s si ble . E x t r a p o l at io n c h a m b e r s ( se e C h a pt er 6 ) a r e t h e i ns t r um ent s o f c ho i c e f o r t he se m e a s ure m e nt s. However, few i n s t it u t io n s have t he s e i ns t r um e nt s a v a il a bl e . Ins t e a d , fixeds e p a r a ti o n pl a n e - p a r al l el io n i z a ti o n c ha m be r s a r e mo s t co m m onl y us e d f o r t his p u r p o s e . A l t ho u g h t h es e c h a m b e r s a r e v e r y s ui t a bl e f o r m e a s ur em e nt s i n r e gi o ns o f s e v e r e do s e gr a d ien t s , t h e i r r e s po ns e i s d e pe nd e nt , i n a c o mp l e x m a nne r , o n t h e i r d e si g n . S e v e r al p a p e r s h a v e di s c us s ed t he i na c c ur a c ie s i n t he me a s ur e m e nt of dose in the b u ild - u p r e g io n w he n us i ng f i x e d - s e p a r at ion p l a ne - p a r a ll el c h a m b e r s . T h e s e i n a cc u r a c i e s a r i se p r i ma r il y a s a r e s ul t o f e l ec t r o n s c a tt e ri ng f r o m t h e s i de w a l l s o f t h e c h a m b e r ( 1 8 , 19 , 2 0 ) . T he s e m a y b e m ini m i z e d b y us i ng a s m a ll e r p l at e se p a ra t io n a n d w i de r g ua r d r i ng i n t he de s i g n o f t he c ha mb e r. F u r t h e r m o r e , t h e c h a m b e r s m a y e x hi bi t a s i g ni f i c a nt p ol a r it y e f f e c t i n t he b uil d u p r e g io n , w h i c h m a y b e co r r e ct e d b y a v e ra g i ng t he r e ad i ng s o bt a i ne d w i t h t he p o s it i ve and n eg a ti ve po l a ri ti e s . G e r bi and K ha n (21) ha v e s t ud ie d s e v e r al c o m m e r ci a ll y a v a il a ble pl a n e - p a r al le l c ha m b e r s a nd f o und t ha t the y o v e r r e sp o nd

WWW.MEDRAD.IR

i n t h e b u i l d - u p r eg ion . T h e e r r o r s w e r e m o r e s e v e re a t t he s ur f a c e a nd f o r t he l o w e r b e a m e n er g ie s ( e . g . , for a
60 60

C o ) . T he m a gni t ud e o f o v e r r e sp o nse a t t he s ur f a c e

C o b e a m r a n g ed f r o m 9 % to 2 0% f o r t he c ha m b e r s s t ud ie d.

T h i n l a y e r s ( < 0 . 5 m m ) o f t h e r m ol um i ne s ce nt d o si m et e r ( T L D ) m a t e ri a l c a n a l s o b e u s e d f o r me a s u r i ng do s e d i st r ib ut io n i n t he b uil d - up r e gi o n. The T L D p ho s p ho r ( e . g . , L i F ) c a n b e i n t h e f o r m o f c hi p s , c r y s t a l s e m be d de d i n pl a s ti c , o r p o w d e r l a y e r s ( 1 8 ,2 2 , 23 ) . T h e s u r f a c e d o s e m a y be o bt a i ned b y e x t r a pol a ti ng t he de p t h d o s e di s tr i b ut io n c u r v e t o z e ro d e pt h. In v i v o m e a s ur e m e nt s o f s ur f a c e d o s e c a n a l s o b e m a de b y p la c i n g t h i n T L D c hi p s d i r e c tl y o n t he s k i n s ur f a c e . S uc h m e a s u r e m e n t s a r e u s e f u l i n c h e c k i ng do s im e t r y i f a n una c c e pt ab l e d eg r ee o f s k i n r e a c ti o n d e v el op s .

C. Skin Sparing as a Function of Photon Energy

S t u d i e s h a v e s h o w n t h a t t h e d o s e d i st r i b uti o n i n t he b ui ld - up r eg i o n d ep e nd s o n many variables such as tray beam e ne r g y , SS D , f i e ld size, a nd c o nf i g ur a ti o n giv e s v a l ue s of for secondary b lo c k i n g ( 1 8 , 2 2 ,2 3 , 24 , 2 5, 2 6 ) . Table 13 . 2

d i f f e r e n t e n e r gi e s . T he s e d at a a re p re s e nted he r e a s a n e x a m p le a nd s ho ul d not b e co n s i de r e d u n i v e r sa l f o r a ll m a c hi ne s , es p e c i al l y fo r de pt hs le s s t ha n 2 m m . R e a s o n a b le a g re e me n t b et w e e n di f f e r e nt m a c hi ne s ha s b e e n sho w n t o e x i st f o r g r e a te r d ep t h s . E x a m i n a t i o n o f T a b le 1 3 . 2 wo u l d al s o i ndi c a t e t ha t f o r al l e ne r g ie s t he do s e i n c r e a s e s r ap i dl y w i t hi n t h e f i r s t fe w m i ll ime t e r s a nd t he n g r a d ua l l y a c hi e v e s i t s m a x i m u m v a l u e at t he de p t h o f p e a k d o se . F o r e x a m pl e , i n t he ca s e o f 4 M V , t he p e r c e n t de pt h d o s e i nc r e a s e s f r o m 14 % to 7 4 % i n t he f i r st 2 m m, r e a c he s 9 4 % a t a 5 - m m d e pt h a n d ac h i e v e s it s m a xi m um v a l ue a t a 10 - m m de p t h. A p r a ct i cal a p p li c a ti o n o f t h i s p he n o m e n o n i s t he c a s e i n w hi c h b ui l d - up b olus ( C ha p t e r 1 2 ) i s u s e d i n t e nt io n a l l y to m a x i m i z e t he d o se on t he P.281 s k i n ( e . g . , co v e r i n g a s c a r w it h a st ri p o f b o l us ) . A ti s s ue e q ui va l e nt b ol us o f 5 t o 6 - m m o f t h i c k n e s s i s u s u a l l y a d e q ua t e f o r 4 M V . T hus t he t hi c k ne s s o f b o l us r e q u i r ed to a c h i e v e 90 % t o 9 5 % b uil d - up o f d o s e i s s ub st a nt i all y l e s s t ha n t he d e pt h o f m a x i m u m d os e .

TABLE

13.2.

BUILD-UP

DOSE

DISTRIBUTION

IN

POLYSTYRENE FOR A 10 10 cm FIELD

WWW.MEDRAD.IR

Depth (mm)

60

Co 80 cma

4 MV 80 cma

10 cmb

MV

100

25 cma

MV

100

18.0

14.0

12.0

17.0

70.5

57.0

30.0

28.0

90.0

74.0

46.0

39.5

98.0

84.0

55.0

47.0

100.0

90.0

63.0

54.5

100.0

94.0

72.0

60.5

96.5

76.0

66.0

99.5

84.0

73.0

10

100.0

91.0

79.0

15

97.0

88.5

20

98.0

95.0

25

100.0

99.0

30

100.0

D a t a f ro m V e l kl e y DE , M a n s o n D S , P ur d y J A , O l i v e r G D . Bui l d up r e gi o n o f p h o ton r a d i at io n s o ur ce s . Med P hy s 1 9 75 ; 2 : 14 . D at a f r o m K h a n F M , M o o r e V C , Le v i tt S H . E f f e c t o f v a r i o us a tom i c num b e r

m e g a v ol t ag e
b

a b s o r be r s o n s k i n d o se f o r 1 0 - M e V x - r a y s . R a d i ol og y 1 97 3 ; 10 9 :20 9 .

A l t h o u g h t h e s k i n sp ar i n g de p e n d s o n m a ny c o nd it io ns , a s me nt ione d e a rl ie r , t he effect, in ge n e r a l , b e c o me s mo r e a nd more p r o no unc e d as p ho to n e ne r g y i n c r e a s e s . F o r h i g h er -e n e r g y b e a m s , s ig ni f ic a nt s p a r i ng c a n b e ac hi e v e d no t o nl y f o r t h e s k i n s u r f a c e b u t a l s o f o r t he s ub c uta ne o us t i s s ue s .

WWW.MEDRAD.IR

D. Effect of Absorber-skin Distance

T h e e l e ct r o n co n t a mi n a t io n w i t h no ab s o rb er p l a ce d i n t he be a m is m a i nl y c a us ed by the se c o n d a r y el e c tr o n em i s si o n f r om t he co ll i ma to r (inc l ud i ng s o ur ce , f l a t te n i n g f il te r , a n d a i r ) . W h e n a n a b s o r be r o f t hi c k ne s s g r e at er t ha n t he r a nge o f s e c o n d a r y e l e ct ron s ( e q u i l i b ri um t hi c kne s s ) i s i nt r o d uc ed in t he b e a m , t he c o ll i m at o r b e c o me s el e c tr o n s the are a l mo st source c o mp le te ly of e l e ct ro n a b s o r be d b ut t he of a b s o rb e r t he i t se l f By p ri n c i pa l c o nt a mi na t io n be a m .

i n c r e a s i n g t h e di s t a nc e b e t w ee n t he t r a y a nd t he s ur f a c e , t he e l e ct r o n f l ue nc e i n c i d e nt o n t h e s k i n is r e d u c e d be c a us e o f d i v e r ge nc e a s w e ll as a b s o r pt io n a nd s c a t te r i n g o f e le c t ro n s i n t h e a i r . T h us s k i n s p a r i ng i s e nha nc e d b y p l a c i ng t he s h a d o w t r a y f a r t h e r aw a y f r o m t he s k i n. In t he c a s e o f a
60

C o r a y b e a m , it ha s

b e e n s h o w n ( 2 7 , 28 ) th a t f o r s m a ll f i el d s an a i r g a p o f 15 to 20 c m b e t w ee n t he s c a t te r e r a n d t h e s kin i s a d eq u a t e to k eep t he s ki n d o se t o a n a c c e pt a b le l e v el ( < 5 0 % o f t h e D m a x ) . T h i s h a s b e e n fo und t o b e t r ue fo r hig he r -e ne r g y be a m s a s w e l l ( 17 ) . F i g u r e 1 3 . 6 s h o w s t he e f f e ct o n d o se di s tr i b uti o n i n t he b ui ld -up r e gi o n a s a L u c i t e s h a d o w t r a y i s p l a c e d i n t he b e a m a t v a r i o us d i s ta nc e s f r o m t he p ha nt o m s u r f a c e . N o t o n l y do es t h e r e l at i ve s ur f a c e d o s e i nc r e a s e w it h d ec r e a s i ng tr a y - t o s u r f a c e d i s t a n c e b u t t h e p oi n t o f m a x i m um d o s e b ui ld up m o ve s c l o se r to t he surface. F i g u r e 1 3 . 6 al so il l u s tr a t e s t h e pr i nc ip l e o f w ha t i s k no w n a s t he b e a m s poi l e r . A l o w ato m i c n u m b er a b s or b e r , s uc h a s a L uc it e s ha d o w t ra y , p l a c ed at a n a p p r op r i at e d i st a n c e fr o m t h e s u r f a c e , c a n b e us e d to mo di f y t he b ui ld - up c ur v e . D o pp k e e t al . ( 2 9 ) h av e d i s c u s s e d t he t r e atm e nt o f c e rt a i n he a d a nd ne c k c a nc e r s w i t h 1 0 - M V x - r a y s u s i n g a be a m s po il e r to i nc r e a se t he d o se to t he s upe r f i ci a l neck nodes.

WWW.MEDRAD.IR

F I G . 1 3 . 6 . E f f e c t o f L u c i t e s h a d o w tr a y o n d o s e b uil d up f or 1 0 - M V x - r a y s . P e r c e n t d ep t h do s e di s t ri b u ti o n i s pl ot te d f o r v a r i o us t r a y - to - sur f a c e d i s t a nc e s ( d ) . 1 0 - M X x - r a y s , t ra y t h i c k n e s s = 1 . 5 g /c m 2 , f i e ld s i z e = 1 5 1 5 c m , S S D = 1 0 0 c m , a n d S D D = 5 0 c m . ( F r o m K ha n F M , M o o r e V C , L e v i tt S H . E f f e c t o f v a r i o us a t o mi c number a b so r b e r s on skin d os e for 10-MeV x - ra y s . R a d i o lo g y 1 9 73 ; 1 09 : 20 9 , w i t h pe r m i s si o n . ) P.282

E. Effect of Field Size

T h e r e l a ti v e s k i n do s e d e pe n d s s t ro ng l y o n f i e l d s i z e . A s t he fi el d d i m e nsi o ns a re i n c r e a s e d , t h e do s e i n t h e b u il d - up re g io n inc r e a s e s . T hi s i nc r e a se i n do s e i s d ue t o i n c r e a se d el e ct r o n e m i s si o n f r o m t he c ol li m a to r a nd a i r . F i g ur e 1 3 . 7 i s a p lo t o f r e l at i v e s u r f a c e do s e a s a f u n c t io n o f f i el d s i z e f o r sizes. S a y l o r a n d Q u il li n ( 24 ) h a v e di s c us s e d t he r el a ti v e i m po r t a nc e o f f ie l d s i z e a nd t r a y - t o - s ki n d i st a n c e f o r a n d r i s t he r a d i u s o f a n P.283
60 60

Co , 4 - M V , and 1 0 - M V b e a m s.

T h e s e d a t a s h o w t h a t s k i n s p a r i ng i s s i gni f i c a nt l y r e d uc e d f o r t he l a r g e r f i el d

C o r a y s . T he y ha v e s ho w n t ha t t he o p ti m um s k i n

s p a r i n g o c c u r s f o r a n h / r v a l u e o f a b o ut 4 , w he r e h i s t he t r a y - t o - s ur f a c e d i s t a nce

WWW.MEDRAD.IR

e q u i v a le n t c i r c u l a r fi el d . T h i s r a ti o c a n be e a s i l y a c hie v e d f or t he 5 5 c m f ie ld , b e c a u s e i t r e q u ir e s a d i s t a n c e o f 1 2 c m ; ho w e v e r , f o r t he 3 0 3 0 c m f i el d , t he c o r r e s po n di n g a b s o r be r - s u r f a c e d i s t a nc e i s 6 7 c m , w hi c h i s ha r d l y p o s si b le f or i s o c e nt r i c tr e a tm e n t s .

F I G . 1 3 . 7 . P e r c e n t su r f a c e d o s e a s a f unc t io n o f f ie ld s i z e . 1 0 0 c m , S D D = 50 cm .

60

Co , T he r a t ro n 80 ,

S S D = 8 0 c m , S DD = 5 9 c m . 4 M V , C l i na c 4, S S D = 8 0 c m . 1 0 M V, L M R 1 3 , S S D =
60

C o a n d 4 - M V . (Da t a a re f r o m V el k l e y D E , M a ns o n D J ,

P u r d y J A , e t al . B u i ld u p r eg io n o f me g a vo lt a g e p hot o n r a d i at io n s o ur c e s . Med P h y s 1 9 7 5 ; 2 :1 4 . 10 -M V d a t a a r e f r o m K ha n F M , M o o r e V C , L ev i t t S H . E f f e c t o f v a r i o u s a to mi c n u m be r a b so r be r s o n s ki n d o se f o r 1 0 - Me V x - r a y s . R a d i ol og y 1 9 73 ; 1 09 : 20 9 . )

WWW.MEDRAD.IR

F I G . 1 3 . 8 . V a r i a tio n o f pe r c e n t s ur f a c e do s e wi t h at o mi c numb e r o f a b so r be r . E a c h a b s o r b e r h a d a th i c k n e s s o f 1 . 5 g / c m 2 a nd w a s m o unt e d und e r ne a t h a L uc ite s h a d o w t r a y . 10 - M V x - r a y s , f i e l d si z e = 1 5 1 5 c m a nd a b so r b e r -to - s ur f a c e d i s t a n c e = 1 5 c m . ( F ro m K h a n F M , M o o r e VC , L e v i tt S H . E f f e c t of v a r i o us a t om i c n u m b e r a b s o r be r s o n s k i n d o s e f o r 1 0 - M e V x - r a y s . R a d i o lo g y 19 73 ; 1 09 : 2 09 , w i t h p e r m i s sio n . ) W h e n u s i n g l a r g e f i e ld s w i t h a t r a y - t o - s k i n d i s t a nc e o f 1 5 to 2 0 c m , i t b e c o m e s n e c e s s a r y to u s e e le ct r o n f il te r s t o m a i ntai n t he s ki n- s p a r i ng e ff e c t . T he s e ar e d i s c u s s e d i n t h e n e x t s e c t io n .

F. Electron Filters
T h e s k i n d o s e c a n b e r e d u c e d b y us i ng r a y a b s o r b e r s o f m e d i um a t o mi c num b e r ( Z i n t h e r a n g e o f 3 0 8 0 ) . S u c h a b s o r be r s a r e c o m mo nl y k no w n a s e l e c t ro n f i l te r s , be c a u s e t h e i r i n t ro d u c ti o n i n t he p ho to n b ea m re d uc e s t he s e co nd a r y e l e ct r o n s c at te r i n t he f o r w a r d d i re c ti o n. H i ne ( 3 0 , 31 ) st ud ie d t he s c a tt e ri ng o f e l e ct r o n s p r od u c e d b y r a y s i n m a t e ri a l s of v a r i o us a t om i c numb e r s . H e s ho w ed t h a t t h e m e di u m a tom i c n u m b e r a b so r be rs g i v e l e s s e le c t ro n s c a t te r i n t he f o r w a r d di r e ct io n t h a n e it h e r t h e lo w o r t he v e r y hi g h Z m at e r ia l s. K ha n ( 2 2 ) a nd S a y l o r a n d Q u il li n ( 2 4 ) a pp li e d t he re s ul t s o f H i ne ' s s t ud y to t he d e si g n o f e l e ct r o n f il te r s f o r t he p u r p o se o f i m p ro v i ng s k i n d o se f o r t h e b u i ld - u p c h a r a c t e ri s ti c s o f l a r ge f i e ld s (3 2 ) . F i g u r e 13 . 8 i s a pl ot o f r e l at i v e s ur f a c e d os e a s a f unc t i o n o f l og ( Z + 1 ) . T he s e data are p lo tt e d in this m a n ne r to s ho w a g r e em e nt w it h t he t he o re ti c al r e l at io n s h i p di s c u s s e d b y H i n e ( 3 0 , 31 ) . A s Z i nc r e a s e s , t he s ur f ac e d o se f a ll s to a s h a l l o w m i n i m u m d u e t o i n c r e a s ed e le c t ron s c a t t e r i ng i n t he a b s o r be r s . F ur t he r
60

C o te l et he r a p y . L at e r

i t w a s s h o w n t h a t s u c h f i l t e r s n ot o nl y r e duc e t he s ur f a c e d o s e b ut a l s o i m p ro v e

WWW.MEDRAD.IR

i n c r e a s e s i n Z re s u l t i n i n c re a s e d s ur f a c e d o se d ue to i nc r e a se d p r o d uct io n o f p h o to el e c tr o n s a n d el e c tr o n p ai r s i n a d dit io n to t he C o m pt o n e le c t ro ns . T he m i n i m u m o c c u r s a t ab o u t Z = 50 , w hi c h i s t he at om i c num be r o f ti n. T he s e r e s u l t s q u a li t at i ve l y a g r e e w it h t ho s e ob t ai ne d f o r

60

C o r a y s ( 2 4 ,3 0 , 3 1 ) .

E f f e c t i v e n e s s o f ti n i n r e d u c i n g s k i n d o s e i s d e mo ns t r at e d i n F ig . 1 3 . 9 . G r e at e r r e d u c t io n i s po s s i bl e b y i n c r e a s i n g f i lt e r - s ki n d i s t a nc e a s di s c us s e d p r e v io us l y . T o p re s e r v e t h e l ig h t f i e ld , S a y lo r a nd Q ui ll i n ( 24 ) ha v e s ugg es t e d t he use o f l e a de d g l a s s a s a n el ec t r o n f il te r . H o w e v e r , b r e a k a b il it y o f l e ad ed g l a s s m a y p o se a s e r i o u s p ro bl e m . We h a v e u s e d a t i n s he e t mo unt e d o n a p r es s e d w o od s he et t h a t c o u l d be s l ip p ed u n d e r t h e P l e x i gl a s t ra y a t t he e nd o f t he t r e a t me nt s e t - up . In t h i s a r r a n g e m e n t , th e t i n f i l te r m us t f a c e t he p a t ie nt s ur f a c e .

F I G . 1 3 . 9 . P e r c e n t s u r f a c e d o se p lot t ed a s a f unc t i o n o f f i el d si z e f o r op e n be a m , L u c i t e t r a y a n d t i n f il t er m o u n t e d und e r nea t h t he t r a y . 1 0 - M V x - r a y s , t r a y - t o s u r f a c e d i s t a n c e = 1 5 c m . ( F r o m K ha n F M , M o o r e V C , L e v i tt S H . E f f e c t o f v a r i o us a t o mi c number a b so r b e r s on skin d os e for 10-MeV x - ra y s . R a d i o lo g y 1 9 73 ; 1 09 : 20 9 , w i t h pe r m i s si o n . ) P.284

WWW.MEDRAD.IR

T h e t h i c k n e s s o f a n e l e ct r o n f il te r , i n t heo r y , s ho ul d be a t l e as t e q ua l to t he m a x i m u m r a n g e o f s e c o n d a r y el e ct r o ns . F o r g/cm
2 60

Co , t hi s t hi c k ne s s i s ab o ut 0 .5

o r 0 . 9 m m o f t i n ( a s s u m i ng t i n = 5 . 7 5 g / c m 3 ) . F o r hi g he r e ne r gi e s ,

t h i c k n e s s e s l e s s t h a n t h e m a x i m um r a ng e o f e l e ct r o ns m a y b e us e d f o r p r a c ti c a l reasons.

G. Skin Sparing at Oblique Incidence

Skin dose has be e n shown to i nc r e a s e with i nc r e a si ng a ng l e of i nc id e nc e ( 3 3 , 3 4 ,3 5 , 36 , 3 7 , 38 , 39 ) . C l i n i ca ll y , b r i s k r ea c t io ns ha v e be e n o b se r v e d i n p at ie n t s w h e n t h e b e a m i s i n c i d e n t at n e a r g l a nc i ng a ng l e s . J a c k s o n ( 3 5 ) ha s e x p l a i ned t h e i n c r e a se i n s k i n do s e w it h i n c r e a si ng ang l e o f i nc i de nc e t hroug h t he c o nc e pt o f e le c t ro n r a n g e s u r f a c e ( E R S ) . T he E R S i s a 3- D re p r e se nt a tio n o f s e co nd a r y e l e ct r o n r a n ge a n d d is t r i b ut io n p r od uc e d by a p e nc i l be a m o f p ho to ns i nt e r a ct i ng w i t h t h e me di u m ( F ig . 1 3 . 10 ) . E l e ct r o ns g e ne r a te d i ns i de t he E R S v o l um e w ill r e a c h P a n d c o n t r i b u t e to t h e do s e t he re, w he r e a s t ho s e g e ne r a t ed o ut si d e , b e c a u s e o f t h e i r i n a d eq u a t e r a n g e , m a k e no c o nt r ib ut io n. T he E R S f o r
60

Co rays

i s i n t h e s h a p e o f a n e l l i p soi d w i t h a x i a l d i m e ns io ns o f 5 2 . 4 m m ( 3 5 ) . A s i ll u s t r a te d i n F ig . 1 3. 1 0 , t h e i n c r e a se i n t he a ng l e o f i nc i d e nce o f t he p hot o n b e a m re s u l t s i n a dd it io n a l s u r f a c e do s e a t P b e c a us e o f el e ct r o n co nt r ib ut io n f r om t h e p o rt io n o f t h e E R S , w h i c h a p p e a r s be l o w t he p ha nto m s ur f a c e ( ha t c he d c u r v e ) . F o r t a n g e n t i al b e a m i n c i de nc e , s i nc e ha l f o f t he E R S i s b e l o w t he p ha nto m s u r f a c e , a n u p p e r e s t i m at e o f t he do s e to t he s k i n m a y b e o b t ai ne d b y t he f o l lo w i n g r el a ti o n s h i p ( 3 5 , 3 9 ) :

P.285

where

the

entrance

dose

r ep r e s e nt s

t he

s ur f a c e

dose

for

no r m a l

i nc id e nc e

e x p r e s s ed a s a p e r ce n t a g e o f D m a x . T he s k i n d o s e f o r o t he r a ngl e s o f i nc i de nc e w il l l i e be t we e n t h e v a l u e s f o r t h e n o r m a l a nd t he t a ng e nti a l i nci d e nc e.

WWW.MEDRAD.IR

F I G . 1 3 . 1 0 . T h e u s e o f E R S t o d e t e rm i ne s ur f a c e d o s e b ui ld up a t p oi nt P . A : P e r p e n di c u l a r be a m in c i d e n c e . B : Ob li q ue b e a m i nc id e nc e . C : T a ng e nt i a l be a m incidence. G e r b i e t a l . ( 40 ) di d a s y s t e m at i c st ud y o f d o se b uil d up fo r ob l iq ue l y i nc i d e nt b e a m s a s a f u n c t io n o f e n e rg y ( 6 2 4 M V ) , a ng l e , d ep t h, f ie l d si z e , a nd S S D . A q u a n t i t y ob li q u it y f a c t o r ( O F ) w a s de f i ne d a s t he do s e a t a p oi nt i n p ha nt o m o n c e n t r a l a xi s o f a b e am i n c i de n t a t a ng l e , w i t h r e sp e ct to t he p e r pe nd i c ul a r to t h e s u r f a c e , d i v id e d by t h e d o se at t he s am e po i nt a nd d ep t h al o ng c e nt r al a x is w i t h t h e b e am i n c i den t a t a n g l e 0 . T he o b li q uit y f a c t o r , t he re f o r e , r ep r e se nt s d o s e e n h a n c e m e n t d ue t o be a m o bl iq ui t y f or t he s a m e d e pt h. F i gur e 1 3 . 1 1 s ho w s t h a t t h e o b li q u it y f a c to r at t he s ur f a c e i nc r e a s e s w it h t he i nc r ea se i n t he a ngl e o f i n c i d e n c e , f i r s t g r ad u a l l y a n d t he n d ra m at i c al l y b e y o nd 4 5 d eg r e e s . T hus t he s u r f a c e d o s e a t l a rg e o bl iq u e a n g le s c a n b e si g ni f i c a ntl y hi g her t ha n a t no r m al i n c i d e n c e . At t a n g e nti a l o r g r a z i ng i nc i de nc e , t he s ur f a c e do s e a p p r o a c he s t he v a l u e g i v e n b y E q u a t io n 1 3 . 1 .

WWW.MEDRAD.IR

A n o t h e r i mp o rt a n t e f f e c t a s so c i at ed w i t h ob l iq ue a ng le s i s t ha t a s t he s ur f a c e dose i n c r e a se s w it h the a n gl e of i nc i denc e , t he d e pt h o f m a x i m um b uil d up d e c r e a se s . T h e d o s e r e a c h e s i t s m a x i m um v a l ue f a s t e r a t g l a nci ng a ng l e s t ha n a t n o r m a l i n c i d e n c e . A s a r e s u l t , t h e do s e b ui ld - up r e gi o n i s c o mp r es s e d i nto a mo re s u p e r f i c i al r e gi o n . U n d e r t h e se c o nd iti o ns , a hi g h s k i n r e a c t i o n b e c o me s m uc h m o r e li k e l y . J a c k s o n ( 3 5 ) h a s d i s c us s e d t he p o s s ib il it y t ha t i f t he s e ns i t i v it y o f t h e s k i n e x t e n d s t o th e f i r s t o r se c o nd mi ll i me t er b el o w t he s ur f a c e , a t g l a nc i ng a n g l e s s k i n s p a r i n g i s p r a c t i c al l y l o st f o r the c o b a lt uni t a nd g r e a t l y r e d uce d f o r h i g h e r - e n e r g y be a m s .

13.4. SEPARATION OF ADJACENT FIELDS

A d j a c e n t t r e at m e n t fi e ld s a r e co m mo nl y e m p lo y e d i n e x te r na l b e a m r ad i at io n therapy, such as t he mantle a nd i nv e r t ed - Y f i el d s fo r the t r e at m e nt of H o d g k i n ' s d i se a s e . In s o m e c a s e s , t he a d j a ce nt f i e ld s a r e o rt ho gona l , s uc h a s t he c r a n i o s pi n a l f i el d s u s ed i n t h e P.286 t r e at m e n t o f m e d u ll ob l a s to m a . A no t he r e xa m p l e i s t he i r r ad i at io n o f he a d a nd n e c k t u m o r s w h e n t h e l a te r a l n e c k f ie l d s a r e p l a ce d a dj a c e nt t o t he a nt e ri or supraclavicular f i el d . In each of t he s e s i t ua ti o ns , t he re is a p o s s ib il it y of i n t r od u c i n g v e r y l a rge d o s ag e er r o r s a c ro s s t he j unc ti o n. C ons e q ue nt l y , t hi s r e g io n i s a t r i s k f o r tu m o r r e c u r r e nc e i f it i s und e r d o se d o r se v er e c o m pl i c at io ns i f i t i s o ve r do s e d .

WWW.MEDRAD.IR

F I G . 1 3 . 1 1 . O b l iq u i t y f a c t o r a t t he s ur f a c e p l ot te d a s a f unc t i o n o f b e a m a ng l e f o r v a r i o u s e n e r g y bea m s . J a c k s o n f o r m ul a f o r t a ng e nt i al be a m i nc i d e nc e i s ba s e d o n E q u a t io n 1 3 . 1 . (F r o m G e rb i BJ , M ei go o ni A S , K ha n F M . D o s e b ui ld up f or o b li q u el y i n c i de n t p h ot o n b e a m s . M e d P hy s 1 9 87 ; 1 4 :3 93 , w i t h p er m i s s io n. ) The p r o bl e m of adjacent f i el d s ha s been e x te ns i v e l y st ud i ed

( 4 1 , 4 2 ,4 3 , 44 , 4 5 , 46 , 47 , 4 8 , 49 , 5 0 , 51 , 5 2 ,5 3 ) . A n um b e r o f t e c hniq ue s ha v e b e e n d e v i s ed to a c h ie v e dos e u n i f o r m it y i n t he fie l d j unc t i o n re g io n. S o m e o f t he mo r e c o m m o n l y u s e d t e c h ni q u e s a re i ll us t r at e d in F i g . 1 3 . 12 . F ig ur e 1 3 . 1 2 A ha s be e n d e s c r ib e d b y L a n c e a n d M o r g a n ( 4 1 ) ; he r e f i e ld s a r e a ng l ed a w a y f r o m a c o m m o n l i n e o f a b ut m e n t t o av o i d o v e r l ap o f t he f ie l d s d ue t o t he i r g eom e t ri c d i v er g e nc e . F i g u r e 13 . 1 2 B i ll u s t r at e s t h e m et ho d s i n w hi c h t he f i e ld s a r e s e p a r a te d at t he s k i n s u r f a c e t o p r o v ide d o se u n i f o r mi t y at a d e s i re d d e pt h. T he se p a r a ti o n o r g ap b e t w ee n t h e f i e ld s i s c a l c u l a t ed o n t he b a s i s o f g e o me t ri c d i ve r g e nc e ( 53 ) o r i s o do s e curve m a t c hi n g ( 4 2 ,4 3 ) . A t e c hni q ue us i ng s pl it bea m s ( 4 9 , 53 ) is i ll u s t r a te d i n F i g . 13. 1 2 C . In t hi s m e t hod, t he b e a m i s s pl it a l o ng t he pl a ne c o n t a i n i n g t h e c e nt r al a x i s b y u s i ng a ha l f- b e a m bl o c k o r a be am - s p li tt e r , t hus r e m o v i n g t h e g eo m et ri c di v e r g e n c e o f t he be a m s a t t he sp li t l i ne. F i g ur e 13 . 1 2D

WWW.MEDRAD.IR

u s e s p e n u m b r a g e n e ra t o r s o r sp oi le r s ( 46, 4 7 ) . T he s e l e ad w e dg e s a re c us to m d e s ig n e d to p r o vi d e sa t i s f a c to r y d o se d i st r ib ut io n a c r o s s t he f i el d j unc t i o n. In c l i n i c a l p r a ct i ce , th e f i el d s a r e us ua ll y a b ut t ed at t he s ur f a ce i f t he t um or i s s u p e r f i c i al a t t h e j u n c t io n p o i n t . C a r e i s how e v e r t a k e n t ha t t he ho t s p ot c r e a te d d u e t o t h e o v e r l ap o f t h e b e a m s a t d e pt h i s c l i ni c a ll y a c c e pt a bl e , c o ns i d e ri ng t he m a g n i t u de o f t h e o v er d o s a ge a n d t he v o l um e o f t he ho t sp ot . In a d d i t io n, t he d o s a ge re c ei v e d b y a s e n s i ti v e st r uc t ur e s uc h a s t he s p i nal co r d m us t no t e x c eed i t s to le r a nc e d os e . F o r t h e tr e at m e n t o f d ee p - s e at ed l e s io ns s uc h a s i n t he t ho r ax , a b d o me n, a nd p e l v i s , t h e f ie ld s c a n b e s ep a r a te d o n t he sur f a c e . It i s a s s um e d i n t hi s c a se t h at t h e c ol d s po ts c r e ate d b y t h e fi el d s ep ar a t io n a r e lo c at e d s up e r f i ci a ll y w he r e t h e r e i s n o t u mo r .

WWW.MEDRAD.IR

FIG.

13.12.

Schematic

r ep r e s e nt a ti o n

of

v a r i o us

t e c hni q ue s

us e d

for

field

m a t c h i n g . A : A n g l i n g t h e b e a m s a w a y f r o m e a c h o t he r s o t hat t he t w o b e a m s a b u t a n d a r e a l i g n e d v e r t i c a ll y . B : F i e l d s s e p a r a t ed a t t he s k i n s ur f a c e . T he j u n c t i o n p oi n t i s at d ep t h w h e r e do s e i s uni fo r m a c ro s s t he j unc t io n. C : Is o c e nt ri c s p l it b e a m te c h n i q u e f o r h e a d a nd ne c k t um o r s . ( R ed r a w n f r o m W i l li a m so n T J . A t e c h n i q u e f o r m at c h in g o r t h o go na l me g a vo lt a g e f ie ld s . I nt J R a d i a t O nc ol Bio l Phys 1 9 7 9 ; 5 :1 11 . ) D: C r a n i o s p i na l i r r ad i a ti o n us i ng p e numb r a g e ne r ato r s .

WWW.MEDRAD.IR

( R e d r a w n f r o m G r i f f in T W , S c h um a c he r D , Be r r y H C . A te c hni q ue f o r c r a ni a l s p i n a l i r r ad i at io n . B r J R a d i ol 1 97 6 ; 49 : 88 7 . ) P.287

A. Methods of Field Separation

A s s t a te d e a r li e r , t he f i el d s e p ar a ti o n c an b e a c co m pl i s hed ge o m et ri c a ll y or d o s im e tr i c al l y .

A.1. Geometric
If t h e ge o me t ri c b o u n d a r y o f t h e fi el d i s d ef i ne d b y t he 5 0% d e cr e m e nt li ne ( l i ne j o i n i n g t h e p oi n t s a t de p t h w h e r e t he do s e is 5 0 % o f t he c e nt r al a x i s v a l ue a t t he s a m e de p t h ) , t h e do se a t t h e po i nt o f j unc t io n b et w e e n t he b eam s w i ll a d d up to b e 10 0% . T h e do s e d i s t ri b u tio n l a te r a ll y a c r o s s t he j unc t io n is m o r e o r l e ss uniform, d e p e n di n g on the i n t e r f ie ld s c a t t er c o nt ri b uti o n a nd t he p e num b ra c h a r a c t e r i st i c s o f t h e b e a m . If t h e t w o f i el d s a r e in c i d e n t f r o m o ne s id e o nl y a nd m a d e t o j unc t i o n a t a g i v e n d e pt h ( F i g . 1 3 . 13 ) , th e d o s e a bo v e t he junc t i o n w i l l b e lo w e r a nd b e l o w t he j u n c t i o n h i g h e r t h a n th e j u n c t i o n do s e . In the c a s e o f f o ur f ie ld s w he n t w o f i el d s a r e i n c i de n t f r o m o ne s i de a n d t w o f ro m t he p a r a ll el op po s ed d i re c ti o n ( F ig . 1 3 . 1 4 ) , t h e fi el d s a re u s u a l l y m a d e to j unc tio n a t t he mi dl i ne d ept h ( e . g . , m a ntl e a n d i n v e r t e d Y f i el d s ) . S u c h a n a r r a ng e m e nt P.288

P.289 c a n b e u s e d t o o bt a i n a l m o s t a u ni f o r m d i str i b uti o n a t t he m id li ne , b ut c o l d s po ts a r e c r e a te d a bo v e a n d b e lo w t h e j unc t i o n poi nt .

WWW.MEDRAD.IR

F I G . 1 3 . 1 3 . G e o m e t ry o f t w o a d j a ce nt be am s , s e p a r a te d b y a d is t a nc e S 1 + S 2 o n t h e s u r f a c e a n d j u n c t i o n i n g a t d ep t h d .

WWW.MEDRAD.IR

F I G . 1 3 . 1 4 . T w o p a i r s o f p a r a l le l o p po s ed f i e ld s . A d j a c e nt f ie ld s a r e s e p a r at e d o n t h e s u r f a c e s o t h a t th e y a l l j oi n a t a p o i nt o n t he m i dl i ne . A : Id e a l ge o me t r y i n w h i c h t h e r e i s n o t hr e e - f ie l d o v e rl a p . B : A r r a ng e m e nt i n w hic h t he r e a re t w o r e g io n s ( s h a d e d ) o f t hr e e - f ie l d o v e r l ap . F i g u r e 1 3 . 13 s h o w s th e g eo m et r y o f t wo ad j a c e nt b e am s t ha t a re a ll o we d to jo in a t a gi v e n d ep t h d . Le t L 1 a n d L 2 b e t he f ie l d l e ngt hs a nd S S D 1 a nd S S D 2 b e t he s o u r c e - s u r f a c e d i st a n c e s . S i n c e t r i a ngl e s ABC a nd C DE a r e s i m i l a r :

or

WWW.MEDRAD.IR

giving

S i m i l ar l y ,

T h u s t h e t o t a l s ep a r a ti o n S o n t h e s ur f a c e i s g i v e n b y :

F i g u r e 1 3 . 14 A s h o w s a n i d e a l g eo m et r y i n w hi c h t he r e i s no o v e r l a p be t w ee n a f i e l d a n d i t s a dj a c e n t o p po s i n g n e ig hb o r . T he a r r a ng em e nt s ho w n i n Fi g . 1 3 . 14 B, o n t h e ot h e r h a n d , c r e a t e s re gi o ns o f t hr ee - f i el d o v er l a p ( s ha de d a r e a s ) w he re t h e b i gg e r f ie l d s di v e rg e i n to t h e o pp o si ng s m a l le r f i e ld s . C o ns e que nt l y , t he t ot a l d o s e t h e r e m a y e x cee d t h e ce n t r a l a xi s do s e a t t he s a m e d ep th. T hi s w i l l b e o f c o n c e r n i f a s i g n i fi c an t p o rt io n o f t he s pina l c o r d i s i n t he t hr e e - f ie l d o v e rl a p r e g io n . T h e m a x i m u m le n g t h o f t h r e e - f ie ld o v e r l ap ( S ) o c c ur s o n t he s ur f a c e a nd i s given by:

S can be made equal to zero if:

T h u s i f t h e f i e l d l e n gth s a r e d i f f e r e nt , t he S S D s c a n b e a d j us te d t o e li m i na te t he t h r e e - f ie ld o v e r l ap . A ls o , i f t h e g eo m et r i c al ly c a l c ul a t e d g ap ( S 1 + S 2 ) i s i nc r e a s e d b y S , t h e t h r e e - f ie ld o v e rl a p i s el i mi na t ed a t t he e x p e ns e o f a c o l d s po t a t t he m i d li n e . A s a c o mp r om i s e , o n e co uld i nc r ea s e t he g ap ( S 1 + S 2 ) b y a n a m o unt S j u s t e n o u g h to e li m i na t e t h e t h r ee - f i el d o ve r l a p i n a s pe c i f i c r eg i o n s uc h a s t he s p i n a l c o rd . S c a n b e c a l c u l a te d ge o me t ric a l l y :

w h e r e d i s t h e de p t h o f t h e co r d f r om t he a nt e r io r s ur f a c e a nd d i s t he m id li ne d e pt h . T h e t h r e e - fi el d o v e rla p i n Fi g . 1 3 .1 4 B c an a l s o b e a v oi d ed b y us i ng t he s a me l e n g t h a n d S S D fo r a ll t h e f o u r f ie l d s a nd blo c k i ng t he s e co nd p air ( e . g . , p a r ao r ti c o r i n v e r t ed Y f i e l d s ) ca u d a l l y a s ne e d e d . T hi s t e c hni q ue i s m o re c o nv e ni e nt w he n the a c c e le r a to r i s eq u i p pe d w it h a s y m m e t ri c c ol li m a to r s t ha t can be m o v ed i n d e pe n d e n tl y o f e a c h o t h e r . P.290

Example 1
WWW.MEDRAD.IR

A p a t ie n t i s tr e at e d w i t h p a r a ll el - op p o se d m a nt l e a nd p a r ao rt i c f i e l d s o f l e ngt hs 3 0 a n d 1 5 c m , r e s p e ct i v el y . C a l c ul a t e ( a ) the g a p r e q ui r ed o n t he s ur f a c e f o r t he b e a m s to i n t e r se c t a t a m i d l i n e de pt h o f 1 0 c m a nd ( b ) t he g a p r e q ui r e d t o j ust e l im i n a te t h e t h r e e - f ie l d o v e rl a p o n t he c or d a s s um e d to b e a t a d ep t h o f 15 cm f r o m t h e a n t e ri o r s u r f a c e , g i v e n S S D = 1 0 0 c m f o r a l l t he f ie l d s :

A l t h o u g h t h e p re v i o us g e o me t ri c c o ns id e ra t io ns p r o v id e us e f ul c r i t e ri a f o r f i el d s e p a r a ti o n , o n e m u s t b e a w a r e o f t he i r li m it a ti o ns . F o r e x a m p le , t he a c t ua l d o s e d i s t ri b u tio n m a y p r e se n t a di f f e r e nt p i ct ur e t ha n t he p r e di c ti o ns b a s e d o n p ure g e o me t r y of beam d i v e r ge n c e . P a t ie nt p o s it io ni ng , be a m al i g nme nt , f i el d p e n u m b r a , a n d r a di a ti o n s c a tt e r a r e al l r ele v a nt f a c t o r s t ha t m ak e t hi s pr o bl e m o n e o f t h e m o st c o mp le x i n r a d i a ti o n t he r apy . F i g u r e 1 3 . 15 s h o w s th e d o se d i st r ib ut io n fo r t he c a se s di s c us s ed i n E x a m p l e 1 . T h e e x p e c t ed t h r e e - f ie l d h ot s p ot i s s e e n i n F i g . 1 3 . 1 5 A w he n t he b e a m s i nt e r se ct a t t h e m i dl i n e . T h i s h o t sp ot i s e li mi na t ed w he n t he g a p i s i nc r ea s e d f r o m 2 . 3 to 3 . 0 c m ( = S 1 + S 2 + S ) ( F i g . 1 3 . 15 B) . H ow e v e r , t he d o se i n t he j unc t io n r eg io n h a s d r o p p ed c o n s i de ra b l y . S u c h a p r o c e d ure w i l l be j us t i f ie d o nly i f t he j unc t i o n r e g io n is t u m o r f re e . F i g u r e 13 . 1 5 C s ho w s t he d i st r ib ut io n w hen t he g a p i s j u s t e n o u g h t o e li m i n a te th e t h r e e - f ie l d o v e rl a p a t t he co r d , i . e . , g ap = 2 . 7 c m . T hi s r e d u c e s t h e d o se to th e c o r d b u t a l so c ools d o w n t he mi d j unc tio n a r e a b y a bo ut 10%. In p r a c t i c e , t h e c h o i ce b e t w ee n t he o pt io ns s ho w n i n F i g . 1 3 . 1 5 s ho ul d b e b a s ed o n p h y s i c a l , c li n i c al , an d t e c h n i c a l co ns id e r at io ns . A s us ua l , t he gui d i ng pr i nc i pl e s a r e t h a t t h e t u m o r mu s t r e ce i v e a d eq ua t e d o s a ge a nd s e ns it i v e s t r uc t ur e s m ust n o t b e t r e at e d be y on d t o le r a n c e . If t he s e c o nd it io ns a r e no t s a t i s f i ed , o t he r m e t h od s o f f i e ld m a t ch i n g , d i s c u s s e d e a rl i er i n t hi s c ha p t e r , m a y b e c o ns i de r e d .

A.2. Dosimetric
T h e s e p a r a tio n o f f i eld s c a n b e d et e r mi ne d b y o pt i mi z i ng t he pla c e m e nt o f f i el d s o n t h e co n to u r s o th a t t h e co m po si t e i so d o se d i st r ib ut io n i s uni f o r m a t t he d e s i re d d e pt h a n d t he h o t a n d co ld s po t s a r e a c c e pt a bl e . T he a c c ur a c y o f t hi s p r o c ed u r e de p e n d s on the a c c ur a c y of t he i ndi v i d ua l f i el d i s od o se c ur v e s e s p e ci a ll y i n t h e p e n u m b r a r e gi o n.

B. Orthogonal Field Junctions

WWW.MEDRAD.IR

O r t h o go n a l

f ie l d s

d en o t e

an

a r r a ng em e nt

in

w hi c h

t he

c e ntr a l

axes

of

t he

a d j a c e n t f i el d s a r e ort h o go n a l ( i . e . , p e r pend i c ul a r t o e a c h ot her ) . F o r e x a m p l e , o r t h og o n a l f ie l d s a r e u s e d fo r t he t r e at me nt o f m ed ul lo bl a s tom a i n w hi c h t he c r a n i o s pi n a l ir r a d ia ti on i s a c c o m pl is he d b y l a te r a l p a r a ll el - op pos e d b r ai n f i el d s c o u p l ed w i t h a p o st e rio r s p i n e f ie l d . A no t her c o m m o n P.291 e x a m p le is t re a tm e nt of the ne c k by bi l at e r al f ie l d s w hi le an o r t hog o na ll y

a d j a c e n t a n te r io r f i el d i s u s e d t o t re a t t he s up r a c l a v i c ul a r a r e a s .

F I G . 1 3 . 1 5 . G e o me t ric s e p a r at io n o f f i el d s w i t h a ll t he fo ur b e ams i nt er s e c ti ng at m i d po i nt . A d j a c e n t fi el d s i z e s: 3 0 3 0 c m a nd 1 5 15 c m ; S S D = 1 0 0 c m; A P

WWW.MEDRAD.IR

t h i c k n e s s = 2 0 c m ; 4 - M V x - r a y b e a m s . A : F i e l d s ep a r a ti o n a t s ur f a c e = 2 . 3 c m . A t h r e e - f ie ld o v e rl a p e xi s t s i n t hi s c a s e b e caus e t he f i e ld s ha v e d if f e r e nt s i z e s b ut t h e s a m e S S D . B : T h e a d j a c e nt f i el d s ep ar a t io n i nc r e a s ed to 3 c m t o e li m i na te t h r e e - f ie ld o v e r l ap on the surface. C: F i e ld s e p a r at io n a d j us t e d 2.7 cm to e l im i n a te t h r e e - fi e ld ov e r l a p a t t he c o r d at 1 5 c m d e pt h f r o m a nte r io r . The p r ob l em of m a tc h i n g o rt h o go na l f ie ld s ha s b ee n d is c us s e d by se v e r al

i n v e s t ig a to r s ( 48 , 4 9 ,5 0 , 5 1 ,5 2 ) . Fo r s up e r fi c i al t umo r s s uc h a s i n t he he ad a nd n e c k a r e a s , it m a y b e i n a d v i s a bl e to s ep a r a t e t he a d j a ce nt f i e l d s unl e s s t he j u n c t i o n a re a i s o v e r a t u m o r - f r ee re gi o n. If s e p a r a t io n i s no t po s s i bl e , o ne m a y u s e b e a m s pl it te r s a n d a b u t t h e f ie ld s a lo ng o r c lo s e t o t he i r cent r a l a x e s ( 50 ) . T h e m a t c h i n g l i n e s h ou l d b e d r a w n e a c h t i me b e fo r e t r e at me nt to a v o i d o v e rl a p o f t h e f i e ld s . If a s e n s i t i v e s t r u c t u r e s uc h a s t he s p i na l c o r d e x i sts i n t he j unc t i o n r e g io n , o ne m a y a dd iti o n a ll y b lo c k a n a p p rop r i a te s eg m e nt o f t he c o r d a nte r io r l y o r l a te r a ll y , p r o v id e d t h e r e i s n o t umo r i n the s hi e l de d r e gi o n.

WWW.MEDRAD.IR

F I G . 1 3 . 1 6 . A : A g e n e r a l di a g r a m s ho wi ng t he s e p a r at io n o f o rt ho g o nal f i el d s . B : A n e x a m p l e o f o r t h og o n a l fi e ld s us e d f o r c r a ni o s pi na l i r r a di a tio n. C : A l a te r al v i e w o f B , i l l u s t r a ti n g t h e g eo m et r y o f o r t hog o na l f i el d s ep a r a ti o n. P.292

A s s t a t ed p re v i o u s l y , f i e l d s e p a r at io n i s p os s i b le f o r d e ep - s e at ed t um o r s i f t he re i s n o t u mo r i n t h e s u pe r f i c i al j u n c t io n r e gion. A g e o m et r i c al me t ho d o f o rt ho go na l f i e l d se p a r at io n h a s b e e n de s c r i be d b y W e r ne r e t a l . ( 52 ) . A c c o r d i ng to t his m e t h od , o n e p ai r o f op p o si n g f i el d s , d e fi ned b y t he c ol li m a ti ng lig ht , i s a ll o w ed t o d i v e r ge o n t h e s k i n an d t h e p oi n t o f i nt e r se c t io n o f t he f i el d bor d e r s i s m ar k e d .

WWW.MEDRAD.IR

F r o m t h i s po i nt , a di st a n c e S i s c a l c ul a te d t o se p a r at e t he o rt hog o na l fi el d s . T he s e p a r a ti o n S i s g i ve n b y :

w h e r e d i s t h e d e pt h a t w h i c h t h e o r t ho go na l f i e ld s a r e a l lo w e d to j o i n. A g e ne r a l d i a g r a m f or o r t ho go n a l f i e ld s e p a r at io n i s i llus t r a t ed i n F i g . 1 3 . 16A .

B.1. Craniospinal Fields

C r a n i o s p i n al i r r a di a tio n i n v ol v e s a c o mpl e x t e c hni q ue in whi c h o r t ho g o nal j u n c t i o n s a r e c re a te d b e t w ee n t h e l at e r al br a i n f i e ld s a nd a po s te r io r s p i ne fi el d . T h e s p i n a l f i e l d , be c au s e o f i t s l a r g e le ng th, m a y b e s p l it i nt o t w o s p i na l f i el d s w i t h a j u n c t i o n g ap c a l c u l a te d a c c or d i ng t o E q ua t i o n 1 3 .5 . T he j unc t i o n b et w e en the cranial and t he spinal f i el d s can be a c c o m pl i s hed in several ways ( 4 8 , 4 9 ,5 0 , 52 , 5 4 , 55 ) . P.293

Technique A
F i g u r e 13 . 1 6 B p r e s e nt s a n e x a m pl e s ho w i ng b il a te r a l c r a ni a l fi eld s a d j a ce nt to a s p i n a l f ie l d . T h e c r a n ia l l ig h t f i el d s a re a ll ow e d t o d i v e rg e o n t he s k i n a nd t he ir i n f e r i o r bo r de r s m e et a t a p o i n t mi d w a y o n t he p o st e ri o r ne c k s ur f a c e . F r o m t hi s p o i nt , t h e sp i n a l fi eld i s se p a r at e d b y a d i s t a nc e S , w hi c h i s c a l c ul a te d f ro m E q u a t i o n 1 3 . 9 b y s u b s t it u ti n g d e pt h d o f s p i ne ( f r o m t he p os t e ri o r s ur f a c e ) , l e n g t h L , a n d S S D f o r t h e s p i n a l f i el d . In t hi s d i a g r a m , t he s ol id l i ne r e p re s e nt s t h e li g h t f ie ld o n t h e s u r f a c e . T he d a s he d l i ne s ho w s t he f i el d p r o je c te d at t he d e pt h o f t h e s p i n a l cor d . F i g u r e 1 3 .1 6 C i s the l a t e r al v i e w o f F i g . 1 3 . 1 6 B.

Technique B
T h e p a t ie n t i s po s it ion e d p r o n e w it h t he f or e he a d r e st i ng o n a r i g i d he a d s upp o rt a n d t h e c h e s t a n d a bdo m e n r e st i ng o n ha r d S t y r o f o a m bl oc k s ( F i g. 1 3 . 1 7 A ) . S o me i n s t it u t io n s u s e a h a l f- s h e l l pl a st e r bo d y c as t und e r t he p a ti e nt fo r i m mo bi li z a ti o n o f h e a d a n d n e c k r e l at i v e to t h or a x ( 5 4 , 5 5 ). T he s p i ne f i e l d i s s im ul a t ed w i t h t he c e p h a l a d m a r gi n o n th e n e c k b u t w it ho ut e x i ti ng t hro ug h t he mo ut h. By o p e ni ng t h e l ig h t f i el d , t h e div e r g i n g bo u nd a r y o f t he c e p ha l a d m a r gi n of t he s p i na l f i el d i s d i s pl a y e d o n t h e la t e r al a s p e c t o f t he ne c k . T hi s b o und a r y i s m a r k e d o n t he p a t ie n t ' s s k i n t o p ro v i d e a m at c h li ne f o r t he l at e r al c r a nia l fi el d s . T he c r a ni al f i e l d s a re s e t u p s o t ha t t h e i r c a ud a d f ie ld m a r g i ns a r e p a r al l el w i t h t he d i v er g i ng cephalad m a r gi n of the spinal f i e ld . T hi s is a c c o m p li s he d by r o t a t i ng t he c o ll i m at o r o f t h e c r a n ia l f i e ld s t h r o ug h a n a ng l e c o l l ( F i g . 1 3 . 17 B) . If t h e c r a n i a l f i e l d s w e r e n o n d i v e rg e nt , t he r o t a ti o n o f t he c r a nia l f i e ld s t hr o ug h c o l l w o u ld be s u f f i c ie n t to p ro v id e t he de s i r ed ge o me t ri c m atc h b e t w ee n t he c r a n i a l a n d t h e s p i n a l f i e l d s . H o w e v e r , to m a t c h t he d i v e rg i ng cr a ni a l f i el d s w i t h t h e d i v e rg i n g s p i n al f i e l d , t h e c o u c h m us t a ls o b e r ot a te d t hr o ug h c o u c h i n a d di ti o n t o t h e r ot a ti o n o f t he c r a n i a l f ie ld s t hr o ug h c o l l ( Fi g . 1 3 . 17 C ) . T he t wo a ngl e s c o l l a n d c o u c h , c a n b e c a l cu l a t e d a s :

WWW.MEDRAD.IR

w h e r e L 1 i s t h e le n g t h o f t h e po s t er io r s pi na l f i el d , L 2 i s t he le ngt h o f t he l at e r al c r a n i a l f i el d , S S D i s th e s o u r c e - to - s ur f a c e d i s t a nc e f o r t he s p i na l f i e l d , a nd S A D i s t h e s o u r c e -t o - a x i s d i st a n c e f o r t he c r a ni al f i e l d s , a s s um i ng t he S S D t e c hni q ue is u s e d f o r t h e s pi n a l f i el d a n d t h e S A D te c hniq ue f o r t he c r a ni al f i el d s . T he c o uc h i s r o t at e d t o w a r d t h e s i de t h e c r a n i a l f i el d e nte r s t he he a d . An a l t e r n a ti v e a p pr oa c h to r ot a ti ng t he c o uc h is to e li m i na t e c r a ni al f i eld d i v e r ge n c e b y u si n g a h a l f - b e a m b lo c k o r an i nd e pe nd e nt j a w to s p l it t he f ie l d s a t t h e c r a n i o sp i n a l j u n c tio n l i n e ( F ig . 1 3 . 17 D ) . T he b e a m s p li tt e r i s p o s it io ne d at t he c e n t r a l a x i s o r cl o se t o i t , t h e r eb y e li m ina t i ng di v e r ge nc e o f t he r a y s a t t he j u n c t i o n li n e . T h e co ll i m at o r o f t he c r a ni al f i el d s i s st il l t il te d t hr o ug h c o l l a s d i s c u s s e d e a rl ie r . T h e t e c h n i q u e o f u s i n g i n de p e n de nt j a w a nd c o l l t o m a t c h t he c ra ni o s pi na l f ie ld s , h a s t w o a d v a n t a g e s: ( a ) o r t h og o na l fi el d m a t c hi ng i s a c hie v e d w i t h no o v e rl a p s b e t w ee n t h e c r a n i a l an d s p i n a l f i el d s a t a ny d e p t h, a nd ( b ) t he i nd e pe nd e nt j a w c a n b e c o n v e n i e n tl y u s e d to m o v e t he c r a nio s p i nal j unc t io n l i ne ca ud a l l y b y a b o ut a c e n t i m et e r e a c h w e e k d u r i n g t he t r e a tm ent c o ur s e t o s m e a r out t he j unc t i o nal d o s e d i st ri b u ti o n . A s lo n g a s t h e i nd e pe nd ent j a w s pl it s t he c r a nia l f i el d s w i t hi n a f e w c e n t i m et er s o f t h e c e n t r al a x i s , t he d iv e r g e nc e o f t he c r a nia l f i el d s i nt o t he s p i n a l f i el d a t t h e m a tc h i n g l i n e w i ll b e mi nim a l .

C. Guidelines for Field Matching

T h e s i t e o f f i el d m a tch i n g s ho ul d b e c ho s en, i ns o f a r a s p o s s i b le, o v e r a n a r e a t h a t do e s n o t con t a i n t um o r o r a c r it i ca l l y s e ns it i v e o rg a n.

WWW.MEDRAD.IR

F I G . 1 3 . 1 7 . C r a n i o s p i n a l i r r ad i at io n te c hni q ue . A : P a t i e nt s et - up s ho w i ng S t y r o f o a m b lo c k s a n d A l p ha C r a dl e mol d t o p r o vi d e s t ab l e po s it io n f o r a b d o me n , c h e s t , a n d h e a d . B : L at e r al v ie w o f f ie ld s s ho w i ng c r ani a l f ie ld r o t at e d t o al i g n w i t h t h e d i v e r gi ng b o rd er o f t he s p i na l f i el d . C : C o uc h r o t at e d t o p ro v i de m at c h b e t w ee n t he s p i nal f i e ld a nd t he d i v e rg ing b o r d e r o f t h e c r a n i al f ie ld . D : E l i m i nat io n o f c r a nia l f i el d d i v e rg e nc e b y us i ng a n i n d e pe n d e n t j a w a s a b e a m s pl it te r . T hi s pr o v i de s a n al t er na t i v e t o c o uch r o t at io n i n C .

P.294

WWW.MEDRAD.IR

If t h e t u m o r i s s u pe rf i c i a l at t he j unc t io n s i t e , t he f ie l d s s ho ul d not be s e p a r a te d be c a u s e a c o l d s pot o n t he t um or w i l l r i s k r e c ur r e nc e . H o w e v e r , i f t h e d i v e rg i n g fi el d s a b u t o n t he s ki n s ur f a c e , t he y w il l o v e rl a p a t de pt h. In s o m e c a s e s , t h i s m a y b e cl i ni c al l y a c ce p t ab le , p ro v i d ed t he e x c e s s i v e d o s a ge de li v e r ed t o th e u n d e r l y i ng ti s s ue s d o e s no t e x c ee d t he ir t ol e r a nce . In p a r t i c u l a r , t h e t ole r a n c e s o f c r it i c al st ruc t ur e s s uc h a s t he sp i na l co r d m u s t n o t be e x c ee ded . In t he c a s e o f a sup e r f i c i al t umo r w i t h a c r i ti c a l organ l o c at ed at dep t h , o ne may ab ut t he f ie ld s at t he s ur f a c e b ut e l im i n a te b e a m di v e r ge n c e us i ng a b e a m s p li tt e r o r b y ti lt i ng t he b e a m s .

F o r de e p - se a te d t u m or s , t he f i el d s m a y b e s e p a r a te d o n t he s k i n s ur f a c e s o t h a t t h e j u n c t io n p oin t l i e s at t he mi dl i ne. A g a i n, c a r e m us t b e t a k e n i n r e g a r d t o a c r it i c al s t ru c t u r e ne a r t he j unc t io n r e g io n. P.295

T h e l i n e o f f i el d m at ch i n g m us t b e d r a w n at e a c h t re a tm e nt se s si o n o n t he basis of the f i r st fie l d t re a te d . It is no t ne c e s s a r y a na tom i c a ll y to r e p r od u c e t h i s l i n e ev e r y d a y b e c a us e v a r i a ti o n i n it s lo c a ti o n w i l l o nl y s m e a r t h e j u n c t io n p o i n t , w hi c h i s d e s i r ab l e . F o r t he s a m e r ea s o n s o me a d v o c a te m o v i n g t h e j u n c t i o n s it e t wo o r thr e e t im e s d ur i ng a tr e a t me nt course.

A f i e l d - m at c h i n g te c h n i q u e m us t b e v e r i fi ed b y a c t ua l i s od o se d is t r i b ut io ns b e f o re i t i s a do pt e d fo r g e ne r al c li ni c al us e . In a d d i t io n, b e a m a l i g nme nt w i t h t h e li g h t f ie ld an d t he a c c ur a c y o f i so d o se c ur v e s i n t he p e num b r a r e g io n a r e e s s e n ti a l pr e r e q ui si te s .

REFERENCES
1 . P o w e r s W E , K i n z i e J J , D e mi de c k i A J , e t a l . A ne w s y s t e m o f f i el d s ha pi ng f or e x t e r n a l -b e a m r a di a tio n t h e r a p y . R a d i olo g y 1 9 7 3 ;1 08 : 4 07 . 2 . E a r l J D , B a g s h a w M A . A r a p i d m et ho d f o r p re p a r at io n o f c o mp l e x f ie ld s ha p e s. R a d i ol og y 1 96 7 ; 88 : 116 2 . 3 . M a r u y a m a Y , M o o re V C , B u r n s D , e t al . Ind i v i d ua l i z ed l ung s hi e ld s co ns t r uc t ed f r o m l e a d s h ot s e mb ed d e d i n p l a s ti c . R a d io lo g y 1 96 9 ;9 2 : 63 4 . 4 . E d l a n d R W , H a n s en H . Ir r e g u l a r f i el d - sha p i ng f o r 1 9 69 ; 9 2 :1 56 7 . 5 . J o n e s D . A m et h od f o r t h e a c c ur at e ma nuf a c t ur e o f l e a d s hi e ld s . Br J R a d io l 1 9 71 ; 4 4 :3 98 . 6 . P a r f i t t H . M a n u f a c t u r e o f l e a d s hi el d s . Br J R a d i o l 19 71 ; 4 4 :8 95. 7 . K a r z m a r k C J , H u i s m a n P A . M e l t i ng , c a s t i ng a nd s ha p i ng o f l e a d s hie ld i ng b l o c k s : m et h o d a n d tox i c i t y a s p e ct s . A J R 1 97 2 ; 11 4 : 63 6 . 8. Kuisk H. New method to f a ci li t at e ra d i ot he r a p y pl a nni ng a nd t r e a t me nt , i n c l u d i n g a m et h od f or f a s t p r od u c t io n o f sol i d le a d b lo c k s w it h div e r g i ng w al l s f o r c o b a lt 6 0 b e a m . A J R 19 7 3 ;1 1 7 :1 61 .
60

C o t el et he r a p y . R a d iol og y

WWW.MEDRAD.IR

9 . K h a n F M , G e r b i B J , D e ib el F C . D o si m et r y o f a s y m m e tr i c x - r a y c o ll i m at o r s . Me d P h y s 1 9 8 6 ; 1 3 :9 36 . 10. Brahme A. O p tim a l s et ti n g of m ult il e a f c ol li m a to r s in s t a ti o na r y b e am r a d i at io n t h e r a p y . S t ra h l e n t h e r O nk o l 19 88 ;1 6 4 :3 4 3 . 1 1 . B o y e r A L . B a s i c a p p li c a ti o n s o f a m ul ti le a f c o l li m at o r . In: M a c k i e T R , P a l t a J R , e d . T e l et he r a p y : p re se n t a n d f u t ur e . C o l l eg e P a r k , M D : A m e r i c a n A s s o c i a t io n o f P h y s i c i s t s i n M e d i ci n e , 1 9 9 6 . 1 2 . A l mo n d P R , R o o s en b e e k E V , Br o w ne R , e t a l . V a ri a ti o n i n t he p o s it io n o f t he c e n t r a l a x i s m a x i m u m b u i l d u p po i nt w it h f i el d s i z e f o r hi g h e ne rgy p ho t o ns b e a m s [ C o r r e s po n d e n c e ] . B r J R a d i ol 1 9 70 ; 43 : 91 1 . 1 3 . M a r i n el lo G , D u t re i x A . E t u d e do s i m t ri q ue d un f a i s c e a u d e r a y o ns X d e 25 M V ( D o s i m et r i c st u d y o f a 2 5 M V x - r a y b e a m ) . J R a d i o l E le c t ro l 19 7 3 ;5 4 : 95 1 . 1 4 . Jo h n s H E , R a w l i n s o n J A . D e si r a bl e c ha r a c t e ri s ti c s o f hi g h- e ne r g y p hoto ns a nd e l e ct r o n s . In : K r a m er S, S u n t ha r a l i ng a m N, Z i nni g e r GF, e ds . High e ne r g y p h o to n s a n d e l e ct r o n s . N e w Y o r k : J o hn W i l e y & S o ns , 1 9 7 6 : 11 . 1 5 . M a r b a c h J R , A l mon d P R . S c a t t e r ed p hoto ns a s t he c a us e o f the o b s e r ve d d m a x s h i f t w i t h f i e ld s i z e i n h i g h - e n e r g y p ho to n be a m s . M e d P hy s 1 9 7 7 ;4 : 3 10 . 1 6 . P a d i k al T N , D e y e J A . E l e c t r o n c o nt a m ina t i o n o f a hig h e ne rg y x - r a y b e a m . P h y s M e d B i o l 1 9 78 ; 23 : 1 08 6 . 1 7 . B i g g s P J , L i n g C C . E l e c t ro n s a s t he c a us e o f t he ob s e r v ed d m a x s hi f t w i t h f i e ld s i z e i n h i g h e n e r g y p h o to n s b e a m s . M e d P hy s 1 9 7 9 ;6 : 29 1 . 1 8 . V el k l e y D E , M a n s on D J , P u r d y J A , e t al . Bui l d up r eg io n o f me ga v o l t ag e p ho to n r a d i at io n s o u r c e s . M e d P h y s 1 9 7 5 ; 2 : 14 . 1 9 . N il s o n B , M o n te li u s A . F l u e nc e pe r t ur b a t io n i n p ho to n b ea m s und e r no ne q u i li b ri u m c o n d it io n s. M e d P h y s 1 9 8 6 ; 1 3 :19 2 . 20. Rubach A, Conrad F, B i s c he l H. Dose b uil d - up c ur v e s for c o b a lt 60 i r r a di a ti o n s : a s y st em a t i c e r ro r w it h p a nca k e c ha m b e r m e a s ur em e nt s . P hy s M e d B i o l 19 86 ; 3 1 :4 41 . 2 1 . G e r bi B J , K h a n F M . M e a s u r e m e nt o f do s e i n t he b uil d up r eg i o n us i ng f i x ed s e p a r a ti o n pl a n e - p a r al l el io n i z a ti o n c ha m b er s . M e d P hy s 1 9 9 0 ; 1 7: 1 7 . 2 2 . K h a n F M . U s e o f el e c tr o n f il te r t o r e d uce s k i n do s e i n co b al t t e le t he r ap y . A J R 1 9 71 ; 1 11 : 18 0 . 2 3 . K h a n F M , M o o r e V C , L e v i t t S H . E f f e c t o f v a r i o us a t o mi c num b e r a b s o rb e r s o n s k i n d o s e f o r 1 0 - Me V x - r a y s . R a d i o l og y 1 973 ; 1 09 : 2 09 . 2 4 . S a y l o r W L , Q u il li n R M . M e t h o d s f o r t he e nha nc e m e nt o f s k i n s p a r i ng i n c ob a lt 6 0 t el et h e r a p y . A J R 1 9 7 1 ;1 1 1 :1 74 . 25. Gray L. R e l at i ve surface doses f rom s up e r v o lt a ge r a dia t io n. R a d i ol og y 1 9 73 ; 1 09 : 43 7 . 2 6 . R a o P X , P i l l a i K , G r e g g E C . E f f e c t o f s ha d o w t r a y s o n s ur f a c e d o s e a nd b uil d up f o r m e g a v ol t ag e r a di at io n . A J R 1 9 7 3 ; 11 7 : 16 8 . 2 7 . J o h n s H E , E p p E R , C o r m a c k D V , e t a l . D e p t h do s e d at a a nd d ia p hr a g m d e si g n f o r t h e S a s k a t c h e w a n 1 , 0 0 0 c u r ie c o b al t unit . Br J R a d i o l 19 5 2 ;2 5: 3 0 2 . P.296

WWW.MEDRAD.IR

2 8 . R i c h a r d s o n J E , K e r m a n H D , Br uc e r M . S k i n d o s e f r o m c o b al t 60 t el et he r a p y u n i t . R a d i ol og y 1 9 54 ;6 3 : 25 . 2 9 . D o pp k e K , N o v a c k D , W a n g C C . P hy s i c a l c o ns i de r a ti o ns i n t he t r e at m e nt o f a d v a n c e d c a r c i n o m a s o f t h e l a r y n x a nd p y r i f o r m s i nus e s us i ng 1 0 M V x - r a y s . I nt J R a d i a t O n c ol B i ol P h y s 1 9 8 0 ;6 : 12 5 1 . 3 0 . H i n e G J . S c a t t e ri n g o f s e c o nd a r y e l ec t r o ns p r od uc e d b y g a m m a r a y s i n m a t e ri a l s o f v a r io u s a t o mi c n u m b e r s . P hy s R e v 1 9 5 1 ;8 2 :7 5 5 . 31. 32. Hine Leung GJ. Secondary Johns e l e ct r o n Use of e mi s s io n e l e ct r o n a nd effective to a to m i c num b e r s. b uil d up N u c l e o n i c s 19 5 2; 1 0 :9 . PMK, HE. f i lt e r s i mp ro v e t he c h a r a c t e r i st i c s o f l a r ge f i e ld s f r o m c o b al t -60 b e a m s . M e d P hy s 1 97 7 ; 4 :4 4 1 . 3 3 . B u r k e l l C C , W a t s o n T A , J o h ns H E , e t a l . S k i n e f f e c t s o f cob a l t 6 0 te le c ur i e t h e r a p y . Br J R a d i o l 19 5 4 ;2 7 : 17 1 . 3 4 . H u g h e s H A . M e a s u r e m e n t s o f s up e r fi c i al a b s o r be d do s e w it h 2 M V x - r a y s us e d a t g l a n c i n g a n g le s . B r J R a d i o l 19 59 ; 3 2 :2 55. 3 5 . J a c k s o n W . S u r f a c e e f f e c t s o f hi g h- e ne r g y x - r a y s a t o b li q ue i nc i de nc e . Br J R a d i ol 1 97 1 ;4 4 : 10 9 . 3 6 . O r t o n C G , S e i b e rt J B . D e p t h d o s e i n s k i n f o r o b l i q uel y i nc i dent B r J R a d i o l 19 7 2 ;4 5 :27 1 . 3 7 . H a n s o n W F , G r a n t W . U s e o f a u x i l l a r y c o ll i m at i ng de v i c e s i n the t r e a t me nt f o r b r e a s t c a n c e r w it h t a n g e n ti a l beams
60 60

C o r a d i at io n.

C o t el et h e r a p y uni t s . II . D o s e to t he s k i n. A J R 1 9 7 6 ;1 2 7 :6 53 . c o b al t -6 0 gamma rays a nd 4 MV x -r a y s . R a d i ol og y

3 8 . G a g n o n W F , P e t er s o n M D . C o m p a r i so n o f s k i n d o s e s to l ar g e f i el d s us i ng f rom 1 9 78 ; 1 27 : 78 5 . 3 9 . G a g n o n W F , H o r to n J L . P h y s i c a l f a c t o rs a f f e c t i ng a b s o rb ed d o s e t o t he s k i n f r o m c o b al t -6 0 g a m ma r a y s a n d 2 5 - M V x - r a y s . M e d P hy s 1 9 7 9 ; 6 :2 8 5 . 4 0 . G e rb i B J , M ei go on i A S , K h a n F M . D o s e b ui ld up f o r o bl iq ue l y i nc i de nt p ho to n b e a m s . M e d P h y s 1 9 87 ; 1 4 :3 9 3 . 4 1 . L a n c e J S , M o r g an J E . D o s e d i st r ib ut io n b e t w ee n a d j oi ni ng t he r a p y f i e ld s . R a d i ol og y 1 96 2 ; 79 : 24. 4 2 . G l e n n D W , F a w F L , K a g a n R A , e t a l. F i e l d se p a r at io n i n m ul t ip l e p o rt a l r a d i at io n t h e r a p y . A J R 1 9 6 8 ;1 02 : 1 99 . 4 3 . F a w F L , G l e n n D W. F u r t h e r i nv e s t ig a ti ons o f p hy s i c a l a s p e ct s o f m ul t ip le f i el d r a d i at io n t h e r a p y . A J R 1 9 7 0 ;1 08 : 1 84 . 4 4 . P a g e V , G a r d n e r A , K a r z m a r k C J . P h y s i c a l a nd do si m et r i c a s p e ct s o f t he r a d io t h e r ap y o f m a li gn a n t l y m p ho m a s . II. T he i nv e r t ed Y t e c hni q ue . R a di ol og y 1 9 70 ; 9 6 :6 19 . 45. Agarwal SK, Marks at RD, a C o ns t a b l e de pt h WC. for A d j a c e nt t he 8 MV f i e ld s e p a r a ti o n 8) for h o m o ge n e o u s d o s ag e gi v e n ( Mev a t r o n li ne a r

a c c e l e r ato r . A J R 1 9 7 2; 1 1 4 :6 2 3 . 4 6 . A r m s t ro n g D I, T a i t J J . T h e m a t c hi ng o f a d j a c e nt f i el d s in r a d i ot he r a p y . R a d i ol og y 1 97 3 ; 10 8 :41 9 . 4 7 . H a l e J , D a v i s L W, B l o c h P . P o r t a l s e pa r a t io n f o r p a i r s o f p a r a l le l o p po s ed p o rt a l s a t 2 M V a n d 6 M V . A J R 1 9 7 2 ; 1 14 : 1 72 . 48. G ri f f i n TW, Schumacher D, Be r r y HC. A t e c hni q ue for c r a ni al - s p i nal i r r a di a ti o n . B r J R a d i ol 1 9 76 ; 49 : 8 87 .

WWW.MEDRAD.IR

4 9 . W il li a m so n T J . A te c h n i q u e f o r m a t c hi ng o rt ho go na l me g a v ol ta g e f ie ld s . I nt J R a d i a t O n c ol B i ol P h y s 1 9 7 9 ;5 : 11 1 . 5 0 . B u k o v i t z A , De u ts c h M , S l a y t o n R . O rt ho go na l f ie ld s : v a r i at io ns i n do s e v s . g a p s i z e f o r t re a tm e n t o f t h e c e n t r a l ne r v o us s y s t e m . R a d i ol og y 19 7 8 ;1 2 6 :7 95 . 5 1 . G il li n M T , K li n e RW . F i e ld se p a r at io n be t w e e n l a te r a l a nd a nt e ri o r fi el d s o n a 6 M V l i n e a r a c c e le r a tor . I n t J R a d i a t O nc o l Bi ol P hy s 1 9 8 0 ; 6 :2 3 3 . 5 2 . W e r n e r B L , K h an F M , S h a r m a S C , e t a l . Bo r de r se p a r at io n f o r ad j a c e nt o r t h og o n a l f ie ld s . M e d D o s 1 9 9 1 ;1 6 : 79 . 5 3 . H o p f a n S , R e i d A , S i m p s o n L , e t a l. C l i ni c a l c o m pl i c ati ons a r i s i ng f r o m o v e r l ap p i ng o f ad j a ce n t r a di a ti o n f ie ld s p hy s i c a l a nd t e c hni c al c o ns id e r at io ns . I n t J R a d i a t O n c ol B i ol P h y s 1 9 7 7 ; 2 : 80 1 . 54. Van Dyk J, Jenkin RDT, L e ung PMK, et al. M e d ul lo b l a sto m a : t r e at m e nt t e c h n i q u e a n d r a d i ati on d o s i m et r y . I nt J R a d O nc o l Bi o l P hy s 1 9 77; 2 : 9 93 . 5 5 . B e n t el G C , N el s on C E , N o e l l K T . T r e a tm e nt pl a nni ng a nd dos e c a l c ul at io n in r a d i at io n o n c o lo g y , 4 th e d . N e w Y o r k : P e r g a m o n P r e s s , 1 9 8 9 :2 82 .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Th erapy > 14 - E lectron Beam Therapy

14 Electron Beam Therapy

H i g h - e n e r g y el e ct r o n s h a v e b e e n us e d i n r ad i a ti o n t he r a p y s i nc e t he e a rl y 1 95 0 s . O r i g i n al l y , t h e b e am s w e r e e x t ra c t ed mo s tl y f r o m be t at r o ns al t houg h a f e w l i ne ar a c c e l e r ato r s a n d V a n d e G r a a f f ge ne r a to r s w i t h r el a ti v e l y l o w el e c tr o n e ne rg ie s w e r e a l s o a v a il a bl e . In t h e 1 9 7 0 s , hi g h- e ner g y l i ne a r a c c e le r a to rs , ha v i ng p ho t o n a n d m u l t ie n e r g y el e ct r o n b ea m c a p a bi li ti es , b e c a m e i nc r e a s i ngl y a v a i l a bl e f or c l i n i c al u s e . T h e s u r g e i n t h e co m me r c i al d e v e lo p me nt o f t he se m a c hi ne s w a s p r o m pt ed l a r ge l y b y th e c l i n i c a l e x pe r ie nc e g a i ne d a t a f e w m a j or c e nt e r s , w hi c h s h o w e d t h a t i n s o m e c o m m o n l y e nco unt e re d s it ua t io ns t he r e is no a l t er na t i v e t r e at m e n t to el e ct r o n b e a m t h e r ap y ( 1 ) . T h e m o s t cl i n i ca ll y u s e f u l e n e r g y r a ng e f or e l e ct ro ns i s 6 to 20 M e V . A t t he s e e n e r g ie s , t h e e l e ct ron b e a m s c a n b e us ed f o r t re a ti ng s up e r f ic i a l t um o r s ( le s s t h a n 5 c m d e e p ) w i th a c h a r a c t e r i s t i c al l y s ha r p d r o p - o f f i n do s e b e yo nd t he t u m o r . T h e p r i n c i p al a p p li c a ti o n s a r e ( a ) the t r e a t me nt o f s k i n a nd l i p c a nc e r s , ( b ) c h e s t w a l l i r r ad ia t io n f o r b r e a s t c a nc e r , ( c ) a d m i ni s te r i ng b o o st d o se to n o d e s , a n d ( d ) t h e t re a t m e nt o f he ad a nd ne c k c a nc e r s . A l t ho ugh m a ny o f t he s e s i t e s c a n b e t r e at ed w i t h s u p e r f i c i al x - r a y s , b r a c hy t he r a p y , o r t a ng e nti a l p hot o n b e a m s , t h e el e ct r o n be a m i r r a di a ti o n o f f e r s d i s ti nc t a d v a nt a ge s in t e r m s o f d o se u n i f o r m i t y i n t h e t a rge t v o l u me a nd i n m i nim i z i ng d o se to d e ep e r t i s s ue s . This chapter is i nte n d e d to pr o v id e ba s i c i nf o r m a ti o n on e le c t ro n be a m c h a r a c t e r i st i c s , d o si me t r y , a n d t r e at m e nt p l a nni ng . M o st o f t he di s c us s i o n w il l p e r t ai n to 6 - t o 20 -M e V e le c t ro ns , a lt ho ug h t he d a t a a t t he se e ne r gi e s c a n be q u a l it a ti v e l y e x t r ap ol at e d t o t h e l o w e r o r t he hi g he r e ne r g y r a ng e.

14.1. ELECTRON INTERACTIONS

A s e l e ct r o n s t r a v e l t hr o u g h a m e di um , t hey i nt e r a ct w i t h at o m s b y a v a r i et y o f p r o c e s se s o wi n g to C o u l o mb f o r ce i nte r a c ti o ns . T he p r o ce s s e s a r e ( a ) i nel a s tic c o ll i si o n s w i t h a t om i c e l e ct r o n s ( io ni z a ti o n a nd e x c i t a ti o n) , ( b ) i ne l a s ti c c ol li s io ns w i t h n u c l e i (b r e m s st ra h l u n g ) , ( c ) e l a s ti c co ll i si o ns w it h a to m i c e l e ct r o ns , a nd (d ) e l a s ti c c ol li s io n s w i t h n u c l e i . In i n e l a s t i c co ll i si o n s , s o m e o f t h e k i net i c ene r g y i s lo s t a s it i s us e d i n p ro d uc i ng i o n i z a ti o n o r co n v e r te d t o ot h e r f o r m s o f e ne r g y s uc h a s p hot o n e ner g y a nd e x c i t at io n e n e r g y . In e l a s ti c co ll i si o ns , k i net i c e ne r g y i s not lo s t a l t ho ug h i t m a y b e r ed i st r ib u t ed a mon g t h e p a rti c l e s e me rg i ng f r om t he c ol li s ion. In l o w a t o mi c n u m b e r m e d i a s u c h a s w a t e r o r ti s s ue s , e l e ct r o ns lo s e e ne rg y p r e do m i na nt ly t h r o u g h i o n i z i n g e v e nts w i t h a t o m i c el e ct r o ns . In hi g he r a t o m i c num b e r m a te r i al s , s u c h a s l e a d , b r e m ss t r a h l u n g p r o d uct io n i s m o r e i m po r t a nt . In t he c o l l i si o n p r o c e s s w it h t h e a t om i c e le c t ro n s , i f t he k i ne t i c e ne rg y a c q ui re d b y t he s t r ip p ed e l e ct r o n i s l a rg e e no u g h f o r i t t o c a us e f urt he r io ni z a ti o n, t he ele c t ro n i s k no w n a s a s e c o n d a r y e l e ctr o n o r a - r a y . A s a b e a m o f e le c t ro ns t r a v e l s t hr o ug h a

WWW.MEDRAD.IR

m e d i u m , t h e e n e rg y i s c o n t i n u a ll y d e g r ade d unt i l t he e l e ct ro ns r e a c h t he r m a l e n e r g ie s a n d a r e c a p tu r e d b y t h e s ur r o und ing a t o m s .

A. Rate of Energy Loss

A n e l e ct r o n t r a v el i n g i n a m e di um l o s e s e ne r g y a s a r e s ul t of c o ll i si o na l a nd r a d i at i v e p ro c e s se s . T h e m a g n i t ud e s o f t he t w o e f f e c t s f o r w a te r a nd l e a d a re shown in Fig. 14.1. P.298 T h e t h e o re ti c a l t re a tm e n t o f t h i s s ub j e ct i s g i v e n e l s e w he re ( 2 , 3 , 4 , 5 ) . It w i ll s u f f i c e h e r e t o p ro v i de s o m e im p or t a nt ge ne r a li z a t io ns .

F I G . 1 4 . 1 . R a t e o f e n e r g y l o s s i n M e V p e r g / c m 2 a s a f unc t i o n o f e l e ct r o n e ne rg y f o r w a t e r a n d l e a d . (F r o m J o h n s H E , C un n i ng ha m J R . T he p h y s i c s o f r a d i ol og y , 3 r d e d . S p ri n g f i el d , IL : C h a r l e s C T ho m a s , 1 9 6 9 , w i t h pe r m i s si o n.)

A.1. Collisional Losses (Ionization and Excitation)

( a ) T h e r a t e o f e n e rgy l o s s de pe nd s o n t he e le c t ro n de ns i t y o f t he m ed i um . ( b ) T h e r a t e o f e n e r g y lo s s p e r g r am p e r c ent i m et e r s q ua r ed , w hi c h i s c a l le d t he m a s s s t op pi n g po w e r , i s g re a te r f o r l o w at om i c num b e r ( Z ) m at e ri a l t ha n f o r hi g h Z m a t e r i a l s ( co m p a re t h e w a t e r c ur v e t o the l e a d c ur v e i n F i g . 1 4 . 1 ) . T he r e a r e t w o r e a so n s f o r t h i s : F i r s t , h i g h Z m a t e ri a ls ha v e f e w e r e l e c t ro ns p e r g r a m t ha n l o w Z m at e ri a l s h a v e a n d , s e co nd , hi g h Z m a t e ri a l s ha v e mor e ti g htl y bo und e l e ct r o n s , w h i c h a r e n o t a s a v a il a bl e fo r thi s t y p e o f i nt e r a ct ion. ( c ) A s s e e n i n F i g . 1 4 . 1 , t h e e n er g y l o s s r a te f i r s t de c r e a se s a nd t he n i nc r e a s e s w i t h i nc r e a s e i n

WWW.MEDRAD.IR

e l e ct r o n e n er g y w i t h a m i n i m u m o c c ur r i ng a t a bo ut 1 Me V . A b o v e 1 Me V , t he v a r i a t io n w it h e n e r g y i s v e r y g r a d ua l . ( d ) T he e ne r g y lo s s r ate o f e le c t ro ns o f e n e r g y 1 M e V a n d a b ov e i n w a t e r i s r o ug hl y 2 M e V / c m .

A.2. Radiation Losses (Bremsstrahlung)

T h e r a t e o f e n e r g y l o s s p er c e nt i me te r i s a p p ro x i m a te l y p rop o rt io na l t o t he e l e ct r o n e n e r g y a n d t o t h e s q u a r e o f t he a t o mi c num b e r ( Z 2 ). M o r e o v er , t he p r o b ab il it y o f r a d i at io n l o s s r el a ti v e to the c o l li s io na l lo s s i nc r e a s e s w i t h t he e l e ct r o n ki n e ti c e n e rg y a n d w it h Z . T ha t m e a ns t ha t x - r a y p rod uc t io n i s m o re e f f i c i e n t f o r h ig h e r e n e r g y e le c t ro ns a nd hi g he r a t o mi c num b e r a bs o r b e r s . P.299

A.3. Polarization
A h i g h - e n e r g y e le c t ron l o se s mo r e e ne rg y p e r g r a m p e r s q ua r e c e nt i me te r i n a g a s t h a n i n t r a v e r si n g a m o r e d e ns e me d i um , b e c a us e o f a pp r e cia b l e p ol a r i z at io n o f t h e co n d e n s e d m e di u m ( 5 , 6 , 7 ) . At o m s clo s e t o t he el e ct ro n t ra c k s c r e e n t ho se r e m ot e f ro m t h e t r a ck . T h i s p h e no m e no n is p a r ti c ul a rl y i mp o rt ant i n do s im e tr y w i t h io n i z a t io n c h a m be r s w h e n e ne r g y d epo s it io n i n a m ed i um a nd a g a s c a v it y a r e c o m p a re d . T h e ra t io o f m a s s s to p pi ng p o w e r o f w a t e r to a i r v a r i e s w i t h e l e ct r o n e n e rg y , and c o n s e q u e ntl y , t he dose co nv e r s io n factor for an air i o n i z a ti o n c h a m b e r i n w a t e r ( o r a not he r c o nd e ns e d m ed i um ) v a r i es w i t h d e p t h.

A.4. Stopping Power

T h e t ot al m a s s s to pp i n g p o w e r ( S / ) t o t of a m a te r i al fo r c har g e d p a rt i cl e s i s d e f i n e d b y t h e In t e rn a t i o n a l C om m i s si o n o n R a d i a ti o n U nit s a nd M e a s ur e m e nt s ( IC R U ) ( 8 ) a s t h e q u ot i e nt o f d E b y dl , w he r e d E i s t he tot a l e ne r g y lo s t b y t he p a r t i cl e i n t r a v e r s i n g a p a t h l e n g t h dl i n t he m a t e r i al o f d e ns it y .

where

(S/)col

and

(S/)rad

a p pl y

to

co lli s io na l

lo s s e s

a nd

ra d i a tio n

l o s se s ,

r e s p e ct i v el y , d i s c u s s ed i n p r e v i o u s s e ct io ns A . 1 a nd A . 2 .

A.5. Absorbed Dose

In c a l c u l a t i n g t h e e n er g y a b s o rb ed pe r uni t m a s s ( a b so r be d d o se) , o ne ne ed s t o k n o w t h e e l e c t ro n f l u e n c e a n d t h e r e s t r i c ted c o l li s io n s t o pp i ng po w e r . R e s t ri c te d c o ll i si o n s to p pi n g p ow e r r e f e r s t o t he l i nea r e ne r g y t r a ns f e r ( L E T ) c o nc e p t , t h at i s , t h e r at e o f e n e r gy l o s s pe r uni t pa t h le ng t h i n c ol li s io ns i n w hi c h e ne r g y i s l o c a ll y a b s o rb e d , r at h e r t h a n c a r r ie d a wa y b y e ne r g et i c se c ond a r y e l e ct r o ns . T h u s t h e r e s t r i ct e d c o ll i si o n m a s s s to pp ing p o w e r , ( L / ) c o l , of a m a t e r i al f or c h a r g e d p a rt i cl e s i s d e f i n e d (8 ) a s t he quo t ie nt o f d E b y d l , w he r e d E i s t he e n e r g y lo s t b y a c h a r g e d p a r ti c le i n t r a v e rs i ng a d i st a nc e dl a s a r e s ult o f t ho se c o ll i si o n s w i t h a to m i c e l e ct r o n s i n w hi c h t he e ne r g y l o s s i s le s s t h a n .

If E i s t h e d i f f e r e n t i at e d di s t ri b u tio n o f f l ue nc e w i t h r e s p e ct to ene r g y

WWW.MEDRAD.IR

, t h e a b s o r be d do s e , D , i s c l o s e l y a pp r o x i ma t e d b y :

T h e u s e o f s to p pi n g po w e r s i n p ho to n a nd e l e ct r o n d o si m et r y ha s b e e n di s c us s ed i n C h a p t e r 8 . Q u a n tit a ti v e d at a o n st o pp ing p o w e r s a s a f unc t io n o f e le c t ro n e n e r g y f o r v a r io u s e le m e n t s a n d m at e ri a l s ha v e b e e n c a l c ul a ted b y Be r g e r a nd S e l t z e r ( 9 , 10 , 1 1 ) a n d t ab u l a te d i n T a bl e A . 8 o f t he ap p e ndi x. M o r e e x t e nsi v e t a b le s o f s to p pi n g p ow e r s a r e g i v e n b y t he IC R U ( 1 2 ) .

B. Electron Scattering
W h e n a b e a m o f e l e c tr o n s p a s s e s t hr o ug h a m e d i um , t he e le c t ro ns s uf f e r m ul t i ple s c a t te r i n g d u e to C o u l o mb f o r c e i nte r a c ti o ns b e t w e e n t he i nci d e nt e l e ct ro ns a n d , p r e do m i n a n tl y , t h e n u c l e i o f t h e me d i um. A s a r e s ult , t he el e c tr o ns a c q ui r e v e l o ci t y c o mp o n e n t s a n d d i s pl a c e me nt s t ra ns v e r s e t o t he i r or ig i na l di r e ct io n o f m o ti o n . F o r m o st p ra c t i c al a p pl i c at io ns , t he a ng ul a r a nd s p a t i al s p r e ad o f a narrow, P.300 c o ll im a te d be a m of el e ct r o ns c an be ap p ro x i m at e d by a G a us s i a n d i s t ri b u tio n ( 1 3 ) .

B y a n a l o g y w it h m a ss s t op pi n g po w e r , t he IC R U ( 8 ) de f i ne s the m a s s a ng ul a r s c a t te r i n g po w e r o f t he m a t e ri a l a s t he q uo ti e nt

/l, where

i s t h e m e a n s q u a r e s c a t te r i n g a ngl e . F oll o w i ng t he c a l c ul a ti o ns o f R o s s i (1 3 ) ,

m a s s s c a t t e ri n g p o w er s f o r v a r i o us m a t e r ia l s a nd e l e ct r o n e ne rg i e s ha v e b e en t a b u l at e d ( 14 ) . T h e s c a t t e ri n g p o w er v a r i e s a p p ro x i m at e l y a s t he s q ua r e o f t he a t o mi c num b e r a n d i n v e r s e l y a s t h e s q u a r e o f t he k i net i c e ne rg y . F o r t hi s r e a s o n, hi g h Z m a t e ri a l s a re u s e d i n t h e c o n s t r uct io n o f sc a t t er i ng f oi l s . S c at ter i ng f o il s s p re a d o u t t h e e le c t ro n b e a m t h a t e m e r ge s f r o m t he a c c e l e r at or t ub e a nd a r e m a d e t hi n t o m i ni m i z e x - r a y c o n t a m i n a ti o n o f t he el e ct r o n b e a m .

14.2. ENERGY SPECIFICATION AND MEASUREMENT

Although an e l e ct r on beam is a l mo s t m o no e ne rg et i c be f o r e s tr i k i ng t he a c c e l e r ato r w i n do w , th e r a n d o m e ne r g y deg r a d a ti o n t ha t t he ele c t ro ns s uf f e r a s t h e y p a s s t h r o u g h t h e e x it w i n d o w , s c a tt er i ng f o il , m o nito r c ha m b e r s , a i r , a nd o t h e r m at e ri a l s r e s u lt s i n t h e b e a m t a ki ng o n a s p e c t r um o f e ne r g ie s a t t he p h a n t o m s u r f a c e . F u r th e r d e gr a d a tio n a nd sp r e a d o f be a m e ne r g y t a k e p l a ce w it h d e pt h i n t h e p h a n t o m ( F i g . 1 4 . 2 ) . In c l i n i c a l p r a c ti c e , an e l e ct r o n b e a m i s us ua l l y c ha r a c t e ri z e d b y t he e ne r g y at t h e b od y s u r f a c e . T h e r e a r e s e v e ra l me t hod s t ha t c a n b e us ed to d et e r mi ne t hi s energy: m e a s u re m e nt of t h r e s hol d e ner g y for nuc l e a r r ea c t io ns ; r a ng e m e a s u r e m e n t s ; a n d th e m e a s u r e me nt o f C e r e nk o v r a di a ti o n t hr e s ho ld ( 14 ) . O f t h e s e , t h e r a n g e m et ho d i s t h e mo s t p ra c ti ca l a nd c o nv e ni e nt f o r c l i ni c al us e .

WWW.MEDRAD.IR

F I G . 1 4 . 2 . D i s t ri b u tio n o f e le c t ro n f l ue nc e i n e ne r g y , E , a s the b e a m p a s se s t h r o u g h t h e c o ll i m at ion s y s t e m o f t he a c c e l e r a to r a nd t he p ha nt om . ( F r o m IC R U . R a d i a ti o n d o si m et r y : e l e ct r o n s w i t h i ni ti al ene r g i e s be t w ee n 1 a nd 50 M e V . Re po rt No. 21. W a s h i n g to n , DC: In t e r na t i o na l C o m m i s si o n on R a d ia t io n U ni t s a nd M e a s u r e m e n t s , 1 97 2 , w i t h p e r mi s s io n. )

WWW.MEDRAD.IR

F I G . 1 4 . 3 . D e pt h - d o se c u r v e i l l u s t r at i ng t he d e f i nit io n o f R p a nd R 5 0 . P.301

A. Most Probable Energy

T h e N o r d i c A s s o c i at ion o f C l i n i c a l P hy s i c s ( 1 5 ) r e c om m e nd s t he s p e c i f i c at io n o f m o s t p ro b ab le e n e r g y, ( E p ) 0 ( d e f i ne d b y t he p o si ti o n o f t he s pe ct r a l pe a k i n F i g . 1 4 . 2 ) a t t h e p h a n t o m s u r f a c e a n d t he us e o f t he f o l lo w i ng r el a ti o ns hi p :

w h e r e R p i s t h e p r a ct ic a l r a n g e i n c e nt i me te r s a s d e f i ne d i n F ig . 1 4 . 3 . F o r w a t e r, C 1 = 0 . 2 2 M e V , C 2 = 1 . 9 8 M e V c m - 1 , a nd C 3 = 0 . 0 0 25 M e V c m - 2 ( 1 6 , 1 7 ,1 8 ) . T he y f u r t h e r r e c o m m e n d t h a t t h e f i el d s i z e f o r r ang e m e a s ur e m e nt s be no l e s s t ha n 1 2 1 2 c m f o r e n e r gi es u p to 1 0 Me V a nd no le s s t ha n 2 0 2 0 c m f o r hi g he r e n e r g ie s . F o r t h e d et e r mi n a t ion o f r a n g e , io n c ha m b e r s , di od e s , o r f i lm m a y b e us ed . A l t h o u g h t h e r a n g e m e a s u r e m e n t s a r e usua l l y m a de us i ng t he d e pt h io ni z a ti o n c u r v e t h e r e s u l t i s on l y s l i g h tl y d i f f e r e nt f r o m w ha t w o ul d be o bt a i ned us i ng d e pt h d o se c u r v e s (19 ) . T h e p r a ct i c al r a nge , R p , i s t he de pt h o f t he p oi nt w he r e the tangent to t h e d e s c e n di n g l i ne a r por t io n o f t he c ur v e (at t he p oi nt of i n f l e c ti o n ) i n te r s e ct s th e e x t r a p ol a te d b a c k gr o und , a s s ho w n i n F i g . 1 4 . 3 . T o be i n s t ri c t a c c or da n c e w i t h E q uat io n 1 4. 4 , e a c h po i nt o n t he d e pt h io ni z a ti o n c u r v e s h o u l d b e c o r re c t ed f o r b e a m di v e rg e nc e b e f or e t he r a ng e i s d et e rm i ne d . T h e c o r r e c ti o n f a c t or is

, where

f i s t h e e f f e c t i ve

s o u r c e- to - s ur f a c e

di s t a nc e

( se e s ec t io n 1 4 . 4 E fo r R p i s c l i ni c al l y n ot

d e t ai l s ) a n d z i s t h e d e pt h . H o w e v e r , thi s c o r r e ct io n i n

s i g n i f i c a n t i n t e r m s o f i t s i m p a ct o n t he io niz a t i o n to d o se c o nv e rs i o n f a c t o r ( 20 ) .

B. Mean Energy
It h a s b e e n s h o w n ( 2 1 ) t h a t t h e m e a n e ner g y o f t he e l e ct r o n be a m , 0 , a t t he p h a n t o m s u r f a c e i s re l a te d t o R 5 0 (t he d ep t h a t w hi c h t he d o se i s 5 0% o f t he m a x i m u m d o s e ) b y t he f o l lo w i n g r el a ti o ns hip :

w h e r e C 4 = 2 . 3 3 M e V c m - 1 f o r w a t e r . A g a i n t he di v e r ge nc e co r r e ct io n i s a p pl ie d to e a c h p o i n t o n t h e d e pt h d o s e c u r v e b e f o re d e te r m i ni ng R 5 0 . The AAPM TG-21 p r o to c ol r e co m m e nde d t he v a l ue of C4 as 2.33 MeV cm-1. H o w e v e r , m o r e r e ce n t M o n t e - C a r l o c al c ul a tio ns o f R o g e r s a nd Bi el a j e w ( 2 2 ) ha v e s h o w n t h a t t h e v a l u e o f C 4 i n t h e e ne r g y r ang e o f cl i ni c a l i nte r e st i s c lo s e r to 2 . 4 MeV cm-1. P.302 A g a i n , t h i s s m a ll c h a n g e i n t h e v a l ue o f C 4 a s w e l l a s t he d i ve rg e nc e c o r re c ti o n m e n t io n e d a bo v e h a s l it tl e i mp a c t o n c li ni c al d o si m et r y ( 2 0 ) .

WWW.MEDRAD.IR

C. Energy at Depth
H a r d e r ( 23 ) h a s s h ow n t h a t t h e mo s t p ro b a bl e e ne r g y a nd , ap p r o xi m a te l y , t he mean energy of the spectrum d e c re a s e s l i ne a r l y with d ep t h. T hi s can be e x p r e s s ed b y t h e r e l ati o n s h i p s :

a n d a p p r o x i m at el y :

where z is the depth. E q u a t i o n 1 4 . 7 i s i m por t a n t i n d o si m et r y be ca us e f o r a b so r be d d o se m e a s ur e me nt s i t i s n e c e s s ar y t o k n ow t h e m e a n e l e c t ro n ene r g y a t t he l o c ati o n o f t he c ha m b e r .

14.3. DETERMINATION OF ABSORBED DOSE

C a l o r im e tr y i s t h e m os t b a si c me t hod f or t he de t er m i na ti o n o f a bs o r b ed do s e , b ut b e c a u s e o f te c h n i c a l d i f f i c u l ti e s , t he us e o f c a l o ri m et e r s i s no t p r a ct i c al i n a c l i n i c al s e tt i n g . Io n i za t io n c h a m b e r s a nd F r i c k e d o si m et e r s a re m o r e c o m mo nl y u s e d . F i l m , t he r m ol u m i n e s c e n t do si m et e r s ( T L D ) , a nd s o li d st a te d io de s a r e us ed t o f i n d t h e r at io o f th e d o se at o ne p oi nt i n a p ha nt o m to t he d o se at a not he r p o i nt b u t n o t u s u a l l y to m e a s u r e t he a b so l ute a b s o r be d do s e at a p o i nt . Io n i z a t i o n c h a m be r s should be c a li b r at ed by an A c c r e di t ed Dose C al ib r a ti o n L a b o r at or y ( A D C L ) o r t h e N a t io n a l Ins t i t ute o f S t a nd a r d s a nd T e c hno l o g y ( N IS T ) . H o w e v e r , a n A D C L c a n u s u a l l y p r o v i d e ca lib r a t io ns o nl y f o r high- e ne r g y p ho to n b e a m s ( 6 0 C o o r 2 - M V x - r a y s ) b u t no t f o r hig h- e ne r g y el e ct r o n bea m s . T he us e o f i o n i z a ti o n c h a m be r s c a l i br a t ed for p hot o n b ea m s for t he m e a s ur e m e nt of a b s o r be d d o se i n e lec t r o n be a m s ha s b een t he s ub j e ct o f m any na t i o na l a nd i n t e r n a ti o n al p ro to c ols ( 1 4 , 15 , 2 4 ,2 5 , 26 ) . The m o st c ur r e nt r e com m e nd a ti o ns a re i n c l u d e d i n t h e p r oto c ol s b y T a s k G r o up 5 1 o f t he A me r i c an A s s o c i a tio n o f P h y s i c i s t s i n M e di c i n e ( A A P M ) ( 2 4 ) a nd t he Int e r na ti o na l A to m ic E ne r g y A g e nc y ( IA E A ) T R S 3 9 8 ( 25 ) . E l e m e n t s o f t he se p rot o co l s a nd o t he r r e l ate d c o nc ep t s w e re p r e s e n te d i n C h a p t e r 8 .

A. Output Calibration
T h e v a r i a ti o n o f o u tp u t ( a b so r be d d o se a t a r e f e r e nc e p oi nt i n p hant o m ) w it h f i el d s i z e d i f f e r s c o n si d e r ab l y f r o m o n e t yp e o f a c c e l e r ato r t o a not her . T he r e f o r e , f o r e v e r y a v a i l a bl e el e ctr o n e n e r g y , t he o utp ut o f e a c h t r e at m ent a p p li c a to r o r r e p r e se n t a ti v e f ie ld si z e s h o u l d b e m e a s ure d . T he o ut p ut f or one a p p li c at o r o r f i e l d si z e ( o f te n t h e 10 1 0 c m f i e ld ) , i s se l e ct ed a s t he s t a nd ar d t o w hi c h t he o t h e r o u t p ut m e a s u r em e n t s a r e r e f e r re d . Si nc e t he b e a m i s c al ib r a t ed to gi v e 1 c G y / M U f o r t h e s t a n da r d a p pl i c at o r a t t he d e pt h o f m a x i m um dos e o n c e nt r al a x i s ( n o m i n a l S S D = 1 00 cm ) , t h e o u t p ut f a c to r f o r a ny a p pl i c at o r r epr e s e nt s c G y / M U a t d m a x . T h i s t o pi c w i ll b e f u r t h e r d i s c us s e d in s e c t i o n 1 4 .4 D .

B. Depth-dose Distribution
T h e d e pt h- do s e a n d is o d o se d i st r ib ut io ns c a n b e d et e r mi ne d by i o n c ha m be r s , d i od e s , o r f il m s . A u to m a ti c i s o do s e a nd is o d e ns it y pl ot te r s a re us e f ul i n t hi s r e g a r d a n d a r e a v a il ab l e co m m e r ci a ll y .

WWW.MEDRAD.IR

P.303

B.1. Ionization Chambers

D e pt h i o n i z at io n c u r v e s o bt a i n ed w it h a i r io ni z a t io n c ha m b e r s ca n b e c o nv e r ted i n t o d ep t h- do s e c u r v es b y m a k i n g c o r re c ti ons f o r c ha ng e i n s to pp i ng p o w e r r a tio o f w a t e r to ai r wi t h de p t h . In a d di ti o n, p e rt ur b a ti o n a nd di s p l a cem e nt co r r e ct io ns a r e r e q u i re d f o r c y l i n dr i c a l c h a m b e r s . A g e n e r a l e q u a ti o n fo r ob t ai n i n g pe r c e nt d e pt h d o se i n w a te r ( % D W ) f r om io n c h a m b e r m e a s u r e m e nt s m a d e i n a ny m e d i um o r p ha nt o m i s gi v en b y t he f o l l o w i ng e q u a t io n ( 2 0 ) :

w h e r e t h e q u a n ti ti e s i n t h e n u m e r a to r a re d e te r mi ne d at t he e ff e c t i v e d ep t h o f m e a s u r e m e n t a n d t he d e n o m i n at o r eq ua ls t he v a l ue o f t he num e r a t o r a t t he d e pt h o f m a x i m u m d os e .

B.2. Silicon Diodes

S i l i co n p - n j u n c ti o n dio d e s o f f e r so m e a d v ant a g e s i n te r m s o f s ma l l si z e a nd hi g h s e n s i ti v i t y ( C h a p te r 8 ) . H o w e v e r , di od e s s uf f e r f r o m e ne r g y a nd t e mp e r at ur e d e pe n d e n c e and can be d a m a g ed by r a d i a ti o n. For t he se r e a s o ns a b s ol u t e d o s im e tr y w i t h di o des i s n o t re c om m e nde d . D o se di s t ri b uti o ns o bt a i ne d wi t h d i od e s s h o u ld b e c h e ck e d b y i o n c ha m b e r me a s ur e m e nt s . B e c a u s e t h e v a r i at ion o f s i li c o n to w a ter s t op p i ng p o we r r a ti o w it h el e c tr o n e n e r g y i s q u it e m i n i ma l ( ~ 5 % be t w ee n 1 and 2 0 M e V ) , m e a s ur em e nt s m ad e wi th a d io d e m a y b e u s e d d i r e ct l y t o g i v e d ep t h- d o s e d i st r ib ut io ns . F ig ur e 1 4 .4 s ho w s a c o m p a r i so n o f d e pt h P.304 d o s e di s t ri b u ti o n s o bt a i n e d w it h a n io n cha m b e r ( co r r e ct e d f or s to p pi ng po w e r r a t io s a n d o t h e r e f f e cts ) a n d a d i o d e . T he da t a s ho w c l o s e a gr e em e nt .

WWW.MEDRAD.IR

F I G . 1 4 . 4 . C o m p a r i so n o f d e pt h - d o se c ur v e s m e a s ur e d w it h a d i od e a nd a n i o n c h a m b e r . W h e r e a s t he d io d e re s po ns e w a s unc o r r e c t ed , t he cha m b e r r e a di ng s w e r e c o r re c t ed f o r c ha n g e i n ( [ L w i t h b a r ab o v e ] ) w a t e r a i r a s a f unc t i o n o f d ep t h, a nd t h e di s p l a ce m e n t o f th e e f f e c t i v e po i nt o f m e a s ur e m e nt . ( F ro m K ha n F M . C l i ni c a l e l e ct r o n be a m do s i met r y . In : M o no g r a p h N o . 1 5 . K e r i a k e s J G , E l so n H R , Bo r n C G , eds. R a di a ti o n o n c olo g y p h y s i c s 1 98 6 . AAPM M o no g r a p h No . 15. Ne w Y or k : A m e r i c a n In s t i t u te o f P h y s i c s , 1 9 8 6 : 21 1 , w it h p e r m i s si o n. )

B.3. Film
F i l m d o si m et r y o f f e r s a c o n v e n i e nt a nd r ap id m et ho d o f o bt a i ni ng a c om p le te se t o f i s od o se c u r v e s i n th e p l a n e o f t he f il m . It s us e f o r d et e r mi ni ng e le c t ro n b e a m d o s e di st r i b ut io n s i s w e l l e st a bl i s he d (2 7, 2 8 , 2 9 ) . It ha s b e e n s ho w n t ha t t he d e pt h d o s e d i st r i b ut io n s m e a s u r e d b y us ing f i l m a g r ee w e ll w i t h t ho se b y i o n c h a m b e r s w h e n t h e la t t er m e a s ur e me nt s a r e c o r re c te d a s o utl ine d i n s e ct io n A ( F i g . 1 4 . 5 ) . G oo d a g re e m e n t h a s a l so b ee n d e m o ns t r at ed b et w e en f i l m a nd F e S O 4 d o s im e te r s u s e d f o r t h e m e a s u r e m e nt o f d e pt h d o s e c ur v e s ( 2 9 ) . T he e ne r g y i n d e pe n d e n c e o f f il m m a y b e e x pl a i ne d by t he f a c t t ha t t he ra t io o f c ol li s io n s t o pp i n g p o w e r i n e mu l s i o n a n d i n w a t e r va r i e s s lo w l y w it h e l e ct r o n e ne rg y ( 9 ) . T h u s t h e o p ti c a l d e n s it y o f t h e fi l m ca n b e ta k e n a s p r o po rt io na l to t he d o se w it h e s s e n t i al l y n o c o rr e c tio n s . F i l m i s u s e f u l f o r a va r i et y o f d o si m et r y pr o b le m s s uc h a s d et er m i ni ng p r a c ti c al r a n g e , i s od o se c u r v e s, a n d b e a m f l at ne s s . H o w e v e r , f i l m c a nnot b e us e d re li a bl y f o r a b s ol u t e do s im et ry b e c a u s e t he op ti c a l d e ns i t y o f a f i l m e x pos e d to e le c t ro ns d e pe n d s o n m a n y v a r i a b l e s s u c h a s e m ul s ion, p r o c e s s i ng c o ndi tions , m a g ni t ud e o f a b s o r be d d o se , a n d so m e me a s u r e me nt cond i t io ns , w hi c h c a n g iv e r i s e to s e ri o us

WWW.MEDRAD.IR

a r t i f a c t s . T h e u s e o f f i l m i s , t he r e f o re , r e st r i ct e d to re l at i v e dos i m et r y . C a r e i s r e q u i r ed to a v o i d a ir g a p s a d j a c e nt to t he f i l m . In a d d i t io n, the s e ns i t o me t ri c c u r v e ( o p ti c a l de n s i t y a s a f u n c t i o n o f a b s or b e d do s e ) m us t be k no w n t o i nt e rp r et t h e o p ti c a l de n s i t y i n t e rm s o f a b so r b ed do s e . W he re v e r p o s si b le , a f il m wi t h a l i n e a r re s po n s e o v er t h e r a n g e o f m e a s ur ed d o se s ho uld b e us ed . E r r o r s c a us e d b y c h a n g e s i n t h e p roc e s s i n g co n d it io ns c a n b e mi ni mi z e d b y de v e l op i ng t he fi l ms at P.305 a p p r o xi m a te l y t h e s am e t im e . A c c ur a c y c a n a l s o b e i m p ro v e d by us i ng f i l m s f r o m the same batch.

F I G . 1 4 . 5 . C o m p a ri so n o f ce n t r a l a x i s d ep t h do s e c ur v e m e a sur e d w it h a n i o n c h a m b e r , f i lm , a n d F eS O 4 d o si m et e r . ( F ro m A l m o nd P R . In: H a nd b o ok o f me di c al p h y s i c s , V o l 1 . B o c a R a t o n , F L : C R C P r e s s , 1 9 82 : 1 73 , w i t h p e r mis s i o n. )

WWW.MEDRAD.IR

F I G . 1 4 . 6 . F i l m a r ti f ac t s c r e at ed b y m i s al i gnm e nt o f t he f il m i n the p ha nt o m . T he effects of (A) ai r ga p s b et w e e n t he f ilm a nd t he p ha nt o m , (B) film ed g e e x t e n d i n g b e y o n d t h e p h a n t o m , a nd ( C ) f i lm e d g e re c e s s ed w i t hi n t he p ha nt o m . ( F r o m D u t re i x J , D u t re i x A . F i l m do s i me t r y o f hi g h e ne r g y e le c t rons . A n n N Y A c a d S c i 1 9 69 ; 1 61 : 33 , w i t h p e r m i s si o n . ) F i l m c a n b e p o si ti o n ed e it h e r p e r pe nd i c ular o r pa r a ll el to t he be a m a x i s . In t he l a tt e r c a s e , pr e c a u ti on s m u s t b e t a k e n to a l i g n t he t op e dg e o f t he f i l m w it h t he surface of the phantom or se r io us a r ti fa c t s a nd er r o r s in t he de p t h- do s e d i s t ri b u tio n m a y r e s u l t ( 2 8 ) ( F ig . 1 4 . 6 ) . T o o bt a i n i s o do s e c u rv e s , t h e f i l m i s us ua l ly p l a c e d i n a p l a st i c p ha nt o m s uc h a s p o l y st y r e n e a n d o ri e nt e d p ar a ll e l t o t he b ea m a x i s . T he f i l m c a n b e k e p t i n it s o r i gi n a l p ap e r j a c k et a n d p r e s s e d t ig ht l y be t w e e n t he p ha nt o m sl a b s . S m a l l hol e s c a n b e p u n c h e d i n t he c o r n e r s o f t he j a c ke t f or t r ap p ed ai r to e s c a p e . T he fi l m w r a p p i n g t h a t e x t e n ds b e y o n d t he p ha nt om s ho ul d b e f o ld ed t o o ne si de a nd t a p ed d o w n . A f t e r p ro c e s s i n g , t he f i l m ma y b e a na l y z e d us i ng a d e ns i t om et e r h a v i n g a li g h t a p e rt u re o f a b o ut 1 m m d i a me t e r . F i g ure 14 . 7 s how s a n e x a m p le o f a f i l m e x po s e d t o e l ec t r o n s a n d a s e t o f is o d o se c ur v e s o bt a i ne d b y i so d e ns it y s c a n n i n g . B e c a u s e t h e e f f e c ti v e d e ns it y o f t ra ns p a r e nt pol y s t y r e ne i s cl o se t o t h at o f w a t e r , t h e r e s u lt in g i s od o se c ur v e s ca n b e us ed c li ni c al l y w i t ho ut f ur t he r c o r r e ct io n .

WWW.MEDRAD.IR

Because a u t o m a ti c them

many f il m

e le c tr o n do s im e t r y

e n e r gi e s s y s te m

are is a

o ft e n

a v a il a bl e t hi ng

wi t h to

a c c e l e r ato r s , in a

an

d e s i r ab le

ha v e

c li ni c al ha nd

d e p a rt m e n t . A u to m a tic d e n s i t y pl ot te r s a r e c o m m e r ci a ll y a v a i l abl e , a nd s o me o f are i n te r f a c ed with t r e at m e nt -pl a nni ng c o m p ut e r s . A l t ho ug h p r o c e s si n g o f f il m s giv e s t h e b e st r e s ul t s , a ut o m a ti c r ap id p ro c es s o r s c a n be us ed i n m a n y i n s t a n c e s . A s t r i ct q u a li t y a s s ur a nc e , ho w e v e r , i s ne c e ss a r y t o m a i nt ai n c o n s i s te n c y i n f i l m d os i m et r y .

F I G . 1 4 . 7 . F i l m u se d f o r ob t ai n i ng i s o d o se c ur v e s . A : A f i l m e x p o s ed to 1 2 - M e V e l e ct r o n be a m , 1 4 8 c m c o n e , i n a p o l y s t yr e ne p ha nt o m . B : Is o d e ns i t y c ur v e s . P.306

B.4. Phantoms
W a t e r i s t h e s t a n d a r d p h a n t o m f o r t he do s im e t r y o f el e ct r o n b e am s . H o w e v e r , it i s n o t a l w a y s po s s i bl e o r p r a c ti c a l t o pe r f o rm d o s i me t r y i n a w a te r p ha nt o m . F or e x a m p le , pl a s ti c p h a n t o m s a re mo re s uita b l e w he n us i ng f il m o r p la ne - p a r al l el c h a m b e r s . It a l s o i s d i f f i c u l t t o m a ke m e as ur e m e nt s ne a r t he sur f a c e o f w a t e r ,

WWW.MEDRAD.IR

b e c a u s e o f i t s s u r f a c e t e n si o n a n d t he unc e r t a i nt y i n po s iti o ni ng t he de te c to r ne ar the surface. F o r a p h a n t o m to b e w a t e r e q u i v a le nt f o r e l e ct r o n do s i me t r y it m us t ha v e t he s a m e li n e a r s to p pi n g p o w e r a n d t he s a m e l ine a r a ng ul a r s c a t te r i ng p o w e r . T hi s i s a p p r o xi m a te l y a c h ie v ed i f t h e p h a nt o m ha s t he s a m e e le c t ro n d ens i t y ( num b e r o f e l e ct r o n s p e r c u bi c ce n t i me te r ) a nd t he s am e e f f e ct i v e ato m i c num b e r a s w a te r . O f t h e c o m mo n l y u s ed m a t er i al s f o r el e ct ro n d o si m et r y , p ol y s t yr e ne a nd e le c t ro n s o li d w a te r ( R a di a ti o n M e a s u r e m e nt s , Inc . , M i d dl et o n, W I) c o m e c l o s e st t o be i ng w a t e r e q u i v al e n t . A d e pt h - d o se d i st r ib u t io n m e a s u r ed i n a no nw a t e r p ha nt o m m a y b e c o nv e rt e d to t h a t e x p e ct ed i n a w a t e r p h a n t o m b y t he f ol lo w i ng r e l at io ns hi p ( 20) :

p r o v id e d t h e e n e r g y sp e c t r a o f e le c t ro ns a t e a c h p o s it io n a r e i dent i c a l . H o w e v e r , b e c a u s e o f di f f e r e n c es i n s t op p i ng p o w e r a nd s c a t te r i ng po w e r a m o ng di f f e r e nt p h a n t o m s , it i s n o t p o s s ib le to f i nd c o r res p o nd i ng d ep t hs at w hi c h t he e ne r g y s p e c t r a a re id e n ti c a l . C o n s e q u e nt l y , t he re i s no s i ngl e s c a li ng f a c t o r t hat c a n a c c u r a t e l y tr a n s f o r m a n e n t i r e d e pt h d o se c ur v e i n a no nw a t e r pha nt o m to t ha t i n w a t e r . A n e f f e c t i v e d en s i t y m a y b e a s si g ne d t o a me d i um t o g i v e w a t e r e q ui v a l e nt d e pt h d o s e di s t ri b u tion n e a r t h e t he r a p e ut ic r a ng e a nd P.307 along the d e s c e n di n g po r ti o n o f t he d ep t h do s e c ur v e . T he AAPM (20) has

r e c o m me n d e d t h a t t he w a t e r eq u i v a l e nt d ep t h o r t he e f f e c t i ve de ns i t y ( e f f ) m a y b e e s ti m at e d f r om t h e f o l lo w i n g r e l at io ns hi p:

w h e r e R 5 0 i s t h e d e pt h o f 5 0 % do s e o r de te ct o r re s p o ns e . Re c o m me nd e d v a l ue s o f e f f f o r v a r i o u s p h a n t om s a r e g i v e n i n T a b l e 1 4 . 1 .

TABLE 14.1. EFFECTIVE DENSITY FOR SCALING DEPTH IN NONWATER PHANTOMS TO WATER FOR ELECTRON BEAMS a

Material

M a ss ( g/ c m 3 )

D e n si t y

E f f e c t iv e R e l a t iv e t o W a t e r

D e n si t y

Water

P o l y s t y r e n e ( cl e a r )

1.045

0.975

Polystyrene i m p a ct , w h i t e )

( hi g h

1.055

0.99

WWW.MEDRAD.IR

Acrylic

1.18

1.15

E l e c t ro n s o li d w a t e r

1.04

1.00

R e c om m e n d ed i n A A P M . C l i n i c a l el e ct r o n - be a m d o si m et r y . A A P M T a s k G r o up

N o . 2 5 . M e d P h y s 1 9 91 ; 1 8 :7 3 .

14.4. CHARACTERISTICS OF CLINICAL ELECTRON BEAMS A. Central Axis Depth-dose Curves

T h e m a j o r at t r a ct io n o f t h e el e ct r o n be a m i r r a di a ti o n i s t he s ha p e o f t he d ep t h d o s e c u r v e , e sp e ci a lly i n t h e e n e r g y r a nge o f 6 t o 1 5 Me V . A r e g io n o f mo r e o r l e s s u n i f o r m do s e f oll o w ed b y a r a p i d d r op o f f o f d o se o f f e r s a d i s ti nc t c li ni c a l advantage over the c o n v e n t i o n al x-ray m o d al it ie s . T hi s a d va nt a g e , ho w e v e r , t e n d s to d i s ap p e ar w i th i n c r e a s i n g e ne r g y . It w a s s t a t e d e a r li e r th a t h i g h - e n e r g y e le c t ro ns l o s e e ne r g y a t t he r a t e o f a bo ut 2 M e V / c m o f w at e r o r so f t t i s s u e . B e y o nd t he m a x i m um r a nge o f ele c t ro ns , t he d o se i s c o nt r ib u t e d o nl y b y t h e x - r a y co nt a mi na ti o n o f t he b e am , i ndi ca t e d b y t he t a il o f t h e d e pt h d o se c u r v e ( F i g . 1 4 . 8 ) . F o r a b ro a d b e a m , t he de p t h i n ce nt i me te rs a t w hi c h e le c t ro ns d e li v e r a do s e to t h e 8 0 % to 9 0% i s odo s e l e v el , i s e q ua l to a p p r o xi m a te l y o ne -t hir d t o o ne - f o urt h o f t h e e le c t ro n e n e rgy i n M e V . T hus a 1 3 -M e V e le c t ro n be a m i s us e f ul to a d e pt h o f a b o u t 3 t o 4 c m , d e pe n d i n g o n t he i sod o s e l e v el s p e ci f i ed . A s s e e n i n F i g . 14.8, the de pt h d o se curve falls off s ha r p l y b e y o nd t he us e f ul d e pt h and, t h e r e f o re , t h e u n d e r l yi n g t i s s u e s a r e sp a r e d. T h e m o s t u s e f u l t r e a tm e n t d e pt h , o r t he r ap e ut i c r a ng e , o f el e ctr o ns i s g i v e n b y t h e d ep t h o f t h e 90% d e pt h d o se . F o r m o d er n a c c e l e r ato r s w i t h t r i mm e r t y pe a p p li c a to r s t h i s de pt h i s a p p r o x im a te l y g i ve n b y E / 3 . 2 c m , w he r e E i s t he m o s t p r o b ab le e n e r g y i n M e V o f t h e e l e ct ro n b ea m a t t he s ur f a c e . T he d e p t h o f t he 8 0 % de p t h do s e o c c ur s a p p r o x i m at el y a t E / 2 . 8 c m . T he d e p t h of D m a x d o e s n o t f o l lo w a l i n e a r re l at ion s h i p w i t h e ne r g y b ut i t c o v e rs a b r o ad r e gi o n a nd i t s v al ue m a y b e ap p ro x i m at e d b y 0 . 4 6 E 0 . 6 7 ( 30 ) . F igur e 1 4 . 9 s ho w s a co mp a r i so n o f de pt h of 90% do s e the (R90) These as a function can us i ng of of b ea m b ea m e ne r g y data for two ha v e d i f f e r e nt a nd , been li ne a r a c c e l e r ato r s . underscore differences be c l i ni c al l y s ig ni f i c a nt t ha t t he r e f o r e, m e a s ur e d

re q ui r e me n t

s p e c i f i ca ll y f o r t h e g i ve n m a c h i n e . T h e c h o i c e o f b e am en e r g y i s m uc h m o re cr i ti c a l f o r e le c t ro ns tha n f o r p hot o ns . B e c a u s e t h e d o se d e cr e a s e s ab r up tl y be y ond t he 9 0% do s e le v e l , t he t r e at m e nt d e pt h a n d t h e re q u ir e d e le c t ro n e ne rg y m us t be c ho se n v e ry c a r e f ul l y . T he

WWW.MEDRAD.IR

g u i d i n g p ri n c i pl e i s th a t , w h e n i n d o ub t , us e a hi g he r e l e ct r o n e ne r g y t o m a k e s u r e t h a t t h e t a r ge t vo l u m e i s w el l w it hi n the s p e c i f ie d i so do s e cur v e .

F I G . 1 4 . 8 . C e n t r a l a x i s d e pt h d o se di s tr i b uti o n m e a s ur ed i n w a t e r . Inc i d e nt e n e r g y , ( E p ) 0 = 13 M eV ; 8 1 0 c m co ne ; e f f e c t i v e so ur c e t o s ur f a c e d i st a nc e = 68 cm. P.308

The

skin-sparing

e f fe c t

w it h

t he

cl i ni c al

e l e ct ro n

beams

is

o nl y

m od e s t

or

n o n e x i s t e n t . U n l i ke th e p h o to n be a m s , t he pe r c e nt s ur f a c e dos e f o r e le c t ro ns i n c r e a s e s w it h e n e r g y. T h i s e f f e c t c a n b e ex p l a i ne d b y t he na t ure o f t he el e ct ro n s c a t te r . A t t h e lo w er e n e r g ie s , t he e le c tr o ns a r e s c a t te r ed m o r e e a si l y a nd t h r o u g h l a rg e r a n gl e s. T h i s c a u s e s t he d o se to b uil d up m o re r ap i dl y a nd o v er a s h o r t e r di s t a n c e . T h e r a t i o o f s u r f a c e d o s e t o m a x i m um d o se i s, t he r e f o r e , le s s f o r t h e lo w e r - e ne r g y e l e ct r o n s t ha n f o r the hi g he r - e ne r g y el ec t r o ns . A s i m pl e i ll u s t r a ti o n o f t h i s e f f e c t i s se e n i n F ig . 14 . 1 0 . F o r t he s a me inc i d e nt e l e ct ro n f l u e n c e ( e - / c m 2 ) , t h e l o w e r -e n e r g y e le c t ro ns b ui l d up to a l a r ger f l ue nc e a t t he d e pt h o f m a x i m u m d os e t h a n t h e hi g he r - e ne r g y e l e ct ro ns . T he i n c r e a s e i n f l ue nc e i s g i v e n b y 1 / c o s , w h e r e i s t h e a ng le o f s c a t te r . B e c a u s e o f d i f f e r e n c es i n b e a m g e ne r a ti o n, b e a m b e nd i ng , a nd c o l li m a ti o n, t he d e pt h do s e d i st r ib u t ion a n d t h e s ur f a c e dos e c a n be q ui te di f f e re nt f o r di f f e r e nt m a c h i n e s . F i g u r e 1 4 .11 il l u s t r at e s t hi s p oi nt b y c o mp a r i ng ce nt r al a x i s de p t h d o se curves for the S a g i t t ai r e li n e a r a c c el e ra t o r a nd t he S ie m en' s b e t a t ro n for

WWW.MEDRAD.IR

d i f f e r e n t be a m e n e r gi e s . In c l i ni c a l p r a c tic e , t he r e f o re , i t i s no t s uf f i c i e nt t o s p e c i f y j u st be a m e n e r g y . Is o do s e di s t ri b ut io ns f o r a n i ndi v i d ual m a c hi ne , c o ne , a n d / o r f i e ld s i z e a r e re q u i r ed .

B. Isodose Curves
T h e s c a t t e ri n g o f el ec t r o n s pl a y s a n i m p o rt a nt r ol e i n d e te r m i ning t he s ha p e o f t h e i s od o se c u r v e s th e c e n t r a l a x i s d i st r ibut i o n, f l a t ne s s , a nd c ur v a t ur e ne a r t he f i e l d bo r de r s . S i g n i f ic a n t d i f f e r e nc e s e x i st a m o ng t he s ha p e s o f t he i s o d o se c u r v e s f o r di f f e r e n t m a c h i n e s . T he s e d i f fe r e nc e s a ri s e a s a re s ul t o f d i f f e r e nt c o ll i m at io n s y s t e m s th a t t h e a c c e l e r at o r s e m p lo y . T he c o l li m a tio n s y s t e m ( e . g . , s c a t te r i n g fo il , m o n it or c h a m b e r s , j a w s , a nd c o ne s ) a nd t he ai r c ol um n a b o v e t he p a t ie n t c a u s e a n a n gu l a r d i sp e r si o n o f t he b e a m a s w e ll a s e ner g y s p r e ad . T hus b e a m s o f t h e s a me en e r g y , E 0 , b ut p a s s i ng t hr o ug h d i f f e r e nt c ol li m a ti o n s y s t e m s g i v e r i se t o d i f f e r e n t d o s e di s t ri b utio ns .

WWW.MEDRAD.IR

F I G . 1 4 . 9 . P l ot s o f de p t h d o se r a ng e s a s a f unc t i o n o f t he mo s t p r o b ab le e ne rg y ( E p ) 0 a t t h e s u r f a c e f o r t w o d i f f e re nt li ne ar a c c e l e ra to r s . A : R 1 0 0 , t he d ep t h o f m a x i m u m d o se v e r s us ( E p ) 0 . B : R 9 0 , t he de p t h o f 90 % d e pt h do s e v e r s us ( E p ) 0 . ( F r o m K h a n F M . C l i n i ca l e le c t ro n b e am d o sim e t r y . In: K e r i a k e s JG , E l s o n H R , Bo r n C G , e d s . R a d i a t io n o nc o lo g y p h y s i c s 19 86 . A A P M M o no g r a p h N o . 1 5 . N e w Y o r k ,

WWW.MEDRAD.IR

A m e r i c a n In s t i t u te o f P h y s i c s , 1 9 8 6 : 21 1 , w it h p e r m i s si o n . ) P.309

A s t h e b e a m p e n et r a te s a m e d i u m , t he b ea m e x p a nd s r a p i dl y b e l o w t he s ur f a ce due to s c at te r i n g . Ho w e v e r , i n d i v id ua l sp r e a d of t he i s od o se c ur v e s v a r ie s , d e pe n d i n g o n t h e i sod o s e l e v el , e ne r g y , f ie l d si z e , a nd c ol li m a ti o n. F i g ur e 1 4 . 12 s h o w s i s o do s e p at te rn s f o r t w o d i f f e r e nt e ne r g y b e a m s . W he re a s f o r t he lo w energy beams a ll t he i s od o s e c ur v e s s ho w some e x p a ns io n, for t he hi g he r e n e r g ie s o n l y t h e lo w i s od o se l e v el s b ulg e o ut . T he hig he r i so dos e le v e l s te nd to s h o w l a t e r al c o n s t ri c tio n , w h i c h b e c o m e s w or s e w i t h d e c r ea s i ng f ie l d s i ze .

C. Field Flatness and Symmetry

U n i f o r m it y o f t h e el ec t r o n be a m i s us ua l l y s p e c i fi e d i n a pl a ne p e r pe nd i c ul a r t o t h e be a m a x i s a n d at a fi x e d d e pt h. T he IC R U ( 3 1 ) s pe c i f ie s be a m f l at ne s s i n t e r m s o f a u n i f o r m it y i n d e x . P.310 T h i s i s d e f i n ed i n a re f e r e n c e p l a ne a nd at a r e f er e nc e d ep t h a s t he ra ti o o f t he a r e a w h e r e t h e d o se ex c e e d s 90 % o f i t s v alue a t t he ce nt r a l a xi s t o t he g eo me t ri c b e a m c ro s s - s e ct io n a l a r e a at t h e p ha nto m s ur f a c e . T he uni f o r m it y i nd e x s ho ul d e x c e e d a gi v e n f r a c tio n ( e . g . , 0 .8 0 f or a 1 0 10 c m f i el d si z e a nd a t d ep t h o f m a x i m u m d o se ) . In a d d it io n , t h e do s e at a ny a r b i t r a r y po i nt i n t he r e f e re nc e p l a n e s h o u l d n ot e x c ee d 1 03 % o f t he c e nt r al a x i s v a l ue .

F I G . 1 4 . 1 0 . S c h e m a t i c il l u s t r at io n s ho w i ng t he i nc re a s e i n p e r ce nt s ur f a c e do se w i t h a n i n c r e a s e i n e l e ct r o n e ne rg y . ( F r o m K ha n F M . C l i ni c a l e le c t ro n b e a m d o s im e tr y . In : K e r i a k e s J G , E l s o n H R , Bo r n C G , e d s . R a d i a ti o n onc o l og y p hy s i c s 1 9 86 . AAPM M o n o g ra p h No. 15. New Yo r k , American Ins t i tut e of P hy s i c s , 1 9 86 : 2 11 , w i t h p e r mis s i o n . )

WWW.MEDRAD.IR

F i g u r e 14 . 1 3 s h o w s i so d o se c u r v e s o bt a i ned f r o m a f i l m e x po s e d p e r pe nd i c ul a r t o a n e l e c t ro n b e a m a t th e d e p t h o f m a x i m um d o s e . T he d a s he d li ne i s t he bo und a r y o f t h e g e o me t ri c b e am a t t h e s u r f a c e . I n t hi s e x a m p l e , t he ho mo g e nei t y i nd e x is 0.8. B e c a u s e o f t h e p r e se n c e o f l o w e r -e ne r g y e l e ct ro ns i n t he b ea m , t he f l at ne s s c h a n g e s s i g n i fi c a n t l y w i t h de p t h . T he re f o r e, i t ha s be e n re c o m me nd e d ( 3 2 ) t h at t h e u n i f o r m it y P.311 i n d e x b e de f i n e d at th e d e pt h o f ha l f t he t he r a p e ut i c r a ng e (e .g . , o ne - ha l f t he d e pt h o f 8 5 % de pt h d o s e ) . F u r t he r mo r e , it i s d e fi ne d a s t he ra t io o f t he a r e as i n s i d e t h e 9 0 % a n d 50 % i so do s e li ne s a t t hi s d ep t h. A uni f o r mi t y i nd e x o f 0 . 7 0 o r h i g h e r i s a c c e pt a bl e w i t h f i e l d si z e s l a r ge r t ha n 1 0 0 c m 2 . T he p e a k v a l ue i n t hi s p l a n e s h o u l d be l e s s th a n 1 0 3 % .

F I G . 1 4 . 1 1 . C o m p a r i so n o f c e n t r al a x i s d e pt h - d o s e d i st ri b u ti o ns o f t he S a gi tt a i re linear a c c e le r at o r ( co n t i n u o u s c ur v e s ) and t he Si e me n' s b et a t ro n ( d a s hed c u r v e s ) . ( F r o m T a p l ey N , e d . C l i ni c a l a p pl i c at io ns o f t he e l e ctr o n b e a m . N e w Y o r k : J o h n W i l e y & S on s , 1 9 7 6 , w i t h p e r mi ss i o n. )

WWW.MEDRAD.IR

F I G . 1 4 . 1 2 . C o m p a r is o n o f i so do s e c ur v e s f o r di f f e r e nt e ne r g y e l e ct r o n b e a m s. ( F r o m T a p le y N , e d . C l i n i c a l ap pl i c at io ns of t he e le c t ro n b e a m . N e w Y o r k : J o hn W i l e y & S o n s , 1 97 6 :86 , w i t h p e r m i s si o n. ) T h e A A P M ( 2 0 ) r e co mm e n d s t h a t t he f l at nes s o f a n e le c t ro n b e am b e sp e c i fi e d i n a r e f e r e n c e pl a n e p er p e n d i c u l ar t o t he c ent r a l a x i s , a t t he dep t h o f t he 95 % i s o do s e b e yo n d t h e de p t h o f do s e m a x i m um . T he v a r i a ti o n i n do s e re l at i v e to t he d o s e at c e n t r a l a x i s sh o u l d P.312 n o t e x c ee d 5 % (o pt im a l l y t o b e w i t hi n 3% ) o v e r a n a r e a co nf ine d w i t hi n l i nes 2 c m i n s i d e t h e g eo me t ri c e d ge o f f i el d s e qua l t o o r l a r g e r t ha n 1 0 1 0 c m .

WWW.MEDRAD.IR

F I G . 1 4 . 1 3 . Is o d o s e c u r v e s i n a p l a ne p e r p e ndi c ul a r to c e nt ra l a x i s , o b t ai ne d w i t h a f i l m pl a c e d i n a p h a n t o m a t t he d e pt h o f m a x i m um d o s e . ( Fr o m A l mo nd P R . R a d i a ti o n p h y s i c s o f e l e c tr o n b e a m s . In: T a p l e y N , e d . C l i ni c a l a pp l i c at io ns o f t he e l e ct r o n be a m . N e w Y o r k : J o h n W i l e y & S o ns , 1 9 7 6 :5 0 , w i t h p e r mi s s io n. ) B e a m s y m m e t r y c o mpa r e s a d o se p r o fi le o n o ne s i de o f t he c e ntra l a x i s to t ha t o n t h e o t h e r . T h e A A P M r e c om m e n d s t ha t t he c r o s s- b e a m p ro f il e i n t he r e f e re nc e p l a n e s h o u l d n o t di f f er m o r e t h a n 2 % a t a ny p a i r o f p o i nt s lo c a ted s y m m e t r i c al l y o n o p po s it e s id e s o f th e c e n t r a l a x i s .

C.1. Beam Collimation

A c c e p t a bl e fi el d f l at n es s a n d s y m m e t r y a r e o b t ai ne d wi t h a p ro per d e s ig n o f be a m s c a t te r e r s a n d b e am d e f i n i n g c ol li m at o r s . A c c e l e r at o r s w it h m a gne t i c al l y s c a nne d b e a m do n ot r eq u i r e s c a t te r i n g fo il s . O t he r s us e o ne o r mo r e s c a t te r i ng fo il s , u s u a l l y m a d e u p o f le a d , to wi d e n t he be a m a s w el l a s gi v e a uni f o r m d o se d i s t ri b u tio n a c r o s s t h e t r e a t me n t f i el d . T h e b e a m co ll i m at io n h a s b e e n s ig ni f i c a ntly i m p r o ve d b y t he i ntr o d uc ti o n o f t he d u a l - f o il s y s t e m ( 3 3 ). F i g u r e 1 4 . 1 4 s ho ws a t y p i c a l a r r a ng em e nt f o r s uc h a s y s t e m . W h e r e a s , t h e f i r s t f o il w id e ns the b e a m b y m ul ti pl e s c a t te r i ng , t he s e c o n d f oi l i s d e si g n ed to m a k e t he be a m uni f o r m i n c ro s s - s e ct ion. T he t hi c k ne s s o f t h e s e co n d f oi l i s d i f f e r e n ti a ll y v a r ie d ac r o s s t he be a m to p ro d uc e a de s i re d d e g re e o f b e a m w id en i n g a n d f l a t t e ni ng . A na l y s i s b y W e r ne r e t a l . ( 3 4 ) s ho w s t h a t t h e d u a l - f oi l s ys t e m s c o mp a r e w e ll w i t h t he s c a nni ng b e a m s y s t e m s i n m i n i m i zi n g angular spread a nd , he nc e , t he effect on dose di s t ri b utio n c h a r a c t e r i st i c s .

WWW.MEDRAD.IR

T h e b e a m - de f i n i n g co ll i m at o r s a r e d e si g ne d t o p ro v i d e a v a r ie t y o f f i el d si z e s a nd t o m a i nt a i n o r i mp r o ve t h e f l a t n e s s o f t he be a m . Ba s i c a l l y , a l l co ll i m at o r s p ro v i de a primary P.313 c o ll i m at io n c l o se to the source t ha t d e f ine s t he m a x i m um field si z e a nd a

s e c o n d a r y c ol li m a ti o n c l o s e t o t h e p at ie nt to d e f i ne t he t r e at m e nt f i e l d . T he l att e r c a n b e i n t h e f o r m o f t r i m me r b a r s o r a s er i e s o f co ne s . In t he e l e ct r o n t he r a p y m o d e , t h e x - r a y co ll im a t o r j a w s a r e us ua l ly o p e ned to a s i z e l a rg e r t ha n t he co ne o r t h e a p pl i c ato r o pen i n g . B e c a u s e t he x - r a y j a w s g i v e r i s e to ex t e ns i v e e le c tr o n s c a t te r , t h e y a re i n t er l o c k ed w it h t he i nd i vi d ua l co ne s t o op e n aut o m a ti c a ll y t o a f i x e d p r ed e te r mi n e d s iz e .

F I G . 1 4 . 1 4 . P r i n c i p l e o f d u a l - f oi l s y s te m f o r o b t ai ni ng uni f o rm e l e ct r o n be a m f i e l d . ( F ro m Al m o n d PR . H a n d b o o k o f m e di ca l p hy s i c s , V ol I . Bo ca R a t o n, F L : C R C P r e s s , 1 9 8 2 :1 49 , w i t h p e r m i s si o n . )

D. Field Size Dependence

WWW.MEDRAD.IR

T h e o u t p u t a n d t h e ce n t r a l a x i s d e pt h- d o se d i st r ib ut io n a r e f i eld s i z e d ep e nde nt . T h e d o s e i n c re a s e s w i t h f i e ld s i z e be c a us e o f t he i nc r ea s e d s c a t te r f r o m t he c o ll i m at o r a n d t h e ph a n t o m . A s s ta t ed pr e v i o us l y , so m e el e ct r o n co ll i m ato r s p r o v id e a f i x e d j a w ope n i n g , a n d t he t r e at me nt f i e ld s i z e i s v a r i e d b y v a r i o us s i z e c o n e s , i n s e r t s , o r mo v a b le t r i mm e r b a r s . S uc h a n a r r a ng e m ent m i ni m i z e s t he v a r i a t io n o f co ll i m at o r s c a t te r , a nd t he re f o re , t he o ut p ut v a ri a ti on w i t h f i e ld s i ze i s k e p t r e a so n a b l y sm a l l . If t h e c o l li m ato r a p e rt ur e ( x - r a y j a w s e t t i ng ) w e re a l lo w e d t o c h a n g e w ith t h e t re a tm e nt fi e ld , t he o ut p ut w o ul d v a ry t oo w id e l y wi t h f i e l d si z e , e s pe c i al l y f o r lo w e r - e ne rg y b e a ms . T hi s e f f e c t i s s ho w n i n F i g . 1 4 . 1 5, w h e r e t h e c o n e s i z e is h e l d f i x e d w hi le t he x - r a y j a w s a r e v a r i e d ( 3 5 ) . N ot e t hat t h e d o se r a te v a r i e s b y a f a c t o r o f g re a ter t ha n 2 b e t w ee n s m a l l a nd l a rg e j a w o p e n i n g s at 4 M e V . T h e e f f e c t s o f f i e ld s iz e o n o u t p ut a nd t he c e nt r a l a x i s de p t h do s e c ur v e d ue to p h a n t o m s c at t er a lo n e i s si g n i f i c a nt a s lo ng a s t he d i st a nc e be tw e e n t he po i nt of m e a s u r e m e n t a n d t h e e d g e o f t h e f ie ld i s sho r t e r t ha n t he r a ng e o f t he l at e r al l y s c a t te r e d el e ct r o n s . W h e n t h i s d i st a nc e i s r e a c he d , t he r e i s no fur t he r i nc r e a se i n d e pt h do s e c a u s ed by p h a n t o m s c at te r . W he n t he f ie l d i s r ed uc e d b e lo w t h a t r e q u i r ed f o r l a te r a l sc a t t er e q ui li b r i um , t he d o se r at e de c r e a ses r a p i dl y . T hi s i s s h o w n i n F i g . 1 4 . 1 6 . In t h e s e m e a s ur e m e nt s , t he f i e ld s i z e a t the p ha nt o m w a s v a r i e d w i t h o ut c h a n gi n g t h e p h oto n c ol lim a t o r op e ni ng . Fo r s m a l l f i el d s , t he o u t p u t f a c to r a s w el l a s d e pt h d o s e ca n b e s i g ni fi c a nt l y r ed uc ed c o m p a re d w it h t h e b r o ad b e a m di s t rib u t io n .

F I G . 1 4 . 1 5 . V a r i a t i o n o f r e l at i v e d o se a t d m a x , t hro ug h a 1 0 10 c m c o ne , w it h c h a n g e o f j a w se tt i n g, r e l at i v e to t he re c om m e nd e d j a w se tt i ng . ( F r o m Bi g g s P J ,

WWW.MEDRAD.IR

B o y e r A L , D o p p k e K P . E l e c t ro n d o s im e tr y o f i r r e g ul a r f i e ld s o n t he C l i na c - 1 8 . I nt J R a d i a t O n c ol B i ol P h y s 1 9 7 9 ;5 : 43 3 , w i t h p e rm i s s io n. )

FIG.

14.16.

Output

factors

as

f unc t i o n

of

side

of

s q ua re

f i e ld .

Primary

c o ll i m at o r f i x ed , s e c on d a r y c o l li m a to r s ( t rim m e r s ) c lo s e to t he pha nt o m v a r i e d to c h a n g e t h e f i e l d si z e . D a t a a r e f r o m T he r a c 2 0 l i ne a r a c c e le r a to r . ( F r o m M i ll s M D , H o g s t ro m K R , A l m o n d P R . P r e d i c t io n o f e l ec t r o n b e a m o ut p ut f ac t o r s . M e d P hy s 1 9 82 ; 9 : 60 , w i t h p e r mi s s io n . ) P.314

F i g u r e 1 4 . 1 7 s h o w s th e c h a n g e i n c e nt r al a x i s d ep t h- do s e d i st r ib ut io n w i t h f ie ld s i z e . A s t h e f i e l d s i z e i s i n c r e a s e d , t he p erc e nt d e pt h d o s e i ni ti al l y i nc r e a s e s b ut b e c o me s c o n s t a nt b e yo n d a c e r t ai n f i el d s i ze w he n t he l a t er a l s ca t t er e q uil ib r i um i s r e a c h e d . F u r t h e r mor e t h e de p t h d m a x s hi ft s t o w a rd t he s ur f a c e f o r t he s m a ll e r f i e l d s . T h u s i n c li n i c a l p r a c ti c e , d ep t h- do s e d i s t ri b utio n f o r sm a ll f i e l d s s ho uld be m e a s u r e d i n di v i d u a ll y i n a d d i ti o n to t he o utp ut c a l ib r a ti o n. It h a s b ee n s h o w n ( 36 ) t h at t h e mi ni m um f i el d r a d i us f o r t he e s t a bl i s hm e nt o f l a t er a l s c a tt e r eq u i li br i u m a t a l l de pt hs o n c e nt r a l a x i s i s g i v e n b y t he f o l l o wi ng a p p r o xi m a te P.315 r e l at io n s h i p :

w h e r e R e q i s t h e f ie ld r a d i u s i n c m a nd E p , o i s t he m o st p ro b ab l e e ne r g y i n M e V . For e x a mp le , the equ i l i br i u m f ie ld s fo r 8 MeV a nd 32 MeV e le c t ro ns ha v e d i a m et e r s o f 5 c m a n d 1 0 c m , re s p e ct i ve l y , whi c h a g r e e w it h t he d at a s ho w n i n F i g .

WWW.MEDRAD.IR

1 4 . 1 7 . In c l i ni c a l p r ac t i c e , t h e a bo v e re l ati o ns hi p m a y b e us e d t o cl a s s i f y f i el d s w i t h r a d i u s < R e q a s s m a l l o r n a r r o w f i e lds a nd r a d i us R e q a s b r o a d f ie ld s . A s s t a t ed e a r li e r , t h e dep t h - d o se di st r i b ut io n f o r s m a ll f ie ld s i s f i eld s i z e d ep e nd e nt w h i l e f o r b r oa d f i el d s i t i s i n de pe nd e nt o f f ie l d s i ze .

F I G . 1 4 . 1 7 . V a r i a t i on o f d e p t h - do s e di s tr i b uti o n w i t h f i el d siz e . ( F r o m IC R U . R a d i a ti o n do s i me t r y : e l e ct r o n be a m s w i t h ene r g i e s be t w ee n 1 a nd 5 0 M e V . R e p or t No. 35. B e t h e sd a , MD: In t e r na t i o nal C o m m i s si o n on R a di at io n U ni t s a nd M e a s u r e m e n t s , 1 98 4 , w i t h p e r mi s s io n. )

E. Field Equivalence
E x a c t f i e l d e q u i v al e n ce f o r el e ct r o n be a m s c a nno t b e e s t ab li s he d. H o w e v e r , i t ha s b e e n s h o w n ( 36 ) t h at a pp r o x i ma t e e q ui v a l e nt ci r c ul a r o r sq ua r e f i el d s ca n be d e te r m i n ed f o r f i el d s o f a n y s i z e , s ha p e , and e ne r g y . T he t e r m f i e l d eq ui v a l e nc e m e a n s t h a t f o r t h e sa m e i n c i de nt f l ue nc e a nd c r o s s - s e c ti o nal be a m p r o fi l e , t he e q u i v a le n t f i e ld s h a v e t h e s a m e d ep t h- dos e d i s tr i b ut io n a l o ng t he c e nt r a l r a y . T h u s f i e l d eq u i v a l e n ce h e r e i s de f i ne d i n te r m s o f p e r c e nt de p th d o s e s a nd not t h e o u t p u t f a c to r s , w h i c h d e p e n d o n p a rt i c ula r j a w s e t t i ng f o r t he g i v e n a p p li c a to r o r ot h e r c ol li m a ti o n co n d it io n s . A c c o r d i ng to t hi s de f i ni tio n, a l l b r o a d f ie ld s a r e e q u i v a le n t be c a u s e t h e i r d ep t h - do s e d i st r ibut i o n i s t he s a me i r r es p e c ti v e o f f ie ld s i z e . F o r e x a mp le , 1 0 1 0 , 1 0 15 , 1 0 2 0 , 2 0 2 0 , et c . a re a l l b r o ad f i el d s f o r e n e r g ie s u p t o 30 M e V ( s e e E q . 1 4 . 1 1 ) a nd he nc e a r e e q ui v a le nt . F i e ld e q u i v a le n c e i s t h e re f or e r e le v a n t o nl y f o r sm a l l f ie l d s i n w hi c h t he l a t e r al s c a tt e r e q u i li b ri u m do e s no t e x i s t a n d c o ns eq ue nt ly , t he d ep t h- do s e d i st r i b ut io n i s fi eld s i z e d e pe n d e n t .

WWW.MEDRAD.IR

H a r d e r et al . ( 37 ) h av e s h o w n t ha t fo r a sq ua r e f i el d o f c ro s s - se c t io n ( 2 a 2 a ) t h e e q u i v a le n t c i r c u l ar f i e l d h a s a r a d i us R e q u i v , g i v e n b y :

H o w e v e r , f o r a s m al l r e c t a n g u l a r o r i r re g ula r l y s ha p e d f ie l d s , f i el d e q ui v a le nc e i s n o t a s st r ai g h t f o r w a rd. K h a n a n d H i g gi ns ( 36 ) ha v e a pp li e d G a us s i a n p e nc il b e a m theory to this p ro ble m and d e ri v e d r e l at io ns hi p s t ha t can be us e d to f i nd a p p r o xi m a te eq u i v a l en t c i r c u l a r o r sq ua r e f i e ld s f o r f i el d s o f a ny s ha p e . T he r e a d e r i s r e f e r r ed to th e i r p a p er f o r f ur t he r d e t ai l s o n t hi s s ub j e c t.

F. Square Root Method

H o g s t ro m et a l . (3 8 ) h a v e s h o w n t ha t , i f t he c ha ng e i n c ol li ma t o r s c at te r w i t h f i e l d s i ze i s n ot co n s i d e re d , t h e d ep t h dos e f o r r e ct a ng ul a r fi el d si z e s c a n be e x t r a c te d f r o m s q u a r e f i e l d d at a b y t he f o ll ow i ng r e l a ti o ns hip s :

w h e r e D i s t h e c e n t r al a x i s de pt h do s e a nd X a nd Y a re t he f ie l d d i m e nsi o ns . T hus t h e d o s e f o r a r e c t a ng u l a r f i e ld s i z e c a n b e d e te r m i ned f r o m t he s q ua r e r o ot o f t h e t wo sq u a r e f ie ld d e pt h do s e s w he n t he s id e s o f t he t w o sq ua r e f ie l d s a re e q u a l t o t h e t w o si d es o f t h e re c t a ng ul a r f i e l d . Re f e r r ed t o a s t he s q ua r e roo t m e t h od , t h i s c o n c e pt h a s a l s o b e e n a p pl i ed t o t he d et e r mi na t io n o f o ut p ut f a c t or s w h e n t h e p r i m a r y c o lli m a ti o n i s f i x ed a nd the s e c o nd a r y c o ll im a ti o n c lo s e to t he phantom is varied v a l id (3 9 ) . for It may be r e s t a t ed in t ha t t he c ol lim a t o r s c a tt e r is n e g l e ct ed i n t h i s mo de l . T h u s t h e a p p li c a bil it y o f t he s q ua r e root m et ho d i s no t a u t o m a ti c a ll y those m a c hi ne s w hi c h c o l li m a tor s c a t te r varies s u b s t a n t i al l y w i t h f i eld s i z e .

G. Electron Source
U n l i k e a n x - r a y b e am , a n e l e ct r o n b e a m d oe s no t e m a na te f r o m a p hy s i c a l so ur ce i n t h e a c c e le r a to r h e ad . A pe n c i l e le c t ro n be a m - a f t e r p a s si ng t hr o ug h t he v a c uum window P.316 o f t h e a c c el e r at o r , be n d i n g m a g net i c fi el d, s c a t t e ri ng f oi l s , moni t o r c ha m be r s , a n d t h e i n t e r v e n i n g a i r c o l u m n - i s s p re a d i nt o a b r o a d be a m t ha t a p p e a r s to d i v e r ge f r o m a p oi n t . T h i s p o i n t i s c a ll ed the v i r t ua l so ur c e ( 4 0) , w hi c h m a y b e d e f i n e d a s a n i n te r s ec t io n po i n t o f t he b ac k p r o j e ct io ns al o ng the m o st p r ob a b le d i r e ct io n s o f el e ct r o n m o ti o n at t he p a ti e nt s ur f a c e ( 4 1 ) . T hi s i s ill us t r a te d i n Fi g . 14.18.

WWW.MEDRAD.IR

FIG.

14.18. of

D e f i n it io n e l e ct ro n s of t he

of at

v i rt ua l the

p oi nt

s o ur c e s ur f a c e . s o ur c e

of

an

el e ct r o n

be a m :

t he P.

i n t e r se c ti o n po i n t o f t h e b a c k p ro j e ct io ns a l o ng t he m o st p ro b a bl e di r e ct io ns of m o ti o n p a t i e nt e le c t ro n (From of a S c hr o e d e r- Ba b o Acta D e te r m i n at io n v i rt u a l b et a t ro n. R ad io l

1 9 83 ; 3 64 [ s u p pl ] : 7 , w it h p e r m i s si o n. ) A n u m b e r o f me t h od s h a v e b e e n s ug ge s te d f o r t he d et e r mi na ti o n o f v i r t ual s o ur ce p o s it io n . P o h l it ' s ( 40 ) m e t h od c o ns i st s o f ta k i ng e le c t ro n r a d io g ra p hs o f a g r id o f c o p pe r w i r e s at d i f f er e n t d i st a n c e s f r o m the c o l li m at o r a nd b ac k p r o j e ct i ng t he i m a g e s to a po i n t , t he v i rt u a l so ur c e . A mul t i pi nho le t e c hni q ue ( 4 1 ) us e s do ub l e conical h o le s in a metal pl a te . P i nho l e i m ag e s are o bt aine d on a film. B a c k p r o j e ct io n o f t h e p i n h o le i m a g es gi v e s t he v i rt ua l so ur c e p os i ti o n. M e y e r e t a l . ( 4 2 ) h a v e de s c r ib ed t h e me t h od o f de te rm i ni ng f i el d si z e m a gni f i c a t io n o n f il m w i t h di s t a n c e . T h e v i rt u a l so u r c e p oi nt i s found b y t he b a c k p ro j e ct io n o f t he 5 0% w i d t h o f t h e be a m pro f i le s o bt a i ne d a t di f f e r e nt d i st a nc e s . A b ro a d b e a m ( 2 0 2 0 c m ) i s u s e d f o r t h es e m e a s u r e m e nt s . The use of virtual so u r c e - to - s ur f a c e d i sta nc e (SSD) does not give a c c ur at e i n v e r s e s q u a r e l a w c o r r e ct io n f o r o ut p ut a t e x t e nde d S S D s und e r a l l c li ni c al c o n d it io n s . M e a s u r e me n t s h a v e s ho w n t ha t t he v i rt ua l S S D g i v es c o r r e ct i nv e r s e s q u a r e l a w f a c t o r o n l y f o r l a r ge f i el d s i z e s (4 3 ) . F o r s m al l f ie ld s iz e s , t he i nv e r s e s q u a r e l a w co r r e ct io n u n d e r e s ti m a te s t he cha ng e i n o ut p ut w i t h v i r t ua l S S D . T hi s d e v i at io n f r o m t h e i nv e r s e s q u a r e l a w i s c a us e d b y a n ad di ti ona l d e c re a s e i n

WWW.MEDRAD.IR

o u t p u t b e c a u se o f a lo s s o f s id e - s c at te r e qui l i br i um i n a ir a nd i n p ha nt o m t hat i s s i g n i f i c a n t f o r s m al l f i e ld s i ze s a nd l o w ele c t ro n e ne r gi e s . T hus t he us e o f t he v i r t u a l S S D t o p re d i ct d o s e v a r i a ti o n w i t h di s t a nc e r eq ui r e s c o r rec t io n f a c t o r s , i n a d d it io n to t h e i n v e r s e s q u a r e l a w f a c to r , a s a f unc t i o n o f f i el d s i z e a nd e ne r gy (42).

F I G . 1 4 . 1 9 . D e t e r mi na t io n o f e f f e c ti v e S S D. ( F r o m K ha n F M , S e w c ha nd W , L e v i t t S H . E f f e c t o f a i r s p a c e o n d e pt h d o s e in e l e c t ro n b e a m t her a p y . 1 9 78 ; 1 26 : 24 9 , w i t h pe r m i s si o n . ) P.317 R a d i o log y

A n a l t e r n a t i v e me t h od o f c o r r e ct i ng do s e o ut p ut f o r t he a ir g a p b et w e e n t he e l e ct r o n c ol li m a to r a n d t h e p a ti e nt i s to d ete r m i ne e f f e ct i v e S S D , w hi c h g i v e s t he c o r r e ct i n v e r se s q u a re l a w re l at io ns hi p f or t he c ha ng e i n o ut p ut w it h d i st a nc e . K h a n e t al . ( 44 ) h av e r e co m m e nde d a m e t hod t hat si m ul a te s a s cl o se l y a s p o s s ib le t h e c li n i c al s i t u a ti o n . In t hi s m e t ho d , d o se s a r e me a s ur e d i n a p ha nt om a t t h e d ep t h o f m a x im u m d o s e ( d m ) , w i t h t he p ha nt o m f i r st i n c o nt a c t w it h t he c o n e o r a t t h e s t a n da r d S S D ( z e r o g a p ) a nd t he n a t v a r i o us d i s t a nc e s , up to a b o u t 20 c m f r o m t h e c o n e e n d . S up p o s e f = e f f e c t i v e S S D ; I 0 = d o s e w i t h z e r o g a p ; I g = d o s e w i t h g a p g b et w e e n t he st a nd a r d S S D p oi nt and t he p ha nt o m s u r f a c e . T h e n , i f e l e c tr o n s o b e y i nv e r s e s q ua r e l a w ,

or

B y p l o tt i n g

WWW.MEDRAD.IR

a s a f u n c t i o n o f g a p g ( F i g . 1 4 . 19 ) , a s t r ai ght l i ne i s o bt a i ned , t he s l op e o f w hi c h is:

. Thus,

A l t h o u g h t h e e f f e ct i v e S S D i s o bt a i ned b y m a k i ng m e a s ur e me nt s a t t he de pt h d m , i t s v al u e do e s n o t ch a n g e s i g n i fi c a nt l y wi t h t he de p t h o f mea s ur e m e nt (4 4 ) . H o w e v e r , t h e e f f e c ti ve S S D do e s c ha ng e w it h e ne r g y a nd f i el d siz e , e s p e ci a ll y f o r s m a l l fi el d si z e s a n d l o w e n e r gi e s . A t a ble o f e f f e c t i ve S S D s a s a f unc t i o n o f e n e r g y a n d f i e l d si z e is n e c e s s a r y t o m e et c li ni c a l s it ua ti o ns .

F. X-ray Contamination
T h e x - r a y c o n t a m i n a tio n d o s e a t t he e nd o f t he e l e c tr o n r a ng e c a n b e d e t e r mi ne d f r o m t h e t ai l o f t h e de p t h - do s e c ur v e b y re a d i ng o f f t he d o se v a l ue a t t he p oi nt w h e r e t h e t a i l be c o me s s t r a i g ht ( F i g . 1 4 . 3) . T hi s d o s e i n a p a t i e nt i s c o nt r ib uted by b r e m s st r a h l u n g i n t e r a ct io n s of el e ct r o ns w it h t he co lli m a ti o n s y s te m ( s c a t te r i n g f oi l s , c h a m b e r s , c ol li m a to r j a ws , e t c . ) a nd t he b o d y t i s s ue s .

TABLE WATER,

14.2. AT

X-RAY THE END

CONTAMINATION OF THE

DOSE

(Dx) AS

TO A

ELECTRON

RANGE

PERCENTAGE OF D m a x

Energy (MeV)

Dx (%)

0.1

10

0.5

15

0.9

20

1.4

30

2.8

40

4.2

WWW.MEDRAD.IR

50

6.0

D a t a a re fo r t h e o re tic a l be a m wi t h no i nit i al x - r a y co nt a m i nat io n a nd a re e x t r a c te d f r o m Mo n t e C a r l o d a t a o f Be r g er M J , S e l t z e r S M . T a b l e s o f e ne r g y d e po s it io n d i st ri b u tio n s e le c tr o n in water with p ha nt o m s e ner g i e s i r r a di a te d from 1 to 60 by p oi nt a nd m o n o di r e ct io n a l beams MeV,

a p p li c a ti o n s to b ro a d b e a m s . N BS IR 8 2 2 4 5 1 . W a s hi ng to n, D C : N a t i o nal B u r e a u o f S t a n d a r d s , 1 9 82 .

P.318

T a b l e 14 . 2 g i v e s t h e x - r a y d o s e f o r t he t he o r et i c al b e a m , w i t h no i ni t i al x - r a y c o n t a m i n at io n . T h e s e v a l u e s w e r e e x t r a ct e d f r o m t he d ep t h- do s e d i st r ib ut io ns i n w a t e r c a l c u l at ed b y B e r g e r a n d Se lt z e r ( 45 ), us i ng a M o nt e C a r lo p r o g r am . T he x r a y c o n t a m i n a ti o n dos e f r o m a m e di c a l ac c e l e r ato r d e pe nd s v e r y m uc h o n i t s c o ll i m at io n s y s t e m a n d i s u s u a ll y a n o r de r o f t w o g r e at e r t ha n t he v a l ue s gi v e n i n T a b l e 1 4 .2 . In g e n e ra l , t h e x - r a y c o nt a m ina t i o n i s l e a st i n t he s c a nni ng be a m t y p e o f a c c e le r a to r , be c a u s e t h e s c at te r i ng f o i l s ar e not us e d . In a m o de r n l i near a c c e l e r ato r , t y pi c a l x-ray c o n t a mi na t ion dose to a p at ient r a ng e s f ro m a p p r o xi m a te l y 0 . 5 % to 1% i n t h e e ne rg y ra ng e o f 6 to 1 2 Me V ; 1 % to 2 % , f ro m 1 2 to 1 5 M e V ; a n d 2 % t o 5 % , f r o m 15 to 2 0 M e V . F o r r e g u l a r t re a tm e n t f i e l d si z e s , t he d o s e co nt r ib ut ed b y t he x - r a y c o nt a m i na t io n i s n o t o f m u c h c o n c e r n . H o w e v e r , e v e n s m a l l a mo unt s o f x - r a y c o nt a m i na t io n b e c o me c r it i c al f o r to t al b od y e le c t ro n i rr a d i at io n s uc h a s i n t he t r e at m e nt o f m y c o s i s f u n g o i de s ( s ec t io n 1 4 . 8 ) .

14.5. TREATMENT PLANNING

M o s t e l e ct ro n b e a m tr e a t me n t s a r e pl a nne d f o r a si ng le f ie l d te c hni q ue . F o r a r e l at i v el y f l a t a n d h o m og e n eo u s b l o c k o f t i s s ue , t he d o se d i st r i b ut io n c a n b e found by using the a p p r op r i at e i s od o se c ha r t . However, t hi s s i mp li c it y of t r e at m e n t pl a n n i n g is t h e e x c e pt io n r a t he r t ha n t he r ul e . S ur f a c e a r e a s a r e s e l do m f l at , a n d i n m a n y c a s e s , i nho m oge ne i ti e s , s uc h a s b o ne , l ung , a nd ai r c a v i t ie s , p r e s e nt d o sim e t ri c c o m pl e x iti e s .

A. Choice of Energy and Field Size

T h e e n e r g y o f be a m is d i c t at ed , i n ge ne r a l, b y t he d ep t h o f t he t a r g et v ol um e , m i n i m u m t a rg et do s e r e q u i r ed , a nd c li ni c a lly a c c e p t a bl e d o se to a c r i ti c a l o r g a n, i f p r e s e n t i n t h e p a th o f t h e b e a m . In m o s t c a s e s , w he n t he re i s no d a ng e r o f o v e r do s i n g a c ri ti c a l s t r u c t u r e b e y o nd t he t a r g et vo l um e , t he be a m e ne rg y m a y b e s e t s o t h at t h e ta r g e t v ol u m e l ie s e nt i re l y w i t hi n t he 9 0% i s o do s e c ur v e . H o w e v e r , i n t h e t r e atm e n t o f t h e b r e a st , the e ne r g y i s o f t e n c ho s e n so t hat t he d e pt h d o s e a t t h e c h e s t w a l l -l u ng i nt e r f a ce i s 8 0 % ( 46 ) . T he r a t io na l e f o r t hi s

WWW.MEDRAD.IR

l o w e ri n g o f t h e e n e r gy i s to s p ar e t he l ung , w i t h t he b el ie f t hat the t a r ge t vo l ume f o r t h e c h e s t w a l l i r r ad i a ti o n i s q ui t e s upe r f i c i al a nd t ha t a m i ni mum o f 8 0 % ( a nd s o m e e v e n a d vo c a te 7 0 % ) i so do s e c ur v e is s uf f i c i e nt fo r t he c he s t w al l . Be yo nd t h e 8 0 % de pt h d o s e , t h e d o s e f a ll o f f i s c ha r a c t e r i st i c al l y r a pi d a t t he s e b e am e n e r g ie s . T h e c h o i c e o f f i e l d s i ze i n e l e c tr o n b e a m t he r a p y s ho ul d b e s t ri c tl y b a s e d o n t he i s o do s e co v e r a ge o f t h e t a r g et v o l ume . E x a m i na t i o n o f t he e l e ct r o n i so do s e curves (Fig. 14.20) P.319 r e v e a l s t h at t h e r e i s a s i g n i f i c a n t t ap e ri ng o f t he 8 0 % i so do s e c ur v e a t e ne r g ie s a b o v e 7 Me V ( 4 6 ) . T he c o n s t ri c ti o n o f t he us e f ul t r e a tm e nt v ol um e a l so d ep e nd s o n t h e f i el d si z e a n d is w o r s e f o r t he s m a ll er f i e ld s . T hus , w i t h e le c t ro ns , a l a r g er f i e l d a t t h e s u r f a c e th a n o n e i s us ua ll y ac c us t o m ed to (i n t he c a s e o f p hot o n b e a m s ) m a y b e n e c e ss a r y t o c o v e r a t a rg e t a r e a a d e q ua te l y .

F I G . 1 4 . 2 0 . L a t e r a l c o n s t r i ct io n o f t he 80 % i so do s e c ur v e w it h d e pt h . ( F r o m Almond PR. R a di a ti on Physics of e le c t ron beams. In: Tapley N, ed. C li ni c al a p p li c a ti o n s o f t h e ele c t ro n b e a m . N e w Yor k : J o hn W i le y & S o ns , 1 9 76 : 7 , wi t h p e r m i s sio n . )

B. Corrections for Air Gaps and Beam Obliquity

In e l e c t ro n b e a m t h e ra p y , t h e r e i s a f r e q uent p r o bl em o f t re a tm ent c o ne e nd 1 no t b e i n g p a r a ll el to t h e sk i n s u r f a c e . T he s e un e v e n a i r g ap s c a n s om e ti m e s b e l a r ge a s a r e s u l t o f t h e e x t re m e c u r v a t ur e o f t he s l o pi ng s ur f a c e . In t he s e c a s e s , it i s a c o m m o n p r a c ti c e to ca l c u l a te do s e d i st ri b ut io n s i m pl y b y ap pl y i ng i nv e r s e s q ua re

WWW.MEDRAD.IR

l a w c o r r e ct io n t o t h e d o s e di st r i b ut io n a l o ng f a n l i ne s e m a na t i ng f r o m a v i r t ua l or e f f e c t i v e e le c t ro n s o ur c e ( 4 7 ,4 8 , 49 ) . A s a r e s ul t o f t hi s co r r e ct io n, t he r el a ti v e d e pt h d o s e di s t ri b u ti on f o r a s l o p i ng c o ntour r e m a i ns a l m o s t unc ha ng e d b ut t he a b s o l ut e v al u e o f t h e d o s e i s de c r e a s ed at al l d ep t hs b e c a us e o f be a m d i v e r ge nc e . T h i s m e t h od , h o w e v e r, d o e s n ot t a ke i nto a c c o unt c ha ng e s i n s id e s c a tt e r o w i ng t o b e a m ob li q u it y . T h i s h a s be e n po i nte d o ut b y E k s t r a nd a nd D i x o n ( 50 ) , w ho s h o w e d t h a t t h e b e a m o bl iq u i t y te nd s t o ( a ) i nc r e a se si d e s c a tt e r a t t he d ep t h o f m a x i m u m d o s e ( d m a x ), ( b ) s h i f t d m a x t o w a rd t he s ur f a c e , a nd ( c ) d e c r e a se t he d e pt h o f p e n et r a ti o n ( a s m e a s u r e d b y t he d e pt h o f t he 8 0 % do se ) . T he s e e f f e c t s a r e e v i de n t i n F i g . 1 4 .2 1 . A b r o a d el e ct ro n b e am c a n b e r e p re s e nte d b y a s um m a t i o n o f a l a r g e num b e r o f p e n c i l o r s l it b e a m s p l a c ed a d j a c e nt t o ea c h o t he r . W he n t he b e a m i s i nc id e nt o b li q u el y o n t h e p a ti en t s u r f a c e , t he p oi nt a t t he s ha l lo w de pt h r e c e i v e s g re a te r s i d e s c at t er f r o m t he a d j a c e n t pe nc i l b ea m s , w hi c h ha v e t r a v e r s e d a g r e at e r a m o u n t o f m at e ri a l , wh e r e a s t h e p oi nt at t he g r e at e r d ep t h r e ce iv e s l e s s s c at te r . T h i s i s s c h e m at i c al l y i ll u s t r a te d i n F ig . 14 . 2 2 A . A s a re s ul t o f the s e c ha ng e s i n t h e r el a ti v e o r ie n t a tio n o f t h e p e nci l s , o ne w o ul d e x p e ct a n i nc r e a s e i n d o se at s h a l l o w d ep t h s a n d a d e c r e a se i n d o se a t g re a t e r d e pt hs . H o w e v e r , b e c a us e t he P.320 b e a m i s d i v e rg e n t , t he do s e w i ll al s o de c re a s e at al l de p t hs a s a r e s ul t o f t he i n v e r s e s q u a r e l a w e ff e c t , a s t h e ai r ga p be t w e e n t he c o ne e nd a nd t he s ur f a c e i n c r e a s e s w it h t h e i nc r e a s e i n t he a ngl e of o b li q uit y . T hus t he d e pt h d o s e at a p o i nt i n a n o b l iq u e l y in c i d e n t b e am i s a f f e c t e d bo t h b y t he p e nci l s c a tt e r e f f e ct a n d t h e b e a m d i ve r g en c e .

WWW.MEDRAD.IR

F I G . 1 4 . 2 1 . C h a n g e i n d e p t h d o s e w it h t he a ng l e o f o b li q ui t y f o r a 9 - M e V e l e ct r o n b e am . ( F r o m E k s t r a n d K E , D i x o n R L . T he p r o b l e m o f ob l iq ue l y i nc i de nt beams in e le c t ro n beam t r e at m e nt p l anni ng . Med P hy s 1 9 8 2 ;9 : 2 76 , w i th p e r m i s sio n . ) F i g u r e 1 4 .2 2 B s c h e ma t i c al l y r e p re s e nt s a n a r r a ng e m e nt us e d f re q ue nt l y f o r t he t r e at m e n t o f c h e s t w a l l . T h e b e a m i s i nc i dent v e r t i c al l y o n a s l opi ng s ur f a c e , t hus i n c r e a s i n g t h e a n g le o f o bl iq u i t y a s w el l as t he a i r g a p be t w een t he e nd o f t he c o n e a n d t h e s u r f a c e . L e t D 0 ( f , d ) b e t he do s e at a po i nt a t d e pt h d f o r a b e am i n c i d e nt n o r m a l l y o n a f l a t - s u r f a c e d p ha nt om w i t h a n e f f e c t i v e S S D = f . W he n t he c o n e i s p l a ce d o n t h e c h e s t w a l l , t he de p t h d o s e D ( f + g , d ) w i l l be g i v e n b y :

w h e r e g is t h e ai r ga p a n d O F ( , d ) i s t he o bl iq ui t y f a ct o r fo r t he pe nc i l b e a m s c a t te r e f f e c t di s c u s s e d p r e v io u s l y . O F ( , d ) a c c o unt s f o r t he c ha ng e i n d e p th d o s e a t a p oi n t i f th e b e a m a ng le c ha ng e s r el a ti v e t o t he s ur f a c e w i t ho ut c h a n g e i n t h e d i s t a n ce f r o m t h e p oi nt to t he e f f e c t i v e so ur c e p o si ti o n. T h e o b l iq u i t y f a c to r be c o m es s i g ni f i c a nt f or a ng l e s o f i nc i d e nc e a p p r o a c hi ng 45 d e g re e s o r h ig h e r . F or e x a m p l e , a 6 0 -d eg re e a ng l e o f o bl i q ui t y f o r a 9 - M e V b e a m g i v e s r i se t o O F = 1 . 18 a t t h e d m a x , a s hi f t of t he d m a x to a bo ut 0 . 5 c m , a nd a s hi f t o f t h e 8 0 % de pt h t o a b o u t 1 . 5 c m ( 52 ) . O f c o ur s e , i n a g i v e n c l i ni c al s i t uat io n, t h e s e e f f e ct s a r e c o mp o u n d e d b y t he i nv e r s e s q ua r e l a w e f f e c t w he n s i g ni f i c a nt ly l a r g e ai r g a p s a r e c a us e d b y t h e s lo p i ng s urf a c e . K h a n e t a l . ( 5 1 ) h a v e d e te r m i n ed o bl iq ui ty f a c t o r s a s a f unc t i o n o f e ne r g y a nd d e pt h f o r o bl iq u i t y a ng l e s o f 3 0 de g re e s , 45 d e g re e s , a nd 60 d eg r e e s . T he s e d at a a r e p r e se n t ed i n T a b le 1 4 . 3 . De pt hs a r e nor m a l i z ed to t he pr a c tic a l r a ng e , w hi c h i s a p pr o x i m at el y gi v en b y E ( M e V ) / 2 i n c ent i m et e r s o f w a te r . T he Z / R p v a l ue s i n c o l u m n 1 c a n b e c o n v e r t ed to P.321

P.322 d e pt h s b y m u l t ip l y i n g w i t h t h e R p f o r t he gi v e n e ne r g ie s . T he s e o b li q uit y f a c t o r s c a n b e u s e d i n E q u a t io n 1 4 . 1 5 f o r t he c a l c ul a ti o n o f d o se a t a p o i nt f o r a n o b li q u el y i n c i de n t b e am .

WWW.MEDRAD.IR

F I G . 1 4 . 2 2 . A : A s c h e m a ti c il l u s t r at io n o f ho w t he r e la ti v e o ri ent a t io n o f pe nc i l b e a m s c h a n g e s w i t h th e a n g l e o f o bl i q ui t y . F o r a p a r a l le l b e am , t hi s e f f e c t w o ul d i n c r e a s e do s e at t h e s h a l l o w e r p oi nt s a nd d e c r e a se d o se a t t he d e ep e r po i nt s as the a n g le of o bl iq u it y is increased. ( Red r a w n from E k s t r a nd KE, Dixon RL. O b l iq u e l y i n c id e n t e le c t ro n b e a m s . M e d Phy s 1 9 8 2 ; 9 :2 7 6 . ) B : A d i a g r a m m at i c r e p r e se n t a ti o n o f i r r ad i a ti o n o f a c he s t w a ll w i t h s l op i ng s ur f a c e. T he g a p g a nd d e pt h d fo r a p oi n t a re m e a s u r ed al o ng t he f a n l i ne (t he l i ne jo ini ng t he p oi nt to t h e e f f e ct i v e s o u r c e lo c a ti o n ) . i s t he a ngl e b et w e e n t he f a n li ne a nd no rm a l to the t a n ge n t to the s l o pi n g surface. T he f i g ur e on t he r i g ht r e p re s e nt s t he r e f e r e n c e se t - u p , w ith b e a m i n ci d e nt no r ma l , w i t h no ai r g a p s be t w e e n t he co ne e n d a n d t h e p h a n t o m. C : C o m p a r i s o n o f m e a s ur e d ( s ol id l i ne s) a nd c a l c ul a t ed (dashed li n e s ) i so dos e d i st r ib u t io n for a beam i nc id e nt on a p o l y s t y re ne c y l i n d r i c al p h a n t o m . T h e m e a s u r e d d i st r i but i o n r e p re s e nt s i so de ns i t y d i st r ib ut io n o b t ai n e d w it h a f il m s a n d w i c h e d i n t he p ha nt o m a c co r di ng to t he p ro c ed ur e o u t li n e d in s e ct io n 14.3B. The c a l c ul a ted d i st r ib ut io n was ob t a i ned with a

WWW.MEDRAD.IR

computer

using

d i v e r g e nt

p e nc i l

be am

a l g o ri t hm .

Bo t h

d i s t ri b utio ns

are

n o r m a l i z ed to t h e D m a x i n a r e f er e nc e se t - up i n w hi c h t he b e a m i s i nc i de nt n o r m a l l y o n a f l a t ph a n t o m w it h no ai r g a p s be t we e n t he c one e nd a nd t he p h a n t o m . 1 2 - M e V el e ct r o n s ; f i el d s i z e 18 1 2 c m ; e f f e c ti v e S S D = 7 0 c m .

TABLE 14.3. OBLIQUITY FACTORS FOR ELECTRON BEAMS a

E0 (MeV) Z/Rpb 22 18 15 12 9 6

(a) = 30

0.0

1.00

0.98

0.98

1.00

0.94

1.01

0.1

1.00

1.00

1.00

1.00

1.00

1.08

0.2

1.00

1.00

1.01

1.02

1.05

1.11

0.3

1.01

1.00

1.02

1.03

1.05

1.06

0.4

1.01

1.01

1.02

1.00

1.00

0.96

0.5

1.00

1.00

0.98

0.96

0.92

0.86

0.6

0.95

0.94

0.92

0.90

0.86

0.79

0.7

0.92

0.90

0.87

0.86

0.86

0.83

0.8

0.93

0.85

0.82

0.90

1.00

0.96

0.9

1.09

1.00

1.20

1.11

1.44

1.00

1.0

1.42

1.54

1.50

1.50

1.30

1.00

(b) = 45

WWW.MEDRAD.IR

0.0

1.03

1.02

1.03

1.05

0.98

1.14

0.1

1.03

1.04

1.04

1.06

1.10

1.14

0.2

1.05

1.06

1.07

1.11

1.12

1.12

0.3

1.06

1.07

1.09

1.09

1.05

1.07

0.4

1.04

1.04

1.04

1.01

0.93

0.92

0.5

1.00

0.99

0.92

0.92

0.80

0.77

0.6

0.93

0.90

0.86

0.82

0.70

0.69

0.7

0.84

0.84

0.82

0.77

0.70

0.76

0.8

0.87

0.83

0.85

0.86

0.83

1.10

0.9

1.30

1.00

1.43

1.20

1.40

1.46

1.0

2.17

2.31

2.19

2.50

2.00

2.14

(c) = 60

0.0

1.06

1.06

1.10

1.14

1.14

1.30

0.1

1.10

1.12

1.17

1.20

1.23

1.21

0.2

1.12

1.14

1.15

1.16

1.17

1.08

0.3

1.07

1.07

1.07

1.02

0.98

0.90

0.4

1.00

0.96

0.93

0.86

0.79

0.70

0.5

0.87

0.84

0.79

0.74

0.67

0.56

WWW.MEDRAD.IR

0.6

0.75

0.74

0.69

0.63

0.58

0.51

0.7

0.70

0.68

0.67

0.62

0.57

0.56

0.8

0.75

0.71

0.67

0.74

0.77

0.87

0.9

1.21

1.00

1.29

1.14

1.60

1.40

1.0

2.31

2.46

2.75

3.0

3.2

2.45

M e a s u r e d o n a V a r i a n C l i n a c 2 50 0 l i ne a r a cc e l e r ato r , b y D ei be l FC , K ha n F M , P hy s 1 9 83 ; 1 0 :5 27 .

W e r n e r B L . E l e ct r o n b e a m t r e at m e nt p la nni ng w i t h s t ri p b e a ms [ a b s t r a ct ]. Med
b

Z i s t h e d ep t h me a su r e d a lo n g t he l i ne j oi ni ng t he p oi nt o f me as ur e m e nt to

t h e v i r t u a l el e ct r o n s ou r c e .

C o m p u t e r al go r it h m s h a v e b e e n d e v e lo pe d ( 3 8 , 5 2 , 53 , 5 4 ) b y w h i c h b r o a d be am d i s t ri b u tio n i s c a l c u l at e d b y pl a c i ng a se t o f na r r o w o r p e nc il be a m s a lo ng t he c o n t o u r . T h e di v e r ge n c e c o r re c ti o n c a n b e ta k e n i nt o a c co unt b y a l i g ni ng c e nt r al a x e s o f t h e p e n c il bea m s a l o n g t he f a n li ne s a nd no r m al i z i ng t he r e s ult i ng d o se d i s t ri b u tio n to t h e d os e a t d m a x f o r t he b e am i nc id e nt no r m al l y on a f l a t - s ur f a c ed p h a n t o m . F i g u r e 14 . 22 C c o m p a r e s t he c a l cul a t e d d i st r ib ut io n us i ng a p e nc i l b e am a l g or it h m w i t h t he me a s u r e d di s tr i b ut io n o b t ai ne d i n a c y li nd ri c a l p ol y s t y r e ne phantom. S h a r p s u r f a c e i r r eg u l ar i ti e s p r od uc e lo c a li z ed ho t a nd c ol d sp ot s in t he und e r l y i ng m e d i u m d u e to s c a tte r i n g . E l e ct ro ns a r e p r e do m i na ntl y s c a tt er e d o ut w a r d b y s t e ep p ro je c ti o n s a n d i n w a r d b y s te ep de p r es s i o ns . T hi s c a n be s ee n i n F i g . 1 4 .23 ( 5 5 ) . In p r a c t i c e , s uc h s h a r p e d g e s m a y b e s m oo t hed w i t h a n a p p r o p ri a te l y s h a p e d bo l u s . A l so , i f a b ol u s i s us e d t o re d uc e be a m pe ne t r at io n i n a s el e c te d p a r t o f t h e fi e ld , i t s ed g e s s h o u ld b e t a p e red t o mi ni m i ze t he e f f ec t s ho w n i n F i g . 14.23.

WWW.MEDRAD.IR

FIG. 14.23. Effect d i s t ri b u tio n s . (From

of sharp Dutreix

s ur f a c e J.

i r re g ul a r iti e s o n e l e ct ro n b e a m i s od o se In: Gil y Gil, Gil Gayarre, eds. M ad r i d : G e ne r a l D ir e c to r a te o f H e al t h,

Do s i me t r y.

S y m p o s i u m o n h i g h -e n e r g y el e ct r o ns . 1 9 70 : 1 13 , w i t h p e r mis s i o n . ) P.323

C. Tissue Inhomogeneities
E l e c t ro n b e a m d o se d i s t ri b u tio n c a n b e s ig ni f i c a nt l y al te r e d i n t he p re s e nc e o f t i s s u e i n h o mo g e n ei ti es s u c h a s b o ne , l un g , a nd a i r c a v i t i e s . It i s d i f f i c ul t to d e te r m i n e do s e d i st r ib u t io n w i t h i n o r a ro und s m a l l i nho mo g e nei ti e s b e c a us e of enhanced s c a t te r i n g effects. However, for l a r ge a nd uni f or m slabs, do se

WWW.MEDRAD.IR

d i s t ri b u tio n b e y o n d th e i n h o m o ge ne it y c a n b e c o rr e c te d b y us i ng t he co e f f i c ie nt o f e q u i v a l e n t t h i c k n e s s ( C E T ) m e t ho d ( 4 9 ,5 6 , 5 7 ,5 8 , 59 ) . It i s a s s um e d t ha t t he a t t e n u a ti o n b y a gi v e n t h i c k n e s s z o f t he i nho mo g e nei t y i s eq ui v a l e nt to t he a t t e n u a ti o n ( z C E T ) o f w a t e r . T he C E T f o r a g i v e n m at e ri a l i s a p p ro x i m at el y g i v e n b y i t s el e ct r o n d e n s i t y ( el e ct r o n/ ml ) r e l at i v e to t ha t o f w a te r . T he d o s e a t a p o i nt be y o n d t h e i n h om o g e n ei t y i s d et e r mine d b y c al c ul at i ng t he e f f e c ti v e d e pt h, d e f f , a l o n g t h e r a y j o i ni n g t h e p oi nt a nd t he v i r t ua l s o ur c e o f t he el e c tr o ns .

w h e r e d i s t h e a ct u a l d e pt h o f po i nt P f r om t he s ur f a c e . T he de p t h d o se i s r e ad from do s e d i st r ib u t ion data for water at t he e f f e ct i v e d ep t h. An a d d it io na l c o r r e ct io n m a y b e a p pl i ed d u e to t he i nv e r se s q ua r e l a w , t ha t i s ,

, w h e r e f i s t h e e f f e c t iv e S S D . P.324

C.1. Bone
T h e C E T m e t h o d i s i n g o od a g re e m e nt w i t h i n v i v o m e a s ur e me nts i n p a t ie nt s f o r t h e do s e be h i n d t h e m a n d i b le (6 0 ) . T he ele c t ro n d e nsi t y (o r C ET ) o f a c o mp a c t b o n e ( e . g . , m a n di b le ) r e l a ti v e t o t ha t o f w at e r i s t a k e n a s 1 . 65 . F o r s p o ng y bo ne , s u c h a s s t e r n u m , w h i c h h a s a d e ns it y o f 1 . 1 g / c m 3 , t he el e ct ro n de ns i ti e s a re not m u c h d i f f e r e n t f r o m w a t e r , a n d t he r e fo r e , C E T c a n b e a s s um e d t o b e uni t y .

C.2. Lung
T h e p r ob le m o f l u n g i n h o m og e nei t y ha s b e e n st ud ie d b y m any i nv e s t i g at or s ( 5 6 , 5 7 ,5 8 , 59 ) . R e s u lts o f i n v i vo m e a s ur em e nt s i n t he l ung s o f d o g s ha v e s ho w n t h a t t h e r e i s a co n s i de r a b le v a r i at io n o f C ET w i t h de p t h i n t he l ung ( 6 1 ) . T hi s i s i ll u s t r a te d b y F ig . 1 4 .2 4 f o r a w a te r - c o r k sy s t e m ( s i m ula ti ng c he s t w a l l a nd l ung i n t e r f a c e ) . T h e do s e n e a r t h e i n te r f a c e i s d e c r e a se d d ue to r e duc e d s c a tt e r f r om t h e lo w - d e n s it y c o r k . B e y o n d a c e r t ai n d ep t h, t he do s e to t he c o r k b e gi ns to i n c r e a s e r el a ti v e to th e r e f e r e n c e c ur v e ( m e a s ur e d i n w a t e r ) a s t he i nc r e a s e d p e n e t r at io n o v e rt a k e s t h e r e d u c e d s c a tt e r . T h u s , i n g e n e r a l , t h e C E T v a l u e s f o r l un g d e pe nd o n d ep t h w i t hi n t he l un g . E m p i r i c al eq u a t io n s f o r t h e C E T v a l ue s der i v e d f r om i n v i v o m ea s ur e m e nt s ha v e b e e n p r op o se d to t a k e t h i s v a r i a t io n i nt o a cc o unt ( 6 0 ) . A n a v e r a g e l ung C E T v a l ue of 0.5 has also been s u g g e s t ed have (56). More t ha t a r e c e nt CET m e a s ur e m e nt s based on ( 6 2) in a n t h r o p o mo r p hi c w a l l i r r a di at io n s . T h e r e l a ti v e e le c t ro n d e n s i t y o f l ung m a y b e e q ua t ed to i t s ma s s d e ns i t y . T he s t u d i e s wi t h c o mp u t ed t om o gr a p hy ( C T ) h a v e s ho w n t ha t t he ele c t ro n d e ns it y o f l u n g v a r i e s b e t w ee n 0 . 2 0 a n d 0 . 2 5 r e l at i v e t o t ha t o f w a t e r . T he r e f o r e , i f C E T i s a s s u m e d eq u a l t o e le ct r o n de n s i t y , E q ua ti o n 1 4 . 16 m a y be us e d to c a l c ula t e l ung c o r r e ct io n b y s u b s t itu t i n g l u n g d e nsi t y in p l a c e o f C E T . F i g ur e 1 4 . 25 s ho w s e x a m p le s o f u n c o r r e ct e d a n d co r r e ct e d i so d o se di s t ri b uti o ns ob t a i ned b y us i ng phantoms s ho w n v a l ue e le c t ro n

d e n s i t y gi v e s a n a c c u r a c y o f a p p r o xi m a te l y 1 0 % i n d e pt h do s e fo r t y pi c a l c he st

WWW.MEDRAD.IR

p e n c i l be a m s . In t h e c a s e o f t h e c o r r e ct ed d i s t ri b uti o n, t he e f f ec t i v e de p t h w a s c a l c u l a te d a s s u m i n g C E T e q u a l t o t he l ung de ns i t y . In r o u t i n e t r e at m e nt p l a n n i n g , a ny o f t he p re v i o us m et ho d s m a y b e us e d a s a p p r o xi m a ti o n s . O b v io u s l y , the e f f e ct i v e d e pt h c a l c ul at io n b as e d o n e l e ct ro n d e n s i t y o r so m e e m pir i c a ll y d e ri v e d C E T i s o nl y a r o ug h a pp r o xim a t io n, f o r w hi c h s c a t te r i n g e f f e ct s a r e n o t f u l l y t a k e n i nt o a cc o unt .

F I G . 1 4 . 2 4 . D e pt h - do s e d i st r ib ut io n i n wa t e r a nd w a t e r - co r k p ha nt o m s . C E T v a l u e s m a y b e c a l c u la t e d f ro m t he se d at a. C E T = X 1 / X 2 . ( M o d i f i e d f ro m A l mo nd P R , W r i g h t A E , B o o n e M L . H i g h - e ne r g y el ec t r o n do s e pe r t ur b at io ns i n r e gi o ns o f t i s s u e h e te r og e n ei t y . R a d i ol og y 1 96 7 ; 88 : 114 6 . )

WWW.MEDRAD.IR

F I G . 1 4 . 2 5 . A n e x a m p l e o f c h e s t w a ll ir r a d i at io n w i t h e le c t ro ns . T he s ur f a c e contour was as i r r e g u lar w e ll as in shape, so b o l us was us e d A: to even o ut c he s t wall thickness maximize s ur f a c e dose. C al c ul a ted i so d o se c ur v e s

u n c o r r e c t ed f o r l u n g d e n s i t y . B : C a l c ul a te d i so do s e c ur v e s c or r e c t ed f o r l ung d e n s i t y ( = 0 . 25 g /c m 3 ) . 1 0 - Me V e le c t ron b e a m ; e f f e ct i v e S S D = 6 8 cm ; f i eld size = 13 15 cm. P.325

C.3. Small Inhomogeneities

S m a l l i n h o m og e n ei ti es p r e se n t a m o re c om p l e x si t uat io n b e c aus e o f el e ct r on s c a t te r i n g b e h i n d e dg e s . F ig u r e 14 . 2 6 s che m a t i c al l y i ll us t r at es t he e f f e c t at a s i n g l e e dg e . Fo r s im p li c it y , i t i s a s s um ed t ha t t he p a t h o f t he e lec t r o ns i n m e di um M i s a l o n g s t r ai g h t l in e s . If a m a t e r i a l M o f a hi g he r m a s s s c a t t er i ng po w e r i s i n t r od u c e d , e le c t ro n s a r e s c a t te r ed a t l a r ger a ng l e s . T hi s c a us e s a d e c r e a s e i n t he e l e ct r o n f l u e n c e b e h in d t h e s l a b , t hus r e d uc i ng t he d o s e t here . T he s c a t t e r e d e l e ct r o n s , o n t h e o t he r h a n d , i n c r e a s e t he d o s e i n t he m ed i um M . T hus a s m a l l i n h o m o ge n e it y c a u s e s c o l d s po t s a nd ho t spo t s be hi nd i t s e d ge s . P o h l it a n d M a n e go l d (6 3 ) h a v e m a de a s y st e m at i c a na l y si s o f do s e di s tr i b ut io ns b e h i n d e dg e s o f d i f f er e n t m a t e ri a l s . T he i r m e t ho d c a n b e us e d t o g et a r o ug h e s t im a te o f t h e m a x im u m v a l u e s f o r i nc r ea s e a nd d e c re a s e o f d o s e b e hi nd s uc h i n h o m o ge n e it ie s . F i g ur e 1 4 . 27 d e fi ne s a ng le s a nd o f d o se pe r t ur b at io n. T he m e a n a n g l e gi v e s th e p o s it io n o f t he ma x i m a o f r e d uc ti o n and o f i nc r e a s e o f d o s e , a n d r e p re s e n ts t h e m e a n a ng l e at w hi c h t he e f f e c t o f t he i nho m og e nei t y i s p r a ct i c al l y n eg li g ibl e . T h e s e a ng l e s , w hi c h a r e re l at e d to t he s c a tt e ri ng o f e l e ct r o n s i n t he m ed iu m , d e p e n d m a i nl y on t he m e a n e le c t ro n e ne r g y at t he e d ge . F i g u r e 1 4 .2 8 giv e s t h e s e a ng l e s a s a f unc t i o n o f . The dose di s t ri b u tion u n d e r t h e i nho m og e ne it y b ut o uts i de a ng l e m a y be c a l c u l a te d a c c o rd i n g to t h e r eg u l a r C E T m e tho d d i s c us s ed p r e v io us l y . T he m a x i m a and minima of P.326 d o s e al o n g t h e bo u n da r i e s o f a n g le m a y b e e s ti m at e d b y de f i ni ng a m a x i m um change, Pmax, in dose.

w h e r e D m i s t h e do s e a t t h e h i g h e st i nc r e a se o r d ep r e s si o n a nd D 0 i s t he d o se i n t h e h o m og e n e o u s w at e r p h a n t om a t t ha t p o i nt . F i g ur e 14 . 2 9 m a y b e us e d t o e s t im a te P m a x P.327 f o r d i f f e re n t e n e rg i e s a n d m a t e ri a l s . It i s im p o rt a nt to not e t ha t t he i nf l ue nc e o f a n e d g e i n c r e a se s w i th i n c r e a s i n g e l e ct ro n e ne r g y .

WWW.MEDRAD.IR

F I G . 1 4 . 2 6 . S c h e m a t i c il l u st r a ti o n o f el ec t r o n s c a tt e r be hi nd e d g e s b et w e e n m a t e ri a l s M a n d M . T h e s c a t t e ri n g p o we r o f M i s g r e a t e r t ha n t ha t o f M .

F I G . 1 4 . 2 7 . Is o d o s e d i st r ib u t io n be hi nd a n e d ge o f a t hi n l ea d s l ab i n w at e r. A n g l e d e n ot e s t h e m a x i m a o f d o s e c ha ng e a nd a ng l e o f neg l ig ib l e c ha ng e . ( F r o m Po hl it W , M a n eg o ld K H . E le c t ro n- b e am d o se d i st r ib ut io n i n i nho m og e neo us

WWW.MEDRAD.IR

m e d i a . In : K r a m e r S , S u n t h a r a l i ng a m N , Z i nni ng e r G F , e d s . H i g h e ne r g y p hot o ns a n d e l e ct r o n s . N e w Y or k : J o h n W i l e y & S o ns , 1 9 7 6 :2 4 3 , w it h p e r mi s s io n. )

F I G . 1 4 . 2 8 . P l o t o f a n g l e s a n d a s a f unc t i o n o f me a n e ne r gy a t t he ed g e for i n h o m o ge n e it ie s i n w a t e r ( o r t i s s ue ) . ( F r om P o hl i t W , M a ne g old K H . E l e c t r o nb e a m d o se di s t ri b u ti on i n i n h o m og e neo us m e d i a . In: K r a m e r S , S unt ha r a l i ng a m N , Z i n n i n g e r G F , e d s . H i g h e n e r g y p hot o ns a nd e l e ct r o ns . N e w Y or k : J o hn W i l e y & S o n s , 1 9 7 6 :2 4 3 , w it h p e r m i s sio n . )

F I G . 1 4 . 2 9 . P l o t o f m a x i m u m c h a ng e i n d o s e P m a x a s a f unc t i o n o f m e a n e l e ct ro n

WWW.MEDRAD.IR

e n e r g y at t h e e d ge o f v a r i o u s i n h o mo ge ne it ie s i n w a t e r . ( F r o m P ohl i t W , M a ne go ld K H . E l e c t r o n - be a m do s e di s t ri b uti o n i n inho m o g e neo us m e di a. In: K r a m e r S , S u n t h a r a l i n g a m N , Z in n i n g e r G F , e d s . H i gh e ne r g y p ho to ns a nd el e ct r o ns . N ew Y o r k : J o h n W i l e y & S on s , 1 9 7 6 : 24 3 , w i t h p er m i s s io n. ) S c a t t e ri n g e f f e c t s c a n b e e n h a n c e d b y a d j oi ni ng s c a t te r i ng e d ge s, a nd t he r e f o r e , s m a l l i n h o m o ge n e it ie s p r o d u c e co m pl e x e f f ec t s , r e s ul ti ng i n l a rg e c ha ng e s i n d o s e c a u s e d b y t h e o v e r l app i n g o f t h e s e re gi o ns . T h e p r e v i o u s m e t ho d i s u s e f u l f o r q ui c k - a nd - r o ug h c a l c ul a ti o ns . M o r e a c c ur a t e c a l c u l a ti o n s re q u i re m o r e s op h i s ti c a te d m e t hod s b a se d o n m ul t ip le s c at t er i ng theory. Some work along t h e se l i ne s ha s been r e po r te d in t he l i te r at ur e ( 3 4 , 3 8 ,5 4 , 64 , 6 5 ) .

D. Use of Bolus and Absorbers

B o l u s i s o f te n u s e d i n e le c t ro n be a m t her a p y to ( a ) fl a tt e n out a n i r re g ul a r s u r f a c e , ( b ) r e d u c e t h e p e n e t r at io n o f t he e l e c tr o ns i n p a r t s o f t he f i e l d , a nd ( c ) i n c r e a s e t h e s u r f a c e d o s e . Ide a ll y , t he b ol us m a t er i al s ho ul d be e q ui v a l e nt to t i s s u e i n s t op pi n g p ow e r a n d s c a t te r i ng p ow e r . A g i v e n b ol us ma t e ri a l s ho uld be c h e c k e d b y c o m p a ri n g d e p t h do s e di st r i b ut io n i n t he b ol us w i t h tha t i n t he w a t e r . If a s c a l i n g f a c t o r i s r e q u i r ed , i t s ho ul d b e do c um e nt ed a nd us e d i n t re a t me nt p l a n n i n g w h e n e v e r t h e b ol u s i s u s e d . A n u m b e r o f c o m m e r ci a ll y a v a i l a bl e m at e ri al s c a n b e us e d a s b olus , e . g . , p a r a f f i n w a x , p o l y s t y r e n e , L u ci t e , S u p e r st uf f , a nd S up e r f l a b . U s e f ul ne s s o f s o m e o f t he s e m a t e ri a l s f o r e le c t ro n b ol u s i n g h a v e b ee n d i s c us s e d i n t he l it e ra t ur e ( 66 , 6 7 ) . In m y e x p e r i e n c e , S u p e rf l a b 2 i s e x c el le nt f o r b o l usi ng . T hi s m a t e r ia l i s t r a ns p a re nt , f l e x i bl e , a n d a l mo s t w a t e r eq u i v a l e nt . A p l at e of lo w at om i c number m a te r i al s uc h as L uc i te a nd po l y s t y r e ne is s o m et i me s u s e d to r ed u c e t h e e n e r g y o f a n e le c t ro n b e am . S uc h p l a te s a re k no w n a s d e ce l er a to r s . T h e d e c el e ra to r s ho uld b e pl a c ed i n c lo s e co nt a c t w i t h t he p a t ie n t s u r f a c e a s w it h a b o l u s . L a r ge a i r g a p s b et w e e n t he ab s o r be r a nd t he s u r f a c e w o u l d r e s u lt in s c a t t e ri n g o f e l e ct ro ns o ut s id e t he f ie l d a nd r e d uc ti o n in d o s e , w h i c h m a y n ot b e e a si l y p r e di c t ab le unl e s s s p e ci f i c a ll y m ea s ur e d f o r t ho s e c o n d it io n s . F o r t h e s e r e a s o n s , a fl e x ib l e b o l us t ha t co nf o r m s t o t he s ur f a c e i s m o r e de s i r ab l e .

WWW.MEDRAD.IR

F I G . 1 4 . 3 0 . Is o d o s e d i s t ri b u tio n s f o r a d j ac e nt e le c t ro n f i e ld s w i t h d i f f e re nt g a p w i d t h s . ( F r o m Al m o n d P R . R a d i a ti o n p hy s i cs o f e le c t ro n b ea m s . In: T a p l e y N , e d . C l i n i c a l ap p li c at io n s of t h e e l e ct r o n be a m . N e w Y o r k : J o hn W i l e y & S o ns , 1 9 7 6 ,

WWW.MEDRAD.IR

w i t h p e r mi s s io n . ) P.328

E. Problems of Adjacent Fields

W h e n t w o a d j a ce n t e le c t ro n f i el d s a re o v erl a p pi ng or a b utt i ng , the r e i s a d a ng e r o f d e li v e ri n g e x c e s si v e l y h i g h d o se s i n t he j unc t i o n r e gi o n. O n t he ot he r ha nd , s e p a r a ti n g t h e f ie l d s m a y s e r io u s l y und e r do s e p a r t s o f t he t umo r . E x a m p l e s o f c o m bi n e d i so do s e di st r i b ut io n s f o r d i f f e r e nt f i e ld s e p a r at io ns a r e s ho w n i n F i g . 1 4 . 3 0 . In a c li n i c a l s i t u a ti o n , t he d e ci s ion a s t o w he t he r t he f i e ld s s ho ul d b e a b u t t ed o r se p a r at e d s h o u l d b e b a se d o n t he uni f o r m i t y o f t he c o m bi ne d do se d i s t ri b u tio n a c r o s s t he t a rg et v ol um e . Be c aus e t he t um o r s t re a ted w it h el e c tr o ns a r e mo s tl y s u p e r fi c i al, t h e e le c t ro n f i el d s ar e us ua l l y ab ut te d o n t he s ur f a c e . T he h o t s po t s c a n b e a c ce p te d , d ep e ndi ng o n t he i r m ag ni t ude , e x t ent , a nd l o c a ti o n. S i m i l ar c o n s i de r a ti o n s a p p l y t o e l e ct ro n f i e ld s a d j a c e nt t o x - r a y f i e l d s . W h e n a n e l e c t r o n f i eld i s a b u tt e d at t he sur f a c e w i t h a p ho t o n f i e l d , a hot s p ot d e v e lo p s o n t h e s i de o f t h e p h ot o n f i el d a nd a c o ld s p ot d e ve lo ps o n t he s i de o f t h e e le c t ro n f i e l d (68 ) . T h i s i s c a us e d b y o ut s c a t te r i ng o f ele c t ro ns f r o m t he e l e ct r o n f i el d . Fi g u r e 1 4 . 31 s h o w s t hi s e ff e c t w he n a 9 - M e V e l e ct r o n f i el d i s a b u t t ed w i t h a 6 - M V ph o t o n f i el d , a n P.329 e x a m p le t y pi f y i n g a cl i n i c al s it u a t io n i nv olv i ng t r e at m e nt o f t um o r s i n t he ne c k . W h e r e a s t h e p h o to n f i e ld i s u s e d t o t r e at the a nt e r i o r ne c k , t he e l e c t ro n f i e ld i s u s e d t o t re a t t h e po s te r io r n e c k no d e s o v e rl y i ng t he c o r d . Be c a us e o f t he l i m it ed r a n g e o f t h e e le c t ron s , t h e c o r d c a n b e s p a r e d , w hi l e s uf f i c ie nt d o se c a n b e d e li v e r ed t o t h e n o d e s.

WWW.MEDRAD.IR

F I G . 1 4 . 3 1 . Is o d o s e c u r v e s i n a p l a ne pe rp e nd i c ul a r to t he j unct io n l i ne b et w e e n a b u t ti n g p h ot o n a n d e l e ct r o n f ie ld s . 9 - M e V E l e c t ro n b e am ; f i el d s i z e = 10 10 c m ; 6 - M V p h o to n be am ; S S D = 1 0 0 c m . A : E l e ct r o n b e a m a t s t and a r d S S D o f 10 0 c m . B : E l e c t r o n b e a m a t e x t e n d ed S S D o f 1 2 0 c m . ( F r o m J o hnso n J M , K ha n F M . D o s i me t ri c e f f e c t s o f a b u t ti n g e x te nd ed S S D e le c t ro n f ie l d s w i t h p ho to ns i n t he t r e at m e n t o f h e a d a n d n e c k c a n c e r s . I nt J R a d i a t O nc o l Bi ol P hy s 1 9 9 4 ; 28 : 74 1 7 4 7 , w i t h pe r m i s si o n .) A n e x a m i n a t io n o f t he i so do s e di s tr i b ut io n i n F i g . 1 4 . 31 a l so re v e a l s t ha t t he e x t e n t o f h ot a n d co ld s po t s d e pe nd s o n the e le c t ro n b e am S SD . In F i g . 14 . 3 1 A , t h e el e c tr o n be a m i s i n c i d e nt a t t he s ta nda r d S S D o f 10 0 c m , w i t h t he di s ta nc e b e t w ee n t h e ap pl i c ato r e n d a n d t he s ur fa c e b ei ng 5 c m . In F i g . 14 . 3 1 B, t he

WWW.MEDRAD.IR

e l e ct r o n b e a m i s i n c ide n t at a n e xt e nd ed SS D o f 1 2 0 c m , e x e m pli f y i ng a p r a c ti c a l s i t u a ti o n w h e n c l e a ra n c e i s r e q ui re d b etw e e n t he a p p li c at o r a nd t he p a ti e nt s h o u l d e r . T h e i n c r e a se d a i r g ap b et w e e n the a p p l i ca to r a nd t he s ur f a c e c a us e s t h e e l e ct ro n b e a m p r of i l e to b e co m e le s s f l a t a s a r e s ul t o f i nc r e a s e d s c a t te r i ng of e l e ct r o n s b y a i r . C o n s e q u e n t l y , t he ho t a nd c o l d s p ot s s p r e ad o ut t o c o v e r l a r g er a r e a s , w i t h o u t s ig n i f i ca n t l y c h a n g i ng t he i r m a g ni t ude s . P.330

14.6. FIELD SHAPING

E x t e n s i v e f i e ld s h a p in g i s s o m e ti m e s r equi r e d i n e le c t ro n b e am t he r a p y . L e a d c u t o u t s a re o f t e n u s ed to g i v e s ha p e t o the t r e at m e nt a re a a nd to p r ot e ct t he s u r r o u n d i n g n o r m a l ti s s u e o r a c r i ti c a l o rg a n. T he s e c ut o ut s a r e p l a c ed e it he r d i r e ct l y o n t h e s k i n o r a t t h e e n d o f t he t re at m e nt c o ne . F o r l o we r - e n e r g y el ec t r o n s ( < 1 0 M e V ) , le s s t ha n 5 m m t hi ck ne s s o f l e a d i s r e q u i r ed f o r ad e q u a te s h i e ld i n g (e . g . , 5% t r a ns m i s si o n) . Le ad s he e t s o f t hi s t h i c k n e s s c a n b e m o ld e d to c o n f o r m m o re o r l e s s t o t he s ur f a c e c o nt o ur a n d , t h e r e f o re , c a n b e p la ce d di r e ct l y o n t he s kin s ur f a c e . F o r hi g he r -e ne r g y el e ct r o ns , h o w e v e r , t h i c k e r l e ad i s r e q u i r ed a nd c a nn o t b e so e a s il y c o nt o ur e d . M o r eo v e r , a h e a v y l e a d m a s k m a y c a u s e d i s co m f o rt to t he p at i e nt . T he a lt e rna t i v e m et ho d i s t o s u p po r t a le a d c u to u t a t t h e e nd o f t he t r e a t me nt c o ne o r t he f i e ld t ri m m e r s . S h i e l d s to be u s e d i n s u c h a c o n f i g ur a t i o n c a n b e d e s ig ne d f r o m p ur e l e ad s he e ts o r a l o w m e lt i n g a llo y s u c h a s L i p o w it z m e ta l ( t r a de na m e s : C e r r o b e nd , O s t al lo y , a n d L o m et o y ) .

A. External Shielding
S e v e r a l p u b li c a tio n s h a v e r e p o rt ed t he t hi c kne s s o f l e a d o r lo w me l ti ng p oi nt le a d a l lo y r e q u i r ed f o r s h i e l di n g i n e l e ct r o n b ea m t he r a p y ( 6 9 , 7 0 ,71 , 7 2 , 73 ) . F i g ur e 1 4 . 3 2 s h o w s a s et o f t r a n s m i s s io n m e a s ur em e nt s t hro ug h l e ad . The t hi c k ne s s f o r s h i e l di n g c a n b e c h o se n o n t h e b a s i s o f a ll o w a bl e tr a ns m i s s io n ( e . g . , 5 % ) . T he s h i e l d t h i c k n e s s s ho u l d b e n ei t he r o v er l y l a r g e no r so c ri ti c a l i n m e a s ur e me nt t h a t a sm a ll c h a n g e in t h i c k n e s s w o ul d c aus e a l a rg e c ha ng e i n t he t r a ns m it te d dose.

WWW.MEDRAD.IR

F I G . 1 4 . 3 2 . T r a n s m i s s i o n c u r v e s t hr o ug h l e a d f o r 7 - , 9 - , 1 1 - , 1 5 - , a nd 1 8 - M e V e l e ct r o n s . M e a s u r em en t s m a d e wi t h a p l ane - p a r a ll e l c ha m b e r in a p o l y st y r e ne p h a n t o m , a t a d e pt h o f 0 . 5 c m . S ol id li ne s a r e f o r 10 . 5 1 0 .5 c m e f f e c t i ve f i el d s i z e a n d d a s h e d li n e s a r e fo r 6 .3 6 . 3 cm e f f e c ti v e fi e ld si z e. ( R e d r a w n f r o m Giarratano JC, D u e rk e s RJ, A l m o nd PR. Lead s hi el d i ng t hi ck ne s s for d o se r e d u c t io n o f 7 - to 2 8 -M e V e l e ct r o ns . M e d P hy s 1 9 7 5 ;2 : 3 36 . ) P.331

A n i m p o rt a n t c o n si d e ra t io n i n e le c t ro n b eam s hi e ld i ng i s to m a ke c e rt a i n t ha t t he t h i c k n e s s i s a p p ro p ria t e to r e d u c e t he d os e t o a n a c c e pt a b le v a l ue . A s s e e n i n F i g . 1 4 . 32 , i f t h e le ad i s to o t hi n, t he t r ans m i t te d do s e m a y ev e n b e e nha nc e d

WWW.MEDRAD.IR

d i r e ct l y be h i n d t h e s h i e ld . N o r m al l y , i f w e i ght o r t hi c k ne s s i s no p r o bl e m , o ne c a n u s e a s h i el d o f t h i ck n e s s g r e a te r t ha n the r e q ui re d m i ni m um. But t he r e a r e p r a c t i ca l l i mi t s o n t h e a m o u n t o f l e ad t ha t c a n b e us e d . Fo r e x a m p l e , i n t he c a s e o f e y e s h i e ld s ( 7 4 ) an d i n t e r n a l s hi e ld s , i t i s i mp o rt a nt to us e t he m i ni m um t h i c k n e s s o f l e a d t o ob t a i n t h e de s i re d r ed uc t io n i n d o s e .

B. Measurement of Transmission Curves

T r a n s m i s s i o n c u r v e s f o r a s h i el d i ng m at e ri al m a y b e o bt a i ned w ith a n i o n c ha m be r e m b ed d ed i n a p h a n to m . A s u i t a bl e a r r a nge m e nt f o r s uc h m e a s ur e m e nt s co ns i s t s o f a p a r al l el - pl a te io n c h a m b e r i n a p ol y s t yr e ne p ha nt o m . Be ca us e t he m a xi m um t r a n s m i tt ed d o se t h r ou g h l e a d o c c ur s a t a po i nt cl o s e t o t he p a ti ent ' s s ur f a c e , t he m e a s u r e m e n t de pt h i n t h e p h a n t o m s ho ul d no t e x c ee d 5 m m ( 75 ) . T h e t r a n s m i s s io n c u r v e i s a p l ot o f i o ni za t io n c ur r e nt a s a f unc t i o n o f s hi e ld t h i c k n e s s . G e n e r a ll y , t h e s h i el d i ng me a s ure m e nt s m ad e w it h b ro a d be a m s gi v e s a n u p p e r l im it t o t h e s h i e l di n g re q ui re m e nts f o r al l f i el d s i z e s ( 69 , 7 3 ) . Ho w e v e r , i f m i n i m u m t h i c k n e s s s h i e l d s a r e ne e de d , as f o r i nt e r na l s hi el d i ng , a t r a ns mi s s io n c u r v e m a y b e m e a s u re d e s p e ci a ll y f o r t he g i v e n f ie l d s i z e a nd the d e pt h o f t he s t r u c t u r e to b e s h i el de d . A l t h o u g h i t i s de s i r ab l e to m a k e m e a s ure m e nt s w i t h t he s hie l d s i n t he s a me c o n f i g u r a ti o n r e l at i v e t o t h e a pp li c a to r a nd t he p ha nt o m a s us e d c l i ni c al l y , t hi s i s n o t a c ri ti c a l co n s i de ra t io n . P u r d y e t a l . (73 ) m a d e m e a s ur e me nts w i t h t he s hie ld p l a c ed a t t h e e n d o f th e t r e a t me nt c o ne a nd a t t he p ha nt o m s ur f a c e . T he y d i d no t f i n d s i g n i f i c a n t di f f e r en c e s i n t h e p e r c e nt tra ns m i s s i o n f o r t he t w o a r r a ng e m e nt s . F i g u r e 1 4 . 33 s h o w s a p lo t o f mi ni m um le ad t hi c k ne s s re q ui re d t o st op el e ct r o ns as a function of the most p ro b a bl e el ec t r o n e ne r g y i nc i de nt on lead. T he t r a n s m i tt ed do s e i n th i s c a s e i s o nl y t he r e s ul t o f b r em s s t r a hlung . F r o m t he se d a t a a r u l e o f t h u m b m a y b e f o rm ul a te d : the m i ni m um t hi c k ne s s o f le a d re q ui re d f o r b l o c ki n g i n m i ll i met e r s i s gi v e n P.332 b y t h e el e ct r o n e n e r gy i n M e V i n c i de nt o n le a d di v i de d b y 2 . A not he r m il li m et e r o f l e a d m a y b e a d de d as a s a f e t y m a r g i n. T he r e q ui r e d t hi c k ne s s o f C e r r o b e nd i s a p p r o xi m a te l y 2 0% g re a t e r t h a n t ha t o f p ur e l e a d .

WWW.MEDRAD.IR

F I G . 1 4 . 3 3 . A p lo t o f p u b li s h e d d a t a f o r m ini m um l e ad t hi c k ne s s r e q ui r ed t o s to p p r i m a r y e le c t ro n s a s a f u n c t i o n o f e l e c t ro n e ne r g y i nc i d e nt o n le a d . ( F r o m K ha n F M , e t a l . C l i n i c al ele c t ro n - b e a m do s im e try . R e p o r t o f A A P M R a d i a tio n T he r a p y C o m m it t ee T a s k G r o u p N o . 2 5 . M e d P hy s 1 99 1 ; 18 : 7 3 , w it h p e r m i ss i o n. )

F I G . 1 4 . 3 4 . R a t io o f io n i z a t io n f o r t he op e n c o ne to t he i o ni z at ion f o r t he s ha p ed f i e l d (o u t p ut r a t io ) as a f u n c t i o n o f b e a m e ne r g y . O ut p ut f a c to r i s i nv e r s e o f

WWW.MEDRAD.IR

o u t p u t r a tio . T h e f i e ld s i z e s f o r t he r e d uc ed f i e l d s w e re d e f i ned b y a l e a d c ut o ut p l a c ed at the p h a n to m s u r f a c e . ( F r o m C ho i M C , P ur d y J A , Gerbi BJ , e t al . V a r i a t io n i n o u t p u t fa c t o r c a u s e d b y s e cond a r y b l o c k i ng f o r 71 6 M e V e le c t ro n b e a m s . M e d P h y s 1 9 79 ; 6 : 13 7 , w i t h p e rm i s si o n. )

C. Effect of Blocking on Dose Rate

B l o c k i n g a p or ti o n o f t h e el e ct r o n b e a m f i eld , i n ge ne r a l , p r od uc es c ha ng e s i n t he d o s e r a te a n d d o se d i s t ri b u tio n . T he m a gni t ud e o f t he c ha ng e d e pe nd s o n t he e x t e n t o f bl o c k i n g , t h e t h i c k n e s s o f l e ad , and t he el e ct r o n e ne rgy . F i g ur e 1 4 .3 4 s h o w s i n c r e a s e i n o u tp u t r a tio ( o r de c r e a s e i n o utp ut f a ct o r ) a t d m a x w he n a f i eld i s b lo c k ed do w n t o a s m a l le r s i z e ( 7 2 ) . If a f i e ld p ro d uc ed b y a l e a d c ut o ut i s s m a l le r t h a n t h e m i n im u m s i z e r eq ui r ed f or m a x i m um l at e r al dos e b uil d up , t he d o s e i n t h e o p e n po r tio n i s r e d u c e d ( 70 ) ( F ig . 1 4 . 3 5 ) . P.333 T h e r e d u c ti o n i n do se a l so d e pe nd s o n the d e pt h o f m e a s ur em e nt . T hus f i e ld s h a p i n g a f f e c t s o ut pu t f a c t o r a s w el l a s d e pt h- d o se d i st ri b uti o n i n a c om p le x manner.

F I G . 1 4 . 3 5 . C h a n g e o f d o s e a t D m a x a s t he f i e ld s i z e i s c ha ng e d us i ng a l e ad c u t o u t a t t h e p h a n to m s u r f a c e ( 7 2 ) .

WWW.MEDRAD.IR

F I G . 1 4 . 3 6 . M i n i m um f i el d d i am e te r , d , v e r s us m o st p r ob a bl e e ne r g y at t he s u r f a c e , E p , 0 , f o r w h i ch t h e d e pt h d o se d i st ri b ut io n c a n b e co ns i de r e d i nd e pe nd e nt o f f i e ld s i z e . T h e c u r v e l a be le d 2 z 1 s ho w s m a x i m um l a te r a l e x c ur s i o n di a m et e r o f e l e ct r o n s . R p i s t h e e x t r a po l at e d r a ng e . z is t he ma x i m um s hi f t in t he de pt h do se d i s t ri b u tio n f o r f ie l d d i a m et e r r el a ti v e to b r o a d b e a m . T he c ur v e 2 R 1 gi v e s t he f i e l d d i a me te r a t w h i ch t h e m a x i m um d o se i s 1 % l e s s t ha n i t s va l ue f o r a b ro a d b e a m . T h e s e d a t a do n o t i n c l u d e t he e f f ec t s o f c o ll i m ato r o r ai r s c a t te r . ( F r o m L a x I, B r a h m e A . O n t h e co ll i m at io n o f hi gh e ne r g y el e ct r o n b ea m s . A c t a R ad io l O n c o l 1 98 0 ; 19 : 19 9 , w i t h p e r mi s s io n. ) A s t h e m o s t c o n s e r va t i v e m e a s ure , a s p e c i a l d o si m et r y ( e . g . , o ut p ut f a c t o r, d e pt h - d o se , a n d i s o do s e di s t ri b uti o n) s houl d b e m e a s ur ed f o r a ny i r r e g ul a r l y s h a p e d e le c t ro n f i el d u s e d i n t h e cl i ni c . H ow e v e r , t hi s i s i mp r a c tic a l be c a us e mo s t

WWW.MEDRAD.IR

r a d i at io n t h e r a p y f i eld s a r e i r re g ul a r . T he IC R U ( 1 4 ) s ug g e s te d R p a s t he lo w e r l i mi t f o r fi e ld d i a me ter , a b o v e w hi c h t he f i el d si z e d e pe nd e nc e o f t he d e pt h do s e i s n e g li gi b le . T h a t m e a n s t h a t f o r a g i v en p o i nt o f i nt e r e st in a n i r r e g ul a r ly s h a p e d f ie ld , t h e f i eld e dg e s s ho ul d b e f a r t he r t ha n R p / 2 fo r the l a te r a l s c a tt e r e q u i li b ri u m t o be a p p ro x i m a te l y a c hi e v ed . F o r e x a m p le , a 1 0 1 0 c m s i z e f i e ld o f a 1 2 - Me V el e ct r o n b e am ( R p [ a s y m p to ti c a ll y e q ua l t o ] 6 c m ) m a y be bl o c k ed do w n t o 6 6 c m f i e ld w i t ho u t s i g n i fi c a nt l y a f f e ct i ng t he de pt h- d o se d is t r i b ut io n. L a x a n d B r a h m e ( 76 ) h a v e m e a s ur e d f i el d d i a me te r s a bo v e w hic h t he m a x i m um s h i f t o f t h e d e pt h - d o se c u r v e i n w a t e r i s l es s t ha n 2 m m a nd t h e d o s e m a x i m um i s w i t hi n 1 % o f it s v a lu e f o r a b ro a d b e a m . F r o m t he se d at a ( Fi g . 1 4 . 36 ) a ro ug h r u l e o f t h u m b m a y be f o r m u l at ed : t he mini m um f i e ld d i a me te r f o r a pp r o xi m a te l a t er a l s c a tt e r e q u i li br i u m ( L S E ) i s g i v e n by E ( M e V ) / 2 . 5 i n c e nt i m et e r s o f w a t er . T h i s r u l e i s s l i g h tl y l es s s t r i n g e n t t ha n t ha t o f t he IC R U ( 1 4 ) d i s c us s e d a b o v e . A n a l t er n a t i v e m et h o d i s t o d et e r mi ne eq ui li b rium r a d i us , R e q , f r o m E q ua t i o n 1 4 . 11 . F o r a n i r re g u l a rl y s h a p e d f ie ld , r a di us i n a ny d i r e c ti o n m us t be R e q f or t he e s t a bl i s h m e nt o f L S E .

D. Internal Shielding
In s o m e s i t u a ti o n s , s u c h a s t h e t r e a t ment o f l ip , b uc c a l m uc o s a , a nd e y e li d l e s io n s , i n t e r n a l s h i eld i n g i s u s e f ul t o p r ote c t t he no r m a l s tr uc tur e s b e y o nd t he t a r g et v o l u me . L e a d sh i e l di n g P.334 m a y b e u s e d to r ed u c e t h e t r a n s m it te d do se to a n a c c e pt a bl e v alue . H o w e v e r , t he e l e ct r o n b a c k s c at te r fr o m le a d e nha nc e s t he d o se to t he t i s s ue ne a r t he s hi el d . T h i s e f f e c t h a s b e e n d i s c u s s e d b y s e v e r a l i nv e s t i ga to r s ( 7 0 , 77 , 7 8 ,7 9 , 8 0 ,8 1 , 82 ) .

WWW.MEDRAD.IR

F I G . 1 4 . 3 7 . E l e c t r o n b a c k s c a t te r f r o m l e a d a s a f unc t i o n o f m e a n e l e c t ro n e ne r g y a t t h e i n t er f a c e . T h e s o li d li n e r e p re s e nt s the b e s t f i t to t he e x pe r i me nt a l d at a o f K l e v e n h a g e n e t al . ( 84 ) , f r o m w h i c h t hi s g r a p h i s r e p r i nte d b y p er m i s s io n. T h e e n h a n c e m e n t i n d o s e at t h e t i s s ue -l ea d i nt e r f a ce c a n b e q ui t e s ub st a nti a l , e . g . , 3 0 % to 7 0% i n t h e r a n g e o f 1 t o 20 M e V , ha v i ng a hi g he r v a l ue f o r t he l o w e r -e n e r g y b e am s . Figure 1 4 . 37 s ho ws t he i nc r e a s e in do s e ( r el a ti v e to h o m o ge n e o u s p h a n t om ) a s a f u n c t i o n o f the m e a n e ne r g y i nc i de nt a t t he ti s s ue l e a d i n te r f a c e . T h e s c a t t er i n t h e e x p e r i ment a l d a t a i s p ro b ab l y d ue t o d i f f e re nc e s i n t h e me a s u r e m e nt te c h n i q u e s a nd t he s ta t e o f a ng ul a r sp r e a d o f t he el e c tr on b e a m be f o r e i n c i de n c e a t t h e i nt e r f a ce . T he c ur v e b y K l e v e nha g e n e t al . ( 8 2) r e p r e se n t s t h e b e st f it to t h e e x pe r im e nt al da t a f o r t he po l y s t y re ne - l e ad i nt e r f a ce a n d h a s b e e n c h a r a c t e r i z e d b y t h e f ol lo w i ng e q ua t io n:

w h e r e E B F i s t h e e l e ct r o n b a c k s c a tt e r f a c tor , d e f i ne d a s t he q uo ti e nt o f t he d o se a t t h e i n te r f a c e w it h t h e l e ad p r e se nt to t ha t w i t h a ho m og e ne o us p ol y s t y r e ne p h a n t o m at t h e s a m e p oi n t . Z i s t he a v er a g e el e ct ro n e ne r g y i nc i de nt a t t he interface. V a r i a t io n o f e l e ct ro n b a c k s c a t te r w i t h at o mi c num b e r Z o f t he s ca t t er i ng m at e ri al h a s a l s o b e e n s t u di e d ( 8 1 , 8 2 ) . F ig ur e 1 4 . 38 g i v e s t he d at a b y K le v e nha g e n e t a l. (82). A n i m p o rt a n t a s pe c t o f t h e e l ec t ro n b a ck s c a t t e r p r ob le m i s t he r a ng e o f t he b a c k s c a t te r e d el e ct r on s . M e a s u r e m e nt s o f d o s e i n t he p ha nt o m l a y e r s pr e c ed i ng

WWW.MEDRAD.IR

t h e l e ad h a v e s h o w n ( 7 0 , 8 1 ,8 2 ) t hat f o r el ec t r o ns i n t he r a nge o f 1 t o 2 5 M e V t he r a n g e o f t h e b a c k s ca t t er e d e le c t ro ns i s a b o ut 1 t o 2 g / c m 2 o f p ol y s t y r e ne , d e pe n d i n g o n t h e e n er g y o f t h e i nc i d e nt ele c t ro ns . T he d o s e e nha nc e m e nt d r o p s o f f e x p o n e n ti a ll y w i t h t h e di s t a n c e f r o m t he i nte r f a c e o n t he e ntr a nc e s i de o f t he b e a m . F i g u r e 1 4 . 39 i llu s t r a t e s t hi s e f f e c t f or 1 0 - M e V b e a m i nc i dent o n a p ha nt o m w i t h a s h e e t o f l e ad p la c e d a t v a r io us d e pt hs .

F I G . 1 4 . 3 8 . V a r i a ti o n o f e le c t ro n b a c k s c at te r w it h a to mi c num b er Z o f s c a tt e ri ng m a t e ri a l f o r di f f e r e n t e l e c tr o n e ne r gi e s a t t he i nt e r f a c e . ( F r om K l e v e nha g e n S C , L a m b e rt G D , A r b ab i A . B a c k s c a t t e r i ng i n e l e ct ro n b e a m t he ra p y f o r e ne r gi es b e t w ee n 3 a n d 3 5 M eV . P h y s M e d Bi o l 1 98 2; 2 7 : 36 3 , w i t h p e rm i s si o n. )

WWW.MEDRAD.IR

F I G . 1 4 . 3 9 . M o d i fi c at io n o f d e pt h do s e by l e a d pl a c e d a t v a r io us d ep t hs i n a p o l y st y r e n e p h a n t om . L e a d t hi c k ne s s = 1 . 7 m m . ( F r o m K ha n F M , M o o r e V C , L e v itt SH. Field s h a pi n g i n e l e ct r o n be a m t he ra p y . Br J R a d i ol 1 97 6 ; 49 : 8 83 , w i t h p e r m i s sio n . )

WWW.MEDRAD.IR

F I G . 1 4 . 4 0 . In t e n s i ty o f b a c k s c a tt e re d e le c t ro ns f r o m l e ad t r ans m i t te d t hr o ug h p o l y st y r e n e i n t h e u ps t r e a m d i re c ti o n o f the p r i m a r y b e a m . ( F ro m L a mb e rt G D , Klevenhagen SC. P e n e t r a ti o n of b a c k s c a t t er e d e le c t ro ns in p o l y st y r e ne f or e n e r g ie s b et w e e n 1 25 M e V . P h y s M e d Bi o l 1 9 82 ; 2 7 :7 21 , w i t h p er m i s s io n. ) P.335

P.336

T o di s s ip a t e t h e e f f e ct o f e le c t ro n b a c k s c att e r , a s ui t ab le t hi c k ne s s o f l o w at o mi c n u m b e r a b s o r be r s u c h a s b o l u s m a y b e p l a c e d b et w e e n t he le ad s hi e l d a nd t he p r e c ed i n g ti s s u e s u r f a c e . S a u n d e r s a nd P e t e r s (8 ) r e co m m e nd t he us e o f a n a l u m i n u m s h e a t h a r ou n d a n y l e a d us e d f or i nt e r na l s hie ld i ng . O r a l s hi el di ng ha s also and The given been a c co m pl i sh e d by s p e ci a l o r al s t e nt s m ad e of d ent a l a c r y li c t h at l e ad t he e n c o m p a s se s t h e l e a d ( 4 6 ) . S u c h a s hi e l d pr o v i de s l ea d p ro te c ti on f o r t he to ng ue other structures as well thickness energy of of lo w a s r e d uc e s t he num b e r on e l e ct r o n b a c k s ca t t er f r o m r e q ui r e d t hi c k ne s s to of a b so r b r e a c h i n g t h e b u c c a l mu c o s a . a to m i c a b s o rb e r le a d , t he b a c k s c a t te r e d el e ct ron s m a y b e c a l c ul a t e d us i ng t he d a t a i n F i g . 1 4 . 4 0 . F o r a el ec t r o n s i n c id e nt p ol y s t y r e ne , d e te r m i n ed f r om F ig . 1 4 . 4 0 , i s co nv e r te d to t he a b so r be r t hi c k ne s s b y di v id i ng i t b y i t s r e la ti v e e le c t ron d e n s i t y .

Example
WWW.MEDRAD.IR

A b u c c a l m u c o s a le s ion i s t r e at ed w i t h a 9 -M e V e l e ct ro n b e a m i nc i d e nt e x te r na l l y o n t h e c h e e k . A s s u m i n g c h e e k t hi c k ne ss , i nc l ud i ng t he l es io n, t o b e 2 c m , c a l c u l a te ( a ) t h i c k n es s o f l e a d r eq ui r ed t o s hi el d o r a l s tr uc tur e s b e y o nd t he c h e e k , ( b ) m a g n i t u de o f e l e ct ro n b a c k s c a t t er , a nd ( c ) t hi c k ne s s o f b ol us o r a l u m i n u m t o a b so r b ba c k s c a t t e re d el e ct r o ns. For these c al c u l a tio n s , the most p ro b ab le e ne r g y a nd t he mean e ne r g y of e l e ct r o n s m a y b e a s s um e d to b e t he s a me .

In c i d e n t e n e rg y = 9 Me V ; R p 4 .5 c m . E ne rg y a t t he l e ad - m uc o s a i nte r f a c e ( a t 2 c m d e pt h ) = 9

5 M e V , ( s e e E q . 1 4 . 7 ) a n d l e a d t hi c k ne s s f o r s hi e l di ng

= 2 . 5 m m ( F i g . 1 4 . 3 3) .

From

E q u a t io n

1 4 . 18

or

Fig.

1 4 . 38 ,

e le c t ro n

backscatter

fo r

5-MeV

e l e ct r o n s i n c id e n t o n l e a d [ a s y m p to ti c a ll y eq ua l t o ] 56 % . F r o m F i g . 14 . 4 0 , d ep th u p s t r e a m i n p o l y st y r e ne f o r b a c k s c a t te r ed e l e ct ro ns i s a p p ro x i m at el y e q u a l t o 1 0 m m f o r a 10 % t r a ns mi s s io n o f ba c k s c a t t e r i n t e n s it y . A s s u m i n g d e n s i t y o f p ol y s t y r e ne o r b o l us t o be a p p ro x i m a te l y unity and that of a l u m i num e q ua l to 2. 7 g/cm3, t hi c k ne s s of b o l us [ a s y m p t ot i c al l y eq u a l t o ] 1 c m a nd t hi c k ne s s o f a l um i num [ a s y m p to ti c a ll y e q u a l to ] 4 m m . T h u s , e i t h e r 1 c m o f b o l u s o r 4 m m o f a l um i num m a y b e us e d to a b s o rb 9 0% o f t h e b a c k s c a t te r ed e lec t r o n s . C o ns i d er i ng the a v a i l a b le s p a c e f or o r a l s hi el di n g , o n e m a y ad j u s t t h e c a l c u l a te d t hi c k ne s s o f m a te r i al s o r t he inc i d e nt e le c t ro n energy P.337 to p ro v id e ac c e p t ab le t a r ge t do se a nd t he a l lo w e d tr a ns m i t te d do s e through lead.

E y e s h i e l d s a re d e si g ne d u s i n g t he s a me p ri nc i p le s to p ro te c t t he l e ns . M i ni m um t h i c k n e s s o f l e a d i s u s e d t o p r o vi d e a c c ep t a bl e t r a ns mi s s io n v a l ue . Be c a us e a significant thickness of low Z m a t e ri al is r e q ui re d to a b so r b t he e le c t ro n b a c k s c a t te r , e y e s h ie ld s c a n n o t be c o at ed w i t h a n a d e q uat e thi c k ne s s o f s uc h m a t e ri a l s w it h o u t e x ce e di n g t h e s i z e r eq ui re m e nt s . In s uc h c a s e s , i t i s d e si r a b le t o c o at t h e l e a d s h ie ld w i t h a t h i n f i l m o f d e nt a l a c r yl i c ( to a b so r b t he v e r y lo w e n e r g y e l e ct ro n s ) a n d c a l i b r at e t he s et - up f o r t he a c t ua l e nha nc e d d o se r e c ei v e d b y t h e li d . Al t er n a t i ve l y , i f s p a c e a ll o w s , a 2 - m m -t hi c k al um i num s he a t h m a y b e

WWW.MEDRAD.IR

i n t e r po s ed b et w e e n th e l e a d s h i el d a nd the e y e l id t o a b so r b the b a c k s c a t t e re d e l e ct r o n s .

14.7. ELECTRON ARC THERAPY

E l e c t ro n beam arc technique gi v e s e x c e l le nt d o se d i st r ib uti o n for t r e at i ng s u p e r f i c i al t u m o r s a lon g c u r v e d s ur f a c e s . T he t e c hni q ue w a s f i r s t d e s c ri b ed b y B e c k e r a n d We it z e l ( 83 ) i n 1 95 6 . Se v e r a l pa p e r s (8 4 , 85 , 8 6 ,8 7 , 88 , 8 9 , 90 , 9 1 ) ha v e s i n c e a p pe a r ed i n t he l it e ra t u r e d e s c ri b i ng t he v a r io us te c hni c a l a nd p hy s i c al a s p e c t s o f e l e ct ro n a r c t h e r a p y . F o r d et a il s , t he r e a d e r i s r e f e r r ed t o P a l i w al ( 9 2 ) . O n t h e b a s i s o f i so do s e di s t ri b uti o n, el e ct r o n a r c t he r ap y i s m o s t s uit ed f o r t r e at i n g s u pe r f i c ia l vol u m e s t h at f ol lo w c ur v e d s ur f a c e s s uc h a s c he s t w a ll , r ib s , a n d e n t i re li m b s . Al th o u g h a l l c he st w a ll ir r a d i at io ns c a n b e d one w i t h el e ct r on a r c i n g , t h i s t e c h n i q u e i s m o s t l y us e f ul i n c a s e s f o r w hi c h t he t um o r i nv o l v e s a l a r g e c h e s t w a ll s pa n a n d e x t e n d s p o st e rio r l y be y o nd t he m id ax i l l a r y l i ne . T he c o n v e n t i o n al t e c h n iqu e of using t a ng e nti a l p hoto n beams in t hi s case w il l i r r a di a te to o m u c h o f t h e u n d e r l y i ng l ung . T he a l te r na t i ve ap p r o a c h o f us i ng m u l t ip le a b u t ti n g e le ct r o n f i el d s i s f r a ug ht w i t h f i e l d j unc ti o n p rob l e m s , e sp e ci a ll y w h e n a n g l e d b e a m s a r e u s e d . In s ho rt , it a pp e a r s t ha t fo r a c e r t ai n c l a s s o f c a s e s , e l e ct r o n a r c t he r a p y h a s n o r e a s o na b l e al t er na t i v e . N o t al l el e ct ro n a c c e le r a to r s a r e e q ui pp e d w i t h e le c t ro n a r c m ode . H o w e v e r , w i t h i n c r e a s i n g i n t e re s t i n t h i s te c h n i q ue , mo r e a nd m o r e li ne a r a c c ele r a to r s a r e b ei ng m a d e w it h t h i s c a p abi li t y . B e s i de s t he a r cing c a p a b il it y , c e r t ai n m o d i fi c a ti o ns i n e l e ct r o n co ll i m at io n ar e n e c e s s a r y to m a k e t hi s te c hni q ue f e a s ibl e . F o r e x a m p le , o n e n e ed s a be a m - de f i n i n g a pe r t ur e wi t h a de q ua t e c l e ar a nc e f r o m t he p at ie nt a nd a d d it io n a l co ll im a ti o n c l o se t o t h e p a ti e nt s ur f a c e t o s ha r p e n t he do s e f al lo f f a t t h e a r c l i mi t s ( 86 ) . M a c h i n e s t h a t c a n n o t r o t at e i n t he e le c t ron m o d e ma y s t il l b e us e d to pe r f o rm w h a t i s c a ll ed a p s e ud o a r c te c h ni q ue (9 3 ). In t hi s t e c hni q ue , t he f i el d i s de f i ned b y t h e x - r a y j a w s a n d t h e el e ct r o n c ol li ma t io n i s p ro v i de d o n t he p a ti e nt ' s s ki n s u r f a c e . T h e b e a m i s d i r e ct ed i so c e nt ri c a ll y t hr o ug h e q ual l y s p a ce d l a rg e num b er o f a n g le s . T h e f ie l d s a r e o ve r l a pp ed b y al ig ni ng t he c e nte r o f a g i v e n fi x e d fi e ld w i t h t h e e dg e o f i t s n e x t n e ig hb o ri ng f ie l d . T hus t he p s e udo a r c t e c hni q ue is d e s ig n e d to a c h i e v e th e r e s u l t s o f a c o nt i nuo us a r c b y us i ng a s uf f i c i e nt l y l a r ge n u m b e r o f o v e r l ap p i n g f i e l d s di r e ct ed i s o ce nt r i c al l y .

A. Calibration of Arc Therapy Beam

C a l i b r at io n o f a n e l e ctr o n a r c t h e r a p y p ro c ed ur e r e q ui re s s p e ci a l c o ns i d er a ti o ns i n a d d it io n t o t h o se r e qu i r e d f o r s t at io na r y b e a m t r e at m e nt s . Do se p e r a r c c a n b e d e te r m i n ed i n t w o w ay s : ( a ) i n t e g r ati o n o f t he s t at io na r y b e a m p r o f il e s a nd (b ) d i r e ct me a s u r e m e n t . T h e f i r s t me t hod re q ui r e s a n i s od o se di s t rib ut io n a s w e ll a s t h e do s e r a te c al i b ra ti o n o f t h e f i el d ( und er s t at io na r y b e a m c o nd i ti o ns ) us ed f or a r c i n g . T h e i nt e g r atio n p ro c e d u r e i s il l ust r a te d i n F ig . 14 . 4 1 . R a d ii a re d r a w n f r o m t h e i so c e n te r at a f i x e d a n g ula r i nt e r va l ( e . g . , 1 0 d eg r ee s ) . T he i so do s e c h a r t i s pl a c e d alo n g e a c h r a d i u s w hi l e t he d o se a t p oi nt P a s a f r a c t i o n o f t he m a x i m u m do s e o n t he c e n t r al a xi s i s r e co r d ed . Le t D i ( P ) b e thi s d o se a s t he i s o do s e c h a r t i s p l a ce d at t h e r ad i us . T he do s e p e r a r c a t P i s g i v e n b y t he f o l lo w i n g e q u at io n ( 9 4) :

WWW.MEDRAD.IR

P.338

w h e r e [ D w i t h d ot a bo v e ] 0 i s t h e d o se r a te p e r m i nut e i n t he s ta t io na r y f i e l d at t h e d ep t h o f d m a x , n i s t h e s p ee d o f r ot a ti o n ( num b e r o f r e v ol uti ons p e r m i nut e ) , a n d In v ( i ) i s t h e i n v e r s e s q u a r e l a w c o r r e ct io n f o r a n a i r g a p b e t w e e n t he d ot ted c i r c l e a n d t h e be a m e n t r y p oi n t . T he t e rm N i = 1 D i ( P ) a l s o c a n b e e v a l ua te d g r a p h i c a ll y a s s h o w n i n F i g . 1 4 . 4 1 .

F I G . 1 4 . 4 1 . In t e g r a tio n o f do s e p e r a r c at a p oi nt P . S ol id li ne r ep r e s e nt s a n i r r e g ul a r l y s h a p ed p at i e nt c o n to ur a nd t he d o tt ed li ne i s a ci r cle a p p ro x i m at i ng t h e c o n to u r . Is o d o s e c u r v e s f o r t he s c a nni n g f i e ld a r e pl a c e d al ong e a c h r a d i us to i n t e g ra t e t h e do s e at p o i nt P . ( F r om K ha n FM . C a l i b r at io n a nd t r ea t m e nt p l a nni ng o f el e c tr o n be a m a r c th e r a p y . In : P a l i w a l B, e d . P ro c ee d i ng s o f t he s y m po s i um o n e l e ct r o n do si m et r y and arc therapy. N ew York: AAPM/American Ins t i t ut e of P h y s i c s , 1 9 8 2 , w i t h pe r m i s si o n . ) T h e d i r e ct m e a s u re me n t o f do s e p e r a r c r e q ui r e s a c y l i nd ri ca l p ha nt o m o f a s u i t a bl e m at e ri a l s u c h a s p ol y s t y r e ne o r L uc i t e . A ho le i s d ri ll e d i n t he p ha nt om t o a c co m m od a te t h e ch a m b e r a t a de pt h c or r e s p o ndi ng to t he d m a x . T he r a d i us o f t h e p h a n t o m n ee d o n ly b e a p p ro x i m at el y eq ua l to t he r a di us o f c ur v a t ur e o f t he p a t ie n t , b e c a u s e o n l y a s m al l p a rt o f t he a r c c o nt ri b ute s d o se t o t he c ha m b e r

WWW.MEDRAD.IR

r e a d i n g ( 94 ) . H o w e v er , t h e d ep t h o f i so c e nt e r m us t b e t he s a m e a s us e d f o r t he t r e at m e n t . T h e i n te g ra t e d re a di n g p e r a r c c a n b e c o nv e r te d to d o s e p e r a r c by u s i n g c o r r e c tio n f a c t or s n o r m a l l y a p pl i c ab le t o a s t a ti o na r y b e a m .

B. Treatment Planning
T h e t r e at m e n t p l a n n in g f o r el e ct r o n a r c t he r a p y i ncl ud e s ( a ) c ho i c e o f be am e n e r g y , ( b ) c ho i ce o f f i e l d s i z e , ( c ) c hoi c e o f i so c e nte r , ( d ) f i el d s ha p i ng , a nd (e ) i s o do s e di s tr i b ut io n . T h e s e a r e b r ie f l y c o ns id e r ed b el o w .

B.1. Beam Energy

T h e c e n t r a l a x i s d o se di s t ri b u ti o n i s a lt er e d d ue to f ie ld mo ti o n. F o r a s m all s c a n n i n g f i e l d wi dt h , th e d e pt h d o se c ur v e shi f t s s l ig ht l y a nd t he b e a m a pp e a r s t o p e n e t r at e s o me w h a t fa r t h e r t h a n f o r a s t ati o na r y be a m ( Fi g . 1 4 .4 2 ) . T he s ur f a c e d o s e i s r ed u c e d a n d th e b r e m s st r a hl ung d os e a t t he i so c e nte r i s i nc r e a s e d . T his p h e n o m e n o n i s k n o w n a s t h e v e lo c it y e f f ec t : a de ep e r p oi nt i s e x p o se d to t he b e a m l o n ge r t h a n a sh a l l o w e r po i nt , r e s ult ing i n a pp a r e nt e nha nc e m e nt o f b e am p e n e t r at io n .

F I G . 1 4 . 4 2 . E f f e c t o f i s o c e nt e r d e pt h o n d ep t h - d o se di s t ri b uti o n c o m p a re d w it h a s t a ti o n a r y be a m . C y l in d r i c a l p ol y s t y r e ne pha nt o m s o f r a di i 1 0 a nd 1 5 c m w e re u s e d . S A D = 1 0 0 c m ; S S D = 6 4 c m ; d i a p hr a g m o pe ni ng = 3 6 c m ; a r c a ng l e = 1 2 0 d eg r e e s . ( Fr o m Kh a n F M , F u l l e r to n G D , L e e J M , M oo r e V C , Lev i t t S H . P hy s i c a l a s p e c t s o f e l e ct ro n - b ea m a r c t h e r a p y . R a d i ol og y 1 9 77 ; 1 24 : 49 7 , w i t h p e r mi s s io n. ) P.339

WWW.MEDRAD.IR

B.2. Scanning Field Width

A l t h o u g h a n y f i e l d w id t h m a y b e us e d t o pr o d uc e a c c e pt a bl e i sod o s e di s t ri b utio n, s m a l le r s c a n n i n g f ie ld s ( e . g . , wi d t h o f 5 c m o r le s s ) gi v e l o we r do s e r a te a nd g r e a te r x - r a y c o n t a mi n a t io n ( 8 6 , 88 ) . H o we v e r , s m a ll f i el d w idt hs a l lo w a l mo s t n o r m a l i n c i de n c e o f th e b e a m o n t he s ur f a c e , t hus s i m p l i f y i ng do s i me t r y . A no t he r a d v a n t a g e o f t h e s m all e r f i el d w i dt h i s t ha t t he d o se p e r a r c i s les s d e p e nde nt o n t h e t ot a l a r c a n gl e . F o r t h e s e re a s o ns , a g e o m et ri c f i e ld w i dt h of 4 t o 8 c m a t t he i s o c e nt e r i s re c o m me n d e d f o r mo s t c li ni c a l si t ua ti o ns .

B.3. Location of Isocenter

T h e i s o c e n t er s h o u l d b e p l a c ed a t a p o i nt a p p r o xi m a te l y e q uid i s t a nt f r o m t he s u r f a c e c o n t o u r f o r all b e a m a n gl e s . In a d d i ti o n, t he d e pt h o f is o c e nte r m us t be g r e a te r t h a n t h e m a xim u m r a n g e o f el e ct r ons s o t ha t t her e i s no a c c um ul a t io n o f e l e ct r o n do s e a t t h e i so c e n te r .

B.4. Field Shaping

Without el e ct r o n c o lli m a ti o n at t he p a ti ent s ur f a c e , t he dose falloff at t he t r e at m e n t f i el d b or d e rs i s r at h e r g r a d ua l . To s ha r p e n t he d i st r ib ut io n, l e ad st r ip s o r c u t o u t s s h o u ld b e u s e d t o de f i ne t he a r c l i m it s a s w e ll a s t he f i e l d l i mi t s i n t he l e n g t h di r e ct io n ( F i g . 1 4 . 4 3 ) . C a s t s hi el d ing ha s b e e n f o und to b e us e f ul f or r o u t i n e el e ct r o n a r c th e r a p y ( 9 1 ) . F o r a g r e a t e r de t ai l o f t he t r ea t m e nt -p l a nni ng p r o c e s s a n d t h e a c ce ss o r y p r ep a r a ti o n s te ps , t he r e a de r i s re f e r re d to Le a v i tt et al. (95).

B.5. Isodose Distribution

T h i s c r u c i a l i n f o r m at io n f o r a r c t he ra p y i s no t a s e a s il y a v a il a ble f o r e le c t ro ns a s it is for p ho to n s . a v a i l a bl e Until fo r co m p ut e r arc pr o gr a m s t he ra p y , b e am of t hi s a d eq ua t e m o d al it y so p hi st i c at io n of t r e a t me nt However, a re w i ll t he r o u t i n el y of the e le c t ro n of

p r o b ab l y re m a i n i n a c c e s s i bl e to mo s t i ns ti tut i o ns . O f co ur s e , t his p r ob le m i s p art ge n e r al p ro b le m e l e ct ro n t r e at m e nt pl a nni ng . c u r r e n t s u r g e o f a c t i v it y i n t h i s a r e a a s w e l l a s t he C T P.340 d e v e lo p me n t p r o vi d e a n o pt i mi s ti c f ut ur e f o r t he de v e lo p me nt o f s op hi s ti c a te d e l e ct r o n be a m t h e r a p y t e c h n i q u e s , i nc l ud i ng t he a r c .

WWW.MEDRAD.IR

F I G . 1 4 . 4 3 . Is o d o s e d i s t ri b u tio n i n a r c r ota t io n w i t h a nd w it ho ut le a d st r ip s a t t h e e n d s o f t h e a r c , u s i n g a s e c t io n o f a n A l d e r s o n R a nd o pha nt o m c l o se l y s i m u l a ti n g a n a c t u a l p a t ie n t c r o s s s e cti o n. A r c a ng l e = 2 3 6 d eg r e e s ; a v e r age r a d i u s o f c u r v a t u r e = 1 0 c m ; b e a m e ne r g y = 1 0 M e V ; l e a d s tr ip t hi c k ne s s = 6 m m ; f i el d si z e at t h e s u r f a c e = 4 . 2 8 .5 cm . ( F r o m K ha n F M , Ful l e rt o n G D , L e e JM, Moore VC, L e vit t SH. Physical a s pe c t s of e le c t ro n- b e am arc t he r a p y . R a d i ol og y 1 97 7 ; 12 4 :49 7 , w i t h p e r mi s s io n. )

14.8. TOTAL SKIN IRRADIATION

E l e c t ro n s i n t h e e n e rg y r a n g e o f 2 t o 9 Me V ha v e be e n f o und us e f ul f o r t re a ti ng s u p e r f i c i al l e si o n s c ov e r i n g l a r ge a r e a s o f t he b o d y , s uc h a s m y c o s i s f ung o i des and other c u t a n eo us lymphomas. At the s e e ne r gi e s , el e ctr o n beams a re c h a r a c t e r i z ed b y a r ap i d f al lo f f i n d o se b e yo nd a s ha l lo w de p t h and a m i ni m al x r a y b a c k g r o u n d ( 1 % o r l e s s ) . T h us s up e r f i c i a l s k i n l e si o ns e x tend i ng t o a bo ut 1 c m d e p t h c a n b e e f f e ct i v el y t r e at e d w it ho ut e x c e e di ng b o ne m a r row t o l e ra nc e . T h e t r e at m e nt o f m y co s i s f u n g o i de s w it h to t al s k i n i r r a di a tio n w a s s ug g e s te d a t l e a s t 5 0 y e a r s a go ( 96 ) . S i n c e t h a t ti m e , v a r i o us t ec hni q ue s ha v e b e e n d e ve lo p ed

WWW.MEDRAD.IR

and

a p p li ed

w it h

success

to

t he i n to

t re a t me nt two

of

t hi s

di s e a se r el at iv e

( 9 7 , 98 , 9 9 , 10 0 ) . (a) to t r a ns l at io na l a b e am of

Basically, technique

the

me t ho d s

f al l

g e ne r a l

c a te go r ie s :

i n w h i c h a h o r i z o n t al

p a ti e nt i s t r a ns l a te d

e l e ct r o n s o f s u f f i c i e nt w i d t h t o c o v e r t he t ra ns v e r s e d im e ns io ns o f t he p a ti e nt a nd ( b ) l a r g e f ie ld t e c h n i qu e i n w h i c h a s t a nd i ng p a t ie nt i s tr e at e d w it h a P.341 c o m bi n a t io n o f b ro a d b e a m s p ro d uc ed b y ele c t ro n s c a t te r i ng a nd l a r g e S S D s (2 to 6 m ) . S a l i e n t f e at u r e s o f t h e s e t e c hni q ue s ar e d i s c us s e d be lo w .

A. Translational Technique
T h e t r a n s l a t io n a l te ch n i q u e h a s b e e n d e s c r i b ed b y a num b e r o f i nv e s t i ga to r s ( 9 8 , 1 03 , 1 04 ) . T h e p a ti e n t li e s o n a m o to r - dr i v e n c o uc h a nd i s m ov e d r e l at i v e t o a d o w n w a r d - d i re c te d bea m a t a s u i t a bl e v e loc i t y . A l te r na t i v el y , t he p a ti e nt m a y b e s t a ti o n a r y and the r a d i at io n so ur c e tr a ns l a t ed ho ri z o nt al ly .
90

In

t he

l a tt e r

t e c h n i q u e , w h i c h h a s b e e n d e s c ri b ed b y H a y b i tt le ( 10 3 ) , a 24 - C i

S r so ur c e , i n

t h e f o r m o f a 6 0 - c m li n e a r a r r a y , i s us ed . T he s o ur c e i s co nt ai ne d i n a s hie ld ed s o u r c e h o u s i n g a n d p o s it io n e d a b o ve t he c o uc h. T he m a x i m um e ne r g y o f t he p a r t i cl e s e mi tt ed b y m i ll i me te r . T h e t r a n s l a ti o n a l t e ch n i q u e u s i ng a 3 - M eV V a n d e G r a a f f g e n e r a to r ha s b e e n d e s c r ib e d b y W ri g h t et al . ( 10 2 ) . A w e ll - c oll i m at e d mo no e ne rg et ic e le c t ro n be a m i s s c a tt e re d j u s t a ft er l e a vi n g t he v a c uum w i nd o w t o i mp r o v e uni f o r m i t y . T he b e a m i s t h e n c ol li m a te d b y a n a l um i num c one w i t h a 5 m m 45 c m d e f i ni ng sl it . T h e p a ti e n t i s t r a n s la t e d u n d e r t hi s be am a t a s ui t ab le s pe ed . W i ll i am s et al . ( 1 0 3 ) h a v e d e s c ri be d a s i m il a r t e c hni q ue w it h a li ne a r a c ce le r a tor . N o a pp li c a to r i s u s e d i n t hi s te c h n i qu e a n d t h e x - r a y c o ll im a t o r s a r e f ull y r et r ac t e d . T he p at i e nt i s t re a te d a n t e ri o rl y an d p o st e ri o rl y . T he do s e uni f o rm it y a lo ng the l e ngt h o f t he p a t ie n t i s a c h i e v ed by m o v i n g t he p a t ie nt t hr o ug h a d i s t a nc e s uf f i c i e nt t ha t t he a r e a s t re a te d st a r t ou t s i d e t h e e le c t ro n be a m , p a s s t hr o ug h, and f i ni s h o ut si d e t h e e l ec t ro n b e a m . T h e d o s e u n i f o r mi t y i n the t r a ns v e r s e d i r e cti on i s e nha nc e d b y s u i t a bl y c o m b i ni n g t r an s v e r s e l y o v e r l ap pi ng f i e l d s .
90

S r i s 2 . 2 5 M e V . H o w ev e r , d ue t o t he s p e ct ra l di s t ri b uti o n o f

- r a y e n e r g ie s , t h e e ff e c t i v e de pt h o f t r e a tm e nt i n t hi s c a s e i s onl y a f r a c t i o n o f a

B. Large Field Technique

L a r g e el e ct r o n f i el d s r e q u i r ed f o r to t al b ody s k i n i r r a d i a ti o n c a n b e p r od uc e d b y s c a t te r i n g e le c t ro n s th r o u g h w i d e a ngl e s a nd us i ng la r g e t re a t ment d i st a nc e s . T he f i e l d i s m a de u n i f o rm o v e r t h e hei g ht of t he p a ti e nt b y v e rt i c al l y c o mb i ni ng m u l t ip le f i e ld s o r v e r tic a l a r c i n g . T he p a t ie nt i s t r e at ed i n a s t a nd i ng p o si ti o n w i t h f o u r o r s i x f i el d s di r e ct e d f ro m e q ual l y s p a ce d a ng le s f o r c i r c um f er e nt i al c o v e r age o f t h e b od y s u r f a c e .

B.1. Field Flatness

L o w - e n e r g y e le c t ro n b e a m s a r e c o ns id e r ab l y w i de ne d b y s c at te r i ng i n a i r . F or e x a m p le , a 6 - M e V na r r o w el e ct r o n b e a m, a f t e r p a s s i ng t hroug h 4 m o f ai r , achieves a Gaussian i n t e n s it y di s t ri b utio n with a 5 0% to 50% w i dt h of a p p r o xi m a te l y 1 m ( 10 4 ) . T h i s u s ua l l y g i v e s a d e q ua t e uni f o r mi t y o v e r a p a t ie nt ' s w i d t h . If t w o s u c h f ie l d s a r e j oi ne d t og ethe r v e r ti c a ll y a t t heir 5 0% li ne s , t he

WWW.MEDRAD.IR

r e s u l t a n t f ie ld w i ll be u n i f o r m o v e r a he ig ht o f a p p ro x i m at el y 1 m . A p r o p er c o m bi n a t io n o f mo r e s u c h f i e l d s o r a c o ntinuo us a r c c a n l e a d to a l a rg e r uni f o rm f i e l d , s u f f i c i e nt t o co v e r a p a t ie n t f r o m he ad t o f oo t ( F ig . 1 4 . 44 ) . T h e s i z e a n d s h a pe o f a n e le c t ro n b e a m de v e l op ed a t a di s t a nc e by a i r s c a tt e r c a n b e e s ti m at e d b y m u l t ip l e s c at te r i ng t heo r y . H o l t a nd P e r r y ( 1 04 ) ha v e us e d t hi s a p p r o a c h to ob t ai n a u n i f o r m f i e ld b y c o m bi ni ng m ul ti pl e f ie l d p ro f i le s i n p ro p er p r o po r tio ns a n d a n g u l a r s e p a r a ti o n ( F i g . 14. 4 4 A ) . In a d d i t io n to a i r , t h e e le c t ro n b e am i s sc a t t er e d b y a s c a tt e ri ng f o il i nsi d e or o u t s id e t h e co ll i m ator . H o w e v e r , t he x - r a y c o nt a m i na ti o n w o uld b e i nc r e a se d , b e c a u s e u n n e c e s s a r i l y w i d e b e a m s w a s te e lec t r o n f l ux t o t he s id e s.

B.2. X-ray Contamination

X - r a y c o n t a m i n a ti o n is p r e s e nt i n e v e r y t he r a p y el e ct r o n be a m a nd b e co m e s a l i mi ti n g f a c t o r i n t ot al s k i n i r r a d i at io n. O r d ina r i l y , t he s e x - r a y s a re c o nt ri b ut ed b y b r e m s s tr a h l u n g P.342 i n t e r a ct io n s p r od u c e d i n t h e e x it w i nd o w o f t he a c c el e r at o r , s ca t t er i ng f oi l , i o n c h a m b e r s , b e a m -d e f in i n g c o ll i m at o r s , ai r , a nd t he p a ti e nt . T he b r e m s st r a hl ung l e v e l c a n be m i n im i ze d i f t h e e le c t ro n b ea m i s s c a tt e re d b y ai r a lo ne b e fo r e incidence on the p at i e nt . This w o ul d nec e s s i t at e s o me m od if i c a t io ns in t he a c c e l e r ato r , s u c h a s r e m o v i n g t he s c a tt er i ng f o il a nd ot he r sc a t t er e r s i n t he c o ll i m at io n s y s t e m . V a r i o u s s a f e t y i nt e rlo c k s w o ul d b e r e q uir e d t o m a k e t hi s s e p a r a ti o n f e a s ib le f o r r o u ti n e c l i ni c al us e . S uc h a s y s t e m w a s d e v e lo p ed a t M e m o ri a l H o s pi t al , N ew Y o r k , o n a V a r i a n C l i na c - 6 ( 1 05 ) .

WWW.MEDRAD.IR

F I G . 1 4 . 4 4 . A : C o m b i n a ti o n o f t hr e e be am i nt e ns i t y p ro f i le s al o ng t he v e rt i c al a x i s to o bt a i n a r e s u lta n t b e am p ro f il e . T he c e nt r al be a m i s d i re ct e d ho r i zo nt a ll y , w h e r e a s t h e o t h e r s a r e d ir e c te d at 18 . 5 d e g re e s f ro m t he ho r i z o nt a l . i s a

WWW.MEDRAD.IR

w e i g h ti n g f a c to r u s e d i n a n e q u at io n d e v elo p ed b y Ho lt a nd P e r ry . ( F r o m H ol t J G , P e r r y D J . S o m e p h y s i c a l c o n s i de r a ti o ns i n w ho l e s k i n e l e ct r o n be a m t he r a p y . M ed P h y s 1 9 8 2 ; 9 :7 69 , w i th p e r m i s si o n. ) B : V er t i c al be a m p ro f il e at t he t r e at m e nt p l a n e f o r a s t at io n a r y s i n g l e f i el d a nd a n a r c i ng f i e ld . ( F r o m S ew c ha nd W , K ha n F M , W i l l i a m so n J . T o ta l - b od y s u p e r f i c i al e le c t ro n- b e a m t he r ap y us i ng a m ul t i p le f i e l d p e n d u l u m - a r c te ch n i q u e . R a d i o log y 1 9 79 ; 1 30 : 4 93 , w i t h p e r mi s s io n. ) In the Stanford te ch n i q u e , d e s c r ib ed by Karzmark et al . ( 97 , 1 0 6 ,1 0 7 ) , t he

e l e ct r o n b e a m , a f t e r e m e rg i n g f r o m t he a c c e l e r ato r w i ndo w , is s c a tt e r ed b y a m i r r o r (0 . 0 28 - i n c h A l ) , a n a l u m i num s c a t t e r e r lo c a te d e x te r na l ly a t t he f r o nt o f t h e c o ll i m ato r ( 0 . 0 37 -i n c h P.343 Al), and a bo u t 3 m of a ir be f o r e i nc i d e nc e on t he p at ie nt . T he x-ray

c o n t a m i n at io n i n c i de n t o n t h e p ati e nt i s r ed uc e d b y a ng li ng t he b e a m 10 d eg r ee s t o 15 d eg r ee s a b o ve a n d b e lo w t he ho r i zont a l . Be c a us e t he x - ra y s p r o d uc e d i n t h e s c a tt e r er s a t t h e c o l li m at o r s a re p r e fe r e nti a ll y d i r e ct ed a lo ng t he c e ntr al a x e s , t h e y l a rg el y mi s s t h e p a ti e nt . In a d d it io n, t hi s se t - up p r o v id e s a l a r ge e l e ct r o n f ie l d wi t h su f f i c i e n t d o se uni f o rm i t y i n t he v e rt ic a l d i m e nsi o ns o f t he p a t ie n t .

B.3. Field Arrangement

In the Stanford and te ch n i q u e , four the p at ie nt is t re a te d 60 w it h six fields ( a nt e ri o r , t he p o s te r io r , o b li q u e s ) p os it io ne d de g r ee s a pa r t a r o und

c i r c u m f e r e n c e o f t h e p a ti e n t . E a c h f i e ld is m a d e up o f t w o c om p o ne nt b e am s , p o i nt i n g at a s u it a b le a n g l e w i t h r e s pe c t to t he ho r i z o nt a l . T he pa t i e nt t r e at m e nt p o s it io n s a n d t h e f u l l s i x - f i e ld t r e at me nt c y c l e a r e il l us tr a te d i n F i g . 1 4 . 45 .

WWW.MEDRAD.IR

F I G . 1 4 . 4 5 . P a t i e n t p o si ti o n s f o r t he six - f i e l d St a nf o r d t e c hni q ue . P a t ie nt i s t r e at e d b y t wo be a ms a t e a c h p o si ti o n, one b e a m d i re c te d 1 5 d e g re e s b el o w h o r i z o n t al a n d t h e o th e r 1 5 d eg r ee s a bo v e ho r i z o nta l . ( F ro m P ag e V , G a r d ner A , K a r z m a r k C J . P a t i e n t d o s i me t r y i n t he t re a t m e nt o f l a r ge s up e r f i ci a l le s io ns . R a d i ol og y 1 97 0 ; 94 : 635 , w i t h p e r m i s si o n. ) P.344

T h e M e m o r i al t e c h n i qu e ( 1 0 5 ) a l so us e s d ua l f i e ld s t o o bt a i n f i eld f l a t ne s s i n t he v e r t i c al di r e ct io n . T h e p at i e nt i s t re a te d fr o m f o ur d i re c ti o ns , t he a nt e rio r , t he p o s te r io r , and each of the l at e r al s . H ol t a nd Perry (1 0 4 ) r e e x a m i ned t his

WWW.MEDRAD.IR

t e c h n i q u e a n d f o u n d t h a t a t l e a st s i x f ie ld s a r e r eq ui r ed to ac hi e v e a d eq ua te u n i f o r m i t y . T h e y r e c om m e n d ei g ht f ie ld s , t r e at i ng w it h f o ur f i el d s 1 d a y , a nd r o t at e d f o u r t h e n e x t . A m u l t i pl e fi el d a r c t e c h n i q u e us e d a t t he U ni v e r s it y o f M i nne s o ta ha s b e e n d e s c r ib e d b y Se w c h a n d et al . ( 10 8 ) . In t hi s t e c hni q ue , t he b e am d e s c r ib e s a n up a n d - d o w n a r c a s t h e g a n t r y o f t he li ne a r a c c e le r a to r ro ta t e s in a n o s c il l at o r y m a n n e r a n a l o go u s t o a p e n d u l u m . S i x f i el d s a r e us e d f o r e a c h c y c l e o f t r e at m e nt, a s i n t h e S t a n f o rd tec h n i q u e . T he a d v a nt a g e o f t hi s t e c hni q ue i s t ha t t he do se d i s t ri b u tio n i n t h e ve r ti c a l pl a n e c a n b e m a d e r ep r od uc i bl y uni f o r m o v e r t he h e i g h t o f a n y p a ti e nt s t a n di n g at a d i sta nc e o f a bo ut 4 m . H o w e v e r , i f t he e l e ct r o n b e am i s s c a tt e r ed b y a s c a t t e ri ng f o i l a t t he p o si ti o n o f t he c o l li m at o r s , t h i s t e c h n i q u e co n t rib u t e s h ig h e r x - r a y co nt a m i nat io n to t he p a t ie nt t ha n d oe s t h e s t at io n a r y d u a l f ie l d te c h n i q ue . T hi s pro b le m m a y b e m i ni miz e d b y re m o vi ng s c a t te r i n g f oi l s a n d all o w i n g t h e el e ct r o n b ea m t o b e s c a tt e re d b y a i r a lo ne , a s i n t h e M e m o ri a l t e c h n i q ue .

B.4. Dose Distribution

T h e d e p t h - do s e di s t ri b u t io n i n a s i ng l e la r g e f i el d i nc id e nt on a p a t i e nt w ill d e pe n d o n t h e a n g l e o f i n c i d e n c e o f t he b ea m r e l a ti v e to t he s ur f a c e c o nt o ur . F o r a n o b li q u e b e am , t h e d e pt h - d o se c ur v e a nd i t s d m a x s hi f t to w a r d t he s ur f a c e . W he n m u l t ip le l a r ge f i el d s are d i re c t ed a at t he s hi f t p a ti e nt w it h f r om d i f f er e nt a ng l e s , in t he c o m po s it e d i st r ib u t ion shows ne t a p p a re nt d e cr e a s e b ea m

p e n e t r at io n . T h i s s h i f t o f t h e r e l at i v e d ep th d o s e s c l o se r t o t he s ur f a c e ha s b e e n e x p l a i ne d b y B j a r n g a rd e t a l . ( 10 9 ) a s b ei ng d ue to gr e at e r pa t h l e ng t hs t a k e n b y t h e o bl iq u e l y i n c i de n t e l e ct r o n s i n r e a c hi ng a p o i nt . A l t h o u g h a do s e u n i f o r m it y o f 1 0% c a n b e a c hi e v ed o v e r mo s t o f t he bo d y s u r f a c e u s i n g t h e si x -f i e l d te c h n i q ue , a r e a s a d j a c e nt to s ur f a c e i rr e g ul a ri ti e s v a r y s u b s t a n t i al l y d u e t o loc a l s c at te r i ng . A re a s suc h a s i nne r t hi g hs a nd a x il l a e , w hi c h a r e o b st r u c t ed b y a d ja c e n t b od y s t r uc t ur e s , r e q ui r e s up pl e me nt a ry i r r a d i at io n. T h e t ot a l b r e m s st r a h lu n g d o s e i n t he mi dl ine o f t he p a ti e nt fo r t he m ul ti pl e fi e ld t e c h n i q u e i s a pp r o x i ma t e l y t w i c e t he l e v el of a s i ng l e fi el d . T hi s fa c t o r o f t wo ha s b e e n e x p e ri m e nt a ll y ob s e r v e d b y a num b e r o f i nv e s t ig a to r s ( 1 04 ,1 0 8 , 11 0 ) .

C. Modified Stanford Technique

T h e S t a n f o r d t e c h n i q ue o f s i x d u a l f ie l d s d es c r i b ed e a rl i er r e q ui re s m o di f i c at io ns o f t h e a c c e le r a to r s u c h a s r e m o v i ng t he s ca t t er i ng f oi l a nd i ns t al li ng a s c a t te r er a t t h e f r o n t e n d o f t he c o ll im a to r . T he s e cha ng e s w o ul d r e q ui r e s a f e t y i nt e rl o c k s t o p re v e n t o p e r at io n o f t h e a c c el e r at o r in t hi s c o nf i g ur a ti o n f o r c o nv e nt io na l e l e ct r o n be a m t r e atm e n t s . Most i ns ti t ut io ns , i nc l ud i ng t he U ni v e r s i t y of M i n n e s o t a , h a v e ad op t ed t h e S t a nf o r d tec hni q ue i n p ri nc i pl e w i t ho ut m a ki ng a l t er a ti o n s i n t h e a c c e l e r ato r h a r d w a r e . Be c a us e t he r e g ul a r s c a t t er i ng f o il s a nd various i n t e rl o c k s a re left in pl a c e , no special p r e c a uti o ns are r e q ui r ed in p r e p a ri n g t h e m a c h i n e f o r t o t al s k i n i r r a di a tio n. In s o m e a c c e le r a to r s ( e . g . , V a r i a n C l i na c C s e r i e s ) a hi g h d os e r a te m od e i s i n s t a ll e d t o al lo w a n o u t p u t o f m o r e t ha n 2 , 0 0 0 mo nit o r uni t s p e r m i nut e . T hi s s i g n i f i c a n tl y s pe e d s u p t h e t re a t me nt s . Bec a us e c o nv e nt io na l e le c t ro n c o ne s a re not used, the el e c tro n f i el d is co ll im a ted by a s p e ci a l w i de- a p e r t ure i ns er t a t t a c h ed at t h e e n d o f t h e c ol li m at o r . It is p r e se t v i a i nte r lo c k to a w i de r j aw

WWW.MEDRAD.IR

s e t ti n g a n d a s p e ci f ic e l e ct r o n e ne rg y , s e l e ct ed f o r hi g h do se r a t e mo de o f o p e r at io n . S o m e i n s tit u t io n s u s e a n a c r y l ic s c a t te r pl a te ( [ a s ym p to ti c a ll y e q ua l t o ] 1 c m i n t h i c k n e s s) i n f r o n t o f t he p a ti ent t o p r o v id e ad d it io na l s c a tt e r t o t he e l e ct r o n be a m ( F i g . 14 . 4 5 ) . T o s h o rt e n t h e t r e atm e n t t i me , t he p at ient i s t re a te d wi t h t hr e e d ua l f ie ld s p e r d a y , f o r e x a m p le , d a y 1 : o n e d u al f i el d f rom t he a nt e ri or , t w o dua l o bl i q ue f i el d s f r o m t h e p o st e ri o r ; da y 2 : o n e d ua l f i el d p o s te r io r a nd t w o d ua l f i el d s a nt e r io r o b li q u e . A c o m pl et e cy c l e o f s i x P.345 d u a l f ie l d s i s t h u s c om p l et ed i n 2 d a y s ( F ig . 1 4 .4 5 ) . A so ur c e -to - p a ti e nt di s t a nce o f a b o u t 4 m i s s u f f i c ie n t f o r t h i s te c hni q ue .

C.1. Dual Field Angle

A l o w - e n e rg y el e ct r o n b e a m i s c o ns id e r a bl y w i d e ned i n s i z e b y sc a t t er i ng i n a ir . F o r e x a m p le , a 9 - M e V e l e c tr o n b e a m , a f t e r t r a ns v e r s i ng 4 m o f a ir a nd a n a c r y l i c s c a t te r p l at e , a tt a i n s a G a u s s i a n d o s e p r of i l e m e a s uri ng a 9 0 % t o 9 0% i s od o se w i d t h o f a bo u t 60 c m , w h i c h i s u s ua l l y s uf f ic i e nt t o c o v er a p a ti ent ' s w i d t h. Al o ng t h e h e ig h t o f t h e p at ie n t , t w o fi e ld s , o ne di r e ct e d t o w a rd t he hea d a nd t he o t her t o w a r d t h e fe et , a r e a n g l e d s u c h t ha t i n the c o m po s it e do s e d i st r i b ut io n a 1 0% d o s e u n i f o r mi t y c a n b e o bt a i n e d o v e r a l e ngt h o f a b o ut 2 00 c m . A m e t h o d o f d e te r mi n in g d u a l f i e ld a ng l e b y f i l m d o si m et r y ha s b e e n d e s c ri b ed b y K h a n ( 1 1 1 ) . A se r i e s o f d o si me t r y f il m s i n the i r j a c k et s a re mo unt e d o n a v er ti c a l b o a r d , l a r ge r t h a n th e h e i g h t o f a t y p i ca l p at ie nt , a nd a r e p o s it io ne d a t t he t r e at m e n t di s t a n c e . Th e s c a t t e r pl a te i s pla c e d i n f r o nt o f t he f i l m s a s i n a c t ua l t r e at m e n t . T h e f il m s a r e e x po s e d t o a si ngl e el e ct r o n f ie l d d i re ct e d at 10 d eg r ee t o 15 d eg r ee a n g l e w it h r e s p e ct to t he ho riz o nt a l a x i s . T he f i l m s a r e s c a nne d f o r t h e o p ti c a l de n s i t y p ro f i le i n t h e v e r ti c a l dir e c ti o n. T he p r o f il e i s t he n pl a c ed si d e b y s i de w it h it s m i r ro r i m a ge a n d s ep a r a te d b y a d i st a nc e s uc h t ha t t he co m bi ne d p r o f il e s ho w s n o t m ore t h a n 1 0% v a r i at ion w i t hi n a bo ut 2 0 0 cm ( F i g . 1 4 . 46 A ) . T h e s e p a r at io n be t w ee n t h e t w o p ro f i le s g iv e s t he d e si r ed a ngl e b e t w ee n t he d ual f i e l d s . A c o n f i r m a to r y c o m po s it e p ro f i le i s t he n m e a s ur e d b y e x p o si ng t he f i l m s to t h e d u a l f ie l d s w it h th e i n t er f i el d a ng l e det e r mi ne d ab o v e ( F ig . 1 4 . 4 6 B) . Fi g ur e 1 4 . 4 7 s h o w s a t r a n s v er s e b e a m p ro f il e f o r the d ua l f i e l d a r r a ngem e nt .

WWW.MEDRAD.IR

F I G . 1 4 . 4 6 . C o m b i n i ng i n di v i d u a l b e a m p ro f i l e s to ob t ai n a co m pos i t e p ro f i le w it h 1 0 % do s e v a r ia ti o n in t h e v e r t i c al di r e ct ion. A : D a t a f o r 9 M e V ; S S D = 4 1 0 c m ; s c a t te r p l at e to p h a n t o m di s t a n c e = 2 0 c m ; i nd i v i d ua l p ro f il e b e a m a ng l e = 1 2 d e g re e s re l at i v e to h or i z o n t a l a x i s . A d ua l f ie l d a ng l e = 11 de gr e e s i s o b t ai ned b y c o mb i n i n g t h e p rof i l e s a s s h o w n. B : Co nf i r m a to r y be a m p r of i l e f o r t he d ua l field u si n g and AAPM = 11 d e g re e s . In : No. ( F r om P ur d y 19 . K ha n JA, ed. York, FM. Total skin in el e c tr o n r ad i a ti o n of t he r ap y : o nc o lo g y P hy s i c s , technique physics. do si me t r y . Monograph A d v a nc e s American

New

Ins t it ut e

1 9 90 : 4 66 , w i t h p e r mis s i o n . )

F I G . 1 4 . 4 7 . T r a n s v e r s e d o s e p ro f i le s ho w ing w i d t h o f t he p r o f il e w i t hi n 9 0 % dose r el a ti v e to c e nt r a l axis. ( F ro m K han FM. T o t al skin e le c t ro n t he r ap y :

WWW.MEDRAD.IR

technique physics.

and AAPM

do si me t r y . Monograph

In : No.

P ur d y 19 .

JA,

ed. York,

A d v a nc e s American

in

r ad i a ti o n of

o nc o lo g y P hy s i c s ,

New

Ins t it ut e

1 9 90 : 4 66 , w i t h p e r mis s i o n . ) P.346

C.2. Calibration
A t h i n w i n d o w ( 0 . 05 g / c m 2 ) pl a ne - p a r al le l c ha m b e r i s a s ui t ab le i ns t r um e nt f o r measuring c a l i b ra ti o n (20). T h e A A P M ( 1 1 2 ) r e c om m e n d s t h a t t he t ot al s k i n i r r a di a ti o n do s e b e m e a s ur e d at t h e c a li b r at io n po i nt l o c at e d a t t he s ur f a c e o f t he p ha nt o m a nd t he ho r i zo nt al a x i s . T h i s d o s e f o r a s i n g l e d u al f i e ld i s c a lle d t he c a li b r at io n p oint d o s e , D P . A p l a n e - p a r al le l c h a mb e r , e m be dd e d i n a p o l y st y r e ne p ha nt om , i s p o si ti o ned to f i r s t me a s u r e t h e de pt h d o se di s t ri b utio n a l o ng t he ho ri z o nt al a xi s f o r t he si ng le d u a l f i e ld ( t h e de pt h d o s e di st r i b ut io n c a n a l s o be m e a s ur e d b y a f i l m s a nd w i c he d i n a p ol y s t y r e n e p h a n t o m a n d p l a ce d p a r a lle l t o t he ho ri z o nt al ax i s ) . T he s ur f a c e d o s e m e a s u r e me n t given by: is m a d e at a de pt h o f 0 . 2 m m ( 2 0 ) . S up p o se M i s t he i o n i z a ti o n c h a r g e me as u r e d , t h e c a l ib r a ti o n p o i nt do s e t o po l y sty r e ne , ( D P ) P o l y , i s d ep t h d os e d i s tr i b ut io n they may for be t he l o w - e ne r g y by b ea ms us e d for t hi s a t e c h n i q u e . B e c a u s e pl a n e - p a r al l el c ha m b e rs a r e p r e s e nt l y no t ca l i b r at ed b y t he l a bo r a to rie s , c a l i b r at ed i nt e r com p a r i so n with c a l i b ra t ed F a r m e r -t y pe c h a m b e r , us i ng a h i g h- e ne r g y ( 1 0 M e V) e l e c tr o n b e a m

T h e s y m b o l s a r e d e f i ne d i n C h a p t e r 8 . T he c a l i b ra ti o n p oi nt d o se t o w a t e r , ( D P ) W , c a n t h e n b e d e t e rm i n ed a s :

T h e e l e ct r o n f l u e n c e f a c t o r W P o l y i s a p p ro xi m a te l y uni t y , b e c a use t he c al i br a ti o n m e a s u r e m e n t i s ma d e c l o se t o t he s ur f a c e . P r e p l c a n a l so be eq ua t e d to uni t y f or t h e p l a n e - p a r a ll el c h a m b e r s . T h e p a r a m et e rs [ L w i t h b a r a b o v e ] / a nd

/ a r e d et e r mi n e d fo r t h e m e a n e ne r g y o f ele c t ro ns a t t he de pt h of m e a s ur e m e nt , w h i c h i s g i v e n b y E q u a t io n 1 4 . 7 . T h e t r e a t me n t s k i n d os e , (

) P o l y i s d e f i n ed b y t h e A A P M ( 1 12 ) a s t he m e a n o f t he s ur f a c e d o se al o ng t he

c i r c u m f e r e n c e o f a c y li n d r i c al p ol y s t y r e ne pha nt o m 3 0 c m i n d i am e t er a nd 3 0 c m h i g h t h a t h a s b e e n i rr a d i at e d u n d e r t he tot a l s k i n i r r ad i at io n c ond i t io ns w i t h a ll s i x d u a l fi e ld s . If ( D P ) P o l y i s t h e ca li b r at io n p oi nt d o s e f o r t he si ng l e d ua l f i el d , then

WWW.MEDRAD.IR

w h e r e B i s a f a c to r re l a ti n g t h e t re a tm e nt s k i n d o se w i t h t he c a l i b ra ti o n po i nt dose, bo t h me a s u r ed at the s ur f a c e of a c y l i nd r i c al p ol y s ty r e ne p ha nt o m . T y p i c a l l y , B r a n g e s b et w e e n 2 . 5 a nd 3 f o r the S t a nf o r d t y p e te c hni q ue .

F I G . 1 4 . 4 8 . C o m p o s ite d e pt h - do s e di s t ri b uti o n f o r s i x d ua l f i el d s o b t ai ne d wi t h a d o s im e tr y f i l m s a n d w i c h e d i n a c y li nd r i c al p ol y s t y r e ne p ha nt om e x p o se d und e r t r e at m e n t co n d it io n s . Ir r a d i a ti o n co nd it io ns a r e gi v e n i n F ig . 14 . 4 6 . ( F ro m K ha n F M . T o t a l s k i n e l e ct ro n t h e r a p y : t e c hni q ue a nd d o s i me t r y . In: P ur d y J A , e d . A d v a n c e s i n r a di a ti on o n c o lo g y p hy s i c s . A A P M M o no g r a p h N o . 1 9 . Ne w Y o r k : A m e r i c a n In s t i t u te o f P h y s i c s , 1 9 9 0 : 46 6 . ) P.347

T h e t r e a t me n t s k i n d os e f o r a w a t e r p ha nt om ,

) W , c a n b e c a l c u l at ed f r o m E q u a t i o ns 14 . 2 1 a nd 1 4 . 2 2 :

T h e f a c t o r B c a n a l s o b e d et e rm i ne d b y t a ping a f i l m s t ri p i n i t s li g ht -t i g ht p a pe r to the surface of the c y l i n d r i c al p ol y s t y re ne p ha nt o m , s p e ci f ie d above, a nd

WWW.MEDRAD.IR

e x p o si n g it to a s i n gle d u a l f ie l d . A no t he r f i l m s t ri p t ap e d a ro und t he p ha nto m i s e x p o s ed to s i x d u al f ie l d s . B y r e l at i ng o pt i ca l d e ns it ie s to do s e s in t he t w o c a s e s , f a c t o r B c a n b e d e te rm i n e d f r o m E q ua ti o n 1 4 . 2 2 . T h e c o m p o si t e de pt h - d o s e di s t ri b uti o n f o r t he s i x d ua l f i e l d s m ay b e d e t e r mi ned by sandwiching a d o s i me t r y film (in i ts paper jacket) in t he c y l i nd r i c al p o l y st y r e n e p h a n t o m a n d c u t t i n g t he e x c e ss f i l m s o t ha t t he e d ge s c o nf o r m to t he c i r c u l a r s u r f a c e o f t h e p h a n t o m . A b l a c k ta p e i s w r a p p ed a r o und t he p ha nt o m o v e r t h e f i l m ed ge s t o m a k e t he f il m l ight - t ig ht . T he p ha nt o m , w i t h t he f i l m p a r a l le l to t h e h or i z o nt a l a x i s , i s e x po s ed to t he s i x d ual f i el d s , dup l i c at i ng a ct ua l t r e at m e n t co n d it io n s . A f t e r a p p ro p ri a te p ro ce s s i ng , t he fi l m i s s c anne d f o r o pt i c al density di s t ri b u tio n , which is r e l a te d to d o se di s t ri b uti o n by a r e f e r e nc e s e n s i to m et r i c c u r v e . F i g u r e 1 4 .4 8 gi v e s t he r e s ul t s o f s uc h a m e a s ur e m e nt .

C.3. In Vivo Dosimetry

A l t h o u g h a n o v e r a ll s u r f a c e d o se uni f o r mi t y o f 1 0% c a n b e a c hi e v e d a t t he t r e at m e n t d i st a n c e , i n a p l a n e p e r pe nd i c ul ar t o t he ho ri z o nt al a xi s a nd w i t hi n a n a r e a e q u i v al e n t t o a p a t ie n t ' s di m e ns io ns , t he r e a re lo c a li z e d r eg i o ns o f e x t r eme n o n u n i f o r m i t y o f d o se o n t h e p a t ie nt ' s s k i n. E x c e s s i v e d o s e ( e . g. , 1 2 0 % 1 3 0% ) c a n o c c u r i n a r e a s w i t h s h a r p b od y p r o je ct io ns , c ur v e d s ur f a c e s , o r r e g io ns o f m u l t ip le f ie l d o ve r l a p s. L o w - do s e r e gi o ns o cc ur w he n t he s k i n i s shi e l de d b y o t h er p a r t s o f t h e bo d y o r o v e r l yi n g bo d y f o ld s. F r o m i n v i v o m e a sur e m e nt s , a r e a s r e c e i vi n g a s i g n i f i c a n tl y l e s s d o se c a n b e i de nt i f ie d f o r lo c a l boo st . If P.348 e y e l id s n e ed to b e t re a t ed , i n te r na l e y e s hie l d s c a n be us e d , b ut t he d o se to t he i n s i d e o f t h e li d s s ho u l d b e a s s e s s ed , ta k i ng i nto a c co unt t he el e ct r o n b a c k s c a t te r from lead. T h e r m o l u m i n e s ce n t do s i me te r s ( T L D ) a re m o s t o f t e n us ed f o r in v i v o d o si m et r y . F o r t h e se me a s u r e m en t s , t h e T LD m us t b e t hi n ( < 0 . 5 m m ) to mini m i z e t he e f f e ct o f d o s e g r ad ie n t a c r o ss t h e d o s i me te r s . T L D c hi p s a r e c o m m e r ci a ll y a v a i l a b le t ha t m e e t t h e se s pe c i fi c a tio n s . T h e s e c hi p s c a n b e s ea l ed i n t hi n po l ye t hy l e ne s he e t s t o a v oi d co n t a mi n a t ion . T h e r e f e r e nc e c hi ps m a y b e c a li b r at ed in a p o l y s t y re ne p h a n t o m u s i n g a n e lec t r o n b e am o f a p p ro x im a t el y t he s a m e me an e ne r g y i nc i d e nt o n t h e T L D s a s i n t h e i n v i v o m e a s ur e me nt c o nd it io ns . T he d e s i re d m e a n e ne rg y m a y b e o b t ai n e d b y se l e ct i n g a n a p p ro p ri a te i nc i d e nt b e a m e ne rgy a nd d e p t h ( E q . 14.7).

14.9. TREATMENT-PLANNING ALGORITHMS

Early methods of e le c t ro n beam do s e co m p ut at io n were b a se d on e m pi r i ca l f u n c t i o n s t h a t u s e d r a y l i n e g eo m et r i c s , as s um i ng b r o a d be a m d o s e di s tr i b utio n. In h o m o g e n e it y c o r re ct io n s w e r e i nc o r po r ate d us i ng t r a ns m i s si o n d a t a m e a s ur e d with l a rg e sl a b s of h e t e ro g e n ei ti e s . em p i ri c al T he se m et ho d s b a se d on ha v e b een reviewed a nd by s l ab S t e r n i c k ( 1 13 ) . M a j o r l i mi t at io n s o f t h e me t hod s br o a d b e a m s g e o me t ri e s a re t h ei r i n a b i li t y to p re di c t e f f e c t s o n do s e di s t ri b ut io n o f s m a ll f i e l d s , s u d de n c h a n g e s i n s u r f a c e c o nt o ur, s m a l l i nho mo g e nei tie s , a nd o b li q ue b e a m i n c id e n c e . A n im p r o v e me n t o v e r t he e m p i ri c a l me t ho d s c am e a b o ut w it h t he d e v e lo p me n t o f al g or it h m s b a s ed o n t he a ge - d i f f us i o n e q ua ti o n by K a w a c hi ( 1 14 )

WWW.MEDRAD.IR

a n d o t h e rs i n t h e 1 97 0 s . T h e s e m et ho d s ha v e b e e n re v i e w ed b y A nd r e o ( 1 15 ) . A l t h o u g h t h e s e a lg o rit h m s a r e a b l e to us e s e m i e m pi ri c a ll y d e r iv e d p e nc i l be a m s t h a t c a n b e pl a c ed a lon g t h e s u r f a c e c o nto ur t o pr e di c t e f f e c t s o f s m a l l f ie ld s a nd surface i r r e g u l a ri t y , their accuracy to c al c ul a te i nho m og e nei ty c o r r e c ti o n is l i mi te d . T h e y u s e e f f ec t i v e p at h le ng t hs b e tw e e n t he v i r t ual so ur c e a nd t he p oi nt o f c a l c u l a ti o n b u t t h e e f f e c t s o f a na t o m y a nd s m a l l ti s s ue he te r oge ne i ti e s i n t hr e e d i m e n si o n s a r e n o t f u ll y a c c o u n t e d f o r . M a j o r ad v a n c e m e n t in e l e ct r o n b e a m t re at m e nt p l a nni ng o c c urr e d i n t he e a rl y 1 9 80 s ( 3 8 , 54 , 6 5 ,1 1 6 ). M e t h o d s w e r e de v el o pe d t hat w e r e b a se d o n G a us s i a n p e n c i l b e a m d i st r ib u t io n s c a l c u l a te d w it h the a p p li c a ti o n o f Fe rm i - E y g e s m ul ti pl e s c a t te r i n g t h e o r y ( 117 ) . F o r a de t ai le d re v i e w o f t he s e a lg o rit hm s t he r e ad e r i s r e f e r r e d t o B r a h m e ( 11 8 ) a n d H o g s t ro m , S ta r k s c ha l l , a nd S hi u ( 1 1 9 ) . P e n c i l be a m al go r it h ms b a s e d o n m ult ip l e sc a t t er i ng t he o r y a re the a l go r it hm s o f c h o i c e f o r e le c t ro n be a m t re a t me nt pl a nni ng . A b r i e f d i s c us si o n i s p r e se nt ed to f a m i l i a ri z e t h e u s e r s of t h e s e a l go r it hm s w i th t he b a s i c t he o r y i nvo l v ed .

A. Pencil Beam Based on Multiple Scattering Theory

A s s u m i n g s m a l l - a n g le m u l t i pl e s c a tt e ri ng a p p r o xi m a ti o n, a n e le m e nt a r y p e nc il b e a m p e n e tr a ti n g a s c a t te r i n g me di um i s v e r y ne a r l y G a us s i an i n i t s l at e r al s p r e a d at a ll de pt h s . L a r g e - a n gl e s c at te r i ng e v e nt s co ul d c a us e d e v i at io ns f r o m a pure Gaussian d i st r ib u t io n , but t hei r o ve r a ll effect on do s e d i s tr i b ut io ns is c o n s i d er e d t o be s m a ll . T h e s p a t i al do s e dis t r i b ut io n f o r a G a us s i a n p e nc i l b e a m c a n b e r e p r e se n t e d t h u s :

w h e r e d p ( r , z ) i s t h e d o s e co n t ri b ut ed b y the p e nc i l b e a m at a p o i nt a t a r ad i al d i s t a n c e r f r om i t s cen t r a l a x i s a nd d e pt h z , d p ( o , z ) i s t he a x i al d o s e a nd 2 r ( z ) i s t h e m e a n sq u a r e r a dia l di s p l a ce m e nt o f e lec t r o ns a s a r e s ult o f m ul t ip le C o ulo m b s c a t te r i n g . It c a n b e s h o w n t h a t 2 r = 2 2 x = 2 2 y w he r e 2 x a nd 2 y a r e t he m e a n square l at e r al di s pl ac e m e n t s p r o je c te d on t he X, Y, a nd Y, Z p l a ne s . T he e x p o n e n ti a l f u n c t io n i n E q u a t io n ( 1 4 .2 5 ) r e p r e se nt s t he o f f - a x i s r a ti o f o r t he p e n c i l be a m , n o r m a li ze d to u n i t y a t r = 0 . P.349

A n o t h e r u s e f u l f o r m of E q u a t i o n ( 1 4 . 2 5 ) i s :

w h e r e D ( o , z ) i s t h e d o s e a t de p t h z i n a n i nf i ni t e l y b r o ad f i el d w i t h t he s a m e i n c i d e nt f l u e n c e at th e s u r f a c e a s t he penc i l be a m . T he G a uss i a n d i st r ib ut io n f u n c t i o n i n E q u a ti o n 14 . 2 6 i s n o rm a li z e d so t ha t t he a r e a i nte g r al o f t hi s f unc t io n o v e r a t r a n s v e r s e pl a n e a t d e pt h z i s uni t y .

WWW.MEDRAD.IR

F I G . 1 4 . 4 9 . A p e n c i l b e a m c oo r di na t e s y s te m . ( F r o m K ha n F M . D o s e di s t ri b uti o n a l g or it h m s f o r e le c t ron b e a m s . In: K ha n FM , P o ti s h R A , e d s . T re a t m e nt pl a nni ng in r a d i at io n o n c o lo gy . B a l t i m o re : W il li am s & W il k i ns , 1 9 98 : 1 13 12 2 , w it h p e r m i s sio n . ) In C a r t e s i a n c o o r di n a te s E q u a t i o n ( 14 . 2 6 ) ca n b e w r i t te n a s :

w h e r e d p ( x , y , z ) i s t h e do s e co nt ri b ute d t o po i nt ( x , y , z ) by a p e nc il be a m w h o s e c e n t r a l a x i s p as s e s t h r o u g h ( x , y , z ) ( F i g 1 4 . 49 ) . T h e t o t al d o se d i st r ibu t i o n i n a f i e ld o f a ny s i z e a nd s ha p e c a n b e c a l c ul a te d b y s u m m i n g a l l t h e pe n c il b e a m s :

T h e i n t eg r a ti o n o f a G a u s s i a n f unc t i o n w ithi n f i ni t e li mi t s c a nno t b e pe r f o r m ed a n a l y t i c a ll y . T o e v a l ua t e t hi s f u n c t i o n ne c es s i t at e s t he us e o f e r ro r f unc t i o n ( e r f ) . T h u s c o n v o l u t io n c a l cu l u s s h o w s t ha t fo r an e l e ct r o n b e a m o f a r e c t a ng ul a r c r o s s s e c t io n ( 2 a 2 b ) , t h e s p a t i al d o se d i st r ib uti o n i s g i ve n b y :

w h e r e t h e e r r o r f u n c t io n i s d e f i n e d t hus :

T h e e r r o r f u n c t i o n i s n o r m a l i z ed s o t ha t e r f( ) = 1 ( i t i s k no w n t ha t t he i nt e gr al 0 e - t d t = / 2 ) . E r r o r f u n c t i o n v a l ue s f o r 0 < x c a n b e o b t a i ne d f r o m t a bl es
2

WWW.MEDRAD.IR

p u b l i s h ed i n m a t h e m at i c s h a n d b oo k s ( 1 2 0 ) . T he q ua nt i t y D ( o , o , z ) i s us ua l l y d e te r m i n ed P.350 f r o m t h e m e a s u r e d c en t r a l a x i s d e pt h- do s e d a t a o f a b r o ad e le c t ro n f i e l d ( e .g . , 2 0 20 cm).

F I G . 1 4 . 5 0 . A p l o t o f n o r m a l di s t ri b uti o n func t i o n g i v e n b y E q ua t io n 1 4 . 29 f o r = 1 . T h e f u n c t i o n i s n o r m a l i z ed t o uni t y fo r li mi t s . ( F rom K ha n F M . D o s e d i s t ri b u tio n T r e a t m e nt a l go r it hm s p la n n i n g in for el e ct ro n b ea m s . In: K ha n FM, P o ti s h & RA, eds. r a d i at io n o nc olo g y . Ba l ti mo r e : Wi lli a m s Wi l ki ns ,

1 9 98 : 1 13 1 2 2 , w it h p e r m i s si o n . )

A.1. Lateral Spread Parameter,

G a u s s i a n f u n c t i o n i s c h a r a c t e r i z ed b y i t s la t e r al s p re a d p a r a m et e r , , w hi c h i s s i m il a r to t h e s t a n da r d d e vi a ti o n p a r am et e r o f t he f a mi li a r no r m a l f re q ue nc y d i s t ri b u tio n f u n c t i o n :

The

previous

f u n c t i on

is

p l ot te d

in

F ig .

14.50

for

1.

T he

f unc t i o n

is

n o r m a l i z ed s o t h at i t s i n t e g r al b et w e e n t he l i mi t s - < x < + i s uni t y . T h e d o s e d i st r ib u t io n i n a p e n c il el e c tr o n b e a m i nci d e nt o n a uni f o r m p ha nt om l oo k s l i k e a t e ar d ro p o r o n i o n ( F i g . 14 . 5 1) . T he l a t e r a l s p re a d ( o r ) i nc r e a s e s w i t h d e pt h u n t i l P.351 a m a x i m u m s p r e a d i s a c h i e v e d . Be y o nd t his d e p t h t he re i s a p re c i pi to us l o s s o f e l e ct r o n s a s t h ei r l a r ge r l a te r a l e x c ur s io n c a us e s t he m t o r un o ut o f e ne r g y .

WWW.MEDRAD.IR

F I G . 1 4 . 5 1 . P e n c i l be a m do s e d i st r ib ut io n m e a s ur e d w i t h a na r r o w b e am o f 2 2 M e V e n e r g y i n ci d e n t o n a w a t e r p ha nt om . ( F r o m IC R U R e por t 35 . R a d i at io n d o s im e tr y : e le c t ro n be a m s w i t h e ne rg ie s be t w e e n 1 a nd 5 0 M e V. Be t he s d a , M D : In t e r n a t i o n al C o m mi ss i o n o n R a di a tio n U ni t s a nd Me a s ur e m e nts 1 9 84 : 36 , w i t h p e r m i s sio n . )

WWW.MEDRAD.IR

F I G . 1 4 . 5 2 . S c h e m a t i c r e p re s e nt at io n o f t he H o g s t r om a l go r it hm f o r e l e ct r on b e a m t re a t me n t p l a nn i n g . ( F r o m H o g s t rom K R , M i l l s M D , A l m o nd P R . E l e c t r o n b e a m do s e c a l c u l at io n. P h y s M e d Bi o l 19 8 1 ;2 6 : 44 5 , w i t h p e rm i s sio n. ) Eyges ( 1 17 ) p re di c ted t h eo r et i c al l y by e x t e ndi ng t he s m all - a ng l e m ult i pl e

s c a t te r i n g t h eo r y o f Fe r m i t o s l ab g eo me t r y o f a ny c o m p o s it io n. C o ns i d e ri ng x ( z ) in the x-z plane,

w h e r e 2 / l i s t h e m as s a n g u l a r s c a t te r i ng p o w e r a nd i s t he d ens i t y o f t he sl a b phantom. T h e r e a r e l i mi t at io n s t o t h e p re v io us E y g e s e q ua ti o n. A s po i nte d o ut b y W e r ner et a l . ( 5 4 ) , , g i v e n b y E q u a t i o n 1 4 . 32 , i nc r e a s e s w i t h d ep t h i nde f i ni te l y w hi c h i s c o n t r a r y to w h a t i s ob s e r v e d e x p e ri m e nt al ly i n a na r r o w b e a m do s e di s t ri b utio n.

WWW.MEDRAD.IR

A l s o , E q u a t io n 1 4 . 3 2 i s b a s e d o n s m a l l - a ngl e m ul ti pl e C o ulo m b sc a t t er i ng , he nc e i g n o re s t h e p ro b a bi li ty o f l a r ge - a ng le s c at te r . T hi s r e s ult s i n a n und e r e s t im a te of . C o r r e c ti o n f a c to rs have been p ro pos e d to o v e r c o me the s e p ro b le m s ( 5 4 , 1 21 , 1 22 ) . P r a c t i c al i m pl em e n t at io n o f t h e a bo v e a lg o ri t hm w a s c a r r ie d o ut b y H o g s t ro m et a l . i n 1 98 1 (3 8 ) a n d w a s s u b s e q ue ntl y a dop t ed b y s e v e r al co m me r c i al tr e at m e nt planning s y s te m s . Fi g u r e 1 4 . 52 s ho w s a s c he m a ti c re p re s ent a t io n of t he H o g s t ro m a lg o ri t h m . T h e p e n c i l b e a m i s c a l c ul a te d us i ng t he F e r m i - E y g e s e q u a t io n ( E q . 1 4 . 3 2 ) . B y c o r r e l a t i ng el e ct ro n l i ne a r c ol li s io n s t op p i ng po w e r a nd linear a n g ul a r s c at ter i n g po w e r re l at i v e to t ha t of w a te r w it h CT num b e r s , e f f e c t i v e d ep t h a n d a r e c a l c u l at ed f o r i nho m o ge ne o us m ed i a . T hus t he m e t hod a l lo w s p i x e l -b y - p i xe l ca l c u l a ti o n o f he te r og ene i t y c o r re c ti o n. P.352

F i g u r e 1 4 .5 3 s h o w s a c o m p a r i so n o f c a l c ula t e d a nd m e a s ur ed i so d o se c ur v e s a s a n e x a m p l e . St a r k s c h a l l e t al . ( 1 23 ) ha v e e x t e nde d t he H o g st ro m a lg o ri t hm t o t h r e e d i me n s io n s . A n i r r e g ul a r l y s ha pe d f i eld i s di v i de d i nto st r ip b e a m s a nd e a c h s t r i p i s di v i de d i n to s e g m e n t s so t ha t o f t he p e nc i l be a m s a nd e f f e c t i v e d ep t hs a r e c a l c u l a te d i n t h r ee d i m e n si o ns . Int e g r at io n o f t he p e nc i l s i s c a r r i e d o ut o v e r a l l s t ri p s a n d s e gm e n ts .

F I G . 1 4 . 5 3 . C o m p a r is o n o f c a l c ul a te d a nd m e a s ur e d i so d o se d is t r i b ut io n. ( F r o m H o g s t ro m K R , M i ll s M D , A l m o n d P R . E l e c t ron b e a m d o s e c al c ul at io n. P hy s M e d Bi o l 1 9 81 ; 2 6 :4 45 , w i t h p er m i s s io n . )

REFERENCES

WWW.MEDRAD.IR

1.

F l et c h e r

GH.

In t r o d u c ti o n .

In:

Tapley

N,

ed.

C l i ni c al

a p pl i c at io ns

of

t he

e l e ct r o n be a m . N e w Y o r k : J o h n W i l e y & S o ns , 1 9 7 6 :1 . 2 . E v a n s R D . T h e a t o m i c n u c l e u s . N e w Y o r k : M c G r a w - H i l l , 1 9 55 . 3 . J o h n s H E , L a u g h l in J S . In t e r a c t io n o f r a d i at io n w it h m a tte r . In: H i ne G , B r o w n e l l G , e d s . R a d ia t io n d o s i me t r y . N e w Y o r k : A c a d e m i c P r e s s , 1 9 5 6 :4 9 . 4 . N a t io n a l C o u n c i l on R a d i a t io n P r o te c ti on a nd M e a s ur e m e nt s ( N C R P ) . S t o p p i ng p o w e r s f o r u s e w i t h c a v i t y i o n i z a tio n c ha m b e r s . R e po r t N o . 27 . H a nd b o o k 7 9. W a s h i n g t o n , D C : N a t io n a l B u r e a u o f S t a nd a r d s , 1 9 61 . 5 . S t e r n h e i me r R M . Th e d e n s it y e f f e c t fo r the i o ni z at io n lo s s i n va r i o us m at e ri a l s . P h y s R e v 1 9 5 2 ; 8 8 :8 51 . 6 . F e r mi E . T h e i o n i z at io n lo s s o f e ne rg y i n g a s e s a nd c o nde ns e d m a t er i al s . P hy s R e v 1 9 4 0 ;5 7 :4 8 5 . 7 . L a u g h l i n J S , B e a t t ie J W . R a n g e s o f hi g h e ne r g y e l e ct r o ns i n w a t e r . P hy s R e v 1 9 51 ; 8 3 :6 92 . 8. IC R U . R a d i a t io n q u a n t i ti e s a nd uni t s. Report No. 33 . W a s hi ng t o n, DC: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 8 0 . 9 . B e r g e r M J , S el t z e r S M . T a b l e s o f e ne r gy l o s s e s a nd r a nge s o f e le c t ro ns a nd p o s it ro n s . 10. B e r ge r NASA MJ, S P - 3 0 12 . S el tz e r and S e ltz e r W a s hi ng to n, A d d it io na l NASA DC: N a t io na l A e ro naut i c s a nd ra ng e a nd S p a ce f or A d m i n i s tr a ti o n , 1 9 64 . SM. st o pp i ng p o we r t ab l es p r ot o n s , 11. mesons, MJ, e le c t ro n s . SM. SP-3036. po w e r s a nd W a s hi ngt o n, r a ng e s of DC: N a t i o nal a nd

A e r o n a u t i c s a n d S p a ce A d m i n i st r a ti o n, 1 966 . Berger S t o p p i ng e l e c t ro ns p o s it ro n s , 2 n d e d . W a s h i n g t o n , D C : U . S . D e p a rt m e nt o f C om m e r c e , N at io nal B u r e a u o f S t a n d a r d s , 1 9 83 . 1 2 . IC R U . S t o p pi n g po w e r s f o r el e ct r o ns and p o s it r o ns . R e po rt N o . 3 7 . Be t he sd a , M D : In t e r n a t i o n a l C om m i s s io n o n R a d i a ti o n U ni t s a nd M e a s ur e m ent s , 1 9 8 4 . 1 3 . R o s s i B B . H i g h e n e r g y p a r ti c le s . E ng l e wo o d C li f f s , N J : P r e nt i ce - H a l l , 1 95 6 . 1 4 . IC R U . R a d i at io n do s i me t r y : e l e ct ro ns w i t h i ni ti a l e ne r gi e s b et w e e n 1 a nd 50 M e V . R e po r t N o . 2 1 . W a s h i n g to n, D C : Int e r na ti o na l C o m mi s s io n o n R ad i at io n U n i t s a n d M e a s u r e m e nt s , 1 9 72 . 1 5 . N o rd i c A s so c i at io n o f C l i n i c al P hy s i c s ( NA C P ) . P r o c e d ur e s i n ex t e r na l r a di at io n therapy do s im et r y with el e ct r o n a nd p ho to n b e am s w it h ma x i m um e ne r gi e s b e t w ee n 1 a n d 5 0 M eV . A c t a R a d i o l 19 80 ; 19 : 5 5 . 1 6 . M a r k u s B . B e i t ra g e z u r E n t w i c k l ung d e r D o si m et r ie s c hne l l e r . E l e kt r o nen S t r a h l e n t h e r ap i e 1 9 64; 1 2 3 :3 5 0 , 50 8 a nd 1 96 4 ; 12 4 : 33 . 1 7 . N u s s e M . F a c t o rs a f f e c t i n g t he e ne rg y - r a ng e r el a ti o n o f f a s t e le c t ro ns i n a l u m i n u m . P h y s M e d B i ol 1 9 69 ; 14 : 31 5 . 1 8 . H a r d e r D , S c h u l z H J . S o m e ne w p hy s i c a l d a t a f o r e le c t ro n b e a m d o si m et r y . In : P r o c e e d i n g s o f th e E u r o p e a n C o ng r e ss o f R a d io lo g y . A m s te r d a m : E x c e r pta M e d i c a , 1 97 1 . P.353

1 9 . S v e n s s o n H , H e t t i n g e r G . D o si m et ri c m e a s ur e m e nt s at t he no r d i c m e di c al a c c e l e r ato r s . I. C h a r a c t e ri s ti c s o f t he r a d ia ti o n b e a m . A c t a R a di ol 1 9 7 1 ;1 0 :3 6 9 .

WWW.MEDRAD.IR

2 0 . K h a n F M , D o p p k e K , H o g s t ro m K R , e t a l . C l i ni c al e le c t ro n- be a m d o si m et r y . R e p o rt o f A A P M R a d ia t io n T h e r a p y C o m mit t ee T a s k G r o up N o . 2 5 . M ed P hy s 1 9 91 ; 1 8 :7 3 . 2 1 . B r a h m e A , S v e n s s o n H . S p e c i f i c a t io n o f e l e c tr o n b e a m qua l i t y f r o m t he c e n t r a l - a x i s de pt h a b s o r b ed - do s e di s t ri b uti on. M e d P hy s 1 9 7 6 ; 3 :95 . 22. R o ge r s DWO, B i e l aj e w AF. D i f f e r e nc e s in e le c t ro n d e pt h- d o s e c ur v es c a l c u l a te d w i t h E G S a n d E T R A N a nd i m p ro v e d e ne rg y - r a ng e r el a ti o ns hi p s . M e d P h y s 1 9 8 6 ; 1 3 :6 87 . 2 3 . H a r d er D . E n e r gi es p e c t re n S c hne l le r E l ec k t r o ne n i n V e r s c hi e de ne n T i e f e n. In: M o n t r e u x Z u p p i n g e r A , P o r e t ti G , e d s . S y m p o s i um o n hi g h- ene r g y e l e ct ro ns . B e r l i n : S p r i n ge r - V e r lag , 1 9 6 5 :2 60 . 2 4 . A A P M . T a s k G r o u p 5 1 . P r o to c ol f o r c l i ni ca l r e f e r e nc e do s im e try o f hi g h- e ne r g y p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 9 9 ;2 6 : 18 4 7 18 7 0 . 2 5 . IA E A . T e c h n i c a l R e p o rt s S e ri e s No . 39 8 . A b so r b ed do s e de t e rm i na ti o n i n e x t e r n a l be a m r a di ot h e r a p y . V i e n na : Int e r na t io na l A t om i c E ne r g y A g e nc y , 2 0 0 0 . 2 6 . A m e r i c a n A s s o c i at io n o f P h y s i c i s t s i n M e d i ci ne ( A A P M ) . A p r ot o co l f o r t he d e te r m i n at io n o f a b s o r b ed d o se f r o m hi gh e ne r g y p ho t o ns a nd e l e ct ro ns . R T C T a s k G r o u p N o . 2 1 . M e d P h y s 1 9 8 3 ; 10 : 74 1 . 2 7 . Lo e v i n ge r R , K ar z m a r k C J , W e i s s bl uth M . R a d i a ti o n d o sim e t r y w it h hi g h e n e r g y e le c t ro n s . R a d io lo g y 1 96 1 ;7 7 : 90 6 . 2 8 . D u t r ei x J , D u t r e ix A . F i l m d o s im et r y o f hi g h e ne r g y e l e c t r ons . A nn N Y A c a d S c i 1 9 69 ; 1 61 : 33 . 2 9 . H e tt i n g e r G , S v e n s s o n H . P h o t o g r a p hi c f i l m f o r de t er m i na ti o n o f i s o do s e f r om b e t at r o n el e ct r o n r a dia t io n . A c t a R a d i ol 1 967 ; 5 : 74 . 3 0 . K h a n F M , H i g g i n s P D . C a l c u l a t i o n o f d e pt h d o s e a nd d o s e pe r m o ni to r uni t f o r i r r e g ul a r l y s h a p e d ele c t ro n f i e l d s : a n a d de nd um . P hy s M e d Bi o l 1 99 9 ;4 4 : N7 7 N80. 3 1 . IC R U . R a d i a t i o n do s i me t r y : e le c t ro n b ea m s w i t h e ne r g i e s bet w e e n 1 a nd 5 0 M e V . R e p o rt N o . 35 . B e t h e s d a , M D : Int e r na t io na l C o m mi s s io n on R a d i a t io n U ni t s a n d M e a s u r e m e n t s , 1 98 4 . 3 2 . A l mo n d P R . C h a r a c t e ri s ti c s o f c ur r e nt me d i c al el e ct r o n a c ce ler a t o r b e a m s . In: C h u F , e d . P r o c e e d i ng s o f t h e s y m po s i um o n e l e ct ro n b e a m t her a p y . N e w Y o r k : M e m o ri a l S lo a n - K e tt e ri n g C a n c e r C e nt e r , 1 97 9 : 43 . 33. Mandour MA, Harder D. S y s t e ma ti c o p ti mi z a t io n of t he d o ub le - s c a tt e re r s y s t e m f o r e le c t ro n b ea m f i e l d f l at te ni ng . S tr a hl e nt he r a pi e 19 7 8 ;15 4 : 32 8 . 3 4 . W e r n e r B L , K h a n F M , D e i be l F C . M od e l f o r c a l c ul at i ng de pt h d o s e d i st r ib ut io ns f o r b r o a d e l e ct ro n b e am . M e d P h y s 1 9 8 3 ; 1 0 :5 8 2 . 3 5 . B i g g s P J , B o y e r AL , D o pp k e K P . E l e c t ron d o s i m et r y o f i r re g ula r f i e l d s o n t he C l i n a c - 1 8 . I n t J R a di at O n c o l B i ol P hy s 1 9 79 ; 5 : 43 3 . 3 6 . K h a n F M , H i g g i n s P D . F i e ld eq ui v a l e nc e f o r c l i ni c a l e le c t ro n be a m s . P hy s M e d B i o l 20 01 ; 4 6 : N9 N1 4 . 3 7 . H a r d e r D , S c h r d er - B a b o P , A b o u M a nd o ur M . P r i v a t e c o m m uni c a t io n, 1 9 8 2 . 3 8 . H o g s t ro m K R , M i ll s M D , A l m o nd P R . E l e c t ro n b e a m d o se c a lc ul a t io ns . P hy s M e d B i ol 1 9 81 ; 26 : 44 5. 3 9 . M il l s M D , Ho g s t ro m K R , Al m o nd P R . P r e di c ti o n o f el e ct ro n b e am o ut p ut f a c t o r s . M e d P h y s 1 9 82 ; 9 : 60 .

WWW.MEDRAD.IR

4 0 . P o h l it W . D o s i me tr i e Z u r B e t a t ro nt he r ap i e . S t utt g a rt : V e r l ag , 1 9 6 5 . 4 1 . S h r o d e r - B a bo P . D e te r m i n at io n o f t he v i r t ua l el e ct r o n s o ur ce o f a b et a t ro n. A c t a R a d io l 19 8 3 ;3 64 [s u p p l ] : 7 . 4 2 . M e y e r J A , P a l t a JR , H o g s t r o m K R . De te r m i na ti o n o f r el a ti v el y ne w e l e c tr o n d o s im e tr y m e a s u r e m en t t e c h n i q u e s o n M e v at r o n 8 0 . M e d P hy s 1 9 84 ; 1 1 :6 7 0 . 4 3 . J a m s h i di A , K u c h n i r F T , R e f t S C . D e t e rm i na t io n o f t he s o ur ce p o si ti o n f o r t he e l e ct r o n be a m f r o m a h i g h - e n e r g y l i ne a r a c ce l e r ato r . M e d P hy s 1 9 8 6 ; 13 : 9 42 . 4 4 . K h a n F M , S e w c h a n d W , L e v i t t S H . E f f e c t o f a i r s p a c e on d e p t h d o s e i n e l e ct r o n be a m t h e r a p y. R a d i o lo g y 19 7 8; 1 26 :2 4 9 . 4 5 . B e r ge r M J , S el t ze r S M . T a b le s o f e ne r g y - d ep o si ti o n d i st r ib ut io ns i n w a t er p h a n t o m s i r ra d i at ed by p o i n t - mo no di r e cti o na l e le c t ro n b e am s w i th e ne r g i e s f ro m 1 to 6 0 Me V , a n d a p pl i c at io n s t o b r o ad be am s . N BS IR 8 2 2 4 51 . W a s hi ng t o n, D C : N a t io n a l B u r e a u o f S t a n d a r d s , 1 9 82 . 4 6 . T a p le y N , e d . Cl i ni c a l ap p li c at io ns o f t he e le c t ro n be a m . N e w Y o r k : J o hn W i le y & Sons, 1976. 4 7 . O k u m u r a Y . C o r r e c t io n o f d o s e di s t rib ut io n f o r a i r s p a c e i n hi g h e ne r g y e l e ct r o n t h e r ap y . R a d io lo g y 1 97 2 ;1 0 3 :1 83 . 4 8 . K h a n F M , L e e J M F . C o m p u t e r a l go ri t hm f o r e l e ct ro n b e a m t r ea t m e nt pl a nni ng . M e d P h y s 1 9 7 9 ; 6 :1 42 . 4 9 . H ol t J G , Mo h a n R , C a l e y R , et a l . M e m o ri a l e le c t ro n be am A E T t r e at m e nt p l a n n i n g s y s te m . In : O r t o n C G , Ba g ne F , ed s . P r a c ti c a l a s p e ct s o f el e ct r o n b e a m t r e at m e n t pl a n n i n g . N e w Y o r k : A m e r i c a n In s t it ut e o f P hy s i c s , 1 9 78 . 50. Ekstrand KE, Dixon RL. O b li q ue l y i nc i d e nt e le c t ro n b ea m s . Med P hy s 1 9 82 ; 9 : 27 6 . 5 1 . K h a n F M , D e i b el F C , S o l e i m a ni - M ei go oni A . O b l i q ui t y c o r re ct io n f o r e l e c tr o n b e a m s . M e d P h y s 1 9 85 ; 1 2 :7 4 9 . 5 2 . M c K e n z i e A L . Ai r -g a p c o r re c ti o n i n e le ct r o n t re a tm e nt pl a nning . P hy s M e d Bi o l 1 9 79 ; 2 4 :6 28 . P.354

5 3 . D e ib el F C , K h a n F M , W e r n e r BL . E l e c t r on b e a m t r e a t me nt p l anni ng w i t h s t r ip b e a m s [ a b st . ] . M e d P h y s 1 9 8 3 ; 10 : 5 27 . 54. Werner BL, K h an FM, D e ib e l FC. Mo d el f or c a l c ul a ti ng e le c t ro n be a m s c a t te r i n g i n t re a t me n t p l a n n i n g . M e d P hy s 1 9 82 ; 9 : 18 0 . 5 5 . D u t r ei x J . D o s i me t r y . In : G i l y G i l , G i l G a y a r r e , e d s . S y m p o s i um o n hi g he n e r g y e le c t ro n s . M a d r i d : G e n e r al D i re c to r at e o f H e a lt h, 1 9 70 : 1 13 . 5 6 . L a u g h li n J S . H i g h e n e r g y e le c t ro n t re a tm e nt pl a nni ng f o r i nho m og e nei ti e s . Br J R a d i ol 1 9 65 ; 38 : 14 3 . 5 7 . L a u g h l i n J S , L u n d y A , P h i l l i p s R , e t al . E l e c t ro n- b e a m t r e atm e nt p l a nni ng i n i n h o m o ge n e o u s ti s s u e. R a d i o lo g y 19 6 5; 8 5 :52 4 . 5 8 . A l mo n d P R , W ri g ht A E , B o o n e M L . H ig h- e ne r g y el e ct r o n d o se p e r t ur b at io ns i n r e g io n s o f t i s s u e h et er o g e n ei t y . R a d iol og y 1 9 67 ; 8 8 :1 14 6 . 5 9 . D a h l e r A , B a k e r A S , L a u g h l i n J S . C o m p r e he ns i v e el e ct r o n- b e a m t re a t me nt p l a n n i n g . A n n N Y A c a d S c i 1 9 69 ; 16 1 : 18 9 .

WWW.MEDRAD.IR

6 0 . A l mo nd P R . R a dia t io n p h y s i c s o f e le c tr o n b e a m s . In: T a pl ey N , e d . C l i ni c a l a p p li c a ti o n s o f t h e el ec t r o n b e a m . N e w Y o r k: J o hn W i l e y & S o ns , 1 9 76 : 7 . 6 1 . B oo n e M L M , A l mon d P R , W r i g ht A E . H i gh e ne r g y e le c t ro n do se p e rt ur b at io n i n r e g io n s o f t i s s u e h et er o g e n ei t y . A nn N Y A c a d S c i 1 9 69 ; 16 1 : 21 4 . 6 2 . P r a s a d S C , B e d w i n e k J M , G e r b e r R L . L ung d o s e i n e le c t ro n b e a m t he r ap y o f c h e s t w a l l . A c t a R a di ol 1 9 83 ; 22 : 9 1 . 6 3 . P o h li t W , M a n e go l d K H . E l e c t ro n- b e am d o s e d i st r ib ut io n in i nho m o g e neo us m e d i a . In : K r a m e r S , S u n t h a r a l i ng a m N , Z i nni ng e r G F , e d s . H i g h e ne r g y p hot o ns a n d e l e ct r o n s . N e w Y or k : J o h n W i l e y & S o ns , 1 9 7 6 :2 4 3 . 6 4 . G oi te i n M . A t e c hn i q u e f o r c a l c ul a ti ng t he i nf l ue nc e o f t hi n i nho m o ge ne it ie s o n c h a r g e d p a r ti c le b ea m s . M e d P hy s 1 9 7 8 ;5 : 2 58 . 6 5 . P e r r y D J , H ol t J G . A m od el f o r c a l c ul a ting t he e f f e c t s o f s ma ll i nho mo ge ne it ie s o n e l e ct r o n b e am d o se d i st r i b ut io ns . M e d P hy s 1 9 8 0 ; 7 :2 0 7 . 6 6 . B a g n e F , T u l l o h M E . L o w e ne r g y e l ec t r o ns . In: O r t o n C G , Ba g ne F , e d s . P r a c t i c al a s p e ct s o f e l e ct r o n be a m t re a tme nt p l a nni ng . A A P M P ub l i c a ti o n . N e w Y o r k : A m e r i c a n In s t i tu t e o f P h y s i c s , 1 9 7 8 : 80 . 6 7 . S h a r m a S C , D e i be l F C , K h a n F M . T i s s ue e q ui v a l e nc e o f bo lus m a t e r i a l s f or e l e ct r o n be a m s . R a d iol og y 1 9 83 ; 1 46 : 85 4 . 6 8 . J o h n s o n J M , K h a n F M . D o s i m e t ri c e f f e ct s o f a b ut ti ng e x t e nde d S S D e l e ct r o n f i e l d s w i t h p h o to n s i n t h e tr e at m e nt o f he ad a nd ne c k c a nc e r s . Int J R a d i at O nc ol B i o l P h y s 1 9 9 4; 2 8 :7 41 74 7 . 6 9 . G i a r r a t a no J C , D u e r k e s R J , A l m o nd P R . L e a d s hi e ld i ng t hic k ne s s f o r d o s e r e d u c t io n o f 7 - to 2 8 -M e V e l e ct r o ns . M e d P hy s 1 9 7 5 ;2 : 3 36 . 7 0 . K h a n F M , M o o r e V C , L e v i t t S H . F i e ld sha p i ng i n el e ct r o n bea m t he r a p y . Br J R a d i ol 1 97 6 ;4 9 : 88 3 . 7 1 . Go e de M R , Go od en D S , E l li s R G , e t a l . A v e r s a ti l e el e ct r o n co ll i m at io n s y s te m t o be u s e d w it h e l e ct r o n c o n e s s up pl ie d w i t h V a r i a n' s C l i na c 1 8 . I nt J R a di at O n c o l B i ol P h y s 1 9 7 7 ;2 : 7 91 . 7 2 . C h o i M C , P u r d y J A , G e r b i BJ , et a l . V a r i a t io n i n o utp ut fa c t o r c a us e d b y s e c o n d a r y b lo c k i n g f or 7 1 6 M e V el e ct r o n be a m s . M e d P hy s 1 9 7 9 ;6 : 1 37 . 7 3 . P u r d y J A , C h o i M C , F e l d m a n A . L i p o w it z m e t a l s hie ld i ng t hic k ne s s f o r d o s e r e d u c t io n o f 6 2 0 M e V e l e ct r o n s . M e d P hy s 1 9 80 ; 7 : 25 1 . 7 4 . A s b e ll S O , S i l l J , L i g h t f oo t D A , e t al . Ind i v i d ua l i z e d e y e shi e l d s f o r us e i n e l e ct r o n be a m t h e r apy a s w e l l a s lo w - e ner g y p ho to n i r r a di a ti on. I nt J R a d i a t O n c o l B i ol P h y s 1 9 8 0 ;6 : 5 19 . 7 5 . K h a n F M , W e r n e r B L , D e i b el F C . L e a d s hi e l di ng f o r e le c tr o ns . M e d P hy s 1 9 81 ; 8 : 71 2 . 7 6 . L a x I, B r a h m e A. O n t h e c ol li m at io n o f hi g h e ne rg y el e ct ro n b e a m s . A ct a R a d i ol O n c o l 19 80 ; 1 9 :1 9 9 . 7 7 . O k u m u r a Y , M o r i T , K i t a g a w a T . M o d i f i c a ti o n o f d o se d i s tr i b uti o n i n hi g h e n e r g y e le c t ro n b e a m t r e at m e n t . R a di ol og y 1 9 71 ; 9 9 :6 83 . 7 8 . W e at h e r b u r n H , M c M i l l a n K T P , S te d f o rd B, e t al . P hy s i c a l me a s ur e m e nt s a nd c l i n i c al o b se r v a ti o n s o n t h e b a c k s c a tt e r o f 1 0 M e V e le c t ro ns f r om l e a d s hie ld i ng ( c o r r e s po n d e n c e ) . B r J R a d i ol 1 9 75 ; 48 : 22 9 . 7 9 . S a u n d e r s J E , P e t e r s V G . B a c k s c a t t e r i ng f r o m m et a l s i n s up e r f i ci a l t he r a p y w i t h h i g h e n e r g y e l e ctr o n s . B r J R a d i o l 1 97 4; 4 7 : 46 7 .

WWW.MEDRAD.IR

80.

Nusslin

F.

Electron

b a c k - s c a tt e r i ng

from

lead

in

Perspex

p ha nt om

( c o r r e s po n d e n c e ) . B r J R a d i ol 1 9 74 ; 48 : 46 7 . 8 1 . G a g n o n W F , C u n d i f f J H . D o se e nha nc e m e nt f ro m b a c k s c a t te r e d r a di a ti o n at t i s s u e - me t al 1 9 80 ; 5 3 :4 66 . 8 2 . K l e ve n h a g e n S C , L a m b e rt G D , A r b a b i A . Ba c k s c a t t e r i ng in e l e c t ro n b e am t h e r a p y f o r e n e r gi e s be t w e e n 3 a nd 3 5 M e V . P hy s M e d Bi o l 1 9 82 ; 27 : 3 63 . 8 3 . B e c k e r J , W e i t z el G . N e u e F o r m e n d e r Be w e g ung s t r a hl ung b e i m 15 M e V B e t a t ro n d e r S i em e n s -R e i n g e r - We r k e . S t r a hle nt he r a pi e 1 95 6 ;1 0 1 :1 8 0 . 8 4 . B e n e d et ti G R , D o b r y H , T r a u m a nn L . C o m p ute r p r og r a m m e fo r d et e r mi na t io n o f i s o do s e c u r v e s f o r e l e ct r o n e n e r gi e s f r om 5 4 2 M e V . E l e c t rom e d i c a ( S ie m e n s ) 1 9 71 ; 3 9 :5 7 . P.355 i n te r f a c e s i r r a di a te d w it h hi g h e ne r g y e le c t rons . Br J Radiol

8 5 . R a s so w J . O n t h e t e le c e n t ri c s ma ll - a ng le pe nd ul um t he r ap y wi t h hi g h e le c t ro n e n e r g ie s . E l e c t ro m ed ic a ( S i e m e n s ) 1 97 2 ; 40: 1 . 8 6 . K h a n F M , F u l l e r t on G D , L e e J M , e t a l . P hy s i c a l a s p e c t s o f e le c t ro n- b e a m a rc t h e r a p y . R a d io lo g y 1 97 7 ; 12 4 : 49 7 . 8 7 . R u e g s eg g er D R , Le r u d e S D , L y le D . E lec t r o n be a m a r c t he r ap y us i ng a hi g h e n e r g y b et a t ro n . R a d io lo g y 1 97 9 ;1 3 3 :4 83 . 8 8 . K a se K R , B j a r n g a rd B E . B r e m s s t r a hl ung d o s e to p a ti e nt s i n ro ta t io na l e l e ct ro n t h e r a p y . R a d io lo g y 1 97 9 ; 13 3 : 53 1 . 8 9 . L e a v itt D D . A t ec h n i q u e f o r o pt i mi z a ti o n o f do s e di s tr i b ut io ns i n e l e ct ro n r o t at io n a l t h e r ap y [ a b s t . ] . M e d P hy s 1 9 7 8 ; 5: 3 4 7 . 9 0 . B l a c k b u r n B E . A p r a c t i ca l s y s t e m f o r el e c tr o n a r c t he r a p y . In: P a l i w a l B, e d . P r o c e ed i n g s o f t h e s ym p o si u m o n e l e c t ro n d o s im e tr y a nd a r c t he r a p y . N e w Y o r k : A A P M / A m e r i c a n In s t i t u t e o f P h y s i c s , 1 9 8 2 : 29 5 . 9 1 . T h o m ad s e n B . T er t i a r y co ll i m ati o n o f m o v i ng e le c t ro n b e am s . In: P a l i w a l B, e d . P r o c e ed i n g s o f t he s y m p o s i u m o n e le ct r o n d o si m et r y a nd a r c t he r a p y . N e w Y o r k : A A P M / A m e r i c a n In s t i t u t e o f P hy s i c s , 1 9 8 2 :3 1 5 . 9 2 . P a l i w al B , e d . P r o c e ed i n g s o f t he s y m p o s i um o n e l e ct r o n do s i me t r y a nd a r c t h e r a p y . N e w Y o r k : A A P M / A m e r i c a n Ins t i t ute o f P hy s i c s , 1 9 8 2 . 93. Boyer AL, F u l l er t o n GD, Mira MD, et al. An e l e c tr o n beam p s e udo a r c t e c h n i q u e . In : P a l i w al B , e d . P r o c ee di ng s o f t he s y m po s i um o n e le c t ro n d o si m et r y a n d a r c t h e r a p y . N e w Y o r k : A A P M / A m e r i c a n Ins t i t ut e o f P hy s i c s , 1 9 8 2 :2 6 7 . 9 4 . K h a n F M . C a l i b r a t io n a n d t r e a tm e nt pla nni ng o f e l e ct r o n b ea m a r c t he r a p y . In : P a l i w a l B , e d . P r o c e ed i n g s o f t he s y mp o s i um o n e le c t ro n do s i me t r y a nd a r c t h e r a p y . N e w Y o r k : A A P M / A m e r i c a n Ins t i t ute o f P hy s i c s , 1 9 8 2 : 249 . 9 5 . L e a vi tt D D , P e a co c k L M , G i b b s F A , et a l . E l e ct r o n a r c t he r a p y : p hy s i c al m e a s u r e m e n t s a n d t re a t m e nt p l a nni ng t e chni q ue s . I nt J R a d i at O nc o l Bi ol P hy s 1 9 85 ; 1 1 :9 87 . 96. Trump J G , W ri gh t K A , E v a ns W W , et al . H i g h e ne r g y e l e ct r o ns fo r t he t r e at m e n t o f e x t e n s i ve s u p e r f i c i al m a li g na nt l e si o ns . A J R 1 9 5 3 ;69 : 6 23 . 9 7 . K a r z m a r k C J , Lo ev i n g e r R , S te el R E . A t e c hni q ue f o r l a r g e- f i e ld , s up e r f i ci al e l e ct r o n t h e r ap y . R a d io lo g y 1 96 0 ;7 4 : 63 3 .

WWW.MEDRAD.IR

9 8 . S z u r L , S i l v e s t e r J A , B e w l e y D K . T r e a t m e nt o f t he w hol e bo d y s ur f a c e w i t h e l e ct r o n s . L a n c et 1 9 62 ; 1 : 13 7 3 . 9 9 . F u k s Z , B a g s h a w M A . T o t al - s k i n el e c tr o n t re a t me nt o f m y c o s i s f ung oi d e s. R a d i ol og y 1 97 1 ; 10 0 :14 5 . 1 0 0 . H el le r E H . T h e m a n a g e m e nt o f c ut a ne o us m a ni f e st a ti o ns o f l y m p ho m a b y m e a n s o f e l e ct r o n b e am . A u s t r a l a s J De r m a to l 19 7 2 ;1 3 :1 1 . 101. H a y b it tl e JL. A 24 curie st r o nti um 90 uni t for w ho le -b o d y s up e r fi c i al i r r a di a ti o n w i t h b et a ra y s . B r J R a d i o l 19 64 ;3 7 : 29 7 . 1 0 2 . W ri g h t K A , G r a n k e R C , T r u m p J G . P hy s i c a l a s pe c t s o f m eg av o l t ag e e l e ct ro n t h e r a p y . R a d io lo g y 1 95 6 ; 67 : 5 33 . 1 0 3 . W il li a m s P C , H u n t e r R D , J a c k s o n S M . W ho l e bo d y e l e ct ro n t he r a p y i n m y c o s i s fungoidessuccessful t r a n s l a ti o nal te c hni q ue a c hi e v e d by m od i f i c at io n of an e s t a bl i s h ed l i n e ar a c c e l e r ato r . B r J R a d i o l 19 7 9 ;5 2 : 30 2 . 1 0 4 . Ho lt J G , P e rr y DJ . S o m e p h y s i c a l c o nsi d e r at io ns i n w hol e s k i n e le c t ro n be a m t h e r a p y . M e d P h y s 1 9 8 2 ; 9 :7 6 9 . 1 0 5 . E d el s te i n G R , C l a r k T , H o l t J G . D o s i m et r y f o r t ot a l -b o dy e l e c t ro n- b e am t h e r a p y i n t h e t re a t me n t o f m y c o s i s f ung o id e s . R a d io lo g y 1 97 3 ;10 8 : 69 1 . 106. 107. Karzmark Karzmark CJ. CJ. L a r g e - f i el d Physical s up e r fic i a l of el e c tr o n t he r ap y with t he r ap y l i ne a r with a c c e l e r ato r s . B r J R a d i ol 1 9 64 ; 37 : 30 2 . a s p e ct s w ho l e - bo d y s up e r fi c ia l e l e ct r o n s . F r o n ti e r s Ra d i a t T h e r O nc ol 1 9 68; 2 : 3 6 . 1 0 8 . S e w c h a n d W , Kh a n F M , W i l l i a m so n J. T o t a l -b od y s up e r f i cia l el e ct r o n- be a m t h e r a p y u s i n g a m u l t ip l e - f ie ld p e nd ul um - a rc t e c hni q ue . R a d io lo gy 1 9 7 9 ; 13 0 :4 93 . 1 0 9 . B j a r n g a rd B E , C h e n G T Y , P i o nt e k R N , e t a l . A na l y s i s o f d o se di s t ri b uti o ns i n w h o l e b od y s u p e r f i c i al e l e ct r o n t he r ap y . I nt J R a d i a t O nc ol Bi o l P hy s 1 9 7 7 ;2 : 3 19 . 110. T et e n e s PJ, G oo d w i n te ch n i q u e s PN. C o m p a r at iv e a 4- M e V s t ud y of s up e r f i ci a l w ho le - bo d y beam. r a d io t h e r ap e u ti c u s i ng no na ng ul a t ed e le c t ro n

R a d i ol og y 1 97 7 ; 12 2 :21 9 . 1 1 1 . K h a n F M . T o t al s k i n e l e ct r o n t he r a p y: t e c hni q ue a nd d o sim e t r y . In: P ur d y J A , e d . A d v a n c e s i n r a d i at io n o nc ol og y p hy s i c s . A A P M M o no g r ap h N o . 19 . N e w Y o r k : A m e r i c a n In s t i tu t e o f P h y s i c s , 1 9 9 0 : 46 6 . 1 1 2 . A A P M . T o t a l s k i n e l e c t ro n t he r a p y t e chni q ue a nd d o s i m et r y . R e p o r t N o . 2 3. N e w Y o r k : A m e r i c a n In s t i t u te o f P hy s i c s , 1 9 8 8 . 1 1 3 . S te r n i c k E . A l g or i t h m s f o r co m p ute r i ze d t re a t me nt pl a nni ng . In: O r t o n C G , B a g n e F , e d s . P r a c ti ca l a s p e ct s o f e le c t ro n b e a m t r e at m e nt p l a nni ng . N e w Y o r k : A m e r i c a n In s t i t u te o f P h y s i c s , 1 9 7 8 : 52 . P.356

114.

Kawachi

K.

C a l c u l a ti o n

of

el e ct r o n

dose

di s tr i b ut io n

for

r a d iot he r a p y

t r e at m e n t pl a n n i n g . P h y s M e d B i o l 1 97 5 ; 20 :5 7 1 . 1 1 5 . A n d r eo P . B r o a d b e a m a p pr o a c he s t o do s e c o mp ut at io n a nd t he i r l im it a ti o ns. In : Nahum AE, ed. The c o m p u t a tio n of dose d i st r i b ut io ns in e l e ct r o n be a m r a d io t h e r ap y . K u n g a l v , S w e d e n : m i m i a b /g o at a b , 1 98 5 : 12 8 . 1 1 6 . J et te D . T h e a p p l i c at io n o f m ul t ip le s c a t t er i ng t heo r y t o t her a p e uti c e le c t ro n d o s im e tr y . M e d P h y s 1 9 83 ; 1 0 :1 41 .

WWW.MEDRAD.IR

1 1 7 . E g y e s L . M u l t ip le s c a t t e ri n g w i t h e ne r gy l o s s . P hy s R e v 1 9 4 8 ; 7 4 : 15 3 4 . 118. Brahme A. B r ie f r e v ie w of c ur re nt a l go r it hm s for el e ct r o n beam d o se p l a n n i n g . In : N a h u m A E , e d . T h e c o m p ut at io n o f do s e d i st r ib uti o ns i n e l e ct ro n b e a m r a di ot h e r a p y . Ku n g a l v , S w e d e n: m i ni a b / g ot a b , 19 8 5 :2 71 . 119. Ho g st r o m beams. KR, In : Starkschall Purdy JA, G, ed. S hi u AS. Dose in c al c ul at io n r a di a tio n a l go r it hm s f or e l e ct r o n A d va nc e s onc o l og y p hy s i c s .

A m e r i c a n In s t it u t e o f P h y i s c s M o no gr a p h 1 9 . N e w Yo r k : A me r ic a n Ins t i t ut e o f P h y s i c s , 1 9 9 2 : 90 0 . 1 2 0 . B e y e r W H . S t a n d a r d m at h e m a ti c a l t ab l e s , 2 5t h e d . Bo c a Ra t o n: C R C P r e s s , 1 9 78 : 5 24 . 1 2 1 . L a x I, B r a h m e A . C o l li m a ti o n o f hi gh e ne r g y el e ct r o n b ea m s . A c t a R a di ol O n c o l 1 98 0 ; 19 : 19 9 . 1 2 2 . L a x I, B r a h m e A , A n d r e o P . E l e c t r on b e a m d o s e pl a nni ng us i ng G a us s i a n b e a m s . In: B r a h m e A , e d . C o m p ut ed e le c tr o n b e a m do s e pl a nni ng . A c t a R a d iol 1 9 83 ; 3 64 [ s u p pl ] : 49 . 1 2 3 . S t ar k s c h a l l G , S h i e A S , B u y no w s k i S W , e t a l . E f f e c t o f d i m e nsi o na li t y o f h e t e ro g e n ei t y c o r re c tio n s o n t h e i m p l em e nta t io n o f a t hr e e - d i mens i o na l e le c t ro n p e n c i l -b e a m al g or it h m . P h y s M e d Bi o l 19 9 1 ;3 6 : 20 7 .

1

In a g e n e r a l s e n s e , t h e c o n e e n d m e a ns a p l a ne p e rp e nd i c ul a r to t he b e a m a x is D e v el o pe d b y G . R . Fe a s t e r , U n i v e r s it y o f K a ns a s a t K a ns a s C it y , a nd s up p li e d b y

a t t h e n o m i n al S S D .
2

M i c k R a d i o - N u c le a r In s t r u m e n t s , Inc . , T he Br o nx , N e w Y o r k .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Th erapy > 15 - Brachytherapy

15 Brachytherapy

B r a c h y t h e r a p y i s a m e t h o d o f t re a t me nt i n w hi c h s e a l e d r a di oa ct i v e so ur c e s a r e u s e d t o de li v e r r a di at io n a t a s ho r t di s t anc e b y i nt e r s ti ti a l , int r a c a v i t a r y , o r s u r f a c e a p p l i c at io n . W i t h t h i s m od e o f the r a p y , a hi g h r a d i a t io n d o s e c a n b e d e li v e r ed l o c al l y to th e t u m o r w i t h r a p i d d o s e f a ll - o f f i n t he s ur r o und i ng no r m a l t i s s u e . In t h e p a st , br a c h y t h e r a p y w a s c a rr i e d o ut m o stl y w i t h r a d i um o r r ad o n s o u r c e s . C u r r e n t l y , u s e o f a r ti f i c i al l y p ro duc e d r a d io nuc l i de s s uc h a s

198 137

Cs,

192

Ir ,

Au,

125

I, a n d

103

P d i s r a p i dl y i n c r e a s i ng .

N e w t e c h n i c a l de v e lo pm e n t s h a v e s t i m ul a t ed i nc r e a s ed i nte r e st in b r a c hy t he r a p y : t h e i n t r od u c t io n o f a r t i f i ci a l i sot o pe s , a f t er l o ad i ng d e v i ce s to r e d uc e p e r so nne l exposure, and a u tom a t i c d e v i ce s w it h r e m ot e co nt ro l to de l i v er c o nt rol l ed r a d i at io n e x p o s u r e f ro m h i g h - a c ti v i t y s o urc e s . A l t ho ug h e le c t rons a r e o f t e n us e d a s a n a l te r n a t i ve to in t e r s ti ti a l i m pl a nt s , br a c hy t he r a p y c o nti nue s to re m a i n a n i m po r t a n t mo d e o f t h er a p y , e i t h e r a lo ne o r co m bi ne d w i t h e x te r na l b e a m .

15.1. RADIOACTIVE SOURCES

F r o m t h e t i me o f it s di s c o v e r y i n 18 9 8 , r a dium ha s b e e n t he mo st c o m mo nl y us e d i s ot op e in b r a c h y t he r a p y . However, a rt i f i ci a l r a di oi s ot op e s offer s pe c i al a d v a n t a g e s i n s o me si t u a ti o n s be c a us e o f t he i r r a y e ne rg y , s o ur c e f l e xi b il it y , s o u r c e si z e , a n d h a l f- l i f e . T ab le 15 . 1 l i st s t he m o st co m m o nl y us e d s o ur c e s f o r b r a c h y t h e r a p y w i t h t h e i r r el e v a n t p hy s i c a l pr o p e rt ie s .

A. Radium A.1. Decay

R a d i u m i s t h e s i x t h m e m b e r o f t he ur a ni um s e r i e s , w hi c h s t a r t s w i t h e n d s w it h s t ab l e
206 82 238 92

U a nd

Pb ( F ig . 2 . 3 ) . R a di um d i s i nt e g r at e s w i t h a ha l f - l i f e o f a b o ut

1 , 6 0 0 y e a r s t o f o r m ra d o n .

T h e p r o d u c t n u c l e u s r a d o n i s a h e a v y i ne r t g a s t ha t i n t ur n d i s int e g r at e s i nto it s d a u g h t e r p ro d u c t s a s s h o w n i n F i g . 2 . 3 . A s a r e s ul t o f t he d e ca y p r o c e s s f r o m r a d i u m to st a bl e l e ad , a t l e a st 49 r a y s a re p ro d uc e d w i t h e ne r gi e s r a ngi ng f r om 0 . 1 8 4 t o 2 . 4 5 Me V . T h e a v e r a g e e n e rg y o f t he r a y s f r o m r a d ium i n e q ui li b ri um w i t h it s d a u g h te r p rod u c t s a n d f il t er e d b y 0 . 5 m m o f p la ti num i s 0 . 8 3 Me V ( 1 ) . A f i l t r at io n o f a t l e a st 0. 5 m m pl at i num p ro v id e d b y t he s o ur c e c a se i s s uf f i c i e nt to a b s o r b al l t h e p a rt ic l e s a n d m o st o f t he p a r ti c le s e mi tt e d by r a d i um a nd i t s d a u g h t e r p ro d u c t s . O n l y r a y s a r e us e d f o r t he r a p y . B e c a u s e t h e h a l f - l i f e f o r r a d io a c ti v e de c a y i s m uc h g r e a t e r fo r

226

R a t ha n f o r a ny

o f i t s d a u g h te r p ro d uc t s , r a d i u m , w he n pl ac e d i n a se a le d co nt ai ne r , a c hi e v e s a

WWW.MEDRAD.IR

s e c u l a r e q u il ib r i u m w it h i t s d a u g hte r s ( F ig . 2 . 5 ) . T he t i me r e q uir e d to e st a bl i s h e q u i li b ri u m i s a p p ro x im a t el y 1 m o nt h f r o m t he t i me o f e nc a p s ul ati o n.

TABLE

15.1.

PHYSICAL

CHARACTERISTICS

OF

RADIONUCLIDES USED IN BRACHYTHERAPY

P h ot on HalfR a d i on u c l i d e Life E n e r gy (MeV)

Half-Value Layer lead) (mm

E x p os u r e C on st a n t (Rcm2/mCi-h)

Rate

226

Ra

1,600 yr

0.047 2 . 4 5 ( 0 . 83 avg)

12.0

8.25a,b h)

( R c m 2 / mg -

222

Rn

3.83 days

0.047 2 . 4 5 ( 0 . 83 avg)

12.0

10.15a,c

60

Co

5.26 yr

1 . 1 7 , 1 . 33

11.0

13.07c

137

Cs

30.0 yr

0.662

5.5

3.26c

192

Ir

73.8 days

0.136 1 . 0 6 ( 0 . 38 avg)

2.5

4.69c

198

Au

2.7 days

0.412

2.5

2.38c

125

59.4 days

0.028 avg

0.025

1.46c

103

Pd

17.0 days

0.021 avg

0.008

1.48c

a b

In

e q u i l i br i u m F il te r ed by

with 0.5

d a ug ht e r mm

p r o d uc t s . Pt.

WWW.MEDRAD.IR

U n f i l te r ed .

P.358

A.2. Source Construction

T h e r a d i u m i s s u p pl ied m o st l y i n t he fo r m o f r a d i um s ul f a te o r r a d i um c hl o ri de w h i c h i s m i x ed w it h an i n e r t f i ll e r a nd l o ade d i nt o c el l s a bo ut 1 cm lo ng a nd 1 m m i n d i a me te r . T h e s e ce l l s ar e m ad e o f 0 . 1- t o 0 . 2 - m m -t hi c k go l d fo il a nd a r e s e a l ed t o p re v e n t l e ak a g e o f r a do n g a s . T he s e al ed c el l s a r e t hen l o ad e d i nto t he p l a ti n u m s h e a t h , w h i c h i n t u r n i s s e a l e d . R a d i um s o ur c e s a r e m a nuf a c t ur e d a s n e e d le s o r t u be s i n a v a r i e t y o f le ng t hs a nd a c t i v it i e s ( Fi g . 1 5 . 1) .

A.3. Source Specification

R a d i u m so u r c e s a re sp e c i f ie d b y : ( a ) a c ti v e l e ngt h, t he di s t a nc e b e t w ee n t he e nd s o f t h e r a di o a cti v e m at e ri a l ; ( b) p hy s i c a l l eng t h, t he d i st a nc e bet w e e n t he a ct ua l e n d s o f t h e so u r c e ; ( c ) a c ti v it y o r s t reng t h o f so ur c e , mi ll ig r a m s o f r a di um c o n t e n t ; a n d ( d ) f il tr a t io n , t r a ns v e r s e t hi c k ne s s o f t he c a p s ul e w a l l , us ua l l y e x p r e s s ed i n t e r m s o f m i ll i me te r s o f p l at i num . L i n e a r a ct i v it y o f a s o u r c e c a n b e d et e rm i ne d b y d i v id i ng t he a c ti v i t y b y t he a c t i v e l e ngt h . F i g u r e 1 5 . 1 i ll u s t r at e s t hr e e t y p e s o f r a di um ne e d le s us e d for i m p la n t s : n e e dl e s o f u n i f o r m l i n e a r a ct i vi ty , ne e d l e s w it h hi g her a c t i v it y a t o ne end ( In d i a n club), and needles w it h hi gh activity at bot h e nd s ( d um b b el l ) . U n i f o r m li n e a r a c ti v i ty n e e d l e s m a y be f ul l i nte ns i t y ( 0 . 6 6 m g / c m ) o r ha l f i n t e n s it y ( 0 . 3 3 mg / cm ) . N e e dl e s al s o a re c o ns t r uc t ed w i t h l i ne ar a c t i v it ie s o f 0 .5 a n d 0 . 2 5 mg / c m . T u be s f o r i nt r a c a v i t ar y a nd m o ld t he r ap y a r e us ua l l y f ur ni s he d i n m u l t i pl e s o f 5 m g of r a d i u m f i l t er e d b y 1 m m p l a ti num .

WWW.MEDRAD.IR

F I G . 1 5 . 1 . T y p e s o f r a d i u m s o u r c e s us e d i n i nt e r s ti ti a l a nd i nt r a ca v i t a r y t he r a p y .

F I G . 1 5 . 2 . A n a u t o r ad i og r a p h o f a c e s i um - 1 3 7 t ube . Is o do s e cur v e s a r e s ho w n f o r t h e s a m e s o u r c e i n t h e d i a g r a m o n t he r ig ht . P.359

T o t e st t he u n i f o r m ity o f a c t i v i t y d i st r ib uti o n, a n a ut o r a d io g r aph i s o b t a i ned b y p l a c i n g t h e s o u r c e o n a n u n e x p o s e d x - r a y f i l m f o r a t im e lo ng eno ug h t o o bt a i n r e a s o n a bl e d a r k e n i n g o f t h e f i l m . T he s o u r c e m a y b e r a d i og r a phe d a t t he s a m e t i me to show p h y si c a l di m e ns io ns of t he s o ur c e s up e rim p o s ed on t he a u t o r a di og r a p h . F ig u r e 1 5 .2 s h o w s a n a uto r a di o gr a p h ob t ai ne d i n t hi s m a nne r . T h e e x p o se d f il m m ay b e s c a n n e d w it h a d e ns i to m et e r to o b t ain o p ti c a l d e ns it y

WWW.MEDRAD.IR

d i s t ri b u tio n . U n i f o r m ity o f a c t i v it y d i st ri b utio n c a n t hus b e a s s e ss e d f r o m s uc h a d i s t ri b u tio n .

A.4. Exposure Rate Constant

rate by the e x po s u re r a te c o n s t a nt ,

T h e a c t i v it y o f a r a d io a c ti v e n u c l i de e mi tt ing p ho to ns i s r e la t ed t o t he e x p o s u re (see s e ct io n 8.8 fo r d e r i v at io n) . In b r a c h y t h e r a p y , t h i s c o n s t a n t i s us ua l l y e xp r e s s ed a s num e r i c a ll y e q ua l to t he e x p o s u r e r a te i n R / h a t a p o i n t 1 c m f r o m a 1 m C i p o i nt s o ur ce . In t he c a s e o f r a d i u m , t h e so u r c e str e n g t h i s s p e ci f i ed i n t e r m s o f m il li g r am s of r a d i um i nst e ad of mCi. T h e In t e r n a t io n a l C om m i s s io n o n R ad i at ion U ni t s a nd Me a s ur em e nt s ( IC R U ) ( 4 ) h a s r e c o m m e n d ed t h at f o r r a d i um f i lt e r ed b y 0 . 5 m m p l at i num b e t a k e n a s P.360 8 . 2 5 R c m 2 h - 1 m g - 1 . T a b l e 15 . 2 gi v e s f a c t o r s f o r r a d i um w it h ot he r f i lt r a ti o ns . T h e s e v a l u e s a r e b a se d o n r el a ti v e t r a ns mi s s io n m e a s ur e m e nt s v e r s us p l a ti num t h i c k n e s s ( 5 ) a n d n o r m a l i z ed t o = 8 . 2 5 fo r 0 . 5 m m p la ti num .

TABLE

15.2.

EXPOSURE

RATE

CONSTANT

FOR

RADIUM

POINT SOURCE FILTERED BY VARIOUS THICKNESSES OF PLATINUM

F i l t r a t i on ( m m P t )

(R c m 2 h - 1 m g - 1 )

9.09

0.5

8.25

0.6

8.14

0.7

8.01

0.8

7.90

0.9

7.81

1.0

7.71

1.5

7.25

WWW.MEDRAD.IR

2.0

6.84

F r o m S h a l e k R J , S tov a l l M . D o si m et r y i n i m pl a nt t he r ap y . In: A t ti x F H , R o e s c h W C , e d s . R a d i a ti o n do s i me t r y . V o l . 3 . N e w Y o r k : A c a d em i c P r e s s , 1 9 69 : c h a p 3 1 , w i t h p er m i s s io n .

A.5. Radon Hazard

L e a k a g e o f r a do n g a s f r o m a r a d i um s o ur c e r e p r e se nt s a s i g ni f ic a nt ha z a r d i f t he s o u r c e i s b ro k e n . T h e s o u r c e s a r e , ho w e v e r, d o ub l y e nc a p s ul at e d t o p re v e nt s uc h a n o c c u r r e n c e . S po n ta n e o u s r u p t ur e o f a s e a l ed r a di um so ur c e d ue to p r e s s ur e b u i l d - u p o f h e l i u m ga s ( f r o m p a r ti c le di s i nte g r at io ns ) i s c o ns i d e re d unl i k el y . V a n R o o s e n be e k et al. ( 6 ) h a v e c a l c ul at ed t ha t s o ur ce s e nc a p s ula t e d i n pl a ti num m a y r e m a i n s a f e l y s e al e d f o r mo r e t ha n 4 00 y e a r s .

B. Cesium-137
C e s i u m - 1 37 i s a r a y - e m it ti n g r a d io i sot o pe t ha t i s us e d a s a r a dium s ub s t i t ute i n b o t h i n te r s ti ti a l a n d i n t r a c a v it a r y b r a c hy t he r a p y . It i s s up p l i ed i n t he f o r m o f i n s o l u bl e po w d e r s or ceramic m i cr o s p here s , l a b el ed with
137

Cs,

a nd
137

d o ub l y C s o ve r

e n c a p s u l a te d i n s t ai n le s s - s t ee l n e e dl e s a nd t ub e s . T he ad v a nt a ge s o f

r a d i u m a r e t h a t it re q u i r e s l e s s s hi el di ng ( c o mp a r e ha l f - v a l ue l a y e r s i n T a bl e 1 5 . 1 ) a n d i s le s s h az a r d o u s i n t he mi c ros p he r e f o r m . Wi t h a l o ng ha l f -l i f e o f a b o u t 30 y e a r s , t h e se s o u r c e s c a n b e us e d c l i ni c al l y f o r a bo ut 7 y e a r s w i t ho ut r e p l a ce m e n t , a lt h o u gh t h e t r e at m e nt ti me s ha v e t o b e a d j ust e d to al lo w f o r r a d io a c ti v e d e c a y ( 2 % p e r y e a r ) .
137

C s e m it s r a y s o f e n e r g y 0 . 6 62 M e V . T he d e c a y s c he m e s ho w s t ha t
137

137

Cs

t r a n s f o r m s to

B a by t h e p ro c e s s o f
137

de c a y b ut 93 . 5 % o f t he d i si nt eg r a tio ns

a r e f o l lo w e d b y r a y s f r o m t h e

Ba m e t as t a b le s t at e . T he pa r t i cl e s a nd l o w -

e n e r g y c h a r a c te r i st i c x - r a y s a r e a b so r be d by t he s ta i nle s s - s te e l m a t e ri a l , so t h a t t h e c l i n i c al s o u r c e i s a p u r e e m i t te r . It s h o u l d b e e m p h a s i ze d t h a t i s d e f i ned in t e r m s o f a n i de a l po i nt so ur c e . A ny p r a c t i ca l so u r c e w il l h a v e a f i n i te s i ze a nd w o ul d ne ce s s it a te c o r re c ti o ns f or p h o to n a t t e n u a ti o n a n d s c a t te r i n g . T h e r a y s f r o m ce s i um h a v e n e a r l y t he s am e pe ne t r at i ng po w e r a s r a di um r a y s i n t i s s u e . M e i sb e rg e r e t a l . ( 7 ) ha v e c om p a r e d t he m e a s ur ed a nd c a l c ul a ted d e pt h - d o se v a l u e s a l on g t h e t r a n s v e r s e a x e s o f t he s o ur c e s a nd s ho w e d t ha t t he e x p o s u r e i n w a t e r t o e x p o s u r e i n a i r r at io is t he s a m e f o r r a d i um a nd c e s i um f o r d e pt h s u p t o 10 c m . S i g n i f i c a n t di f f e r e nc es , ho w e v e r , e xi s t b etw e e n r a di um a nd c e s i u m d o se s a t po i nt s a l o n g o bl i q ue a ngle s ( ne a r t he lo ng it ud i na l a x i s ) d ue to t h e f i lt r a ti o n e f f e ct (8 , 9 ) . N o t o nl y i s t he a t t e nua ti o n o f r ay s i n s t e e l a nd

WWW.MEDRAD.IR

p l a ti n u m q u i te di f f e r en t b u t a l so c e si um e mi t s mo no e ne rg et i c ra y s w hi l e r a d i um e m it s r a y s o f w i d e e n e r g y r a n g e . P.361

T h e e x p o s u r e r a te c on s t a n t f o r unf i l t e re d

137

C s i s 3 .2 6 R c m 2 m C i - 1 h - 1 ( 1 0 ) . Cs/mg of Ra. However,

C o m p a r i n g t h i s w i t h th e o f 8 .2 5 R c m 2 m g - 1 h - 1 f o r r ad i um fi lt e re d b y 0 . 5 m m P t , t h e c o n v e r s io n f a c t o r i s 8 . 2 5 /3 . 2 6 = 2 .5 3 m C i o f
137 226

a l o n g t h e t r a n s v e r s e a x e s o f c l i ni c al s o ur c e s ( c e s i um w it h 0 . 5 m m s t ee l a nd r a d i u m w i t h 0 .5 m m P t f i lt r a ti o n ) , t he me a n c o nv e r s i o n f a c to r ha s b e e n c a l c ul ated t o be 2 . 5 5 f o r c e si u m n e e d le s a n d 2 . 5 9 f o r ce s i um t ub e s ( 9 ) .

C. Cobalt-60
60

Co

has

been
60

used

for

b r a c h y t he r a p y

b ut

is

r a re l y

us e d

no w .

T he

main

advantages of Cs and has

C o i s i t s h i g h s p e c i fi c a c t iv i t y , w hi c h a l l o w s f a b r i c a ti o n o f s m a ll a s ho r t h a l f - li f e ( 5 .2 6 years), ne c e s s it at i ng m o re f r eq ue nt

s o u r c e s r e q u i re d f o r so m e s pe c i al a p pl i c at o rs . H o w e v e r , i t i s m or e e x p e ns i v e t ha n
137

r e p l a ce m e n t a n d a c om p l e x i n v e n to r y s y s t em . C o b a lt b r a c h y t h e r a p y s o u r c e s a r e us ua l l y f a b r i c a te d i n t he f o r m o f a w i r e t ha t i s e n c a p s u l a te d i n a s h e a t h o f p l a ti num i r i di um o r s t a i nle s s s t ee l . T he s o ur c e s c a n b e u s e d t o re p l a ce
226

R a i n i n t r a c a v i t a r y a pp l i c at io ns . C ur i e - s i z e d c o b a lt s o ur c e s

h a v e a l s o b ee n u s e d in a u n i t c a l le d t he C at he t ro n ( 1 1 , 1 2 ,1 3 ) . Thi s i s a r e m ot e l o a di n g d e v i ce a n d p ro v i de s h i g h d o se r at es f o r i nt r a c a v it a r y t her a p y , e . g . , 25 0 3 0 0 c G y / m i n a t po i n t A ( s e e s e c t i o n 15 . 7B f o r d e f i ni ti o n o f p oint A ) .

D. Iridium-192
Ir i d i u m - 19 2 ( a l lo y o f 3 0 % Ir a n d 7 0 % P t ) s o ur c e s a r e f a b r i c a ted i n t he f o r m o f t h i n f l e x ib l e w i r e s w hi c h c a n b e c ut t o d e sir e d le ng t hs . N y lo n r i bb o ns c o nt ai ni ng i r i di u m se e d s 3 m m l on g a n d 0 . 5 m m i n d i am e t er , s p a ce d wi t h t he i r ce nt e r s 1 cm a p a r t , a r e a l so c om mo n l y u s e d . Bo t h t he w i r e s a nd t he s e ed r ib b o ns a r e q uit e s u i t a bl e f o r t h e a f te r lo a d i n g t e c h ni q ue ( 14 ,1 5 ) ( s e e s e cti o n 1 5 . 6B) .
192

Ir h a s a c o m p li c a te d r a y s p e c t r um wi t h a n a v e r a g e e ne rgy o f 0 . 3 8 M e V . Ir ha s t he d i s a d v a nt ag e o f us e d in no np e r m a ne nt

B e c a u s e o f t h e l o w e r e n e r g y , t h e s e so ur ce s r e q ui re le s s s hi el di ng f o r pe r s o nnel p r ot e c tio n ( c o m p a re h a l f - v a l u e l a y e r s i n T a bl e 15 . 1 ) . average t re a t me n t tim e so that t he s o ur c e s can

192

a s h o r t h a l f - l i fe ( 73 . 8 d a y s ) . H o w e v er , the ha l f - l i f e i s lo ng co m p a re d t o t he be i m p la n t s si m il a r t o r ad i u m a n d c e si um . T he a c ti v i t y v a ri e s b y o nly a f e w pe r c e nt d u r i n g a n a v e r a g e i m pl a n t d u r a ti o n. M a n y v a l u e s h a v e b e e n c i t ed i n t he li te r a tur e f o r f o r

192

Ir . T he d i f f e r e nc e s i n

t h e c a l c u l at ed v a l u e s a r i s e b e c a us e d i f f e re nt s p e ct ro s c op i c d a ta w e r e us e d b y e a c h i n v e s t i g at o r . T h i s p r o bl e m ha s b e e n d i s c us s e d i n d e t ai l b y G l a s g o w a nd D i ll m a n ( 16 ) . B a s i n g t h e i r c al c u l at io ns o n t he m o st re c e nt nuc le a r s p e ct ro s c op y data for

192

Ir , t h e y r e co m m e n d a v a l ue o f 4 .6 9 R c m 2 h - 1 m C i - 1 .

E. Gold-198
S e e d s o r g r ai n s c o n s i s ti n g o f a r a d io a c ti ve i s ot op e o f g o ld , u s e d f o r pe r m a n e n t i m p la n t s .
198

A u, a r e us e d f o r

i n t e r st it i al im p l a nt s . T h e y a r e u s e d i n t he s a m e w a y a s r a do n s e e d s ha v e b ee n
198

A u ha s a ha l f - l i f e o f 2 . 7 d ay s a nd e m it s a

WWW.MEDRAD.IR

m o n o e n e rg et i c r a y o f e n e r g y 0 .4 1 2 M e V . r a y s o f m a xi m um e ne r g y 0 . 96 M e V a r e a l s o e m it te d b u t ar e a b s o rb e d b y t he 0 .1 - m m - t hi c k pl a ti num w a l l s ur r o und i ng t h e s e e d . A g ol d s ee d i s t y p i c al l y 2 . 5 m m l ong w i t h a n o ut e r d i a me t e r o f 0 . 8 m m . B e c a u s e o f i t s lo w e r r a y e n e r g y , pe r s o nne l p ro te c ti o n p r ob lem s w i t h g ol d ar e e a s i e r to m a n a g e t h an t h o s e o f r ad o n. Mo re o v e r , r ad o n se ed s cont i nue to e x hi b it l o w - le v e l a c t i vi t y f o r m a n y y e a r s d ue t o b r e m s st r a hl ung , a r is i ng f r o m hi g h e n e r g y p a rt i cl e s em i tt e d b y i t s lo ng - li v e d d a ug ht e r p ro d uc t s. It i s s us p e c ted t h a t t h i s c h ro n i c i rr ad i a ti o n m a y be c a r c ino g e ni c (1 7 ) . F o r t hes e r e a so ns , g o ld seeds re pl a c e d r a don seeds for m a ny years, unt i l
125

s e ed s

g a i ned

mo r e

w i d e s p re a d a c c ep t a n ce .

F I G . 1 5 . 3 . S c h e m a t i c d i ag r a m o f

125

I se e d s . A : M o de l 6 7 02 . B : Mod e l 6 71 1 . ( F ro m

M e d i c al P r o d u c t s Di v i si o n , 3 M C o . , N e w Br i g ht o n, M N , w i t h p e r m i ss i o n. ) P.362

F. Iodine-125
125

I h a s g a i n e d a w i de u s e f o r p e r m a ne nt i m p la nt s i n r a d i at io n t he r a p y ( 1 8 , 19 ) .
198

T h e a d v a n t a g e s o f t h i s i so to p e o v e r r ad o n a nd l e s s s hi e ld i n g . Ho w e ve r , t h e do s i me t r y o f c o n v e n t i o n al i n t e r sti tia l s o u r c e s .

A u a r e it s lo ng ha l f - l i f e (5 9 .4

d a y s ) , w h i c h i s c o n v e n i e n t f o r s t o r ag e , a nd i t s l o w p hot o n e ne r gy , w hi c h r e q ui r e s
125

I i s m uc h mo r e co m pl e x t ha n t he

WWW.MEDRAD.IR

Three

125

seed
2

mo d el s ,

d e si g na te d

67 0 1 ,

6 70 2

a nd

6 71 1 ,

ha v e

been

manufactured,

w h i c h a r e i d e n ti c a l i n si z e a nd e nc a p s ul at io n but d i f f e r i n t he

a c t i v e so ur c e d e si g n . T h e e a r l ie r m od el 6 701 i s no w ob s ol et e . F i gur e 1 5 . 3 s ho w s t h e d e s ig n o f t h e c u r r e n t l y u s e d s e ed s . T he e nc a p s ul a t io n c o ns i s ts o f a 0 . 0 5 - m m thick ti t a n i u m tube w e l de d at bo t h e nd s to form a c y li ndr i c a l c ap s ul e of d i m e n si o n s 4 .5 0 .8 m m . T h e mo de l 67 0 2 s e ed co nt a i ns i on- e x c ha ng e r e s i n b e a d s , w h i c h a re im pr e g n a t ed w it h a d s o r be d o n it s s u r f a c e . In t h e n e w s e e d d e sig n , n a m e l y m o de l 671 1 , t he si l v e r wi r e i s r e a d il y v i s ib le o n r a d io g r a p h s a n d s h o ws s e e d po si ti o n a s w e ll a s o ri e nt at io n. T he m o d el 67 02 s e ed i s r a d io g r a p hi c a ll y l e ss v i s i b le a l t ho ug h t he t i t a ni um e nd w e ld s c a n b e s e e n w he n s u r r o u n d e d b y r e d u c ed t h i c k n e s s o f t i s s ue .

125 125

I i n t he f o r m o f t he i od i de io n. T he m od el

6 7 11 s e e d c o nt a i n s a s i l v e r w i r e w i t h t he a c t i v e m a t e ri al , s i l ve r i o di de ( A g I) ,

I d e c a y s e x c l u s i v e ly b y e l e c t r o n c a pt ur e t o a n e x c i te d s t ate o f

125

T e , w hi c h

s p o n t a n eo u s l y d e c a y s t o t h e g r o und s t at e w i t h t he e m i s s io n o f a 3 5 . 5 - k e V p h o to n . C h a r a c t e r i s ti c x - r a y s i n t he r a ng e o f 2 7 t o 3 5 k e V a l so a re p r o d uc ed d ue t o t h e el e ct r o n c a p t u re a n d i n t e r na l c o nv e r si o n p r o ce s s e s . T i t a ni um e nc a p s ul a t io n s e r v e s t o a b so r b li b er a t e d el e ct r o ns a nd x - r a y s w i t h e ne r g i e s le s s t ha n 5 k e V . T h e m o d el 6 71 1 s eed e m it s t w o ad di ti o na l p ho to ns a t 22 . 1 ke V a nd 2 5 . 2 k e V e n e r g ie s . These

125

a re

f l u o r e s c e nt

( c ha r a c t e ri s ti c )

x-rays

p ro d uc e d

by

t he

i n t e r a ct io n o f

I p h o to n s w i t h t h e s i l v e r w i re ( 2 0 ) .

B e c a u s e o f t h e pr e se n c e o f ti t a ni um e nd w e l d s , t he d o se di st r i b ut io n a r o und i o di n e s ee d s i s h i g h l y a n i s o t ro pi c ( F ig . 1 5 .4 ) . T hi s c a n p o s e p r ob l e m s o f c r e at i ng c o l d s po t s n e a r t h e s o u r c e e n d s . T he us e r s o f d i s t ri b u tio n s . A l t h o u gh t h e b a s i c p r ob l em P.363 s t il l r e m ai n s , most t r e a t me n t - pl a nni ng systems do no t ta k e i nt o a c c o u nt

125

I i m p l a nt s eit he r i g no re t hi s

p r o bl e m o r t r y t o min i m i z e t h e e x t e nt o f c o l d sp ot s b y c r e at ing r a nd o m s e ed

a n i s o t ro p y a r o u n d i n div i d u a l s o u r c e s .

WWW.MEDRAD.IR

F I G . 1 5 . 4 . A n g u l a r p h o to n f l u e nc e di s tr ib ut io n f r o m

125

I s eed s . T he r el a ti v e

p h o to n f l u e n c e i n a n y d i r e ct io n i s p ro po r ti o na l to t he r a di a l d is t a nc e f r o m t he s e e d to t h e p lo tt e d c u r v e . n i s t he numb e r o f s ee d s us e d to o bt a i n a v e r a ge r e s u l t s . ( F r om L i n g CC , Y o r k e E D , S p i r o IS , e t a l . P hy s i c a l do s im e t r y o f w i t h p e r mi s s io n . ) S i g n i f i c a n t di f f e r e n c e s e x i s t i n t h e p ubl i s hed v a l ue s o f e x p o s ur e r a t e c o ns ta nt f o r

125 125

I seeds

o f a n e w d e si g n f o r i nt e r st it i al i mp l a nt . I nt J R a d i at O nc o l Bi ol P hy s 1 9 83 ; 9 : 17 47 ,

I. S c h u l z e t a l . ( 2 1 ) h a v e r e p o r t ed a c a l c ul a t ed v a l ue o f 1 . 4 64 R c m 2 m C i - 1 h - 1 f o r

a n u n f i l t e re d po i n t so u r c e . A s w i l l be d i sc us s e d , t he us e o f the e x p o s ur e r a te c o n s t a n t f o r u n f i l t er ed p oi n t so u r c e s t o c alc ul a t e d o se di s t ri b utio n a r o und a c t ua l s o u r c e s o f c o m pl e x d es i g n s u c h a s

125

I ha s s e r io us a c c ur a c y l i m i t at io ns .

G. Palladium-103
103

P d s ee d s h a v e re c e nt l y be c o me a v a il a b le fo r us e i n b ra c hy t he r a p y . T he i r c l i ni c a l
125

a p p li c a ti o n s a r e si mi la r to t h o s e o f that of
125

I. H av i ng a s ho rt e r ha l f - li f e ( 17 d a y s ) t ha n

I ( 59 . 4 d ay s ) ,

103

P d m a y pr o v ide a bi ol og i c a d v a nt ag e i n p e r m a ne nt

i m p la n t s b e c a u s e t h e d o s e i s d el i v e re d a t a m uc h f a s t e r r a t e ( 2 2 ) . T h e p a l l a di u m - 1 03 se e d mo d el 2 00 3 c o nsi s t s o f a l a se r - w e ld ed t it a ni um t ub e c o n t a i n i n g t w o g r ap h i t e p al le t s p l at e d w it h
103

P d ( F i g . 1 5 .5 ) . A l e ad m a r k er

b e t w ee n t h e p a ll et s p ro v i de s r a d io g r ap hi c i de nt i f i c at io n.
103

P d de c a y s b y el e ct ro n c a p t u r e wi t h t he em i s s io n o f c ha r a c t er i st i c x - r a y s i n t he

r a n g e o f 2 0 to 23 ke V ( a v e r a ge e ne rg y 2 0 . 9 k e V ) a nd A ug e r e le c t ro ns . T he p h o to n f l u e n c e d i s t rib u t io n a r o und t he s o ur c e i s a ni s ot r op i c d ue t o t he s el f a b s o r pt io n b y t h e s o ur c e P.364 p a l le t s , t he w el d s , a n d t h e l e ad x - r a y m a r k e r ( F i g . 1 5 . 6 ) . T he d os i m et r y d a t a f or

WWW.MEDRAD.IR

103

P d i s s p a r se . T h e r e a d e r i s r e f e r r ed to M e i go o ni e t a l . ( 23 ) and C hi u- T s a o a nd

A n d e r s o n ( 2 4 ) f o r do se - d i st r ib u t io n d a t a .

FIG. 15.5. Schematic diagram of

103

P d se e d ( mo d el 2 00 ) . ( F r o m T he r a g e ni cs

C o r p . , N o r c r o s s , G A , w i t h p e r mi s s io n. )

15.2. CALIBRATION OF BRACHYTHERAPY SOURCES A. Specification of Source Strength

T h e s t r e n g t h o f a b r a ch y t h e r a p y s o ur c e m a y b e s p e c i fi e d i n s e v e ra l w a y s .

A.1. Activity
T h e s o u r c e s t r e n g t h f o r a n y r a d i o nuc l i de ma y b e s p e c i f ie d i n t e rm s o f m i l li c ur i es ( m C i ) . T h e e x p o s u r e ra t e at a n y p a r t i c ul ar p o i nt i s p ro po rt io na l to t he pr o d uct o f a c t i v it y a n d it s e x p os u r e r a t e c o ns t a nt . Er r o r s , ho w e v e r , m a y b e i nt r od uc e d i n t h i s m e t h od f r o m t h e f a c t t h a t c o r r e ct io ns m us t b e a p p li ed f o r t he s o ur c e a nd w a l l f i l t r at io n a n d t h a t t h e e x p o s u r e r a te c o nst a nt m a y no t b e k no w n a c c ur a t e l y . It s h o u l d b e r e c al le d t h at t h e a c c u r a c y o f t he P.365 exposure r a te co n s t an t d ep e n d s cr it i c al l y o n t he a c c ur a te k no w l ed g e o f t he

s p e c t ro s c op i c d at a a n d t h e r e le v a nt a b s o rp ti o n c o e f f i ci e nt s .

WWW.MEDRAD.IR

F I G . 1 5 . 6 . P h o t o n f l u e n c e d i st r ib ut io n in a i r f o r Group, ed. I n te r s tit i al b r a c h y t he r a p y . New

103

P d s ee d . ( F r o m M e li J A , R a v e n, 1 9 9 0 :2 1 , w it h

A n d e r s o n L L , W e a v e r K A . D o s e d i st r ib ut io n. In: Int e r s t i ti a l C o ll a bo r a ti v e W o r k i ng York: p e r m i s sio n . )

A.2. Exposure Rate at a Specified Distance

T h e N a t io n a l Co u n c i l o n R a di a ti o n P ro te ct io n a nd M e a s ur em ent s ( N C R P ) ( 2 5 ) r e c o m me n d s t h a t t h e s t r e n gt h o f a ny em i tt e r s ho ul d b e s p ec i f i e d di r e ct l y i n terms of e x po s u r e ra t e in air at a s p ec i f i e d d i st a nc e s uc h as 1 m. T hi s s p e c i f i ca ti o n c a n b e ca r r i e d o ut s im p l y b y m e a s ur i ng e x p o s ur e ra t e i n f r e e a i r a t a d i s t a n c e s u f f i c i e n tl y la r g e t h a t t he gi v e n s o ur c e c a n b e t re a te d a s a p oi nt . A l o ng d i s t a n c e me a s u r e m e nt g eo m et r y m i ni m i z es t he d e p e nde nc e o f t he c a l i b r at io n u p o n t h e c o n s t r u c t io n o f t h e s o u r c e a nd t he d e t e ct o r be c a us e b oth c a n b e t r e a te d a s p o i n t s . In a d d i ti o n, t h e e f f e c t o f o bl i q ue t r a ns m i s s io n o f p hot o ns t hr o ug h t he s o u r c e c a p s u l e be c o me s n e g l ig ib le . L o e v i n ge r ( 26 ) h a s r ec o m m e n de d c a li b r at ion o f b r a c hy t he r a p y s our c e s i n t e r m s o f a b s o r be d do s e i n w a te r , c lo s e to t he so ur ce . H o w e v e r , s uc h c a l ib r a t io ns a re n ot r o u t i n el y a v a i l a bl e . S o , u n t i l t h e s e a r e a v a i l a bl e , t he e x po s ur e r a t e c a l i br a ti o n, f a r f r o m t h e s o u r c e , r e m a i n s t h e m o st a p p ro p r ia t e me t hod .

A.3. Equivalent Mass of Radium

T h e r e a r e h i s to r i c al r e a s o n s t h a t m a k e i t c o nv e ni e nt to s p e ci fy b r a c hy t he r a p y sources in t e rm s of the e q u i v a le nt m as s of r a di um . Be c aus e some us e r s ,

WWW.MEDRAD.IR

e s p e ci a ll y t h e p h y s i c ia n s w h o a r e a c c us t o me d to r ad i um s o ur ce s , c o nt i nue t o use m g - R a e q , it h a s b e en s u g g e s t ed ( 2 5 ) t ha t t he e x p o s ur e r at e coul d b e e x pr e s s ed i n t e r m s o f e f f e c ti v e e q u i v a le n t m a s s o f ra d i um . T hi s c o nv e r s ion i s s i m pl y m a de b y d i v i di n g t h e e x po su r e r a t e a t 1 m b y the e x p o s ur e r a te c o ns t a nt o f r a d i um ( p o i nt s o ur c e f il t er e d b y 0 . 5 m m P t ) a t 1 m . It s ho ul d , ho w e v e r , b e e m p ha s i z ed t h a t t h e b e st w a y t o c a l i b ra t e a n d s pe c i f y b r a c hy t he r a p y s o ur c es i s s t i ll i n t e r ms o f e x p o s u r e r a te o r air k e r m a r a t e a t a di st a nc e o f 1 m . T he e f f e c t i ve m g - R a e q s h o u l d b e u s e d o nl y to p r o v id e o ut p ut c om pa r i s o n w i t h r a di um s our c e s .

Example
A n i r i d i u m - 19 2 so u r c e h a s b e e n c a l i b ra t ed a nd i t s s t re ng t h i s s pe c i f ie d a s 0 . 49 5 m R / h a t 1 m . W h a t i s t h e s t r e n gt h o f t hi s s our c e i n t e r m s o f e f f e c ti v e m g - R a e q ? E x p o s u r e r a te co n s t an t o f r ad i u m fi lt e r ed b y 0 . 5 m m P t = 8 .2 5 R c m 2 / h m g = 0.825 mRm2/hmg

N o t e t h a t s u c h a c o n ve r s io n o f u ni t s m us t e x p l i ci tl y s pe c i f y t he r a d i um s o ur c e i n t e r m s o f a p oi n t s o u r ce a n d i t s f i lt r a tio n.

A.4. Apparent Activity

If t h e s o u r c e i s c a li b ra t e d i n te r m s o f e x pos ur e r a t e a t 1 m , it s s t r e ngt h m a y b e s p e c i f ie d a s a p pa r e n t a c t i v it y . It i s d e fi ne d a s t he a ct i v it y o f a ba r e po i nt s o ur ce o f t h e s a me n u c l id e t h a t p ro d u c e s t he s a me e x p o s ur e r at e a t 1 m a s t he so ur c e to b e s p e ci f i e d . T h e a p pa r e n t a c t i v it y o f a b r a c hy t he r a p y s o ur c e i s d e t e r mi ne d b y d i v i di n g t h e m e a s u r ed e x p o s u r e r a te a t 1 m w i t h t he e x p o s ur e r a t e c o ns t a nt o f t h e u n f i l t e re d s o u r c e a t 1 m . It i s a c o m mo n p r a ct i c e wi t h t he v e ndo r s o f b r a c hy t he r a p y s our c e s t o s pe c i f y s o u r c e s t r e n gt h a s a p p a r e n t a c ti v i t y , a l t houg h t he o r i g i na l c a li br a t io n i s d o ne i n t e r m s o f e x p o s u r e r ate . In o r d e r f o r t he use r t o c al c ul at e e x po s ur e r a t e f ro m t he a p p a r e n t a ct i v it y , t h e e x p o s u r e r a te c o ns t ant t o be us e d m us t be t he s a m e a s t he o n e u s e d b y t h e v e nd o r . T h u s t he e x po s ur e r a te c o nst a nt i s us e d a s a d um m y c o n s t a n t i n t h i s c o n v er s i o n , t h a t i s , a p ur e ly P.366 a r b i tr a r y v a l u e w o u l d d o , p r o v i de d it s p r od uc t w i t h t he a p p a r ent a c t i v i t y y i el ds t h e s a m e e x po s u r e r a te a s d e te r m i ned b y t he o r ig i na l c al i b r at io n.

A.5. Air Kerma Strength

Although e x po s u r e ra t e at a sp e ci f i e d di s t a nc e is t he m et ho d of c hoi c e in d e s ig n a t i n g s o u r c e s tr e n g t h , t h e q ua nti t y e x p o s ur e i s i n t he pr o c e s s o f b ei ng p h a s e d o u t . M o st o f th e s t a n d a r d s l ab o r at or i e s ha v e a l r ea d y r ep la c e d e x p o s ur e b y t h e q u a n t it y a i r k e r ma . In k e e p i ng w i t h t he s e t re nd s t he A A P M r e c o m me nd e d t he q u a n t i t y a i r k e rm a s t re n g t h f o r t he s p e ci f i ca t io n o f b r a c hy t he r a py s o ur c e s . T h e a i r k e r m a s t r e n g th i s d e f i n e d ( 2 7 ) a s the p r o d uc t o f a i r k e rm a r a t e i n f r e e s p a c e a n d t h e s q u a r e o f t h e d i st a nc e o f t he c a l ib r a ti o n po i nt f r o m t he s o ur c e c e n t e r a lo n g t h e pe r pe n d i c u l a r bi s e ct o r , t ha t i s ,

WWW.MEDRAD.IR

w h e r e S K i s t h e a i r k e r m a s t r e n g t h a nd [ k w i t h d o t a bo v e ] l i s t he ai r k e r m a r a t e at a s p e c i f ie d d i st a n c e l ( u s u a l l y 1 m ) . R e c om m e nd e d unit s f o r a ir k e r m a s t r e ngt h are Gym2 h-1. B e c a u s e n o si n g le s y st e m i s b ei n g c ur r e nt l y f o ll o w ed uni v e r s al l y , it i s i ns t r uc t i v e t o de r i v e r e l at io n s h i ps b e t w ee n t he di f f e re nt q ua nt it ie s b ei ng us e d f o r s o ur c e s t r e n gt h s p e c i f i c at io n . F r o m E q u a t io n s 8 . 6 a n d 8 . 1 3 ( s ee C ha p t e r 8) k e r m a i s r e l at e d t o e x p o s ur e b y :

where K is kerma, X is exposure,

/ e i s t h e a v e r a ge e n e rg y a b s o r be d p e r uni t c ha r g e o f i o ni z at io n i n a i r ,

tr

/ and

en

/ a r e , r e sp e ct i v el y , t h e a v e r a g e v a l ue s of t he m a s s t r a ns f e r c o e f f i c i e nt a nd t he

m a s s e n e r g y a b s o rp tio n c o e f f i c ie nt o f a i r f or t he p ho to ns . A l s o ,

w h e r e g i s t h e f r a c t io n o f t h e e ne r g y l o st t o b r e m s st r a hl ung . H o w e v e r , i n t he e n e r g y r a n g e o f b r a c hy t h e r a p y p ho to ns a nd f o r t he a i r m ed i um

en

/ [ a s y m pt ot i c al l y eq u a l t o ]

tr

/. Therefore,

F r o m E q u a t io n s 1 5 . 1 an d 1 5 . 4 ,

T h u s t h e e x p o s u r e c ali b r a tio n o f a br a c hy t he r a p y s o ur c e c a n b e re a d il y c o nv e rt e d t o ai r k e r m a s t re n g t h b y t h e u s e o f E q ua t io n 1 5 . 5 . If e x p o s ur e r a t e i s m e a s ur ed in R/h at l = 1 m,

where 0.876 cGy/R is the value of

/ e f o r d r y a i r ( s e e s e ct io n 8 . 3 ) o r :

Milligram Radium Equivalent

B y d e f i n i ti o n , 1 mg - Ra e q gi v e s 8 .2 5 10 - 4 R / h a t 1 m ; t he r e f ore , i n t er m s o f ai r k e r m a s t r e n gt h ( f r o m E q . 1 5 . 6 ) ,

WWW.MEDRAD.IR

P.367

or

Apparent Activity
B y d e f i n i t io n , 1 u n i t o f a p p a r e n t a ct i v it y , A p p , g i v e s e x po s ur e r a t e a t 1 m e q ual t o t h e e x p o s u r e r a te c o n s t a n t o f t he s p e ci fi e d s o ur c e a t 1 m . U si ng t he e x po s ur e r a t e co n s t a n t s g i v e n in T a b l e 15 . 1 a nd E q ua t io n 1 5 . 6 , 1 G y m 2 h - 1 = 0 . 3 4 8 m Ci for
103 137

C s ; 0 . 2 43 m C i f o r

192

Ir ; 0 . 48 6 m Ci f or

198

A u; 0 . 78 7 f o r

125

I; a nd 0 . 77 3 for

P d . T h e s e a pp a r e nt a ct i v it ie s pe r unit a i r k e r m a st r e ngt h m a y be us e d to

c o n v e r t so u r c e st r e n gt h s c a l ib r a te d i n a ir ke r m a s tr e ng t hs t o a pp a r e nt a ct i vi ti e s i n m i l li c u r ie s .

Example
An
192

Ir s e e d c a li b r ate d b y a n a c c r e di te d d o s e c al ib r a ti o n l ab o ra t o r y ( A D C L ) ha s

a i r k e r m a s t r e n gt h o f 5 . 0 0 G y m 2 h - 1 . W h a t i s t he s t r e ngt h o f t he s o ur c e ( a ) i n u n i t s o f m g - R a e q a n d ( b ) i n u n i t s o f m C i ( a p p a r e nt a ct i v it y ) ? U s i n g t h e c o n v e r s io n f a c t o r s de r i v ed a b o v e ,

B. Exposure Rate Calibration

The N a t io n a l Co , In s t it u te Cs, and of S t a n d a rd s a nd T e c hno l og y ( N IS T ) ha s e s t a bl i s hed e x p o s u r e r a te c a li b r ati o n st a n d a r d s fo r so me o f t he b r a c hy t he r a py s o ur c e s , e . g . ,
226

Ra,

60

137

192

Ir . T h e N IS T m etho d c o nsi s t s o f c al ibr a t i ng a w o r k i ng

s t a n d a r d o f e a c h t y p e u s i n g op e n- a i r ge o me t r y a nd a s e ri e s o f sp he r i c a l g r ap hite c a v i t y c h a m b e r s ( 28 ,2 9 ) . A g i v e n so ur c e i s t he n ca li b r at e d b y i nt er c o mp a r i so n with the working s ta n d a r d u s i ng a 2 . 5- l it e r s p he ri c a l al um i num i o ni z a ti o n c h a m b e r , p o si ti o n ed a t a d i st a n c e o f a b o ut 1 m . A s i mi l a r p r o ce d ur e i s us ed f o r c a l i b ra ti n g a r a d i u m s o u r c e e x c e pt t ha t the w o r k i ng s t a nd a r d s o f r a d i um ha v e b e e n c a li b r at e d i n te rm s o f a c t u a l m a s s o f r a d i um . B e c a u s e o f t h e i r lo w er e x p o s u re r at e a nd sho r t e r ha l f - li f e ,

192

Ir is c a l ib r a te d i n a

s l i g ht l y d i f f e r e nt m a n n e r ( 2 9 ) . A c o m p o si te s o ur c e c o nt ai ni ng a b o ut 5 0 se e d s is c a l i b ra t ed i n t e r m s o f e x p o s u r e r at e at 1 m i n o pe n- a i r s c a tt e r - f re e ge o me t r y , as in the case of This

137

C s s ou r c e s , u s i n g s p he r i c a l g r a p hi te c ha m b e r s . Ea c h s e e d i s t he n chamber no w serves as t he w o r k i ng s t a nd a r d f or

m e a s u r e d i n d i vi d u a ll y i n a w el l -t y p e io ni z a ti o n c ha m be r t o c al ib ra t e t he c ha m be r . w e l l - t y pe
192

io n i z a t io n

c a l i b ra ti n g
125

Ir s e e d s .

I s e e d s a re c a li b r ate d a t t h e N IS T i n t e rm s o f e x p o s ur e r at e in f r e e s p a c e a t 1

m u s i n g a f r ee - a i r ion i z a t i o n c h a m be r (3 0) . F o r ro ut i ne c a li b r at io ns a w e ll -t y p e i o n i z a ti o n c h a m b e r i s u s e d w h o s e c a l i b r at ion i s m a i nt a i ne d b y a f r e e - a ir c ha m b e r a s t h e p r i m a r y s t a n d ar d . C a l i b r at io n o f c l i n i c a l s o u r c e s s h o ul d b e d ir e c tl y t r a c e a bl e to N IS T o r o ne o f t he AAPM-ADCLs. This means that t he so ur c e s s ho ul d be c a lib r a t ed by d i re c t

WWW.MEDRAD.IR

c o m p a ri s o n w i t h a N I S T - o r A D C L - c a l i b r at ed s o ur c e o f t he s a m e k i nd , i . e . , t he s a m e r a dio n u c l i de w ith t h e s a me e nc a p s ula t io n, s i z e , a nd s ha pe . If a w e ll - t y pe i o n i z a ti o n c h a m b er i s u s e d , i t s h o ul d b e a r a c a l i b r at io n f a c t o r de t e rm i ne d w it h a N IS T - o r A D C L - c a l i b r at e d so u r c e o f t he s a me k i nd .

B.1. Open-air Measurements

F i g u r e 1 5 .7 i s a s c h e m a t i c r ep r e se nt a ti o n o f a n o p e n- a i r m e a s ur e m e nt ge o me t r y f o r t h e c al ib r a ti o n o f b r a c h y t h e r a p y s o ur c es . T he a r r a ng e m e nt co ns i s t s o f a l a r g e source to ion P.368 c h a m b e r di s t a n c e re la t i v e t o so ur c e a nd d e te c to r di m e ns io ns . T he a p p a r a t us i s s e t u p a s f a r a w a y as p o s si bl e f r o m p ot ent i a l s c a tt e ri ng s ur f ac e s . Be c a us e t he o u t p u t f r o m b r a c h y t h e r a p y so u r c e s i s lo w a t la r g e di s t a nc e s , t he c ha m b e r v ol um e s h o u l d b e l a rg e , f o r e x a m p le , 1 0 0 m l o r la r g e r . A s i g na l - to - nois e r a t io g r e at e r t h a n 1 0 0 : 1 s h o u l d b e a c h i e v a b le .

F I G . 1 5 . 7 . S c h e m a t i c d r a w i n g o f o p e n ai r g e o me t r y f o r e x p o s ure r a te c al ib r a ti on of brachytherapy sources. B e c a u s e o f t h e di f f i cu l t y i n o bt a i ni ng g oo d ge o me t r y c o ndi tio ns , t he o pe n- a i r m e t h od is a t i me - co n s u m i n g m e a s ur e me nt . It is not s ui ta b l e fo r r o uti ne c a l i b ra ti o n c h e c k s r e qu i r e d i n a b us y d e pa rt m e nt . A w e ll - t y pe ioni z a t i o n c ha m b er i s m o r e s u it ed t o ro u t in e m e a s u r e m e nt s .

B.2. Well-type Ion Chambers

R o u t i n e c al i br a ti o n o f b r a c h y t h e r a p y s o ur ce s i s us ua l l y c a r r ie d o ut w i t h a r e e n t r a n t - t y p e i o n c h a m b e r i n w h i c h t he w a l l s o f t he c ha m b e r s ur ro und t he s o ur c e , a p p r o xi m a ti n g a 4 me a s u r e m e n t g eo me t r y . E x a m p l e s o f s uc h c ham b e r s ar e t ho se d e s ig n e d b y t h e B r i tis h N a t i o n a l P hy s i c s La b o r at o r y ( 31 ) , a r e -e nt r a nt c ha m b er d e s ig n e d b y R a d i olo gi c a l P h y s i c s C e nt e r ( 3 2 ) , a s p he r i c a l a l um i num c ha m b e r d e s ig n e d b y N IS T ( 3 3 ) , a n d c o m m e r c i al l y a v a i l a bl e do s e c al i br a to rs ( 3 4 , 3 5 , 36 ) . F i g u r e 1 5 .8 i s a s c h e m a t i c d r a wi ng o f a d os e c a l ib r a to r , C a p i nt ec M o d e l C R C - 1 0. T h i s u n i t c o n s i s t s o f a n a l u m i n u m w a l l i o n c ha m b e r f i l l ed w i t h a r g o n g a s und e r h i g h p r e s s u r e . T h e c o l l e ct io n p ot e nti a l a p pli e d to t he c ha m b e r i s a b o ut 1 5 0 V . A

WWW.MEDRAD.IR

s o u r c e h o l de r i s d e v is e d t o re p ro d uc e t he s o ur c e g e o me t r y i n r e l a ti o n to t he surrounding chamber walls. T h e d o se c al i b r ato r is t r a di ti o n al l y us ed fo r a s s a y o f r a di op ha r m a c e ut i c al s i n w h i c h t h e i n s t r u m e n t r e s p o n s e i s i nte r p ret e d a s a c ti v i t y i n uni t s o f m i ll i c ur ie s . T h e s e a c t i v it y c a li b r at io n s o f v a r i o us i so to p e s a re b a s ed o n re l a ti v e c ha m be r r e s p o n s e m e a s u re d by i n t e r co m p a ri s o n w i th t he r e sp e ct i v e s t a nd a r d s c al ib r a te d b y N IS T d i r e c tl y i n t er m s o f a c ti v i t y ( 37 ) . H o w e v e r , t he s e st a nda r d s a r e us ua l l y i n t h e f o r m o f a n a qu e o u s s u s p e ns i o n o f t he i so to pe s e al e d i n a g l a s s am p ul e . These vendor c a li b ra t io n s s o u r ce s and of t he i ns t r um e nt of Even a re , t he re f o r e, in of no t v a li d a f or brachytherapy brachytherapy because di f f e r e nc e s t he c o ns t ruc t i o n us i ng b et w e e n r a d i um

standard

s o ur c e s .

p r a c t i ce

s t a n d a r d f o r c a li b r at in g d i f f e r e n t s o ur c e s i s p r o ne t o s ig ni f i c a nt e r r o r s d ue to e n e r g y d e pe n d e n c e of t h e i n s t r um e nt ( 3 5 ,3 6 , 3 8 ) . In a d d i ti o n, t he r e s po ns e o f w e l l c h a m be r s i s k n ow n t o de p e nd o n t he s o ur c e po s it io n i n t he w e l l a nd o n t he l e n g t h o f t h e so u r c e ( 3 2 ) . C o r r e ct io n f a c t o rs m us t b e d et e r mi ne d f o r t he s e e f f e c ts f o r a g i v e n i n s t r u m e n t a n d t h e t y p e o f s o ur ce s t o be c a l ib r a te d . T h e e n e r g y d e pe n d e nc e o f t h e c ha m b e r a ris e s f r o m a b so r pt io n a nd s c a t t e ri ng o f p h o to n s a n d s e co n d a ry e l e ct r o n s i n t he c ha m b e r w a ll s a nd t he g a s . Be s i de s t hi s i n t r i n s i c e n e rg y d ep en d e n c e , o bl iq ue f il tr at io n t hr o ug h t he so urc e e nc a p s ul at io n affects changes the in chamber the used r e s po n s e b ot h by p ho to n ef f e c t T he s e a b so r pt io n of s o ur c e and by p ro d uc i ng on t he e n e rg y spectrum. T hi s co ns t r uc t io n co nc lud e : In

c h a m b e r r e sp o n s e h a s b ee n s t u di e d i n d et a il b y Wi ll i am s o n et a l . (3 4 , 39 ) f or commonly P.369 exposure r a te gi v e n fixed energy, f il tr at io n, a nd s o ur c e pos i ti o n. F or each b r a ch y t h e r a p y s o ur c e s . a ut ho r s t he s e a p p a r a t u s e s , a ll o n e ca n c o u n t o n i s a l i ne a r r e s p o ns e w it h r e s p ec t t o

i s ot op e , a n e x p o s u r e c a l i b ra t ed s t a nd a rd i s ne e d e d ( 34 ) . T he s e s t ud i e s s upp o rt t h e r e c o m me n d a ti o n s t h a t t h e b r a c hy t he ra p y s o ur c e s s ho ul d b e c a l ib r a te d i n t e r m s o f e x p o s u r e r at e u s i n g e x po s ur e c al i b r at ed s t a nd a rd s o f t he s a m e k i nd (25,26).

WWW.MEDRAD.IR

F I G . 1 5 . 8 . S c h e m a t i c d r a w i n g o f a d o s e c a li b r a to r , C a p i nte c M o de l C R C - 1 0 . ( F r o m W i l li a m so n J F , K h a n F M , S h a r m a S C , e t a l . M e t ho d s f or r o uti ne c a l ib r a ti o n o f b r a c h y t h e r a p y s o u r c es . R a d i o lo g y 19 8 2; 1 42: 5 1 1 , w i t h pe r m i s si o n. )

15.3. CALCULATION OF DOSE DISTRIBUTIONS A. Exposure Rate

E x p o s u r e r a t e di s tr i b ut io n a r o u n d a l i ne a r br a c hy t he r a p y s o ur c e c a n b e c a l c ul a ted u s i n g t h e Si e v e rt i n t eg r a l , i n t r od uc e d b y S ie v e r t ( 4 0 ) i n 1 9 21 . The m e t ho d (1 , 4 1) c o n s i s t s o f di v i di n g th e l i n e s o u r c e i nto s m a l l el e me nt a r y s o ur c e s a nd a p p l y i ng i n v e r s e s q u a r e l a w a n d f i l t r at io n c o r r e ct io ns t o e a c h. C o ns i d e r a s o ur c e o f a c t i v e l e n g t h L a n d f i lt r at ion t ( F i g . 1 5 . 9 ) . T he e x p o s ur e r a te d I at a p o i nt P ( x , y ) c o n t r ib u t ed b y t h e s ou r c e e l e me n t o f l e ngth d x i s g i v e n b y :

WWW.MEDRAD.IR

w h e r e A a n d a r e t h e a c ti v i t y a n d e x po s ur e r a t e co ns t a nt o f t he unf i l t e r ed so ur c e a n d i s t h e e f f e c t i ve a t te n u a t i o n c oe f f i c ie nt f o r t he f i lt e r . O the r v a r i a b l e s a re d e f i n e d b y F ig . 1 5 . 9 . P.370 M a k i n g u s e o f t h e f o l lo w i n g r e l at io ns hi p s :

a n d i n t e g r at i n g E q u ati o n 1 5 .9 , w e o bt a i n the e x p o s ur e r at e I ( x , y ) f o r t he w ho l e source.

T h e a b o v e S i e v e rt i n te g r a l c a n b e e v al ua t ed b y num e r i c a l m e t hod s ( 1 ) .

F I G . 1 5 . 9 . D i a g r a m il l u s t r at i n g g e om et r i c al r e l at io ns hi p s us e d in c a l c ul a t io n o f e x p o s u r e a t poi n t P , f r o m a l i n e a r so ur c e . If t h e s o u r c e i n t e n s i t y i s s p e c i f ie d i n te r m s o f e x p o s ur e r a te

a t a s p e c i fi e d di s t an c e s f a r f r o m t he s o ur c e , i . e . , s
L , t he n t he S i e v e r t

i n t e g ra l c a n b e w r i tt en a s :

A l t e r n a ti v el y , i f t h e so u r c e s t re ng t h i s s pec i f i e d i n te r m s o f e qui v a l e nt m a s s o f radium, meq, such that

= meqRas-2, then:

WWW.MEDRAD.IR

If t h e s o u r c e s t r e n g t h i s s p e c i f ie d i n a i r k e rm a s t r e ng t h, t he n:

Several

a d di tio n a l

co r r e ct io n s

are

a p pl ie d

to

c o m p ut e

t he

e x p o s ur e

r a te

a c c u r a t e l y u s i n g t h e S i e v e rt i n te g r al . A c o r r e ct io n f o r se l f -a b s o r pt io n i n t he s o u r c e m at e ri a l , al t h ou g h s m a l l f or c li ni c a l s o ur c e s , ha s b ee n us ed b y S ha l e k a nd S t o v a ll ( 1 ) . W a l l t h i ck n e s s , t , s h o ul d b e c o r r e ct e d f o r t he i nt e rna l r a d i us o f t he s o u r c e , b e c a u s e s o me p h o to n s t r a v e r s e a t hi c k ne s s o f f i l t e r gr e a t er t ha n t he radial thickness of th e wall (42,43). Dep e nd i ng on t he t y pe of s o ur c e a nd f i l t r at io n , t h e e n e r g y s p e c t r u m m a y b e si g ni f i c a nt l y a lt e re d b y t he f i lt e r . N ot o nl y i s a n e f f e c ti v e a tt e nu a t i o n co e f f i ci e nt nee d ed b ut t hi s co e f f i cie nt v a r i es w i t h f i l te r t h i c k n e s s ( 43 , 44 ) . T h i s p r o bl e m be co m e s mo r e s e v er e w he n t he e f f e c t s o f o b li q u e f il t r at io n a r e c o n s i d er e d ( 45 ) . In t h e c a s e o f f i l te r P.371 c o m bi n a t io n , c a l c u l a te d v a l u e s h a v e t o be us e d . W i l li a m s o n et a l . ( 4 5 ) g i ve t he f o l lo w i n g e x p re s s io n f o r a s a f u nc t i o n o f f i l te r t hi c k ne s s d :

226

R a en c a p s u l a t e d i n p l at i num , m e a s ur e d v a l ue s of ( 4 3 , 44 ) m a y

b e u s e d ( F ig . 1 5 .1 0 ) . H o w e v e r , i f s uc h d at a a r e not a v a il a bl e fo r a g i v e n so ur c e -

w h e r e p i d e n o te s t h e n u m b e r o f p ho t o ns w i th e ne r g y E i e m i t t e d pe r d i si nt e g ra ti o n, a n d ( e n / ) a i r i i s t h e ma s s e n e r g y a b so r pt io n c o e f f i ci e nt i n a i r fo r p ho to n o f e ne rg y Ei.

WWW.MEDRAD.IR

F I G . 1 5 . 1 0 . E f f e c t i v e e n e r g y a b so r p tio n c o e f f i c ie nt s o f r a di um g a m m a r a y s i n p l a ti n u m . ( D a t a a r e fr o m W h y t e G N . A t te nua t i o n o f r a di um g a mm a r a d i at io n in c y l i n d r i c al g eo m et r y . Br J Radiol 19 55 ;2 8 : 63 5 ; a nd Keyser GM. Absorption c o r r e ct io n f o r r a d i u m s t a n d a r d i z at io n. C a n J P hy s 1 9 5 1 ; 2 9 :3 0 1 . ) Because the by S i e v er t the by i n t e g r al is that us e s t he t he e ne r g y by a b s or p ti o n f l ue nc e t he
226

c o e f f i c ie nt , is T hi s M o nt e is

t he an

underlying a t t e n u a te d r e g io n

a s s u m pt ion

em it te d

e ne rg y

e x p o ne nti a ll y

f i l te r the

t hi c k ne s s a c t i ve

t r a ve r s e d end s

p ho tons .
192

a p p r o xi m a ti o n t h a t ha s b e e n s ho w n t o w or k w e l l fo r b o u n d ed s o ur c e

R a a nd

Ir s e ed s i n t he C a r lo

(1,45).

H o w e v er ,

s i m u l a ti o n s (4 5 ) h a v e s h o w n t h a t be y o nd the e nd o f t he a ct i v e so ur c e r eg io n, t he S i e v e r t ap p ro a c h i n t ro d u c e s s ig n i f i c a nt e r ro r s a nd p r a ct i c al l y b re a k s d o w n i n t he e x t r e me o bl iq u e d i re ct io n s .

A.1. Effect of Inverse Square Law

F i g u r e 15 . 1 1 co m p a res t h e r a d i al e x po s ur e r a t e di s t ri b uti o n o f a l i ne s o ur c e o f r a d i u m w it h t h a t o f a p oi n t so u r c e o f r ad i um , b ot h f i lt e r ed b y 1 m m P t . W he r e a s t h e c u r v e fo r t h e p oin t s o u r c e r ep r e se nt s a n i nv e r s e s q ua r e la w f unc t i o n, t he l i n e a r s o u r c e c u r v e w a s o b t ai n e d us i ng t he S i e v e r t i nt e g r al . T he e x p o s ur e r a te constant for
226

R a w i th 1 m m P t f i lt e r w a s a s s um e d to b e 7 .7 1 Rc m 2 m g - 1 h - 1 . It i s

e v i d e n t f r o m Fi g . 15 . 1 1 t h at f o r t he li ne a r s o ur c e , t he e x p o s ur e r a t e i s le s s t ha n t h a t p re d i ct ed b y t h e i n v e r s e s q u a r e l a w , es p e c i al l y at po i nt s cl os e to t he so ur c e . T h i s i s a s e x pe c te d be c a u s e t h e p ho to ns re a c hi ng t he se po i nt s f r o m t he so ur c e e x t r e mi ti e s t r a v el l a rg e r d i st a n c e s a nd s uf f e r o b li q ue f i lt r a ti o n w hi c h i s g r e a t e r t h a n t h e r a d i a l w a ll t h i c k n e s s . A s t he d i s t a nc e i s i nc r e a s ed , ho w e v e r , t he s e effects of the P.372

WWW.MEDRAD.IR

l i n e a r s o u r c e a pp r o a ch t h o s e o f t he p o i nt so ur c e a nd , t he r e f o r e , i t s e x po s ur e r a t e c u r v e a p p r o a c h e s i n v er s e s q u a r e l a w .

F I G . 1 5 . 1 1 . P l o t o f ex p o s u r e r a te f r o m 1 -m g f i l t r at io n , 1 . 5 c m a c t iv e l e n g t h .

226

R a s o ur ce a s a f unc t i o n o f r a d i al

d i s t a n c e . P oi n t s o u r ce w i t h 1 . 0 m m P t f i l tr a t io n. L i ne a r s o ur c e w i t h 1 . 0 m m P t

B. Absorbed Dose in Tissue

T h e S i e v e rt i n t eg r a l gi v e s t h e e x po s ur e r a te di s t ri b uti o n i n a ir and c o ns i de r s o nl y t h e i n v e r s e s q u a r e l aw a n d f i l t r a t io n e f f e c ts . W he n a s o ur c e i s i m p l a nte d i n t he t i s s u e , o n e n e ed s to co n s i d er , i n a dd it io n, a t t e nua ti o n a s we ll a s s c a t te r i ng i n t he s u r r o u n d i n g t i s s u e . Th e e x p o s u r e r at e c al cul a t e d at a po i nt i n tis s ue c a n t he n b e c o n v e r t ed i n to ab s o rb e d d o se r a te b y us i ng t he ap p ro p ri a te r o e ntg e n- to - r a d f a c t o r ( s e e C h a p te r 8 ). S e v e r a l i n v e s ti g at o r s h a v e e x p e r i m e nt al l y d e t e rm i ne d t he r a t io o f e x p o s ur e in w a t e r t o e x po s u r e i n a i r a s a f unc t i o n o f d i st a nc e fo r a num b e r o f i s ot op e s . B e c a u s e o f t he l a rg e d i s c re p a n c ie s be t w ee n v a r i o us s et s o f ex p e r i me nt a l d a t a, M e i s be r g e r et a l . (4 6) f o r m u l a te d a t hi rd o r d e r po l y no mi a l t o f it t he a v e r a g e o f t h e i r t h e o re ti c a l a n d a l l a v a il a bl e e x pe r im ent a l d at a ( 4 6 ,4 7 , 48 , 49 , 5 0 , 51 , 5 2 ) . T hi s

WWW.MEDRAD.IR

p o l y n o mi a l i s c o mm o nl y u s e d f o r r o uti ne c a lc ul a t io n o f a b s o rb ed d o s e i n t i s s ue i n v a r i o u s c o m p u te r p ro gr a m s . M o r e r e c e nt l y , W e b b a n d F o x ( 5 3 ) c a l c ul a te d t he do s e di s t ri b utio n a r o und p o i nt r a y e m it t er s i n w a te r b y t h e M o nt e C a r lo m e t hod . T he i r re s ul t s a g r e e v e r y w e ll w i t h M e i s be r g e r ' s a v er a g e o r s e le c te d c ur v e . T h e r a d i al de pe n d e n ce o f d o se i n a w a te r m e d i um , wi t h t he i nve r s e sq ua r e l a w r e m o v ed c a n al s o b e r e p re s e n te d b y D r = B r e - r w he r e deno t e s t he li ne a r a t t e n u a ti o n co e f f i ci e nt a n d B r i s a b uil d - up f a c t o r a t d i st a nc e r fr o m t he so ur c e . T h i s e x p r e s s io n i s s i mi l a r to t h e P.373 r a t io o f e x p o s u r e i n w a t e r to e x p o s ur e i n a i r . E v a ns ( 5 4 ) ha s sug g e s te d t ha t B r m a y b e r e p r e se n t ed by :

w h e r e k a a n d k b a re co n s t a n t s . K o r nel s e n and Y o ung ( 5 5 ) ha v e f i tt e d t he M o nte C a r l o d at a o f W eb b an d F o x ( 5 3 ) to de t erm i ne t he co ns t a nt s k a a nd k b . T he s e a r e g i v e n i n T a b l e 15 . 3 . F i g u r e 1 5 .1 2 s ho w s t he c ur v e s c a l c ul a t e d b y t he s e a ut ho r s . 4

TABLE 15.3. CONSTANTS k a AND k b DETERMINED BY USE OF MONTE CARLO DATA

I s ot o p e

(cm2/g)

ka

kb

60

Co

0 . 0 6 32

0.896

1.063

226

Ra

0 . 0 8 11

1.17

1.19

137

Cs

0 . 0 8 58

1.14

1.20

198

Au

0.105

1.48

1.32

192

Ir

0.113

1.59

1.36

D a t a f ro m Ko r n e l se n R O , Y o u ng M E J . Br a c hy t he r a p y b ui ld - up f ac t o r s . Br J R a d i ol 1 98 1 ;5 4 : 13 6 .

Figure

15 . 1 2

shows that

at

s h o rt

di s t a nc e s , t he

a tt e nua t io n o f t he

p ri m a r y

p h o to n s i s v e r y m u c h c o mp e n s a te d fo r b y t he co nt r ib ut io n o f s ca t t er e d p hot o ns w i t h t h e r e s u l t t h a t th e e x p o s u r e i n w a t e r i s a l m o st e q ua l to t he e x p o s ur e i n a i r a t t h e s a m e p oi n t . H o w e v e r , ti s s ue a tt enua t i o n o v e rt a k e s s ca t t er i ng at l a r g er distances. For r a di um sources, t he ne t r e d uc t io n is a b o ut 1% per cm of intervening tissue up to 5 cm.

WWW.MEDRAD.IR

It i s i n s t r u c ti v e t o s t ud y t h e d o se f a ll o f f wi th d i s t a nc e i n t i s s ue . Fi g ur e 1 5 . 13 i s a p l ot o f pe r c e n t do s e a s a f u n c t i o n o f d i s t anc e i n w a t e r f o r p oi nt s o ur c e s o f
226 60

Co,

Ra,

137

Cs,

198

Au,

192

Ir , a n d
2

125

I. T he s e p lo ts a l s o a r e co mp a r e d w i t h t he i nv e r s e C o , a nd C s a r e a bo ut e q ua l and s ho w a s l ig ht
192

s q u a r e l a w f u n c t i o n ( 1 / r ) . T h e s e d a t a s how t ha t o v e r a d i st a nc e o f a b o ut 5 cm t h e p e r ce n t d o s e r a tes f o r and

226

Ra,

60

137

d e c r e a se be lo w i n v e r se s q u a r e l a w d ue t o ti s s ue a tt e nua ti o n. T he c ur v e s f o r
198

Ir

A u , o n t h e o t h e r h a n d , a r e p r a c t i c al l y i nd i st i ng ui s ha bl e fr o m t he i nv e r s e
125

s q u a r e la w c u r v e u p t o a bo u t 5 c m . T he do s e d i st r ib ut io n f o r

I p r og r e s si v e ly

d e v i at e s f r o m t h e i n ve r s e s q u a r e l a w a s a r e s ul t o f i nc r e a s ed tis s ue a t t e nua ti o n f o r t h i s i so to p e . H o we v e r , u p t o a bo ut 1 cm , a l l t he c ur v e s a r e i nd i st i ng ui s ha bl e d u e t o t h e se v e r it y o f t h e i n v e r s e s q ua r e l aw e f f e c t a t s uc h s ho r t d i s t a nc e s . A b s o r be d do s e r a te t a b le s f o r li ne a r r a d ium s o ur c e s ha v e b e e n p ub l i s he d by S h a l e k a n d S t o v a l l (1 ) w h i c h t a k e i nt o ac c o unt a t te nua t i o n and s c a t t e ri ng i n t i s s u e . S i mi l a r d a t a al s o a r e a v ai l ab l e fo r c a l c u l a ti o n s .

137

C s a nd

125

I ( 9 , 5 6 ) . S uc h t a b l e s a r e

u s e f u l f o r m a n u a l c a lc u l a t io n s a s w e ll a s f o r c he c k i ng t he a c c ura c y o f c o m p ute r

C. Modular Dose Calculation Model: TG-43

T h e t r a d i tio n a l m e t ho d o f c a l c u l at i ng d os e i n a m e d i um ( s e c t io ns 1 5 . 3 A a nd 1 5 . 3 B ) u s i n g Si e v e rt i n t eg r a l r e q uir e s t he d et e rm i na ti o n o f , t he e f f e ct i v e a t t e n u a ti o n co e f f i ci e nt f o r t h e f il te r a s a f unc t i o n o f t hi c k ne s s a nd t he t i s s ue a t t e n u a ti o n f a ct o r s . Both of t he s e p a r am e t er s are di f f i c ul t
125

to

m e as ur e
103

or

c a l c u l a te , e sp e ci a ll y fo r so u r c e s o f co m pl ex d e s ig n s uc h a s

I a nd

P d . It i s ,

t h e r e f o re , a d v a n t a g eou s t o c a l c u l a te d os e ra t e s f r o m q ua nti ti e s m e a s ur e d s ol el y i n t h e m ed i u m . T h e da t a f o r a p a rt i c ul a r s our c e c a n b e c o m pi le d i n a t a b ul a r fo r m a s a f u n c t i o n o f po s it io n . A m o d ul a r a p p ro a c h ha s b e e n p ro pos e d b y t he A A P M T a s k G r o u p 4 3 i n w h i c h t h e e f f e c t s o f s e v e r a l p hy s i c al f a c tor s o n d o se r a te d i s t ri b u tio n a r e c o n s id e r ed s e p a r at el y ( 5 7 ). T he d o s e r at e , [ D wi t h do t ab o v e ] ( r , ) a t p oi n t P w i t h p ol ar c o o r di n a t e s ( r , ) i n a m e d i um P.374

P.375 ( e . g . , w a t e r ) f r o m th e c e n t e r o f a s o urc e o f a i r k e r m a s t re ng t h S K c a n b e e x p r e s s ed a s :

w h e r e i s t h e d o se r a t e co n s t a nt , d e fi ned a s t he do s e r at e pe r uni t a i r k e r m a s t r e n gt h ( U ) a t 1 c m a l o n g t he t r a ns v e r s e a x i s o f t he s ee d a nd ha s uni t s o f c G y h 1

U-1, i.e.,

WWW.MEDRAD.IR

F I G . 1 5 . 1 2 . A t t e n u a t io n c o r r e ct io n f a c to r in w a t e r a s a f unc t i o n o f d i st a nc e f o r a p o i nt s o u r c e . C u r v e s a r e c a l c u l at e d b y E q ua t io n 1 5 . 15 a nd f i tt ed t o Mo nt e C a r lo d a t a . S e e te x t f o r d eta i l s .

WWW.MEDRAD.IR

F I G . 1 5 . 1 3 . P e r c e n t d o s e v a ri a ti o n w i t h di s t a nc e i n w a t e r f o r p o i nt s o ur c e s o f
60

Co,

226

Ra, in

137

Cs,

198

Au ,

192

Ir , a n d

125

I. F un c t io n ( 1 / r 2 ) r e p r e se nts i nv e r s e s q ua r e
125

f a l l o f f . ( 1 2 5 I d a t a a re f r o m K r i s h n a s w a m y V . D o s e di s t ri b uti o n a round a n source ti s s u e . Ra d i olo g y 19 7 6 ;1 26 : 48 9 . ) T he ot he r i so to p e c a l c u l a te d f r o m F ig . 15 . 1 2 i n a d di ti o n to t he i nv e r s e s q ua r e l a w .

I seed w e re

data

TABLE 15.4. RECOMMENDED DOSE RATE CONSTANTS IN WATER

WWW.MEDRAD.IR

Seed

cGy hr-1 U-1

cGy mCi-1 hr-1

125

I m o d el 6 70 2

0.919

1.16

125

I m o d el 6 71 1

0.847

1.07

192

Ir

1.11

4.55

The

units

for

are Group,

Gy ed .

m2

h-1

or

cGy

cm2 New

h-1. York:

F r o m M e li J A , A n d e r s o n L L , W e a v e r K A . D o s e d i st ri b uti o n. In: Int e r s t it i al C o l l ab o r at i v e W o r k i ng I nt er st it i al b r a c hy t he r ap y . R a v e n , 1 9 9 0 : 21 , w i t h p e r m i s sio n.

T h e d o s e r a te c o n s t an t , , d e p e nd s o n t he t y pe o f so ur c e , it s c o ns t r uc t io n, a nd i t s e n c a p s u l at io n . T h e v a l u e s re c o m me nd ed f o r and
192 125

I s e ed s ( mo de l s 6 7 02 a nd 6 71 1)

Ir s e e d a r e li s ted i n T a b l e 15 . 4 .

G ( r , ) i s t h e ge om e try f a c t o r ( c m - 2 ) t ha t a cc o unt s f o r t he g e om etr i c f a l lo f f o f t he p h o to n f l ue n c e w it h di s t a n c e f ro m t he s o urc e a nd de p e nd s o n t he di s t ri b uti o n o f r a d io a c ti v e m a t e ri a l . For a p o i nt s o ur c e, G(r, ) = 1/r2 and for uni f o r m l y d i s t ri b u te d li n e s o u r c e, G ( r , ) = ( 2 - 1 ) / L y . 5 F ( r , ) i s t h e a n i so tr op y f a c t o r n o r m al i z ed a t = / 2 (t r a ns v e r se a x i s ) , w i t h t he g e o me t ri c f a c to r f a c t or e d o u t , t h a t i s ,

T h e a n i s o t r op y f a c t o r a c c o u n t s f o r t he a ng ul a r d e p e nde nc e o f pho t o n a b so r p tio n a n d s c a t t e r i n t h e e n c a p s u l a ti o n a nd t he m ed i um . The r a d i al do s e f u n c t io n , g(r), a c c o unts for r a di a l d ep e nde nc e of p ho to n a b s o r pt io n a n d s c a t te r i n t h e m e d i um a lo ng t he t r a ns v e r s e a x i s a nd i s g i v e n b y :

A g a i n t h e g eo m et r i c fa c t o r i s f a c to r ed o ut fr o m t he do s e r a te s i n d e f i ni ng g ( r ) . T a b l e 1 5 .5 i s a n e x a m p l e o f t h e g eo m et r y f a c t o r c a l c ul a t ed fo r a 3 - m m -l o ng li ne s o u r c e . T a b le 15 . 6 p ro v i de s a n i s ot ro p y a nd r a d i al do s e f unc t i on d a t a m e a s ured for

125

I s e e d s , m od el s 6 7 02 a n d 6 7 11 .
192

B e c a u s e a n i s o t ro p y is n o t a s s e ri o us a pr o b le m f o r

Ir s e eds a s i t i s fo r

125

s e e d s , i r id i u m s ee d s m a y b e t r e at ed a s p oi nt so ur c e s i n a d o se c a l c ul at io n f o r m a li s m . F o r a p oi n t s o u r c e , E q ua t i o n 1 5 .1 6 r e d uc e s t o :

w h e r e a n i s t h e a v e r a g e a ni s ot r op y f a c to r . It i s d e f i ned a s t he r a ti o o f 4 a v e r a g e d do s e r at e at a g i v e n r a d i al d i st anc e d i v i d ed b y t he do s e r a te a t t he s a m e d i st a n c e a lo n g th e t r a n s v e r s e

WWW.MEDRAD.IR

P.376 axis. an for Ir s e e ds m a y b e e q ua t e d t o uni t y . T he d a t a f o r g ( r ) f o r Ir s e e ds

192

192

a r e g i v e n i n T a b l e 1 5 .7 .

TABLE 15.5. EXAMPLE OF THE GEOMETRY FACTOR, G ( r , ), FOR A 3.0-MM LINE SOURCE

(deg)

r = 0.5 cm

r = 1.0 cm

4.396

1.023

10

4.377

1.022

20

4.323

1.019

30

4.246

1.015

90

3.885

0.993

F r o m M e li J A , A n d e r s o n L L , W e a v e r K A . D o s e d i st ri b uti o n. In: Int e r s t it i al C o l l ab o r at i v e W o r k i ng Group, ed . I nt er st it i al b r a c hy t he r ap y . New York: R a v e n , 1 9 9 0 : 21 , w i t h p e r m i s sio n.

D. Isodose Curves
T h e a b o v e m et h o d s ca n b e u s ed to c al c ul at e ab s o rb e d do s e to a m a t ri x o f p oi nt s around a source. The i s o do s e c ur v e s are t he n c o ns t r uc t e d by i nt e r po l at io n b e t w ee n p o i nt s , c o n n e c t i n g t h o s e po i nt s rec e i v i ng t he s a me d o se. Be c a us e o f t he c o m pl e x a n d t i me - c on s u m i n g c a l c ul a t io ns r e q ui r ed to g e ne r at e i s o do s e c ur v e s , the jo b is id e al l y suited for co m p ute rs . i nv o l ving P r e s e nt l y , al m o st all c o m me r c i al of t r e at m e n t p l a n n i n g co m p u te r s o f f e r b r a c hy t he r a p y s o ft w a r e t ha t c a n pe r f o r m s o p h i st i c at e d t re a t me n t pl a n n i ng t hr e e -d i me ns i o na l d i st r i b ut io n m u l t ip le s o u r c e s . E x p e r i m e n t al d et e r min a t i o n o f i so do s e c ur v e s i s so m et im e s ne ce s s a r y to c he c k n e w c a l c u l a ti o n a l go ri t h m s . Fi l m a nd t he rm o l um i ne s ce nt d o si me t r y ( T LD ) ( se e C h a p t e r 8 ) re q u i re t he l e a st a pp a r a t us f o r s uc h m e a s ur e m e nt s . Fi l m o f f e r s a hi g h r e s ol u t io n b u t h a s a s e r io u s l i m it a ti o n o f e ne r g y d e pe nd e nc e , tha t i s , i nc r e a s e d s e n s i ti v i t y to lo w - e n e rg y p h o t o n s P.377 p r e s e n t i n t h e n u c l ide s r a y s pe c t r um and t he s c at te r ed r a dia t io n. T L D s ho w s e n e r g y d e pe n d e n c e ( 58 ) a l s o b u t t o a le s s e r d e g r ee t ha n t he f i l m .

WWW.MEDRAD.IR

TABLE 6711

15.6.

THE

ANISOTROPY

FACTOR,
125

F(r,

),

AND

RADIAL DOSE FUNCTION, g ( r ), FOR

I MODELS 6702 AND

A n i s ot r op y F a c t or M od e l r(cm)a 0 10 20 30 90

Radial D ose F u n c t i on

6 7 02

0.5

0.448

0.544

0.701

0.815

1.0

1.04

1.0

0.501

0.598

0.758

0.866

1.0

1.00

2.0

0.537

0.628

0.781

0.874

1.0

0.851

3.0

0.572

0.656

0.798

0.873

1.0

0.670

4.0

0.605

0.683

0.814

0.872

1.0

0.510

5.0

0.634

0.707

0.826

0.871

1.0

0.389

6.0

0.651

0.719

0.828

0.870

1.0

0.302

8.0

0.178

10.0

0.131

6 7 11

0.5

0.376

0.448

0.627

0.783

1.00

1.04

1.0

0.369

0.464

0.658

0.799

1.00

1.00

2.0

0.419

0.503

0.683

0.791

1.00

0.832

3.0

0.474

0.551

0.715

0.800

1.00

0.632

4.0

0.493

0.579

0.736

0.813

1.00

0.463

WWW.MEDRAD.IR

5.0

0.478

0.583

0.743

0.823

1.00

0.344

6.0

0.264

8.0

0.145

10.0

0 . 0 8 20

For

< W o r k i ng

0.5 Group,

cm ed .

g(r) I nt er st it i al

1.00

New

0.1. York:

F r o m M e li J A , A n d e r s o n L L , W e a v e r K A . D o s e d i st ri b uti o n. In: Int e r s t it i al C o l l ab o r at i v e b r a c hy t he r ap y . R a v e n , 1 9 9 0 : 21 , w i t h p e r m i s sio n.

TABLE 15.7. THE RADIAL DOSE FUNCTION, g ( r ), FOR

192

IR

r(cm)

g(r)

0.5

0.994

1.0

1.00

2.0

1.01

3.0

1.02

4.0

1.01

5.0

0.996

6.0

0.972

8.0

0.912

10.0

0.887

WWW.MEDRAD.IR

F r o m M e li J A , A n d e r s o n L L , W e a v e r K A . D o s e d i st ri b uti o n. In: Int e r s t it i al C o l l ab o r at i v e W o r k i ng Group, ed . I nt er st it i al b r a c hy t he r ap y . New York: R a v e n , 1 9 9 0 : 21 , w i t h p e r m i s sio n.

A u t o m a ti c i so do s e plo tt e r s ( 59 , 6 0 ) al s o ha v e b e e n us e d to m e a s ur e i so do s e curves. One of the ray d e t e ct o r s s c i n t i ll a ti o n use d in t he se is i ns tr um e nt s to an is a s m all s c i n t il l at io n d e te c to r . T h e c ount e r c o nne c t ed a ut o m a ti c

i s o do s e r e co r di n g de v i c e . T h e o u t p ut o f t he s c i nti ll a ti o n co unt e r is i nd ep e nd e ntl y c a l i b ra t ed b y c o m p a ri s o n w i t h a c a l ib r a ted s o ur c e o f t he s a me k i nd . A s i l i c o n d i od e de t e cto r c o n n e c t e d to a r a d i at io n f i e ld s c a nne r a l s o ha s b e e n us e d f o r r e l at i v e cl o se d i st ri bu t i o n m e a s ur em e nt s ( 2 0 ) . S m a ll s i z e a nd a l m o st c o mp le te e n e r g y i n d e pe n d e n c e m a k e i t q u it e s ui ta b le f o r t he s e m e a s ur e ment s . Figure 1 5 .1 4 shows an example o f i so dos e c ur v e s a r o und a r a d i um ne e dl e . E x a m i n a t i o n o f t h e c u r v e s i n d i c a te s t ha t c los e t o t he so ur c e t he y a r e m o r e o r l e ss e l li pt i c al . A t l a r g e dis t a n c e s , t h e i s o do s e c ur v e s b e c o m e c i r c le s , b e c a us e t he s o u r c e b e h a v e s a s a p o i nt s o u r c e . T he d i p i n t he c ur v e s c l o s e t o t he s o ur c e a x i s i s d u e t o t h e e f f e c t o f o b li q u e f i lt r at io n.

WWW.MEDRAD.IR

F I G . 1 5 . 1 4 . Is o d o s e c u r v e s i n te r m s o f r a d / h a r o und a 1 - m g r a d i um so ur c e . A c t i v e le n g t h = 3 . 0 c m ; f i l t r at io n = 0 . 5 m m P t . P.378

15.4. SYSTEMS OF IMPLANT DOSIMETRY

T h e o b j e ct i v e s o f t r ea t m e n t pl a nni ng a r e ( a ) t o de te r m i ne t he d i s t ri b uti o n a nd t y p e o f r a d i at io n s o u rc e s to p ro v i de op ti m um d o se d i st ri b uti o n and ( b ) to p ro v i de a c o m p le te d o se d i st r i b ut io n i n t he i r r ad i a te d v ol um e . N um er o us s y s t e m s o f d o s im e tr i c p l a n n i n g h a v e b e e n de v i s ed ov e r t he p a s t 5 0 y e ar s . O f t he s e t he P a t e r s o n - P a r k e r s y s tem ( 6 1 ) a n d t he Q ui m by s y s t e m ( 6 2 ) ha v e rec e i v e d t he mo s t w i d e s p re a d u s e . T h e s e a n d o t h e r s y s t em s w e r e d e si g ne d d uri ng t he t i me s w he n c o m p u te r s w e r e n ot a v a i l a bl e f o r r o uti ne t r e at m e nt p l a nni ng . E x t e ns i v e t a bl e s a n d e l a bo r a te r u l e s o f s o u r c e d i st r i b ut io n w e r e d e vi s e d t o f a c il it at e t he p ro c e s s o f m a n u a l t r e at m e n t p l an n i n g . T h e n a m o r e s i g ni f i c a nt d e v el op m ent o c c ur r e d : t he u s e o f d i g it a l c om p u te r s t o c a l c ul at e i so dos e d i s t ri b utio ns f o r i nd i v i d ual p a ti e nt s ( 6 3 , 6 4 ,6 5 ) . This g a ve the r a di a ti o n t hera p i s t f re e do m to dev i a t e f r om t he e s t a bl i s h ed s y s t em s . A l t h o u g h , t he o ld s y s t e m s w it h t hei r r ul e s a nd t a bl e s are s t il l b ei n g u s e d , t h e co m p u te r t r e at m e nt p la nni ng i s f a s t r e pl a c ing t he t r a di ti o nal

WWW.MEDRAD.IR

s y s t e m s . S o m e o f t h e s e m et h o d s w il l b e r e v i e w ed he r e to il l us t r a te t he b a si c p r o bl e m s a n d c o n c ep ts o f b r a c h y t he r a p y p l anni ng .

A. The Paterson-Parker System

T h e P a t e r s o n - P a r k e r or M a n c h e s t e r s y s t e m ( 6 1 ) w a s d e v e lo p ed to d e li v e r uni f o r m d o s e ( w it h i n 1 0 % ) to a p l a n e or v o l um e . T he s y s t e m s p e c i fi e d r ul e s o f s o ur c e d i s t ri b u tio n t o a c h ie v e t h e do s e uni f o r mi t y a nd p r o v i de d do s a ge t a b le s f o r t he se i d e al i z ed i m pl a n t s . T h e s e t a bl e s a re r e p ro duc e d i n t he a p p e ndi x .

A.1. Planar Implant

In t h e c a s e o f pl a n a r i m pl a n t s t he uni f o rm i t y o f do s e i s a c hie v e d i n p a r al lel p l a n e s a t 0 .5 c m f r om t h e i m pl a nt ed p l a ne a nd w i t hi n t he a r e a b o und e d b y t he p r o je c ti o n o f t h e pe r ip h e r a l n ee d le s o n t ha t pl a ne . T he s t a te d d o s e , d et e r mi ned f r o m t h e P a te r s o n - P ar k e r t a bl e s , i s 10 % hi g he r t ha n t he m i nim um d o s e . T he m a x i m u m d o se s h o u ld n o t e x ce e d 1 0 % ab o v e t he s t at e d d o se t o s ati s f y t he u n i f o r m i t y c ri te r io n . T h e d o s e i s , ho w e v er , m uc h m o r e no nuni f o r m w i t hi n t he p l a n e o f i m pl a n t . F o r e x a m p l e , t he do s e at t he s ur f a c e o f t he ne e d le s i s a b o ut f i v e t i me s t h e s t at e d d o s e . T h e d i s t ri b u ti o n r u l e s f o r t h e p l a na r i mp l a nts a r e :

T h e r a t io b et w e e n t h e a m o unt o f r a d i um in t he p e ri p he r y a nd the a m o unt o f r a d i u m o v er t h e a r e a i ts e l f de pe nd s o n t he s i z e o f t he im p l a nt , f or e x a m p le :

Area

F r a c t i on U se d i n P e ri p h e r y

Less than 25 cm2

2/3

2 5 1 0 0 c m 2

Over 100 cm2

1/3

T h e s p a c i n g o f t h e n ee d le s s ho uld not b e m o r e t ha n 1 c m f ro m e a c h ot he r o r f r o m t h e c r o s si n g en d s . If t h e e n d s o f t h e i mp l a n t ar e unc r o s se d (F i g . 15 . 1 5 B o r C ) , t he e f f e ct i v e a r e a o f d o s e u n i f o r m ity i s r e d uc e d . 6 T he a r e a i s , t he r e f o r e , r e d uc ed b y 1 0 % f o r e a c h u n c r o s s e d e n d f o r t a bl e r e ad i ng p ur p o s e s .

In t h e c a s e o f m u l t ip le i m pl a nt pl a ne s , t he r a d i um s ho ul d b e a r r ang e d a s i n r u l e s 1 3 , a n d t h e p l an e s s ho ul d b e p a r al l el t o e a c h o t he r .

WWW.MEDRAD.IR

F I G . 1 5 . 1 5 . E x a m p l es o f t h re e p l a na r i mp l a nt s . A : Bot h e nd s c r o s s ed . B : O ne end uncrossed. C: Both ends uncrossed. P.379

A.2. Volume Implants

Some tumors are be t te r i m pl a nt ed us i ng t hr ee - di m e ns io na l s ha p e s s uc h as c y l i n d e r s , s p h e re s , o r c u b o i d s .

T h e t ot a l a mo u n t o f ra d i u m i s d i v id e d i nto e i g ht p a rt s a nd di s t ri b ut ed a s f o l lo w s f o r t h e v a r iou s s ha p e s . T he c y l i nd e r i s c o mp o se d o f b e lt , f o ur p a r t s ; c o re , t w o p a rt s; a n d e a c h e nd , o ne p a r t ( F ig . 1 5 . 1 6 ) . T he s p he r e i s m a d e u p o f s h e l l , s i x p a r t s , a nd c o r e , t w o p a r t s . T he c ub o i d c o ns i s t s o f e a c h s i d e , o n e p a rt ; ea c h e nd , o ne p a r t ; a nd c o r e , t w o pa r t s .

T h e n e e d l e s s h o u ld b e s p a c e d a s uni f o r m l y a s p o s s ib le , no t m o re t ha n 1 c m a p a r t . T h e r e s h o u ld be a t le a s t e i g ht ne e dl e s i n t he b el t a nd f our i n t he core. P.380

If t h e e n d s o f t h e v ol u m e i mp l a nt a re unc r o s s e d , 7 . 5 % i s d ed uc t e d f ro m t h e v o l u m e f o r u n c r o ss e d e nd f o r t ab l e re a di ng p ur p o se s .

WWW.MEDRAD.IR

F I G . 1 5 . 1 6 . E x a m p l e o f a v o l u m e i m pl a nt w i t h o ne e nd unc r o s s e d . T he i m p l a nt h a s e i g h t n e ed le s i n th e b el t , fo ur i n t he co r e ( no t s ho w n) , a nd f o ur a t o ne e nd . W h e r e a s t h e n e ed le s in t h e b e lt a nd co r e a re 1 m g e a c h, t he c ro ss i ng ne e dl e s at t h e e n d a r e 0 . 5 m g e a c h , t h u s s at i s f y i ng t he P a te r s o n- P a r k er r ul e o f r ad i um d i s t ri b u tio n . For a v o l u me i mp l an t , the p r e s c ri be d do s e is st at e d 10% hi g he r t ha n t he

m i n i m u m d o se w i t h i n t h e i m pl a n t ed v o l um e .

A.3. Paterson-Parker Tables

The P a t e r s o n - P a r k e r t a b le s ( 6 1 ) a r e d e sig ne d to gi v e m i ll ig ra m ho ur s / 1 , 0 0 0 r o e n tg e n s ( m g - h / 1 , 00 0 R ) f o r i mp l a nt s o f v a r i o us s i z e s , bo th f o r p l a na r a nd v o l u m e i m pl a n t s ( s e e T a b le s A . 1 2 .1 a nd A . 1 2 . 2 i n t he a p pe nd i x ) . T o c o nv e rt P a t e r s o n - P a r k e r ro e n tg e n s t o c G y i n ti s s ue , o ne ne e d s t o m a ke t he f o ll o wi ng c o r r e ct io n s : ( a ) E x p o su r e r a t e c o ns t a nt ( ) : t he t a b le s a s s um e = 8 . 4 R c m 2 / mg h i n s t e a d o f t h e c u r r e n t v a l u e o f 8 . 25 R cm 2 / m g - h. ( b ) A ro e ntg e n: c G y f a c t o r o f 0 . 9 5 7 s h o ul d b e u s ed t o co n v e r t e x po s ur e i nt o d o se i n m us c l e . ( c ) O b li q ue f i l t r at io n : P a te r s o n - P ar k e r t a bl e s do not t ak e i nto a c co unt i nc r ea s e d at te nua t i o n b y o b l iq u e f i lt r a ti o n by t h e p l a t i n um c a p s ule , g i v i ng r i s e to a 2 % t o 4 % e r ro r f o r t y p i c al i mp l a n t s . (d) P a t e r so n - P a r k e r t abl e s a re b a se d on ex p o s ur e in ai r . C o r r e c ti o n s a r e n e ed ed f o r t i s s u e a tt e nua ti on a nd s c a t t e r i ng ( s e cti o n 1 5 . 3 B) . S t o v a ll a nd S h a l e k ( 6 6 ) h a v e d e mo ns t r a te d t ha t f o r t y p i c al p la na r a nd v o l um e i m p la n t s a c o mb i n ed factor of 0 . 90 s el ec t s an i s od o s e c ur v e a pp r o x im a te l y e q u i v a le n t t o t h e P ate r s o n - P a r k e r d o s a ge . T hus t he m g - h/ 1 , 00 0 R i n t he o ri gi na l P a t e r s o n - P a r k e r ta b les s h o u l d b e c o ns id e r ed e q ui v a le nt to m g - h/ 9 0 0 c G y .

A.4. Determination of Implant Area or Volume

WWW.MEDRAD.IR

D o s a ge t ab le s f o r i n t er s t it i al im p l a nt s r eq uir e t he k no wl e dg e o f ar e a o r v o l um e o f i m p la n t . If t h e n e e dl es a r e c lo s e t o t he s ur f a c e , o ne c a n d et e r mi ne t he s i ze o f t he i m p la n t d i re c tl y . If n o t , i t h a s t o be d et e r mine d r a d io g r a p hi c a ll y .

Orthogonal Radiographs
T h r e e - d i me n s i o n al loc a l i z a ti o n of i nd i v idua l s o ur c e s can be o bt a i ned by o r t h og o n a l ( p e rp e n di cu l a r ) r a d io g r ap hs , s uc h a s a nt e r o po st e ri o r ( A P ) a nd l a te r a l ( L a t ) v ie w s . It i s i mp o rt a n t t h at t he c e nt r a l a xe s o f t he a nte r o po s te r io r a nd l a t er a l x - r a y b ea m s m e e t a t a p oi nt , a p p ro x i m a te l y i n t he mi d dl e o f t he im p l a nt . This can be e a s il y achieved by an i so ce nt r i c r a d io g r ap hi c uni t , s uc h as a t r e at m e n t si m u l at o r . F o r t h e ab o v e i so c e nt r i c g eo m et r y , t he f ilm m a g ni f i c at io n f a c t o r i s g i v e n b y S F D / S A D , w h e r e S F D is s o ur c e - to - f il m di s t anc e a nd S A D i s s o u r c e - to - a x i s di s t a n ce . A l t e r n a ti v el y , a c i r c ul a r o b je c t , s uc h a s a m e t a ll i c r i n g , m a y b e t a pe d t o t h e p a t ie n t at t he l e v el of t he im p la nt . T he r ati o o f t he la r g e st o u t s id e di a me t er o f th e r i n g i m ag e t o t he a c t ua l o ut s id e di a me t e r o f t he r i ng g i v e s t h e m a g ni f i c a ti on f a c t o r . T o d e te r m i n e t he w i d t h o r l e n gt h o f a n i m p la nt , o ne ne e d s to d e te r mi ne t he d i s t a n c e be t we e n t w o p o i n t s , t h r ee d i me ns i o na ll y . F i g ur e 1 5 . 17 i ll us t r a te s t he p r i n c i pl e o f d e r i vi n g t h i s i n f o rm a ti o n f r om o r t ho go na l r a dio g r a phs . L e t A ( x 1 , y 1 , z 1 ) a n d B ( x 2 , y 2 , z 2 ) b e t h e t w o p oi nt s i n que s t io n. T he n b y t he a p p li c a ti o n o f t he P y t h a g o r e a n t h eo r e m , i t c a n b e s ho w n t ha t :

E q u a t i o n 1 5 .2 1 c a n a ls o b e w r it t e n a s :

w h e r e a i s t h e l e n gt h o f t h e i m ag e o f A B on o ne o f t he r a dio g r ap hs a nd c i s t he p r o je c ti o n o f t h e i ma g e o f A B to t he ba s e l i ne i n t he o t he r r a d io g r a p h (t he b a s e li n e i s a li n e per p e n d i c u l ar t o t he i nt e r s e ct io n o f t he r a dio g r a p hs , us ua l l y p a r a l le l t o t h e e dg e s o f t h e f i l m s ) . Fi g ur e 15 . 1 7 a s s um e s a m a g nif i c a t io n f a c t o r o f u n i t y . H o w e v e r , i n a c t u a l p r a ct i ce , a a nd c w i l l ha v e to be co r r e ct e d fo r f i lm m a g n i f i c a ti o n .

WWW.MEDRAD.IR

F I G . 1 5 . 1 7 . O r t h o gon a l r a d i o g r a p hs o f a n i m p l a nt . Ba s e li ne is p a r a l le l to t he e d ge o f t h e f i l m . T h u s , b y d e t e r m i ni n g t h e w i dt h o f t he i mp l a nt i m a ge o n o ne fil m a nd it s w i dt h p r o je c te d to t h e b a s e li n e o n t h e o t he r , o ne c a n c a l c ul a t e t he a c t ua l w i d t h o f t he i m p la n t . T h e le n g t h of t h e i mp l a nt c a n a l so be de te r m i ned t he s a m e w a y b ut i s u s u a l l y g i v e n b y t h e k n o w n a c t i v e l e ng t h o f t he ne e dl e s . P.381

Example
Figure 15 . 1 7 shows the a n t e ro po s te r io r a nd l a t er a l r ad io g r ap hs of a p l a na r i m p la n t t h a t w a s p l an n e d a c c o r d i ng to t he P a t e r s o n- P a r k e r s ys t e m . A s s um e a m a g n i f i c a ti o n f a c to r of 1 . 4 f o r b o t h f il m s . De t e rm i ne t he t i me to d e li v e r 65 0 0 c G y a t 0 . 5 c m f r o m t h e pla n e o f i m p l a nt .

G i v e n w i d t h o f t h e i mp l a n t i m ag e o n t he l a te r a l r a di og r a p h = a = 3 . 8 c m P r o j e ct io n o f A P i m a g e o n b a s e li ne = c = 0 . 9 c m P e r i p h e r al n e e dl e s = 3 2 m g C e nt r a l n e e dl e s = 2 1 m g

A l l n e e dl e s h a v e a c t i ve l e n gt h o f 3 c m a nd 0 . 5 m m P t f i lt r a ti o n. T r e a t m e nt d i st a n c e = 0 . 5 c m f r o m t he p l a ne o f i m p l a nt W i d t h o f i mp l a n t

= 2.79 cm

L e n g t h o f i mp l a n t = 3 c m A r e a o f i m pl a n t = 2 . 7 9 3 = 8 . 4 c m 2

B e c a u s e o n e e n d i s u n c r o s s e d , t he a r e a f or t a b l e r e ad i ng p ur pos e s = 8 . 4 - 1 0 % ( 8 . 4 ) = 7 . 6 c m 2 . F r om P a t e r s o n - P a r k e r t ab l e ( T a bl e A . 12 . 1 i n the a p p e ndi x ) , t he m g - h / 1 , 0 00 R o r m g - h / 9 0 0 c G y r e q ui re d = 20 0 .

WWW.MEDRAD.IR

B. The Quimby System

T h e Q u i m b y s y s t e m (6 2 ) o f i n t e r st it i al im pl a nt a ti o n i s c ha r a c t e riz e d b y a uni f o r m d i s t ri b u tio n o f s o u r ces o f e q u al li ne a r a ct i vi t y . C o ns e q ue nt l y , t his a r r a ng e m e nt o f s o u r c e s r e s u l t s i n a n o n u n i f o r m d o s e di s t rib ut io n, hi g he r i n t he c e nt r a l r eg io n o f t r e at m e n t . F o r pl a n a r P.382 i m p la n t s , t h e Q u i m b y t a b le g i v e s t he m i ll ig ra m - ho ur s r e q ui r e d t o p r o d uc e 1 ,0 0 0 R i n t h e c e n te r o f t h e t r e at m e n t p l a ne s , up t o 3 c m di s t a nc e f ro m t he p l a ne o f i m p la n t . T h e s t a t ed do s e i s t h u s t he m a x i mum d o s e i n t he pl a ne o f t r e at m e nt . F or v o l u m e i m pl a n t s , t h e s t a te d do s e i s t he m i ni m um do s e w i t hi n t he i m pl a nt ed volume. T h e o r ig i n a l Q u i mb y ta b l e s , li k e t he M a nc he s t e r t ab le s , a r e b a sed o n a n e x po s ur e r a t e co n s t a n t o f 8 . 4 R c m 2 / m g - h i ns te a d o f t he c ur r e ntl y a c c e pte d v a l ue o f 8 . 25 R c m 2 / m g - h . A l s o , o th e r c o r r e ct io ns , na m e l y t he ro e ntg e n: c G y f a c t o r , ob li q ue f i l t r at io n , a n d t i s s ue a t te n u a t i o n, ha v e to b e ap pl ie d a s i n t he c a s e o f t he P a t e r s o n - P a r k e r ta b les . S h a l e k a n d S t o v a ll co m p a re d t h e Q ui m b y a nd t he P a te r s o n- P ar k e r s y s t e m s f o r s e l e ct ed i d e al i z ed c a se s a n d fo u n d t ha t f und a m e nt al di f f e r e nc e s e x i s t b et w e e n t he t w o s y s t e m s . T h e y c a u t i o n a g a i n s t t he us e o f t he s e s y s t e m s i nte r c ha ng e a b l y . It i s i m pe r a ti v e t h at a ra d i a tio n t h e r a pi s t us e o ne r a d i um s y s te m to t he e x cl us i o n o f the other (1).

C. The Memorial System

The M e m o ri a l of s y s t em , the as d e s c ri be d system by a nd L a ug hl i n is et al. (6 4) by in 19 6 3 , is an e x t e n s io n Qu i m b y c ha r a c t e ri z e d c o m pl et e do se

d i s t ri b u tio n s a r o u n d la t ti c e s o f p oi nt s o ur ce s o f uni f o r m s tr e ng th s p a c e d 1 cm a p a r t . B a s e d o n c o mp u t e r - ge n e r a te d do s e d i s t ri b uti o ns , t a bl e s w e r e c o ns t r uc te d that g a ve m il li g r am -h o u r s to d el i v er 1 ,0 0 0 rads at d e s ig na t e d po i nt s , fo r e x a m p le , m i n i m u m p e r ip h e r a l a nd r e f er e nc e m a x i m um d o se p o i nt s i n t he p l a n e 0 . 5 c m f r om t h e s o u r c e p l a ne f o r t he p l a na r i m pl a nt s . F o r vo l um e i m pl a nt s , s i m il a r d at a po i n t s w it h i n t h e i mp l a nte d v olum e a s w e l l a s c e nt ra l li ne p e ri p he r al d o s e po i nt s w e r e c ho s e n . T h e s e t ab le s us e p r op e r e x p o s ur e ra t e co ns t a nt a nd i n c l u d e t h e e f f e ct s o f o b li q u e f il t r at io n a nd t i s s ue a tt e nua ti o n. A n o t h e r m et h o d , k n ow n a s t h e d i m e ns i on a v e r a g i ng t e c hni que a l s o ha s b ee n u s e d a t M e m or i al H o sp i t al f or pe r m a ne nt im p l a nt s (6 7 , 68 ) . T he m e t ho d i s b a se d o n t h e r a t i o n al e t h a t r a d i a ti o n t ol e r a nc e o f t i s s ue d ep e nd s o n t he s i z e o f t he i m p la n t and the sma l l er volumes c o uld be i nte nti o na ll y g i v en larger doses. A c c o r d i n g to t h i s met h o d , t h e t ot a l a c ti v it y r e q ui r e d f o r a n im p l a nt i s d i re c tl y p r o po r tio na l to t h e a v e r a g e o f t h e t hr e e dim e ns i o ns o f t he i mp l ant r e g io n.

WWW.MEDRAD.IR

M a t h e m a ti c a ll y ,

w h e r e A i s t h e a c ti v ity i n m C i a nd d i s t he a v e r a g ed d i me ns i o n, t ha t i s , [d w it h bar a bo v e ] = (a + b + c)/3, w he r e a, b, I. a nd c are t he t hr ee m ut ua ll y p e r pe n d i c u l a r d im e n s io n s . T h e c o ns t a nt K o f p ro p or ti o na li t y i s b a s e d o n c li ni c al e x p e r ie n c e : K = 1 0 f or

222

Rn and K = 5 for

125

In a d d i ti o n t o t h e to ta l a c ti v it y r e q ui r e d f or a n i m pl a nt , o ne nee d s t o k no w t he n u m b e r o f s e ed s a n d t h e s p a c i n g b et w e e n s e e d s . A nd e r so n ( 6 8 ) ha s d e s c r i be d a nomogram for

125

I s e ed s p a c i n g t ha t t a k e s int o a c c o unt t he e lo nga t io n f a c t o r f o r

t h e i m pl a n t s h a p e , f o r e x a m p l e , s p he ro id o r c y l i nd e r .

D. The Paris System

T h e P a r i s s y s t e m ( 6 9) o f d o s i me t r y i s i ntend e d p r i m ar il y f o r r e m o v a b le i m pl a nt s o f l o n g li ne s o u r c e s , s u c h a s
192

Ir w i r e s . The s y s t e m pr e s c r ib e s w i d e r sp a c i ng f or

l o n g er s o u r c e s o r l a rg e r t r ea t me nt v o l um es . A s s um m a r i z e d i n T a b l e 15 . 8 , t he s o u r c e s a r e o f u n i f o rm l i n e a r a c ti v i t y a nd a r e im p l a nt e d i n p ar a l le l l i ne s . T he d e t ai l s o f t h e s y s t e m a r e d e s c ri b ed b y P i e r qui n e t a l . ( 7 0 ) . In t h e P a r i s s y s te m th e d o se s pe c i f i c ati o n i s b a se d o n a n i so do se s ur f a c e , c a ll e d t h e r e f e r e n c e i s od o se . H o w e v e r , i n p r a c t i ce , t he v a l ue o f t he r e f er e nc e i s od o se is f i x e d a t 85 % o f t h e ba s a l d o se , w hi c h i s d e f i ne d a s t he a ve r a g e o f t he m i ni m um d o s e be t w ee n s o u r c e s. It h a s be e n s ho w n tha t t he r e f e re nc e i s od o s e f o r a P a ri s i m p la n t surrounds the implant w it hi n a few m i l l i me te r s , a nd its v a l ue is a p p r o xi m a te l y eq u a l to 8 5% o f t he b a s a l do s e ( 71 ) . F i g ur e 1 5 . 18 i ll us t r at e s ho w t h e b a s al d o se i s cal c u l a te d i n d i f f e r e nt p a t te r ns o f im p l a nt s us i ng t he P a r i s system.

TABLE 15.8. RULES OF INTERSTITIAL IMPLANT SYSTEMS

Characteristi c

P a t e r s on Parker

Quimby

Paris

C om p u t e r a

Linear s t r e n gt h

V a r i a b le ( f u l l i n t e n s it y , 0.66 Ra/cm; i n t e n s it y , 0.33 Ra/cm) mg mg half

C o ns t a nt ( f ul l i nt e ns it y , 1 Ra/cm; ha l f i nt e ns it y , 0.5 Ra/cm) mg mg

C o ns t a nt ( 0 . 6 1 .8 mg eq/cm) Ra

C o ns t a nt ( 0 . 2 0 .4 mg eq/cm) Ra

Source d i s t ri b u tio n

Planar i m p la n t s :

U ni f o r m

U ni f o r m

U ni f o r m

WWW.MEDRAD.IR

Area cm2, area Ra 2/3 25

2

<25 Ra to in >100 1/3 Ra

in periphery; 100 cm , 1/2 p e r ip h e r y . Area cm2,

i n p e r ip h e r y

Volume i m p la n t s Cylinder: b e lt , parts; two each one Sphere: shell, parts; two Cube: side, part; two parts. si x co r e , parts. each one co r e , four co r e , parts; end, part.

U ni f o r m d i s t ri b utio n s o ur c e s t hr o ug ho ut t he v o l um e of

L i ne s o ur c e s a r r a ng e d i n p a r a l le l p l a ne s

L i ne s o ur c e s a r r a ng e d in p a r a l le l p l a ne s or c y l i nd r i c v o l um e s

Line

source

Constant a p p r o xi m a te l y 1 cm apart from each other or from crossing ends

Same Parker

as

C o ns t a nt , b ut s e l e ct ed a c c o r di ng to im p l a nt d i m e nsi o ns -larger s p a c i ng us e d large v o l um e s ; 8 mm m i ni m um to 15 mm in

C o ns t a nt , 11.5 cm, d e pe nd i n g o n s i ze of i m p la nt (larger s p a c i ng f o r l a r g er size i m p la nt s )

spacing

P a t e r s o n-

WWW.MEDRAD.IR

m a x i m um s e p a r a ti o n

Crossing n e e d le s

Crossing n e e d le s r e q u i r ed at ends to enhance dose i mp l a n t

Same Parker

as

C r o s s i ng ne e d le s not us e d ; active l e ng t h 3 0% to t a r g et l e ng t h 4 0% l o ng er t ha n

C r o s s i ng ne e d le s no t r e q ui r ed ; active l e ng t h s o ur c e s 30% 40% l o ng er t ha n t a r g et l e ng t h to of

P a t e r s o n-

The

computer

s y s te m

used

at

t he

U ni v e r s it y

of

M i nne s o ta

H o s p i t al .

F r o m K h a n F M . B r a c h y t h e r a p y : r ul e s o f i mp l a nt at io n a nd d o s e sp e c i f i ca ti o n. In : L e v i t t S H , K h a n F M , P o t i s h R A , ed s . T e c hno l og i c al b a si s of r a d i a tio n t h e r a p y . P h i l a de l p hi a : L e a & F e bi g er , 1 9 92 :1 1 3 , w i t h pe r m i s si o n.

P.383

E. Computer System
A n i m p l a n t s y s t e m t ha t h a s e v ol v e d t hr o ug h t he us e o f c om p ute r s b ut b e a r s no f o r m a l n a m e i s u s ed i n m a n y i n s t it ut io ns in t he U ni te d St a te s . I w i l l c al l i t t he c o m p u te r s y s te m . T h e i m pl a n t at io n r ul e s a re v e r y si m pl e : t he sour c e s o f uni f o r m s t r e n gt h a r e i m pl a n t ed , s p a c ed u ni f o r ml y (e . g . , 1 . 0 t o 1 . 5 c m , w i t h l ar g e r s p a ci ng f o r l a r g e r si z e i m pl a n ts ) , a n d c o v e r t he e nt ir e t a r ge t v ol um e . It i s r e a li z e d t h a t t h e i m pl a n t a ti o n o f unif o r m a c t i vi t y s o ur c e s g i v e s r i s e t o a n i m p la n t t h a t i s h o t ter i n t h e m i d d l e t ha n i n t he p e r i p he r y , a s i s t he c a s e w i t h t h e Q u i m b y a n d t h e Pa r i s s y s t e m s . Ho w e v er , t hi s do s e i nho m o gene i t y i s a c ce pt ed w i t h t h e b el ie f t h a t th e c e n t r a l p a rt o f t he t a r ge t w o uld ne ed hi g he r d o se s to s t e ri li z e t h a n t h e p e r ip h e r y . In t h e c o m p u t e r s y s te m , t h e t a r ge t v ol um e i s d e si g ned w i t h s uf f i c i e nt s a f e t y m a r g i n s s o t h a t t h e pe r i p h e r al s o ur c e s c a n b e p l a ce d a t t he t a r ge t bo und a r y w i t h a d e q u a te c o v e r a ge o f t h e t u m o r . T he d o s e is s p e c i f i ed b y t he i s od o s e s ur f a c e t h at j u s t s u r r o u n d s t h e t a rg e t o r t h e i mp l a nt . An i m p o r t a nt c r i te r io n i s f o l lo w e d: It i s b e tt e r to i mp l a n t a l ar g e r v ol u m e t ha n t o s e l e ct a l o w e r v a l ue is o d o se c ur v e to i n c r e a s e t h e c o ve r a ge . If t h e t a r ge t vo l um e i s d e si g ne d wi t h a d e q ua te s a f et y m a r g i n s , t h e p e ri p h e ra l s o u r c e s s ho ul d t hen b e i m p l a nte d o n t he o ut e r s ur f a c e o f

WWW.MEDRAD.IR

t h e t a r ge t vo l u m e . A ls o , t h e a c ti v e le ng t h o f t he li ne s o ur c e s s ho ul d be s ui t ab l y l o n g er ( [ a s y m pt ot i c all y equal to ] 40 % l o ng e r ) t ha n t he l e ngth of t he t a r ge t volume because of uncrossed ends. F i g u r e 15 . 1 9 A s h o w s is o d o se di s t ri b uti o n i n t he c e nt r al c r o s s - se c tio na l pl a ne f o r a c o m p u te r s y s t e m vo l um e i m pl a n t (t w o p a r al l el pl a ne s ) . T he p r e sc r i p tio n i s od o se c u r v e j u s t s u r r o u n d s t h e p e ri p h e r al so ur c e s . F i g ur e 15 . 1 9 B s ho w s t he i so do s e p a t te r n P.384 p r e s c r ip ti o n i s o do s e cu r v e i n t h i s pl a ne . In f a c t , t a r ge t vo l um e c o v e r a ge c a n b e v i e w e d i n a n y p l a n e o r t h r e e -d i me ns i o nal l y , p ro v i de d vo l um etr i c d at a f o r t he t a r g et a r e a v a il a bl e . in the lo n g it u d i n a l pl a ne t hr o ugh t he m i d dl e of i mp l a nt to a s s e ss a d e q u a te c o v e r ag e b y t h e

WWW.MEDRAD.IR

F I G . 1 5 . 1 8 . D et e r mi n a t io n o f b a s a l do s e ( BD ) i n i m pl a nt s usi ng the P a r i s s y st e m. A : L i n e so u r c e s i m pla n t e d i n p a tt e r ns o f ( a ) s i ng le pl a ne , ( b ) s q ua r e s , a nd ( c ) t r i a n gl e s . B : Is o do s e c u r v e s i n c e nt r a l p l a ne o f a v ol um e im p l a nt us i ng t he P a r i s s y s t e m . T h e i s od o se v a l u e s a r e no r m a li z ed t o t he a v e r a ge b a sa l d o se , w hi c h i s

WWW.MEDRAD.IR

g i v e n b y 1 / 4 ( B D 1 + B D 2 + B D 3 + BD 4 ) . ( F r om D ut r ei x A , M a r i ne l lo G . In: P i e r q ui n B , W i l s o n J F , C h a s s a g n e D , e d s . M o de r n b ra c hy t he r a p y . N e w Y o rk : M a s s o n, 1 9 8 7 , w i t h p e r mi s s io n . )

15.5. COMPUTER DOSIMETRY

T h e o l d e r do si m et r y s y s t e m s a r e b a s e d o n i d e a li z e d im p l a nt s c o nf o r m i ng to c e r t ai n d i st r ib u t io n r ul e s . In a c t u a l p r a c ti c e, ho w e v e r , s uc h i d e al d i s t ri b utio ns a r e s e l do m r e al i ze d . W it h a c o m p u te r , it i s po ss i b le to p re pl a n no t onl y i m p l a nts b ut a c o m pl et e i s od o se di s t ri b u ti o n , c o r re s po nd i ng t o t he f i na l s o ur c e di s t ri b uti o n. T h e r a p i d t u r n a r o u n d t i me w i t h t he m o d er n c o m p ute r s y s t e m s a ll ow s t he t he r a p i s t t o m od i f y t h e i mp l a n t , i f n e c e s s a r y , o n t he b a s i s o f 3 - D do s e di s tr i b uti o n.

F I G . 1 5 . 1 9 . Is o d o s e c u r v e s f o r a v o l ume i mp l a nt us i ng t w o p a r a ll el pl a ne s containing five

192

Ir l in e s o u r c e s p e r pl a ne . A : C e nt r a l c ro s s - s e ct io na l p l a ne . B:

L o n g it u d i nal p l a n e t h r o u g h m i d dl e o f i mp la nt . P r e s c r i pt io n d o se i s s pe c i f ie d o n t h e 4 5 c G y / h i so do s e c u r v e , w h i c h j us t e nc l o s e s t he i mp l a nt i n t he c e nt r al c r o s s s e c t io n a l p l a n e . ( F rom K h a n F M . Br a c hy t h e r a p y : r ul e s o f i mp l ant a t io n a nd do s e s p e c i f i ca ti o n . In : L e v i tt S H , K h a n F M , P o t i s h R A , e d s . T e c hno l og i c al b a s i s of r a d i at io n t h e r a p y . P h i la d e lp h i a : L e a & F e bi ge r , 1 9 92 : 1 13 , w i t h p er m i s s io n. ) P.385

C o m p u t e r c a l c u l at io n o f a br a c h y t he r a p y d o s e d i st ri b uti o n co ns i s t s o f r ep e at e d c a l c u l a ti o n o f d o se a t a p o i n t f o r e a c h o f t he i m pl a nt s o ur c e s . T he t ot a l do s e a t a g i v e n po i n t i s d et e r mi n e d b y s u m m i ng t he i nd i v id ua l so ur c e cont r i b uti o ns . P oi nt d o s e r at e s a r e c o mp u te d f o r e a c h o f a g r i d o f p o i nt s a r r a nge d i n a c ub i c l a t ti c e so that i so do s e curves may be ge ne r a te d in a ny a r b i t r ar y p la ne . T he i s o do se p a t te r n s c a n a l s o b e m a g n i f i ed a nd s up e r im p o s ed o n a n i m p l a nt r a d io g r ap h f o r v i e w i n g t he di s t ri b u ti on i n r e l a t io n t o t he p at i e nt ' s a na t o m y .

A. Localization of Sources
WWW.MEDRAD.IR

Dose

c al c u l a ti o n

al go r it h m s

r e q ui re

s p ati a l of

co o r di na te s t he so ur c e

for

each

r a d i oa c ti v e is us ua l l y

source.

T h r e e - di m e n si o n a l

re c o nst r uc t io n

ge ome t r y

a c c o m pl i s h e d b y u s i n g a s e t o f t wo r a di o gr a p hs , e x p o s ed w i t h e i t her o rt ho go nal o r s t e r eo - s h i f t ge om e t r y . M o s t p r o gr a ms a l l o w i np ut o f t he f i l m c oo r d i nat e s u s i n g a d i g it i z e r .

A.1. Orthogonal Imaging Method

A s d i s c u s s e d i n s e ct io n 1 5 . 4 A . 4 , t he o r t ho g o nal r a d io g ra p hs a r e t a k e n a t ri g ht a n g l e s , w it h t h e c e n tr a l a x e s o f t he x - r a y b e a m s me et i ng ap p ro x i m a te l y i n t he m i d dl e o f t h e i m pl a n t. U s u a l l y , A P f i l m a n d l a t er a l f i lm , e x p o s ed i s o c e nt r i c al l y , p r o v id e s u c h a g e o me t r y . T h e c o o rd i na te s y s t e m i s co nv e nt iona l l y e s t ab li s he d w i t h t h e x a x i s f r o m t h e r i g h t to t he le f t o f t he p a ti e nt , t he y a x i s f r o m i nf e r i o r to s u p e r io r , a n d t h e z a x i s f r o m p o st e ri or to a nt e ri o r . T he a nt er o po s t er io r f i lm r e p r e se n t s a m a g n i f ied v i e w o f t he i m pl a nt i m a g e p ro je c t ed o nto t he x y p l a ne w h i l e t h e l a te r al f i l m p r e s e n t s t he i m a ge p ro j e ct ed o nt o t he z y p l a ne . T he o r i gi n o f t h e c oo r di n a t e s y ste m i s c h o s e n t o b e a p o i nt id e nti f i ed t o b e t he s a m e o n b ot h f i l m s s u c h a s o n e e n d o f a s o u r c e . T he s o ur c e s c a n b e i d e nt i f ie d b y c o m p a r i ng t he y c o o r di n a te s o f t h e e n d s o n bo t h f il m s . Fo r e x a m pl e , a so ur c e e nd ha v i ng t he s m a l le s t y c oo r d i n at e o n o n e f i l m w il l ha v e t he s m a l le s t y c oo r di na t e o n t he o t her f i l m a l so , b e c a u s e t h e y a x i s i s c o m m o n t o b o t h f il m s . A f t e r a l l the s o ur c e s ha v e b e e n id e n ti f i ed , t h e tip a n d e n d o f e a c h l i ne a r s o ur c e i m ag e a re s a m p le d w it h a d i gi ti z e r , s a m pl i n g e ac h e n d s e q ue nti a ll y f ro m o ne f i lm to t he o the r . T he s o ur c e c o o rd i n a te s on each film are c o r re c te d for m a g ni fi c a ti o n a nd s to r ed in t he c o m p u te r a s x , y , a n d z c o o r d i na te s o f e a c h s o ur c e e nd . T h e p r o gr a m a l so d e te r m i n e s e r r o r s i n s o u r c e lo c a li z a t io n b y c o m p a r i ng t he y c o or d i na te s ( w hi c h s h o u l d b e t h e s a me ) o f a s o u r c e e nd o n b ot h f i l m s a nd c o m p a ri ng t he c a l c ul at ed p h y s i c a l l e n gt h w i t h th e a c t u a l p hy s i c a l l eng t h o f t he s o ur c e . If ( x 1 , y 1 , z 1 ) a nd ( x 2 , y 2 , z 2 ) a r e t h e c o o r d i n a te s P.386 o f t h e t w o e n d s o f t h e s o u r c e , t h e n t he l e ngt h L o f t he s o ur c e i s gi v e n b y :

WWW.MEDRAD.IR

FIG.

15.20. is

D i a g r am m o di f i ed

i ll u s t r at i ng from

s t er eo - s hi f t L L.

m et ho d

of of

sour c e

l o ca li z a t io n. r a d i at io n

(Drawing

Anderson

D o s i m et r y

i nt er s t it i al

t h e r a p y . In : H i l a r i s B S , e d . H a n d b o o k o f int e r s ti ti a l b r a c hy t he ra p y . A c t o n, M A : P u b l i s h i n g S c i e n c e s Gr o u p , 1 9 75 : 87 . )

A.2. Stereo-shift Method

T h e s t e r e o - s hi f t m et h o d o f s o u r c e lo c a li z a tio n c o ns i s t s o f t a k i ng t w o r a d io g r ap hs o f t h e s a me v i e w b ut t h e p at ie n t o r t he x -r a y t ub e i s s hi f t ed a c e r t ai n d i st a nc e (e.g., 20 cm) be t wee n the two e x p o s ure s . T he p ri nc i pl e of t he me t hod is i ll u s t r a te d i n Fi g . 1 5 .2 0 . S u p po s e bo t h f ilm s a r e a nt e ro po s te r ior , p a r a ll el t o t he x - y p l a n e o f t h e pa ti en t a s t h e t ub e i s s hi fte d i n t he y di r e ct io n b e t w ee n f i l m s . A t a b le to p f i d u ci a l m a rk e r i s u s e d t o s e r ve a s o r i gi n a t f i l m s , t h e z c o o rd i n a te s c a n b e d e r i v ed a s f o ll o w s . L et : O . B e c a us e t he x , y c o o rd i n a te s o f a p oi n t s o u r c e o r a so ur c e end c a n b e ob t ai ne d f ro m e it he r o f t he

P = p o i n t t o be lo c a li z e d t hr e e d i me ns i o na lly y 1 = d i s t a n c e b et w e e n i m a g e s o f P a nd O o n t he f i r s t f i l m y 2 = d i s t a n c e b et w e e n i m a g e s o f P a nd O o n t he s e c o nd f i l m s = f i l m s h i f t i n t h e o r i g i n O d ue to t ub e s hif t d = t u b e s h i f t d i st a n c e F = t a r g e t -t o - f il m di s ta n c e f = t a b l e - to - f il m d i st an c e

F r o m s i mi l a r tr i a n gl e s A P B a n d C P D

WWW.MEDRAD.IR

A l s o , f r o m s i mi l a r t r i an g l e s A O B a nd E O G

P.387

F r o m E q u a t io n s 1 5 . 2 5 a n d 1 5 . 2 6 , w e g e t

T h e a c c u r a c y o f t h e o r t h og o n a l f i l m m et ho d i s ge ne r a ll y b ett e r t ha n t ha t o f t he s t e r eo - s h i f t me t ho d (7 2 ) . F o r e x a m p le , sm a l l e r r o r s i n t he me a s ur e m e nt o f y c o o rd i n a te s p ro d u c e s a l a rg e e r ro r i n t he z v a l ue s . Ho w e v e r , t he st e re o - s hi f t m e t h od i s mo r e s u it ab l e fo r c a s e s i n w hi c h s o ur c e s c a nno t be e as i l y id e nti f i ed b y o r t h og o n a l f il m s s u c h a s a l a r g e num b e r o f s e e d s or s o m e so ur ce s b ei ng m a s k e d b y o v e r l y i n g bo n e .

B. Dose Computation
E a r l i e r co m p u te r p ro gr a m s w e r e us e d mo s tly t o ob t ai n l i ne a r so urc e t a bl e s , b uil d u p f a c t o r s , a n d s c a t t e r f a c t o r s . L a te r , p r og r a m s b e c a m e a v a il ab l e ( 63 , 6 4 , 65 ) to c a l c u l a te i s od o se d is t r i b ut io n s for i nd i v id ua l p a ti e nt s . C ur r e nt l y , a l m o st a ll t r e at m e n t -p l a n n i n g s of t w a r e p a c k a g e s p ro v id e b r a c hy t he r a p y do si m et r y . M o s t o f t h e s e p r og r a m s u s e e i t h er t h e S i e v er t i nt e g r al d i re c tl y o r p re c a l c ul at e d do s e t a b le s f o r d i f f e r e nt ty p e s o f s o u r ce s . S o me , b ut not a ll , us e tis s ue a t te nua t i o n c o r r e ct io n s , d i s c u s s e d i n s e c t io n 1 5 . 3 B. F o r r a di u m a n d o t h e r l o n g -l i v ed i so to pe s , t he do s e r at e s , p r e s e nt ed i n t he f o r m o f i s o do s e c u r v e s , c a n b e d i re c tl y u s e d t o c alc ul a t e im p l a nt d ur a t ion. I n t he c a s e o f t e m po r a r y i mp l a n t s of r e l a ti v e l y s ho rt - li v ed i s ot op e s s uc h a s
192

Ir , t he c o m p ut e r

c a l c u l a te s c u m u l a t ed d o s e , u s i n g d e c a y c or r e c ti o n f o r t he i mp la nt d ur a t io n. A n a p p r o xi m a te ti m e f o r t h e i mp l a n t d ur a ti o n ca n f i r s t be d et e rm i ned f r o m d o s e r a te [ D w i t h d o t a bo v e ] 0 wi t h o u t de c a y c o r r e ct ion a nd t he t o t a l do s e t o b e de li v e r ed . T h e c u m u l a t e d d o se D c i s t h e n g i v e n b y :

w h e r e T a v i s t h e a v e r ag e l i fe a n d t i s t he i mp l a nt d ur a ti o n. F o r p e r m a n e nt i m pl a nt s s u c h a s is given by:
125

I or

198

A u, c um ul a t e d do s e ( to c o m pl e te d e ca y )

15.6. IMPLANTATION TECHNIQUES

B r a c h y t h e r a p y s o u r c es a r e a pp li ed i n t hr e e w a y s : e x t e r na l a p pl ic a t o r s o r mol d s , i n t e r st it i al i mp l a n t at io n , a n d i n t r a c a v it a r y t he r a p y . A c ho i c e o f o ne te c hni q ue or t h e o t h er i s d i ct at e d pr i m a r il y b y t he s i z e and l o c a ti o n o f t he t umo r . F o r e x a m pl e , s u r f a c e m o l d s a re u s ed t o t r e at s m al l s up erf i c i a l a re a s , s uc h a s t he e a r o r t he li p ; i n t e r st it i al t h e r ap y i s i n d i c a te d w he n t he t um o r i s w el l -l o c al iz e d a nd c a n b e i m p la n t e d d i re c tl y ac c o r d i n g to a c c e pt ed r ul e s of di s t ri b ution; i nt r a c a v i t a r y

WWW.MEDRAD.IR

t h e r a p y i s u s e d w h e n a p p li c a to r s co nt a i ni ng r a d io a c ti v e so ur c e s ca n b e i ntr o d uc ed i n t o bo d y c a v i ti e s . In a l l t h e s e c a s e s , o wi ng t o t he s ho rt t r e at me nt d i st a nc e , t he g e o me t r y o f s o u r ce d is t r i b ut io n i s c r i ti c a l .

A. Surface Molds
P l a s t i c mo ld s a r e p rep a r e d ( 73 ) to c o nf o rm t o t he s ur f a c e to be t r e at ed a nd t he s o u r c e s a r e se c u r e l y p o s it io n e d o n t he o ute r s ur f a c e o f t he m old . T he d i st a nc e b e t w ee n t r e at m e n t the plane of of the sources 0.5 to to t he 1.0 skin cm. s ur f a c e T he is chosen to a nd give a di s t a n c e usually d o s i me t r y s o ur c e

d i s t ri b u tio n r u l e s a r e t h e s a m e f o r e x te r na l m o ld s a s f o r i nt e r st it ia l s o ur c e s ( 6 1 ) .

B. Interstitial Therapy
In i n t e r s t i ti a l t h e r a py , t h e r a d i o a c ti v e so ur c e s a r e f a b r i c at e d i n t he f o r m o f n e e d le s , w i r e s , o r s e ed s , w h i c h c a n b e i ns er t e d di r e ct l y i nt o t he t i s s ue . T he re a re b a s i c a ll y t w o t y pe s o f P.388 i n t e r st it i al i mp l a n t s : t e m po r a r y a nd pe rm a ne nt . In a t e m p or a r y i m p l a nt , t he s o u r c e s a re re m o v ed a f t e r t h e de s i re d do s e ha s b ee n de li v e re d (e . g . , r a di um n e e d le s , i ri di u m w i r e s, o r i r i di u m s ee d s ) . In a p e rm a ne nt i m pl a nt , t he so ur c e s a re l e f t pe r m a n e n t l y i n t he i m pl a n t ed t i s s ue s (e . g . , than a pe r m a n e n t im p l a n t . Ho w e v e r , t he
198

A u a nd

125

I s e e d s ) . In g e ne r a l , is a o ne - ti me

a t e mp o r a r y i m pl a n t p r o v id e s be tt e r co nt ro l o f s o ur c e d i st r ib ut io n a nd d o si m et r y pe r m a ne nt i mp l a nt p r o c ed u r e a n d i s a p r e f e r r ed m et ho d f o r s o m e t umo r s s uc h a s t ho s e i n t he a b d o mi n a l a n d t h o r a cic c a v i t i e s . A major t u be s i mp r o ve m en t p r e v io u s ly in t e mp o r a r y in i mp l a nt t he t e c hni q ue T hi s o c cur r e d p r o ce d ur e with t he i n t r od u c t io n o f a f t e rlo a d i n g t e c hni q ue s (74 , 7 5 ) i n w hi c h t he s our c e s a r e lo a de d into i m p l a n t ed t i s s ue s . e li mi na t e s e x p o s u r e i n t h e o p era t i n g ro o m , x - r a y roo m , a nd t he ar e a s thr o ug h w hi c h t he p a t ie n t i s t r a n s po rt ed . D u m m y s o ur c e s a r e us e d fo r r a di og r ap hi c lo c a li z a t io n a n d d o s i me t r y . T h e r ad i o a ct i ve s o ur c e s a re l o a de d a f te r t he p a ti ent i s r e t ur ned to h i s o r h e r r o o m a n d th e i m p l a n t ha s b ee n e v a l ua t e d . Figure 15 . 2 1 il l u s t r at e s the b a si c p ri nc ip l e s of t he a f t e rl o ad i ng t e c hni q ue d e s c r ib e d b y H e n s c h k e e t al . ( 7 4 ) . S t ai nl es s s t e el ne e dl e s (e . g ., 1 7 g a ug e ) a re f i r s t i m pl a n t ed i n a n d a r o u n d t h e t um o r . The ny l o n t ube s a re thr e a d e d t hr o ug h t h e n e e dl e s , a n d t h e n e e d le s a r e t he n w it hd r a w n, l e a v i ng t he ny l o n t ub e s i n p l a c e . T h e n y lo n t u b es a r e s e c u r ed i n p o si tio n b y b utt o ns o n t he s k i n s ur f a c e . T he t u b e e n d s a r e t h e n u s u a l l y c u t o f f a f e w c e n t i me t er s b e y o nd t he but t o ns . M a n y v a r i a t i o n s o f t h e a b o ve p ro c e d ur e ha v e b e e n p ubl i s hed in t he l it e r at ur e. F u r t h e r d e t ai l s c a n b e o b t ai n e d f r o m H il a r i s ( 7 6 ) . T h e s i m p l e st d e v i ce f or p e r m a n e nt i m pl a nt s i s a s i ng l e - se e d i ns e rte r c o ns i s ti ng o f a s t a i n l e s s - st ee l n e ed l e . E a c h s e e d i s i nd i v i d ual l y l o ad ed i nto t he t ip o f t hi s n e e d le a n d , a f te r i n se r ti o n i nt o t he ti s s ue, t he s e ed i s p us he d o ut b y a st y le t . T h i s t e c h n i q u e , h o w ev e r , i s u n s a t i s f a c to r y f o r t he i m pl a nt a tio n o f d ee p - s e at ed t u m o r s a n d v o l u m e imp l a n t s r eq u i r i ng m a ny s e e d s .

WWW.MEDRAD.IR

F I G . 1 5 . 2 1 . Il l u s t r a tio n o f a n a f t e rl oa d i ng t e c hni q ue fo r G r o u p , 1 9 75 : 8 7 , w it h p e r m i s sio n . ) P.389

192

Ir s e ed s . ( F r o m Hi l a ri s

B S , e d . H a n d b o o k o f i n t e r st it i al b r a c hy t he r a p y . A c t o n, M A : P u b l i s hi ng S ci e nc es

A n a f t e r l o a di n g t e c h n iq u e h a s a l s o b e e n a d op t ed f o r t he p e r m a ne nt i m pl a nt s ( 7 7 ) . T h e f i r s t s t ep i n t h i s te c h n i q u e c o ns i s ts o f ins e r t i ng unl o ad e d 17 -g a ug e s t ai nl e s s s t e el n e e dl e s i n to t h e t u m o r . T h e ne e d l e s ar e s p a c e d 1 to 2 c m a p a r t , d ep e nd i ng o n t h e si z e o f t h e t u m o r . T h e n e ed le s a re t he n a f t e rl o ad e d w i t h r ad i o a ct i ve s ee d s , u s i n g a s p e ci a l i mp l an t a t io n i n s t r ume nt t ha t a ll o w s i ns e rt io n o f s e v e r a l s e ed s at d i f f e r e n t de pt h s , d e t er m i n e d b y a g a ug e a s t he ne e dl e i s w it hd r aw n. S e e d - i nt r od u c i n g guns (76,78) ha v e b een devised t hat a l low p r e l o ad i ng of r a d io a c ti v e s ee d s i nto a m a g a z i ne f r o m whi c h t he y a r e p us he d i nt o t he ne ed le ,

WWW.MEDRAD.IR

a n d t h e n i nt o t h e t is s u e . T h e s e i nst r um e nt s a r e c o nv e nie nt t o us e a nd c an p r o v id e g re a te r p r eci s io n than p o s s ib le with s i ng le s e ed i ns e r t e r s . Mo d e r n t e c h n i q u e s o f s ee d i mp l a n t s a r e di s c us s e d in C ha p t e r 2 3 .

C. Intracavitary Therapy C.1. Uterine Cervix

In t r a c a v i t a r y t h e r a p y i s m o s t l y us e d f o r c a nc e r s o f t he ut e r i ne c e r v i x , ut e r i ne b o d y , a n d v a g i n a . A v a r i et y o f a p p li c at o r s ha v e b e e n d e si g ned to ho l d t he so ur c e s i n a f i x e d c o n f i g u r a t io n . A c e r v i x a p p l i c at or b a s i c a ll y c o ns i s t s o f a c e nt r a l t ub e, c a l l ed t h e t a n de m , a n d l a t e r al c a p s ul e s or o v o i d s . T he o v o ids a r e s e p a r a te d f r o m e a c h o t h e r b y s pa c e r s . S i n c e t h e f i r st a pp li ca t io n o f r a di um i n t he t re a t me nt o f c a nc e r o f t he ute r us i n 1 9 08 , s e v e r a l te c h n i qu e s h a v e e v o l v e d , m o s t o f w hi c h a r e m o di f i c a ti o ns o f t he S t o c k h o l m t e c h n i q u e ( 7 9 ) a n d t h e P a r i s t ec hni q ue ( 8 0 ) . T he M a nc he s t e r s y s t e m , w h i c h e v o l v e d f r o m t h e P a r i s t e c hniq ue , us e s a r ub b e r ut e r i ne t a nd e m to ho ld o ne t o t h r e e r ad i u m t u b e s a n d r u b b e r o v o id s , se p a r a te d b y a r ub b e r s p a c e r , to e a c h h o l d a r a di u m t u be . Th e r a d i at io n i s d el i ve re d i n a t l e a st t w o ap pl i c at io ns . In t he F l e t c h er - S u i t ap pl i c ato r ( 75 , 8 1 ) ( F ig . 1 5 .22 ) t he t a nde m a nd t he o vo i d s ( o r t he c o l po st a t s ) a r e m a de o f s t a i n l e s s s t ee l and t he n s e c ur e d t o ho ll o w ha nd l e s to p e r m it a f te r lo a di n g of the sources. T a ble s ha v e been de v i se d with v a r io us c o m bi n a t io n s o f e x te rn a l b e a m t he r a p y a nd i nt r a c a v it a r y r a di um us i ng s t a nd a rd l o a di n g s ( 8 2 ) .

F I G . 1 5 . 2 2 . A F l e t c h e r - S u i t e a pp li c a to r s e t . ( F r o m Fl et c he r G H . T e x t b o o k o f r a d io t h e r ap y , 2 n d e d . P h i l a d el p h i a : Le a & F eb i ge r , 1 9 73 : 62 0 , w i t h p e r m i s si o n. ) P.390

WWW.MEDRAD.IR

C.2. Uterine Corpus

C a n c e r o f t h e u t e r i n e b o d y c a n b e t r e at ed w i t h r a d i um o r c e s i um s o ur c e s us i ng H e y m a n c a p s u l e s ( 83 ) . T h e s e c a p s ul e s a r e a v a i l a bl e i n d i f f e r e nt s i z e s , e a c h c o n t a i n i n g 5 to 10 mg - R a e q so ur c e . T he H e y m a n t e c hni q ue c ons i s t s o f p a c ki ng t h e u t e ri n e c a v it y w i th m u l t i pl e so ur c e s . Ta b l e s ha v e b e e n p ubl is he d t ha t sp e c i f y d o s e t o t he i n s i d e s u rf a c e o f t h e ute r i ne c av i t y i n te r m s o f mi ll igr a m - ho ur s ( 8 3 ) . T h e s e d o s a ge s h a v e b e e n e s t a bl i s he d o n t he b a s i s o f v a r io us m ea s ur e m e nt s , a nd t h e r e f o re , i n d i v id u a l pa t i e nt c a l c ul at io ns a r e us ua l l y no t r e q ui r ed .

15.7. DOSE SPECIFICATION: CANCER OF THE CERVIX

P i e r q u i n e t a l . ( 70 ) h a v e r e v i e w e d v a r io us s y s t e m s o f d o s e s p ec i f i c a ti o n f o r t he c e r v i x t re a tm e n t . W he r e a s no si ng l e s y s tem ha s b ee n de v i s ed tha t c a n m ee t a ll t h e c r i te r i a o f do s e s p e c i f i ca ti o n, t hr e e sy s t e m s a r e d e s c ri be d t ha t a r e m o s t c o m m o n l y u s e d i n m an y f o r m s a n d c o m b i na t io ns .

A. Milligram-Hours
O n e o f t h e ol de s t s y s te m o f do s e s pe c i fi c a tio n f o r t he b r a c hy t he ra p y t r e at m e nt o f c e r v i x i s t h e mi ll i g ra m- h o u r s , t h a t i s , t he p ro d uc t o f to t al so ur c e s t r e ngt h a nd t he i m p la n t d u r a tio n . T h e r a t io n a l e f o r t hi s s y st e m i s b a se d o n e x te ns i v e c li ni c a l d at a t h a t h a v e b e e n a c c u m u l a t e d u s i n g p a r ti c ul ar a p pl i c at o r s a nd g ui de l i ne s f o r s o ur ce l o a di n g a n d i m p la n t du r a t i o n f o r v a r i o us s ta g e s o f t he d i s ea s e . T he m o s t no t a bl e e x a m p le o f t h i s s y s t em i s t h e F l et c he r g uid e li ne s , w hi c h w e r e d e v e lo p ed o n t he b a s i s o f M . D . A n d e r s o n e x p e r ie n c e ( 8 4 ) . It i s o b v io u s t h a t t h e d o s e s pe c i f i ca ti o n b y m i ll i gr a m - ho ur s a l o ne i s no t a d e q uat e . It l a c k s t h e i n f o rm a ti on o n s o u r c e a r r a ng e me nt , po s it io n o f t a nd em r e la ti v e t o t he o v o id s , p a c k i n g o f t h e a p p l i c at o r s , t umo r s iz e , a nd p a t i e nt a na t om y . B y c o m p ut e r d o s im e tr y , i t i s e a s y to s h o w t h at a do s e spe c i f i c at io n s y s t e m b a se d o n m i ll ig r a m h o u r s a l o n e i s f r a u g h t w i t h l a r g e unc e r ta i nt ie s i n t he d o se d i s t ri b utio n f r o m p a t ie n t to p a ti e n t . Although t he m il li g ra m - ho ur s is an i mpo r t a nt t re a t me nt p a r a m et e r , it c a n n o t b e m a d e t h e s o le b a s is o f d o s e - re s p o ns e c ur v e .

B. The Manchester System

T h e M a n c h e s t e r s y s te m i s o n e o f t he o ld e s t a nd t he mo st e x t e ns i v el y us e d s y s t e m s i n t h e w o r ld . It i s c h a r a c t e ri z e d b y d o s e s t o f o ur p oi nt s : p o i nt A , p oi nt B , a b l ad d er po i n t , a n d a r e c t u m po i nt . T he dur a t i o n o f t he i m p la nt i s b a s e d o n t he d o s e r at e c a l c ul a t ed a t p oi n t A , a l t ho ug h t he d o se a t t he o t he r p o i nt s i s t a k e n i n t o co n s i d e r ati o n i n e v a l u a t i n g a t re a t me nt p l a n. W i t h t he av a i l a bi li t y o f t he t r e at m e n t pl a n n i n g c om p u t e r s , m o st us e r s o f t he M a nc he s t e r s y s t e m e x a mi ne t he i s o do s e d i st r ib u t io n s i n t h e f r o n t al a nd s ag i tt a l p l a ne s i n a dd iti o n to o b ta i ni ng d o s e at t h e f o u r d es i g n a t ed p oi nt s . P oi nt p r e s c r ip ti o n . P o i n t A w a s o r ig i n a ll y d e f i n e d a s 2 c m s up er i o r t o t he l a te r a l v a gi na l f o r ni x a nd 2 c m l at e r al to t h e ce r v i c a l c a n al ( F ig . 15 . 2 3) ( 8 5 ) . L a te r , it w a s re d e f i ned t o b e 2 c m s u p e r io r t o t h e e x t e r n a l ce r v i c al o s ( o r c e r v i c a l e nd o f t he t and e m ) , a nd 2 cm l a t er a l to t h e c e r vi c a l c a n a l ( 8 6 ) . P o i nt B i s d e f i ne d 3 c m l a t er a l to p oi nt A . Id e a l l y , a p oi n t A r ep r e s e n t s t h e lo c a ti o n w he r e t he ut e r i ne ve s s e l s c ro s s t he u r e t e r . It i s b el ie v e d t h a t t h e t ol e r a nc e o f t he s e st r uc t ur e s i s the m a i n l i mit i ng f a c t o r i n t h e i r r ad i at io n o f t h e u te r i ne ce rv i x . T he a na t o mi c s igni f i c a nc e o f p oi nt A s t il l r e m ai ns t he p oi nt o f d ose

WWW.MEDRAD.IR

A , h o w e v e r , h a s b e e n q u e s t io n e d b y s e v e r al i nv e s t ig a to r s ( 7 0 ,8 4, 8 7 ) . T he c r i t i cs p o i nt o ut t h e f ol lo w i n g li m it a ti o n s o f po i nt A : ( a ) it r el at e s t o t he po s it io n o f t he s o u r c e s a n d no t to a s p e ci f i c a na to mi c s tr uc t ur e ; ( b ) d o se t o p oi nt A i s v er y s e n s i ti v e t o t h e po s iti o n o f t h e o vo id so ur c e s r el a ti v e to t he ta nd e m so ur c e s , w h i c h s h o u l d n o t b e th e d e t e rm i n i ng f a c to r i n d e c i di ng o n i m pl a nt d ur a t i o n; a nd P.391 ( c ) d e pe n d i n g o n t h e s i z e o f t h e c e r v i x , p o i nt A m a y l ie i ns ide t he t um o r o r o u t s id e t h e t u mo r ( Fi g . 15 . 2 4 ) . T hus , d os e p r e s c ri pt io n a t p oi nt A c o ul d ri s k u n d e r d o s a ge o f l a r ge c e r v i c a l c a n c e r s o r o v e r d o s ag e o f s m al l o nes .

F I G . 1 5 . 2 3 . O r i g i n a l d e f i n i ti o n o f po i nt s A a nd B , a c c o r d i ng t o t he M a nc he s t er s y s t e m . ( F r o m M e r ed it h W J . R a d i um do s a ge : t he M a nc he s te r s ys t e m . E d i nb ur g h: L i v i n g st o n e , 1 96 7 , w i th p e r m i s s io n. )

B.1. Dose to Bladder and Rectum

T h e c o l po s t at s i n t h e F l e t c h er - S u i t a pp li c a to r a r e p a rt i al l y s hi el de d a t t he t op a nd the bo tt o m to p ro vi d e so me p ro te c ti o n to b l ad de r a nd rec t um . However, d o s im e tr i c al l y i t i s di f f i c u l t t o d em o ns t r at e t he e xt e nt o f p rot e c tio n a c t ua ll y p r o v id e d b y t h e se s h ie l d s .

WWW.MEDRAD.IR

F I G . 1 5 . 2 4 . V a r i a ti on o f po i n t A r el a ti v e t o a na to m y . A : P oint A i ns id e l a rg e c e r v i x , r e s u lt i n g i n u n d e r d o s ag e . B : Po i nt A o ut si d e s m a ll c e rv i x , r e s ul ti ng in o v e r do s a g e . ( F ro m Pierquin B, W i l son JF, C ha s s a g ne D, eds. M o de r n b r a c h y t h e r a p y . N e w Y o r k : M a s s o n, 1 9 8 7 , w it h p e r m i s si o n. ) P.392

T h e d o s e to bl a d de r an d r e c t u m de pe nd s o n t he di s t ri b uti o n o f s our c e s i n a gi v e n a p p li c a ti o n . If t h i s d o s e i s a s s e s s ed t o be t oo hi g h e i t he r b y m e a s ur e m e nt o r c a l c u l a ti o n , o n e h a s th e o pt io n o f al te r i ng t he ge o me t r y o f t he so ur c e s . A lt ho ug h v a r i o u s i n s t r u m e n t s , in c l u d i n g i n t r a c a v it a r y i o ni z a ti o n c ha m b e r s , a r e a v a i l a bl e f o r s u c h m e a s u r e m e n t s , th e c a l c u l at io n m et ho d ha s b e e n fo und t o b e m o r e r el i ab l e in this case. The lo c a li z a t io n of bl a d de r and r e c t um can be p e r f o r me d us i ng r a d io g r a p h s ta k e n w i th c o n t r a s t me d i a i n the b l a dd e r a nd re c t um . T he m a x i m um d o s e t o bl a dd e r a n d re c t u m s h o ul d be , a s f a r a s p o s s ib l e , l e s s tha n t he d o s e to p o i nt A ( e . g . , 8 0 % o r l e s s o f t h e do s e to po int A ) .

C. The International Commission on Radiation Units and Measurements System

T h e IC R U h a s r e c o m m e n d e d a s y st e m o f d o s e sp e ci f i c a ti o n t ha t r e la t e s t he do se d i s t ri b u tio n t o t h e t a rg e t v ol u m e , i ns t e ad of t he d o s e t o a s p e ci f ic p o i nt ( 88 ) . T he d o s e i s p re s c r ib ed a s t h e v a l u e o f a n i s o d o s e s ur f a c e t ha t j ust s ur r o und s t he t a r g et v o l u me . F i g u r e 1 5 . 25 il l u st r a te s t h e c o n c e pt o f t ar g e t v o l ume w he n onl y i nt r a c a v it a r y t r e at m e n t is g i ve n and when i nt r a c a v ita r y a nd e x te r na l b ea m t he r ap y are

WWW.MEDRAD.IR

c o m bi n e d . F o r t h e i n tr a c a v i t a r y t re a tm e nt , t he t a rg et v o l ume i ncl ud e s t he c e r v i x r e g io n a n d t h e c o r p u s. T a b l e 1 5 . 9 s u m m a ri z e s t h e IC R U s y s t e m o f d o se s pe c i f i c at io ns, w hi c h i nc l ud e s r e c o r di n g o f v a r io u s t r e a t me n t p a r a m et e r s . T he s e p a r a m e te r s a r e d i s c us s e d .

D e s c r i pt io n a p p li c a ti o n .

of

the

Te c h n i q ue .

M i ni m um

inf o r m a t io n

s ho ul d

i nc l ud e

t he

a p p li c a to r t y pe , s o u r ce t y p e a nd l o ad i ng a nd o r t ho go na l r a di og r ap hs o f t he

T o t a l R e fe r e n c e A i r Ke r m a . By t hi s p a r a m e t e r i s m e a nt t he t ot a l a i r k e r m a s t r e n gt h o f s o u r c e s t im e s t he i mp l a nt d ur at io n. T hi s i s s i m i l a r to t he to t al m i ll i gr a m - h o u r s o f r a d i u m o r to t al m g - R a eq - h e x c e p t t ha t t he so ur c e s a r e c a l i b ra t ed i n u n i t s o f a i r k e r m a s t r e ngt h, t ha t i s , G y m 2 h - 1 .

F I G . 1 5 . 2 5 . D e f i n i t ion o f t a r g e t a nd tr e atm e nt v o l um e s f or b r ac hy t he r a p y a n d e x t e r n a l be a m t re a t m e nt . ( F r o m IC R U . D o s e a nd v ol um e s pe c i f i c at io n f o r r e po r ti n g i n t r a c av i t a r y t he r a p y i n g yne c o lo g y . IC R U R e p or t N o . 3 8 . Bethesda, MD: In te r n a t io na l C o m mi s s io n on R a d i at io n U ni t s a nd M e a s u r e m e n t s , 1 98 5 , w i t h p e r mi s s io n. )

TABLE

15.9.

DATA

NEEDED

FOR

REPORTING

INTRACAVITARY THERAPY IN GYNECOLOGY (ICRU)

WWW.MEDRAD.IR

D e s c r ip ti o n Total D e s c r i pt io n Dose Dimensions Absorbed Bladder Rectal Lymphatic Pelvic T i m e - do s e p at te r n of of le v e l

of r e f e r e nc e t he if v o l ume at

t he air r e f e r e nc e no t ( he i g ht , r e f e r e nc e 60 w i d t h,

t e c hni que kerma v o l ume Gy t hi c kne s s ) p oi nts p o i nt p o i nt t r a p e zo id p o int

r e f e r e nc e do s e

r e f e r e nc e r e f e r e nc e wall r e f e r e nc e

F r o m IC R U . D o s e a n d v o l um e s pe c i fi c a ti o n f o r r e po r ti ng i nt r a c av i t a r y therapy in g y n e c o lo g y . IC R U report no . 38. Be t he s d a , MD: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 8 5 .

P.393
R e f e r e n c e V ol u m e . T h e r e f e r e nc e v o l um e i s t he v o l um e o f the i s o do se s u r f a c e t h a t j u s t s u r r o u n d s t he t a r ge t v olum e . T he v a l ue o f t hi s i s od o se s u r f a c e , b a s e d o n t h e P a r i s e x p e ri e nc e ( 70 ) , i s s e t a t 60 G y . T h e p r e s c r ip ti o n i so do s e v a l u e o f 60 G y i nc l ud e s t he d o s e co nt ri b ut io n f r o m t he e x t e r n a l be a m . T h e re f e r e n c e v ol um e f o r the i nt r a c a v i t ar y p a r t o f t he t re a t me nt s h o u l d b e i de n t i fi e d a n d i t s d i me ns i o ns r e c o r de d . F i g ur e 15 . 26 s ho w s ho w t he h e i g h t ( d h ) , w id t h P.394 ( d w ) , a n d t h i c k n e s s ( d t ) o f t h e p e a r - s ha ped r e f e r e nc e vo l um e ca n b e m e a s ur ed f r o m t h e ob li q u e f r on t a l a n d o bl iq ue s ag it t al pl a ne s . T he r e f er e nc e v ol um e i s a p p r o xi m a te d b y ( d h d w d t ) c m 3 .

WWW.MEDRAD.IR

F I G . 1 5 . 2 6 . D e t e r min a t i o n o f t he

re f e r enc e

i s o do s e

s ur f a c e d i m e nsi o ns .

dw,

w i d t h ; d h , h e ig h t ; d t , t h i c k n e s s . ( F r o m IC R U . D o s e a nd v o l um e s p e c i f i c at io n f o r r e p o rt i n g i n t r a c a v it a ry t h e r a p y i n g y ne c o l og y . IC R U R e p o r t N o . 38 . Be t he s d a , M D : In t e r n a t i o n al p e r m i s sio n . ) C o m mi ss i o n on R a d i at io n Uni t s a nd Me a s ur e m ent s , 1 98 5 , w it h

WWW.MEDRAD.IR

F I G . 1 5 . 2 7 . L o c a li z a t io n o f bl a d de r a nd re c t um po i nt s . ( F ro m IC R U . D o s e a nd volume sp e c i fi c a ti o n for r ep o rt i ng i nt r a ca v i t a r y t he ra p y in gy ne c o l og y . IC R U R e p o rt No . 38 . B e t hes d a , M D : Int e r na tio na l C o m mi s s io n o n R ad i a ti o n U ni t s a nd M e a s u r e m e n t s , 1 98 5 , w i t h p e r mi s s io n. )

C.1. Absorbed Dose at Reference Points

B l a d d e r P oi n t . T h e bl ad d e r p oi nt i s l o c al i z ed b y us i ng a Fo le y c a t he t e r , wi t h t h e b al loo n f i ll ed w ith a c o nt r a st ma t er i al. O n t he f ro nt a l r a di og r a p h, t he b l a dd e r p oi n t i s m a rk e d at t he c e nte r of t he b a ll oo n; o n t he l at e r al r a d io g r a p h , t h e bl a d de r p oi nt i s ob t ai ne d on a l i ne d r a w n a nt e r op o s te r io rl y t h r o u g h t h e c e n t e r o f t h e b a ll oo n, a t t he p os t e ri o r s ur f a c e ( F i g . 15 . 2 7 ) .

R e c t a l P oi n t . T h e re c ta l po i nt i s id e nti f i ed o n t he f ro nt a l r a di og ra p h a t t he m i d po i nt o f t h e o v oid s o ur c e s ( or at t he l o we r e nd o f t he i nt r a ut e ri ne s o u r c e ) . O n t h e l at e ra l r a di og r a p h, t he r ec t a l p oi nt i s l o c at ed o n a li ne d r a w n f r o m t h e mi d dl e o f t he o vo id s o ur ce s , 5 m m be hi nd t he p o st e r io r v a g i n a l w a l l ( F i g . 15 . 2 7 ) . T he p o s t er io r v a g i na l w a l l m a y b e v i sua l i z e d b y u s i n g r a d i op a q u e g a u z e f o r t he v a g i na l p a c ki ng .

L y m p h a t i c T r a pe z o id o f F l e t c her . T he s e p o int s c o r r e s po nd to t he p a r a a o r ti c a n d i l i a c n od e s a n d a r e s h o w n i n F i g . 1 5 . 2 8 . P e l v i c W a ll P o i n t s . O n t h e a nt e r o po st e ri o r ra d i og r a p h, t he p el v i c w a l l p oi nt s a r e l o c at e d at t h e i n te r s e c ti o n o f a ho r i z o nt a l t a nge nt t o s up e ri or a s p e c t o f t h e a c et a b u l u m a n d a v e r ti c a l l i ne to uc hi ng t he m ed i al a s pec t o f t he a c e t a b u l u m . O n t h e l a t e r al v i e w , t he s e p oi nt s a r e m a r k e d a s the hi g he s t m i d di s t a n c e poi n t s o f t h e r i g ht a nd le f t a c eta b ul um s ( F i g . 1 5 . 29 ) .

WWW.MEDRAD.IR

T i m e D o se P a tt e r n . Th e d u r a t io n a nd ti me s e q ue nc e o f t he i m pl ant r e l at i ve t o t h e e xt e r n a l be a m t r e at m e nt s ho uld b e re c o r de d .

D. Commentary
S e v e r a l p a pe r s h a v e d i s c u s s e d t he pr o s and c o ns o f v a r i o us d o s e s p e ci f i c at io n systems for the i n tr a c a v i t a r y t r e at m e nt of cervix na t ur e c a nc e r ( 7 0 , 8 8 ,8 9 , 90 ) . At p r e s e n t , u n i v e r s a l agr e e m e nt d oe s no t e xi s t a s to t he s up e ri or i t y o f a ny o ne system. The p r o bl e m i s p e r h a p s w i t h t he o f b r a c hy t he r a p y a hi g hl y e m p i ri c a l di s c ip li n e , n o mo r e s o p hi s ti c a te d t ha n g o ur m et co o ki ng. H o w e v e r , a s i n c o o k i n g , t h e re i s a l it tl e bi t o f e v e r yt hi ng: a r t , s c i e nc e , t e c hniq ue , a nd t a s t e . Although P.395 I w o u l d l i k e t o t a ke th e a u t h o r ' s p r i v i le g e a nd e x p r e s s m y o p i nio n o n t he s ub j e c t o f d o s e s pe c i f ic a ti o n f o r c e r v i x t r e at me nt . do s e sp e ci f i c a ti o n s y s te m s sho ul d be e ndo r s ed by a p p ro p ri a te c o m m it te e s ,

F I G . 1 5 . 2 8 . D e t e r min a t i o n o f re f e r e nc e po i nt s co r r e sp o ndi ng to t he l y m p ha t i c t r a p e zo i d o f F l et c h e r . ( F r o m IC R U . D o s e and v o l um e s p e ci f i c at io n f o r r e po r ti ng i n t r a c a v it a r y In t e r n a t i o n al p e r m i s sio n . ) therapy in gynecology. on R a d i at io n IC R U Uni t s R e p o rt a nd No. 38. Be t he s d a , 1 98 5 , MD: w it h C o m mi ss i o n Me a s ur e m ent s ,

E s t a b li s h e d te c h n i q u e g u i d e li ne s s ho ul d b e f o l lo w e d to t a k e a d va nt a g e o f t h e v a s t a m o u n t o f c lin i c a l d at a t ha t ha v e be e n a c c um ul a te d wi t h e x c e ll e nt results.

WWW.MEDRAD.IR

B y u s i n g s e m ir i gi d a pp l i c at or s uc h a s Fl et che r - S ui t a nd t he r e com m e nd e d s o u r c e lo a di n g s o n e e n s u r e s c o ns i s te nc y of t e c hni q ue . H o w e v e r , t he do s e d i s t ri b u tio n p a tt e r n s w i l l v a r y f r o m p at ie nt to p a ti e nt , d e pe nd ing o n t he p a c k i n g a n d t h e s o u r ce g e om e tr y a c hi e v e d .

T h e m o s t s ig n i f i c a n t p a r a m et e r s t ha t d et er m i ne t he cl i ni c al o ut c o me , i n t e r m s o f t u m o r c o n t rol a n d co m pl i c at io ns , ar e t he m g R a e q - h o r t he t ot al r e f e r e n c e a i r k e r m a , so u r c e l o ad i ng , a nd t he t y p e o f a p pl i c at o r use d .

D o s e t o t h e IC R U r e c om m e nd e d re f e r e nc e po i nt s p ro v id e us e f ul inf o r m a t io n i n r e g a r d to t h e to le r an c e a nd a d e q ua c y o f t r e a t me nt . F o r e a c h a pp li c a ti o n , t h e i so do s e di s tr i b ut io n s ho ul d be v i e w ed a t le a s t i n t h e f r o n t a l a n d s a g it ta l p l a ne s ( c o nt ai ni ng t he i ni t i al s t r ai g ht pa r t o f t he t a n d e m ) . T h e t a rg e t ( c e r v i x r eg io ns a nd co r p us ) s ho uld be v i sua l i z e d o n t h e i so do s e p at te r n s t o de te r m i ne t he is o d o se s ur f a c e v al ue t ha t j us t s u r r o u n d s t h e t a r g et v o l u m e . T hi s s ho ul d b e c a l le d t he mi ni mum t a r g e t dose.

T h e i m p l a n t d u r at io n s h o u l d b e b a se d o n t he m i ni m um t a r ge t do se r a t e .

F I G . 1 5 . 2 9 . D e f i n i tion o f p e l v i c w a l l p oi nt s . L e f t , A nt e ro po s t eri o r v i e w . R ig ht , L a t e r al view. (From therapy IC R U . in on Dose a nd v o l um e Uni t s a nd s p e c i fi c a tio n No. 38. for r e p o rt i ng MD: w it h 1 98 5 , i n t r a c a v it a r y In t e r n a t i o n al p e r m i s sio n . ) P.396 gynecology. R a d i at io n IC R U R e p o rt Be t he s d a ,

C o m mi ss i o n

Me a s ur e m ent s ,

It i s r e a li z e d t h a t th e w e a k n e s s o f t he w ho l e s y s t em l ie s i n t he i na b il it y to visualize the t a rg et volume. U nl e s s t he t a r g et v o l um e c an be a c c ur a t e l y d e te r m i n ed a n d s u pe ri m po s e d o n t he i so dos e p at t er n, o ne c a nno t d et e r mi ne t he m i n i m u m t a r ge t do s e . In s u m m a r y , t h e IC R U s y s t e m o f do s e s pec i f i c a ti o n i s p ro b a bl y t he b e st t ha t c a n b e a c h i e v ed a t t h i s tim e . It s g r e at e st w e a k ne s s , ho w e v e r , i s i n the d e te r m i nat io n

WWW.MEDRAD.IR

o f r e f e r e n c e vo l u m e . F u r t h e r p r og r e s s nee ds t o be m a de i n t he de t e rm i na ti o n a nd d e li n e a ti o n o f t a rg et v o l u m e so t ha t t he c e r v i x do s e c a n b e s p e c i fi e d b y t he m i n i m u m t a r ge t do s e .

15.8. REMOTE AFTERLOADING UNITS

M o s t b r a c h y t h e r a p y i s n o w p r a c t i c e d w it h d e v i c e s t ha t a ll o w lo a ding o f r a d i o a c ti v e s o u r c e s a f t e r t h e s o ur c e c o n t a i n e r s ( a pp li ca t o r s o r c a t het e r s ) a re p ut i n p l a c e i n t h e p a ti e n t a n d h a v e b e e n c h e c k e d o ut ra d i og r a p hi c al l y f o r p ro p e r po si ti o ni ng using r a d i op a q u e m ar k e r s o r s o ur c e manual h a nd l i ng d umm i e s . T r a d it io na ll y , t he of r a d io a c ti v e m at e ri al a f t e r lo a d i ng so ur c e techniques re q u i re d ur i ng

p r e p a r at io n a n d l o ad in g o f t h e s o ur c e s i nto t he p re v i o us l y i ns er t e d a p pl i c ato r s . A l t h o u g h t h e s e p r o ced u r e s , w h e n c a r r i e d o ut p ro p e rl y , p o se no g r e at e r ri s k t o p a t ie n t s a n d p e r so n n e l t h a n t h e na t i o na ll y o r i nt e r nat io na l l y a c ce p te d s t a nd a rd s , t h e y a r e n o t s t at e o f t h e a rt i n m i nim i z i ng r a d i at io n ha z a r d s . R em o te l y co nt ro ll e d a f t e r lo a di n g d e vi c e s a r e n o w a v a i l a bl e t ha t e li m i nat e t he d i re c t ha nd l i ng o f t he r a d io a c ti v e sources. In a d d i t i o n, t he so ur c e s can be i ns t ant l y l o ad e d a nd u n l o a d e d , m a k i n g i t p o s s ib le to p r o vi d e pa t i e nt c a r e w it h t he s o ur c e s r et r a c te d i n t o t h ei r s h i el de d po si ti o n . R e m ot e a f t e rl o ad e r s a r e a v a i l a bl e f o r ei t he r l o w - do s e r a te ( L DR ) o r hi g h- d o s e r a t e ( H D R ) b r a c h y t h er a p y a n d f o r i nt e r s ti ti a l o r i nt r a c a v it a r y t re a t m e nt s . W i t h t h e L D R u n i t s , i t i s po s s i bl e t o us e t he s am e t y p e o f a p p li c a to rs ( e . g . , F l e t c he r S u i t ) a n d d o se r at e s a s u s e d i n c o nv e nti o na l b r a c hy t he r a p y . T he r o o m s hi e ld i ng r e q u i r em e n t s a r e t h e s a m e e x c e p t t ha t i ns t e a d o f us i ng m o bi le s hi e l d s f o r s t a f f p r ot e c tio n , s o u r c e s ar e a u to m a ti c a ll y re t ra c t e d w he ne v e r re q ui r e d f o r p at i e nt c a r e a n d r e i n s e rt e d a ft e r e a c h i n te r r up ti o n. T h e H D R r e m o t e a f ter l o ad e r t re a t me nt s a re p e r f o r me d i n a f ul ly s hi e l d ed r o om w i t h s a f e t y r e q u i r em en t s c o m p a r a bl e w it h t ho s e r e q ui re d f o r a c o b a lt te l et he r a py unit. For example, th e walls are s hi e ld ed , t he room is eq uip p e d w it h d oo r i n t e rl o c k s t h a t re t ra c t t h e so u r c e w he n t he d o or i s op e ned or w hen t he e me r ge nc y b u t to n i s p u s h e d , r a dia t io n m o n it o r s a re i nst a ll e d wi t h v i s ib le a nd a ud i b le a l a rm s , the p at ie n t is mo n it o re d v ia r e mot e cl o s ed - c i r c ui t t el e v i sio n camera a nd i n t e r co m m u n i c a ti o n de v i c e s , a n d t he e mer g e nc y p ro c e d ur e s a re po s te d a t t he c o n t r ol st a ti o n . In p ra c t i c e , H D R eq ui p me nt i s o ft e n ho us ed i n ex i s t i ng c o ba lt o r a c c e l e r ato r r oo m s .
192 137

Ir i s t h e m o st c o mm o n l y u s e d r a d io i so to p e i n r e mo te a f t e rlo a d e r s , a lt ho ug h C s or
60

C o so u r c e s a l s o a r e u s e d i n so m e uni t s . T he so ur c e s a re c o nt a i ned i n a

s t o r ag e s a f e w h e n n o t i n u s e . S e v e r al c ha nne l s f o r s o ur c e tr a ns p o r t a nd a m e c h a n i s m t o mo v e th e s o u r c e ( s ) f r o m t he s t o r a ge s a f e i nto t he a p p li c a to r ( s ) i n t h e p a ti e n t a re p r o vi de d . T h e m o s t co m mo n m e t ho d o f s o ur c e t r ans f e r i s t he s t eel d r i v e c a bl e to w h i c h t h e s o u r c e i s w e l ded . T he c a b l e i s m o ve d b y a s t e p pi ng m o to r . In o n e s y st e m ( S e l ec t ro n ) , s o ur c e tr a i ns w i t h so ur c e p a lle t s a nd i na c ti v e s p a c e r s a r e mo v e d b y m i c r o p ro c e s so r c o ntro ll e d p ne um at i c de v i ce s . H D R r e m o te a f t e r lo a di n g i m p la n t s a r e a c hi e v e d b y m o v i ng a s i ng l e hi g h- s tr e ng th (e.g., 10 Ci)

192

Ir so ur c e , w e ld e d to t he e nd o f a f le x i bl e c a bl e , t hr o ug h o ne o r

m a n y a v a i l a b l e c h a n n e l s . T h e s o ur c e c a n b e p r e c i se l y p o si ti o ne d a t a ny p o i nt i n t h e im p l a nt e d c a t h et er s o r a p pl i c at o r s . By p r o g r am m i ng d w el l p os i ti o n a nd d w ell t i me o f t h e s o u r c e , d e s i re d i so d o se d i st r ib ut io ns c a n b e ob t aine d . T he s e hig h-

WWW.MEDRAD.IR

d o s e r a te u n i t s c a n be u s e d f or i nte r s ti ti a l , i nt e rl um i na l , o r i nt r ac a v i t a r y i mp l a nt ( s e e C h a p t e r 22 f o r de t a il s ) . A s i n g l e - s o u r c e s y s tem ( m i c r o - S el e ct r o n- PD R ) a l s o ha s b e e n a d o p te d to p r o vi d e e q u i v a le n t L D R b r a c h y t h e r a p y , u s i ng p ul s ed b r a c hy t he r a p y p ri nci p le ( 91 ) . In t hi s unit a single

192

Ir s o u r c e o f a c t i v it y i n t he r a ng e o f 0 . 5 t o 1 . 0 C i i s us e d . T he d o s e

i s d e li v e re d i n s e v e r al p u l s e s o f p r og r a m m ab l e d ur at io n a nd f r e q ue nc y . S o m e o f t h e c o m mer c i a ll y a v a i l ab le r emo t e a f t er lo a d i ng s y s te m s i nc l ude t he C u r i e t r o n , t h e m i c ro -S e l e ct r o n , t he G a m ma M e d , a nd t he Buc hl e r uni t . M a ny o f t h e s e s y s t e m s c om e in d i f f e r e n t m o de l s w i th s p e c i a l i ze d f unc t i o ns . F o r a r e v i e w o f t h e s e s y s t e m s se e G l as g o w ( 9 2 ) . P.397

A. Advantages

T h e m a j o r a d v a n t ag e o f t he re m ot e a f ter l o ad e r s i s t he e li m ina t i o n or r e d u c t io n o f e x p o s u r e t o m ed i c al p e r so nne l . W e l l -d e si g n e d s y st em s can p r o v i de t he c a p a b il it y of op ti mi z i ng do s e

d i s t ri b u tio n s b e y o n d w h a t i s p o s s ib l e w it h m a nua l a f t e r l o ad i ng . T r e a t m e nt t e c h n i q u e s c a n b e m a d e m o re c o ns i s t e nt a nd r e p r od uc i bl e . In L D R r e m ot e a f t e rloa d i n g , so ur c e s c a n be r e t r a ct ed i nt o s hi el d ed po s it io n t o a ll o w be tt e r p at ie n t c a r e und e r no r m a l a s w e l l a s e m e rg e nc y c ond i t io ns . H D R r e m ot e a f te r lo a di n g p e r mi t s t r e at m e nt o n a n o ut p a ti e nt b as i s , us i ng m u l t ip le f r a c t io n r e g im e n s . H D R r e m ot e a ft e rl o ad i n g i s s ui te d fo r tre a t i ng l a rg e p a ti e nt p o p ul at io ns t h a t w o u ld ot h e r w i se r e q ui re p ro lo ng ed ho s p it a li z a ti o n i f t re a te d b y L D R brachytherapy.

B. Disadvantages

R e m ot e a ft e rl o ad i n g de v i c e s a re e x p e ns i v e a nd r e q ui re a s ub s t a nt i al c a pi t al e x p e n d it u r e ( $ 20 0 , 000 $3 0 0 ,0 0 0 ) f o r e q ui pm e nt a c q ui s it io n. In t h e c a s e o f H D R , ad d it io na l co s t s m us t be c o ns id e r ed f o r ro om s hi e l di ng ( i f n o t l o c at ed i n a n e x i s t i ng s hi el d ed f a c i li t y ) a nd i ns t a ll i ng a nc i l l a r y i m a gi n g e q u i pm e n t .

L o c a ti n g H D R i n a n e x i s ti n g r a d i at io n t he r a py r o o m c o m po und s t he p r o bl e m o f p a t ie n t s c h e d u li n g u n l e s s t he r o o m i s d ed i c a te d to H D R b r a c hy t he r a p y . N o s ig n i f i c a n t i mp r o v em e n t s a re e x pe c te d i n c l i ni c a l o ut co m e o v e r s t at e -o f the-art c o n v e n ti o n al LDR b r a c hy t he r a p y , a l t ho ug h t he i s s ue is s t ill c o n t r o v er s i al a n d n e e d s f u r t he r i nv e s t i g at ion.

Quality

assurance

re q u i r e me nt s

f or

r em o te

a f t er lo a d i ng

de v i c e s

a re

s i g n i f i c a n tl y g r e at e r b e c a us e o f t he g r e ate r c o m pl e x it y o f t he e q ui p me nt a n d f r e q u e n t s o u r c e ch a n g e s .

C. High-dose Rate versus Low-dose Rate

WWW.MEDRAD.IR

W h e r e a s r e m ot e a f te rl o a di n g i s und o ub te dly a s up e r i o r t e c hni q ue w he n i t c o m e s t o r a di a ti o n p ro te c ti on a n d r e p r o d uc i bi li t y o f t r e at m e nt , t he q ues t io n o f ho w H D R c o m p a re s w i t h L D R i n c l i n i c al o u t c om e i s a hi g hl y c o nt ro v e r s i al i s sue . If H D R i s o r c a n b e m ad e e q u i v al en t to LD R , t hi s w o uld b e a v i ct o r y fo r H D R, b e c a us e o f i t s other a d v a n t ag e s su c h as its a b i l it y to t re a t large p at ie nt p o p ul a ti o ns , c o n v e n i e n c e o f t re a ti n g o n a n o u t p a ti e nt b as i s , e t c . H o w e v e r , t he q ue s t io n i s n ot c l o s e to b ei n g s et tl e d, b e c a u s e t he o ut c ome d a t a i n t e rm s o f s ur v i v a l r a te s a nd e a r l y a n d l a te ti s s u e c o m p li c a tio n r a t e s fo r t he H D R te c hni q ue t o d at e a r e n ot s u f f i c i e n t to d r a w d e fin i t i v e c o n c l us io ns . T he r e ad e r i s re f e r r ed to s e le c te d pa p e r s t o u n d e r s t a n d t h e s e i ss u e s ( 9 3 , 9 4 , 95 , 9 6 ,9 7 ).

REFERENCES
1 . S h a l e k R J , S t o v a ll M . D o s i me t r y i n i m pl ant t he r a p y . In: A t ti x F H , R o e s c h W C , e d s . R a d i at io n d o s im et r y . V o l 3 . N e w Y o r k : A c a d e m i c P r e s s , 19 6 9. 2. 3. 4. IC R U . IC R U . IC R U . R a d i a t io n R a d i a t io n q u a n t i ti e s q u a n t i ti e s a nd a nd uni t s. uni t s. Report Report No. No. 19 . 33 . W a s hi ng t o n, W a s hi ng t o n, DC: DC: DC: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 7 1 . In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 8 0 . R a d i o a c t i vi t y . R e p o rt No. 1 0C . W a s hi ng t o n, Int e r na t i o nal C o m m i s si o n o n R a d i ati o n U n i t s a nd M e a s ur em e nt s , 1 9 63 . 5 . W h y t e G N . At te n u a t io n o f ra d i um g a m m a r a d i at io n i n c y l i nd ri ca l ge o me t r y . Br J R a d i ol 1 95 5 ;2 8 : 63 5 . 6 . V a n R o o se n b ee k E , S h a l e k R J , M oo r e E B. S a f e e nc a p s ul at io n p e r io d f o r se a le d m e d i c al r a di u m s o u r c es . A J R 1 9 6 8 ; 1 02 : 69 7 . 7 . M e i s be r ge r L L , Kel l e r R J , S h a le k R J . T he e f f e c t i v e at te nua ti o n i n w a t er o f g a m m a r a y s o f go ld 1 9 8 , i r i di u m 19 2 , c e si um 1 37 , r a d i um 2 2 6, a nd c o b a lt 60 . R a d i ol og y 1 96 8 ; 90 : 953 . 8 . H o r s l e r A F C , J o n e s J C , S t a c e y A J . C e s i u m 1 3 7 so ur c e s f o r us e i n i nt r a c a v it a r y a n d i n t e r s ti ti a l r ad io th e r a p y . B r J R a d i o l 1 96 4 ; 37 : 3 85 . P.398

9 . K r i s h n a s w a m y V . D o s e d i st r i b ut io n a b out 1 9 72 ; 1 05 : 18 1 .

137

C s s o ur c e s i n t is s ue . R a d i ol og y C s a nd Co.

1 0 . A t ti x F H . C o m p u t e d v a l u e s o f s p e c i fi c g a m m a r a y c o ns t a nt f o r P h y s M e d B i o l 1 9 68 ; 13 : 1 19 .

137

60

1 1 . O ' C o n n e ll D , J o sl in C A , H o w a r d N , e t a l . T he t r e at m e nt o f ut e ri ne c a r c i nom a u s i n g t h e c a t h e t ro n . B r J R a d i o l 19 67 ; 4 0: 8 82 . 1 2 . J o sl i n C A F , S m it h C W . T h e u s e o f hig h a c t i vi t y

60

C o so ur c e s f o r i nt r a c a v i ta r y

a n d s u r f a c e m o u l d t h er a p y . P r o c R S o c M e d 1 9 70 ; 6 3 :1 02 9 . 1 3 . S n e ll i n g MD , L am b e r t H E , Y a r no l d JR . T he t r e at m e nt o f c a r c i no m a o f t he c e r v i x a n d e n d o m et r i um a t t h e M i d dl e se x H o s p i t al . C l i n R a d io l 19 79 ; 3 0 :2 5 3 . 14. Henschke UK, Hilaris BS, M a ha n GD. A f t e r lo a di ng in i nt e r st it i al a nd i n t r a c a v it a r y r a d i at io n t h e r a p y . A J R 1 9 6 3 ; 90: 3 8 6 . 1 5 . P i e r q ui n B , C h a s s a g n e D , B a i l l et F , e t a l . L e nd o c ur ie t he r ap ie d e s C a nc e r s d e la Langue M o bi le et due P l a nc he r buc c a l par 1 i ri d i um -1 9 2 . Rev M ed 1 9 71 ; 3 1 :1 94 7 .

WWW.MEDRAD.IR

1 6 . G l a sg o w G P , Di llm a n L T . S p e c i fi c - r ay c o ns t a nt a nd e x po sur e r a t e c o ns t a nt of
192

Ir . M e d P h y s 1 9 7 9 ; 6 : 49 .

1 7 . B og g s R F , W il li am s K D , S c hm id t G D . R a d io lo gi c a l he a lt h a s p e c t s o f s p e nt r a d o n s e ed s . R a d i a t He a l t h D a t a R e p 1 9 69 ;1 0 : 18 5 . 1 8 . H i l a ri s B S , e d . H a n d b o ok o f i nt e r st it i al b r a c hy t he r a p y . A c t o n, M A : P ub l i s hi ng S c i e n c e G r o u p , 1 97 5 . 1 9 . K i m J H , H i l a r i s B S . Io d i n e 1 25 s o urc e i n i nt e r st it i al t umo r t he r a p y . A J R 1 9 75 ; 1 23 : 16 3 . 2 0 . Li n g C C , Y o r ke ED , S p i ro IJ , et al . P hy s i c a l d o si m et r y o f
125

I s e e d s o f a ne w

d e s ig n f o r i n t e r st it i al i m p la n t . I n t J R a d i at O nc o l Bi ol P hy s 1 9 8 3 ;9 : 1 74 7 . 2 1 . S c h u l z R J , C h a n d r a P , N a t h R . D e t e r mi na t io n o f t he e x p o s ur e r a t e c o ns t a nt for 22.
125

I u s i n g a s c i n t i lla t io n d e te c to r . M e d Phy s 1 9 8 0 ; 7 :3 5 5 . CG. T i m e - d o se - f a c to r s ( T D F s) in b r a c hy t he r a p y . Br J Radiol

O r to n

1 9 74 ; 4 7 :6 03 . 2 3 . M ei go o n i A S , S a bn i s S , N a t h R . D o si me t r y o f Pd - 1 03 br a c hy t he r a p y s o ur c es f o r p e r m a n e n t im p l a nts e n d o c u r ie t he r / hy p er t he r m i a . O nc ol og y 1 99 0 ; 6 :1 0 7 . 2 4 . C h i u - T s a o S T , A n d e r s o n L L . T he r m olum i ne s c e nt d o si m et ry o f ( m o d el 2 00 ) i n s ol i d wa t e r p h a n t om . M e d P hy s 1 9 9 0 ;1 8 : 44 9 . 25. N a tio n a l C o u n c il of on R ad i at io n P r ot e c tio n a nd M e a s ure m e nt s NCRP R e po r t (NCRP). No. 41. S p e c i f i c at io n g am m a - r a y b r a c hy t he ra p y s o ur c e s .
103

Pd seeds

W a s h i n g t o n , D C : U . S . G o v e r n m e n t P r i nti ng O f f i c e , 1 9 7 4 . 2 6 . Lo e v i n ge r R . T h e r o le o f st a nd a r d s l a bo r a to r y i n br a c hy t he ra p y . In: S he a r e r D R , e d . R e c e n t a d v a n c e s i n b r a c hy t he r a p y p hy s i c s ( A A P M M e d . P hy s . M o no g r a p h N o . 7 ) . N e w Y o r k : A m e r i c a n In s t i t ute o f P hy s i c s , 1 9 81 . 2 7 . A m e r i ca n A s s o c i ati o n o f P h y s i c i st s i n Me d i ci ne . S p e ci f i c a ti o n o f b r a c hy t he r a p y s o u r c e st r e n gt h . A A P M R e po r t N o . 2 1 . N ew Y o r k : A m e ri c a n Ins t it ut e o f P hy s i c s , 1 9 87 . 2 8 . Lo f t u s T P . St a n da r d i z a ti o n o f ce s i um -1 3 7 g a m m a - r a y s o urc e s i n t er m s o f e x p o s u r e u n i t s ( r oe n tg e n s ) . J R e s N a t l Bur S t a nd ( U S ) 1 9 7 0 ;7 4 A :1 6 . 2 9 . L o ft u s T P . S t a n d a r d i z a ti o n o f i r id i um -1 9 2 g a m m a - r a y s o urc e s i n t er m s o f e x p o s u r e . J R e s N a t l B u r S t a n d ( U S ) 1 9 8 0 ; 8 5 : 19 25 . 3 0 . Lo f t u s T P . E x p o su r e s t a n d a r di z a ti o n of R e s B u r S t a n d 1 9 8 4 ; 89 : 2 95 . 31. Dale JWG, P e r ry WE, Pulfer RF. A b e t a - g am m a i o ni z a ti o n c ha m b e r for s u b s t a n d a r d s o f r a di oa c t i v it y . I a nd II. I nt J R a d i a t I so to pe s 1 961 ; 1 0 :6 5 . 3 2 . B e r k le y L W , H a n s o n W F , S ha l e k R J . D i s c us s i o n o f t he c ha r a c t e ri s ti c s a nd r e s u l t s o f m e a s u r e men t s w i t h a po r t ab le w el l i o ni z a tio n c ha m b e r fo r c a li b r at io n o f b r a c h y t h e r a p y s o u r c es . In : S h e a r e r D R , ed . R e c e nt a d v a nc e s in b r a c hy t he r a p y p h y s i c s . N e w Y o r k : A m e r i c a n In s t i t ute o f P hy s i c s , 1 9 8 1 . 3 3 . L o f t u s T P . S t a n d a r d i z a ti o n o f i r id i um -1 9 2 g a m m a r a y s o urc e s i n t e r m s o f e x p o s u r e . J R e s N a t l B u r S t a n d ( U S ) 1 9 7 9 ; 8 0 : 19 . 3 4 . W il li a m so n J F , K ha n F M , S h a r m a S C , e t a l . M et ho d s f o r r o utine c a l ib r a ti o n o f b r a c h y t h e r a p y s o u r c es . R a d i o lo g y 19 8 2; 1 42: 5 1 1 . 35. K u b i a to w c i z DO. C a l i b r a tio n of c e s ium - 1 3 7 b r a c hy t he r a py s o ur c e s . In: S h e a r e r D R , e d . R e c en t a d v a n c e s i n b r a c hy t he r a p y p hy s i c s . N e w Y o r k : A m e r i c a n In s t i t u t e o f P h y s i c s , 1 9 8 1 .
125

I s e ed s us e d fo r b r a c hy t he r a p y . J

WWW.MEDRAD.IR

36.

Cobb

PD,

Chen

TS,

Kase

KR.

C a l i b r a t io n

of

b r a c hy t he r a p y

i r i di um - 1 92

s o u r c e s . I n t J R a d i at O n c o l B i ol P hy s 1 9 8 1 ;7 : 2 59 . 3 7 . S u z u k i A , S u z u k i M N , W e i s A M . A na l y s i s o f a r a d io i sot o pe c al i b r at io n. J N uc l M e d T e c h n o l 1 97 6 ;4 : 19 3 . 3 8 . B o y e r AL , C o bb P D , K a s e K R , et al . , S he a r e r D R , e d . R ec e nt a d v a nc e s i n b r a c h y t h e r a p y p h y s i c s . N e w Y o r k : A m e r i c a n Ins t i t ut e o f P hy s i c s , 1 9 8 1 . 3 9 . W i ll i a m so n J F , M o r i n R L , K h a n F M . D o s e c a l ib r a to r r e s po ns e t o b r a c hy t he r ap y s o u r c e s : a M o n t e C a r lo a n d a n a l y t i c e v a l ua ti o n. M e d P hy s 1 9 8 3 ;10 : 1 35 . 4 0 . S i e v e rt R M . D i e In t e n s i t t s v e r te il ung de r P r i m r e n - S t r a hl ung i n d e r N he m e d i zi n i s c h e r R a d i u mp r p a r a te . A c t a R a d io l 1 9 2 1 ;1 : 89 . 4 1 . Y o u n g M E J , B a t h o H F . D o s e t a b l es f o r li ne a r r a d i um s o ur c e s c a l c ul a te d b y a n e l e ct r o ni c c o m p u te r . B r J R a d i o l 19 6 4 ;3 7 :38 . P.399

4 2 . E v a n s R D , E v a n s R O . S t u d i e s o f s e l f ab s o r pt io n i n g a m m a - ra y s o ur c e s . R e v M o d P h y s 1 9 4 8 ; 20 : 305 . 4 3 . K e y s er G M . A b s or p t io n c or r e ct io n f o r r a d i um st a nd a r di z a ti o n. C a n J P hy s 1 9 51 ; 2 9 :3 01 . 4 4 . W h y t e G N . A tt e n u a t io n o f r a d i um g a m ma r a d ia ti o n i n c y l i ndr ic a l ge o me t r y . Br J R a d i ol 1 9 55 ; 28 : 63 5 . 4 5 . W il li a m s o n J F , M o r i n R L , K ha n F M . M o nt e C a r lo e v al ua t io n o f t he S ie v e rt i n t e g ra l f o r b r a c h y t h er a p y d o s i me t r y . P hy s M e d Bi ol 1 9 83 ; 28 : 10 21 . 4 6 . M e i s be r ge r L L , K el l e r R , S h a l e k R J . T he e f f e c t i v e a tt e nua ti o n i n w a t e r o f t he g a m m a r a y s o f g o ld -1 9 8 , i ri di u m - 1 92 , c e si um - 1 3 7 , r a di um - 2 26 , a nd c o b a l t -6 0 . R a d i ol og y 1 96 8 ; 90 : 953 . 4 7 . V a n D il l a M A , H i ne G J . G a m m a - r a y d i f fus i o n e x p e ri m e nt s i n w a t e r . N uc l eo ni c s 1 9 52 ; 1 0 :5 4 . 4 8 . T e r - P o go s s i a n M , It t n e r W B I II, A l y S M . C o m p a r i s o n o f a i r and t i s s ue d o se s f o r r a d i u m g a m m a r a ys . N u c l e o n i c s 1 95 2 ; 10: 5 0 . 4 9 . W o ot o n P , S h a l e k R J , F l e t c h e r G H . I nv e s t i g at io n o f t he e f f e c ti v e a b s o r pti o n o f r a d i u m a n d c o b al t ga m m a r a d i at io n i n w a t e r a nd it s c li ni c a l s i g ni f i c a nc e . A J R 1 9 54 ; 7 1 :6 83 . 5 0 . R e u s s A , B r u n n e r F . P h a n t o m m e s s ung e n m i t d e n Mi k r o io ni s at io ns k a m m e r n d es B o m k e - D o si m et e r s a n R a d i u m a n d K o b al t 6 . S t a hl e nt he r ap i e 1 9 57 ;1 0 3 :2 7 9 . 5 1 . K e n n e y G N , K a r t h a K IP , C a m e r o n J R . M e a s ur e m e nt o f t he a b s o r pt io n a nd build-up f a c to r for radium, co b al t 60 a nd c e si um 13 7 . P hy s Med Biol 1 9 66 ; 1 1 :1 45 . 5 2 . M e r ed it h W J , G r e e n e D , K a w a s hi m a K . T he a t t e nua t io n a nd s c a t t e ri ng i n a p h a n t o m o f g a m m a ra y s f r o m s om e r ad io nuc l i d e s us e d i n mo ul d a nd i nte r s ti ti al g a m m a - r a y t h e r a p y . B r J R a d i o l 19 66 ; 3 9: 2 80 . 5 3 . W e b b S , F o x R A . T h e d o s e i n w a t e r sur r o und i ng p oi nt i so tr o p i c g a m m a - r a y e m it t er s . B r J R a d i o l 1 9 79 ; 5 2 :4 82 . 5 4 . E v a n s R D . T h e a t o m i c n u c l e u s . N e w Y o r k : M c G r a w - H i l l , 1 9 55 : 73 2 . 55. K o r ne l s e n RO, Young MEJ. Br a c hy t he r a p y b ui ld - up f a c to r s . Br J R a d iol 1 9 81 ; 5 4 :1 36 .

WWW.MEDRAD.IR

5 6 . K r i s h n a s w a m y V . D o s e di s t ri b uti o n a ro und a n R a d i ol og y 1 97 6 ; 12 6 :48 9 .

125

I s e e d s our c e i n t i s s u e .

5 7 . N a t h R , A n d e r so n L L , L u x t o n G , et al . D o s i me t r y o f i nte r s ti tia l b r a c hy t he r a p y s o u r c e s : r e c om m e n d at io n s o f t h e A A P M R a d i a ti o n T he r a p y C o mm i tt e e T a s k G r o up n o . 4 3 . M e d P h y s 1 9 9 5 ; 2 2 :2 0 9 23 4 . 5 8 . C a m e r so n J R , S u n t h a r a l i n g a m N , Ke nne y G N . T he r m o l um i ne sc e nc e d o si m et r y . M a d i s o n : U n i v e r si t y o f W i s c o n s i n P r e s s , 1 9 68 . 5 9 . H i n e G J , F r i ed m an M . Is o d o s e m e a s ure m e nt s o f l i ne a r r ad ium s o ur c e s i n a i r a n d w a t e r b y m e a n s o f a n a u t o m a ti c i so d o se r e c o rd e r . A J R 1 9 50 ;6 4 : 98 9 . 60. 61. C o le A, Moore WJ, EB, ed. Shalek Radium RJ. A s i m p l i fi e d t he a uto m at i c is o d o se r e co r de r . N u c l e o n i c s 19 5 3; 1 1 :46 . M e r r ed it h d o s ag e : M a nc he s t e r s y s te m . E d i nb ur g h: L i v i n g st o n e , L td , 1 96 7. 6 2 . G l a s s e r O , Q u i mby E H , T a y l o r L S , e t al . P hy s i c a l f o und a t io ns o f r a d io lo g y , 3 rd e d . N e w Y o r k : H a r p e r & R o w , 1 9 61 . 6 3 . S to v a l l M , S h a l ek R J . A s t ud y o f t he e x p li c it di s t ri b uti on o f r a d i a tio n i n i n t e r st it i al i m pl a n t at io n . I. A m e t ho d o f c a l c ul a ti o n w i t h a n a ut o m a ti c di g it al c o m p u te r . R a d io lo g y 19 6 2 ;7 8 : 95 0 . 6 4 . L a u g h li n J S , S i l er W M , H o l od ny E I, e t a l . A do s e d e s c ri pt io n s y s t e m fo r i n t e r st it i al r a d i at io n th e r a p y . A J R 1 9 6 3 ; 89 :4 7 0 . 6 5 . P o w e r s W E , B o g ar d u s C R , W hi t e W , e t a l . C o m p ut e r e s ti m a ti o n o f do s a g e o f i n t e r st it i al a n d i n t r a c av i t a r y i m pl a nt s . R a d iol og y 1 9 65 ; 8 5 :1 35 . 6 6 . S to v a l l M , S h a l ek R J . T h e M . D . A nd e r s o n m e t ho d f o r t he c o m p ut at io n o f i s o do s e curves a ro u n d i n t er s ti ti a l a nd i nt r a c a v it a r y r a di a ti on s o ur c e s . III. R o e n t ge n o g r am s f o r in p u t d a t a a nd t he r el a ti o n o f i so do s e c al cul a t io ns to t he P a t e r s o n P a r k e r s y s t em . A J R 1 9 6 8 ; 10 2 : 67 7 . 6 7 . H e n s c h k e U K , C e v c P . D im e n s io n a v e r ag i ng - a si m pl e m et ho d f o r d o si m et r y o f i n t e r st it i al i m pl a n t s . Ra d i a t B io l T he r 19 6 8 ;9: 2 8 7 . 6 8 . A n d e r so n L L . D o si m et r y o f i nt e r st it i al r a d i at io n t he r ap y . In: H i l a ri s BS , e d. H a n d b o o k o f i n t e r st iti a l b r a c h y t he r a p y . A ct o n, M A : P ub li s hi ng S c i e nc e s G ro u p , 1 9 75 : 8 7 . 6 9 . P i e r q u i n B , D u t r e i x A , P a i n e C . T he P a r i s s y s t e m i n i nt e r s ti ti a l r a di a ti on t h e r a p y . A c t a R a d io l O n c o l 1 97 8 ; 17 : 33 . 7 0 . P ie r q u i n B , Wi l son J F , C h a s s a g ne D , ed s . M o de r n b r a c hy t her a p y . N e w Yo r k : Masson, 1987. 7 1 . D ut r e i x A . C a n w e c o mp a r e s y s t e m s f o r i nte r s ti ti a l t he r ap y ? . R a d i ot he r O nc o l 1 9 88 ; 1 3 :1 27 . 7 2 . S h a r m a S C , W i l li a m s o n J F , C y t a c k i E . D o s i m et r i c a nal y s is o f s t e re o a nd o r t h og o n a l r e co n s t r u ct io n o f i n t e r s ti ti a l imp l a nt s . I nt J R a d i at O nc o l Bi ol P hy s 1 9 82 ; 8 : 18 03 . 7 3 . P a te r s o n R . T h e tr e a t me n t o f m a li g na nt di s e a se b y r ad io t her a p y . Ba l ti m o re: W i l li a m s & Wi l k i n s , 1 96 3 . 74. Henschke UK, Hilaris BS, M a ha n GD. A f t e r lo a di ng in i nt e r st it i al a nd i n t r a c a v it a r y r a d i at io n t h e r a p y . A J R 1 9 6 3 ; 90: 3 8 6 .

WWW.MEDRAD.IR

7 5 . S u i t H D , M oo r e EB , F l e t c h e r G H , e t al . M o d i f i c ati o ns o f F le t che r o v o id s y s t em f o r a f t e r lo a di n g u s i n g s t a n d a r d - s i z e r a di um t ub e s ( m i ll ig r a m a nd m i c r o g r a m ) . R a d i ol og y 1 96 3 ; 81 : 126 . 7 6 . H i l a ri s B S , e d . H a n d b o ok o f i nt e r st it i al b r a c hy t he r a p y . A c t o n, M A : P ub l i s hi ng S c i e n c e G r o u p , 1 97 5 . 7 7 . H e n s c h k e U K . I n t e r s ti ti a l i mp l a nt ati o n w i t h r a d io i so to p e s . In: H a h n P F , e d . Therapeutic 1 9 56 : 3 75 . 7 8 . J o n e s C H , T a y l or K W , S t e d e fo r d J BH . M o d i f i c at io n to t he R o y a l M a r s d en H o s p it a l go ld g r a i n i mp l a n t at io n g un. Br J R a d i ol 1 96 5 ;3 8 : 67 2 . 7 9 . H e y m a n J . T h e tec h n i q u e i n t he t r e at me nt o f c a nc e r ut e ri a t r a d i um - he m me t . A c t a R a d io l 19 2 9 ;1 0 :49 . P.400 use of a r t i f i ci a l ra d io i sot o pes . New York: J o hn Wiley & S o ns ,

8 0 . R e g a u d C . R a d i u m t h e r a p y o f c a nc e r a t t he r a d i um i ns ti t ut e o f P a r i s . A J R 1 9 29 ; 2 1 :1 . 8 1 . F le t c h e r G H , S h a le k R J , C o l e A . C e r vi ca l r a di um a p pl i c at o r s w i t h s c r e e ni ng i n t h e d i re c ti o n o f b l ad de r a n d r e c t um . R a d io lo g y 1 95 3 ;6 0 : 77 . 8 2 . F le t c h e r G H . T e x tb o ok o f r a di ot he r a p y , 2 nd e d . P hil a d el p hi a: L e a & F e bi ge r , 1 9 73 : 6 20 . 8 3 . H e y m a n J , Re u te r w a l l O , B e nne r S . T he r a di um - he m m et e x p e ri e nc e w it h r a d io t h e r ap y i n c a n c e r o f t h e c o r p us o f t he ut e r us . A c t a R a d i ol 1 94 1 ; 22 : 1 1 . 8 4 . F l et c h e r G H . S q u a m o u s c e ll c a r c i no m a o f t he ut e ri ne c e r v i x . In: F l e t c he r G H , e d . T e x t bo o k o f r a d io th e r a p y , 3 r d e d . P hi l a de l p hi a : Le a & F eb ig e r , 1 9 8 0 :7 20 . 8 5 . T o d M C , M e r e di t h W J . A d o s a ge s y s t e m f o r us e i n t he t re a t me nt o f c a nc e r o f t h e u t e r i n e ce r v i x . B r J R a d i ol 1 9 38 ; 11 : 80 9 . 86. Tod M , M e r ed it h W J . T r e a t m e nt o f c a nc e r o f t he c e r v i x ut e r i - a r e v i se d M a n c h e s t e r m e t h od . . B r J R a d i o l 1 9 53 ; 26 :2 5 2 . 8 7 . S c h w a z G . A n e v a l u a t io n o f t he M a nc hes t e r s y s te m o f t r e at me nt o f c a r c i no m a o f t h e c e r v i x . A J R 1 9 69 ; 1 05 : 5 79 . 8 8 . IC R U . D o s e a n d v o l u m e s p e ci f i c at io n f o r r e p o rt i ng i nt r a c a vi t a r y t he r a p y i n g y n e c o lo g y . IC R U R e p o rt N o . 3 8 . Be t he sd a , M D : Int e r na t i o nal C o m m i s si o n o n R a d i a ti o n U n it s a n d M e a s u r e m e n t s , 19 8 5 . 89. P ot i s h RA. C e rv i x cancer. In: L e v i tt SH, K ha n FM, Potish RA, e d s. T e c h n o l og i c al b a s i s o f r a d i a ti o n t he r ap y . P h i l a de lp hi a : L e a & F e big e r , 1 99 2 : 28 9 . 9 0 . K h a n F M . B r a c h y t h e r a p y : r ul e s o f imp l a nt at io n a nd d o s e s p e c i f i ca ti o n. In: L e v i tt S H , K h a n F M , P o t i s h R A , e d s . T e c hno l o gi c a l b a si s o f r a d i a tio n t he r a p y . P h i l a d el p h i a : Le a & F eb i ge r , 1 9 92 : 11 3 . 9 1 . H a ll E J , B r e n n e r D J . C o n d it io ns f o r t he eq ui v a l e nc e o f c o nti nuo us t o p ul sed l o w d o se r a te b r a c h y th e r a p y . I n t J R a d i a t Onc o l Bi ol P hy s 1 9 9 1 ; 20 : 1 81 . 9 2 . G l a s go w G P . H i g h d o s e r a te a f t e rl o ade r s : d o si m et r y a nd qua l i t y a s s ur a nc e . In : P u r d y J A , e d . A d v a n c e s i n r a d i a ti o n onc o l og y p hy s i c s . A A P M M o no g r a p h N o . 1 9 . N e w Y o r k : A m e r i ca n I n s t i t u te o f P hy s i c s , 1 9 9 0 :7 7 0 . 93. S p e i se r B. Advances of high dose rate r e mo te a f t e rl o adi ng : p hy s i c s or b i ol og y . I n t J R a d i a t O n c o l B i ol P hy s 1 9 9 1 ;2 0 : 11 3 3 .

WWW.MEDRAD.IR

9 4 . O r t o n C , S e y e d sa d r M , S o m na y A . C o m p a ri s o n o f hi g h a nd l o w d o s e r at e r e m ot e a f te r lo a di n g f o r c e r v i x c a nc e r a nd t he i m po rt a nc e o f f r a c t io na t io n. I nt J R a d i a t O n c ol B i ol P h y s 1 9 9 1 ;2 1 :1 4 25 . 95. Hall E, Brenner of D. The in d o se - r at e e f f e ct I nt J r e v i si te d : Radiat do s e r a d i ob io lo gi c a l Bi ol P hy s c o n s i d er a ti o n s 1 9 91 ; 2 1 :1 40 3 . 96. S t it t J, F o w le r J, Thomadsen B, et al. High ra t e i nt ra c a v i t a r y b r a c h y t h e r a p y f o r c ar c i n o m a o f t he ce r v ix : t he M a d i s o n s y s t em : I- c l i ni c a l a nd b i ol og i c al c o n s id e r at ion s . I n t J R a d i a t O nc o l Bi o l P hy s 1 9 9 2; 2 4 :3 35 . 9 7 . E i f e l P J . H i g h - do se - r a t e b r a c hy t he r a p y f o r c a r c i no m a o f t he c e r v i x : hi g h t e c h o r h i g h r i s k ? . I n t J R a d i a t O n c ol Bi ol P hy s 1 9 9 2 ;2 4 : 38 3 .
1

i mp o rt a n c e

r a d i ot her a p y .

O nc o l

IC R U ( 2 ) d e f i n e s t h e e x p o s u r e r a te c o ns t a nt a s :

w h e r e ( d x / d t ) i s t h e e x p o s u r e r at e d ue to p ho to ns o f e ne r g y gr ea t e r t ha n , a t a d i s t a n c e l f r o m a po in t s o u r c e o f a ct i v it y A . S p e c i al uni t s o f a r e R m 2 h - 1 Ci - 1 o r a n y c o n v e n i e n t m u l t i pl e o f t h e se . T h i s q u a n t it y r ep l a c es , b u t i s n ot i d e nt i c al to , t he sp e c i fi c ra y c o ns t a nt . T he l a tt e r ap p li ed to r ay s o n l y a n d d i d no t inc l ud e t he e x p o s ur e ra t e o f e m it te d x r a y s s u c h a s c h a r a c t e r i s ti c x - r a y s a nd i nt e r na l b r e m s s t r a hl ung . A f u r t h e r c h a n g e h a s b e e n m a d e b y t he IC R U ( 3 ) . A ne w q ua nt i t y , c a l le d a ir kerma r at e co n s t a n t , has been r e co m me nd e d to r e pl a c e t he e x po s ur e r at e c o n s t a n t . T h i s q u a n t i ty i s s t i ll n a m e d , b ut i s no w d e f i ne d a s :

w h e r e k a i r i s t h e a i r k er m a . T h e S I u ni t f o r thi s q ua nt i t y i s m 2 J k g - 1 h - 1 C i - 1 . W he n t he s p e c i al n a m e s , g r a y (G y ) a n d b e c q ue r el ( Bq) a r e us e d , t he unit be c o m es m 2 G y Bq 1 2 3 4

sec-1. M e d i c al P r o d u ct s D i v is i o n / 3 M , N e w Br i g hton, M i nne s o t a . M a n u f a c t u r e d b y T h e r a g e n i c s C o r p . , N o r c ros s , G e o r g i a . T h e a u t h o r s a p p e a r t o h a v e n o r m a li z e d the d o s e v a l ue s to uni t y a t r = 1 c m .

S p o t c h e c k s o f F i g . 1 5. 1 2 r e v e al ed t ha t t he t i s s ue at te nua t i o n co rr e c ti o n f a c to r i s g i v e n b y D r / D 1 , w h e r e D 1 i s t h e d o s e at 1 c m.
5

T h e s e r e s u l t s c a n b e a s c e r t a i n ed b y s ub s t i t uti ng = 0 i n E q u a t io n 1 5 . 1 0 a nd If i t i s no t p o s si b le to c r o s s a n e nd , o ne ca n i nc r e a s e t he s i z e of t he i m pl a nt b y the t u mo r . Ag a i n , 1 0% is de d uc te d f r om t he i mp l a nt area for each

s e p a r a ti n g o u t t h e g eo m et r i c f a c to r .
6

u s i n g l o n g e r n ee dl e s s o t h a t t h e e f f e c ti v e a r e a o f do s e uni f or m i t y a de q ua te l y covers u n c r o s s e d e n d f o r t a ble r e a d i n g p ur p o se s .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Th erapy > 16 - Radiation Protection

16 Radiation Protection
of the first s t a n d a rd These s e t ti n g

R a d i a ti o n e x p o s u r e l im i t s o r s t a nd ar d s w er e i nt ro d uc ed a s e a rly a s t he s t a rt o f t h e t we n t ie t h ce n t u r y w h e n t h e po te nt i al ha z a r d s o f r ad i at io n w e r e re a li z e d . O ne b od ie s f o rm t he was t he Int e r na t i o na l for m a ny C o m m i s si o n on R a d i ol og i c al P r ot e ct ion ( IC R P ) , w hi c h c o nt i nue s i t s f unc t i o n t hroug h i t s s e ri e s o f p u b l i c at io n s . r e p o rt s ba s i s na t io na l p ro te c ti o n g u i d el i n e s . In t h e U n it e d S t at e s , t he N at io na l C o unc i l o n R a d i at ion P r o t e cti o n a nd M e a s u r e m e n t s ( N C R P ) h a s f u n c t i o ned a s a p r i m a r y st a nd a r d - se tti ng bo d y t hr o ug h i t s s e p a ra t e p u bl i c at io n s . O n e o f t he a g e nc i e s w i t h r e g ul at o r y p o w e r s i n t hi s c o u n t r y i s t h e N u c l e ar R e g u l a to r y C o m mi s si o n ( N R C ) , w hi c h ha s c o nt r ol o v e r t he use of a ll re a c to r - pr o d u c e d m a te r i al s (e . g . ,
60

Co

a nd

192

Ir ).

T he

na t ur a l l y

o c c u r r i n g r a d io a ct i v e m a t e ri a l s ( e .g . , r a d i um a nd r a d o n) a nd x - r a y m a c hi ne s a r e r e g u l at e d b y i n di v i d u al s t a te s .

16.1. DOSE EQUIVALENT

B e c a u s e t h e bio lo g i c e f f e c t s o f r a d ia ti o n dep e nd not o nl y o n do se b ut al s o o n t he t y p e o f r ad i at io n , t h e d o si m et ri c q ua nti t y re l e v a nt to r ad i at io n pr o te c ti o n i s t he d o s e eq u i v a le n t ( T H ) . It i s d e f i n e d a s :

w h e r e D i s t h e a b s o r be d d o se a n d Q i s t he q ua l it y f a c t o r f o r t he r a d i at io n. 1 T h e S I u n i t f o r b o t h d o s e a n d d o s e eq uiv a l e nt i s j o ule s p e r k i l og r a m , b ut t he s p e c i al n a m e f o r t h e SI u n i t o f d o se e q ui v a le nt i s s i e v er t ( S v ) . 1 Sv = 1 J/kg If d o s e i s e x p r e s se d in u n i t s o f r ad , t he s pe c i a l uni t f o r d o se equi v a l e nt i s c al le d the rem. H(rem) = D(rad)Q B e c a u s e Q i s a f a c t o r a n d h a s n o u ni t s , 1 rem = 10-2, J/kg T h e u s e o f q u a l i t y f a c t o r i n r a di a ti o n p r ot e ct io n i s a na l o go us t o the us e o f r e l a t i ve b i ol og i c al e f f e c ti v e n e ss ( R B E ) i n r a d i a t io n b i ol o g y . H o w e v e r , t he q ua l it y f a c t o r i s a s o m e w h a t ar b it r a ril y c h o s e n c o ns e r v at iv e v a l ue b a se d o n a r a ng e o f R BE s r e l at e d t o t h e li n e a r e n e r g y t r a ns f e r ( L E T ) o f t he r a di a ti o n. T hus t he Q f a c t o r e n c o m p a s se s R B E s i n a v e r y b ro a d s e ns e , i nd e pe nd e nt o f t he o r g an o r t i s s ue o r of t h e b io lo gi c e n d po i n t u n d e r c o n s i d e r at io n. A l t h o u g h t h e do s e equ i v a l e n t f o r p a rt i c ula r s i t ua ti o ns c a n b e c a lc ul a t e d ( 1 ) , i t is c o n v e n i e n t fo r q ui c k - a n d - r o u g h c a l c ul at io ns t o ha v e a t a bl e o f p r a c t i ca l q ua l it y f a c t o r s a v a il a b le . T a b l e 1 6 . 1 gi v e s t he se a p p r o x im a te f a c t o r s f o r a v a r i e t y of r a d i at io n s u s e d i n r a d ia t io n t h e r a p y .

WWW.MEDRAD.IR

TABLE 16.1. RECOMMENDED QUALITY FACTORS

R a d i a t i on

Q u a l i t y F a c t or

X - r a y s , r a y s , a n d e l e c t ro n s

Thermal neutrons

N e u t r o n s , h e a v y p a r t ic l e s

20

D a t a a re f ro m N C R P . R e c o m me nd a ti o ns on l i mi t s f o r e x p o s ur e t o io ni z i ng r a d i at io n . Report no. 91. B e t he s d a , MD: N a t i o na l C o unc i l on R a d i a t io n P r o t e ct io n a n d M e a s u r e m e n t s , 1 98 7 , w i t h per m i s s io n.

P.402

16.2. EFFECTIVE DOSE EQUIVALENT

Whole bo d y e x po s u re s are r a r el y uni f o rm . For a given e x po s ur e r e c ei v e d , i n t e r n a ll y o r e x te r n a lly , d o s e e q u i v al e nt s f or v a r i o us t i s s ue s m a y d i f f e r m a r k e dl y . A l s o , t i s s u e s v a r y i n s e n s i ti v i t y to r a d i at io n- i nd uc e d e f f e c t s . T o ta k e i nt o a c c o unt t h e s e n o n u n i f o r m i r r ad i a ti o n si t uat io ns t he c o nc e pt o f e f f e c ti v e d o s e e q ui v al e nt h a s b e e n a d o pt e d b y t h e IC R P a n d t he N C R P . T h e e f f e c t i v e do s e e qu i v a l e n t ( H E ) , i s d e f i ne d a s t he s um o f t he w e i g hte d do s e e q u i v a le n t s f o r i r r a di at e d t i s s u e s o r o r g a ns ( 2 ) . M a t he m a t i c al l y ,

w h e r e W T i s t h e w e igh t i n g f a c t o r o f t i s s ue T a nd H T i s t he m e a n d o s e e q ui v a l e nt r e c e i v ed b y t i s s u e T . T h e w e i g h ti n g f a ct o r s r e p r e se n t t he p r op o rt io na t e r i s k ( st o c ha st i c) o f t i s s ue w he n t h e b od y i s i r r ad i at e d u n i f o r m l y . T he y a r e d e r i v e d f ro m r i s k co e f f ic i e nt s ( i .e . , r i s k per unit do s e e q u i va l e n t ) . T a bl e 1 6 .2 gi v e s t he w e ig ht i ng factors a nd t he c o r r e s po n di n g r i s k c oe f f i c i e n t s f o r v a r io us ty p e s o f t i s s ue s a nd o rg a ns .

TABLE 16.2. RECOMMENDED VALUES OF THE WEIGHTING FACTORS WT, FOR CALCULATING EFFECTIVE DOSE EQUIVALENT AND THE RISK COEFFICIENTS FROM WHICH THEY WERE DERIVED

WWW.MEDRAD.IR

Tissue (T)

R i s k C oe f fi c i e n t

WT

Gonads

4 0 1 0 - 4 S v - 1 ( 4 0 10 - 6 r e m - 1 )

0.25

Breast

2 5 1 0 - 4 S v - 1 ( 2 5 10 - 6 r e m - 1 )

0.15

R e d b o n e m a r ro w

2 0 1 0 - 4 S v - 1 ( 2 0 10 - 6 r e m - 1 )

0.12

Lung

2 0 1 0 - 4 S v - 1 ( 2 0 10 - 6 r e m - 1 )

0.12

Thyroid

5 10-4 Sv-1 (5 10-6 rem-1)

0.03

Bone surface

5 10-4 Sv-1 (5 10-6 rem-1)

0.03

Remainder

5 0 1 0 - 4 S v - 1 ( 5 0 10 - 6 r e m - 1 )

0.30

Total

1 6 5 1 0 - 4 S v - 1 ( 1 65 1 0 - 6 r e m - 1 )

1.00

F r o m N C R P . R e c o m m en d a t io n s o n l i m it s f o r e x p o s ur e to i o ni zi ng r a d i a ti o n. R e p o rt n o . 9 1 . B et h es d a , M D : N a t io na l C ounc i l o n R a d i at io n P r o t e cti o n a nd Measurements, 1 98 7 , with p e r mi s s io n. V a l u e s a r e f r o m IC R P . R e c o m m e nd at io ns o f t he I nt e r nat io na l C o mm i s s io n o n R a d i ol og i c al P r ot e ct ion . R e p o r t no . 2 6 . N e w Y o r k : P e r g a m o n P r e ss , 1 9 7 7 .

A. Risk Estimates
T h e r i s k e s t i m a te s g i ve n i n T a b l e 1 6 . 2 i nc l ud e a n a s s um p t i o n o f f ul l e x p r e s si o n o f t h e c a n c e r ri s k a n d an a s s u m p t io n o f a pop ul a ti o n di s t ri b utio n o v e r al l ag e s a nd b o t h s e x e s . T h e g e n et i c c o mp o n e nt i nc l udes s e v e r e g e ne ti c e f f ec t s f o r t he f i r s t t w o g e n er a ti o n s . In t h e t ot a l ri s k c o e f f i ci ent , t he s o m at i c r is k is 1 2 5 1 0 - 4 S v - 1 ( 1 2 5 1 0 - 6 r e m - 1 ) , wh i c h f o r r a d i a ti o n p rot e c tio n p ur p o s e s i s r ound e d o f f t o 1 1 0 - 2 S v - 1 ( 1 10 - 4 r em - 1 ) . T h e ge ne ti c co mp o ne nt o f t he ri s k i s 4 0 1 0 - 4 S v - 1 (0 . 4 10-4 rem-1). P.403

16.3. BACKGROUND RADIATION

R a d i a ti o n i s a p a rt o f t h e n a t ur a l e nv i ro nm e nt . T hi s b a c k g ro und r a d i a tio n i s c o n t r ib u t ed p ri n c i p al ly b y t h r e e s o ur c e s : te r r e s tr i al r a di a ti o n, co s m i c r a d i at io n, a n d r a d i at io n f r o m r ad i o a ct i ve el e me nt s i n o ur bo d ie s . T a bl e 1 6. 3 g i v e s a v e r a ge v a l u e s o f b a c k g r o u n d r a d i a ti o n to w hi c h v a r i o us p a r t s o f t he bo d y a r e e x po s e d

WWW.MEDRAD.IR

a n n u a l l y . T h e t o t al e f f e c t i v e do s e e q ui v a l ent f o r a m e m b e r o f the p o p ul at io n i n the U n it e d S t at e s f ro m v a r io u s s o ur c e s of na t ur a l b a c k g round r a d i a ti o n is a p p r o xi m a te l y 3 . 0 m Sv / y e a r ( 3 0 0 m r e m / y ea r ) .

TABLE THE

16.3.

ESTIMATED STATES AND

TOTAL CANADA a

EFFECTIVE FROM

DOSE

EQUIVALENT RATE FOR A MEMBER OF THE POPULATION IN UNITED VARIOUS SOURCES OF NATURAL BACKGROUND RADIATION

S ou r c e

T ot a l E f f e c ti v e D ose E q u i v a l e n t R a te ( mS v / y ) b Lung G on a d s B on e Surfaces B on e M a r r ow Other T i ssu e s T ot a l

WT

0.12

0.25

0.03

0.12

0.48

1.0

Cosmic

0.03

0.07

0.008

0.03

0.13

0.27

C o s m o ge n i c

0.001

0.002

0.004

0.003

0.01

T e r r e s t ri a l

0.03

0.07

0.008

0.03

0.14

0.28

In h a l e d

2.0

2.0

In t h e b o d y

0.04

0.09

0.03

0.06

0.17

0.40

Rounded t ot a l s

2.1

0.23

0.05

0.12

0.44

3.0

T h e e f f e c ti v e d o se e q u i v a le n t r a te s f o r C a na d a a r e a p p r o xi ma t e l y for the = t e r r e st r i al a nd 1 00 i nha l e d 1mSv

20 %

lower
b

c o m po ne nt s . mrem.

F r o m N C R P . E x p o s u r e o f t h e p op ul a tio n i n t he U ni te d S t at e s and C a na d a f r o m n a t u r a l b a c k g r ou n d r a d i a t io n. R e p o rt no . 9 4 . Be t he s d a , M D : N a t io na l C o u n c i l o n R a d i at io n P r o te c ti o n a nd M e a s ur em e nt s , 1 9 87 , w i t h p e rm i s s io n.

T h e t e r r e st r i al r a di a ti o n v a r i e s o v e r t he e a r t h b e c a us e o f d i ff e r e nc e s i n t he amount b u i l di n g of naturally occurring e l em e nt s in t he e a r t h s s ur f a c e . In a d d i t i o n, m at e ri a l s . m a te r i al s ma y i n c o r p o r at e na t ura l l y o c c ur r i ng r ad io ac t i v e

M a n y b u i l d i n g s m a y ha v e e le v a t ed l e v el s o f r a d o n e m it te d b y na tur a l l y o c c ur ri ng u r a n i u m - 2 3 8 i n t h e so il . It h a s b e e n e s t ima t e d (3 ) t ha t t he a v er a g e a nnua l d o s e

WWW.MEDRAD.IR

e q u i v a le n t to b r o n c h i al e pi t he li u m f r o m r ad on d e c a y p ro d uc t s i s ap p r o xi m a te l y 24 mSv (2.4 rem). C o s m i c r a di a ti o n le v el s c h a n g e w i t h e l e v ati o n. F o r e x a m pl e , a i r t r a v e l e x po s e s i n d i v id u a l s to i n c re a se d r a di a ti o n e x p o s ur e. It ha s b e e n e st i m ate d t hat a t 3 0 , 00 0 f e e t t h e do s e eq u i v a len t i s a p p r o xi m a te l y 0 .5 m r e m / ho ur ( 4 ) . T h e i n t er n a l i r r a di a ti on a r i s e s m a i nl y f r o m

40

K i n o ur b od y , w hi ch e m it s a nd

rays and decays with a half-life of 1.3 109 years. In a d d i ti o n t o t h e b ac k g r o u n d r a d i ati o n, the p o p ul a ti o n i s e x pos e d to r ad i at io n f r o m v a r io u s m e di c a l p r o ce d u r e s t he pl a nne d e x po s ur e o f p a tie nt s , a s di s ti nc t f r o m o c c u p at io n a l e xp o s u r e s re c e i ve d b y he a l t h p er s o nne l . It w a s e s t i m at ed b y t h e U . S . P u b l i c H e a l t h S e r v i c e t h a t t he a v e ra g e a nnua l g e ne t i c al l y s i g ni f i c a nt do s e e q u i v a le n t 2 i n 1 97 0 w a s a p p r o x i m at el y 2 0 m r e m / y e a r f r o m r a di ol o gi c p ro c e d ur e s . U n d e r o r di n a r y c i r c um s t a n c e s , e x po s ur e s f r o m na t ur a l b a c k g round r a d i at io n a nd m e d i c al p ro c e d u r e s a re n o t i n c l u d ed i n t he o c c up a ti o na l e x po s ur e c o nt r o l s f o r t he i n d i v id u a l c a s e s .

16.4. LOW-LEVEL RADIATION EFFECTS

A v a s t l it e r at u r e e x i sts o n t h e bi ol o gi c e f f ec t s o f r a di a ti o n. Di s cus s i o ns p e rt i ne nt t o r ad i at io n p r ot e ct ion c a n b e f o und i n r e p o rt s o f t he U ni te d Na t io ns S c i e nti f i c C o m m it t ee o n t h e E f f e c t s o f A t o mi c R a d i at ion ( 6 ) . P.404

W h e r e a s l a rg e do s e s o f r a d i at io n p ro d uc e id e nt i fi a bl e e f f e ct s w ithi n a r e l a ti v el y s h o r t p e ri od , t h e e f f ec t s a r e d i f f i c ul t to a s ce r t ai n a t l o w do s e s ( e. g . , l e s s t ha n 1 0 c G y ) . T h e d i f f i c u l t y i s d u e m a i n l y t o t he e xt re m e l y lo w f r e q ue nc y w i t h w hi c h t he s e e f f e c t s mi g h t o c c u r . T h e s t a ti st i c al p ro bl em s a r e e no r mo us i n i d e nti f y i ng s m all e f f e c t s i n t h e c o n s t an t p r e s e n c e o f s po nta ne o us l y o c c ur r i ng e ff e c t s . H o w e v e r , c e r t ai n e f f e c t s h a v e be e n d em o n s t r at ed i n hum a ns a nd o t he r m am m a l s at do s e s l o w e r t h a n t h o se r e qu i r e d to p r od uc e a c ut e r a di a ti o n s y nd r o me b ut g r e at l y i n excess of d o se to l i mi ts gen e r e c om m e nd ed r a di a tio n m u t a t io ns , may by t he s t a nd ar d s (a) b re a k s , se tt i ng a nd bo d ie s . T hus as (b ) exposures l o w -l e ve l p r o d uc e ge ne ti c ef f e c t s , s uc h

r a d i at io n - i n d u c e d

c hr om o s o me

a no m a li e s ;

n e o p l a sti c d is e a s e s , su c h a s i n c r e a s e d i nc i de nc e o f le uk e m i a , t hy r o i d t um or s , a nd s k i n l e si o n s ; ( c ) e f f ec t o n g r o wt h a nd de ve l op m e nt , s uc h a s a dv e r s e e f f e ct s o n f e t u s a n d y o u n g c h i l dr e n ; ( d ) e f f e c t o n l i f e s p a n, s uc h a s d i m i nis hi ng o f l i f e s p a n o r p r e m at u r e a gi n g ; a n d ( e ) c a t a r a c t s o r o pa c i f i c a ti o n o f t he e y e le ns . T h e h a r m f u l e f f e c t s of r a d i a ti o n m a y be c la s s i f i ed i nto t wo g e ne r a l c at e go r ie s : s t o c h a s ti c e f f e c t s a n d n o n s t o c h a st i c e f f e c t s. T he N C R P ( 2 ) d e f i ne s t he s e e f f e ct s as f o l lo w s . A s t o c h a s ti c e f f e ct i s o n e i n w h i c h t he p ro b a bi li t y o f o c c ur r e nce i nc r e a se s w it h i n c r e a s i n g a b so r b ed do s e b u t t h e s e v e ri t y in a f f e c t e d i nd i v i d ual s d o e s not d e pe nd o n t h e m a g n i t u d e o f th e a b s o r b ed d o se . In o t he r w o r d s , a s t o c ha s t i c e f f e c t i s a n a l l or n o n e p h e n o me n o n , s u c h a s t he d e v e lo p m e nt o f a c a nc e r or g e ne ti c e f f e c t . A l t h o u g h t h e p ro b ab il it y o f s u c h e f f e c t s o c c ur r i ng i nc r e a se s w i t h d o se , t he i r s e v e r it y d o e s n ot .

WWW.MEDRAD.IR

nonstochastic and

e f f ec t

is

one

w hi c h of

i nc r e a s e s

in

se v e r it y ar e

with

i nc r e a si ng

a b s o r be d d o se i n a f f ec t e d i n di v i d ua l s , o w i ng to d a ma g e to i nc r ea s i ng num b e r o f cells tissues. Examples no ns to cha s t i c effects ra d i a tio n- i nd uc e d d e ge n e r a ti v e c h a n g e s s u c h a s o r g a n a t r o phy , f i b r o s i s , l e ns o p ac i f i c a ti o n, b lo od c h a n g e s , a n d d e c r e a se i n s p e r m c o unt . W h e r e a s n o t h r e s h ol d d o se c a n be p re di c ted f o r st o c ha st i c e f f e ct s , it i s po s s ib le t o s et t h r e s h ol d l i mi ts o n n o n s t o c ha s t i c e f f e c t s t ha t a r e si g ni f i ca nt o r s e r io us ly h e a l t h i m p ai ri n g . H o w e v e r , f o r t he p ur p os e o f r a d i at io n p r ot ec t io n, a c a ut i o us a s s u m p t io n is made that t h e do s e - ri s k r e l at io ns hi p is st r ic t l y p ro po rt io nal ( l i n e a r ) wi t h o u t t h r es h o l d , t h r o ug ho ut t he r a ng e o f do s e e q ui v a l e nt a nd do s e e q u i v a le n t r a t e s o f i mp o rt a n c e i n r o ut i ne r ad i a ti o n p ro te c ti o n. M a n y a n a l y s t s b e li e v e t h a t t h e s e t w o a s s um p ti o ns m a y o v e r e st im a t e t he bi olo g ic e f f e c t s a t lo w d o se l ev e l s . S o m e ha v e p r opo s e d a li ne a r q ua d r at ic d o s e - re s po ns e c u r v e t h a t a s s i g n s r e l a ti v el y r e d uc e d e f fe c t s to l o w do s e s . H o w e v e r , i n t he a b s e n c e o f m o re r el ia b l e d at a it s ee m s p rud e nt t o ad op t a c o ns e r v a t i v e mo de l , t h e n o n t h r e s h o ld li n ea r r e s p o n s e , f o r pr ed i c ti ng lo w d o se e f f ec t s . F o r f ur t he r d i s c u s s io n o f d o s e - re sp o n s e m od el s , t he r e ad e r i s r e f e r re d to r e f er e nc e s 7 t o 1 0 .

16.5. EFFECTIVE DOSE EQUIVALENT LIMITS

N C R P ( 2 ) r e c o m m e n d at io n s o n e x p o s ur e li mi t s o f r a di a tio n w o r k e r s a r e b a s e d o n t h e f o ll o wi n g c r it e ri a: ( a ) a t lo w r a d i at ion l e v e l s t he no ns t o cha s t i c e f f e c t s ar e e s s e n t i al l y a v o id e d ; (b ) t h e p r ed i ct ed r i s k f o r st o c ha s ti c e f f e c ts s ho ul d not b e g r e a te r than the average risk of a c ci dent a l death a m o ng workers in s a f e i n d u s t r ie s ; a n d ( c ) A L A R A p r i n c i pl e s ho uld b e f o ll o w ed , f o r w hic h t he r i s k s a r e k e p t a s lo w a s r e a son a b l y a c h i e v a bl e , t a ki ng i nt o a c c o unt so c ia l a nd e c o no m i c factors. It i s i m p o rt a n t to c om p a r e r a di a ti o n r i s k s w i t h t he r i s k s i n o t her i nd us t r i e s w he n s e t ti n g ra d i at io n p rote c t io n st a n d a r d s . T abl e 1 6 . 4 gi v e s d a t a o n a nnua l f a t a li t y r a t e s f ro m a c ci de n t s in d i f f e r e n t o c c up at io ns . O n t he b a si s o f t he s e d a t a , s a f e i n d u s t r ie s a r e d e f i n ed a s t h o s e ha v i ng a n as s o c i at e d a nnua l f a t a li t y a c c id e nt ra t e o f 1 or le s s p er 1 0 ,00 0 w o r k e r s , t ha t i s , an a v e r a g e a nnua l r i s k o f 1 0 - 4 ( 2 ) . T he a v a i l a bl e d at a f o r t h e r a d i at io n i n d us t r i e s s ho w a v e r a g e f a t a l a c c ide nt r a t e o f l e s s t h a n 0 . 3 1 0 - 4 ( 1 1 ) . F r o m t h i s p e r s p e ctiv e , t he r a d i a ti o n i ndus t r i e s c o mp a r e f a v o r a b l y w it h t h e sa f e i n d u s t r ie s . F o r ra d i a tio n p r ot e ct io n p ur p o s e s , t he t ot a l r i s k c o e f f i c ie n t i s a s s um e d to b e 1 1 0 - 2 S v - 1 ( 1 1 0 - 4 r e m - 1 ) .

TABLE 16.4. ANNUAL FATALITY RATES FROM ACCIDENTS IN DIFFERENT OCCUPATIONS a

WWW.MEDRAD.IR

O c c u p a t i on

N u m be r W or k e r s 1 0 3

of

Annual Fatal Accident Rate ( p e r 1 0 , 0 0 0 W or k e r s)

Trade

2 4 , 0 00

0.5

Manufacturing

1 9 , 9 00

0.6

Service

2 8 , 9 00

0.7

Government

1 5 , 9 00

0.9

T r a n s p o r t at io n u t i li ti e s

and

5,500

2.7

C o n s t r u c t io n

5,700

3.9

Agriculture

3,400

4.6

Mining, quarrying

1,000

6.0

A l l i n d u s t ri e s ( U . S . )

1 0 4 , 30 0

1.1

C e r t ai n o c c u p at io n s h a v e h i g he r a nnua l f a t a l a c ci d e nt r at e s t ha n t ho s e he r e . Report and no. 91. B e t he s d a , MD: N a t i o na l 1 9 87 , C o unc i l with on R a d i a t io n

given r a d i at io n . P r o t e ct io n 1 9 85 .

R e p r i n te d f r o m N C R P . R e c o mm e nd at io ns o n l im it s f o r e x po s ur e t o io ni z i ng M e a s u r e m e nt s , p e r mi s s io n.

D a t a a r e f r o m N S C . A c c i d e n t f a c t s 1 9 84 . C hi c a g o : N a ti o na l S a fe t y C o unc i l ,

P.405

A. Occupational and Public Dose Limits

T a b l e 1 6 . 5 g i v e s o c c u p a t io n a l a n d p ub li c do s e eq ui v a le nt li m it s a s r e c o m me nd ed b y t h e N C R P ( 2 ) . T h e s e l i mi t s do no t i ncl ud e e x p o s ure r e c e i ve d f r o m m e di c a l p r o c ed u r e s o r t h e n a tu r a l b a c k g r o und . R a d ia t io n w o r k e r s a r e l i m it e d to a n a nnua l e f f e c t i v e do s e eq u i v al e n t o f 5 0 m S v ( 5 re m ) a nd t he g e ne r a l p ub l i c i s not t o e x c e e d o n e te n t h o f th i s v a l u e ( 0 . 5 r e m ) for i nf r e q ue nt e x po s ur e a nd 1 m S v ( 0 . 1 r e m ) f o r c o n ti n u o u s o r f r e q u e n t e x p o s ur e . H i g he r

WWW.MEDRAD.IR

P.406 l i mi t s a re s et f or s o me o rg a n s a nd a r e a s of t he bo d y t hat i nv olv e no ns t o c ha s ti c e f f e c t s a n d a r e le s s se n s i ti v e to r a d i at io n t ha n o t he r s . F o r e x am p l e , t he a nnua l o c c u p a ti o n a l do s e e q ui v a l e n t li m it t o t he l ens o f t he e y e i s 15 0 m S v ( 1 5 r em ) a nd t o ot h e r o rg a n s i s 5 0 0 m S v ( 5 0 r e m ) .

TABLE 16.5. SUMMARY OF RECOMMENDATIONS

A . O c c u p a t i o n a l e x po su r e s ( a n nua l )

1.

Effective

do se

eq u i v a l e nt

li mi t

50 mSv

(5 rem)

( s t o c h a s ti c e f f e c t s )

2 . D o s e e q u i v a le n t li m it s f o r t i s s ues a nd o r g a ns ( no ns t o c ha s t i c e f f e c t s )

a. Lens of eye

150 mSv

(15 rem)

b . A l l o t h e r s ( e . g . , r e d b o ne m a r r o w , b r e a s t , l u n g , g o n a d s , s k i n , a n d e x t r e m i ti e s )

500 mSv

(50 rem)

3 . G u i d a n c e : c u m u l a t i v e e x po s ur e

10 age

mSv

(1

rem

age in yr)

B . P l a n n e d s p e c i al oc c u p a t io n a l e x po s ur e , e f f e c t i v e do s e e q u i v a le n t l i mi t

s e e s e c ti o n 15a

C.

Guidance

for

emergency

o c c up a ti o na l

S e e s e c ti o n 16a

exposure

D . P u b l i c e x p o s u r e s ( an n u a l )

1.

Effective

d o se

e q ui v a l e nt

li m it ,

1 mSv

(0.1 rem)

c o n t i n u o u s o r f r e q u e nt e x p o s u r e

2.

Effective

d o se

e q ui v a l e nt

li m it ,

5 mSv

(0.5 rem)

i n f r e q u e n t e x po s u r e

WWW.MEDRAD.IR

3 . R e m e d i a l a ct io n r e c o m me nd e d w he n :

a . E f f e c t i v e d o s e e q u i v a le nt

>5 mSv

(>0.5 rem)

b.

Exposure

to

radon

a nd

it s

de c a y

>0.007 J hm
-3

(>2 WLM)

products

4 . D o s e e q u i v a l e n t l i mi t s f o r le ns o f e y e , s k i n , a n d e x t r e m i ti e s

50 mSv

(5 rem)

E . E d u c a t i o n a n d t r a i n i n g e x p o s ur e s ( a nnua l )

1 . E f f e c t i v e d o se e qu i v a l e n t

1 mSv

(0.1 rem)

2 . D o s e e q u i v a le n t l i m it f o r l e ns o f e y e , s k i n , a n d e x t r e m i ti e s

50 mSv

(5 rem)

F . E m b r y o - f e t u s e x p o su r e s

1 . T o t a l d o se e q u i va l e n t li m it

5 mSv

(0.5 rem)

2 . D o s e e q u i v a le n t li m it i n a m o nt h

0.5 mSv

(0.05 rem)

G . N e g li gi b le i n d i v id u a l r i s k l e v el ( a nnua l ) effective p r a c t i ce do s e e q ui v a l e n t per s o ur ce or

0.01 mSv

( 0 . 0 0 1 re m )

In

NCRP

R e p o rt

no .

91.

F r o m N C R P . R e co m m en d a t io n s o n l i mi t s f o r e x p o s ure to i o ni z i ng r a d i at io n. R e p o rt n o . 9 1 . B e t h es d a , M D : N a t i o na l C ounc i l o n R a d i a t io n P r o t e cti o n a nd M e a s u r e m e n t s , 1 98 7 , w i t h p e r mi s s io n.

T h e N C R P h a s d i s c o n t i n u e d it s p r e v io us r e c o m me nd a ti o n o f t he a g e - p ro r a tio n f o r m u l a f o r t h e c u m u la t i v e l im it , t ha t i s , ( ag e - 1 8 ) 5 r em . T he ne w g ui d a nc e i s that the n u m e r i c al value of t he i nd i vi dua l workers l i f et im e effective do s e e q u i v a le n t i n te n s o f m S v ( r e m ) d oe s no t e x c e e d t he v a l ue o f hi s o r he r ag e i n years.

WWW.MEDRAD.IR

S t u d e n t s u n d e r t h e a ge o f 1 8 w h o m a y b e e x p o s e d to r a di a ti o n a s a r e s ul t o f t he i r e d u c a t io n a l o r t r a i n i ng a c ti v i ti e s s ho ul d not r e ce i v e mo re t ha n 1 m S v ( 0 . 1 re m ) per year.

B. Dose Limits for Pregnant Women

The pregnant wo m an who is a r a di a ti on worker can be co ns i d er e d as an o c c u p a ti o n a ll y e x po s ed i n di v i d u a l , b ut t he f e t us c a nno t . T he t ot a l d o se e q ui v a le nt l i mi t to a n e m b r y o - f etu s i s 5 m S v ( 0 . 5 r e m ) , w i t h t he a d d e d r e com m e nd a ti o n t h a t e x p o s u r e to t h e f et u s s h o u l d n o t e x c ee d 0 . 5 m S v ( 0 . 0 5 r e m ) i n a ny o ne m o nt h. P r e m e n o p a u s al w o m en m u s t b e i nf o r m e d of t he p o t e nti al r i s k o f e x p o s ur e t o t he f e t u s a n d m et h od s a va i l a bl e to mi ni m i ze t he e x po s ur e . If t he re is a po s s i bi lit y o f t h e f et u s r e c ei v i n g mo r e t h a n 5 m S v ( 0 . 5 r e m ) d uri ng t he ge s ta t io n p e rio d , t he e m p lo y e e s h o u ld d i s cu s s h e r o p t i o ns w i t h he r e m p l o y e r . O nc e a p r e g na nc y i s m a d e k n o w n , t h e d o se e q ui v a l e n t li m it o f 0 . 5 m S v ( 0 .0 5 re m ) in a ny o ne m o nt h s h o u l d be t h e g u i di n g p r i n c ip l e . E v e n i f t he r e i s p r a ct i c al l y no p o s s ib il it y o f t hi s l i mi t b ei n g e x c ee d ed , i t i s p r u de nt t o a s si g n p r eg na nt w o r k e r s t o d ut ie s t hat i n v o l v e po te n t i al e x pos u r e m u c h l o w e r t ha n t he r e c o m me nd e d l i mi t . F o r e x a mp l e , s o m e i n s t it u t io n s h a v e d e v el op e d a p ol i c y o f no t a s s ig ni ng p re gna nt t e c hno lo g i st s t o w or k w i t h c ob a lt - 60 t el et h e r a p y uni t s (b e c a us e o f co ns t a nt ra d i a tio n l e a k a ge f r o m t h e s o u r c e h o us i n g ) or to ha ndl e br a c hy t he r a p y s o ur c e s. S uc h m e a s ur e s c o m e u n d e r t h e A L A R A p r i n c i pl e , t ha t i s , t he pr i nc i pl e o f l i mit i ng t he do s e o f e x p o s ed pe r s o n s (i n t h i s c a se t he f e t us) t o le v e l s a s lo w a s i s re a s o na bl y a c h i e v a b le , t a k i n g i n to a c c o u n t e c o no m i c and s o c i a l f a c to r s .

C. Negligible Individual Risk Level

A n e g l i gi bl e i n di v i d u al r i s k l e v e l ( N IR L ) i s de f i ne d b y t he N C R P ( 2 ) a s a l e v e l o f a v e r a g e a n n u a l e x c e s s r i s k o f f a t a l he a l t h e f f e c t s a t t ri b ut ab le t o i r r ad i at io n, b e lo w w h i c h f u r t h e r e f f o r t t o r e d uc e r ad i a ti o n e x p o s ur e to t he i ndi v i d ua l i s unwarranted. c o m p a re d to The the NCRP r i sk of also st a te s t ha t t he N IR L is r e g ar d e d as t r i v ial s o c ie t al fatality a s s o cia t e d w it h o r d i na r y , no r m a l

a c t i v it ie s a n d c a n , t h e r e f o r e , b e d i s mi s s e d fr o m c o ns i de r at io n . T h e c o n c e p t o f N IR L i s a p p li ed t o r a di a ti on p r o t e ct io n b e c a us e o f t he ne e d f o r h a v i n g a r e a s o n a b l y n e g l ig ib l e ri s k l e v el tha t c a n b e c o ns i de r ed a s a t hr e s ho ld b e lo w w h i c h e f f o r t s to r ed u c e t h e r i s k f ur the r w o ul d not b e w a rr a nt e d o r , i n t he w o r d s o f t h e N C R P , w o u l d b e d e li be r a te l y and s p e c i f i c al l y c ur t a il ed . T o a v o id m i si n t e rp r eta t io n o f t he r el a ti o ns hi p s b et w e e n t he NIR L , A L A R A , a nd m a x i m u m p e r mi s s ib le l e v el s , t h e N C R P poi nt s o ut t ha t t he N IRL s ho ul d not be t h o u g h t o f a s a n a c ce p t ab le r i s k l e v el , a l e v e l o f si g ni f i c a nc e , o r a l i mi t . No r s h o u l d i t b e t h e goa l o f A L A R A , a lt ho ug h i t do e s p ro v i de a lo w e r l i mi t f o r a p p li c a ti o n o f t h e A L AR A p r o c e s s . T he A L A RA p r i nc i pl e e nc o ur a g es e f f o r t s t o k ee p r a d i at io n e x p o s u r e a s l o w a s r e a s o na bl y a c hi e v a b le , c o ns id e r i ng the e c o no mi c a nd s o c i al f a c t o r s . T h e a n n u a l N IR L h a s b e e n s e t a t a r i s k o f 1 0 - 7 , c o r r e s po ndi ng t o a d o s e e q ui v al e nt o f 0 . 0 1 m S v ( 0 . 00 1 re m ) . T h i s c o r r e sp o nd s t o a l i f et i me ( 7 0 ye ar s ) r i s k o f 0 . 7 10-5.

Example

WWW.MEDRAD.IR

C a l c u l a t e t h e r i s k f o r ( a ) r a d i a ti o n w o r k e rs , ( b ) m e m b e r s o f t he g e ne r al p ub li c , a n d ( c ) N IR L , c or r e s po n d i n g to r e sp e ct i v e a nnua l e f f e c t i v e do s e e q ui v a le nt l i mi ts ( T a b l e 16 . 5 ) . A s s u m e r i s k c o e f f i c ie nt o f 1 0 - 2 S v - 1 ( 1 0 - 4 r e m - 1 ) . P.407

A n n u a l e f f e c t i v e d o s e e q u i v a le nt l i mit f o r : r a d i at io n w o r k e r s = 5 0 m S v ( 5 r e m ) Annual risk = 5 rem (10-4 rem-1) = 5 10-4

A n n u a l e f f e c t i v e d o s e e q u i v a le nt l i mit f o r m e m b e r s o f : g e n e r a l p u bl i c = 1 m Sv ( 0 . 1 r e m ) Annual risk = 0.1 rem (10-4 rem-1) = 10-5

A n n u a l e f f e c t i v e d o s e e q u i v a le nt l i mit f o r N IR L : = 0.01 mSv (0.001 rem) Annual risk = 0.001 rem (10-4 rem-1) = 10-7

16.6. STRUCTURAL SHIELDING DESIGN

R a d i a ti o n p r ot e ct io n gu i d e li n e s f o r t he d e sig n o f s t r uc t ur al s hi el di ng f o r r ad i at io n i n s t a ll a ti o n s a r e d i s c us s e d i n t h e N C R P R epo r t s 4 9 a nd 51 ( 12 , 1 3) . T he s e r e po r t s contain the n e c e s s a ry technical i nf o r m a tio n as well as r e c om m e nd a ti o ns for p l a n n i n g n e w f a c i li ti e s a n d r e m od el i ng e xi s ting f a c i l it ie s . T he r e a de r i s re f e r r ed to t h e s e r ep o rt s f o r co mp r e h e n s i v e de t ai l s o n t hi s s ub j e ct . T hi s s ec t io n w i l l d i s c us s o n l y s o me o f t h e b a si c f a c t or s t ha t a r e cons i d e r ed i n t he c a l c ula t io n o f b a r ri er thicknesses. P r o t e ct i ve b a r r ie r s a re d e si g n e d t o e ns ur e t ha t t he do s e e q ui v al e nt r e ce i v ed b y a n y i n d i v i d u a l do e s n o t e x c e e d t he a pp li c ab l e m a xi m um p e rm i s si b le v a l ue . T he areas surrounding th e r o om are d e si g na t e d as c o nt r ol le d or no nc o nt rol l ed , d e pe n d i n g o n w h e t h er o r n o t t h e e x po s ure o f p e r so ns i n t he a r e a i s und e r t he s u p e r v i s io n o f a r a d i at io n p r o te c ti o n s up e rv i s o r . F o r p ro t e ct io n c a l c ul a ti o ns , t he d o s e e q u i v a le n t li mi t i s a s s u m e d t o be 0 . 1 r e m / w e e k f o r t he c o ntr o ll e d a re a s a nd 0.01 r e m / w ee k for the no n c o nt ro ll e d areas. T he se v a l ue s a pp r o x im a te l y c o r r e s po n d to t h e a n n u a l l i m it s o f 5 r e m / yea r a nd 0 . 5 r e m / y e a r , r e s p e ct i v el y .

WWW.MEDRAD.IR

P r o t e ct io n i s r eq u i r ed a g a i n s t t h re e t y pe s of r a d i a ti o n: t he p r i m ar y r a d i a ti o n; t he s c a t te r e d r a d i ati o n ; a n d t h e le a k a g e r a d ia t io n t hr o ug h t he s our c e ho us i ng . A b a r r i er s u f f i c i e n t to at t e n u a te t he us e f ul be a m to t he r eq ui r e d d e g re e i s c a ll ed t h e p r im a r y b a r r ie r . T h e r e q u i r ed b a r ri e r a g a i ns t st r a y r a d i at ion ( l e a k a g e a nd s c a t te r ) i s c al l ed t he s e c o n d a r y b a r r ie r . T he f o l lo w i ng f a c to rs e nt e r i nt o t he c a l c u l a ti o n o f b a r ri e r t h i c k n e s s e s .

W o r k lo a d ( W ) . F o r x - ra y e q ui p m e nt o pe r a ting b e lo w 5 00 k V p , t he w o r k l o ad is usually e x p r e s se d in mi ll i a mp e re mi nut e s pe r w ee k , w hi ch can be c o m p u te d b y m u lt ip l yin g t he m a x i m um m A w i t h a p p ro x i m at e mi nut e s / w e e k o f b e am o n ti m e . F o r me g a v ol t ag e m a chi ne s , t he w or k l o ad i s us ua l ly s t a t ed i n t e r m s o f w ee k l y d o s e d el i ve r e d at 1 m f r o m t he s o ur c e . T hi s c a n b e e s ti m a te d b y m u lt ip l y i n g t he num b e r o f p a t ie nt s t r e at ed p e r w e e k w i t h t h e d o se d el i v e re d p er p a t ie nt a t 1 m . W i s e x p r e s s ed i n r a d / w e e k a t 1 m .

U s e F a c to r (U ) . F r a c tio n o f t he op e r at i ng ti m e d ur i ng w hi c h t he r a d i at io n u n d e r c o n s i de r a ti o n is d i r e ct ed to w a r d a p a r t i c ul a r b a r ri e r . A ltho ug h t he u s e f a c t o r s v a r y de pe n d i ng o n t he te c hniq ue s us e d i n a g i v en f a c i l it y , t y p i c al v a l u e s a r e g i ve n i n T a b l e 1 6 . 6 .

O c c u p a n c y F a c t o r ( T ) . F r a c t i o n o f t he o pe r at i ng ti m e d ur i ng w hi ch t he a r e a o f i n t e re s t i s o c c u p ie d b y t he i nd i v id ua l . If m o r e r ea li s ti c o c c up anc y f a c t o r s a r e n o t a v a i l ab le , v a l u e s g i v e n i n T a b l e 16 . 7 m a y b e us e d .

D i s t a n c e ( d ) . Di s t a n ce i n m e te r s f r o m t he r a d i a ti o n so ur c e to the a r e a t o b e p r ot e ct e d . In v e r s e s q u a r e l a w i s a s s um e d f o r b ot h t he p ri m a r y a nd s t r a y r a d i at io n .

TABLE

16.6.

TYPICAL

USE

FACTOR

FOR

PRIMARY

PROTECTIVE BARRIERS

L oc a t i on

U s e F a c t or

F l oo r

Walls

C e i li n g

, d e pe n d i n g o n eq ui p m e nt a nd te c hni que s

TABLE 16.7. TYPICAL OCCUPANCY FACTORS

WWW.MEDRAD.IR

Full Work P a r t i al Corridors, Occasional

o c c up a n c y areas, o cc u p a n c y res t r oo m s , oc c u p a n c y offices,

(T nur s e s (T el e v at o r s (T =

= = with

1) s t a ti o ns ) o pe r a to r s 1 / 8 1 /1 6)

W a i t i n g r oo m s , re s tr o o m s , st a i r w a y s , una t t e nde d e le v a to r s , o uts i d e a r e as u s e d o nl y f o r p e de s t ria n s o r v e hi c ul a r t r a f f i c

P.408

A. Primary Radiation Barrier

S u p p o s e t h e m a x i m um p e r mi s s ib le do s e equi v a l e nt fo r t he a re a to be pr ot e ct e d i s P ( e . g . , 0 . 1 r a d / w ee k f o r co n t r ol le d a nd 0 .0 1 r ad / w e e k f o r no nco nt r ol le d ar e a ) . 3 If B i s t h e t r a n s m i s s ion f a c t o r f o r t he b a r r ier t o r e d uc e t he p r i m ar y b e a m d o s e t o P i n t h e a r e a o f i n t e r es t , t h e n :

T h e r e f o r e , t h e r eq u i r ed t r a n s m i s s io n f a c t o r B i s g i v e n b y :

B y c o n s u l t i n g b r oa d be a m a tt e n u a t io n c ur v e s ( F i g s . 16 . 1 a nd 16. 2 ) f o r t he gi v e n e n e r g y b ea m , o n e c an d e t er m i n e t he b ar ri e r t hi c k ne s s r eq ui r ed . M o r e d a t a o n b e a m a tt e n u a t io n a r e a v a i l a bl e f r o m t he N C R P ( 1 3 ) .

WWW.MEDRAD.IR

FIG.

16.1.

Transmission

through

c o nc r e te

( d e ns i t y

2 . 35

cm-3)

of

x-rays

p r o d u c ed b y 0 . 1 - t o 0 . 4 - M e V e le c t ro ns , und e r b r o a d- b e a m co nd i ti o ns . E l e ct r o n e n e r g ie s d e si g n at e d by a n a s t e r i s k w e r e a c ce l e r at ed b y v o lt a ge s w i t h p ul s ed w a v e form; unmarked el e ct r o n e n er g ie s w e re a c c e l e r at ed in by a c ons t a nt p ot e nt i al r at io . D C: g e n e r a to r . 0 . 1 10 0 Curves r e p r e se n t t r a ns mi s s ion f a c il it ie s . d o s e - eq ui v a le nt No . 51. i nd e x

( R e p r i n te d w it h p e r mis s i o n f r o m N C R P . R a d i a ti o n p ro t e cti o n d e sig n g ui d el i ne s f o r Me V p a r ti c le a c c e le r a to r R e po r t W a s hi ng t o n, N a t io n a l C o u n c i l o n Ra d i a tio n P r o t e ct io n a nd M e a s ur e m e nt s , 1 977 . )

WWW.MEDRAD.IR

F I G . 1 6 . 2 . T r a n s m i s s io n o f t hi c k - t a r ge t x - ra y s t hr o ug h o rd i na r y c o nc r e te ( de ns i t y 2 . 3 5 g c m - 3 ) , u n d e r b r o a d -b e a m co ndi ti o ns . E ne r g y d e s ig na t io ns o n e a c h c ur v e ( 0 . 5 t o 1 76 Me V ) r e f er to t h e mo no e ner g et ic e le c t ro n e ner g y i nc id e nt o n t he t hi c k x - r a y p r o d u c t io n t a r ge t . C u r v e s r e p r e se nt t r a ns m i s s io n to d o se e q ui v a le nt i nd e x r a t io . ( R e p r i n te d for w it h p e r m i s si o n MeV from NCRP. R a d i a t io n f a c i l it ie s . p r o te c ti o n R e p o rt d e si g n No. 51. g u i d el i n e s 1 9 77 . ) T h e c h o i c e o f b a rr i er m a t e ri a l , fo r e x a m pl e, c o nc r e te , le a d , o r st e el , de p e nd s o n s t r u c t u r a l a n d s p a ti al c o n s i d e r at io ns . Be c a us e c o nc r e t e i s r e l ativ e l y c he a p , t he w a l l s a n d r o o f b a r ri e rs a r e u s u a l l y c o ns t r uc t e d o ut o f c o nc r et e . Le a d o r s te el c a n b e u s e d w h e r e s p a ce i s a t a p r e mi um . F o r m e g a v ol t ag e x a nd r a d i a t i o n, e q u i v a le n t t hi c k n e s s o f v a r i o u s m at e ri a l s c a n b e c a l c ul a t ed b y c o m p a ri ng t e nt h v a l u e l a y e r s ( T V L ) f o r t h e g i v e n b e a m e ne rg y . If s uc h i nf o r m a t i on i s no t a v a i l a b l e s p e c i f i ca ll y f o r a g i ve n m a t e ri a l , r e la ti v e d e ns i ti e s c a n b e us ed i n mo s t c a se s . D e n s i ti e s a n d T V L s f or d i f f e re n t m at e ri a l s a nd b e a m e ne rg ie s a re a v a il a bl e f ro m the NCRP (13). 0 . 1 10 0 p a r t i cl e a cc e l e r ato r

W a s h i n g t o n , D C : N a t i o n a l C o u n c i l o n R a di a ti o n P r o te c ti o n a nd M e a s ur e m e nt s ,

B. Secondary Barrier for Scattered Radiation

WWW.MEDRAD.IR

R a d i a ti o n i s s ca tt e r ed f r o m t h e p a ti e nt i n al l d i re c ti o ns . T he a m ount o f s c at t er ed r a d i at io n d e p e n d s o n t h e b e a m i nte ns i t y i nc i d e nt o n t he s c a t t e rer , t he q ua l i t y o f r a d i at io n , t h e a r e a o f t h e b e am a t t he s c at t er e r , a nd t he s c a tt er i ng a ng le . T he r a t io o f s c a t te r ed d os e t o t h e i nc i d e nt d os e m a y b e d e not e d by . T a b l e 1 6 .8 g i v e s v a l u e s o f f o r v a r i o u s a n g l e s a nd bea m q ua l it ie s . F o r m ega v o l t ag e be a m s , i s u s u a l l y a s s u m e d to b e 0 . 1% f o r 9 0 de g re e s s c a tt e r .

TABLE

16.8.

RATIO,

OF

SCATTERED

TO

INCIDENT

EXPOSURE a

S c a t t e r i n g A n g l e ( F r om C e n t r a l Ray)

Rays
60

X-Rays 4 MV 6 MV

Co

15

9 10-3

30

6.0 10-3

7 10-3

45

3.6 10-3

2.7 10-3

1.8 10-3

60

2.3 10-3

1.1 10-3

90

0.9 10-3

0.6 10-3

135

0.6 10-3

0.4 10-3

S c a t te r ed r a d i at io n m e a s u r e d a t 1 m f r om p ha nt o m w he n f i e l d a r e a i s 4 00 w i t ho ut p ha nt o m .

c m 2 a t t h e p h a n t o m s u r f a c e ; i nc i d e nt e x p os ur e m e a s ur e d a t c e nt e r o f f i eld but F r o m N C R P . M e d i c al x- r a y a n d g a m m a - r a y p r ot e c tio n f o r e ne rg i es up t o 1 0 M e V . S t r u c t u r a l s h ie ldi n g de s i g n a nd e v a l uat io n. R e po r t no . 34 . W a s hi ng t o n, D C : N a t io n a l C o u n c i l o n R a d i a tio n P r o t e cti on a nd M e a s ur e m e nt s , 1 9 70 , w i t h p e r m i s sio n . D a t a al s o a r e a v a il a ble i n N C R P . R a d i at io n p r ot e c tio n d e si g n a nd g ui d el i ne s f o r 0 . 1 1 00 M e V p a r ti c l e a c c el e r at o r f a ci li ti e s . R ep o rt no . 5 1 . W a s hi ng t o n, D C : N a t i o n a l C o u n c il o n R a d i a ti o n P r ot e ct ion a nd M e a s ur e m e nt s , 1 9 77 .

T h e s c a t t e r ed r a d i at ion , i n g e n e r a l , ha s l o w e r e ne r g y c o m p a re d w i t h t he i nc i d e nt e n e r g y . H o w e v e r , t h e s o f t e n i n g o f t he be a m a s a r e s ul t o f C o m p to n s c a t te r d e pe n d s o n t h e i n c i de n t e n e r g y a nd t he d i r e ct io n o f s c a t te r . F o r o r t ho v o lt a ge r a d i at io n , t h e q u al it y o f s c a tt e re d r ad i at io n i s us ua l l y a s s um ed to be t he s a m e a s t h a t o f t h e i n c i de n t b e a m . Fo r me g a v olt a g e b e am s , o n t he o t her ha nd , t he

WWW.MEDRAD.IR

m a x i m u m e n e r g y o f th e 9 0 - de g re e s c at te re d p hoto ns i s 50 0 keV . T he r e f o r e , t he t r a n s m i s s io n o f t h i s s c a t te r e d r a di a tio n t hr o ug h a b a r r i e r i s e s t im a te d to be a p p r o xi m a te l y t h e s am e a s t h a t f o r a 5 0 0 -k V p us e f ul b e a m . A t s m a l le r s c a t te r i ng a n g l e s , h o w e v e r , t h e s c a t t e re d b e am ha s g r e a t e r pe ne tr a ti ng p o w e r ( 1 4 ) . In a d d it io n , a g r e a t er f r a c t io n o f t h e i nc i de nt be a m i s s c a tt e r ed a t sm a l le r a ng l e s . S u p p o s e a t r a n s m i s s ion f a c t o r o f B s i s r eq ui re d t o r ed uc e t he s c at te r e d do s e to a n a c c e p t ab le l e v el P i n t h e a r e a o f i nt e re s t ; t he n:

P.409

w h e r e i s t h e f r a c ti on a l s c a t te r a t 1 m f rom t he s c a tt e r e r , f o r be a m a r e a o f 40 0 c m 2 i n c id e n t a t t h e s ca t t er e r , d i s t he d i st anc e f r o m so ur c e t o t he s c a tt e re r , d i s t h e d i st a n c e f r o m t h e s c a t te r e r t o t he a r e a o f i nt e re s t , a nd F i s t he a r e a o f t he b e a m i n c i de n t at t h e s c a tt e re r . T he us e f a c t o r f o r t he se c ond a r y b a r r ie r is c o n s i d er e d u n i t y . T h u s t h e b a r r i e r t r a n sm i s s io n B s i s g i v e n b y :

T h e r e q u i re d t h i c k n es s o f co n c r e te o r l e ad c a n be d e te r mi ne d f o r ap p ro p ri a te t r a n s m i s s io n c u r v e s g iv e n b y t h e N C R P ( 1 3 ) o r F i g s . 1 6 .1 a nd 1 6 . 2.

C. Secondary Barrier for Leakage Radiation

T h e l e a k a ge r eq u i r e me n t s o f t h e r a pe ut i c s our c e a s s e m bl ie s ha v e b e e n r e vi s e d a nd a r e c u r r e n tl y d e s c ri bed i n t h e N C R P R e po r t 1 0 2 ( 1 5 ) . T hi s r e po rt s up e r se d e s t he p r e v io u s N C R P R e p o r t 3 3 . T h e n e w r e c o m m end a t io ns a r e s um m a r iz e d b e lo w : P.410

5 t o 50 k V p . T h e l e ak a g e e x p o s ur e r at e 4 sha l l no t e x c ee d 0 . 1 R i n a ny 1 h o u r a t a n y p o i n t 5 c m f r o m t he s o ur c e a s se m b l y . G r e a t e r t h a n 5 0 k V p an d l e s s t ha n 5 00 k V p . T he l e a k a g e e x po s ur e r a t e a t a d i s t a n c e o f 1 m f r o m t h e s o ur c e s ha l l no t e x c e e d 1 R i n a ny 1 ho ur . I n a d d it io n , t h e se a s se mb l ie s s ha ll l im it e x po sur e r a te t o 3 0 R / h at 5 c m f r o m the surface of the assembly.

G r e a t e r t h a n 5 0 0 k Vp . T h e a b s o r be d do se r a t e d ue to l e a k age r a d i at io n ( e x c l u d i n g n e u t ro n s ) a t a ny p oi nt o ut s ide t he m a xi m um f i el d s i z e , b ut w i t h i n a c i r c u l a r p l a n e o f r a d i us 2 m t ha t i s p e r p e ndi c ul a r t o a nd c e nt e r ed o n t h e c e n t ra l a x i s a t t h e no rm a l t r e at me nt d i st a nc e , s ha ll no t e x c e ed 0 . 2 % o f t h e u s e f u l be a m d o se r a t e at t he t r e a t me nt d i st a nc e . E x c e p t f o r t h e a r e a de f i n e d ab o ve , t h e l ea k a g e do s e ra t e f r o m t he s o ur c e as s e m b l y at a n y p o i n t a t a d i st a nc e o f 1 m f r o m t he ele c t ro n p a t h b et w e e n t he s o ur c e a n d t h e t a r g et s h a ll no t e x c e ed 0 . 5% o f t he us e f ul be a m do s e ra t e at t he t r e at m e n t d i st a n c e . Th e n e ut r o n c o nt r i b ut io n t o t he d o se w it hi n t he us e f ul

WWW.MEDRAD.IR

b e a m s h a ll b e ke p t w e l l b el o w 1 % o f t he x - r a y d o se . O ut s id e t he us e f ul b e a m , t h e n e u t r o n dos e s h o ul d b e r ed uc e d t o a s lo w a s p r a c t i c ab le .

C o b a lt t el e t h er a p y . Le a k a g e d o se r at e f r om t hi s s o ur c e ho us i ng w it h t he b e a m i n t h e o f f p o sit io n s ha l l no t e x c ee d 2 m r a d / ho ur o n t he av e r a g e a nd 1 0 m r a d / h o u r m a x i mu m i n a n y d i r e c t io n, a t a d i s t a nc e o f 1 m f r o m t he s o u r c e . W it h t h e be am i n t he o n p o si ti o n, t he l e a k a ge d o se r ate f r o m t he s o u r c e h o u s i n g s h a l l n o t e x ce e d 0 . 1% o f the us e f ul b e a m do s e r a t e , bot h m e a s u r e d at a di s t a nc e o f 1 m f r o m t he so ur c e . In a d di ti o n, f or s o ur c e s t h a t gi v e ri s e t o a u s e f u l b e a m do s e r at e of l e s s t ha n 1 , 0 0 0 r a d /ho ur a t 1 m , t h e le a k a g e f ro m t h e s o ur c e ho us i ng sha l l no t e x c ee d 1 r a d/ h a t 1 m from the source.

P.411

B e c a u s e l e a k a ge r a dia t io n i s pr e s e nt w he ne v e r t he m a c hi ne i s op e r a te d , t he us e f a c t o r f o r l e a k a ge i s u n i t y . S u p p o s e t he r e q ui r ed s e c o nd a r y b ar r i e r f o r le a k a g e r a d i at io n h a s a t r a n s m i s s io n f a c t o r o f B L t o re d uc e t he le a k a g e do s e t o t he m a x i m u m p e r m i s si bl e l e v e l P ( r e m / we e k ) . F o r t h e r a p y u n i t s b elow 5 0 0 k V p :

w h e r e I i s t h e m a x i mu m t u b e c u r r e nt . T he num b e r 6 0 i s us e d to c o nv e r t l e a k a ge l i mi t o f 1 R / h o u r t o 1 /6 0 R / m i n u t e , b e c a us e t he w o r k l o a d W i s e x p r e s s ed i n t e r ms o f m A - m i nu t e / w e e k . F o r a m e g a v ol t ag e t h er a p y u n i t ,

T h e f a c t o r 0 . 0 01 i s t he 0 . 1 % le a k a g e li mi t thr o ug h t he s o ur c e ho us i ng . 5 T h u s t h e t r a n s m i s s i o n f a c t o r B L f o r t he l e a ka g e b a r ri e r i s gi v e n by :

and

T h e q u a l it y o f l e a k a ge r a d i at io n i s a p p ro x i ma t e l y t he s a me a s t hat o f t he p r i m a r y b e a m . T h e r e f o re , t h e t r a n s m i s s io n c ur v e f o r t he p r i m a r y b e am s ho ul d b e us e d to d e te r m i n e t h e l e a k a ge b a r r i e r t hi c k ne s s ( F i gs . 1 6 . 1 , 1 6 . 2 ) . F o r m eg a v o lt a ge t h e ra p y i n s t a ll a ti o ns , t he l e a k a g e b a r ri e r us ua l l y f a r e x c ee ds t h a t r eq u i r ed f o r t he s c a t te r e d r ad i at io n, be c a us e t he l e a k a ge ra d i a tio n i s m o re p e n e t r at i n g t h a n t h e s c a t t e re d r a di at io n. F o r t he lo w e r - e ne rg y x - r a y b e a m s , h o w e v e r , t h e d i f f e re n c e b et w e e n t he b a r ri er t hi c k ne s s f o r t he le ak a g e a nd f o r t he s c a t te r e d r ad i at io n i s r e l at i v el y l e s s . A b a r r ie r de s ig n e d fo r p ri m a r y r ad i at io n p r o v id e s ad e q uat e p ro t e cti o n a g ai ns t l e a k a g e a n d s c at te r e d r a d i a ti o n . If a b a r r i er i s d e s ig ne d f o r st r ay r a d i a ti o n o nl y ,

WWW.MEDRAD.IR

t h e t hi c k n e s s i s c o mpu t e d fo r l e a k a ge a nd s c a t te r e d r a di a ti o ns se p a r a te l y . If t he t h i c k n e s s e s o f t h e t wo P.412 b a r r i er s d i f f e r b y a t le a s t t h re e H V L s , t he t hi c k e r o f t he t w o w ill b e ad e q ua te . If t h e d i f f e r e n c e i s le s s t h a n t h r e e H V L s , o ne H V L s ho ul d b e a d d e d t o t he l a rg e r o ne t o ob t ai n t h e r e q u i re d s e c o n d a r y b a r r ie r .

D. Door Shielding
Unless a maze e n t ra n c e w a y is p r o v i d ed, t he door m us t p ro v i de s hi e ld i ng e q u i v a le n t to t h e w a ll s u r r o u n d i n g t he do o r. F o r m eg a v ol t a ge i ns t a ll a ti o ns , a doo r t h a t pr o v id e s d i re c t a c c e s s to t he t r e at me nt ro o m w i ll ha v e to be e x t r e me l y h e a v y . It w i l l r e q u i r e a m o t o r d r i v e a s w el l a s a m e a ns o f m a n ua l o p e r at io n i n c a s e o f em e r ge n c y . A m a z e a r r a ng e me nt , o n t he o t he r ha nd , d ra s t i c al l y r ed uc e s t h e s h i el di n g r e q ui r em e n t s f o r t he do o r . The f unc t i o n o f t he ma z e i s to p re v e nt d i r e ct i n c i de n c e o f r a d i a ti o n a t t he do or . W i t h a p r o pe r m a z e d e s i g n, t he d oo r is e x p o s ed m ai n l y to th e m u l ti p l y s c att e r ed r a di a ti o n of s ig ni f i c a nt l y re d uc ed i n t e n s it y a n d e n e r g y . F o r e x a m pl e , i n F ig . 1 6 . 3 , r a di a ti o n i s s ca t t er e d a t le a s t t w i c e be f o re i n c id e n ce o n t h e do or . E a c h C o m p to n s c a t te r a t 9 0 d eg r ee s o r g r e a te r w il l r e d u c e th e e n e r g y t o 5 0 0 k eV o r le s s . T he i nt e ns i t y w il l al s o b e g r e a tl y r e d u c e d a t e a ch l a r g e a n g l e s c a tt e r . T he d o o r s hi el d i ng i n t hi s c a s e c a n b e c a l c u l a te d b y t r a ci n g t h e p at h o f t he s c at te r e d r a di a ti o n f r om the p a ti e nt to t he d o or and r e p e at ed l y applying E q ua ti o n 16.6. For m eg a v olt a g e uni t s , t he a t t e n u a ti o n c u r v e s f o r t h e 5 0 0 - k V p x - r a y s m a y b e us e d t o d e te r m i ne t he do o r s h i e l di n g f r o m m u l ti pl y s c a t t e re d x - r a y s . I n m o s t c a s e s , t he r eq ui r e d s hi el di ng t u r n s o u t t o be l e s s t ha n 6 m m o f l e a d .

WWW.MEDRAD.IR

FIG.

16.3.

S c h e m a ti c

d i a gr a m

of

m eg a v o lt a g e

x-ray

t he ra p y

i ns t a l la ti o n

( d r a w i n g n ot to s c a le ) . R a d i at io n s c a tt e r f r o m p at ie nt c a n r ea c h t he d oo r , as shown.

E. Protection against Neutrons

H i g h - e n e r g y x - r a y b ea m s ( e . g . , > 10 M V ) ar e co nt a m i na te d w i t h ne ut r o ns . T he s e are p ro d uc ed by hi gh - e n e r g y p hot o ns a nd el e ct r o ns i nc i de nt on t he v a r io us m a t e ri a l s o f t a rg et , f l a t t e ni n g f i l te r , c o ll ima t o r s , a nd o t he r s hie ld i ng c o m po ne nt s . T h e c r o s s - s e c ti o n s f o r ( e , n ) r e a c t i o ns a r e s m a l le r b y a f a c t o r o f a b o ut 1 0 t ha n t h o s e f o r ( , n ) r e a c t io n s . B e c a u s e o f t hi s , t he ne ut r o n p r o d uct ion d ur i ng e l e c t ro n b e a m t h e r ap y m o d e i s q u i t e s m a ll c o mp a r ed w i t h t ha t d ur i ng t he x - r a y m o d e . P.413

The

neutron

c o n t a m in a t i o n

i n c r e a se s

r a p id l y

as

t he

e ne r g y

of

t he

beam

is

i n c r e a s e d f r o m 10 t o 2 0 M V , a n d t he n r e m a i ns a p p r o x i m at el y c o ns t a nt a b o v e t hi s . M e a s u r e m e n t s h a v e sh o w n ( 1 6 , 1 7 , 18 ) t ha t i n t he 1 6 t o 2 5 M V x - r a y t he r a p y mo de t h e n e u t r o n d o se e q u iv a l e n t a lo n g c e nt r a l ax i s i s a p p r o xi m a te l y 0. 5 % o f t he x - r a y d o s e a n d f al l s o f f t o ab o u t 0 .1 % o ut s id e t he f i el d . S o hr a bi a nd M o r g a n ( 1 7 ) ha ve l i st e d a w id e r a n g e of n e u t r o n c o nt a m i na tio n v a l ue s t ha t ha v e b e e n r ep o rt e d i n t h e l it e r at u r e f o r s o me m e d ic a l a c c el e r at o r s. T h e e n e r g y s p e ct r u m ( 1 9 ) o f e m it te d ne ut ro ns w i t hi n t he x - r a y be a m i s si m il a r to t h e u r a n i u m f i s si o n sp e c t r u m , s ho w i ng a br o a d m a x i m um i n t he r a ng e o f 1 M e V. T h e n e u t r o n e n er g y i s c o n s i de r a bl y de g r a ded a f t e r m ult i pl e s c a tte r i ng f ro m w a ll s , r o o f , a n d f l oo r , a n d c o n s e q u e n tl y , t he p r opo r ti o n o f t he f a s t ne ut r o n ( > 0 . 1 M e V ) r e a c h i n g t h e i n s id e o f t h e m a z e i s us ua l l y s m a l l . C o n c r e t e b ar r ie r s d e sig n e d f o r x - r a y s hi e l ding a r e s uf f i c i e nt f o r pr o te c ti o n a g a i n st n e u t r o n s . H o w e v e r , t h e do o r m u s t be p r ot e ct e d a g a i nst ne ut ro ns tha t d i f f us e i n to t h e m a z e a n d r e a c h t h e d o o r . R e f le c ti o ns f r o m t he w a l l s c a us e a r e d uc t io n i n t he n e u t r o n f l u e n c e a n d , d e pe n d i n g o n t he a c ce l e r ato r c o nf ig ur a t io n, a d e c r e a se i n n e u t r o n f l u e n c e o f t wo o rd e r s o f m a g ni t ude ( 1 0 - 2 ) f r o m m a c hi ne l o ca ti o n to t he i n s i d e o f t h e m a z e c an b e e x pe c te d ( 2 0 ) . The s hi e ld i ng r e q uir e d f o r t he d oo r c a n b e f u r t h e r r e d u c ed by t h e m a z e d e si g n. In g e ne r a l , a lo ng e r m a z e ( > 5 m ) is d e s i r ab le i n r ed u c i n g t h e n e u t r o n f l ue nc e at t he do or . F i na l l y , a f e w i nc he s o f a hydrogenous m a te r i al such as p o l y e t hy le ne can be a d d ed to t he doo r to t h e r m a li z e t h e n e u t ro n s a n d r e d uc e t he ne ut r o n d o s e f ur t he r . A s t e e l o r l e ad s h e e t m a y b e ad d ed to t h e do o r t o pr ot e ct a g a i ns t s c at t er e d x - r ay s , a s d i s c us s e d p r e v io u s l y . W h e n t h e r m a l n e u t r on s a r e a b so r be d b y the nuc l e i o f at o m s w it hi n t he s hi el d i ng d o or , e n e r ge ti c r a di a ti o n s ( c al l ed t he ne ut r o n- c a pt ur e r a ys ) a r e p ro d uc ed . T h e s e r a d ia ti o n s h a v e a s p e ct r u m o f e ne r gie s r a ng i ng up to 8 M eV , b ut m o st ha v e e n e r g ie s i n t h e r e g ion o f 1 M e V . U nl e s s t he ne ut r o n f l ue nc e a t t he d o o r i s hi g h s u c h a s i n t h e c a s e o f a s h o r t m a z e , t he i nt e ns it y o f c a pt ur e r a y s g e ne r a t ed w i t h i n t h e s h ie ld i n g d o or i s u s u a ll y l o w . Be c a us e t he c a pt ur e r a y s ha v e hi g h e n e r g y , t hi c k s h e et s of l e a d a re r eq ui r ed to p r o v id e e f f e c t i v e a tt enua t i o n. T hus i t

WWW.MEDRAD.IR

i s mo r e d e si r a bl e t o re d u c e t h e ne ut ro n f l ue nc e i nc id e nt a t t he d o or s uc h a s b y d e s ig n i n g a lo n g e r m az e t h a n t o ha v e a high ne ut r o n f l ue nc e a t the d oo r a nd a dd p r o h i bi ti v e a mo u n t s of l e a d s h i e ld i ng t o t he d o o r to a tt e nua t e t he c a p t ur e r a y s . C o m p u t a tio n o f s h ie ld i n g re q u i re m e nt s f or a hi g h- e ne rg y i nsta l l at io n r e q ui r e s m a n y c o n s i d e r a ti o n s th a t c a n n o t b e d i s c us se d i n a d e q uat e de t ai l i n t hi s t e x t . T he r e a d e r i s r e f e r r ed to th e l i te r a t u r e f o r f ur t he r g ui d a nc e ( 13 , 1 9 , 21, 2 2 ) .

16.7.

PROTECTION

AGAINST

RADIATION

FROM

BRACHYTHERAPY SOURCES
T h i s s u b j e c t h a s b ee n d e a lt w i t h i n de t ai l i n N C R P R e p o r t 40 ( 23 ) . In t hi s s e c t io n, o n l y a b r ie f r e v ie w w i l l b e gi v e n o f s ome p r a c ti c a l g ui de li ne s t ha t ha v e b ee n d e v e lo pe d f o r s a f e h a n d l i n g a n d us e o f b r a chy t he r a p y s o ur c e s .

A. Storage
L e a d -l i n ed s a f e s wi t h l e ad - f i ll ed d r a w er s ar e c o mm e r ci a ll y a v a i la b l e f o r st o ri ng b r a c h y t h e r a p y s o u r c es . I n c h o o s i ng a p a r t i c ul a r s a f e , c o ns i de ra t io n s ho ul d b e g i v e n to t h e ad e q u a c y o f s h i el di n g , di s t ri b ut io n o f so ur c e s , a nd ti m e re q ui re d fo r p e r s o n n el t o re m o v e so u r c e s f r o m , a nd r e t ur n s o ur c e s t o , t he s a f e . T h e s t o r a ge a r e a f o r r a d i u m s h o ul d be v e nt il a t ed b y a d i r e ct f i lte r e d e x ha us t to t h e o u td oo r s , be c a u s e o f t h e p o s si bi li t y o f r a d o n le a k s . A s i mi l a r a r r a ng e m e nt i s r e c o m me n d e d m i c r o sp h e r e s . for This en c a p s u l a t e d p r e c a u ti o n is po w d e red taken so s o ur c e s t ha t if or a s o urc e s s o ur c e c o nt a i ni ng t he r up t ur e s ,

r a d io n u c l i de i s n o t d ra w n i n t o t h e g e ne r al v e nt i l at io n s y s t e m o f t he b ui ld i ng . T h e s t o r a g e ro o m s a re u s u a l l y p r o v i d ed w i th a s i nk o f c l e a ni ng s o ur c e a p p li c at o r s . T h e s i n k s h o u l d b e p r o v i de d w i t h a f i lt e r o r t r a p to p r e v e nt l o s s of s o ur c e . P.414

B. Source Preparation
A s o u r c e p r ep a r a ti o n b e n c h s h o u l d be p ro v id e d cl o se to t he s a fe . T he p r e p a r at io n a n d d i s m a n t li n g o f s o u r c e a p pl i c at o r s s houl d b e c a r r ie d o ut be hi nd a s ui t a ble b a r r i er to s hi el d t h e o pe r a to r a d eq ua t el y . M a ny f a c i l it ie s a re e q uip p ed w it h a p r ot e c ti v e L -b lo c k , u s u a l l y c o ns t r uc t ed of l e a d . A le a d g l a s s v i e w i ng w i ndo w p r o v id e s s o me p ro t e ct io n b y p r o v i di ng s hie l di ng a s w e l l a s a sui t a bl e di s t a nc e b e t w ee n t h e f a c e o f th e o p e r at o r a nd t he so ur c e s . B r a c h y t h e r a p y s o u r c e s m u s t n e v e r b e t ouc he d w i t h t he ha nd s . S ui t a b l y l o ng f o r c e p s s h o u l d be u s ed to p r o vi d e a s m uc h d i s t a nc e a s p r a c ti c al b e t w ee n s o ur ce s a n d t h e o p e r at or . Besides v a r io u s the k i nd s of p ro te c ti v e must be s hi e ld i ng of a v a i la b le fo r b r a c hy t he r a p y of t im e a nd a p p li c a ti o n s , o pe r a to r a w ar e t he e f f e ct i v e ne s s

d i s t a n c e i n r a d i a ti o n p r ot e c tio n . E x p o s ur e s o f i nd i v i d ua l s c a n b e g r e a tl y r e d uc e d i f , a s f a r a s p r a c t i c a l , t h e t i m e s p e nt i n t he v i c i ni t y o f t he s o urc e s i s m i ni m i z ed a n d t h e d i s t a n c e f r om t h e s o u r c e s i s m a x i mi z e d . Certain b ra c h y t h e r a py techniques ha v e t he a d v a nt a ge s of g i v i ng re d uc ed e x p o s u r e to p e r so n n e l. F o r e x a m p l e , a f te r loa d i ng te c hni q ue s i nv ol v e no e x p o s ur e t o o pe r a ti n g ro o m p er s o n n e l o r x - r a y t e c hno l og i st s . S o me e x pos ur e i s r e ce i v ed d u r i n g t h e lo a d i n g an d r e m o v a l o f s o ur ce s , b ut e v e n t he s e ex p o s ur e s c a n b e

WWW.MEDRAD.IR

r e d u c e d b y u s i n g m ob i le p r ot e ct i v e s hi el ds . T he us e o f l o w - e ne r g y s o ur c e s i n p l a c e o f r a di u m o r r ad o n i s a n o t he r e x a m pl e o f ho w p e r s o nne l e x p o s ur e c a n b e m i n i m i z ed .

C. Source Transportation
T h e s o u r c e s c a n b e t ra n s p o r te d i n le a d co nt a i ne r s o r le a d ed c a r ts . T he t hi c k ne s s o f l e ad r e q u i re d w il l d e pe n d o n t he t y p e of s o ur c e a nd t he a m ount o f r a d i o a cti v e m a t e ri a l to b e t r a n s po r te d . A t a b l e o f r e q ui r e d t hi c k ne s s f o r v a r i o us c o nd i ti o ns is given by the NCRP (23).

D. Leak Testing
V a r i o u s m et h od s o f l ea k t e st i n g o f a se a led s o ur c e a r e a v a i l ab le ( 23 ) . A r a di um s o u r c e c a n be c h e c k ed f o r r ad o n l e a k s b y pl a c i ng i t i n a s m al l te st t ube w it h s o me a c t i v a te d c a rb o n o r a b a l l o f co tt o n. A f t er 24 ho ur s , t he c a rb o n or t he co tt o n b a ll c a n b e c o u n t ed i n a sc i n t il l at io n - w e ll c o unte r . It i s s om e ti me s c onv e ni e nt t o l e a k t e s t t h e e n ti r e s to c k o f r a di u m b y p ump i ng t he a i r f r o m t he s af e a nd p a s si ng i t t h r o u g h o n a n a c t i v a te d c h a r c o a l f il te r . T he f i l te r i s co unt e d f o r a c t i v it y . If a l e a k i s d et e c te d , t h en i n d i v i d u a l s o ur c e s w i l l ha v e t o b e t e s ted t o i so l at e t he d e f e c ti v e s o u r c e . P e r i od i c l e a k t e st i n g o f r a d i u m i s us ua l l y sp e c i f ie d b y s t at e re g ul a ti o ns . A s o ur c e i s c o n si d e re d to be le a k i n g i f a p re s e nc e o f 0 .0 0 5 C i o r mor e o f re mo v a b le c o n t a m i n at io n i s me as u r e d . T h e le a k i ng sour c e s ho ul d b e re t ur ne d t o a s ui t ab le a g e n c y t h a t i s a u t h o r iz e d f o r t h e d i sp o s al o f r a d i o a ct i v e m at e ri a l s.

16.8. RADIATION PROTECTION SURVEYS

A f t e r t h e i n s t a ll at io n o f r a d i at io n e q ui p m e nt , a q ua li f i ed e x pe r t m us t c a r r y o ut a r a d i at io n p ro t e ct io n s u r v e y o f t he i ns t a lla t io n. T he s ur v e y i nc l ud e s c he c k i ng e q u i p me n t sp e ci f i c a ti on s a n d i n te r lo c k s r el at e d to r ad i at io n s a f ety a nd e v a l ua ti o n o f p o te n t ia l r a di a ti o n e x p o s u r e to i ndi v i d ua ls i n t he s ur r o und i ng e nv i r o nm e nt .

A. Radiation Monitoring Instruments

T h e c h o i c e o f a p a r ti cu l a r r a d i at io n d et e ct or o r do s i me te r d ep e nds o n t he t y pe o f m e a s u r e m e n t re q u i re d. In r a d i a t io n p r ot e ct io n s ur v e y s , l o w l e v el s o f r a d i at io n a r e m e a s u r e d a n d , t h er e fo r e , t h e i n s t r um e nt m us t b e se ns i ti v e e no ug h t o me a s ur e s u c h l o w l e v el s . T h e d e te c to r s mo s t o f te n us e d f o r x - r a y m e a s ur e m e nt s a re t he i o n i z a ti o n c h a m b e r s , G e i ge r P.415 c o u n t e r s , t he r m ol u m in e s c e n t do s i me te r s (T L D ) , a nd p ho to g r a p hi c f il m . T he T LD a n d f i l m d o si m et r y h av e b ee n d i s c us s ed i n C ha p t e r 8 . In t hi s s e ct io n, t he G ei ge r c o u n t e r a n d a n i o n i z a t io n c h a m b e r s ui t a b le f o r l o w - l e v el r a d i at ion m e a s ur e m e nt s w i l l be b r ie f l y d e s c ri be d .

A.1. Ionization Chamber

A n i o n i z a ti o n c h a m ber u s e d f o r lo w - l e v el x - r a y m e a s ur e m e nt s ( o f t he o r de r o f m i ll i ro e n tg e n s pe r h ou r ) h a s a l a r ge v ol um e ( ~ 6 00 m l) to o bt a i n hi g h s e ns it i v it y ( F i g . 1 6 . 4 ) . A d i re c t -c u r r e n t v o l t ag e i s a pp l ie d b et w ee n t he o ut e r s he ll a nd t he c e n t r a l e l e ct ro d e t o co ll e c t io n i z a t io n c ha r ge p r od uc e d b y r a di at io n i n t he i nte r na l a i r v o l u m e w h e n t h e c h a m b e r i s e x po s ed to r a d i at io n. T hi s c a us e s a n i o n c ur r e nt t o f l o w i n t h e e xt e r n al c ir c u i t . T he se c ur r e nt s a r e e xt r e me l y s m all , ho w e v e r , a nd

WWW.MEDRAD.IR

s p e c i al

el e c tr o me te r

circuitry,

i nc l udi ng

c ur r e nt

a m p l i fi e r,

is

r e q ui r ed

to

m e a s u r e t h e m . T h e o u t p u t c u r r e n t i s di r e ct ly p r o p o rt io na l to t he e x p o s ur e r a te .

F I G . 1 6 . 4 . A C u t i e P i e s u r v e y m e t er . ( C o ur t e s y o f t he Vi c to re e n Ins t r um e nt D i v i s io n , C l e v e l a n d , OH . ) A n i o n c h a m b e r s u r v e y m e t e r i s us ua l l y c a li b r a te d f o r e x po s ur e in a r a y b e a m f r o m a c e si u m o r a r ad i u m b r a c h y t he r a p y so ur c e us i ng a n o pe n-a i r m e a s ur e me nt g e o me t r y ( s e e s e ct io n 1 5 . 2 B . 1 ) . F o r a c c ur at e us a ge at m i dd le a nd hi g h e ne r gi e s , the e n e rg y r e s po n s e curve for t he c ha m b e r s ho ul d be us ed to co r r e ct t he e x p o s u r e . A dd it io n a l co r r e ct io n s f o r s c al e l ine a r i t y , a i r te m pe r a t ur e , a nd p re s s ur e a n d a n g u l a r d e p e n de n c e m a y a l s o b e ne c e s sa r y .

A.2. Geiger-Mller Counters

T h e G e i ge r - M l le r c o un t e r ( G - M t ube ) c o ns is t s e s s e nt i al l y o f a c yl i nd ri c a l c at ho de w i t h a f i n e w i r e s tr e t ch e d a l o n g t he a x i s o f t he c y l i nde r . T he t ub e i s f i ll e d w it h a s p e c i al mi x t u r e o f g as e s a t a p re s s ur e o f a b o ut 1 00 m m Hg . T he v o lt a ge a pp li ed t o t he e le c t ro de s i s m u c h h i g he r t ha n t he s a t ur a ti o n v ol t a ge a p pl i ed to a n i o n i z a ti o n c h a m b e r . P o t e n ti al i s s o hi g h t ha t t he p a r ti c le s f r o m t he o ri gi na l i o n i z a ti o n giving ri s e b e co m e to en e r g e ti c e n o ug h to If p r o d uc e t he f ur t he r is s e c ond a r y hi g h e no ug h i o ni z a t io n t ha t an gas a m p li f i c at io n. v o lt a g e

a v a l a n c h e o f c h a r g e i s g e n e r at ed b y t he o r i gi na l io ni z i ng e v e nt, i nd e pe nd e nt o f i t s s i z e , t h e de te c to r is c a l l ed a G e i ge r - M l le r c o unt e r .

WWW.MEDRAD.IR

T h e G - M t u b e i s m u c h m o r e s e n s it i v e t ha n t he i o ni z a t io n c ha m b e r . F o r e x a m pl e, t h e G ei g er c o u n te r c an d e te c t i n d i vi d ua l p ho to ns o r i ndi v i d ua l p ar t i cl e s t ha t co uld never be P.416 o b s e r v ed i n a i o n i z at io n c h a m b e r . Ho w e v e r , t hi s d et e ct o r i s no t a d o se - m e a s ur i ng d e v i c e . A lt h o u g h a G e i g e r co u n t e r i s us e f ul f o r p r e li m i na r y s ur v e y s t o d et e c t t he p r e s e n c e o f r a di at io n , i o n i z a tio n c ha m b e rs a r e r e co m me nd e d f o r q ua nt it a ti v e m e a s u r e m e n t . B e c a u s e o f t h e i r i nhe r e ntl y s l o w r e c o v er y t i m e (~ 5 0 t o 30 0 s ) , t h e y c a n n e v e r r e c o rd m o r e t h a n 1 c o unt / m a c hi ne p ul s e . T hus a G - M c o unt e r c o u l d si g n i fi c a n t l y u nd e r e st i m at e r a di a ti o n l e v el s w he n us e d to c o unt r ad i at io n a r o u n d p u l s e d m a c h i ne s s u c h a s a c c e l e r a t o rs .

A.3. Neutron Detectors

Neutrons d e te c te d counters, can by be d et e c te d with t he aid of t he i r v a r io us i nt e r a ct io ns . In a h y d r o g e n o u s m at e ri a l, n e u t r o n s p ro d uc e hy d r o g e n re c oi l s o r p ro to ns t ha t c a n b e io n i z a ti o n m e a s ur e me nt s , or p r o po r tio na l e m ul si o ns . c o unte r s , N e ut ro ns s c i nt il l at io n can also be c lo u d c h am b e r s , p hot og r a phi c

d e te c te d b y t h ei r i n du c e d n u c l e a r re a c ti o ns . C e r t a i n m a te r i al s , c a l l ed a ct i v at io n d e te c to r s , b e co m e r ad i o a ct i ve w he n e x p o se d to ne ut r o ns . T he d e te c to r , a f t e r e x p o s u r e to t h e n e u t ro n f i e l d , i s co unt e d f or o r r a y a c t i v i t y . N e u t r o n m e a s u r e me n t s i n o r n e a r t he p r im a r y x - r a y b e a m c a n b e m a d e w i t h p a s s i v e de te c to r s s u c h a s a c t i v a t io n d et e cto r s , w i t ho ut b ei ng a dv e r s e l y a f f e c te d b y p u l s e d r a di a ti o n . A n a c t i v a t io n d et e c to r c a n b e us e d e it he r a s a b a r e t hr e s hold d e te c to r or i n s i de a m o d e r ato r s uc h as p o l y et hy l e ne . An ex a m p l e of bare t h r e s h o ld d et e ct o r i s p h o s p h o r u s ( i n t he f or m o f p ho s p ho r us p e nt o x id e ) t hat ha s b e e n s u c c e s s f u l l y u s ed b y s e v e r al i nv e st i g at o r s t o m e a s ur e ne ut ro ns i n a s w e ll as o u t s id e t h e p ri m a r y be a m ( 18 , 2 4 ) . A p ho s pho r us d e te c to r c a n mo ni to r bot h f a s t a n d s l o w o r t h e r m a l n e u t r o n s , us i ng a c t i v a ti o n p ro d u c t s using a c a l i br a t ed

31 31

P ( n, p ) 3 1 S i a nd s pe c t ro m et e r . f r om

31

P ( n, ) 3 2 P r e a c t io ns . T he p rob l e m of p hot o n in t he

Si and

32

P a r e e s s e nt ia l l y p ur e e mi tt e r s a nd a r e c o unt e d T he

li q u i d

s ci n t il l ati o n s uf f e r

i n t e r f e re n c e ( a c ti v a t ion o f t h e d e t e ct o r b y pho t o ns ) i s m i ni m a l w ith t hi s d e t e ct or . M o d e r at ed a c ti v a t io n systems p ho to ne ut ro n p r od uc t io n m o d er a to r it s e l f . T h er e f o r e , t h e se d et e ct or s a r e p r i m a ri l y us ef ul o ut s i de t he p r i m a r y be a m . E x a m p l e s o f t h e mo de r a ted a c t i v at io n d et e ct o rs a r e a c ti v a t io n r e m m et e r s a n d m od er a t e d f o il d e te c to r s . A g o ld f oi l pl a c e d i n a po l y et hy l e ne c y l i n d e r ( 24 c m lo n g a n d 2 2 c m i n di a m ete r ) ha s b e e n us e d b y R o g e r s a nd V a n D y k ( 2 5 ) f o r m e a s u r em e n t s o ut s i de t he p rim a r y p ho to n b e am . M c C a l l et al . ( 2 6) h a v e d e v e lo pe d a s ys t e m i n w h i c h a g ol d f o i l i s s ur ro und e d by a p o l ye t hy l e ne c y l i n d e r c o v e re d b y a l a y e r o f c ad m i um a nd bo r o n t o a b so r b t he r m a l ne ut r o ns . T h e a c t i v i t y i n d u c e d i n t h e g o ld f o il i s me a s ur e d b y us i ng a c a l i b r at ed G e ( Li ) d e te c to r s y s t e m . O u t s i d e t h e t re a t me n t r oo m , i t i s a c o m mo n p r a c t i ce to us e t wo d et e ct o r s t h a t r e s p o n d p r e do mi n a n t ly t o o n e o r t he ot he r r a d i at io n. F o r e x a m p le , a c o nv e nt i o nal a i r - f i ll ed io n i z a t io n ch a m b e r w i t h no nhy d r o g e no us w a ll s ( c a r bon) p r e d o mi na nt l y m e a s u r e s p h oto n s , a n d it s r e sp o n s e to ne utr o ns c a n b e ne g li gi bl e b e c a us e t he n: r a t io o u t si d e t h e s h i e ld i s u s u a l l y s m a l l a nd t he ne ut r o ns a r e l o w e ne r g y . A n i o n

WWW.MEDRAD.IR

c h a m b e r w it h h y d r o ge n o u s w a l l s , o n t he o t he r ha nd , c a n de t ec t bo t h ne ut ro ns a n d x - r a y s . A n i o n c h a m b e r t h a t c a n b e f i ll e d w i t h ei t he r a r gon o r p r o p a ne to o b t ai n a p r e do mi n a n t ly p h o to n o r p ho to n plus ne ut r o n r e s po ns e , r e s p e ct i v el y , ha s a l s o b ee n u s e d t o e st im a t e p h ot o n a nd ne ut r o n e x p o s ur e r a te s o ut s i de t he s hi eld o f a m e d i c a l a c c el e r ato r ( 2 7 ) . A l s o , p ro po r ti o na l c o unte r s , w i t h f i l li ng g a s e s s uc h a s B F 3 , a r e o f te n u s e d i n s id e mo de r a to r s t o d et e c t t he r m al i z ed ne ut r o ns w it h g o od d i s c ri m i n a tio n ag a i n s t si g n a l s p ro d uc ed b y p ho to ns . S uc h a g a s p ro po r ti o nal c o u n t e r , u s e d ei t h e r i n t h e c o unt i ng m od e o r c ur re nt m e a s ur e m e nt , m a y be r e g a r de d a s a n i o n i z at io n c h a m b e r w i t h i nte r na l g a s m ul ti pl i c at ion. T he v o l t a g e is h i g h e n o u g h s o t h a t i o n i z a ti o n b y c ol li s io n o c c ur s a nd , a s a r e s ul t , t he c ur r e nt d u e t o p ri m a r y i o n i za t io n i s i n c r e a s e d ma ny f o l d . T he b a s i s o f t he d e t e ct io n s y s t e m i s t h e re a c ti on
10

B ( n , ) 7 L i , w he r e b y t he p a r ti c le s c a n b e c o unt e d o r t he

i o n i z a ti o n c u r r e n t c a us e d b y t h e m i s m e a s ur e d . A m o de r a te d BF 3 c o unt e r w i ll a l so c o u n t p r ot o n r e c oi l p ar t i cl e s p ro d uc e d b y ne ut r o ns i n t he hy d r o g eno us m a t e r i al . F i g u r e 16 . 5 s h o w s o ne o f t h e co m m e r ci a ll y a v a i l a bl e ne ut ro n s ur v e y m e t e r s , t he E b e r l i ne N e u t r o n R em C o u n t e r . T he i ns t r um e nt c o ns i s t s o f a BF 3 p r o p o rt io nal c o u n t e r s u r r o u n d e d by a 9 - i n c h c a d m i um - l o a d ed p ol y e t hy le ne s phe r e t o mo d er a te t h e n e u t r o n s . T h e c o un t e r op e r at e s t y p i c al ly a t 1 , 6 00 to 2 ,0 0 0 V a nd c a n b e us ed f o r m e a s u r i n g n e u t r o ns P.417 f r o m t h e r m al to a p p rox i m a t el y 1 0 - M e V e ne rg y . T he r e s p o ns e i s d is p l a y e d i n t e r m s o f c o u n t r at e , m R / hou r , a n d m i ll i re m / ho ur. T he s ur v e y m e t er i s c a l ib r a te d us i ng a n N IS T - c a l i b r a t e d P u- B e n e u t r o n s o ur c e .

WWW.MEDRAD.IR

F I G . 1 6 . 5 . A p o rt a bl e n e u t ro n r em c o unt e r , R a s c a l . ( C o urte s y o f E b e rl i ne , Santa Fe, NM.)

B. Equipment Survey
S o m e o f t h e d e si g n s pe c i f i c at io n s ( 1 5) r el a te d t o p a ti e nt a nd pe r so nne l s a f et y c a n be d et e r mi n e d by visual i n s p e ct io n. V a r i o us o pe r a ti o na l a nd b e a m - li m it i ng i n t e rl o c k s a re c h e c k e d o u t a s p a rt o f t he f ie ld te s ti ng o f t he m a c hine . T he l e a k age r a d i at io n t h r o u g h t h e s o u r c e h o u s i ng m a y b e m e a s ur e d a s f o ll o w s:

T h e c o l li m a to r op e n i ng i s b lo c k e d w it h a t l ea s t 1 0 ha l f - v a l ue l a y er s o f l e a d . S h e e t s o f p r ep a c k e d f i l m m a y be w r a p pe d a r o und t he so ur c e ho us i ng to l o c at e a r e a s o f h i g h r a d i a tio n l e a k a g e . U s i n g a n i o n i z a ti o n ch a m b e r o f a p p ro p ri a te v o l um e o r s e ns it i vi t y ( e . g . , s u r v e y m e t e r ) , t h e d os e r a t e i s d et e rm i ne d a t a d i st a nc e o f 1 m f r o m t he s o u r c e , a s a f u n c t i on o f t he e x p e c te d to b e m a x imu m . p r i m a r y b ea m dose r at e at 1 m . T he s e m e a s u r e m e n t s s h o u ld b e m a d e i n s e l e ct ed d i r e ct io ns i n w hi c h l e a k a g e i s

In t h e c a s e o f

60

C o te l et h e r a p y , t he l e a k ag e r a di a ti o n t hr o ug h t he s o ur c e

h o u s i n g w i t h t h e b e am o n p o s i t io n i s d e te r m i ne d i n t he s a m e m a nne r a s

WWW.MEDRAD.IR

a b o v e . In t h e b e a m o f f c o nd it io n, ho w e v e r , m e a s ur e me nt s a re m a de in 1 4 d i f f e re n t d i re c ti o ns t o d et e r mi ne t he a v e r a g e a nd m a x i m um l e a k a g e d o s e r at e ( 15 ) . A c a l i b r a te d i o ni z a tio n c ha m b e r s uc h a s a C ut i e P i e i s a s u i t a bl e i n s t r u me n t f or t h e s e m e a s ur e me nt s. T h e l e a k a g e l im it s t hr o u g h t h e so ur c e a s se m b li e s fo r v a r io us ene r g y r a d i at io n g e n e r a to r s w e r e d i s cu s s e d i n s e c t io n 1 6 . 6C . If a u ni t i s e q uipp e d w it h a b e a m i n t e r ce p to r to r e d u c e P.418 structural s h ie ld i n g r e q u i re m e nt s , t he r a d i at io n t r a ns mi tt e d t hr o ug h t he

i n t e r ce p to r m u s t n o t e x c e e d 0 . 1% o f t he us e f ul b e a m . It s ho ul d a l s o r e d uc e b y t h e s a me f a c to r t h e ra d i a tio n s c a tt e re d b y t he p at ie nt t hr o ug h an a ng l e o f up to 3 0 d eg r e e s f ro m t h e ce n t r a l r a y .

C. Area Survey
A r e a s o u t s id e t h e t r ea t m e n t ro o m t ha t a r e a c c e s s i bl e to a ny i ndi v i d ua l s ho uld be d e s ig n e d a s c o nt r ol led o r n o n c o nt ro ll ed , de p e ndi ng o n w he t he r t he e x p o s ur e o f p e r s o n s i n t h e ar e a i s m o n it o re d o r not . E x p o s ur e l e v el s i n t he s e a r e a s s ho uld be m e a s u r e d w it h t h e b ea m o ri e n t ed i n v a r i o us p o s si bl e d i r e cti o ns . T he t r a ns m it t ed r a d i at io n t h r o u g h t h e p ri m a r y b a r ri e r s ho ul d b e m e a s ur ed wi t h t he be a m o f maximum size di r e ct l y i n ci d e n t at t he b a r r ie r . M e a s ur e ment s o ut si d e t he s e c o n d a r y b a r r ie r s s h o u l d b e m ad e w i t h a p ha nt o m a t t he t rea t m e nt po s it io n. O t h e r op e r at io n a l co n d i ti o n s s u c h a s to t al b o d y i r r a di a ti o n m a y p r e s e nt sp e ci a l t r e at m e n t co n d it io n s t h a t s h o u l d b e c o ns id er e d i n t he a r e a s ur v e y . T h e r e s u l t s o f t h e s u r v e y s h o u l d b e e v al ua t e d b y t a k i ng i nto ac c o unt t he a c t ual o p e r at i n g c o n di tio n s , i n c l u di n g w o r kl o a d , us e f a c to r , o c c up anc y factor, a nd a t t e n u a ti o n a n d s c a tte r i n g o f t h e us e f ul b ea m b y t he p a t ie nt . T he e nv i r o nm e nt al s a f e t y w i ll b e co n s id er e d a c ce pt a b le i f no p e r s o n i s l i k el y to rec e i v e m o re t ha n t h e a p p li c a bl e do s e equ i v a l e n t li m it . T h e s u r v e y d a t a b a s e d o n i n s t a nt a neo us d o s e r a te m e a s ur em e nt s s ho ul d be s u p p l e me n t ed w it h c um u l a t i v e r a di a ti o n m ea s ur e m e nt s a nd pe r s onne l m o nito r i ng o v e r a p p ro p ri a te t im e p e r io d s . If , a s a r e s u l t o f a r a d i at io n s ur v e y , s up p l e me nt a r y s hi e ld i ng i s a d d ed t o t he p r ot e c ti v e b a r ri e r s , a s u r v e y s h o ul d b e ma d e t o e v a l uat e t he a d e q ua c y o f t he s h i e l di n g a f t e r t h e m od i f i c at io n .

16.9. PERSONNEL MONITORING

P e r s o n n e l m o n it o ri n g m u s t b e u s e d i n co nt ro ll e d a r e a s f o r o c c up at io na l l y e x p o sed i n d i v id u a l s . C u m u l a t iv e r a d i a ti o n m o nit o ri ng is m o s tl y p e r f or m e d with f i lm b a d g e s , al t ho u g h T L D b a d ge s a r e al s o us ed i n s o me c a s e . Be c aus e t he b ad g e i s m o s tl y u s e d t o m o n ito r w h o l e b od y e x p o s ur e , i t s ho ul d b e w o r n o n t he c he s t o r a b d o me n . S p e c ia l b a dg e s m a y a l so b e us ed t o m e a s ur e e x p o s ur e t o sp e ci f i c p ar t s o f t h e bo d y ( e . g . , h a n d s ) i f h i g he r e x pos ur e s a r e e x p e ct ed d ur i ng p a r ti c ul a r p r o c ed u r e s . Although f il m mo n i to r i n g is a s i mp l e and c o nv e ni e nt m et ho d of pe r s o nnel m o n i to r i n g , it h a s ce r t ai n d r a w b a c k s . T he e ne rg y d ep e nd e nc e p o se s a m aj or p r o bl e m e s pe c i al l y wh e n a n i n d i v i d ua l i s e x p o s ed to bo t h so f t - a nd hi g h- e ne r g y

WWW.MEDRAD.IR

r a d i at io n . H o w e v e r , s o m e i n f o r m at io n i s o b t ai ne d c o nc e r ni ng b e a m q ua l it y b y p l a c i n g f i lt e r s o f di f f e r e n t m at e ri a l s a nd thi c k ne s s t o p a r tl y c ov e r t he f il m . By c o m p a ri n g t h e f il m d ar k e n i n g u n d e r t he f il te r w it h t ha t o f t he p ar t w it ho ut fi lt er g i v e s s o me i n d i c ati o n o f t h e p e n et r a ti o n a b ili t y o f t he r a di a ti o n. R a d i a ti o n mo n i to r i n g d u r i n g a p a r ti c ul a r p ro c e d ur e m a y a l so be p e r f o r me d w i t h p o c k et do s i me te r s . T h e s e i n s t r u m e nt s a r e us e f ul w he r e e x p o sur e ne e d s t o be m o n i to r ed m o re f r e q u e n t l y t h a n p o s s ib le w it h t he r e g ul a r f il m b ad g e s e r v i ce .

16.10. NUCLEAR REGULATORY COMMISSION REGULATIONS

T h e U n i t e d S t at e s N RC ( U S N R C ) c o nt r o l s t he us e o f a l l r e a ct o r- p ro d uc e d m at e ri a l s ( b y p r o d u ct m a te r i al s ) i n t h i s co unt r y . T he us e o f na t ur a l l y o c c urr i ng r a di o a ct i v e m a t e ri a l s (e . g . , r a di u m ) a n d x - r a y m a c hi ne s i s re g ul at e d b y i nd i v i d ual s t at e s . A l s o , t h e U S N R C h a s a n a g r e em e nt w i t h a num b e r o f st at e s , c al le d t he ag r ee m e nt s t a t es , t h a t a l lo w s t h es e s t a te s t o e nf o r c e the N R C r e g ul a t io ns . T h e N R C r e g u l at io n s t h a t g o v e r n t he m ed i c a l us e o f b y p r od uc t m a te r i al s are c o n t a i n ed in the C od e of F ed e r al Re g ula t io ns 10 CFR P a rt 35 ( 28 ) . T he s e r e g u l at io n s , f o r t h e m o s t p a r t , a re b a se d o n t he r e co m me nd at io ns o f v a r io us a d v i s o r y g ro u p s s u c h a s t h e N C R P , t he P.419 IC R P , a n d t h e A A P M . H o w e v e r , s o me r egul a t io ns a r e e na c t e d i n r e s po ns e to p r o bl e m s t h a t a re b ro u g h t to t h e at te nti on o f t he N R C . A l l new r e g ul a ti o ns go t h r o u g h t h e u s u a l p ub l i c a n d c o ng re s s io na l he a r i ng p r o ce s s a s i s c us t o m ar y f o r t h e e n a c t m e nt o f a n y f e d e r a l re g ul at io n. T e c h n i c a l de t ai l s a n d l eg a l r a m i fi c a ti o ns of t he N R C re g ul at io ns a r e b e y o nd t he s c o p e o f t h i s bo o k . T h e s e r e g u l a ti o ns ma y c ha ng e f r o m t i m e t o t i me . F o r a c o m pl e te te x t o f t h e se r e g u l at io ns , t he r e ad e r i s r e fe r r e d t o t he m o s t up - to - d at e NRC document. In this s e ct io n, a s umm a r y will be p re s ent e d of c ur r e nt r e g u l at io n s t h a t p e rt ai n t o te l et h e r a p y a nd b r a c hy t he r a p y us e o f r a d io i so to p e s .

A. License
L i c e n s e i s r eq u i r ed f ro m t h e N R C (o r t he ag r e e me nt st a t e) f o r po s s e s s io n o r use of b y p r od u c t m a te r ia l s . A l i ce ns e is i ss ue d e t c. after a d e t ai led review of in t he t he a p p li c a n t s ed u c a t ion and t r a i ni ng , p ro g ra m , a dm i ni s t r at i ve A ny r e q ui r em e nt s , c ha ng e s t e c hni c al

r e q u i r em e n t s ,

m a n a ge m e n t

s ub s e q ue nt

c o n d it io n s s t ip u l a te d i n t h e li c e ns e r e q ui r e a p p ro v a l b y t he N R C i n t he f o rm of l i c e n s e a me n d m e n t s .

B. Administrative Requirements B.1. ALARA Program

A w r i t t e n r a d ia ti o n p ro g r a m i s re q ui r ed t ha t i nc l ud e s t he A L A RA p r i nc i p le s ( s e e s e c t io n 16 . 5 ) . The p r o g r am m us t be com m uni c a t e d to t he workers a nd be r e v i e w ed p e ri od i c al l y t o e n s u r e t ha t a rea s o na b le e f f o rt i s be ing m a d e to k ee p i n d i v id u a l a n d c o ll e ct iv e o c c u p a t io na l do s e s A L A R A .

B.2. Radiation Safety Officer

A r a d i at io n safety officer (RSO) m us t be ap po i nte d w ho w i ll ha v e t he r e s p o n si b il it y o f i mp le m e n ti n g t he r a di a tio n p r ot e ct io n p r o gr am . T he l i c e ns e e ,

WWW.MEDRAD.IR

t h r o u g h t h e R S O , m u s t e n s u r e t ha t t he pro g r a m i s c o nd uc te d in a c c o r d a nc e w it h t h e a p p ro v e d p ro c ed u r e s a n d r e g ul a to r y r e qui r e m e nt s .

B.3. Radiation Safety Committee

E a c h m e d i c al i n s t it u tio n li c e n s e e s ha ll e s t ab l i s h a r a di a tio n s a f et y c o mm it t ee t o o v e r s ee t h e u s e o f b yp r o d u c t m a te r i al . T he c o m m it te e m ust i nc lud e t he r ad i at io n s a f e t y o f f i c e r , a u t h o riz e d u s e r , nur s e , a nd a r e p r e s e nt a ti v e o f ma na g e m e nt w ho i s n e i t h e r t h e R S O n o r a n a u t ho r i z e d us e r . T he c ha r g e o f t he c o m m it t ee i s o u t li n e d i n t h e 10 C F R P a r t 3 5 d o c ume nt (2 8 ) . T he c o m m it te e mus t m e e t at l e a st q u a r t e rl y .

B.4. Quality Management Program

T h e l i c e n s ee m u s t m ai n t a i n a w r it te n q ua l ity m a na g e m e nt p ro g r am . T hi s p r o g r am m u s t i n c l u d e t h e f ol low i n g o b j e ct i ve s :

A w r i t te n d i re c ti v e i s p r e p a re d b e f o re a dm i ni s t r at io n. T he d i rec t i v e m ust s p e c i f y t h e d o s ag e an d t he q ua nt i t ie s o f t he r a d io a c ti v e m a te ri a l to b e a d m i n i st e re d .

P a t i e n t i d e nt it y i s v e r if i e d b y m o re t ha n o ne m e t ho d be f o re a d m i ni s t r at io n. T h e f i n a l p l a n s o f t r e at m e n t a nd r el a te d c a lc ul a t io ns a r e i n a c c o rd a nc e w i t h t h e w r i tt e n d i re c ti v e . E a c h a d m i n i s t r a ti o n i s i n a c c o r d a nc e w i t h t he w r i t te n d i re c ti v e . Any unintended d e v ia t io n from t he w r i t te n d i r e c ti v e is id e nti f i e d a nd

e v a l u a t ed i n t e r m s o f a r e c o r d ab le e v e nt o r a m i s a d m i ni st r at io n . P.420

R e c o r d ab le E v e n t . A r e c o r da b le e v e nt me ans t he a dm i ni st r a ti o n o f ( a ) a r a d io p h a r m a c e u ti c a l d o s a ge t ha t d i f f e r s f r o m t he p r e s c ri b ed d o s a ge b y m o r e t h a n 1 0 % , (b ) a w e e k l y c a l c ul at ed a dm i ni s te r ed te l et he r a py d o s e t ha t i s g r e at e r t h a n t h e w e e k l y p re s c r i be d d o se b y 1 5 % , a nd ( c ) a c a l c ul a te d b r a c h y t h e r a p y - a d mi n is t e r ed d o se t ha t d i f f er s f r o m t he p r e s c ri bed do s e b y m o r e t h a n 1 0% o f t h e p r e s c r i be d do s e .

M i s a d m i n i st r at io n .

M is a d m i ni st r a ti o n

me ans

t he

a d mi ni s t r at ion

of

(a)

r a d i at io n t h e r a p y to t h e w r o ng p at ie nt ; (b ) r a d io p ha r m a c e ut i ca l d o s ag e t h a t di f f e r s f r o m t h e p r e s c r ib ed do s e b y mo r e t ha n 2 0 % o f t he p r e s c r ib ed d o s e ; ( c ) a c al c u l at ed s te r eo t a ct i c r a d ia t io n s ur g e r y do s e tha t d i f f e rs f r o m t h e p r e s c ri b ed do s e b y mo r e t ha n 1 0% ; ( d ) a t el e t he r a p y d o s e w he n t h e t r e at m e n t c o n si s ts o f t hr e e o r f e w e r f r a c t io ns a nd t he c a l c ul a t e d to ta l a d m i n i st e re d do s e d i f fe r s f r o m t he to t al p r es c r i b ed d o se b y m o r e t ha n 1 0 % o f t h e t ot a l p r e s c ri bed d o se , w he n t he c al cul a t e d w e e k l y ad m i ni st e r ed do s e is 30% g r e at e r t h an the weekly p r e s c ri b ed d o se , or w he n t he t ot a l a d m i n i st e re d do s e d i f fe r s f r o m t he to t al p r es c r i b ed d o se b y m o r e t ha n 2 0 % o f t h e t ot a l p re s c r i bed d o s e ; a nd / o r ( e) b ra c hy t he r a p y i nv o l v i ng a s e a l e d s o u r c e t h at i s l ea k i n g, w h e n f o r a t em p o rar y i m p la nt o ne o r m or e s e al e d

WWW.MEDRAD.IR

s o u r c e s a r e n o t re m ov e d a f t e r c o mp le ti o n o f t he p r o ce d ur e , o r w he n t he c a l c u l a te d a d mi n i s te r ed d o s e d i f f e r s f r o m t he p r e s c ri b ed d o se b y m o r e t ha n 2 0 % o f t h e pr e s c ri b ed d o s e .

In

case

of

m i s a d m in i s t r a ti o n

t he

l i ce ns e e

m us t

(a)

not i f y

t he

NRC

O p e r a ti o n s C e n t er b y t e le p ho ne no l at e r tha n t he ne x t c a l e nd a r d a y a f t e r d i s c o ve r y o f t h e m i sa d m i ni st r a ti o n; (b ) sub m i t a w ri tt e n r ep or t to t he a p p r op r i at e N R C r e gio n a l o f f i c e w it hi n 1 5 d a y s o f t he d i s c o v er y o f t he m i s a d mi n i s t r at io n ; a n d ( c ) no t i f y t he r e f e r ring p hy s i c i a n a nd t he p a t ie nt no l a t er t h a n 24 h o u r s o f t h e mi s a d mi ni s t r at ion, unl e s s t he r e f er r i ng p hy s i c i a n takes the r e sp o n s ib ili t y o f i nf o r mi ng t he p a t ie nt o r b a se d on m e d i c a l j u d g m e n t , t el li n g t h e p a t ie nt wo ul d b e ha rm f ul . I f t he p a t i e nt w a s no t i f i ed , a w r i t te n r e p or t s h ou l d b e s e nt t o t he p a t ie nt w it hi n 1 5 d ay s o f t he d i s c o ve r y o f t h e m i s ad m i n i st r a ti o n.

The

l i c e n s ee

s h a ll

de v e lo p

p ro c ed ur e s

f or

c o nd uc t i ng

r e v iew

of

t he

q u a l it y m a n a g e m e n t pr o g r a m a t i nt e r v al s no g r e at e r t ha n 1 2 mont hs . T hi s r e v i e w m u s t i n c l u de ( a ) a n a ud i t o f a r ep r e s e nt at i ve s a m p le o f p a ti e nt a d m i n i st r a ti o n , ( b ) a ll r e c o r d ab l e e v e nt s , a nd ( c ) a l l m i s ad m i ni st ra t io ns .

C. Technical Requirements

T h e l i ce n s e e a u t h o ri z e d t o us e r ad io p ha r ma c e ut i c al s m us t po s s es s a do se c a l i b ra to r t o me a s u r e a c t i v i t y a d mi ni s te r ed t o e a c h p a t ie nt . T he c a l i b r at o r must be c h e c k ed f or c o ns t a nc y of r e spo ns e , a c c ur a c y of ca l i b r ati o n, l i n e a ri t y , a n d s o u r c e g e o me t r y de p e nde nc e . T he r e c o r d s o f t he s e c he c k s m u s t b e r e t ai n e d f o r 3 y e a r s .

T h e l i c e n s e e m u s t po ss e s s c a l i b r at ed s ur v e y i ns t r um e nt s . C a l i b r ati o n o f t he s u r v e y m e t e r m u s t b e d o n e a nnua l l y a nd fol lo w i ng re p ai r . T hi s ca l i b r ati o n m u s t i n c l u d e ( a ) a l l s c a l e s w i t h r e ad i ng s up t o 1 , 0 00 m r e m / h, ( b ) t w o s e p a r a te re a di n g s on each scale, (c) c o ns p i c uo us i nd i c at ion on t he i n s t r u m e n t o f t h e app a r e n t e x po s ur e r at e f r o m a d ed i c at e d c hec k s o ur c e , a n d ( d ) a de s c r ip ti o n o f t he c al ib r a ti o n pr oc e d ur e . R e co r d s o f e ac h s ur v e y i n s t r u m e n t c a li b r at io n m u s t b e r e t ai ne d f o r 3 y e a r s .

A l i ce n s e e i n po s s e s sio n o f se a le d so ur c e s o r b ra c hy t he r a p y so ur c e s m us t f o l lo w t h e r ad i at io n sa f e t y i ns t r uc ti o ns s upp l ie d b y t he m a nuf a c t ur e r a nd m a i n t a i n t h e i n s t r u ct io n s f o r t he d ur a t io n o f s o ur c e us e i n a l e g i bl e f o r m c o n v e n i e n t t o t h e u s er s : ( a ) T he li c e ns e e m us t l e a k t e st t he s our c e b e f o re its f i r st use unless the l i ce ns e e ha s a le a k t e st c e r ti f i c at e from t he s u p p l ie r . S u b s e q u e n t l e a k te s t s m ust b e p e r f o r me d at i nte r va l s no t to e x c e e d 6 m o nt h s . If t h e l e a k a ge te s t re v e al s t he p r e s e nc e o f 0 . 00 5 C i o r m o r e o f r e mo v a b le c on t a m i na t io n, t he so ur c e m us t be w i t hd r a w n f r o m us e and a p p r op r i at el y s to r e d ; (b ) T he li c e ns e e m us t co nd uc t a q ua r t e rl y p h y s i c a l i n v e n t o r y o f a l l s o ur c e s i n p o s s es s i o n, a nd ( c ) m e a s u r e a m b i e nt d o s e r at e s q u a r t e rl y in a l l a r e a s w he r e s uch s o ur c e s a r e s to r e d a nd r e t a i n r e c o r d s o f t h e s e s u r v ey s f o r 3 y e a r s .

WWW.MEDRAD.IR

A l i c e n s e e m a y n o t re l e a se a p a t ie nt a d mi ni s te r e d a r a di op ha r m a c e ut i c al f r o m c o n f i n e m e n t f o r m e d i c al c a r e unt il e ithe r t he m e a s ur e d do se r a t e a t a d i s t a n c e o f 1 m f r o m th e P.421

p a t ie n t i s le s s t h a n 5 m r e m / h o r t he a c ti v ity r e m a i ni ng i n t he p ate nt i s l e s s t h a n 3 0 C i . In t h e c a s e o f a p e r ma ne nt b r ac hy t he r a p y i m p l a nt , the p a t ie nt m u s t n o t b e r el e a se d u n t i l t he m e a s ur ed d os e a t a d i s ta nc e o f 1 m f r o m t he p a t ie n t i s l e s s t h a n 5 m r e m / h. A p a t ie nt w i th a t e m p o r ar y i m pl a nt m us t no t b e r e le a s ed u n t i l a ll s o u r c e s ha v e b e e n r e m o v e d a nd t he p a ti e nt s ur v e y e d w i t h a r ad i at io n d et e ct o r to co nf i r m t ha t al l s o ur c e s ha v e b ee n r em o v e d . A r e c o r d o f p a ti e n t s u r v e y s h a v e t o b e r et a i ned b y t he l i c e nse e f o r 3 y e a r s .

P r o m p tl y a f te r re m o vi n g s o ur c e s f r o m t he p a ti e nt , t he l i ce ns e e ( a ) s ha ll r e t u r n t h e s o u r ce s to t h e s to r a ge a nd ( b ) co unt t he num b e r t o ens ur e t ha t a l l so u r c e s t a k e n f r om t h e st or a g e ha v e be e n r et ur ne d . Im m ed ia t e l y a f t er i m p la n t i n g s o u r c e s i n a p a t i e nt , t he l i c e ns ee s ha l l m a k e a r a d i a tio n s ur v e y o f t h e p at i e nt a n d t he a r e a o f use to co nf i r m t ha t no s o ur ce s ha v e b e e n m i s p la c e d . T h e re c o rd s o f t he a bo v e a ct iv i t ie s s ha l l b e r et a i ne d b y t he l i c e n s ee f o r 3 y e a r s .

A l i c e n s ee s h a ll p ro v id e r a di at io n s a f e t y i ns t r uc t io ns to al l p e r sonne l c a r i ng f o r t h e p at ie n t u n d e r go i n g im p l a nt t he r ap y . T he s e i ns t r uc ti o n r e co r d s s ha ll b e r e ta i n e d f o r 3 y e a r s .

A l i c e n s e e s h a l l n ot h o u s e a p a t ie nt r e c ei v ing i m p l a nt t he r ap y i n t he s a m e room with a n ot h e r p a ti e nt w ho is no t re c ei v i ng r ad i at io n t he r a p y . E x c e p t io n s m u s t b e ju s t i f i ed b y ot he r r el ev a nt p r o v i s io ns o f t he N R C . T he p a t ie n t s d oo r s h a l l be p o s te d w it h a R a d i o a c ti v e M a t e ri a l s s i gn. V i s i t s b y i n d i v id u a l s u n d e r ag e 1 8 s ha ll be a ut hor i ze d o nl y o n a p a ti e nt -b y - p a t ie nt b a s i s w it h t h e a pp r o va l o f t he a ut ho r i z ed us e r a nd t he R S O . T he r a d i at io n s a f e t y o f f i c e r m u st be n o ti f i ed i m me di a te ly i f t he p a ti e nt d ie s o r ha s a m e d i c al e me r g e n c y .

D. Teletherapy
T h e f o ll o w i n g r e g ul a tio n s g o ve r n t he us e o f t el et he r a p y unit s f o r m e d i c al us e t ha t c o n t a i n a s e a le d s o u r ce o f c o b al t -6 0 o r c e sium - 1 3 7 .

Maintenance c o m m i s si o n

and (o r

rep a i r . an

O nl y

p e r so n st a te )

s p e ci f i c a ll y to p e r f o rm

li c e ns ed

by

t he uni t

a g r e em e nt

te le t he r a p y

m a i n t e n a n c e a n d r e p ai r s h a l l ( a ) i nst a ll , r e lo c a te , o r r e mo v e a tel e t her a p y s e a l ed s o u r c e o r a te l et h e r a p y uni t c o nt ai ni ng a s e a l ed s o ur c e a nd ( b ) m a i n t a i n , a d j u st , o r r e p a i r t he so ur c e d ra w e r o r o t he r me c ha ni s m t hat c o u l d e x p o se t h e so u rc e , r e d uc e t he s hi el ding a r o und t he so ur c e , o r r e s ult i n i n c r e a s e d r a di a tio n l e v e ls .

WWW.MEDRAD.IR

L i c e n s e a m e n d me n t s . A m e nd m e nt s a r e r e qui r e d i n c a s e o f ( a ) any c ha ng e i n t re a t me n t ro om s h ie l di n g , ( b ) a ny c ha ng e i n t he unit l o c at io n w i t hi n t he r o o m , ( c ) r el o c at io n o f t he t el et he r a p y uni t , ( d ) us e o f t he uni t i n a m a n n e r t h a t w o u l d i n c r e a s e t he r a d i at ion l e v e l s o ut s id e t he t r e a t me nt r o o m , a n d ( e ) a n i n d i v i d ual no t l i st ed on t he l i c e ns e b e i ng a l lo w e d to p e r f o r m t h e d u t ie s o f t h e t el et he r a p y p hy s i ci s t .

S a f e t y i n s t r u c t io n s . A l i c e ns e e s ha l l ( a ) p o s t s a f et y i ns t r uc t ions a t t he t e le t h e r ap y u n i t c o n s o l e i nf o rm i ng t he o pe r a to r o f p r o c ed ur e s t o f o l lo w b e f o re t u r n i n g t h e be a m o n a nd e m e rg e nc y p r o c e d ur e i n c a s e o f s o ur c e m o v e m e n t f a il u r e a n d ( b ) p r o v id e e d uc at ion a nd t r ai ni ng t o a ll ind i v i d ua l s w h o o p e r at e a t el et h er a p y uni t . T he r e c o r d s s ha l l b e k e pt f o r 3 y ea r s .

S a f e t y p r e c a u ti o n s . A l i ce ns e e s ha ll ( a ) cont r o l a c ce s s t o t he te l et he r a p y r o o m b y a do o r ; ( b ) i n s t al l d oo r i nte r lo ck s t o p re v e nt t he be a m f r o m t u r n i n g o n w h e n t h e d o or i s op e n, to t ur n t he b e a m o f f w he n t he d o o r i s o p e n ed , a n d p re v e n t t h e b e am f r o m t ur ni ng b a c k o n a f te r a door i nt e rl o c k i n t e r r u pt io n w i t h o u t clo s i n g t he d oo r a nd r es e t ti ng be a m o n/ o f f c o nt r ol a t the c o n s ol e ; (c) i ns t a ll a pe r m a ne nt r a d i at io n m o nit o r ca p a b le of c o n t i n u o u s l y m o n it or in g b e a m s t a t us ; a nd ( d ) e q ui p te le t he r apy r o o m to p e r m it c o n ti n u o u s o bs e r v a t io n o f t he p a tie nt f r o m t he te le t her a p y uni t c o n s o le d u r i n g i r r ad i at io n .

D o s i m et r y e q u i pm e n t . A l i c e ns e e s ha l l ha v e a c a l i b r a te d do s i me tr y s y s t e m t h a t m u s t h a v e b ee n c a l i b ra t ed b y t he N IST o r b y a c a li b r at io n l a b or a to r y a c c r e d it ed b y t h e A me r i c a n A s s o ci a ti o n o f P hy s i c i s t s i n Me d i ci ne ( A A P M ) . T h e c a l i b r at io n o f t h e d o s im e te r m us t P.422

h a v e b e e n p e r f o r me d w i t h i n t he p r e vi o us 2 y e a r s a nd a f t e r a ny r e p a i r . T he 2 - y e a r i nt e r v a l f o r ca l i b r ati o n m a y be e x t e nd ed to 4 y e a r s i f c ha m b e r i n t e r co m p a ri s o n s a r e c a r r i e d o ut a c c o rd i ng t o t he N R C s p e c i f i c at io ns ; s e e 10 CFR Part 3 5 . 6 3 0 ( 2 8 ) . T he l i c e ns e e s ha l l r e t a i n a r e c or d of each c h a m b e r c a l ib r a ti o n an d i n t e r c o mp a r i so n f or t he d ur a t io n o f t he li c e ns e .

F u l l c a li b r at io n . A li ce n s e e s ha ll pe r f o r m f ul l c a li b r at io n m e a s ure m e nt s o n t h e t el et h e r a p y u n i t (a ) b e f o r e t he f i r st m ed i c a l us e o f t he uni t ; ( b ) i f s p ot c h e c k m e a s u r e m e n t s i n d i c at e t hat t he o utp ut d i f f e r s mo r e t ha n 5 % f r o m t h e o ut p u t o bt a i n ed a t t h e l a st f ull c a li b ra t io n, c o r r e ct ed f o r ra d i o a cti v e d e c a y ; ( c ) f o l lo w i n g r e p l a ce m e nt o f s o ur ce o r r el o c at io n o f t he uni t ; ( d ) f o l lo w i n g r e p ai r o f t h e u n i t ; a nd ( e ) at i nt erv a l s no t e x c ee di ng 1 y e a r . F ul l c a l i b ra ti o n m e a s u r eme n t s m us t i nc l ud e ( a) o ut p ut fo r t he r a ng e o f f ie ld s i z e s a n d d i s t a n c e s u s e d c l i ni c al l y , ( b ) lig ht f i e ld v e r s us r a d ia t io n f i e l d c o i n c id e n c e , ( c ) r ad ia t io n f i el d uni f o r mi t y a nd it s de p e nde nc e o n b ea m o r ie n t a ti o n , ( d ) ti m er c o n s t a nc y a nd l i nea r i t y , ( e ) o n/ o f f e r r or ( s hut t er c o r r e ct io n ) , devices. F u ll and (f) a c c ur a c y of d i st a nc e m e a s ur i ng be m a de a nd lo c a li z a t io n p r ot o co l s c a li b r ati o n m e a s ur e me nt s mus t us i ng

p u b l i s h ed b y t h e A A P M , e i t he r t he o ne de sc r i b ed i n r e f e re nc e 2 9 o r 3 0 . F ull

WWW.MEDRAD.IR

c a l i b ra ti o n m e a s u r e me n t s m us t be p e r fo r me d b y t he l i ce ns e e s te l et he r a p y p h y s i c i s t . A li c e n s ee s h a l l r et a i n a r e cor d o f e a c h c a li b r at ion f o r t he d u r a t io n o f t h e t el et h e r a p y uni t s o ur c e .

P e r i od i c sp ot c h e c k s . A l i ce ns e e s hal l p e r fo r m o ut p ut sp ot c he ck s o nc e i n e a c h c a l e n d a r m o n t h . T h e s e c he c k s m us t inc l ud e ( a ) ti m er c o nst a nc y a nd l i n e a ri t y , ( b ) o n / o f f er r o r , ( c ) li g ht f ie ld v er s us r a d i a ti o n f ie l d c oi nc i d e nc e , ( d ) a c c u r a c y o f a l l d i st a n c e m e a s ur i ng a nd lo c a li z a t io n d e vi c e s , and ( e ) t he o u t p u t fo r o ne t y pi c a l s e t o f op e r at i ng co nd i ti o ns a nd i t s c o mp ar i s o n w it h t h e v a l u e ob t ai n e d at l a s t f ull c a li b r at io n, c o r r e ct e d fo r r a di o a cti v e d e c a y . In a d d i t io n to t h e a bo v e c he c k s , t he li c e ns e e s ha l l p e r fo r m s a f e t y c he c k s o n c e i n e a c h c a l e n da r m o nt h o f ( a ) d oo r i nt e rl o c k , ( b ) i nte r lo c k s f o r r e s t ri c ti o n s o n be a m o r ie n t a ti o n ( i f i ns t a ll ed ) , ( c ) b e a m co nd it ion i nd i c a to r l i g hts on the c o n s ol e , a nd (d) p a ti e nt v i e w i ng system. In case of m a l f u n c t i o n o f a s a f e t y me c ha ni s m , t he l i c e ns ee s ha ll lo c k the c o nt rol c o n s o le i n t h e o f f p o s it io n a nd no t us e t he u ni t unt i l ne c e s s a r y r ep a i r s ha v e been made.

R a d i a ti o n

surveys.

Before

m ed i c al

us e ,

after

each

i ns t al l at io n

of

t e le t h e r ap y s o u r ce , an d a f t e r m a k i ng a ny c ha ng e f o r w hi c h a n a m e nd m e nt i s r e q ui r e d , t h e li c e ns e e s ha ll p e r fo r m a ra d i a tio n s ur v e y o f t he f a c i li t y . T h e s u r v e y m u s t v e r i f y t h a t ( a ) t he l e a k a ge f r o m t he so ur c e he ad w i t h t he b e a m i n t h e o f f p o s it io n d o e s no t e x c ee d 2 m r e m / ho ur o n t he a v e r a g e a nd 1 0 m r e m/ h o u r m a x i mu m , b o t h m e a s ur ed at a d i st a nc e o f 1 m f r o m t he source and (b) d o se rates o ut si de t he room in t he r e st ri c t ed a nd u n r e s t r i c te d a r e a s d o n o t e x ce e d t he li m it s s p e c i f ie d b y t he N R C in 1 0 C F R P a r t s 20 . 1 01 20 . 1 05 ( 2 8 ) . T he m a x i m um pe r m i s si b le w ho le - bo d y e x p o s ur e f o r i n di v i d u a l s i n t h e r e s t ri c te d a re a i s 1 . 25 r e m p e r c a l e nd ar qua r t e r . In t h e u n r e s t r i ct e d a r ea, r a d i a t io n l e v el s m us t no t e x c e ed 2 m r em i n a ny 1 h o u r , 1 0 0 m r e m i n a n y 1 w e e k , a nd 0 . 5 r e m i n a ny 1 y e a r .

Five-year i n s p e c te d

i n s p e ct io n . and

l i ce ns e e d ur i ng

s ha ll

ha v e

t he

t e le t he ra p y

uni t

f ul l y or at

se r v ic e d

t el et he r ap y

s o ur c e

r ep l a ce me nt

i n t e r v a l s no t t o e x c e ed 5 y e a r s , w hi c he v e r c o m e s f i r st . T hi s i ns pe c t io n a nd s e r v i c i n g m a y o nl y b e p e r f o r me d b y pe r s o ns s p e c i f i c al l y l i c e ns ed t o do s o b y t h e c o m m i s si o n o r a n a g r e e m e nt st a te .

E. Training and Experience Requirements

T r a i n i n g a n d e x p e ri en c e r e q u i re m e nt s f o r t he l i ce ns e e , r a di at io n s a f e t y o f f i c e r , a n d t e le t h e r ap y p h y s i c i s t a r e li st e d und e r 10 C F R P a r t s 3 5 . 9 0 0 t o 3 5 . 9 72 ( 2 8 ) .

REFERENCES
1 . R e l at i v e B i ol og i c al E f f e c t i v e n e s s C o mm it t ee o f t he IC R P a nd IC R U . R e p o r t o f t h e R B E C o m m i tt ee to t h e In t e r nat io na l Co m m i s si o n o n R a d io log i c a l P ro te c ti o n a n d o n R a d i o lo gi c a l Un i t s a n d M e a s ur e m e nts . H e a l t h P hy s 1 9 6 3 ; 9: 3 5 7 . P.423

WWW.MEDRAD.IR

2 . N C R P . R e c o m m e n da t io n s o n l i mi ts f o r ex p o s ur e to io ni z i ng ra d i a tio n. R e p o rt No. 91. B et h e s d a , MD: N a t io na l C ounc i l on R a d i at io n P r o te c ti o n a nd M e a s u r e m e n t s , 1 98 7 . 3 . N C R P . Io n i z i n g r a d i a ti o n e x p o s ur e o f t he po p ul at io n o f t he U ni te d St a te s . R e p o rt No. 93 . Bethesda, MD: N a t io na l C o unc i l on R a d i at io n P r o t e ct io n a nd M e a s u r e m e n t s , 1 98 7 . 4 . F r i ed el l H I. R a d i at io n p r ot e ct io n c o nc e pt s a nd t r ad e -o f f s . P e rc e p ti o n o f r i s k , p r o c ee di n g s o f t h e Na t io n a l C o u nc i l o n R ad i a ti o n P r ot e ct io n a nd M e a s ur e m e nt s . W a s h i n g t o n , D C 1 9 80 . 5 . N C R P . B a s i c r a d i a t io n p r o te c ti o n c r it e ri a . R e p o rt N o . 3 9 . W a s hi ng t o n, D C : N a t io n a l C o u n c i l o n Ra d i a tio n P r o t e ct io n a nd M e a s ur e m e nt s , 1 971 . 6 . U n i t ed S t a te s S c i en t i f i c C o m mi tt e e o n the E f f e c t s o f A t o m i c R a d i a ti o n. R e po r t o f t h e U n i te d N at io n s S c i e n ti f i c C om m it te e o n t he E f f e c t s o f A to m i c R ad i at io n. G e n e r a l A s s e m bl y , O f f i c i al R e c o r ds : 1 3 t h S es s i o n S up p l . N o . 1 7 (A / 3 8 3 8 ) (1 9 58 ) ; 17th S e s si o n , S u p pl . No. 16 ( A / 5 21 6 ) (1 9 62 ) ; 21 s t Se s s io n, S up p l . N o . 14 ( A / 6 3 1 4 ) ( 19 6 6 ) ; 24 th S e s s i o n , S up pl . N o . 1 3 ( A / 76 13 ) ( 19 69 ) . N e w Y o r k : U nit ed N a t io n s 7 . E l k i n d M M . T h e i n i t i a l p a rt o f t he s ur v i v al c ur v e : i m p li c a ti o n f or l o w - do s e - r at e r a d i at io n r e s p o n s e s . Ra d i a t R es 1 9 77 ; 71 : 1 . 8 . W i t h e r s H R . R e s p on s e o f ti s s ue s to m ult i pl e sm a ll do s e f r a cti o ns . R a d i at Re s 1 9 77 ; 7 1 :2 4 . 9 . B r o w n M M . T h e s h a p e o f t h e d o se - r e s po ns e c ur v e f o r r a d i a t io n c a r c i no g e ne si s : e x t r a po l at io n t o lo w do s e s . R a d i at R e s 1 97 7; 7 1 : 34 . 1 0 . U pt o n A C . R a d iol o gi c a l e f f e c t s o f lo w d o s e s : i mp li c a ti o ns f o r r a di ol og i c al p r ot e c tio n . R a d i a t R e s 1 9 7 7 ;7 1 :5 1 . 11. D ep a r t me n t of Energy. U.S. De p a r t m e nt of E ne r g y i nj ur y a nd p r o pe r ty d a m a g e s u m m a r y . S p ri n g f i el d , V A : N a t i o nal T e c hni c a l Inf o r m a t i o n S e r v i c e , 1 98 4 . 1 2 . N C R P . S t r u c t u r a l s h i e l di n g de s ig n a nd e v a l ua t io n f o r me d i cal us e o f x r a y s a n d g a m m a r a y s o f e n e r g ie s u p t o 1 0 Me V . R e p o r t No . 4 9 . W a s hi ng t o n, D C : N a t io n a l C o u n c i l o n Ra d i a tio n P r o t e ct io n a nd M e a s ur e m e nt s , 1 976 13. NCRP. R a d i a t io n f a c i li ti e s . p r o te c ti o n R e p o rt No. d e si g n 51 . g ui d el i ne s W a s hi ng t o n, for DC: 0 .1 10 0 N a t io na l MeV p a r ti cle on a c c e l e r ato r C o unc i l

R a d i a ti o n P r ot e ct io n a n d M e a s u r e m e nt s , 1 97 7 . 1 4 . K a r z m a r k C J , C a p o n e T . M e a s ur e m e nt s o f 6 M V x - r a y s . II . C ha r a c t e r i st i c s o f s e c o n d a r y r a d i at io n . B r J R a d i o l 19 68 ; 4 1: 2 24 . 1 5 . N C R P . M e d i c a l x -r a y , e l e c t ro n b e a m and g a m m a - r a y p r ot e ct io n f o r e ne r gi es u p t o 5 0 Me V . R e por t N o . 1 02 . Be t he sd a, M D : N a t io na l Co unc i l o n R a d i at io n P r o t e ct io n a n d M e a s u r e m e n t s , 1 98 9 . 1 6 . A x t o n E , B a r d e l l A . N e u t r o n p r o d uc ti on f r o m e l e c t ro n a c c e le r a to r s us e d f o r m e d i c al p u r po s e s . P h y s M e d B i o l 19 72 ; 1 7 :29 3 . 1 7 . S o h r a b i M , M o r ga n K Z . N e u t r o n d o s im e t r y i n hi g h e ne r g y x - r a y b e a m s o f m e d i c al a c c el e r at o r s . P h y s M e d B i o l 1 9 79 ; 24 : 7 56 . 1 8 . P r i c e K W , N a t h R , H o l e m a n G R . F a s t a n d t he r m a l ne ut ro n p r of i l e s f o r a 2 5 - M V x - r a y b e a m . M e d P h y s 1 9 7 8 ;5 : 28 5 .

WWW.MEDRAD.IR

1 9 . N C R P . S h i e l d i n g fo r h i g h - e n e r g y el e ct ro n a c c e l e r ato r i ns t al l at io ns . R e p o rt N o . 31. W a s h i n g to n , DC : N a t io n a l C o mm it t ee on R a d i at io n P r o te c ti o n a nd M e a s u r e m e n t s , 1 96 4 . 2 0 . D e ye J A , Y o u n g FC . N e u t r o n p ro d uc ti o n f r o m a 10 M V m ed i c al li na c . P hy s M e d B i o l 19 77 ; 2 2 :9 0 . 21. IC R P . P r o t e c tion against e l e ct r o m ag ne t i c r a di a tio n a b ov e 3 MeV a nd e l e ct r o n s , n e u t r o n s , an d p r o to n s . R e p o rt N o. 4 . N e w Y o r k : P e r g a m o n P r e s s , 1 9 6 4 . 2 2 . Ke r s e y R . E st i m ati o n o f n e u t ro n a nd g am m a r a di a ti o n d o se s i n t he e nt r a nc e mazes of SL 7 5 2 0 li n e a r a c c el e r ato r t r ea t me nt r oo ms . M e d i c a m und i 1 9 79 ; 2 4 :1 51 . 2 3 . N C R P . P r o te c ti o n a g a i n s t ra d i at io n f r om b r a c hy t he r a p y so ur c e s . R e po r t No . 4 0 . W a s h i n g t o n , D C : N a t io n a l C o unc i l o n Ra d i a tio n P r o t e ct io n a nd M e a s ur e m e nt s , 1 9 72 . 2 4 . B a di n g J R , Z ei t z L, L a u g h l i n J S . P ho s p ho r us a c ti v a t io n ne ut ron d o s im e tr y a nd i t s a p pl i ca ti o n to a n 1 8 - M V r a d i ot he r a p y a c ce l e r ato r . M e d P hy s 1 9 8 2 ; 9 :8 3 5 . 2 5 . R og e r s D W O , V an D y k G . U s e o f a ne ut r o n re m m et e r to m e a s ur e l e a k a ge n e u t r o n s f r o m m e di c a l e l e ct r o n a c c e le r at o r s . M e d P hy s 1 9 8 1 ; 8 : 16 3. 2 6 . M c C a l l R C , J e n k i n s T M , S h o r e R A . T r a ns p o rt o f a c ce le r a to r pr o d uc e d ne ut r o ns i n a c o n c r e t e ro o m . I EE E T r a n s N uc l S c i 1 9 7 9 ; N S - 2 6 : 15 93 . 27. Schulz RJ. A r g o n / p r op a n e io ni z a ti on c ha m b e r d o si m et ry for mixed xr a y / n e u t r o n f i e l d s . M ed P h y s 1 9 7 8 ; 5 : 52 5 . 2 8 . N u c l e a r R eg u l a to ry C o m m i s s io n. C o d e o f f e d e r al r e g ul a ti o ns, 1 0 C F R P a r t 0 5 0 . W a s h i n g t o n , D C : U . S . G o v e r n m e nt P r i nti ng O f f i c e , 1 9 93 . 2 9 . A A P M . P r o t o c o l f or t h e d o s i me t r y o f x - a nd g a m m a - r a y b e a m s w i t h m a x i m um e n e r g ie s b et w e e n 0 . 6 a n d 5 0 M e V . P hy s M e d Bi o l 1 97 1 ;1 6 : 37 9 . 3 0 . A A P M . A p r o t o c ol f o r t h e d e te r m i nat ion o f a b s o r b e d do s e fr o m hi g h e ne r g y p h o to n a n d e l e ct r o n be a m s . M e d P hy s 1 9 8 3 ;1 0 : 74 1 .
1 2

T h e d i s t ri b u ti o n f a c tor ( N ) o n c e us e d i n t hi s e q ua t io n ha s b e e n d e l et ed . T h e g e n e ti c al l y s ig n if i c a n t d o se eq ui v a l e nt i s t he pe r c a pi t a d o s e e q ui v a le nt

w h e n t h e l o n g - t e r m g e n e ti c e f f e c t s o f r a d i a ti o n a r e a v e r ag e d o v e r t he w ho le p o p u l at io n . T h i s d o s e i s e x p e c te d to p r od uc e t he s a m e t ot a l ge net i c i nj ur y t o t he p o p u l at io n a s d o t h e ac t u a l d o se s r e c ei v e d by t he v a r i o us i nd i v i d ua l s ( 5 ) .
3 4

F o r x a n d r a d i a t io n s , o n e c a n a s s um e 1 r a d = 1 r e m . T h e N C R P R e p o rt 10 2 ( 1 4 ) u s e s t he q ua nti ty k e r m a r a t e i ns te a d o f e x p o s ure r a te

t o c o n f o r m w it h t h e S I u n i t s . A s a n a p p r o x i m a tio n t he q ua nt i ti e s e x po s ur e , a i r k e r m a , a n d d o s e a r e a s s u m e d h e r e t o ha v e t he s a m e num e r i c a l v a l ue . F o r e x a c t r e l at io n s h i p , r e f e r to C h a p t e r 8 .
5

A n y l e a k a g e li m it ma y b e u s e d i n E q ua tio n 1 6 . 8 . H o w e v e r , mo s t me g a v ol t ag e

u n i t s d o n o t e x ce e d t h e l i mi t o f 0 . 1 % f o r s our c e ho us i ng .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Th erapy > 17 - Quality Assurance

17 Quality Assurance

T h e t e r m q u a li t y a s s ur a n c e ( Q A ) d e s cr i be s a p r og r a m t ha t i s d e si g ne d to co nt r ol a n d m a i n t ai n t h e s t a nd a r d o f q u a li t y s et f o r t ha t p ro g r a m . Fo r r ad i a ti o n o nc ol og y , a q u a l it y a s s u r a n c e p r o g r am i s e s s e nt i al ly a s e t o f pol i ci e s and p r o ce d ur e s to m a i n t a i n t h e q u a li t y o f p a t ie n t c a r e . T he g e ne r a l c ri t er i a o r s ta nd a r d s o f q ua l i t y a r e u s u a l l y s e t c ol le ct i v el y b y t h e p r o f e s sio n. It i s e x p e c te d t ha t a Q A p r o g r a m d e s ig n e d s p e ci f i c al l y f o r a n i n s t i t ut io n w i l l m e e t t ho s e st a nd a r d s . M o d el Q A p r o gr a m s in r a d i a t io n o nc ol og y ha v e b e e n p r o po s ed b y p r o f e s s io na l o r g a n i z a ti o n s s u c h a s t h e A m e r i c a n C o ll eg e o f R a d i ol og y ( A C R ) ( 1 ) , t he A m e r i c a n A s s o c i a tio n o f P h y s i c i s t s i n M e d i c i ne ( A A PM ) ( 2 , 8 ) , a nd t he A m e r i c a n C o l le ge o f M e d i c al P h y s i c s ( A C MP ) ( 3 ) . T h e s e p ro g r am s i nc o rp o r at e m a ny o f t he st a nd a r d s and c r i te r i a d e ve lo pe d (NCRP), by the the N at io na l C o unc i l on R ad i at io n on P r o te c ti o n U ni t s a nd a nd Measurements In t e r na t i o na l C o m m i s si o n R a d ia t io n

M e a s u r e m e n t s ( IC R U ) , t h e In t e r na t i o na l Co m m i s si o n o n R a d iolo g i c al P r ot e ct io n ( IC R P ) , a n d t h e I n t e r n a t i o n a l E le c t ro te c hni c a l C o m m i s si o n ( IE C ) . I n a d d i t io n, m a n d a t o r y p r og r a m s w i t h Q A c o mp o ne nt s ha v e b e e n i nst it ut e d b y t he N uc le a r R e g u l a to r y C o m mi s s ion ( N R C ) a n d t he i nd i v i d ua l s t at e s . T he J oi nt C o m m i s s io n f o r A c c r e d it a ti o n D e s pi t e the of of H e al t h Care O rg a ni z a ti ons bo di es (JCAHO) a nd t he ha s also s et m i ni m um t he s t a n d a r d s o f Q A t h a t a r e r e q u i re d o f ho s pi ta l s s e e k i ng a c c r ed it a tio n. many st a n d a r d - s et ti ng o n c o l og y r e g ul a to ry v a r ie d a g e nc i e s , t he standards r a d i at ion p r a c ti c e are q ui te a c ro s s U nit ed

S t a t e s . A p at te r n s o f c a r e st u d y ( 4 ) , us i ng H o dg k i n' s di s e a se , p r o st a t e c a nc e r , a n d c e r v i x c a n c e r a s e x a m p le s , s ho w e d co rr e l at io ns b et w e e n p at ie nt o ut co m e a nd f a c i l it y e q u ip m e n t , st r u c t u r e , te c hni c a l sup p o r t , a nd p hy s i c i an c ha r a c t e r i s ti c s . T h e s e d at a u n d e r s co re t h e i mp o rt a nc e o f qua l i t y a s s ur a nc e i n pro v i di ng p at ie n t s t h e b e st c h a n c e f o r c u r e . T h e m a j o r r e a so n f or t h e l a c k o f c o m mit m e nt to Q A b y m a ny i ns t it ut io ns is f i n a n c i a l . A n a d e q u a te Q A p ro g r a m re q ui re s i nc r e a se d st a f f i ng a nd up - t o -d a te e q u i p me n t , b ot h o f w h i c h c a n b e e x p e ns i v e . A c c o r d i ng to t he a na l y s i s b y P e t e rs (5), the to t al c os t of the QA p ro g r am in r a di a ti o n t he ra p y a m o unt s to a p p r o xi m a te l y 3 % o f t h e a n n u a l b i l li ng f o r c o m b i ned t e c hni c al a nd p r o f e s s io na l c h a r g e s . B e c a u s e Q A p r o g r am s a r e v ol unt ar y ( w i t h t he e x c ep ti on o f t he N R C o r the s t a te - m a n d at e d c o m p o n e nt ) , t he o nl y i nc e nt i v e to es t a b li s hi ng t hese p r o g r am s i s a de s i re t o pr a c ti c e go od r ad i a ti o n t he r a p y o r av o i d m al p r a ct i ce s u i t s . H o w e v e r , t h e l at t er h a s n o t b e e n a s uf f i c i e nt d et e rr e nt to e ff e c t c ha ng e .

17.1. GOALS
T h e In t e r - S o c ie t y C ou n c i l f o r R a di a ti o n Onc o l og y s p e ci f i e s t he g o al s o f a Q A p r o g r am i n w h a t i s c a l l e d t he B l ue Bo o k ( 6 ) :

WWW.MEDRAD.IR

The

p u r p o se

of

Quality

A s s ur a nc e

Pr o g r a m

is

t he

o bj e ct i v e ,

s y st e m at ic

m o n i to r i n g o f t h e q u a l it y a n d a pp r op r i at e nes s o f p at ie nt c a re . S uc h a p r og r a m is e s s e n t i al f o r a ll a c ti v it i e s i n P.425 R a d i a ti o n O n c olo g y . The Quality A s s ura nc e Program s ho uld be re l at ed to

s t r u c t u r e , p ro c e s s a nd o u t co me , a ll o f w hi ch c a n b e me a s ur e d . S t r uc t ur e i nc l ud e s t h e s t a f f , e q u i p m e nt a n d f a c i l i t y . P r o c e s s c o v e r s t he p r e - a nd p o s t -t r e at m e nt e v a l u a t io n s a n d t h e ac t u a l t re a t me nt a pp li ca t io n. O ut c o m e i s do cum e nt e d b y t he f r e q u e n c y o f a c co m pl is h i n g s t at e d ob j e ct i ve s , us ua l l y t um o r co nt r ol , a nd b y t he f r e q u e n c y a n d s e r i o u s n e s s o f t r e a t me nt - i nduc e d s e q ue l ae . That such a program the n ee d is e s s e nt i al l y a for all a ct i v it ie s QA in r ad i a ti o n o nc o lo g y t ha t i nc l ud e s

emphasizes

for

c o mp r e he ns i v e

p r o g ra m

a d m i n i st r a ti v e , cl i n i ca l , p h y s i c a l , a nd t e chni c a l a s pe c t s o f r ad i a ti o n o nc ol og y . O p e r a ti o n al l y n o s i n gl e p e r so n n e l ha s t he e x p e r ti s e to c o v e r a l l t he se a r e a s . T h e r e f o r e , te a m w o r k i s e s s e n ti a l am o ng a d m i ni st r a to r s , r a dia t io n o nc o lo gi s t s , n u r s e s , m e d i c a l p h y s ic i s t s , a n d t he r a p y tec hno l o gi s t s . F o r a Q A p r o g r a m t o be e f f e c t i v e , al l t h e s t a f f i n v o l v ed w it h t he rad i a ti o n o nc ol og y s e r v ic e m us t b e w el l c o o rd i n a te d a n d c o mm i tt e d t o Q A . T h e A m e r i c a n C o ll eg e o f R a d io lo g y ha s r ec o m m e nde d t ha t a qua l i t y a s s ur a nc e c o m m it te e o n c o lo gi s t , (QAC) be formed w it h a p pr o p ri a te t he r ap i s t , p e r so nne l a nd (e.g., r a d i a ti o n to p h y s i c i st , d o s i me t ri s t , nur s e , a d m i ni st r a to r )

r e p r e se n t t he v a r i o u s a s p e c t s o f r a di a ti o n onc o l og y ( 7 ) . T hi s c omm i tt e e w i ll m ee t o n a r e g u l a r b a s i s to r e v i e w t h e Q A p r o g ra m a nd o v e r s e e it s im p l em e nt at io n. If there w e re a h o sp ita l - w i de QA p ro g r a m , t he r a di a tio n o nc olo g y QAC w o ul d c o o rd i n a te i t s a ct i v it ies w i t h t h e ho s p it a l Q AC . T h e m u l ti d i s ci pl i n a r y n a t u r e o f a r ad i at io n o nc ol og y Q A p rog r a m p re c l ude s a c o m p re h e n s i v e c o v er ag e o f t h e s ub j e ct i n thi s b oo k . O nl y t he p hy s i c a l a s pe c t s o f r a d i at io n o n c o lo g y QA w i l l b e pr e s e nt e d he r e . F o r f ur t he r d et a il s , t he r e a de r i s r e f e r r e d t o r ep o rt s g en e r a t e d b y t he v a r io us o r g a ni z a ti o ns ( 1 , 2 , 3, 8 ) .

17.2. PHYSICS STAFFING

T h e p h y s i c s c o mp o n en t o f q u a li t y a s s ur a nc e i n r a di a tio n o nc ol og y i s o ne o f t he m a j o r re s p o n si b il it ie s o f t h e r a di a ti o n p hy s i c i s t . A de q ua te p hy s i c s s t a f f i ng , i n p r o po r tio n to p a ti e nt load and e q uip m ent , is r e q ui r e d to carry o ut t he s e r e s p o n si b il it ie s p ro per l y . T h e B l ue Bo o k re c o m me nd s a t l e a st o ne p hy s i c i st pe r c e n t e r f o r u p t o 4 0 0 p a t ie n t s t re a te d a nnua l l y ( T a b le 1 7 . 1 ) . A d di ti o na l p hy s i ci s t s a r e r e c o mm e n d ed i n t h e r a t io o f o ne p e r 4 0 0 p at ie nt s t re a te d a nnua l l y . T he s e r e c o m me n d a ti o n s a re for cl i n i c al se r v i c e o nl y . A dd it io na l p er s o nne l w il l be r e q u i r ed f o r r e s e ar c h , t e a c h i n g , o r a d mi ni s tr a t i v e f unc t i o ns . M a n y o f t h e c li n i c al p h y s i c s t a s k s t ha t ha v e b e e n t r a di ti o na ll y p e r fo r m ed b y p h y s i c i s t s c a n be d ele g a te d t o do s im et r i sts o r p hy s i c s a s s i st a nt s . F o r e x a m pl e , d o s im e tr i st s c a n a s s is t i n r o u ti n e Q A c he ck s , c o m p ut e r t r e at m ent p l a nni ng , a nd m o n i to r u n i t c al c u l a tio n s a n d b r a c hy t he r a py s o ur c e p r ep a r a ti o ns. A p hy s i c i s t i n t h i s c a s e h a s a ro l e in e s t a b li s h i ng t he p ro c e d ur e s , d i re c ti ng t he a c ti v i ti e s , a nd r e v i e w i n g t he r e s u l t s .

WWW.MEDRAD.IR

In

treatment

p l a n n i ng ,

Fig.

17.1

i ll us t r at e s

ho w

p hy s i c s

s up p o rt

is

us ua l l y

o r g a n i z ed i n t h i s co u n t r y . A r r a n g e m e nt A i n w hi c h t he p hy s i c ia n p r a c t i ca ll y w o r k s a l o n e o r d oe s n o t se e k c o n s u l t at io n f r om t he p hy s i c s t e am i s o b v io us l y n o t a p p r op r i at e and is co n t r a r y to t he co nc e p t of m ul ti di s c i pl i na r y approach to r a d i at io n o n c o lo g y . A r r a n g e m e n t B i s no t s a t i s f a c to r y e it he r b ut i s p r e v a le nt i n m a n y i n s t i t u ti o n s . T h e r e m a y b e se v e r a l rea s o ns w hy a n e s s e nt i a l m e m be r o f t he t e a m , t h e p h y s i ci s t , is e x c l u d e d i n t hi s c a se f r o m t he c li ni c a l p ro c e s s . E c o no mi c s i s o n e r e a s o n , a s p h y s i c i s t s a r e us ua l l y hi g he r s a l a ri ed t ha n t he d o s i me t ri s t s. O t h e r r e a so n s m a y i nc l u d e h a v i n g p hy s i c i s ts w ho l a c k c li ni c a l t ra i ni ng o r a w el l d e f i n e d ro le i n t h e c l i n i c . N o n et he le s s , A r r a ng e m e nt m a t c h e d w it h t h e i r c re d e n ti a l s . T h e B l u e B o o k r e c o mm e n d a ti o n o n do s i met r i st s t a f f i ng i s o ne p e r 30 0 p at ie n t s t r e at e d a n n u a l l y . In s o m e i n s t it ut io ns , d os i m et r i st s p e r fo r m p hy s i c s w o r k o nl y , whereas in others th e y also do s i m ul a ti o ns . T he re l at i v e pr o po r ti o n of a d o s im e tr i st ' s e f f o r t to v a r i o u s t a s k s i s d ic t a t ed b y t he i nd i v idua l ne e d s o f t he d e p a rt m e n t , t h e s c ope o f t h e p h y s i c s a c t i vi ti e s , a nd t he e x t e nt o f o t he r p hy s i c s a n d t e c h n i c a l s u p po r t a v a i l a bl e . C i s p ro b a bl y t he b e st a p p r o a c h , a s it i n v o lv e s t e a m w o r k a mo ng p e r s o nne l w ho se r e sp o ns i bi li ti e s a re

TABLE 17.1. MINIMUM a PERSONNEL REQUIREMENTS FOR CLINICAL RADIATION THERAPY

C a t e g or y

Staffing

R a d i a ti o n chief

o n c ol ogi s t -i n -

O ne p e r p r og r a m

S t a f f r a d i a ti o n o n c ol og i s t

O ne a d d it io na l f o r ea c h 2 0 0 2 5 0 p a ti e nts t r e at e d p a t ie nt s p hy s i c i a n a nnua l l y ; und e r no more t ha n by a 2 5 30 s i ngl e t re at m e nt

R a d i a ti o n p h y s i c i st

O ne

per

c e nt e r

fo r

up

to

4 00

p a ti e nts

a nnua l l y ; a d d i tio na l in r a t i o o f o ne p e r 4 00 p a t ie nt s t re a te d a nnua l l y

T r e a t m e nt - p l a n n i n g s ta f f

D o s i m et r i st assistant

or

ph y s i c s

O ne p e r 3 00 p a ti e nt s t r e at e d a nnua l l y

WWW.MEDRAD.IR

Physics ( m o ld r o om )

t e c h n o lo g i st

O ne p e r 6 00 p a ti e nt s t r e at e d a nnua l l y

R a d i a ti o n t h e r ap y t e ch n o l o gi s t

Supervisor

O n e p e r c e nt e r

Staff (treatment)

T w o p e r m e g a vo lt a g e uni t up to 2 5 p a ti e nt s t r e at e d d a il y p e r uni t ; f o ur p e r me g a v ol t ag e uni t up t o 5 0 p at ie nt s t r e a te d d ai l y p e r uni t

Staff (simulation)

Two

for

every

50 0

p a ti e nt s

s i m ul a t ed

a nnua l l y

Staff (brachytherapy)

A s ne e d e d

T r e a t m e nt a i d

As

ne e d e d ,

us ua l l y

o ne

per

3 00 4 0 0

p a t ie nt s t re a te d a nnua l l y

Nurseb

O ne

per

c e nt e r

fo r

up

to

3 00

p a ti e nts

t r e at e d a nnua l l y a nd a n a d d it io na l o ne p er 3 0 0 p at ie nt s t re a te d annua l l y

S o c i a l w o r ke r

A s ne e d e d to p ro v i de s e r v i c e

D i et it i a n

A s ne e d e d to p ro v i de s e r v i c e

P h y s i c a l t h e r a p i st

A s ne e d e d to p ro v i de s e r v i c e

M a i n t e na n c e e n g i n e e r /e le c t ro n i c s technician

O ne

per

m e g a vo lt a g e uni t a nd a

uni t s

or

1 if

m e g a v ol t ag e

s i m ul a to r

e q ui p me nt s e r v i ce d i nho us e

A d di ti o n a l

p er s o n n e l

w i ll

be

re q ui re d

for

re s e a r c h,

ed uc a t io n,

a nd

a d m i n i st r a ti o n . F o r e x a m p l e , i f 8 0 0 p a ti e nt s a r e t r e at ed a nnua l l y w i t h t hr ee a c c e l e r ato r s , o n e
60

Co te le t h e r ap y uni t , a s up e r f i c ia l x - r a y m ac hi ne , o ne

t r e at m e n t p l a n n i n g com p u t e r , t he c li ni c a l al lo t me nt f o r p hy s i c i sts w o ul d be

WWW.MEDRAD.IR

two

to

three.

t r ain i n g

p r o gr a m

w it h

ei g ht

re s i de nt s ,

t wo

t e c hno lo g y

s t u d e n t s a n d a g r a du a t e s t u de nt wo ul d r e q ui r e a not he r 1 to 1 . 5 F T E s . A d m i n i s tr a ti o n o f t h i s g r o u p w o ul d r eq ui r e 0 . 5 F T E . If t he f a c ul t y ha d 2 0 % t i me
b

f o r r e s e a r c h , a t o t al

of five

to

s i x p hy s i c i s t s w o ul d

be r e q ui r e d .

F o r d i re c t p at i e nt ca r e . O t h e r a ct i vi ti e s s up p o rt e d b y L V N s a nd nur s e s

aides. F r o m IS C R O . R a d i at ion o n c o lo g y i n i nt e g r at e d c a nc e r ma na g e m ent . R e s to n, V A : A m e r i c a n C o l l eg e o f R a d i ol og y , 1 9 91 , w i t h p e r m i s si o n.

F I G . 1 7 . 1 . P a t te r n s o f i n te r a ct io n a m o ng R a d i a ti o n o n c ol og i st works a lo ne . B:

t re a t me nt

pl a nni ng p e r so nne l . a nd

A:

Ra d i a tio n

o nc ol og i st

d o si m et r i st s

g e n e r a te a t r e at m e n t p l a n . C : T e a m w o r k b e t w e e n r a d i at io n o nc o lo g i st , p hy s i c i st a n d d o s i me t ri s t . P.426

P.427

A. Training
B e s i d e s t h e a de q u a cy o f p h y s i c s s t a f f i ng i n t e r m s o f num b e r o f p e r so nne l i n r e l at io n to the p at ie n t lo a d or e q ui p m ent , e d uc a t io n a nd t ra i ni ng of t hese p e r s o n n el a r e o f c r i tic a l i m po rt a nc e . T he g r e a te s t w e a k ne s s i n t hi s r e g ar d ha s b e e n t h e p h y s i c i st ' s tr a i n i n g . M o s t p hy s i c i st s a r e hi r e d w i t h l e ss - t ha n- a d e q ua te c l i n i c al t r ai n i n g . S t r u c t u r e d c li n i c a l t r a i ning p r o g r a m s ha v e be e n t r a di ti o na ll y

WWW.MEDRAD.IR

n o n e x i s t e n t . C er ti f i c at io n b o a rd s f o r p hy s i ci s t s e x i s t , b ut t he e ntr y r e q ui r e me nt s f o r t h e e x a m i n a ti o n s t il l d o n o t m a nd a te r e s id e nc y - t y p e c li ni ca l t r ai ni ng a s i s r e q u i r ed The of t he p h ys i c i a n s . t r a i n in g As a r e s ult, ar e t he r e is an unc he c k e d at t he i nf l ux of i n a d e q u a te l y t r ai n e d ph y s i c i s t s i n to t he f i el d. physicist's p r o bl e m s be ing a d d r e s se d na t i o na l l e vel ( 9 , 1 0 , 11 ) . P h y s i c s r e s i d e n c y p r o gr a m s a r e no w b e i ng i ns t i t ut e d, a l t ho ug h a t a m u c h s l o w e r p a c e th a n n e e d e d . It i s h o p ed t ha t e v e nt ua ll y c l i ni c a l me d i c al p h y s i c i s t s wi ll go t h r ou g h n a t i o n a ll y a c c r ed it e d r e s id e nc y p ro g r am s b e f o re t a k i ng t h e b o a rd e x a m i n a ti o ns o r a s s u m i ng i nd e pe nd e nt c li ni c a l r e sp o nsi bi li ti e s . J u s t a s f o r m al i z ed cl in i c a l t r a i n i n g i s i m po rt a nt f o r p hy s i c i a ns a nd p hy s i c i st s , it i s also i m po r t a nt for d o s im e tr i st s . Efforts are be i ng m ad e by t he A m e r i ca n A s s o c i a tio n o f M ed i c al Do s i me t ri s t s to fo rm a l i z e t he t r ai ni ng of d o si m et r i st s b y e s t a bl i s h i n g t r a i n i n g cu r r i c u l a , a c c r e d it a ti o n, a nd p r o f e s s i o nal c e rt i f i c at io n.

B. Qualifications
Q u a l i f i c a tio n s o f a c l in i c a l m ed i c al p hy s i c i st ha v e b e e n de b at e d i n t he p a st , b ut r e c e n tl y a c o n s e n s u s h a s d e v e l op e d a mo ng t he v a r i o us na t i o nal o r g a ni z a ti o ns . A r a d i at io n o n c ol og y p hy s i c i s t i s co ns i de r ed q ua l i f ie d i f he o r s he ha s a n M . S . o r Ph.D. degree in physics, m e d i c al p hy s i c s , or a closely r e l at e d f i el d a nd a c e r ti f i c a ti o n i n r ad i ati o n o n c ol og y p hy s i c s b y t he A m e ri c a n Bo a r d o f R a di ol og y , t h e A m e r i c a n B o a r d o f M e d i c a l P h y s i c s , o r ano t he r a p p ro p ri a te c er t i f y i ng bo d y . A q u a l i f ie d me di c a l d o s im e tr i st ha s a mini m um o f hi g h s c hool di p lo m a a nd a c e r ti f i c a ti o n b y t h e Am e r i c a n A s s o ci a ti o n of M e d i c a l D o si m et ri s ts . M o s t c e rt i fi e d d o s im e tr i st s a l s o a re c e r ti f i e d r ad i at io n t her a p y t e c hno lo gi s t s .

C. Roles and Responsibilities

T h e r o l e s a n d r e sp o ns i b il it ie s o f t he p hy s ic s t e a m ha v e b ee n d i s c us s e d i n t he l it e r at u r e p r e v io u s l y , i r r e s pe c ti v e d o s im e tr i st , P.428 t h e p h y s i ci s t i s b a s ed o n t h e s a me r at io na le a s t he p hy s i c i a n' s co nt r ol o f me d i c al p r e s c r ip ti o n . N o n c o n fo r m it y t o t hi s p ri nc ip l e p a t ie n t . c a n po s e a s e rio us r i s k t o t he ( 1 1 , 12 , 1 3) the of of or the ot h er and are must these s um m a r i z e d di r e ct a nd a c ti v i ti e s T hi s the are d at a in T a b le 17.2. team ap pl i ed o ut As to by e m p ha s i z e d a s s um e t he t he of f ul l p at ie nt s , p hy s i c i st , p hy s i c s p h y s i c i st w h e th e r p hy s i c s c a r ri e d and

r e s p o n si b il it y

physics

p r o c ed ur e s una m b i g uo us

p e r so n n e l .

re s po ns ib i li t y

p r o c ed u r e s b y

TABLE

17.2.

ROLES

AND

RESPONSIBILITIES

OF

PHYSICISTS

WWW.MEDRAD.IR

Equipment (Teletherap y, Brachyther apy, S i m u l a t or )

Treatment Planning (Teletherapy and Brachytherapy ) D osi m e t ry Radiatio n P r ot e c t i on A c a de m i c / A d m i n i s trative

S e l e ct io n , s p e c i f i ca ti ons

Management/ QA t r e at m e n t planning c o m p u te r of

Dose c a l c ul a t io n f o r m a li sm

R e g ul a t ory

T e a c hi ng

Acceptance t e s ti n g

Beam

data

S p e c i al t r e at m e nt t e c hni q ue s

R a d i a ti on s ur v e y

Research

management

C o m m i s si o ning, beam data measurem ent

S i m u l a ti o n c o n s u l t a ti o n

S p e c i al d o s im e try

Person ne l m o ni to r i ng

D e v e lo p me nt a l

C a l i b r at io n

Patient for planning

data

In try

vivo

F a c i li t y d e s ig n

A d m i ni s tr a ti v e

t r e at m e n t

d o s im e

Quality assurance

Technique o p ti mi z a t io n ; i s o do s e p l a n n i n g ; pl a n analysis/evalu a t io n ; t r e at m e n t aids; m o di f i e r s beam

F r o m K h a n F M . R e s ide n c y t r a i ni ng f o r me di c a l p hy s i c i st s . I nt J R a d i a t O nc o l B i o l P h y s 1 9 9 2; 2 4 :8 53 , w i t h p e r m i s si o n.

WWW.MEDRAD.IR

The

r a d i at io n

o n c ol og i s t

u n d o u b te d l y

has

t he

o ve r a ll

r e sp ons i b i lit y

for

t he

c o n d u c t o f t h e e n ti r e t r e at m e n t p r o ce s s . Be c a us e o f t ha t r ol e , i t i s hi s o r he r r e s p o n si b il it y to e n s u r e t h a t a n a d eq ua t e and c o m p et e nt p hy s i c s t e a m i s i n p l a ce a n d t h a t t h e r o le s o f d i f f e r e n t pe r s o nne l o n t he t e a m a r e a p p ro p ri a t el y d e f i ned . It has been r e co g n i z ed that i n a d eq ua c y of p hy s i c s s up po r t t r a ns l a te s i nto s u b s t a n d a r d o r l e s s t ha n o p t i m al p at ie nt c a r e ( 4 , 6 ) . C a l i b r at io n o f r a d i at io n g e n e r a to r s o r so ur c e s i s t he e x cl us i v e r e s p o ns ib il it y o f t h e m ed i c al p h y s i ci s t . N o ot h e r p e r so nne l ha s t he e x pe r ti s e to pe r f o r m t hi s mo s t c r i ti c a l f u n c t i o n . B e c a u s e o f t h e a b s o l ut e ne c e s s it y o f t he c a l i b ra t io n p r o c ed ur e b e f o re t h e m a c h i n e c an b e re le a s ed f o r p at ie nt t r e at m e nt , a ll i ns ti t uti o ns ma na g e t o a c q u i re p h y s i c s s u p p o rt a t l e a st s uf f i c i e nt t o p ro v i de p e ri od i c ca l i b r ati o n o f t he r a d i at io n e q u ip m e n t . H o w e v e r , t he se pe ri o di c c al ib r a ti o ns , o ut s i de o f a w e ll structured q u al it y assurance program, are i na d eq ua t e a nd c a nno t e ns ur e c o n t i n u e d s a f et y o f m a c h i n e o p e r at io n o n a d a i l y b a si s ( 1 4 ) . N e x t to c al ib r a ti o n a nd q u a li t y a s s ur a nc e o f r a d i at io n e q ui p m e nt is t he p hy s i ci s t 's r o le i n t r e at m e n t p lan n i n g . A l t ho ug h t he t r e at m e nt p l a nni ng pr o c e s s i nv o l v e s s o p h i st i c at e d p h y s i c s c o n c e p t s i n d e si g ni ng a nd o p ti m i z i ng p ati e nt t re a t me nt s , most i n st it u t io n s do not involve p hy s i cis t s s uf f i c i e nt l y in thi s process. As d i s c u s s e d p r e v io u s l y ( F i g . 17 . 1 ) , s o me p hy s i c i a ns t e nd to w o rk a l o ne o r w it h d o s im e tr i st s to d e si g n t r e at m e nt pl a ns . It sho ul d be r ea li z e d t ha t t he ab s e nc e o f p h y s i c i s t f r o m t h e t r ea t m e n t -p l a nni ng s c e ne t a k e s a w a y a n i m p o r t a nt e le m e nt o f q u a l it y c o n t r ol , n a m e l y , t h e o pt im i z a ti o n a nd s c i e nt i f i c a ut hent i c a ti o n o f t he t r e at m e n t pl a n . T h e p h y s i c i s t ' s d i re c t i n v o l v e me nt i n t he tr e a t me nt - pl a nni ng p ro c e s s i s po s s ib le o n l y i f t h e c o n s u l t at ion i s s o u g h t b y t he r a d i a ti o n o nco lo g i st . If t he l a tt e r i s n ot a c c u s t o m ed , b y t r ai n in g o r e x p er i e nc e , to s uc h i nt e r a c ti o ns , t he p hy s i c i st i s not b r o u g h t i nt o t h e t r ea tm e n t - pl a n n i ng l oo p . Co ns e q ue ntl y , a n i m p or t a nt m e mb e r o f t h e t r e at m e nt - p l a n n i ng t e a m i s b y pa s s e d . A t s o m e i n st it u t io n s , t h e p h y s i c i s t ' s ro le i n t r e a tm e nt pl a nni ng ha s b e e n m a d e i n d i s pe n s a b le . from the F or ex a m p l e , on c o l og i st , t im e of at t he t he U niv e r s i t y s ur g eo n, to or of M i nne so t a t he p hy s i c i st ' s To p r e v e nt in c o n s u l t a ti o n i s m ad e a s i m po r t a nt a s o t he r c o ns ul t at io ns , s uc h a s t ho s e s o ug ht m e di c a l at the t he t he r a d io lo gi s t . r ad i at io n b y p a s s i n g t h e p h y s i cs c o n s u l t a ti o n, e a c h p a t ie nt i s a ss i g ned a p hy s i c i s t w ho i s a v a i l a bl e s im ul a ti o n a s s i st o nc o lo gi s t f o r m u l a ti n g t h e be s t p o s s ib le t re a t me nt p l a n. S ub s e q ue nt p hy s i c s w o r k i s t he d e s ig n a t ed p h y s i ci s t ' s r e s po n s i bi li t y , al t ho ug h he o r s he m a y be a s s i s te d b y t he d o s im e tr i st o r o t he r te c h n i c a l p e r so nne l . T he f i na l t r e a t me nt p l an i s a p p r o v e d b y t h e r a d i at io n o n c ol ogi s t a f te r d i s c us s i ng the p l a n w i t h t he p hy s i c i st . A l s o , t he p h y s i c i s t i s p r e se n t at t h e ti m e o f f i r st t r ea t m e nt a nd s ub s eq uent t r e at me nt s , i f n e e d ed , t o e n s u r e p rop e r i mp l em e nt at io n o f t he p l a n. N o t a ll t h e cl i n i c al p h y s i c s p ro c e d ure s ne ed to be p e r f o rm e d b y p hy s i c i s t s . M a ny o f t h e te c h n i c a l t a s ks c a n b e d e l e g a te d to d o s im et r i st s s o t ha t p hy s i c i s t s c a n d e v ot e current t i me with to e s sen t i a l d e v el op m e nt al in t he f i el d . a c t i v it ie s . Every r a di a ti o n rests o nco lo g y with t he d e p a rt m e n t n ee d s to d e v e lo p n e w p r og r a m s a s w e l l a s r e v i s e t he o l d o ne s t o k ee p ad v a n c e m e n t s R e s po ns i bi li t y often p h y s i c i s t to i m pl e men t t h e se a d v a nc e s w hi l e m a i nt ai ni ng t he q ua l it y o f c a re .

WWW.MEDRAD.IR

E x a m p l e s f r o m t h e p as t t h r e e d e c ad e s i nc lud e d e v e lo p me nt o f l ine a r a c c e l e r at or t e c h n o lo g y , co m p u te r i m a gi n g , 3 - D t r e at me nt pl a nni ng , c o nf o rm a l a nd d y na m i c therapy, and r e m o te a f t e r l o ad i ng b r a c hy the r a p y . W he r e a s t he s e t e c hno lo gi e s w e r e n o t d e v el op ed ex c l u s i v e l y b y p hy s i ci st s , t he y ha d a n i mp o rt a nt r ol e i n t hei r d e s ig n a n d c l i n i c al a p p li c a ti o n . A l o ng w it h t he s e m a jo r a d v a nc em e nt s c a m e t he i n n o v a t io n s i r r a di a ti o n , in t r e atm e n t te c h n i q ue s , t h e r ap y , for e x a m p le , m a nt le f ie l d s , t ot a l b od y el e ct r o n These beam i nt e ns it y - m o d ul at ed an i nt e g r a l p a rt r ad i a ti o n of t he t he r a p y , p hy s i c i s t ' s

s t e r eo ta c ti c r a d io s u r ge r y , l o w - e n e r g y s o ur ce b r a c hy t he r a p y , a nd hi g h d o s e r a t e brachytherapy. r e f i n e m e nt s form r e s p o n si b il it ie s a n d a r e o f t e n n o t s e p a r at ed f r o m hi s o r he r r o ut i ne c l i ni c al d ut ie s . It i s , t h e r e fo r e , i m por t a n t to r e co g ni ze t he ne e d o f p r o v id i ng s uf f i c i e nt t e c hni c a l s u p p o r t t o t h e p h y s i c is t f o r a p r o pe r f ul f i ll me nt o f hi s o r he r r o le . P.429

17.3. EQUIPMENT
H i g h - q u a l it y p at i e nt ca r e c a n n o t b e a c hi e ve d o r m ai nt a i ned w itho ut a p p ro p ri a te e q u i p me n t . T u m o r s o cc u r i n m a n y f o r m s , s ha p e s , a nd l o c at io ns . U nl e s s r a di a ti on c a n b e e f f e c ti v e l y d el iv e r e d t o t h e t umo r s ite w i t h mi ni m a l si de e ff e c t s , t he w hol e t r e at m e n t p ro c e s s b ec o m e s n o mo r e t ha n a c o st l y e x e r ci s e co s tl y i n t e r m s of e c o n o mi c s a s w e ll a s h u m a n l i f e . F o r a ny i ns t i t ut io n t o em b a rk o n a r a d i a t io n t h e r a p y p ro g r am , f o re m o st a tt e nt io n m us t b e p a id to i t s c a p a bi li t y o f p ro v i di ng o p ti m al c a r e to a l l th e p a t ie n t s w ho w i l l b e r e f e r r ed to i t . Thus t he a v a i l a b l e e q u i p me n t m u s t b e s u i t a bl e to t r ea t e f fe c t i ve l y t he m a ny d if f e r e nt k i nd s o f c a n c e r s t ha t a r e p r e sen t e d i n t h e c li ni c .

A. External Beam Units

T h e t y p e o r q u a li t y o f r a d i at io n b e am i s d i c ta t ed b y t he t y pe a nd lo c a ti o n o f c a n c e r t o b e t re a te d . M o s t h e a d a nd ne c k c a nc e r s c a n b e t r e a t ed w i t h l o w - e ne r g y m e g a v ol t ag e u n i t s : c ob a l t -6 0 o r l i ne a r a c cel e r at o r s i n t he e ner g y r a ng e o f 4 t o 6 M V . T h a t d o e s n ot me a n t h a t a f a ci li t y equi p p ed w i t h o nl y o ne o f t he s e uni t s is c a p a b le o f p r o vi d i n g q u a l it y c a r e t o a ll p ati e nt s w i t h he a d a nd ne c k c a nc e r s . O n t h e c o n t r a r y , i n s ti t u tio n s w h o s e s o le t r e atm e nt e q uip m e nt i s one o f t he s e uni t s are not in a p o s it io n to undertake c om p l e x a nd s o p hi st i ca t e d t re a tm e nt t e c h n i q u e s r eq u i r ed f o r m o st h e a d a nd ne ck c a nc e r s . D e p e nd i ng o n t he k i nd a nd s t a g e o f t h e di s e a se , a n o p ti m al t re a t me nt p l a n m a y c a ll f or ot her t y p e s o f be a m s s u c h a s a c o mb i n at io n o f l o w - a nd hig h- e ne r g y p ho to n be a m s o r a n el e ct r o n b e a m . A f a c i l it y e q u ip p e d w it h a s i ng l e -e ne r g y b e a m te nd s to f o ll o w s ub o pt im al t r e at m e n t pl a n s or o b s ol et e tr e at m e nt te c hni q ue s w he n t he best a v a i l ab le r a d i at io n t h e r a p y e q u ip m e n t i s a c ob a lt uni t. B e c a u s e o f t h e w id e va r i et y o f c a nc e r s no rm a l l y s ee n i n a r a d i at io n t he r a p y c li ni c , i t i s n e c e s s a r y to h a v e a t l e a s t t w o q ua l it i e s o f p ho to n b e a m s: a l o w - e ne r g y ( c o b a lt - 60 o r 4 to 6 M V x - r a y s ) a nd a hi gh- e ne r g y ( 1 0 M V o r hi g he r ) be a m . In a d d it io n , e l e ct r o n b ea m s o f s e v e r a l d i f f e re nt e ne r g ie s b et w e e n 6 a nd 2 0 M e V m u s t b e a v a i l a bl e bec a u s e a p p r o x i m at el y 3 0 % o f p at ie nt s r e qui r e a n e l e c t ro n b e a m f o r bo o st o r a n e n t i re c o u r s e o f t re a tm e nt .

WWW.MEDRAD.IR

A d u a l - e n e r g y li n e a r a c c e l e r ato r c a n p r o v id e a ll t he be a m s ne c es s a r y f o r m o d e r n r a d i at io n t h e r a p y . T h e s e m a c h i n e s a r e usua l l y e q ui pp e d w it h one l o w - a nd o ne h i g h - e n e r g y p ho to n be a m a n d a num b e r o f e l e ct r o n e ne r gi e s up to 18 o r 2 0 M e V . T h a t p r o v i de s s u f f i c i en t c a p a b il it y t o t re a t a ny c a nc e r t ha t ne e d s e x t e r na l b e am . A d d it io n a l m a c h i n e s a r e r eq u i r ed i f t he pa t i e nt lo a d e x c ee d s ab o ut 3 0 p a ti e nt s p e r d a y . A lt h o u g h it is p o s si b le to t r e at mo r e t ha n 3 0 p at ie nt s p e r m a c hi ne p er d a y , h i g h e r p a ti e n t l oa d s n e c e s s it a te hur r ie d t re a t me nt s a nd c ons e q ue nt l y a ll o w l e s s at te n t io n to de t ai l . It i s im p o rt a nt fo r a r a d io t he r ap y f a c i li t y t o b e e q uip p ed n o t o nl y w i t h a pp r opr i a te t y pe a nd q ual ity o f b e a m s b ut al s o w i t h a s uf f i c i e nt n u m b e r o f m a c h i n e s t o h a n d l e t h e p at ie nt lo a d .

B. Brachytherapy Sources
C e r t a i n c a n c e r s n ee d b r a c h y t h e r a p y , us ua l ly i n c o m bi na t io n w i t h e x t e r na l b e a m . C a n c e r o f t h e u t e r i n e c e r v i x a n d s o m e ot he r g y ne c o lo gi c m a li g na nc i e s a r e be s t t r e at e d wi t h t h e s e te c h n i q u e s . U nl e s s t he c e nte r ha s t he p oli c y no t t o t r ea t p a t ie n t s f o r w h o m t h e b r a c h y t h e r a p y i s t he t r e at m e nt o f c ho i c e, b r a c hy t he r a p y e q u i p me n t m u s t b e av a i l a bl e t o p ro v i d e qua l i t y c a re to p a ti e nts w ho ne e d t hi s form of therapy. F o r i n t r a c a v it a r y a pp li c a ti o n , r a di um a nd ce s i um a re eq ua l l y e f f e c t i ve a s f a r a s t h e t h e r a pe u ti c e f f e c ts a r e c o n c e r ne d . C e sium ha s r e p l a c e d r ad i um m a i nl y o n t he b a s i s o f r a di a ti o n p r ot e c tio n c o n s i d e r at io ns p e r t ai ni ng t o st o ri ng a nd ha nd l i ng o f t h e s e s o u r c e s . F or i n t e r st it i al i m pl a nt s , i rid i um - 1 92 i s t he b e s t a v a i l a b le s o ur ce although sources. A v a i l a b il it y of b r ac h y t h e r a p y of a center s o ur c e s to p ro v id e a nd e q ui p m e nt t he r a p y. adds A g a i n, to if t he t hi s c o m p re h e n s i v e n e s s r a d i at io n io di n e - 12 5 offers s o me a d v a nt a g e s fo r p a rt i c ul a r t e c hni q ue s , f or e x a m p le , p e r m a n e n t i m p la n t s o r t e m po r a ry b r a i n i m pl a nt s w i th hi g h- i nt e ns i ty

c a p a b il it y i s n o t a v ai l a bl e , a p a ti e nt ' s t re a t m e nt m a y b e c om p r o mi s e d i f t he i n s t it u t io n d oe s n o t h a v e a s u i t a b le a l te r na t i v e o r P.430 r a t io n a l i z e s t h e u s e of e x t e r n a l b e a m al o ne no t o n t he b a s i s o f m e r it b ut o n t he n o n a v a i l a b il it y o f b r a ch y t h e r a p y s e r v i c e . A f t e r lo a d i n g is do n e by p r o ce d u re s the are the s t a nd a rd of An p r a c t i ce in b r a chy t he r a p y . can p r o v id e T he t h e r a p e ut i c q u al it y o f t h e p ro c e d ure i s l it tle a f f e c t ed b y w he t he r t he a f t e rl oa d i ng bed s i de or r e mo te l y . i ns t i t ut io n q ua l it y b r a c h y t h e r a p y b y u s in g c o n v e n t io na l a f te rl o a di ng ap p li c at o r s . The ne e d fo r t he r e m ot e a ft e rl o ad e r s (t h e L D R o r t he H D R ) i s b a se d p r i m a ri l y on c o ns i d e r at io ns s u c h a s m i n i m i z i n g ra d i a tio n e x p o s ur e t o p e r s o nnel o r ha nd ling l a r g e p a ti e nt l o a d s . A g ai n , i f i t c a n b e e s t a b li s he d t hat t he r e m o te a f t e rl o adi ng w i l l im p r o ve p a t ie n t c ar e (e . g . , by a ll o w i n g be tt e r nur s i ng care or o pt i mi z i ng so ur c e p l a c e me n t ) , a c a s e c a n b e m a d e t o a c q ui re s uc h e q ui p m e nt . H i g h- t e c h e q ui pm e nt s u c h a s t h e re m ot e a ft e rl o a de r s c a n b e v e ry e x p e ns i v e a nd c a n d r i v e up t he co s t o f p a ti e nt c a r e . T h e re f o r e , t h e a dd it io na l c o s t m us t be j us ti f ied o n t he b a si s o f c o s t v e r s u s p a ti e n t ben e f i t a n a l y s i s .

C. Simulator
WWW.MEDRAD.IR

T h e s i m u l a to r i s a n e s s e n t i al t oo l fo r pl anni ng a nd d e s ig ni ng r a d i at io n t he r a p y t r e at m e n t s . B e c a u se o f t h e p oo r i m a gi ng qua l i t y o f t he t re a t ment b e a m a nd t he l o gi s ti c d i f f i c ul t y o f ob t a i ni n g t i me o n t he t r e at m e nt m a c hi ne , a s i m ul a to r i s t he a p p r op r i at e e q u ip m e nt to i m a ge t he t re a tme nt f i el d s a nd o p ti mi z e t hei r p l a c em e nt b e f o re a ct u a l t r e at m en t . B e c a u s e t he s im ula t o r o f f e r s t he s a m e b e a m g eo m et r y a s t h e t r e at m e n t m a ch i n e , s i m u l a to r fi l m s a r e us e d t o o utl i ne t he f i el d s ha pe a nd d i m e n si o n s f o r c u s t om d e si g n i n g fi el d b loc k s . T he s i m ul a to r roo m is t he pl a c e w h e r e d i f f e r e nt te c h n i q u e s c a n b e m od e led a nd s ol ut io ns to tec hni c a l p r ob le m s d e v i s ed . A n e s s e n t i al r eq u i r e me n t f o r si m ul at io n i s t he ge o me t ri c a c c ur ac y t ha t m us t be m a i n t a i n ed a t t h e s am e l e v el a s t ha t o f t he t r e at m e nt m a c hi ne . If t he s i m ul a t e d f i e l d c a n n ot be a c c u r a t e l y re p ro d uc e d unde r t he t r e at m e nt m a chi ne , t he w ho le s i m u l a ti o n p ro c e s s b ec o m e s a u s e l e s s e x erc i s e . Ina c c ur a t e s i m ula t io n c a n r e s ul t i n e r r o n eo u s t r e a tm e nt . B e s i d e s t h e m e c h a n i ca l a n d r a d ia ti o n f ie ld a c c ur a c y o f a s i m ula t o r , it s i m a gi ng q u a l it y cannot be ov e r e m p h a s i z ed . U nl ess a na t o mi c st r uc t ur es can be made v i s i bl e w it h r e a so n a b le c l a ri t y , f ie l d s c a nno t b e a c c ur a t el y o ut li ne d , ne g at i ng t he v e r y p u r p o s e o f s i m u la t io n . F l u o r o s co pi c c a p ab il ity o f a s i m ul at o r i s a d e s ir a b le o p tio n be c a us e it a ll o w s i t er a ti v e f i e ld a d j u s tm e n t s a n d v i e w i ng be f o r e a f i na l r a d io g ra p h i s o b t ai ne d . N o n a v a i l a bi li t y o f f l uo r o s co pi c op ti o n re sul t s i n a n i nc r e a s ed num b e r o f f il m r e t a k e s a n d , i n t h e lo n g r u n , i s not co s t -e f f e c t i v e . M o r eo v e r , to o m a ny r e pe a t s c o u l d de t er f r o m o pt im i z a t io n o f t he s i m ul at io n p r o c e s s . New d e v el op m e n t s in s i m u l a ti o n are t ak i ng p l a ce in t he ar e a of c o mp ut ed t o mo g r ap h y ( C T ) s i m ul a ti o n . A l a r ge num b e r o f C T s c a ns t a k e n t hro ug h t he r eg io n o f t h e bo d y to be s i mu l a t e d c a n be p ro c e s se d to p ro d uc e a d ig ita l r e co ns t r uc t ed r a d io g r a p h y ( D R R ) i n a n y p l a n e . T he D R R c o r r e ct e d f o r b e a m div e r g e nc e i s l i k e t h e s i m u l at o r r ad io g ra p h , e x c e p t t ha t it i s c r e a t ed f r o m i nd i v idua l C T s l i c e s . If t a r g et s a n d c ri ti c a l s tr u c t u r e s a r e o ut li ne d o n e a c h C T s l i ce , a D RR c a n b e c r e at ed to pr o v id e any s i mu l a t o r v ie w with t he t a r ge t a nd t he cr i ti c a l st r uc t ur e s h i g h l i g ht e d i n di f f e r en t s h a d e s o f c ol or . The D R R v i e w i s us ed t o op ti m i z e t he d e s ig n a n d p l a c e m e n t o f t r e a t me nt f i e ld s b e f o re a s i m ul a ti o n f i l m i s t a k e n f or v e r i f i c a tio n .

17.4. DOSIMETRIC ACCURACY

A v a i l a b le e v id e n c e f or e f f e c t i v el y t r e ati ng c e r t ai n t y p e s o f c a nc e r s p oi nt s to t he n e e d f o r a n a c c u r a c y o f a p p ro x i m at el y 5 % i n do s e d el i v e r y ( 1 5 , 16 ) . T hi s i s i n d e ed a ve r y s t ri n g en t r e q u ir e m e nt , c o ns id e r i ng t he unc e r t a i nt ie s i n e q uip m e nt c a l i b ra ti o n , t re a t me n t p l a n n i n g , a nd p a ti e nt s e t - up . F ur t he r re d uc t io n i n t he do se a c c u r a c y l i m i t w il l be n o t o n l y v e r y d i f f i c ult b ut p r ob a b l y o f m a r gina l v a l ue . C a l c u l a t io n o f o v e r a ll u n c e r t a i n t y i n a r a dia t io n t he r a p y p ro c edur e i s a c o mp le x p r o bl e m , P.431 have p r o p o se d a m o d el in w hi c h t he r a nd o m a nd s y s t e ma t i c e r ro r s a re because som e e r ro r s a re r a nd om w hi l e o t he r s can be s y s te m a ti c . L o e v i n ge r a n d L o f t u s ( 1 5 )

s t a ti s ti c a ll y t r e at ed th e s a m e w a y . Ind i v i d ua l unc e r t a i nti e s a re r e p re s e nte d b y

WWW.MEDRAD.IR

standard

d e vi a ti o n s

that

are

t he n

added

in

q ua d r at ur e

to

d et e rm i ne

t he

c u m u l a t i v e u n c e r t ai n ty . T h e c o m b i ne d s t and a r d d e v i at io n m a y b e m ul ti pl i ed b y t w o to o bt a i n a n u n c e r t a i n t y w i t h a 9 5% c onf i d e nc e i nt e r v al .

TABLE 17.3. UNCERTAINTY a IN THE CALIBRATION OF AN ION CHAMBER

Step

U n c e r t a i n t y ( P e r c e nt )

Physical constants

1.1

S t a n d a r d b e a m , N IS T

0.5

S e c o n d a r y s t a n d a r d , N IS T

0.4

F i e ld i n s t r u m e n t , A D CL

1.0

Cumulative

1.6

A D C L , A c c r e d i te d Do se C a l i b r at io n L a b or a to r y ; N IS T , N a t i o na l Ins t i t ute o f Standards and Technology.

9 5%

c o nf i d e nc e

i nt e r v a l .

F r o m IC R U . D e t e r mi n a t io n o f a b s o r be d do s e i n a p a t i e nt i r r ad i at ed b y b e a m s o f x o r g a m m a r a y s in r a d i ot h e r a p y p ro c edur e s . R e p o rt no . 24 . W a s hi ng t o n D C : In t e r n a t i o n a l C om m i s s io n o n R a d i a ti on U ni t s a nd M e a s ur e s , 1 9 7 6 , w i t h p e r m i s sio n .

T a b l e 17 . 3 gi v e s a n e s t im a te o f unc e r t a i nt y i n t he c a li b r at io n o f a t r e at m e nt b e a m w it h a f ie ld io n c h a m b e r ( e . g . , 0 . 6 cm 3 F a r m e r -t y p e c ha m b e r ) . T he a na l y s is s h o w s t h a t a n i o n c h a m b e r s u i t ab l e f o r c al i b r at i ng r a di at io n t he r a p y b e a m s a nd p r o v id e d w i t h a
60

Co e x p o s u r e c a li b r at io n f a c t o r f r o m a n a c c re d it ed do s i me t r y

c a l i b ra ti o n l a bo r a to r y ( A D C L ) h a s a c um ul at iv e unc e r t a i nt y o f ap p ro x i m a te l y 1 . 5% ( t w o s t a n d a r d de v i at io n s ) . C a l i b r a ti o n o f be a m s w i t h t hi s c ha m b e r w i l l i nt r od uc e a d d it io n a l u n c e r t ai n t ie s such as in t he m e a s ur e m e nt p r o ce dur e a nd in t he p a r a m et e r s o f t h e dos i m et r y p r ot o co l . T he o v e r a ll unc e r t a i nt y o f t he t r e at m e nt b e a m c al i br a ti o n u s i ng c u r r e n t p ro to co l s is e s ti m a te d t o b e abo ut 2 . 5% und e r o p ti m al c o n d it io n s ( 1 5) . T a b l e 1 7 . 4 g i ve s u n c e r t a i n ti e s i n t he v a ri o us s t e ps i nv ol v e d i n d eli v e r i ng a c e rt a i n d o s e t o a p ati e n t a t a r e f e r e n c e po i nt s uch a s a t t he i s o ce nt e r . T he e s t i m at e o f t h e u n c e r t a i nt ie s i n th e s e s te p s is a p p ro x im a t e a nd a rr i v ed a t by c o ns i d e ri ng t he v a r i o u s p r o ce d u r e s as t h e y m a y b e t y p i ca l l y c a r r ie d o ut . T hes e unc e r t a i nti e s

WWW.MEDRAD.IR

c o u l d b e f u r t h e r r e f in e d a n d b r o a d e ned t o i nc l ude unc e r t a i nti e s i n t he d ose d i s t ri b u tio n w i t h i n t h e t a r g et v o l um e a nd t he s ur r o und i ng s t r uc t ure s ( 2 ) . A Q A p ro g r a m m u s t ad d r e s s n o t o nl y t he i ss ue s o f r a ndo m a nd sy s t e m a ti c e r r o rs i n h e r e n t i n t h e p ro c ed u r e s b u t a l so t he po s s i bi li ti e s o f hum a n e r r o r s uc h a s i n reading an i n s t r u men t , s e l e ct i ng a tr e at m e nt p ar a m et e r , ma k i ng a r i t hm et i c c o m p u t at io n s , o r i n t e rp r e ti n g a t r e at m e nt pla n. A l t ho ug h h um a n e r r o r s c a nno t b e e l im i n a te d a lt og et h e r , t h e P.432 p r o b ab il it y o f t h e i r o cc u r r e n c e c a n b e m i ni m i z e d b y a w e l l - de s i gne d Q A p r o g r a m . A n u n d u e r e l a x a t io n o f a Q A p ro g r a m o r t he l a c k o f it c a n b e co ns t r ue d a s p r o f e s si o n a l n e gl ig e n ce .

TABLE 17.4. OVERALL UNCERTAINTY a IN DOSE DELIVERED AT A POINT IN A PATIENT

Step

U n c e r t a i n t y ( P e r c e nt )

Io n c h a m b e r c a l i b r at io n

1.6

C a l i b r at io n p r o ce d u r e

2.0

D o s e c al c u l a ti o n p a r am e t er s a nd m e t hod s

3.0

E f f e c t i v e d e pt h

2.0

SSD

2.0

Wedges

2.0

Blocking trays

2.0

Cumulative

5.6

9 5%

c o n f i d e nc e

i nt e r v a l .

S S D , s o u r c e - t o - s u r f a ce d i st a n c e .

17.5. EQUIPMENT SPECIFICATIONS

A c q u i s i ti o n o f a m a j or p i e ce o f eq ui p me nt i nv o l v e s m a ny s t ep s: j us t i f i c at io n o f need, market e v a l u at io n o f d i f f e r e nt m ak e s a nd m o d e l s , c he c k s o f v e nd o r s

WWW.MEDRAD.IR

b u s i n e s s r el a ti o n s a nd s e r v i ce re c o rd , c a ll ing up us e r s f o r t hei r o p i ni o ns , w r it i ng b i d s pe c i f i ca ti o n s , m a k i n g f i n a l e v a l ua t io n, a nd d o i ng p ri c e ne go ti a ti o ns . E v e n i f t h e i n s ti t u ti o n do e s no t re q u i r e clo s e d b i ds , i t i s i m po r t a nt to p r e p a re d et a il ed s p e c i f i ca ti o n s and obt a i n a f o r m al w r it ten r e s p o ns e from t he v e nd o r b e fo r e d e c id i n g o n t h e p u r c ha s e . M o s t v e n do r s li s t t h ei r e q u ip m e nt sp e ci f i ca t io ns i n c o m p a ny b ro c hur e s t ha t a r e a v a i l a bl e o n r eq u e s t . T h e s e s p e c i f i c at io ns s ho ul d b e c a r e f ull y c o m p a r ed w i t h o t h e r v e n do r s s pe c i fic a t io n s . F o r m a l b id sp e c i f i ca ti o ns c a n t hen b e w r i tt e n f o r t h e p ro d u c t t h a t mo s t c l o se l y me e t s t he i ns t it ut io n' s ne e d s . Fo r a n i m p a rt i al bid p r o c e s s , t h e s p e ci f i c at io n s s h o u l d be a s ge ne r i c a s po s s ib le , s o t ha t al l m aj or v e n d o r s ha v e a f a i r c h a n c e o f r e sp o ndi ng to t he bi d s . S p e ci f ic a t io ns t ha t t he i n s t it u t io n co n s i d e r s e s s e n t i al m us t b e i de nt i f ie d so t ha t v e ndo r s w ho ca nno t m e e t t h o s e sp e c i fi c a tio n s d o n o t ha v e to go t hr o ug h t he p r o ce s s o f a ns w e r i ng t he b i d . If a p a r t i c u l a r s y s t e m i s s pe c i f ie d to me e t a c e rt a i n f unc t i o n, v e nd o r s s ho ul d h a v e t h e o p po r t u n it y t o s u g ge s t a lt e r na tiv e s y s t e m s w i t h e q uiv a l e nt o r b e tt er s p e c i f i ca ti o n s . T h e p u r c h a s e o f r a d ia t io n t h e r ap y eq ui p me nt i s us ua l l y a s ha r e d re s po ns i bi li ty b e t w ee n t h e r a d i at ion o n c o l o gi s t , t he p hy s i c i st , a nd t he ho s p i ta l a d m i ni st r a to r . T h e p h y s i c i s t ' s ro le is p r i m a ri l y to w r it e te c hni c a l s p e ci f i c at io ns a l t ho ug h m o st p a r t i ci p at e i n t h e w h o l e d e ci s io n p r o ce s s . T h e s p e c i f i c a ti o n s a re w r i t te n i n a s ui t a b l e f o r m at s o t ha t the v e nd o r s c a n respond to t h em it em by it e m . Be c a us e t he v e ndo r s r e sp ons e s are l e g al ly b i n d i n g , c l a ri f i c at io n s h o u l d b e s o ug ht i f r e s p o ns e t o a p a rt i cul a r i t em i s n ot c l e a r . Al s o , i f a sp e ci f i c a ti o n i n a co m p a ny ' s b r o c hur e f a ll s s ho r t o f a d e si r ed s p e c i f i ca ti o n , n e go ti at io n s m a y b e c a r ri ed o ut w it h t he v e ndo r t o i m p ro v e t he s p e c i f i ca ti o n i n q u e stio n . M a n y i m p r o v e me nt s i n t he a c c el e r at o r t e c hno lo g y ha v e o c c u r r e d a s a r e s u l t of c u s t o m e r d e m a nd f or b e tt e r s pe c i f i c at io ns. C e r t a i n s pe c i f i c at io n s i n r e g a r d to b e a m cha r a c t e r i st i c s a nd a cc e p t a nc e c ri te r ia require c a re f u l l y s ta t e d de f i nit io ns and m e t hod s of m ea s ur e m e nt . T he s p e c i f i ca ti o n s s h o u ld c l e a rl y s p el l o ut t he se de t ai l s , e s pe c i al l y w he n c o nf l i c ti ng d e f i n it io n s o r c r it e ri a e x i s t i n t h e l it e r at ur e . A s f a r a s p o s si bl e , t he s pe c i f i c at io ns s h o u l d f ol lo w n a ti o n al o r i n te r n a t io na l te r m ino l og y a nd g ui de li ne s unl e s s a s p e ci a l n e e d e x i st s t o j u st i f y d e v i at io n s f r o m t he a c c e p te d s t a nd a rd s .

17.6. ACCEPTANCE TESTING

U n l e s s t h e v e n d o r h a s a g r e e d t o a w r i tt e n se t o f s p e ci f i c at io ns , t he c us t o m e r ha s n o r e c o u r s e b u t to g o a l o n g w i t h t he v e nd or ' s a c c e p t a nc e t e st p ro c e d ur e s . T he s e p r o c ed u r e s a r e s e t u p b y t h e c om p a ny t o de m o ns t r at e t ha t t he pr o d uc t me et s t he s p e c i f i ca ti o n s c o n t ai n e d i n it s b r o c hur e s and s a t i s f i e s t he le g a l r e q ui r e me nt s of e q u i p me n t s a f e t y . If a s e t o f b i d s p e c i f ic a t io n s w a s a g r e e d on b e f o r e t he m a c hi ne w a s p ur c ha s e d , t h e n t h e v e n d o r i s ob li g a te d to s at i s f y al l t he s pe c i f i c at io ns a nd c ri t er i a c o nt ai ne d i n t h e p u r c h a s e c o n t ra c t . In p r a c t i c e , t he v e nd o r f i r s t pe r f o r m s a l l t he t e s t s i n a c c o r d a n c e w it h t h e c o m p a n y ' s p r o ce d ur e m a nua l . A ny d e v i a t io ns o r a dd it io ns s t i p ul a t ed i n t h e b id sp e c i f i ca ti o n s a r e t he n a d d r e s se d to co m pl ete t he a c c ep t a nc e t e s ti n g p ro c e s s .

WWW.MEDRAD.IR

A s a g e n e r a l r u l e , a c c e p t a n c e te s ti ng i s r e qui r e d o n a ny p i e c e o f e q ui p m e nt t hat i s u s e d i n c o n j u n c t io n w i t h p at i e nt t re a t ment s . W he r e a s f o r m al te s t i ng p ro c e d ur es have been d e ve lo p ed for m a jo r eq ui p me nt ( li ne a r a c c el e r ato r s , s i m ul at o r s, b r a c h y t h e r a p y s o u r c es , e t c . ) , t h e s e ha v e t o b e i m pr o v i se d f o r ot he r e q ui pm e nt . T h e g u i d i ng p ri n c i pl e is t h a t a n y P.433 e q u i p me n t t o b e u s ed f o r p a ti e nt s m us t b e t e st e d to e ns ur e t ha t i t m e et s i t s p e r f o r m a n c e s pe c i fi c at io n s a n d s a f e t y s t a nd a r d s .

A. Linear Accelerator
A l i n e a r a c c el e r at o r is a s o p h i s ti c at e d p i ec e o f e q uip m e nt t ha t r e q ui r e s se v e r al months for i n s t al l ati o n , are th e a c c e pt a nc e r e s po n s i bi li t y t e st i ng , of t he a nd c o m mi s s io ni ng . phy s i c i s t . W he r e a s P a ti e nt i n s t a ll a ti o n i s c ar r i ed o u t b y t h e v e ndo r pe r s o nne l , t he a c c e pt anc e t e s ti ng a nd c o m m i s si o ni n g i ns t it ut io n' s t r e at m e n t s d o n o t be g i n u n t il t he uni t ha s b e e n c om m i s si o ne d , t ha t i s , t he m a c h i n e t e s te d to b e a c c e p t ab le a nd s uf f i c i e nt d a t a ha v e b ee n a c q ui r e d t o pe r m it t r e at m e n t pl a n n i n g a n d d o s e c al c ul a ti o ns f or p a t ie nt t r ea t me nt s .

A.1. Radiation Survey

A s s o o n a s t h e i n s t al la t io n h a s r e a c he d a st a g e a t w hi c h a r a di a ti o n be a m c a n be g e n e r a te d , t h e p h y s i ci s t i s c al le d o n to pe rf o r m a pr e li mi na r y r a d i a ti o n s ur v e y o f t h e t r e at me n t f a c i li t y ( C h a p t e r 1 6 ) . T he s urv e y i s e v a l ua t ed to e ns ur e t ha t d ur i ng t h e te s ti n g o f t h e m ac h i n e t h e e x p o s ure lev e l s o ut s id e t he ro om w i ll not e x ce e d p e r m i s si bl e factors, li m it s , co n s i d er i n g t he do s e t he rate o utp ut , m a c hine a re a s . on A ti m e , use and o c c u p an c y factors for s ur r o und i ng p r el i mi na r y

c a l i b ra ti o n o f t h e m a ch i n e o u t p u t ( c G y / M U ) i s ne e d ed to d et e r mine t he e x p e ct e d d o s e l e v el s a s a f u n c t i o n o f m a c h i ne o ut p ut ( M U / m i n) . After c o mp le ti o n of the i n s t al l at io n, a formal r ad i at io n p ro te c t io n s ur v e y is c a r r i e d o u t , i n c l u d i n g t h e m e a s u r em e nt o f he a d l e a k ag e ; a re a sur v e y , a nd t e s t s o f i n t e r lo c k s , w a r n i n g l i g h t s , a n d e m e r ge nc y s w i t c he s . T he s ur v e y i s e v a l ua t e d f o r c o n d it io n s t h a t a r e e x p e c te d t o e x i st i n t he cl i ni c al us e o f t he m a c hi ne , f or e x a m p le , w o r k l o ad , u s e f a c t o r s , a nd o c c up anc y f a c t o r s .

A.2. Jaw Symmetry

O n e o f t h e me t h od s of c h e c k i n g j a w s y m m et r y i s w i t h a m a c hi ni st ' s di a l i ndi c a to r ( F i g . 1 7 . 2 ) . W it h t h e g a n t r y p o i nti ng ho r iz o nt a l l y a nd t he j a w s o p e n t o a l a rg e f i e l d , t h e f ee le r o f t h e d i a l i n d i c at o r i s m ad e t o t o uc h t he f a c e o f o ne o f t he j a w s a n d t h e i n d i c ato r ' s r ea d i n g i s n ot ed . T he c o ll i m at o r i s t he n r ot at e d t hr o ug h 1 80 d e g re e s a n d t h e r e ad in g i s t a k e n w it h t he fe e le r no w r e st i ng o n the o p po s it e j a w . A l e v e li n g de v i c e i s u s e d to s et t he col lim a t o r a ngl e s fo r t hes e m e a s ur e me nt s . T h e s y m m e t r y e r r o r i s o n e - h a l f o f t he di f f e re nc e b et w e e n t he t w o r e a d i ng s o f t he dial i n di c a to r . The p r o c ed u r e is r e pe a ted for t he s e c o nd set of jaws. T he s y m m e t r y e r r or o f t h e c o l li m a to r j a w s i s t y pi c a ll y l e s s t ha n 1 m m .

A.3. Coincidence Collimator Axis, Light Beam Axis, and Cross-hairs

W i t h a g r ap h p a pe r ta p e d o n t h e t a bl e a nd t he g a nt r y v e r ti c a l , t ur n o n t he f ie ld l i g h t t o o b t ai n a r e c ta n g u l a r f i e l d . M a r k t he e d ge s o f t he li g ht f i e ld , i nt e r se c ti on

WWW.MEDRAD.IR

o f t h e d i ag o n a l s , a n d t h e p o si ti o n o f t he c r o s s - ha i r i m ag e s . R ot at e t he co ll i m ato r t h r o u g h 18 0 d e g re e s a n d c h e c k t he co i nci de nc e o f ( a) t he li g ht f i e l d ed g e s a nd (b) the i n te r s e ct io n of d i a go n a l s a nd the p o s it io n of c r o s s- ha i r i m a ge s . If s i g n i f i c a n t m i s al ig n m en t e x i st s , t he fi el d l ight a nd c r o s s - hai r s s ho ul d b e ad j us te d t o b ri n g a b o ut t h e d e si r e d co i n c id e nc e .

Light Beam with X-ray Beam

P l a c e a r e a d y p a c k f ilm o n t h e t a b le at t he s o ur c e -to - a x i s d i st anc e ( S A D ) . W it h t h e c ol li m a to r a n gl e s e t at 0 de g re e s , ob ta i n a r e c t a ng ul a r o r s q ua r e li g ht f ie ld a n d m a r k t h e e d g e s w i t h a r a d i o p aq ue o bje c t o r a b a ll po i nt pe n b y d r a w i ng l i ne s o n t h e f i l m j a c k e t wi t h s u f f i c i e nt p r e s s ure t o s c r a t c h t he e mul s i o n. T he f i l m o r ie n t a ti o n a n d t h e co ll i m at o r a ngl e a r e no t ed . A p l a s ti c s he et , t hi c k e no ug h t o p r o v id e m a x i m u m e l e ct r o n i c b u i ld up , i s pl a ce d o v e r t he f il m w it hout d i st ur b i ng i t s p o s it io n . T h i s i s d o n e t o el i mi n a t e t he p e rt ur b i ng i nf l ue nc e o f P.434 t h e i n c i d e nt e l e ct ro n c o n t a m i n a ti o n. T he f i l m i s e x p o se d to ob t a i n a n o p ti c a l d e n s i t y i n t h e li n e a r r a n g e o f i t s s e ns it o me tr i c c ur v e , us ua l l y a r o und 1 . T w o m o r e e x p o s u r e s at co ll i m ato r a n g le s o f 9 0 d e gre e s a re m a de us i ng f re s h a r e a s o f t he s a m e f i l m o r o n a se c o n d f il m . T he f i l m i s p r o ce s s e d i n a n a ut o m a ti c r a pi d p r o c e s so r .

F I G . 1 7 . 2 . D e t er m i na t io n o f j a w s y m m et ry w i t h t he m a c hi ni st 's d i a l i ndi c a to r . T h e f e e l e r o f t h e di a l in d i c a to r i s s ho w n t o re s t o n t he r ig ht j a w .

WWW.MEDRAD.IR

T h e a l ig n m e n t be t w een t h e x - r a y b e a m e dge s ( c o r re s po nd i ng t o a n o p ti c a l d e ns it y o f 5 0 % re l at i v e t o t h at o n c e n t r a l a xi s ) a nd t he l ig ht b e a m m a r k s c a n b e c he c k e d v i s u a l l y o r b y c ro s s -b e a m op ti c a l d e ns it y p r o f il e s . A t y pi c a l al i g nme nt f i l m i s s h o w n i n F i g . 1 7 . 3 . F o r a c c e pt a n c e te s ti ng , t he a b o v e pr o ce s s s ho ul d be r e pe a ted a t 0 d e gr e e s , 90 d eg re e s , 1 80 d e g re e s , a nd 2 7 0 d eg r ee s a ng ul a tio n o f t he g a nt r y . A c c o r d i n g t o t h e A A P M g u i d e li n e s , t he a li gnm e nt b e t w ee n t he l ig ht b e a m a nd t he x - r a y b e a m s h o u l d b e w i t h i n 3 m m ( 2 ) . H o w e v e r , a m o r e s t ri nge nt r e q ui re m e nt of 2 mm can be m a i n t a i n ed w it ho ut d i f f i c ult y with t he m o de r n l i ne ar a c c e l e r ato r s .

A.4. Mechanical Isocenter

M e c h a n i c a l i so c e n te r i s t h e i nt e r s e ct io n p o i nt o f t he a x i s o f r o t at io n o f t he c o ll i m at o r a n d t h e a x is o f ro t at io n o f t he g ant r y . D ue to he a v y w ei g ht , t he ga nt r y f r a m e m a y f l e x d u r i n g r o t a ti o n . T hi s m a y c a us e t he a x i s o f t he g a nt r y r o t a ti o n to m i s s t h e a x i s o f t h e c o ll i m at o r rot a ti o n, the r e b y c r e at i ng a n unc e r t a i nt y i n t he p o s it io n o f t h e i so c e n te r .

Collimator Rotation
A t t a c h a p i e c e o f g r ap h p a p e r o n a f l a t s u r f a c e o f a p l a s t i c s hee t a nd m a r k a n i n t e r se c ti o n p oi n t o f tw o g r a p h l i ne s ( ce nt er p o i nt ) . U si ng t he di st a nc e m e a s ur i ng r o d a tt a c h e d to t h e ac c e s s o r y m o unt , p l a ce t he c e nt e r po i nt o f t he g r a p h a t t he a s s u m e d i s o ce n t e r ( poi n t P ) . P.435 R e v e r s e t h e d i st a n c e r o d a n d at t a c h a n ad j us t a bl e p oi nt e r de v i c e w it h a s ha rp p o i nt , c a ll e d t h e ce n te r f i n d e r o r wi g gl e r , to it s di s t al e nd ( F ig . 1 7 . 4 A ) . 1 S t ar ti ng w i t h a 0 - de g re e a n gl e , r ot at e t he c ol li ma t o r t o + 9 0 de g re es a nd no t e t he m a x i m u m d i s pl a c e men t o f t h e w i g g le r t ip f r o m p oi nt P i n t he X a nd Y d i r e c ti o ns . T a p t h e w i g g le r p oi n t t o m o v e it i n t he X d i r e c ti o n t hr o ug h ha l f t he d i s t a nc e f r om p o i nt P a n d t h e n t a p t h e p l a st i c s he et t o b r i ng po i nt P und e r t he wi g gl e r ti p . R e p e at t h e p ro c e d u re f o r t h e Y a x i s . Ro t at e t he co ll i m at o r to 9 0 de g r ee s a nd r e p e at t h e w h ol e p ro ce d u r e . B y i t e r at i v e adj us t m e nt o f t he w i gg le r t ip a nd po i nt P , t h e d i sp l a ce m e n t o f t h e w ig g le r ti p f ro m po i nt P c a n be m i ni m i z ed a s t he c o ll i m at o r i s r o t at ed . F o r a n a c c e p t a bl e a l i g nme nt , t he i s o cent e r s ho ul d s t a y w i t h i n a 2 - m m - di a m et e r ci r c le w he n t he c o ll i m at o r i s r ot a te d t hr o ug h i t s f ull r a n g e o f r o t at io n .

WWW.MEDRAD.IR

F I G . 1 7 . 3 . F i l m s t o me a s u r e c oi nc i de nc e bet w e e n li g ht b e a m a nd r a d i at io n b e a m . L i g h t f i el d b o rd e r s a pp e a r a s s c r a t c h m a r ks a s t he c o r ne r e dg e s o f t he r a di a ti o n field.

Gantry Rotation
W i t h t h e w ig g le r po in t p o si ti o n e d a t t he i s o c e nt e r a s de te r mi ne d p re v i o usl y , a n o t h e r h o ri z o n t al r od w i t h a f i ne p oi nt i s he l d i n a ri ng s t a nd s o t ha t t he t wo p o i nt s co i n c id e as be st a s p o s si bl e ( F ig . 17. 4 B) . T he s t a nd f o r t he ho ri z o nt al ro d s h o u l d r e s t o n t h e c o u c h n e a r i t s e nd s o t ha t t he r e i s no po ss i b il it y o f g a nt r y c o ll i si o n w it h t h e cou c h o r t h e ap p a r at us . By m o v i ng t he g a nt r y t hr o ug h 3 60 d e g re e s , t h e d i s pl a c em e n t b et w e e n t he w i gg l e r p oi nt a nd t he hori z o nt a l ro d p oi nt i s v i s u a l l y n ot e d a n d m e a s u r e d . T he to l era nc e o f t he i so c e nte r m o ti o n w i t h f ul l g a n t r y r o t at io n i s 1 m m .

A.5. Radiation Isocenter Collimator

W i t h t h e g a n t r y v e r ti ca l , p l a c e a r e a d y p a c k f i l m f l a t o n t he t a bl et o p at t he S A D . O p e n t h e u p p e r j a w s o f t h e c o l li m at o r w id e o pe n a nd c l o s e t he l o w e r j a w s to o b t ai n a n a r r o w P.436

WWW.MEDRAD.IR

P.437 s l it o f m i n i m u m p o ss i b le w id t h . P l a ce bui l d - up s hee t o n to p o f t he f i lm . By r o t at i n g t h e c ol li m at or t h r o u g h a n um b e r o f d i f f e r e nt a ng l e s , t he f i l m i s e x p o s ed t o ob t ai n a n o p ti c a l d e n s i t y o f a bo ut 1 . The i nt e r v a l be t w ee n a ng l e s s ho ul d b e s u c h t h a t s i x to se v e n e x po s u r e s c a n b e m a d e to co v e r f ul l r ot a ti o n o f t he c o ll i m at o r wi t h o u t o ve r l a p s . U si n g a ne w f il m , r e pe a t t he a bo v e p r o c e s s wi t h t he l o w e r j a w s op e n a n d th e u p p e r j a w s c l o s ed t o a na r r o w s l it .

WWW.MEDRAD.IR

F I G . 1 7 . 4 . D et e r mi n a t io n o f me c ha ni c a l i s o c e nt e r . A : Co ll i m at o r r ot a ti o n. B: G a n t r y r o t a ti o n . S e e te x t f o r d et a il s . T h e p r o c e s se d f il m s w i l l s h o w st a r p at te rns , w i t h a d a r k c e ntr a l r e gio n ( F i g . 1 7 . 5 A ) . B y u s i n g a ba l l po i nt pe n o r a not he r f il m m a r k er w it h a f i ne po i nt , li ne s m a y b e d r a w n t h r o u g h t h e m i d d l e o f t he s l it i m a g e s t o d e fi ne m o r e c le a r l y t he i n t e r se c ti o n p oi n t ( s ) o f t h e s li t i m ag e s . Fo r a n a c ce pt a b le re sul t , a ll t he l i nes s h o u l d i n t e r se c t o r p as s w i t h i n a 2 - m m - d i am e t er c i r c le .

FIG.

17.5.

Star

p a tt e r n

to

de te r m i ne

ra d i a tio n

i s o c e nte r

of

(A)

c o l li m at o r

r o t at io n , ( B ) t a bl e r ota t io n , a n d ( C ) g a nt r y r o t at io n. P.438

Treatment Table
WWW.MEDRAD.IR

P l a c e a f il m o n t h e t ab l et op a t t h e S A D . Ope n t he up pe r co ll i m ato r j a w s w id e a nd c l o s e d o w n t h e l o we r j a w s t o a na r r o w s l it . P l a c e a b ui ld up s he e t o n t o p o f t he f i l m . M a k e s i x t o se v en e x p o s u r e s o n t he s am e f i l m w i t h t he t a bl e r o t at ed t hr o ug h a s e r ie s o f d i f f e re n t a n g l e s to c o v er t he f ul l r a ng e o f co uc h r o t ati o n. S o me e x p o s u r e s m a y h a v e t o b e s t ag g e re d to a v oid o v e r l ap o f i m a ge s . A s t a r p a tt e r n ( F i g . 17 . 5 B ) o n t he p ro c e s s ed f i l m s ho uld i de a ll y s ho w a l l t he sl it i m a g e s i n te r s e ct i n g a t o n e p oi n t , t he r a di a tio n i so c e nt er . A c c e pt ab l e s p e ci f i c at io n r e q u i r e s t h a t a ll t h e l in e s s h o u l d i nt er s e c t or p a s s w i t hi n a 2 - m m -d i a m et e r ci r c le . S t r i c te r s pe c i f i c at io n m a y b e r a d io s u r g e r y . r e q ui re d fo r a uni t d e si g na te d f o r s t e re ot a c ti c

Gantry
A r e a d y p a c k f i l m , s an d w i c h e d b et w e e n t wo p l a st i c s hee t s ( e .g . , a c r y l i c o r c le a r p o l y st y r e n e ) , i s pl a c ed o n t h e t a bl e so t ha t t he p l a ne o f t he f il m i s p e r pe nd i c ul ar t o t h e pl a n e o f c o u ch t o p a n d c o nt ai ns the b e a m ce nt r a l a x i s f o r a ll g a ntr y a n g l e s . C r e a te a s l it o f b e a m p a r a ll el to t he g a nt r y a x i s o f r o t at io n. M a k e 1 2 e x p o s u r e s o n t h e s a me f il m w it h t he g a nt r y r ot a te d b et w e e n e x po s ur e s . T o a v oi d o v e r l ap s , t h e f i r st si x e x p o s u re s m a y b e ma d e at 3 0 - de g re e i nte r v a l s , t he ne xt o n e a t 4 5 de g re e s be y o n d , a n d t he s ub s e q ue nt e x p o s ur e s s uc c e s si v e l y 3 0 de g re es apart. T h e g a n t r y s t a r p a t te rn ( F i g . 1 7 . 5 C ) s ho ul d s ho w t he l i ne s i nte r s ec t i ng o r p a s si ng w i t h i n a 2 - m m - d ia m ete r c i r c le c e nt e re d a round t he p r e s um e d r a di a ti o n i so c e nt er .

A.6. Multiple Beam Alignment Check

W h e n a p a t ie n t i s t r eat e d wi t h mo r e t ha n o ne b e a m , mi s a li g nm e nt b e t w ee n b e am s c a n o c c u r d u e t o a n y o f t h e c a us e s d i s c us s e d p r e vi o us l y . L ut z e t a l . ( 17 ) ha v e r e c o m me n d e d a te s t p r o c e d u r e t ha t c a n d e t e ct s i m ult a ne o usl y t hr e e g e ne r al c a u s e s o f b e a m m i s al i g n me n t : ( a ) f o c a l sp o t di s pl a c e me nt ; ( b) a s y m m e t r y o f c o ll i m at o r j a w s , a n d ( c ) d i s p l a ce m e nt i n t he c o l li m a to r r ot at io n a x i s o r t he g a nt r y r o t at io n a x i s . T h i s m e t h o d i s c al l ed t he s pl it- f i e l d t e st . The s p l it - f i el d t e st consists of do ub l e -ex p o s i ng a f il m ( s a nd w i c he d be t w ee n b u i l d u p s h ee t s ) to t wo f i e ld s , 1 80 d e gr e e s a p a r t . A s s ho w n s c h e m a ti c a ll y i n F i g . 1 7 . 6 , a s q u a r e f i el d i s f i r st e x p o se d f ro m a b o v e w it h ha l f t he f i el d ( re gi o n 2 ) b l o c ke d a n d t h e n e x po s e d f r o m b el o w t o ex p o s e re gi o n 2 w it h re g io n 1 b lo c k e d . R e l a ti v e s h i f t o f t h e tw o i m a g e s i s i nd i c at i ve o f P.439 t h e m i s al ig n m e n t o f th e p a r a ll e l -o pp o se d be a m s . A s i m il a r te s t ca n b e p e r fo r m ed b e t w ee n a n y t w o b e a m s r o t at e d t hr o ug h 1 80 d e g re e s .

WWW.MEDRAD.IR

F I G . 1 7 . 6 . S c h e m a t ic i ll u s t r a ti o n o f L ut z e t al . ( 1 7 ) m et ho d o f d et e r mi ni ng a l i g n me n t b et w e e n o pp o s i n g f ie ld s . A : P e r f e c t a l ig nm e nt . B : M i s a li g nm e nt . If b e a m m i s a l ig n m e n t i s s h o w n b y t he a b o v e te s t , o ne c a n the n p r o c e ed to i n v e s t ig a te t h e c a u s e o f m i s a li g nm e nt b y c he c k i ng i nd i v id ua l l y t he a l ig nm e nt o f t h e r a di a ti o n i s o ce n te r w i t h t h e a x i s o f t he c ol li m at o r o r g ant r y r o t at io n a s d e s c r ib e d p r e v io u s l y .

A.7. X-ray Beam Performance Energy

M e a s u r e m e n t a n d s pec i f i c a ti o n o f p ho to n b e a m e ne rg y ha v e b e e n d i s c us s ed i n C h a p t e r 7 . T h e m o st p r a c t i ca l me t ho d o f s pe c i f y i ng cl i ni c al be a m e ne r g y i s b y t he d e pt h - d o se di s t ri b u ti on . A c e n t r a l a x i s d e pth- d o s e c ur v e me a s ur ed w i t h a s uit a bl e i o n c h a m b e r i n a w a te r p h a n t o m c a n b e com p a r e d w it h p ub li s hed d a t a to s pe c i f y the energy. The f ol lo w i n g c o ns id e r at io ns are r e le v a nt to m a k i ng s uc h a d e te r m i n at io n .

T h e i o n c h a m be r i n t er n a l d i am et e r s ho ul d b e sm a ll ( le s s t ha n 3 m m ) to minimize d i s pl a c e men t c o r r e ct io n ( C ha p t e r 8). For a l a r ge r d i a m et e r c h a m b e r , t h e de pt h - do s e c ur v e s ho ul d b e s hi f t e d t o t he le f t (to w a r d t he s o u r c e ) b y 0 . 6 r , w h e r e r i s t he r a d i us o f t he c ha m b e r .

In c o m p a r i n g d e pt h - d o s e di s t ri b utio n w i th p ub l i s he d d at a , c a r e m us t b e e x e r c i s ed i n re g a rd to t h e r e f e re nc e de pt h us e d i n t he d e f i ni ti o n o f p e r ce nt d e pt h d o se . T o a v o id a m b i g uit y , i t i s p re f e r a b le to c o mp a r e d ep t h d o se r a t io s f o r d ep t h s be y on d t he de pt h o f do s e m a x i m um ( d m a x ) r at her t ha n t he a b s o l ut e v a l u e s o f t he p e r c e nt de pt h d o s e. S ui t a b l e de p t hs f o r c o m p a ri ng d e pt h d o s e r at io s a r e 1 0 a nd 2 0 c m .

WWW.MEDRAD.IR

The The

reference

d e pt h - d o s e data fo r

data

us e d in

for

c o m p a ri s o n

m us t of

be

r el i a bl e .

D a ta is of

p u b l i s h ed b y n a ti o n a l o r i n te r n a ti o na l o r g a ni z a t io ns a r e pr e f e r ab le i n t hi s r e g a rd . d e p t h - do s e used p u b l i s h ed t he Br i ti s h alt ho ug h J o ur na l s o me R a d i ol og y t he (18) commonly specifying e ne r g y , prefer m e t ho d

i o n i z a ti o n r at io a s a m e a s u r e o f e ne r g y and us i ng t he d at a giv e n i n t he T G - 2 1 p r ot o co l ( 19 ) . E i t h e r m e t h od i s a c c e pt a bl e . T h e a c c e p t a n c e c ri te r ia i s u s u a l l y s p e ci f i e d i n t e r m s o f d e pt h- d o se v a r i a nc e f o r a 1 0 1 0 - c m f i el d s i z e , 1 0 0 - c m S S D , a nd 1 0 -c m d e pt h. A d i f f e r e nc e o f 2 % i n t he d e pt h - d o se r a t io o r i o n i z a ti o n r a tio f r o m t he p ub l i s hed v a l ues i s a c c e p t ab le , c o n s i d er i n g t h e f a c t th a t t h i s co mp a r i so n is j us t f o r no mi na l e ne r g y de s i g nat io n o n l y . T h e d e p t h - d o se d a t a f o r c l i ni c al us e i s no t t he p ub li s he d d a t a b ut t he o ne t h a t i s a c t u al l y m e a su r e d f o r t h e gi v e n a c c e l e r ato r . A s m a l l unc e r t a i nt y i n t he n o m i n a l b ea m e n e r g y d e s i g n at io n i s no t i mp o rt a nt a s l o ng a s c a li b r a tio n a nd t he c l i n i c al l y u s ed de p t h- d o s e d at a are b a se d on a c c ur a t el y me a s ur e d e ne r g y p a r a m et e r s ( e . g . , T G - 5 1 d a t a ) .

Field Flatness
F i e ld f l at n e s s f o r p h oto n b e a m s ha s b ee n t ra d i ti o nal l y de f i ne d a s t he v a r i at io n o f d o s e r e l at i ve to t h e ce n t r a l a xi s o v e r t he ce nt r a l 8 0 % o f t he f i eld s i z e ( re f e r e nc e r e g io n ) a t a 10 - c m d e pt h i n a p l a ne p er p e nd i c ul ar to t he ce nt r a l a xi s ( F ig . 1 7 . 7 A ) . A d o s e v a r i at io n o f 3 % i s c o ns i de re d a c c e pt a bl e ( 20 ) . T h e A A P M T a s k G r o u p 4 5 (1 4 ) sp e c i fi e s f la tne s s i n t er m s o f m a xim um p e r c e nt ag e v a r i a t io n f r o m a v e rag e do s e a c ro s s t he c e nt r a l 8 0 % o f t he f ul l w i dt h a t ha l f m a x i m u m ( F W H M ) o f t h e p r o fi le i n a pl ane t r a ns v e r s e to t he b e a m a x i s . T hi s v a r i a t io n o r f l a t n e s s F i s m a t h e m a ti c a ll y g i ve n b y :

w h e r e M a n d m a r e t h e m a x i m u m a nd mi nim um d o s e v al ue s i n the c e nt r a l 8 0% o f t h e p r o f il e . The above d e f i n it io n s o f f i e l d f l a t ne s s do no t d i st i ng ui s h b et w e e n t he d ose v a r i a t io n p ro d u c ed b y t h e fl a tt e n i ng f i lt e r and t ha t d ue t o t he penum b r a . W he r e a s f l a t n e s s c a n b e a l t e red b y t h e f l a t t e ni ng f il te r , t he d o s e v a r i at io n i n t he p e num b r a r e g io n i s g o v er n e d P.440 p r i m a ri l y by the g eo m et r i c and t r a ns m is s i o n p e num b r a , p hot o n s c a t te r , a nd

e l e ct r o n s c a tt e r . T h e f l a t n e s s c r it e ri a s ho ul d , t he r e f o re , r e f l e ct the e f f e c t o f t he f l a t te n i n g f i lt e r a n d n o t t h e pe n u m b r a , w hi c h i s b a s i c a l l y una l te r ab l e .

WWW.MEDRAD.IR

F I G . 1 7 . 7 . A l t e r n a te d e f i n it io n s o f p ho t o n f i e l d f l at ne s s . A : F l a tne s s i s m e a s ur e d w i t h i n a re gi o n bo u n de d b y 8 0% o f t he f i eld w i dt h ( W ) . B : Fl a t ne s s i s m e a s ur ed w i t h i n a r e gio n b o u n d e d b y l i n e s d r a w n a c e r t ai n d i st a nc e ( e .g . , 2 c m ) i ns ide f r o m t h e f i el d e dg e s . D e pt h o f m e a s ur e m e nt i s s p e ci f i ed a t 1 0 c m. B o y e r ( 2 1 ) h a s s u g g e s t e d t h at t he x - r a y b e a m f i e ld f l a t ne s s s ho ul d b e s pe c i f ied t o e x c l u d e t h e pe n u m b r a l e f f e c t s . T he re f e r e nc e re g io n o f f la t ne s s s ho ul d b e d e f i n e d w it h l i n e s a t a s p e c i f i ed d i st a nc e f r o m t he f i e ld e dg e s i nst e a d o f a c e r t ai n

WWW.MEDRAD.IR

p e r c e n t ag e o f t h e f i eld s i z e ( F i g . 1 7 . 7 B) . Ty p i c a l fl a t ne s s at a 1 0- c m d ep t h w it hi n t h e r e gi o n e x te n d i n g u p t o 2 c m f r o m t he f ie l d ed g e i s + 3 % to - 5% ( 2 1 ) . D e f i n it io n s t h a t s p e ci f y f i e l d f l a t ne s s a nd s y m m e t r y w i t h r e sp e c t to a v e r a ge p r o f il e v a l u e s c re a te a m b i g ui t y a nd c li ni ca l i nc o ns i st e nc y . Be ca us e b e a m s a re c a l i b ra t ed at t h e ce n t r a l a x i s , i t i s m o re l o gi c a l to c ha r a ct e ri z e do s e v a r i a tio n r e l at i v e to t h e c e n tr a l a x i s . In t h e l ig h t o f t h e a bov e d i s c u s s io n, t he re i s a ne ed f o r a na ti o na l o r i nt e r na ti o nal g r o u p t o e x a m i n e t h e p r e v ai li n g d e fi ni ti ons o f f i e ld f l a t ne s s and r e c o m me nd a c r i te r io n t h a t c h e c k s t h e e f f e c t i v e ne s s o f t he f l a t te ni ng f i lt e r, e x c l ud i ng t he p e n u m b r a . In t h e m e an t i m e , t h e f l a t ne s s d ef i ni t io n g i ve n b y E q ua t io n ( 1 7 . 1 ) m a y b e u s e d w i t h t h e a c c ep t a bl e li mi t be i ng w i thi n 3 % . F o r a c c e pt a n c e te s ti n g , f l a t n e s s s ho ul d b e c he c k e d f o r t he m a x im um f i e l d si z e at l e a s t at t w o de pt h s : 1 0 c m a n d d m a x . W he r e a s t he f l a t ne s s c r it er i a i s a p pl ie d to t h e p r o f il e at a P.441 1 0 - c m d ep t h , t h e p rof i l e a t d m a x s ho ul d b e e x a m i ne d f o r t he e x te nt o f p e ri p he r al h o t s p ot s , o r h o r n s . T h e s e h o r n s s ho ul d no t e x c ee d 10 5% . F o r b i gg e r ho r ns , a n a c c e s s o r y f i lt e r m a y h a v e t o b e de s ig ne d to r e d uc e t he m w he n us i ng l a r g e f ie l d s (22). In a d d i t io n t o t h e p ro f i le s a l o n g t he p ri nc i p a l a x e s o f t he f i el d, d i a g o na l s c a ns s h o u l d b e o bt ai n e d t o c h e c k f i e l d fl a t ne s s . T y p i c a l l y , t he di a g o nal f l a t ne s s i s + 4% t o -6 % i n t h e r e f er en c e r e g io n , e x te nd i ng up t o 2 . 8 c m f ro m the 5 0 % i s od o se c u r v e i n a p l a n e p e r p en d i c u l a r to t he c e nt r al a x i s a nd a t a 1 0 - c m d e pt h ( 2 1 ) .

Field Symmetry
T h e c r o s s - b e a m p ro f ile s o bt a i n e d f o r f l at nes s a l s o c a n b e us e d f or s y m m e t r y . T he p r o f il e plo t m a y be f o l de d at t h e fi e ld c e nt e r a nd t he t w o hal v es o f t he p ro f il e s c o m p a re d . In t h e r e f e r e n c e r e gi o n, t he dos e s ho ul d no t di f f e r m o r e t ha n 2 % a t a n y p a i r o f p o i n t s si t ua t e d s y m m et r i ca ll y w i t h r e s p e ct t o t he c e ntr a l r a y .

A.8. Electron Beam Performance Energy

S p e c i f i c at io n a n d m e as u r e m e n t o f el e ct r o n b e a m e ne rg y a r e d i s cus s e d i n C ha p t e r 14 as w e ll as in the AAPM TG-25 p r o toc o l ( 23 ) . T he d e pt h- d o s e or d ep t h i o n i z a ti o n c u r v e f o r a b r o a d b e a m m e a s ur e d w it h a s ui t a bl e io n c ha m b e r i n a w a t e r p h a n t om g i v e s t h e p r a ct i c al o r e x t r ap o l at ed r a ng e , R p . T he m o st p ro b a ble e n e r g y ( E p ) o i s gi v e n b y E q u a t i o n 1 4 . 4 . ( E p ) o s ho ul d b e w it hi n a b o ut 0 . 5 M e V o f t h e n o m i n a l e n e rg y s h o w n o n t h e a c c e l e r at or c o nt r ol p a ne l . F o r a r o u ti n e c h e c k of e l e ct ro n b e am e ne rgi e s , f il m c a n b e us e d t o d et e r mi ne Rp a s w e l l a s o t h e r p a ra m e t er s s u c h a s R 1 0 0 , R 9 0 , R 8 0 , a nd R 5 0 . C o m p ut e r -d r i v e n d e n s i to m et e rs a r e c om m e r c i al l y a v a i l ab le t ha t c a n a na l y z e t he s e p a r a m e te r s , i n c l u d i n g t h e mo s t p rob a b le a n d m e a n e ne r gi e s .

Flatness and Symmetry

T h e f l a t n e s s a n d s y mm e t r y s pe c i f i c at io ns of e l e ct r o n be a m s a r e g i v e n i n t he A A P M T G - 2 5 re p or t ( 2 3 ) a nd a l so ar e d i s c us s ed in C ha p t e r 1 4 . Ag a i n, f i l m d o si m et r y i s q u i t e u s e f u l i n a n a l y z in g f l a t n e s s a nd s y m m e t r y o n a r o ut i ne b a sis .

WWW.MEDRAD.IR

A.9. Monitor Chambers

L i n e a r it y o f mo n i to r ch a m b e r s i s a n i mp o rt ant r e q ui re m e nt a nd s ho ul d be c he c k e d a s a f u n c t i o n o f do s e r a t e a n d f o r sp e ci a l op e r a ti ng co nd it io ns s uc h a s t ot al bo d y i r r a di a ti o n , to t al s k i n i r r a d i at io n , a nd a r c r o t at io n. L o ng - te r m st a b il it y c he c k o f m o n i to r c h a m b e r s f o rm s a m a j o r p a r t o f t he q ua l it y a s s ur a nc e p r o g r a m .

A.10. Wedges
W e d g e i s od o s e d i st r i bu t i o n f o r a 1 0 1 0 - cm f i e l d m a y b e us e d t o c he c k w e d ge a n g l e ( C h a p t er 1 1 ) . Th e m e a s u r e d w e dg e ang l e s s ho ul d b e w it hin 2 d e g r e e s o f t h e v a l u e s s p e c i fi e d . T h i s u n c e r t a i nt y i n no m i na l w e d ge a ng le s i s a c c e pt a bl e b e c a u s e w ed ge f il te r s a r e a l w a y s pl a nne d us i ng i so do s e d i st r ib ut io n d et e rm i ned f o r t h e g i v e n w e d ge .

A.11. Miscellaneous Checks

Is o c e n t e r s h i f t w it h c ou c h m o t i o n up a nd d ow n s ho ul d no t e x c e e d 2 m m . O p t i c al di s t a n c e i n di ca t o r s s ho uld b e a c c ur a t e w i t hi n 2 m m . F i e ld s i z e i n di c a to r s sh o u l d b e a c c ur a te w i thi n 2 m m . G a nt r y a n g l e a n d c o l lim a t o r a ngl e s s ho ul d be a c c ur a t e w i t hi n 1 deg r e e . L a s e r li g h t s s h o u l d be a l i g ne d w it h t he i so ce nt e r w i t hi n 2 m m . T a b l et op s a g w i t h l a te r a l o r lo ng it ud i na l t ra v e l und e r a d i s t r ib ute d w e i g ht ( s i m il a r to p a ti e n t ) o f 1 8 0 l b s . s ho uld no t ex c e e d 2 m m . P.442

T h e t e n n i s r a c k e t i n s e r t f o r t he c o uc h s houl d no t s a g m o re t han 0 . 5 c m u n d e r t h e a b o v e s t at ed c o nd it io ns . O t h e r a n c i ll a r y d e vi c es p r o v id e d wi t h t he ac c e l e r ato r s ho ul d b e che c k e d i n a c c o r d a n c e wi t h t h e ve n d o r ' s sp e c i fi c a ti o ns o r a s s p e ci f i ed i n t he p ur c ha s e contract.

B. Simulator
A c c e p t a n c e t e st i n g o f a s i m u l at o r m a y b e d i v i de d i nt o t w o p a r t s: ( a ) c he c k i ng o f t h e ge o me t ri c a n d spa t i al a c c u r a c ie s a nd (b ) p e r fo r m a nc e e v a l ua t io n o f t he x - r a y g e n e r a to r a n d t h e a ss o c i at e d i m ag i ng s y s t e m . T he fi r s t p a rt is s i m il a r to t he acceptance t e st i n g of a linear a c c el e r at or . T he s e c o nd p a rt deals w it h t he s i m u l a to r p e r fo r m a n c e l i k e a d i ag no s ti c x - r a y a nd f l uo r o s c o pi c uni t . S e v e r a l p u b li c a ti o n s h a v e d i s c u s s e d t he s p e c i f i ca ti o ns o f t r e atm e nt s i m ul at o r s a n d t h e r e q u i r ed t e sti n g p r o c ed ur e s ( 2 4 ,25 , 2 6 , 27 ) . A c o m p r e he ns i v e r e v i e w o f t h e s u b j e ct h a s b e e n p r o v id e d ( 28 ) . T he q ua l it y a s s ur a nc e f o r t he x - r a y g e ne r a t or a n d t h e im a g i n g s y s t em h a s b e e n di s c us s e d b y t he N C R P ( 29 ) . S p e c i f i ca ti o ns a nd a c c e p t a n c e t e st p r o ced u r e s m a y a l s o b e a v ai l a bl e f r o m v e ndo r s ( 30 ) . Because the s i m u l ato r s are de s ig ne d to mimic t he t re a t ment m a c hi ne s , for e x a m p le , l i n e a r a c c e le r a to r s , t h ei r g eo m et ri c a c c ur a c y s ho ul d b e c o m p a r ab l e wi t h

WWW.MEDRAD.IR

t h e s e m a c h i n e s . Ide al l y , t h e si m ul at o r s ho ul d b e at le a s t a s a c c ur a t e a s t he t r e at m e n t m a c h i n e i n l oc a li z i n g t r e at m e nt f i el d s . H o we v e r , di f f e r e nc e s b et w e e n t h e s i m u l at or po r t a nd t h e t r e at m e nt p o rt m a y a r i s e be c a us e o f t he d i f f e re nc e s i n the t r e at m e nt t a bl es or a c c e s s o ri e s . To m i ni mi z e t he se di f f e r e nc e s , it is p r e f e r a bl e to h a v e a s i m u l at o r wi t h t he s a m e t ab le de s i g n and t he a c c e s so r y h o l d er s a s t h e t r e at me n t m a c h i n e s . T a b l e 1 7 . 5 i s t h e l i st o f a c c e pt a n c e te s t s rec o m m e nde d b y t he Br i ti s h Ins t i t ut e o f R a d i ol og y . T h e s u g g es t e d t ol e r a nc e s fo r va r i o us p a r a me te r s a re t he s a me a s o r b e tt e r t h a n t h e i r e q u i v a l e n t f o r li ne a r a c ce l e r ato r s a s r e c o m mend e d b y t he IE C (31).

TABLE 17.5. TREATMENT SIMULATOR TOLERANCES

IEC f or Parameter

T ol e r a n c e E l e c t r on

BIR

P r opo se d f or

T ol e r a n c e S i m u l a t or s

A c c e l e r a t or s

I ll u m i n a t io n o f l ig h t f ie l d i n di c at io n

1 . A v e r a g e i ll u m i n a n c e a t t h e no r m al t r e at m e n t di s t a n c e

4 0 l ux

4 0 l ux

R e p r od u c i bi li t y

2.

The

difference and

between x-ray

t he field

2 mm

1 mm

maximum

m i n im u m

s i z e f o r r e pe a te d s et ti n g s o f t he s a m e n u m e r i c a l f i el d i n di c a ti o n

3 . T h e m a x i m u m di s t an c e b e t we e n a ny l i g h t f i el d ed ge a n d x - r a y f i e l d ed ge for r ep e at e d s et ti n gs of the s a me n u m e r i c a l f i el d i n di c a ti o n

2 mm

1 mm

N u m e r i c a l i n di c a tio n o f f i e l d s i z e

4 . T h e m a x i m u m d i f f er e n c e i n m m o r p e r cent a g e o f f ie ld d im e ns io n b e t we e n t h e n u m e r i c a l fi el d i nd i c a ti o n a nd t he d ime ns i o ns o f t he x - r a y f i e l d at t he n o r m a l t re a t me n t d i sta n c e

WWW.MEDRAD.IR

5 cm 5 cm to 20 cm 20 cm

3 mm

2 mm

Greater than 20 cm 20 cm

1.5%

1%

L i g h t f ie ld i n d i c at io n

5 . T h e m a x i m u m d i st an c e a l o n g t he m a jo r ax e s i n m m o r p e r ce nta g e o f f ie ld d i m e n si o n b et w e e n th e l i g h t b ea m e d ge a nd t he x - r a y f i e l d e d ge a t t he n o r m a l t re a t me n t d i sta n c e

5 cm 5 cm to 20 cm 20 cm

2 mm

1 mm

Greater than 20 cm 20 cm

1%

0.5%

6 . T h e m a x i m u m d i s t a n c e a l o n g t he m a j o r ax e s b e t w e e n t he li g ht b e a m e dg e a n d t h e x - r a y f i e l d e dg e a t 1 . 5 no r m al t re a tm e nt d i st a nc e

5 cm 5 cm to 20 cm 20 cm

4 mm

2 mm

Greater than 20 cm 20 cm

2%

1%

7 . T h e m a x i m u m di s t an c e b e t we e n t h e c e n t e r s o f t h e x - r a y f ie l d a n d t he li g ht f i e l d at t h e n o r m al t r ea t m e n t di s t a nc e

2 mm

1 mm

8 . T h e m a x i m u m di s t an c e b e t we e n t he c e n t e r s o f t h e x - r a y f ie l d a n d t he li g ht field at 1.5 ti m es the no r m a l t r e at m e n t di s t a n c e

4 mm

2 mm

G e o m et r y o f f i el d d el in e a t o r s

9.

The

maximum

d e v i a ti o n

from

0.5

0.5

p a r a l le li t y o f op po s i n g e d g e s

10.

The

maximum

d e v i at io n

f r om

0.5

0.5

o r t h og o n a li t y o f a d ja ce n t e d ge s

WWW.MEDRAD.IR

I n d i c at io n o f x - r a y b e a m a x i s

1 1 . M a x i m u m d e v i a ti on o f t h e i nd i c a t io n o f t he r a d i at io n b e a m a x i s f r o m t he r a d i at io n b e a m a x i s

Over

-25

cm

from

the

no r m a l or t he

2 mm

1 mm

t r e at m e n t entry

di s t a n c e

(NTD)

w o r k i n g r a n g e o f t h e i n d i c at o r , b e am

12.

Over

NTD

to

NTD

+50

cm

or

3 mm

2 mm

working range, beam exit

D i s p l a c em e n t o f t h e x- r a y b e a m a x i s f r o m the i s o c e nte r

1 3 . M a x i m u m d i s pl a ce m e n t o f t he x ray beam axis f r om the r a di a ti o n i s o c e nt e r

2 mm

1 mm

I n d i c at io n o f t h e i s o cen t e r

1 4 . M a x i m u m d i sp l a ce m e n t f r om t he r a d i at io n i s o c e nt e r of any device m o u n t e d o n t h e m a c h in e f o r i n d i c a t i ng t h e p o si ti o n o f t h e i soc e n t e r

2 mm

1 mm

I n d i c at io n o f d i s t a n c e a l o n g t h e x - r a y b e a m a x i s

1 5 . M a x i m u m d i f f e ren c e b et w e e n t he i n d i c at e d di s ta n c e and the a c t ua l d i s t a n c e f ro m i s o ce n te r

2 mm

1 mm

1 6 . M a x i m u m d i f f e ren c e b et w e e n t he i n d i c at e d di s ta n c e and the a c t ua l d i s t a n c e f ro m t h e x - r a y t a r g e t

5 mm

2 mm

1 7 . M a x i m u m d i f f e ren c e b et w e e n t he i n d i c at e d di s ta n c e and the a c t ua l

N/A

2 mm

WWW.MEDRAD.IR

distance

be t w ee n

t he

i so c e n te r

a nd

t h e i m a ge p l a n e

Z e r o p o si ti o n o f r ot a tio n a l s c a l e s

M a x i m u m d i f f e r e n c e b e t w ee n t he z e ro p os i ti o n i ndi c a te d b y t he r ot a ti o nal s c a l e a n d t h e i n te n d ed z e r o p o si ti o n

1 8 . R o t at io n o f g a n t r y

0.5

0.5

1 9 . R o t at io n o f d i ap h r a g m h o u s i ng

0.5

0.5

2 0 . Is o c e n t e r ro t at io n o f t h e t a b le

0.5

0.5

2 1 . R o t at io n o f t h e t ab l et op

0.5

0.5

2 2 . P i t c h o f t h e t ab le

0.5

0.5

2 3 . R o ll o f t h e t ab le

0.5

0.5

O p p o si n g f i el d s

24.

Maximum

angular

d e v i at io n

b e t w ee n a x e s o f o p pos e d x - r a y f i e l d s

M o v e m e n t s o f t h e p a tie n t t a bl e

2 5 . M a x i m u m h o r i zo n t a l di s pl a c e me nt o f t h e t a bl e f or a c h a n g e i n h e i g ht o f 20 cm when lo a d ed w it h 30 kg d i s t ri b u te d o v e r 1 m a n d w h e n l o a de d w i t h 13 5 k g di s t ri b u ted o v er 2 m , b ot h w e i g h t s a c ti n g t h r o u gh t h e i s o c e nte r

2 mm

2 mm

2 6 . M a x i m u m d i sp l a cem e n t o f t he a xi s o f i s o ce n t e r ro t at io n o f t h e t ab l e f ro m t h e r a d i at io n i s o ce n t er

2 mm

1 mm

WWW.MEDRAD.IR

P a r a l l el i s m o f t a bl e r ot a ti o n a x e s

27.

Maximum

a n g le

be t w ee n

t he

0.5

0.5

i s o c e nt e r ro t at io n o f th e t a b le a nd t he a x i s o f r o t at io n o f t h e t a b le to p

L o n g it u d i n al r i gi di t y of t h e t a b le

28. load

Maximum re t r a ct ed

d i f f er e n c e po s it io n and

in

t a bl e kg

5 mm

5 mm

h e i g h t n e ar i so c e n te r b et w e e n 3 0 k g 135 l o a d e x t e n de d po s it ion

L a t e r al r ig id it y o f t h e t a b le ( a )

2 9 . M a x i m u m a n g l e o f l a t e r al ti lt f r o m h o r i z o n t al o f t h e p la n e o f t h e t a bl et op

0.5

0.5

L a t e r al r ig id it y o f t h e t a b le ( b )

3 0 . M a x i m u m d e v i at io n o f t h e hei g ht o f t h e t a bl e a s t h e t a b le i s l at e r al l y d i s pl a c ed

5 mm

5 mm

X-ray tube

31. Maximum

focal

spot

si z e

for at

N/A

0.3 mm 0.3 mm

l e a s t o n e f o c a l s po t

32.

Maximum

shift

of

image

at

t he

N/A

0.5 mm

i s o c e nt e r f o r c h a n g e of f o c a l s p o t

F r o m T r e a t me n t S i m u la t o r s . B r J R a d i ol 1 989 ; [ S up p l . 2 3 ] , w it h p er m i s s io n .

P.443

P.444

WWW.MEDRAD.IR

C. Brachytherapy
T h e p u r p o se o f a c ce pt a n c e te s ti ng o f b r a chy t he r a p y e q uip m e nt i s to e ns ur e t h at t h e s o u r c e s a n d t h e a s s o c i at ed e q ui p m e nt m ee t t he us e r ' s s pe c i f i c at io ns . T he r e s u l t s o f t h e s e t e st s s h o u l d b e c a r e f ul l y e v a l ua t ed a nd d o c ume nt e d f o r f ut u re reference.

C.1. Intracavitary Sources and Applicators

T h e f o l lo w i n g p r o ce d ur e s a r e re c om m e nd ed t o e v a l ua te i nt r a c a v it a r y s o ur c e s a nd m a n u a l a f t e r l o ad i n g ap p li c a to r s .

Source Identity
P h y s i c a l l e n g t h , d i a me t e r , s e ri a l num b e r , a nd c o l o r - co di ng o f a l l s o ur c e s s ho uld be checked. W h e r ea s source d i m e nsi ons may be c he c k e d by p hy s i c a l m e a s u r e m e n t o r b y r a d io g r a p h y , t he s e ria l num b e r a nd c o lo r- c o d i ng c a n be c h e c k e d b y v i s u a l i n s p e c t io n .

Source Uniformity and Symmetry

A n a u t o r a di o gr a p h o f a b r a c h y t h e r ap y s o ur c e r e v ea l s d i st r ib ut io n o f a ct i vi t y as w e l l a s a c ti v e l e n gt h ( F i g . 15 . 2 ) . T he s y mm e t r y o f t he s o ur c e lo a d i ng w i t hi n t he c a p s u l e m a y b e a s c e rt a i n e d b y t a ki ng a s i m ul a t o r r ad io g r a p h o f t he s o ur c e b ut leaving it on the The film for an a p p ro p ri a t e of the l e ngt h of t i me and to ob t ai n an a u t o r a di og r a p h . s u p e r po s it io n a ut o r ad io g r a p h t r a ns m i s si o n

r a d io g r a p h pr o v id e s th e r e q u i re d i nf o r m a tio n o n s o ur c e s y m me tr y r e l a ti v e t o t he p h y s i c a l e n d s o f t h e so u r c e s . A l l so u r c e s s h o u ld be c h e c k e d f or s o ur ce uni f o r m i t y a nd s y m me t r y . In a d di ti o n, o n e r a n d o ml y c h o s e n s o u r c e f r o m e a c h gr o up o f de s i g nat e d st r e ngt h m a y b e a u t o r a di og r a p h e d to o b t ai n i s oo pt i c al d e ns i t y c ur v e s . T hi s will do c um e nt s y m m e t r y o f d o se d i str i b u ti o n a r o und t he s e s o ur c e s .

Source Calibration
A l l so u r c e s s h o u ld be i n d i v id u a l l y c al i br a te d t o c he c k s o ur c e st r e ng t h s p e ci f ie d b y t h e v e n d o r . M e t h o d s o f s o u r c e c a l i br a ti o n w e r e d i s c us s e d i n s e ct io n 1 5 . 2 . A w e l l i o n i z a ti o n c h a mb e r (e . g . , a do s e c a li b r ato r ) i s c o nv e nie nt f or t he s e c a li b r at io n c h e c k s . A s t a n d a r d s o u r c e o f t h e s a me r ad i o nuc li d e a nd co ns t ruc t i o n ha v i ng a c a l i b ra ti o n t r a ce a bl e to N IS T is r eq ui re d for t he s e me a s ur e m e nt s . If t he d i s a g re e me n t b et w e en t h e v e n d o r a nd t he us e r c a l i b ra ti o n i s w i t hi n 5 % , t he v e n d o r c a l ib r a ti o n s h o u l d b e u s ed unl e s s t he us e r ' s c a l i b r at io n i s d e e me d m o re a c c u r a t e t h a n t h e v e n d o r ' s . In t h e l a t te r c a s e , t he us e r ' s m e t ho do lo g y a nd r e s ul ts o f c a li b r a tio n m u s t be f u l l y do c um e nt ed and j us t i f i c at io n p ro v id e d fo r not us i ng t h e v e n d o r ' s c al ib r a tio n . D i f f e r e nc e s l a r ger t ha n 5 % a r e not a c c e p t ab le a nd w o u l d r e q u i re r e c a li br a t io n b y t he v e nd o r a nd i s s ua nc e o f a ne w c a l i b r a ti on c e r ti f i c a te .

Applicator Evaluation
A p p li c a to r s f o r i n t r a ca v i t a r y a p p li c a ti o n a re c o ns t r uc t ed t o ho ld t he s o ur c e s i n a s p e c i f ie d g eo m et r y . Some ap p li c a to r s (e .g . , F l et c he r - S ui t ) hav e s t r at e gi c a ll y p l a c ed le a d o r t u n g st en s h i e l d s t o r e d uc e t he d o se to t he r e ct um a nd t he bl a d de r .

WWW.MEDRAD.IR

A c c e p t a n c e t e st i n g of t h e s e a p pl i c at o r s is e s s e nt i al to e ns ure p r op e r so ur c e p l a c e me n t a n d p r ot e cti o n o f c r i ti c al s t r uc t ure s b y t he s hi e ld s . T h e i n t e r n a l s t r u c t u re o f a p p li c a to r s m a y b e e x a m i ne d b y o rt hogo na l r a d io g r ap hs u s i n g a 4 - o r 6 - M V x - r a y b e a m . D um m y s o ur c e s m a y b e i ns e rte d to c he c k t he p o s it io n o f s o u r c e s i n t h e ap pl i c at o r . T he po s it io n o f s hi e ld s s houl d be co m p a red w i t h t h e v e n d or ' s d ra w i n g s . M e c ha ni c a l f unc t i o ns s uc h a s t he e a s e o f so ur c e l o a di n g a n d r e mo v a l s h o u l d a l s o b e c he c k e d b e f o r e a c c ep ti ng t he a p p li c a to r s .

C.2. Interstitial Sources

S o u r c e s f o r i n te r s ti ti al i m pl a n t i n t he f or m o f ne e d le s ( e . g . , c e sium - 1 3 7 ) c a n b e t e s te d P.445 s a m e r a d io n u c l id e a nd c o n s t r u c ti o n s ho ul d b e us e d to ob t ai n a c a l i b ra ti o n f a c t or f o r t h e w e ll i o ni z a t io n c h a m b e r . A l l s o ur c e s s ho ul d b e i ndi v i d ua lly c he c k e d b e f o re c o m m i s si o ni n g i n t o cl in i c a l u s e . S h o r t - li v e d i n t er s ti ti a l s o u r c e s i n t he f o r m of s e e d s , wi r e s , o r se ed - l o ad ed ri b bo ns c a n b e t e s te d b y v i s u a l i n s p e ct io n ( b e hi nd a l e a d ed g l a s s w i ndo w ) a nd c a l i b r a ti on c a n b e c h e c k e d w it h a d o s e c a li b r at o r , a s de s c r i be d i n t he p re v ious s e c t io n. F o r a b a t c h o f a l ar g e n u m b e r o f s o ur ce s ( e .g. ,
192

in

t he

same

way

as

t he

i nt r a ca v i t a r y

s o ur ce s

de s cr i b ed

a bo v e .

Fo r

c a l i b ra ti o n c h e c k s , n e e d le s o f t h e

Ir r ib b o ns ) , a ra nd o m l y se le c t ed

s a m p l e o f t h r e e o r f o u r r i bb o n s o f a giv e n s t r e ngt h s ho ul d b e c he c k ed f o r c a l i b ra ti o n . A s t a n d a rd s e ed o f t he s a me ki nd ( w i t h c al ib r a ti o n t r a c e a bl e to t he N IS T ) s h o u l d b e u s e d t o c a li b r at e t he w e ll io ni z a t io n c ha m b e r . Bec a us e r i b bo ns o f d i f f e r e n t l e n gt h s a r e u s e d , t h e i o n c ha m b er r e s p o ns e s ho uld b e c o r r e c te d a s a f u n c t i o n o f r i bb o n len g t h . T h e s e c o r r e ct ion f a c t o r s c a n b e e st ab l i s hed b y us i ng t h e s t a n d a r d s ee d a n d m e a s u r i n g c ha m b e r r e s p o ns e a s a f unc t i o n o f s e e d p o si ti on i n t h e w e l l io n i z a ti o n c h a m b e r . T h e c a l i b r a tio n c h e c k o f

125

I s e e d s i s d i f f i cul t b e c a us e o f t he low e ne r g y o f t he
125

e m it t ed p h ot o n s . U n le s s s u i t a bl e e q ui p ment i s a v a i l ab l e fo r che c k i ng vendor's c a l ib r a ti o n m e t h o do lo g y s ho uld be r e v i e we d to e ns ur e

I seed t he

c a l i b ra ti o n , t h e i n s ti tu t i o n m a y a c c e pt t he v e nd o r ' s c a li b r at ion. H o w e v e r , t he t ha t c a l i b ra ti o n i s p e r f o rme d w i t h a n a p p r o p ri a te i ns t r um e nt w i t h a c a l i b r ati o n f a c t o r t r a c e a bl e t o N IS T . T h e v e n d o r ' s c al ib r a ti o n s e r v i c e m a y be c he c ke d b y o b t ai ni ng a r e p e at c a li b r at io n o f a s e e d b y N IS T o r a n A D C L .

D. Remote Afterloaders
A c c e p t a n c e p ro c ed u r es f o r r e m o te a f t e rl o adi ng e q ui p me nt ha v e b e e n d i s c us s e d b y s e v e r a l i n v e s t ig a to r s ( 3 2 , 3 3 ,3 4 , 35 ) a nd re v i e w e d b y G l a s go w e t a l . (3 6 ) . T he p r o c ed u r e s m a y be b ro a d l y d i v id e d i nto ( a ) o p e r at io na l t e st i ng o f t he a f t e rl o ad i ng u n i t , ( b ) r ad i at io n s a f e t y c h e c k o f t he f a c i lit y , ( c ) c he c k i ng o f s our c e c a l ib r a tio n a n d t r a n s p o r t , a n d (d ) c h e c k i n g o f t r e a tm e nt p l a nni ng s o f t w ar e . A l t ho ug h t he d e t ai l s a re p re s e n t ed b y G l a s g o w et a l . , s om e o f t he re c o m me nda t io ns a r e li s te d i n T a b l e 1 7 .6 . M o s t o f t h e a c c e p t a nc e t e st P.446 p r o c ed u r e s c o n s i st o f t e s ti n g t h e uni t f o r i t s f unc t i o na l pe r f o r ma nc e a nd s a f e t y f e a t u r e s , u s u a l l y c o v e r e d i n t h e op e r at o r 's m a nua l . T he s e c a n b e s i m pl y c a r r i ed

WWW.MEDRAD.IR

o u t b y a c ti v a ti n g v a r i o u s f u n c t i o ns a nd ob s e r v i ng t he r e s ult s . T he a c c ur a c y o f s o u r c e l o c al i z a ti o n a nd c a li b r at io n c a n be che c k e d us i ng p r o ce d ur e s t hat a r e mo r e o r le s s si m il a r t o t ho s e u s ed f o r c o nv e nt io na l br a c hy t he r a p y . C o ns i de r a ti o ns s p e c i f i c t o r em ot e a f te r lo a d e r s a re d i s c us s ed b e lo w .

TABLE

17.6.

ACCEPTANCE

TESTING

PROCEDURES

FOR

REMOTE AFTERLOADERS

F u n c t i o n a l p er f o r m a n ce a . C o n s o l e f u n c t io n s . M a i n p o w e r , b at te r y po w e r , s o ur c e o n/o f f , d o o r o p e n / c lo s e , et c . b . S o u r c e c o n t ro l . So u r c e d w e ll t i me a nd s o urc e r et r a c ti o n at t he end o f p r e s et ti m e , u n p l a n n e d i nt e r r upt io n o r e m erg e nc y s hut o f f c. B a t t e r y v ol t ag e . A deq u a c y o f b a t te r y v o lta g e und e r lo a d co nd it io ns a n d f u n c t i o n a l p e r f o rm a nc e und e r b a t te r y p o w e r d . T i m e r . T i m e r a c c u r a c y a nd e nd - t i m e e f f e c t s e . D e c a y c o r r e c ti o n . A c c u r a c y o f c o m p ut e r - c a lc ul a t e d d e c a y c o r r e ctio ns f. M u l t i c h a n n e l i n d e x er . P r o p e r so ur c e s e q ue nci ng a nd c ha nne l s e l e c ti o n o r a i r p r es s u r e l o s se s ( f o r p ne um a t i c al l y d riv e n d e v i c e s ) h . R a d i a ti o n de t e cto r s . P r o p e r f unc t io ni ng a s s p e c i f ie d g . B a c k u p s y s t e m s . P r o p e r f unc t i o ni ng d ur i ng s i m ul a te d p o we r f a i l ur e s

F a c i li t y c h e c k a n d s u r v e y a . D o o r i n te r lo c k s . S o u rc e r e t r a ct s w he n t he d o o r i s o pe ne d ; t he uni t d o e s n ot s t a rt u n t i l t he d oo r i s c lo s e d a nd the i nt e r lo c k i s r e s et b . R a d i a ti o n c. Patient warning lig h t s . P r o pe r f unc t i oni ng to i ndi c a te r a di a ti o n o f c los e d o n / o f f c o n d i tio n vi e w i n g a n d c o m m uni c a ti o n . P r o pe r f unc t i o ni ng c i r c u i t T V a n d t h e i n t er c o m m uni c a ti o n s y s t em d . R a d i a ti o n s u r v e y . E x po s ur e r at e s o ut s id e the r a d i at io n f a c i lit y s ho ul d m e e t t h e N R C r e g ul a ti o ns a nd t he l e a k a ge r a d i at io n r a t e s a ro und t he un i t s h o u l d b e a c c ep ta b l e ( s ee c ha p t er 1 6 )

S o u r c e c a l ib r a ti o n a n d t r a n s p o r t

C h e c k o f s o u r c e s pe ci f i c a ti o n s , le a k te s ti ng , c a l ib r a ti o n, t r a ns po r t t o t he a p p li c a to r s , a u to r a dio g r a p h of si m ul at e d s o ur c e po s it io ns , and i so d o se d i s t ri b u tio n t o d et e rmi n e d o se a ni s ot r o p y

D.1. Source Positioning

WWW.MEDRAD.IR

S o u r c e p o si ti o n a c c u r a c y c a n b e c he c k e d b y t a k i ng r a d i og r a p hs o f d um m y s o ur c e s i n t h e ap pl i c at o r s w i th t h e i r p o si ti o ns m ar k e d o n a r e ad y p a c k f ilm a nd c o mb i ni ng w i t h a u t o r a di og r a p h s o f t h e r a d i o a ct i v e so ur c e s i n t he s a m e a p p li c a to r s . T he p o s it io n o f d u m m y s ou r c e s a n d r a d i o a ct i ve s o ur c e s s ho ul d co r r es p o nd w i t hi n 1 mm. S p e c i al t e st de v i c e s have b ee n de s ig ne d to te s t s o ur c e p o si ti o ni ng by a u t o r a di og r a p h y ( 3 4 ,3 5 , 3 7 ) . Fi g ur e 17 . 8 A s ho w s a t e s t p ha nto m d e si g ned b y A l d r i c h a n d S a m a n t (3 7 ) . T h e s y st e m c o nsi s t s o f a n a c r yl i c pl a te w it h c ha nne l s d r i ll ed t o h o ld t h e t rea t m e n t c a t het e r s . L e ad s he et s o f di m e ns io ns 2 0 2 0 0 .8 m m a r e a c c u r a t el y se t i n to o n e s ur f a c e a t a r e g ul ar s p a ci ng o f 2 0 m m . T he p h a n t o m i s p l a c ed o n a r e a d y p a c k X V 2 fi l m w i t h l e a d s he et s f a cing t he fi l m . T he sources are p r og r am m e d The to s t op e v e ry t hus 10 mm for i nt e rv a l s s ui t a b le for a u t o r a di og r a p h y . t o ge t h e r w it h P.447 f i d u c i a l m a r k e r s p ro v id e d b y t h e ed g e s o f l ea d s he e t s ( F ig . 1 7 . 8 B). A n a c c ur a c y o f 1 m m i n t h e s o u r c e p o s it io n s i s a c c e pt a ble . a u t o r a di og r a p h o b t ai ne d s ho w s so ur c e po s it io ns

WWW.MEDRAD.IR

F I G . 1 7 . 8 . Q u a l i t y c on t r o l t e st f o r H D R r em o te a f t e rl o ad e r s . A : T e s t p ha nt o m t o c h e c k t h e a c c u r a c y o f s o u r c e p o si ti o ni ng . B: A ut o r a di og r a p h o f the t e st p ha nt o m s h o w i n g d w e ll po s it ion s . ( F r o m A l d r i c h J E , S a m a nt S . A t e s t pha nt o m f o r H D R d a i l y q u a li t y c o n tr ol . A c t i v it y 1 9 92 ; 6 :8 2 , w it h p e r m i s si o n. )

D.2. Source Calibration

The LDR so u r c e s in r e mo t e a f t er lo a d i ng uni t s can be c al i br a t e d in a w ell i o n i z a ti o n c h a m b er a s d e s c r ib e d b y t he A A P M R e p o rt 1 3 ( 2 ) a nd in C ha p t e r 1 5 o f t h i s boo k . T h e w e ll i on i z a t i o n c h a mb e r m us t be a r a c a li b r at io n f or t he s am e ki nd a n d s p e c i f i c at io n o f s ou r c e a s t h e g i v e n L D R s o ur c e . F o r t h e c al i b ra ti o n o f H D R s o u r c e s , t he w el l io ni z a ti o n c ha m be r m us t b e c a p ab le o f m e a s u r i n g l a r g e cu r r e n t s a s s o c i at e d w it h t he s e s o ur c e s . G oe t s c h e t a l . ( 3 8 ) h a v e d e s c r i be d s u c h a c h a m b e r f o r us e w i t h
192

Ir H D R s o ur c e s . C a l i b r at io n o f w e ll -

t y p e i o ni z a t io n c h a m be r s s u it a b le fo r c al i b ra t i ng H D R s o ur c e s i s a v a i l a bl e a t so me A D C L s ( U n i v e r s i t y o f W i s c o n s i n a nd K & S A s s o c i at e s , Inc . ) . A c y l i n d r i c al le a d i n s e r t f or a c o nv e nti o nal w e ll - io ni z a ti o n c ham b e r (e . g . , d o se c a l i b ra to r ) h a s a l s o b e e n u s e d t o re d uc e t he io ni z a ti o n c ur r ent f r o m a n H D R s o u r c e to a m e a s u r a bl e v a l u e ( 36 ) . It i s i mp o rt a nt to c he c k t he a c c ur a c y o f s uc h a s y s t e m b y a n i n d e p en d e n t c a l ib r a ti o n. Cylindrical ion c h a mb e r s (e.g., F a r m e r -ty p e or l a rg e r v ol um e , d e pe nd i ng on s o u r c e st r e n gt h ) c a n b e u s ed t o c a li b r at e L D R a nd H D R so ur c e s us i ng a f r e e - ai r g e o me t r y ( C h a p t e r 15) . T h e i o n c ha m b e r m us t b e f i t te d w i t h a n a p p r op r i at e b uil d u p c a p a nd be a r a ca l i b r ati o n f o r p hot o n e ne r g ie s em it t ed b y the r a d io nuc l i de . G o e t s c h et a l . ( 3 9 ) h a v e d e s c r i be d a n i nt e rp o l at i ve m e t hod o f o bt a i ni ng e x po s ure c a l i b ra ti o n f a c t o r f o r t h e c h a m b e r . F o r i n t e r pol a ti n g b et w e e n f a c t o r s f o r
137 192

Ir, t he c a l i b r at io n f a c t or i s o b t ai ne d b y 2 50 kVp x-rays. Ezzell

60 192

C s a nd

( 4 0 ) ha s

d e s c r ib e d a m et h o d of i n t e r po l at i ng c ha mbe r f a c t o rs f o r a n d 2 5 0 k V p w i t h o u t a c a p t o ob t ai n c ha m b e r f a c t o r f or a d i r e ct m e t ho d o f c h a m b e r c a li b r at io n w i th i n t e r pol a ti v e t e c h n i q ue .
192

C o w ith a b ui l d - up c ap Ir . U nt il N IS T d e v e l o p s

Ir , t he A A P M ( 3 6 ) r e c o m m e nd s t hi s

17.7. COMMISSIONING
M o s t e q u ip m e n t i s r e ad y f o r c l i n i c a l us e a f t e r a c c e p t a nc e te s ti ng . H o w e v e r , s o m e e q u i p me n t r eq u i r e s ad d it io n a l d at a b e fo r e i t c a n b e us e d i n c o nj unc t i o n w i t h p a t ie n t t r e at me n t s . Fo r e x a m p le , a l i ne ar a c c e l e r ato r c a nno t be us e d fo r p a ti e nt t r e at m e n t s u n t il it h a s b e e n c a li b r at e d and a l l t he b e a m d ata a nd ne c e s s a r y p a r a m et e r s f o r t re a t me n t p l a n n i n g ha v e b e en o b t a i ned . T he s e d a ta a r e t he n i np ut into a t r e at m e n t- pl a n n i n g c o m p ute r in a c c o r d a nc e with t he s o f t w a re r e q u i r em e n t s . T h e com p u t e r - ge ne r at e d d os e di s t ri b uti o ns a re c he c k e d a g ai ns t m e a s u r e d d a ta a n d / or m a n u a l l y c a l c ul a t e d d i s t r ib ut io ns . A f t e r a l l t he ne c e s s a r y b e a m d at a h a v e b e en a c q u i r e d a nd a d op te d to t he tr e at m e nt -p l a nni ng s y s t e m, t h e m a c h i n e c a n b e r el e a s ed o r c o mm i s si o ne d f o r c li ni c a l us e . C o m m i s si o n i n g physicist. The of a linear a c c el e r at o r not be is t he r e sp o ns ib il it y of t he m ed i c al t he m a c h in e should us e d f o r p at ie nt tr e at m e nt s unt i l

p h y s i c i s t h a s d e cl a r ed i t c o m mi s s io ne d . Be ca us e o f d i f f e r e nt be am m o d al it i e s a nd e n e r g ie s , it ma y n o t b e p o s si bl e to co mm i s s io n t he m a c hi ne i n o ne s te p . Fo r

WWW.MEDRAD.IR

e x a m p le , c o m m i s si o n in g m a y b e d o ne f o r p ho t o n b e a m s w hi l e d a t a a r e b e i ng a c q u i r e d o n e le c t ro n b e a m s . H o w e v e r , be ca us e c o m m i s si o ni ng ta k e s l o ng p e r io d s f o r m a c h i n e u s e a n d a p p a r a t u s s et - up , it is b e tt e r no t t o re le a se t he m a c hi ne fo r c l i n i c al u s e u n t i l a ll t h e c o m m i s sio ni ng ha s b e e n c o mp l et ed .

A. Linear Accelerator
T a b l e 17 . 7 g i ve s a l i st o f t y p i c a l d at a t hat a r e r e q ui re d f o r c om m is s i o ni ng a li ne a r a c c e l e r ato r . D et a il s of v a r i o u s m e a s ur e m ent p r o ce d ur e s ha v e be e n d i s c us s ed in t h e p r e v io u s c h a p t e r s . P.448 C o m m i s si o n i n g i s com p l et e o n l y a f te r t he b e a m d a t a ha v e b een i np ut i nto t he t r e at m e n t -p l a n n i n g c om p u t e r a n d t he c o mput e r - g e ne ra t ed do s e di s t ri b uti o ns ha v e been checked.

TABLE

17.7.

COMMISSIONING

DATA

FOR

LINEAR

ACCELERATOR

Data

D e s c r i p t i on

C a l i b r at io n

D o s e p e r mo ni to r uni t c a li b r at io n o f a ll m o d al it ie s a nd e n e r g ie s a c c o r di ng to c ur r e nt p r ot o co l

D e pt h d o s e

C e n t r a l a x i s d e pt h - d os e d i st r ib ut io n f o r al l m o d al it ie s a nd e n e r g ie s , s uf f i c i e nt num b e r of field sizes to a ll o w i n t e r pol a ti o n o f d a t a and a l l a v a i l ab l e e le c t ro n c o ne s

P r o f i le s

T r a n s v e r s e , l o ngi t ud i na l , a nd d i ag o na l d o se p r o f il e s f o r al l m o d al it ie s a nd e ne r g ie s a t d m a x f o r e l e ct ro ns a nd s e l e c t ed d e pt h s f o r p ho to ns (e . g . , d m a x , 5 , 10 , a nd 20 c m ) ; a ll c o n e s f o r e l e ct ro ns a nd s e l e ct ed f i el d si ze s f o r p ho to ns ( e . g . , 5 5 , 1 0 1 0 , a nd 4 0 4 0 c m )

Is o d o s e d i s t ri b u tio n

Is o d o s e c u r v e s f o r a ll m o d al it ie s a nd e ne rg i e s , a ll c o ne s f o r el e ct r o n s a nd s el ec t e d f i el d s i z e s f o r pho t o ns (e . g . , 5 5 , 1 0 1 0 , 4 0 4 0 c m ) , a l l w e d g e f i lt er s f o r s e l e c te d f i e l d si z e s ( e . g . , 5 5 , 1 0 1 0 , m a x i m um )

Output factors

S c , p , S c , a n d S p f a c t o rs a s a f unc t i o n o f f i el d s i z e f o r a ll p h o to n e n e r gi e s : o utp ut f a c t or s f o r al l e lec t r o n e ne rg ie s , c o n e s , a n d s t a nd a r d ins e r t s ; t r a y t r a ns m i s si o n f a c t o r s a nd w e d g e tr a n s m i s s io n f a c t o r s

WWW.MEDRAD.IR

Off-axis r a t io s

A t a b l e o f o f f - a x i s ra t io s f o r a l l p hot o n e ne r g ie s a s a f u n c t i o n o f d i s t a nc e f r o m c e nt r a l a x i s ; t hes e d a t a m a y b e o b t ai n e d f r o m do s e p r o f il e s f o r a 5 4 0 - c m f i el d a t s e l e ct ed d e pt hs ( e . g . , d m a x , 5 , 1 0 , 20 c m )

In v e r s e square law

V e r i f i c at io n o f i nv e r s e s q ua r e l a w f o r a l l p ho to n e ne r g ie s , virtual so u r c e p o si tio n for al l el e ct r o n e ne r gi e s , a nd e f f e c t i v e S S D f o r a ll el e c tr o n e ne r gi e s a nd co ne s

Tissuephantom r a t io s

D i r e ct me a s ur e m e nt of T P R s / T M R s f o r a l l pho t o n e ne r gi e s a n d s e l e ct ed f i el d s i zes ( e . g . 5 5 , 1 0 10 , 4 0 4 0 c m ) and d e pt h s (5, 10, 30 cm) for v e r i fi ca t io n of v a l ue s c a l c u l a te d f r o m pe r c ent d e p t h do s e s

Surface

and

F o r a l l p h ot o n e ne r gi es a nd s e l e c t ed f i e ld s iz e s ( 5 5 , 1 0 1 0 , 30 3 0 , a nd 40 4 0 c m ) , p e rc e nt sur f a c e d o s e f o r a l l el e ct r o n e ne r gi e s fo r a 1 0 1 0 - c m c o ne

b u i l d u p do s e

T r e a t m e nt planning system

B e a m d a t a i np ut , g ene r a t io n, a nd v e r i f i c a t io n o f c e nt r a l axis percent de p t h dose a nd t i s s ue -p ha nt o m / ti s s ue m a x i m u m r a t io t ab le s; s a m p l e i s od o se c ur v e s ( e . g . 5 5 , 1 0 1 0 , m a x i m um ) f o r unw e d g e d , w e d ged , a s y m m e t ri c a n d b l o c k ed f i el d s ; s a m p l e i s od o se c ur v e s f o r m ul ti p le field cones p la n s and us i ng s a mp l e re c t a ng ul a r is o d o se a nd e ll ipt i c al on c o nto ur s ; a nd e l e ct r o n be a m de p t h d o s e da t a , i so do s e c ur v e s f o r a l l c ur v e s re c t a ng ul a r c i r c u l a r c o n to ur s

S p e c i al d o s im e tr y

D a t a f o r s pe c i al t e c hni q ue s s uc h a s t o t al b od y i r r a d i at io n, t ot a l skin i r r ad i at io n, s t e r eo t a ct i c r a d i o s ur ge r y , i n t r a op e r at i v e el e ct r on t he r a p y , e t c .

A.1. Central Axis Depth-dose Tables

The percent d ep t h do s e and TPR/TMR t ab l e s may be p r ep a re d m a nua l l y by i n t e r pol a ti o n o f t he me a s u r e d d at a o r g e ner a t e d b y t he c om p ut er . T he m e a s ur e d a n d t h e c o m p u t er - g e ne r a t ed d ep t h- do s e di st r i b ut io ns f o r a l l c li ni ca l l y us e d d ep t hs a n d f i e l d s i z e s s h o ul d a g r e e w it h i n 2 % ( p re f e r a b l y 1 % ) .

A.2. Isodose Curves

T h e m e a s u r e d a n d c o m p u t e r - ge n e r at e d i sod o s e c ur v e s s ho ul d ag r e e w it hi n 2 % i n t h e c e n tr a l p a r t o f t h e f i el d (e . g . , up to a b o ut 1 c m i nsi d e t he f i e ld e dg e ) a nd within a b o ut 2 mm in the pe num b r a re g io n (e.g., be t w ee n 90% a nd 2 0%

WWW.MEDRAD.IR

d e c r e me n t li n e s ) . T h e s a m e c r it e ri a a pp l y t o t he w e d ge i so do se c ur v e s , e x c e p t t h a t t h e c o mp u t e r al go r it h m s u s ua l l y a r e no t a s a c c ur a t e ne a r the t hi n e d g e s o f the size. P.449 wedges. A l so , some a lg o ri t hm s may no t a c c ur a t e l y c a l cul a t e t he be a m h a r d e n i n g c o rr e c tio n , w h i c h n e e d s t o b e ap p li e d a s a f unc t io n of d e pt h a nd f i eld

A.3. Monitor Unit Calculations

C a l c u l a t io n o f m o ni tor u n i t s t o d el i ve r a ce r t ai n do s e at a po i nt a t d ep t h o n t he c e n t r a l a x i s (e . g . , i soc e n t e r ) re q ui r e s a num b e r o f d o si m et r i c q ua nt i ti e s me a s ur e d a s p a r t o f c o m mi s s io n i n g . A f i n a l c he c k o f t he f o r m a li s m ( C ha p te r 1 0 ) s ho ul d be m a d e to a s c e r t ai n t h a t d o s e s c a n b e a c c ur a t el y d e li v e r ed a t a p o i nt f o r a g i v e n e n e r g y , f i e l d s i z e , a n d d e pt h . It i s i m p o r ta nt t o e s t ab li s h t he a c c ur a c y o f t he r e l at io n s h i p b et w ee n c a l i b ra ti o n a nd t he d os e to b e d el i v e re d at a ny p o i nt i n t he p a t ie n t .

B. Treatment-planning Computer System

Acceptance te s ti n g and c o m m i s si o ni ng of t he t r e at m e nt- p la nni ng c o m p ut e r s y s t e m h a v e be e n di sc u s s e d b y a f e w i nv e st i g ato r s ( 41 , 4 2 , 43 , 4 4 ,4 5 ) . P r o ce d ur e s h a v e b e e n d e s c r i be d fo r t e st i n g bo t h ha r d w a r e a nd s o f t w a r e . T he ha r d w a r e t e s t s i n c l u d e , b u t a r e n o t l i m it ed t o , c he c k i ng t he a c c ur a c y a nd l i ne a r i t y o f i np ut d i gi ti z e r s , o u t p u t p lo tt e r s , a n d p r i nte r s . The s o f t w a r e te s t s p e rt a i n to c he c ki ng t h e a c c u r a c y o f d o s e d i s t ri b u ti o ns f o r a s e l e ct ed s e t o f t r e atm e nt c o ndi ti o ns a g a i n s t m e a s u r ed d i str i b u ti o n s o r m a nua l c al c ul a ti o ns . A n o t h e r i m po rt a n t a sp e c t o f c o m mi s s io ni ng o f a t r e at m e nt -p l a nni ng c o m p ute r i s the to a l go r it h m be a m v e r i f ic a t io n i t s a c c ur a c y , b e am p r e c i si o n, w e i g ht s , l im it a ti ons , c o nto ur a nd s p e c i al f i e ld f e a t u r e s . It i s i m pe r at i v e f or t h e us e r to und e r s t a nd t he a lg o ri thm a s i t pe r t ai ns g e n e r at io n , n o r m a l i z a ti o n, c o r r e ct io ns , b l o c ki n g , o f f - a x i s d i st r i b ut io n , a s y m m e t r i c c o l li m a tio n, t i s s ue he t e ro g e nei ti e s , w e d g ed b e a m s , b lo c k ed w e d g e d be a m s , e t c . It i s t he r e s p o ns i bi li ty o f t he m e d i c a l p h y s i c i s t to o ve r s e e pr o p e r u s e o f t he s y s t em a nd i nte r p re t at io n o f t he t r ea t me nt plan. B r a c h y t h e r a p y s o f t w ar e c o mm i s si o ni ng i nc lud e s te s ti ng o f t he l ine a r s o ur c e a nd s e e d p ro g r am s . D o se d i s t ri b u tio n s a r o und ind i v i d ua l so ur c e s s houl d b e ge ne r a te d a n d c o m p a r ed w i t h pu b l i s h e d t a b le s . A n a g r e e me nt o f 2 % i n d o s e r a te s a nd p u b l i s h ed ta b le s i s a cc e p t ab le , e x c l udi ng ani s o t ro p y o r e xt r e me o b li q ue f i lt r a ti o n c o n d it io n s . S p e c i al att e n ti o n s h o uld be di re c t ed to t he uni t s o f s o ur c e s t re ng t h, f i l t r at io n , t i s s u e at ten u a t i o n , s o ur c e a ni sot r op y , a nd o t he r re lev a nt f e a t ur e s o f t h e p ro g r a m t h a t a f f e c t s t h e a c c ur a c y o f dos e d i st ri b uti o n o r t he i nt e r pr e ta ti o n o f t h e tr e a tm e n t p l a n . M u l t i pl e s o ur c e di s t rib ut io ns s ho ul d b e c he c k e d b y m a nua l c a l c u l a ti o n s f o r t y pi c al i n t r a c a v it a r y a nd i nte r s ti ti a l i mp l a nt co nd it io ns .

17.8. PERIODIC QUALITY ASSURANCE

A p e r i od i c q u a li t y a s su r a n c e p r o g r a m i s d es i g ne d to m a i nt ai n t he s y s t e m w i t hi n i t s a c c ep t ab l e p e r f o rma n c e s t a n d a r d s . T he pr o g r a m i s us ua l l y d e s ig ne d to c o nd u c t t e s t s si m il a r to a c c e pt a n c e t e st i ng o n a r eg ul a r b a s i s . T he t y p e a nd f r e q ue nc y o f

WWW.MEDRAD.IR

t e s ti n g i s di c t at ed pr i m a r il y b y t he p r oba b i li t y o f o c c ur re nc e o f a p a r t i c ul a r p e r f o r m a n c e e r r or , i ts c l i n i c al i mp a c t , a nd t he ti m e re q ui re d f or p e r f o r mi ng t he t e s t . Be c a u s e t h e a mo u n t o f t e st i ng re q ui re d t o m a ke t he e q uipm e nt a b so l ute l y e r r o r -p r oo f i s u n li m ite d , p r a ct i c al a nd l og is t i c co ns i de r a ti o ns p la y a n i m p o rt a nt p a r t i n de s i g ni n g a p e r io di c Q A p r og r a m. T he g ui d i ng p ri nc ip l e i s to f o ll o w n a t i o n a l o r i n t e r n a ti on a l s t a n d a r d s i f t he y e x i s t . If f o r m a l st a nda r d s d o no t e x i s t , t h e i n s t it u t io n s h o u l d d e s i g n i t s o w n p r ogr a m b y c o ns ul t i ng r e le v a nt l i te r a t ur e , m a n u f a c t u r e r ' s m a n u a l s , a n d o t he r e q uipm e nt us e r s . M o r e o v er , a Q A p r o g r a m s h o u l d be r e vi e w e d on a r e g u l a r b a s i s ( e . g. , a nnua l l y ) t o i nc o r po r a te id e a s f rom n e w p r o to c ol s , t h e u s e r ' s e x p e ri e nc e , a nd the e x p e r ie nc e o f o t her us e r s .

A. Linear Accelerator
P e r i od i c q u a li t y a s s u ra n c e f o r l i n e a r a c c el er a t o r ha s b ee n d i s c us s e d b y t he A A P M ( 2 , 8 ) . In s t i t u ti o n s s h o u l d c a r r y o ut t hi s p ro g r a m at t he r e co m me nd e d f r eq ue nc y t o m ai n t a i n c o n f o r mi ty w i t h t h e n a t i o na l sta nd a r d s . S o m e te s t s or t he i r f r e q ue nc y may have to be P.450

P.451 m o di f i ed to t a ke in t o account c e r t ai n uni q ue c ha r a c t e r i s ti c s of a given

a c c e l e r ato r . H o w e v e r , t h e s e m o di f i c a ti o ns s ho ul d b e m a d e w it h t he i nt e nt io n o f i m p ro v i n g t h e Q A p r og r a m r a t h e r t ha n c ut t ing c o r ne r s .

TABLE 17.8. PERIODIC QA OF LINEAR ACCELERATORS

Frequency

P r oc e d u r e

T ol e r a n c e a

Daily

D o s i me t r y

X - r a y o u t p u t c o ns t anc y

3%

E l e c t r o n o u t p ut co ns t a nc y b

3%

Mechanical

L o c a l i z i n g l a se r s

2 mm

D i s t a n c e i n d i c at o r (O D I)

2 mm

WWW.MEDRAD.IR

Safety

D o o r i n t e rlo c k

F unc t i o na l

A u d i o v i s u a l m o ni to r

F unc t i o na l

Monthly

D o s i me t r y

x - r a y o u t p u t c o ns t anc y c

2%

E l e c t r o n o u t p ut co ns t a nc y c

2%

B a c k u p m o n i t o r c o ns t a nc y

2%

x-ray

central

axis

d o s i m et r y

2%

p a r a m et e r ( P D D , T A R ) c o ns t a nc y

E l e c t r o n c e n t r al a x is d o s i me t r y p a r a m et e r c o n s t a nc y (P D D )

mm

at

t he r a p e utic

d e pt h

x - r a y b e a m f l a t ne s s c o ns t a nc y

2%

Electron constancy

beam

f l a t ne s s

3%

x - r a y a n d e l e c t ron s y m m e t r y

3%

S a f e t y i n t e rl o c k s

E m e r g e n c y o f f s w i t c he s

F unc t i o na l

W e d g e , e l e ct ro n c o ne i nt e r lo c k s

F unc t i o na l

Mechanical checks

WWW.MEDRAD.IR

L i g h t / r a d i ati o n c o i n c id e n c e

field

2 m m o r 1 % o n a s i de d

G a n t r y / c o l l i m at o r i n d i c at o r s

a ng l e

W e d g e p o si ti o n

2 m m (o r 2% c ha ng e i n t r a ns m i s s io n f a c t o r)

T r a y p o s i t io n

2 mm

A p p l i c a to r p o sit io n

2 mm

F i e l d s i z e i n di c a to r s

2 mm

C r o s s - h a i r c e nt e r i ng

2 m m d i a me t er

Treatment i n d i c at o r s

c o uc h

p o s it io n

2 mm/1

Latching tray

of

w e d ges ,

b l o c k i ng

F unc t i o na l

Jaw symmetrye

2 mm

F i e l d li g h t i n te ns i t y

F unc t i o na l

Annual

D o s i me t r y

x-ray/electron c a l i b ra ti o n c o n s t a nc y

o ut p ut

2%

F i e l d si z e d e pe nd enc e o f x - r a y o u t p u t c o n st a n c y

2%

Output

factor

c o ns t a nc y

for

2%

WWW.MEDRAD.IR

e l e ct r o n a pp li c a to r s

Central

axis

p a r a m e te r

2%

constancy (PDD, TAR)

O f f - a x i s f a c t o r c o ns t a nc y

2%

Transmission

f a c t or

c o ns t a nc y

2%

f o r a l l t re a tm e nt a c c es s o r ie s

Wedge constancyf

t r a ns m i s s io n

f a c t or

2%

M o n i t o r c h a m b e r li ne a r it y

1%

x-ray

o u t p ut

c ons t a nc y

vs

2%

gantry angle

Electron

o u t p ut

co ns t a nc y

vs

2%

gantry angle

Off-axis

factor

cons t a nc y

vs

2%

gantry angle

Arc mode

Mfrs. specs.

S a f e t y i n t e rl o c k s

Follow p r o c ed u r e s

m a nuf a c t ur e r s

t e st

F unc t i o na l

Mechanical checks

C o l l i m at o r ro t at io n is o c e nte r

2 m m d i a me t er

G a n t r y r o t a t io n i s o ce nt e r

2 m m d i a me t er

WWW.MEDRAD.IR

C o u c h r o t a ti o n i so ce nt e r

2 m m d i a me t er

Coincidence

of

c o l li m et r y ,

2 m m d i a me t er

g a n t r y , c o u c h a x e s w i t h i s o c e nte r

Coincidence

of

r a d i a ti o n

a nd

2 m m d i a me t er

m e c h a n i c a l i so c e nte r

T a b l e t o p s ag

2 mm

V e r t i c a l t r a v el o f t ab l e

2 mm

T h e to l e ra n c e s li s t ed i n t h e t ab l e s s ho ul d b e i nte r p re te d to me an t ha t i f a ( e .g . , t he (e . g . , m e a s ur ed o ut p ut

p a r a m et e r e it h e r : ( 1) e x c e e d s t he t a b ula t e d v a l ue change in the p a ram e t er e x c ee d s t he no m i na l

i s o c e nt e r u n d e r g a n t ry r o t at io n e x ce e d s 2 m m d i a me te r ) ; o r (2 ) t hat t he v al ue t he c h a n g e s b y m o r e t h a n 2 % ) , t he n a n a c t i on i s r e q ui r e d . T he d is t i nc ti o n i s e m p h a s i z e d b y t h e u se o f t h e t e r m co ns t a nc y f o r t he l a tt e r c a s e . M o r eo v e r , f o r c o n s t a n c y , p e r c en t v a l u e s a r e t he d e v i at io n o f t he p a r am e t er w i t h r e s p e ct i t s n o m i n al v a l u e ; di s t a nc e s a r e r e f e r e nce d t o t he is o c e nte r o r nominal

b

SSD. to be check checked with a f ie ld at i ns t r ume nt l e a st us i ng twice weekly.

A ll el e ct r o n e n e r gi e s n e e d n o t be c he c k ed d ai l y , b ut al l e le c t ro n e ne r gi es A c o n st a n c y t em p e r at ur e / p r e s s ur e

are
c

c o r r e ct io n s .
d

W h i c h e v e r i s g r e at e r. S h o u l d a l s o b e c hec k e d a f t e r c ha ng e i n l i g ht f i eld J a w s y m m e tr y i s de f i n e d a s di f f e r e nc e i n d i s t a nce o f e a c h j aw f r o m t he w e d ge s t r a n sm i s s io n f a c t o r s a r e f i e l d si z e a nd d e pt h d e p e nde nt .

source.
e

i s o c e nt e r .
f

Most

F r o m A A P M . C o m p r e h e n s i v e Q A f o r r a d i at io n o nc o lo g y : r ep o rt o f t he A A P M R a d i a ti o n T h e r a p y C om m i tt ee T a s k G r o up 4 0 . M e d P hy s 1 9 9 4; 21 : 5 81 61 8 , w i t h p e r mi s s io n .

A l l Q A m e a s u r e me n t s m u s t b e e nt e r ed i n log bo o k s . T hi s i s i mp or t a nt not o nl y i n f o l lo w i n g m a c h i n e per f o r m a n c e o v e r t he y e a r s b ut a l so be c a us e it i s a le g al r e c o r d t h at do c u m e n ts t h e o pe r a ti o na l hea l t h o f t he m a c hi ne f o r a ny t im e i n w h i c h p a t i e n t s w e r e t re a t ed . A p r o ce d u r e m u st be in p l a c e to de a l w i t h inc i d e nt s i n w hi c h s i g ni f i c a nt d e v i at io n in the machine p e rf o r m a n c e is no te d . For e x a m p le , if out p ut c a li b r at io n (dose/MU) changes P.452

WWW.MEDRAD.IR

suddenly, a d j u s t ed

this

s h o uld

be

i n v e s ti g at e d i nto

t ho r o ug hl y

be f o re

c a lib r a t io n

po t s

ar e

to bring the

machine

c o r re c t

c a li b r at io n. C he c k s w i t h a no t he r

d o s im e te r s y s t e m a n d / o r b y a n o t he r p hy s i c i st m a y b e ne c e s s a r y t o v e r i f y t he c h a n g e . C h a n g e s i n o u t p u t c a li b r at io n c a n a l s o o c c ur d ue t o d e t uni ng o f t he m a c h i n e o r c h a n g e s in b e a m f l at ne s s . A l l the s e f a c t o r s s ho ul d be c he c k e d be f o re a d j u s t i n g t h e c a li b r at io n . If t h e c al ib r a ti o n c ha ng e i s unus ua l l y la r g e (b e y o nd a n o c c a s io n a l dr i f t ) , t h e m a t te r s h o uld be t ho ro ug hl y i nv e s ti g at ed and d i s c us s e d w i t h the manufacturer. to changes M o n i to r In in chambers short, t he co ul d ge t uns e a le d , m us t be w hi c h c o ul d so c a us e that a nd c a l i b ra ti o n significant c h a n ge . Q A p r o gr a m d e s ig ne d

machine

pe r f o r ma nc e

r e c ei v e

p ro m pt

a tt e nti o n

i n v e s t ig a ti o n to d et e rm i n e t h e c a us e o f t he m a l f unc t i o n.

TABLE 17.9. PERIODIC QA OF COBALT-60 UNITS

Frequency

P r oc e d u r e

T ol e r a n c e a

Daily

Safety

D o o r i n t e rlo c k

F unc t i o na l

R a d i a t io n r o o m mo ni to r

F unc t i o na l

A u d i o v i s u a l m o nito r

F unc t i o na l

Mechanical

Lasers

2 mm

D i s t a n c e i n d i c at or ( O D I)

2 mm

Weekly

C h e c k o f s o u r c e p o s i tio ni ng

3 mm

Monthly

D o s i me t r y

O u t p u t c o n s t a nc y

2%

Mechanical checks

WWW.MEDRAD.IR

L i g h t / r a d i ati o n f i el d c o i nc i de nc e

3 mm

F i e l d s i z e i n di c a to r ( c o ll i m at o r se tt i ng )

2 mm

G a n t r y a n d c o l li m a to r a ng l e i ndi c at o r

C r o s s - h a i r c e n t e r i ng

1 mm

L a t c h i n g o f w e d ge s , t ra y s

F unc t i o na l

S a f e t y i n t e rl o c k s

Emergency off

F unc t i o na l

W e d g e i n t e rl o c k s

F unc t i o na l

Annual

D o s i me t r y

O u t p u t c o n s t a nc y

2%

Field constancy

si z e

de pe nd e nc e

of

o utp ut

2%

Central

axis

d o s i m et r y

p a r a m e te r

2%

constancy (PDD/TAR)

Transmission

f a c t or

c o ns t a nc y

for

a ll

2%

s t a n d a r d a c c e s so r ie s

W e d g e t r a n s m i s si o n f a c t o r c o ns t a nc y

2%

T i m e r l i n e a r it y a nd e r r o r

1%

O u t p u t c o n s t a nc y v s g a nt r y a ng l e

2%

WWW.MEDRAD.IR

B e a m u n i f o r m i t y v s g a nt r y a ng l e

3%

S a f e t y i n t e rl o c k s

Follow manufacturers

t e st

p r o c e d ur e s

of

F unc t i o na l

Mechanical checks

C o l l i m at o r ro t at io n is o c e nte r

2 m m d i a me t er

G a n t r y r o t a t io n i s o ce nt e r

2 m m d i a me t e r

C o u c h r o t a ti o n i so ce nt e r

2 m m d i a me t er

Coincidence

of

c ol li m . ,

g a nt r y ,

c o uc h

2 m m d i a me t er

a x i s w i t h i s o c e nt e r

Coincidence

of

r a d i at io n

a nd

2 m m d i a me t er

m e c h a n i c a l i so c e nte r

T a b l e t o p s ag

2 mm

V e r t i c a l t r a v el o f t ab l e

2 mm

F i e l d - li g h t i n t e ns it y

F unc t i o na l

T h e to l e ra n c e s li s t ed i n t he t ab l e s s ho ul d b e i nte r p re te d to (e.g., 2 the mm m ea s ur e d di a me t e r ) ; t he i s o ce nt e r or (2) unde r the g a nt r y c ha ng e t he r o t at io n in t he o utp ut

m e a n t h a t i f a p a r am e t er ei t he r : (1 ) e xc e e d s t he t a b ul at ed value exceeds t ha t v al ue

p a r a m et e r

e x c e ed s

no mi na l

(e.g.,

c h a n g e s b y m o r e t han 2 % ) , t he n a n a c t ion i s r e q ui re d . T he d i s ti n c ti o n i s e m p ha siz e d b y t he us e o f t he t e r m c o ns t a nc y f o r t h e l a tt e r c a se . M o r eov e r , f o r c o ns t a nc y , p e r c e nt v a l ue s a r e t h e de v i a ti o n o f t he p a r a m et e r w i t h re sp e c t to it s no mi na l v a l u e ; d i st a n c e s a re r e f e r e nc e d to t he i soc e nt e r o r no mi na l

WWW.MEDRAD.IR

SSD. F r o m A A P M . C o m p r e he ns i v e Q A f o r r a di a tio n o nc o lo g y : re po r t o f t h e A A P M R a di a ti o n T he r a p y C o m mi tt e e Ta s k G r o up 40 . M e d P h y s 1 9 9 4 ; 2 1 :5 81 618 , w i t h p e r m i s si o n.

TABLE 17.10. PERIODIC QA OF SIMULATORS

Frequency

P r oc e d u r e

T ol e r a n c e a

Daily

L o c a li z i n g l a se r s

2 mm

D i s t a n c e i n d i c at o r ( OD I)

2 mm

Monthly

F i e ld s i z e i n di c a to r

2 mm

G a n t r y / c o l li m at o r a ngle i nd i c at o r s

C r o s s - h a i r c e n t e ri ng

2 d i a m et e r

mm

F o c a l s po t - a x i s i nd i c ato r

2 mm

F l u o r o s co pi c i m a ge q ua l it y

Ba s e l i ne

E m e r g e n c y / c o ll i si o n av o i d a nc e

F unc t i o na l

L i g h t / r ad i at io n f i e ld c o i nc id e nc e

2 mm or 1%

F i l m p ro c e s so r s e ns it om e t r y

Ba s e l i ne

WWW.MEDRAD.IR

Annual

Mechanical checks

C o l l i m at o r ro t at io n is o c e nte r

2 d i a m et e r

mm

G a n t r y r o t a t io n i s o ce nt e r

2 d i a m et e r

mm

C o u c h r o t a ti o n i so ce nt e r

2 d i a m et e r

mm

Coincidence

of

co ll i m at o r ,

g a nt r y ,

2 d i a m et e r

mm

c o u c h a x e s a n d i s o c e nt e r

T a b l e t o p s ag

2 mm

V e r t i c a l t r a v el o f c ouc h

2 mm

R a d i og r a p h i c c he c k s

Exposure rate

Ba s e l i ne

T a b l e t o p e x p o s ur e w i t h f l uo r o s co p y

Ba s e l i ne

K v p a n d m A s c a l i b ra t io n

Ba s e l i ne

H i g h a n d l o w c o nt r a s t r e s ol ut io n

Ba s e l i ne

T h e t ol e r a n ce s m e a n t h a t t h e pa r a m et e r e x c e e d s t he t ab ul a te d va l u e ( e . g . ,

t h e m e a s u r ed i s o ce n t e r u n d e r g a nt r y ro ta t io n e x c e ed s 2 m m d i a me te r ) . F r o m A A P M . C o m p r e h e n s i v e Q A f o r r a d i at io n o nc o lo g y : r ep o rt o f t he A A P M R a d i a ti o n T h e r a p y C om m i tt ee T a s k G r o up 4 0 . M e d P hy s 1 9 9 4; 21 : 5 81 61 8 , w i t h p e r mi s s io n .

T a b l e 1 7 . 8 i s b a s e d on t h e A A P M r e c o m me nd e d l i st o f v a r i o us t e st s , t he f r eq ue nc y w i t h w h i c h t h e y s h o u l d be pe r f o r me d a nd t he a c c ep t a bl e li m it o f v a r i a ti o n. T he a n n u a l f u l l c a l i b r a ti on s h o u l d i n c l ud e o utp ut c a l ib r a ti o n i n a c co r d a nc e w it h t he c u r r e n t p r ot o col , c e n t r a l a x i s d ep t h do s e c ur v e s f o r s e le c te d f ie l d si z e s , be am p r o f il e s a t s el e ct e d dep t h s a n d f i e l d s i z e s , out p ut f a c t o r s , c he c k o f i nv e r s e s q ua r e

WWW.MEDRAD.IR

l a w , t r a y f a c t o r s , w ed g e f a c to r s , a nd o t her p a r a m e te r s t hat a r e no t c o v er e d i n t h e t e st s o n a m o r e f re q u e n t b a si s .

B. Cobalt-60 Unit
Q u a l i t y a s s u r a n c e o f c o b a lt - 60 te le t he r ap y s ho ul d b e si m il a r to t ha t o f a li ne a r a c c e l e r ato r e x c e pt t h a t s o m e a s pe c t s o f the Q A a r e m a nd a t e d b y t he N uc l e a r R e g u l a to r y C o mm i s si on ( 4 6 ) . T a bl e 1 7 .9 cont a i ns t he N R C r e q ui re m e nt s a s w el l a s r e c o m me n d a ti o n s b y t h e A A P M . G r e a te r det a il s o n t hi s s ub je c t a r e p ro v i de d b y t h e A m e r i c a n N a ti o n a l S t a n d a r d s Ins t i t ut e (A N S I) ( 4 7 ) . A s d i s c u s s ed i n C h a p t e r 1 6 , t h e N R C r equi r e s f ul l c a li b r at io n o f a t el et he r a p y u n i t : ( a ) be f o re t h e f i r s t m e di c a l us e of t he uni t ; ( b ) w hene v e r s p ot - c he c k m e a s u r e m e n t s di f f e r b y m o r e t h a n 5 % f r om t he o ut p ut a t t he l as t f ul l c a l ib r a ti o n, c o r r e ct e d f o r r ad io a c tiv e d e c a y ; P.453 ( c ) f o l lo w i n g r ep l a c em e n t o f t h e so ur c e or r e l o c ati o n o f t he uni t ; ( d ) f ol lo w i ng r e p a i r s t h a t co u l d a f fe c t t h e s o u r c e e x p o sur e a s s e m bl y ; a nd ( e) a t i nte r v a l s n ot e x c e e di n g 1 y e a r . T h e N R C r e q u i re m e nts f o r f u ll c al i br a ti o n c he c k s i nc l ud e ( a ) o ut p ut b ei ng w it hi n 3 % f o r t h e r a n ge o f f i e l d si z e s a nd d i st anc e s us e d c l i ni c al l y , (b ) c o i nc id e nc e o f r a d i at io n a n d l i g ht f i el d s , ( c ) u n i f o r m it y o f r a d i at io n f i e ld a nd i t s d e p e nde nc e o n t h e o ri e n t at io n o f t h e r a d i a ti o n f ie l d , (d ) tim e r c o ns t a nc y a nd l ine a r i t y o v e r t he r a n g e o f u s e , ( e ) o n- o f f e r r o r , a nd ( f ) a c c ur a c y o f a l l d i st a nc e m e a s ur i ng a nd l o c al i z a ti o n d e vi c e s i n m e d i c al u s e .

C. Simulator
G e o m et ri c a c c u r a c y of a s i m u l at o r m us t be c o mp a r a bl e wi t h t ha t o f t he l i ne ar a c c e l e r ato r . T h e r e f o r e, t h e s i m u l at o r i s s ubj e c te d to t he s am e QA c he c k s a s t he a c c e l e r ato r e x ce p t f o r t h e c h e c k s re l at ed to t he i ma g e q ua li t y of t he f o r me r a nd t h e d o si m et r y o f t h e la t e r . A f o r m a l p e ri o dic Q A p r o g r a m f o r si mul a t o r s ha s b ee n p r o po s ed b y t h e A A P M ( 8 ) , w hi c h c o nt a i ns s p e c i f i c re c o m mend a t io ns o n t he s u b j e c t ( T a bl e 17 . 1 0 ) .

REFERENCES
1 . A C R . P h y s i c a l a s p e c t s o f q u a l i t y a s s ur a nc e . R e s t o n, V A : A m e r i c a n C o l le ge o f R a d i ol og y , 1 9 90 . 2 . A A P M . P h y s i c a l a s p e c t s o f q u a li t y a s s ur a nc e i n r a d i a t io n t he ra p y , R e p o r t N o . 1 3 C o l c h e st e r , V T : A ID C , 1 9 8 4 . 3. ACMP. R a d i a t io n p ro to c ol , c o n t r ol R e p o rt and No. q ual it y 2 a s s ur a nc e VA: in r a d i at io n C o l l eg e o nc ol o g y : of a s u g g e s te d R e s ton, American M e di c a l

Physics, 1986. 4 . H a n k G E , H e r r i n g D F , K r a m e r S . T he nee d f o r c o mp le x te c hno lo g y i n r a d i at io n o n c o lo g y : 5. P e te r s c o r re l at io ns LJ. of f a c i l it y c ha r a c t e r i st i c s for a a nd s t r uc t ure a s s ur a nc e with o ut co m e . In: C a n c e r 1 9 8 5 ;5 5 : 21 98 . De p a rt m e n t al s up po r t q ua l it y p ro g r a m . S t a r k s c h a l l G , H o r to n J , e d s . Q u a l i t y a s s ur a nc e i n r a d i ot he r a p y p hy s i c s . M a d i s o n, W I: M e d i c a l P h y s i c s , 1 9 9 1 :1 0 5 .

WWW.MEDRAD.IR

6 . IS C R O . R a d i a t io n o n c o lo g y i n i nt eg r a ted c a nc e r m a na g e m e nt : r e po r t o f t he In t e r - S o c i et y C o u n c il f o r R a di a tio n O nc o log y . R e s to n, V A : A m er i c a n C o ll eg e o f R a d i ol og y , 1 9 91 . 7 . A C R . Q u a l i t y a s s u ra n c e p r og r a m i n r a d ia t io n o nc ol og y . R e s ton, V A : A m e r i c a n C o l le g e o f R a d io lo g y , 1 9 89 . 8. AAPM. Comprehensive Q A f o r r a d i a ti on o nc o l o g y : r ep o rt o f t he R a d i a ti on T h e r a p y T a s k G r o u p 4 0 . M e d P h y s 1 9 9 4 ; 21 :5 8 1 6 18 . 9 . A A P M . E s s e n t i a l s a n d g u i d el i n e s f o r hosp i t al - b a se d me d i c al phy s i c s r e s i d e nc y t r a i n i n g p ro g r am s , R e p o rt N o . 3 6 C ol c he s ter , V T : A ID C , 1 9 9 0 . 1 0 . K h a n F M . R e s i d e n c y t r a i n i n g f o r m e di c al p hy s i c i s t s . M ed P hy s 1 9 9 1 ;1 8 :3 3 9 . 1 1 . K h a n F M . R e s id en c y t r a i n i n g f or m ed ic a l p hy s i ci s t s . I nt J R a d i a t O nc o l Biol P h y s 1 9 9 2 ; 2 4 :8 53 . 1 2 . A A P M . T h e ro le s , r e s p o n si b il it ie s , a nd st a t us f or t he cl i ni c al m e d i c al p hy s i c i st . C o l c h e s te r , V T : A ID C , 1 9 8 6 . 1 3 . A A P M . T h e r o l e o f a p h y s i c i s t i n r a di a tio n o nc o lo g y , R e po r t No . 3 8 C ol c he s te r , V T : A ID C , 1 9 9 3 . 1 4 . N a t h R , B i g g s P J , B o v a F J , e t a l . , A A P M c o d e o f p r a c ti c e f o r r a d io t he r ap y a c c e l e r ato r s : r ep o rt o f A A P M R a d i at io n The r a p y T a s k G r o up No . 4 5 . M e d P hy s 1 9 94 ; 2 1 :1 09 3 1 12 1 . 1 5 . IC R U . D et e r mi n a tio n o f ab s o rb e d do s e in a p a ti e nt i r ra d i at ed b y b e a m s o f x o r gamma rays in r a d i ot h e r a p y p r o ce d ur e s, Report No. 24 W a s hi ng t o n, DC: In t e r n a t i o n al C o m m i s si o n o n R a d i at io n U ni t s a nd M e a s ur e m e nt s , 1 9 7 6 . 1 6 . IC R U . U s e o f c o mp u t e r s i n e xt e r na l bea m r a d io t he r ap y p r o ce d ur e s w i t h hi g h energy 17. p ho to n s WR, and L a r sen e le c t ro n s , RD, R e po rt No . BE. 42 W a s hi ngt o n, D C : a li g nm e nt te s t s Int e r na t io na l fo r t he r a p y C o m m i s si o n o n R a d i ati o n U n i t s a nd M e a s ur em e nt s , 1 9 88 . L ut z B j r ng a r d Be a m a c c e l e r ato r s . I n t J R a d i a t O n c ol B i ol P hy s 1 9 8 1 ;7 : 1 72 7 . 1 8 . C e n t r al a x i s d ep th d o s e d a t a f o r us e i n r a d io t he r ap y . Br J R ad i ol 1 9 83 ; [ s up pl 17]. 1 9 . A A P M . A p r o t o c ol f o r t h e d e te r m i nat ion o f a b s o r b e d do s e fr o m hi g h e ne r g y p h o to n s a n d e l e ct r o n b e a m s . M e d P hy s 1 9 83 ; 1 0 :7 4 1 . 2 0 . N C R P . D o s i me t r y o f x - r a y a n d g a m m a ra y b e a m s f o r r ad i at ion t he r a p y i n t he e n e r g y r a n ge o f 10 k eV t o 50 M e V , R e po r t N o . 69 Bet he s d a , MD : N a ti o na l C o unc i l o n R a d i a ti o n P r ot e ct ion a n d M e a s ur e m e nt s , 1 9 81 . 2 1 . B o y e r A L . Q A f o u n d a t i o n s i n e q uip m ent s p e c i f i c ati o ns , a c c e p t a nc e t e st i ng, and c o m mi s s io n i n g . In : S t a r k s c ha l l G, Horton J, eds. Q ua li t y a s s ur a nc e in r a d io t h e r ap y p h y s i c s . M a d i s o n , W I: M e d i c a l P hy s i c s , 1 9 9 1 : 5 . 2 2 . B o g e R J , T ol be r t D D , E d l a n d R W . A c c e s s o r y b e am f l a tt e ning f i l te r f o r t he V a r i a n C l i n a c - 4 l i n e a r a c c e l e r ato r . R a d io lo g y 1 9 7 5 ;1 15 : 4 75 . 2 3 . K h a n F M , D o pp k e K , H o g s t ro m K R , e t a l . , C l i ni c al el e ct r o n-b e a m do s im et r y . R e p o rt o f t h e A A P M R a d i a tio n T he r a p y C o m m i tt e e T a s k G r o up N o. 2 5 . M e d P hy s 1 9 91 ; 1 8 :7 3 . P.454

WWW.MEDRAD.IR

2 4 . M c C u l l o u g h E C , E a r l J D . T h e s e l e ct io n, a c c e p t a nc e t e st i ng , and q ua l i t y c o nt rol o f r a d io t h e r ap y s i m u la t o r s . R a di ol og y 1 9 79; 1 3 1 :2 2 1 . 2 5 . C o n n o r s S G , B a t tis t a J J , B e rt i n R J . O n te c hni c a l s pe c i fi c a ti o ns o f r ad io t he r ap y s i m u l a to r s . M e d P h y s 1 9 84 ; 1 1 :3 41 . 2 6 . IE C . F u n c t i o n a l pe r f o r m a n c e c ha r a c te r is t i c s o f r a d io t he ra p y s i m ul a to r s . D r a f t R e p o rt . G e n e v a : In t er n a t i o n a l E l e ct ro t e c hni c a l Co m m i s si o n, S ubc o m m it te e 6 2 C , 1 9 90 . 2 7 . S u n t h a r a l i n g a m N . Q u a l i t y a s s ur a nc e o f r a d i ot he r a p y l o c al i zer / s i m ul a to r s . In: S t a r k s c h a l l G , H o r to n J , e d s . Q u a l i t y a s s ur a nc e i n r a d i ot he r a p y p hy s i c s . M a d i s o n, W I: M e d i c a l P h y s i c s , 1 9 9 1 :6 1 . 2 8 . B o m f o r d C K , e t al . , T r e a t m e n t s i m ul a to rs . Br J R a d i o l 1 9 89 ; [ sup p l 2 3 ] :1 4 9 . 2 9 . N C R P . Q u a l it y a ss u r a n c e f o r d i ag no st ic i m a gi ng eq ui p me nt , R e p or t No . 99 B e t h e s d a , M D : N a t io na l C o u n c i l o n R a d i at ion P r o t e c ti o n a nd M e a sur e m e nt s , 1 9 88 . 3 0 . C u s t o me r a c c e pta n c e t e st p ro c e d ur e f o r X i m a t ro n C - s e r ie s . P a l o A lt o , C A : V a r i a n A s s o c i a te s , 1 99 0 . 3 1 . IE C . M e d i c a l el e ct r o n a c c el e r at o r s , f unc t i o na l p e r f o rm a nc e , c ha r a c t e r i st i c s. G e n e v a : In t e r n a t i o n a l E l e c t r ot e c hni c al C o mm i s s io n, S ub c o m m i tt ee 6 2 C , 1 9 88 . 3 2 . G r i g sb y P W . Q u a l it y a s s u r a nc e 33. Flynn A. Q u a l i ty assurance o f r e m ot e on a a f te r lo a di ng eq ui p m e nt at t he M a l l i n c k r od t In s t it u t e o f R a d i ol og y . S e l e ct r on Br a c h y t he r a p y 1 9 89; 1 : 1 5 . c he c k M i c r o S e le c ti o n-H D R . S e l e c t ro n B r a c h y t h e r a p y 1 9 9 0 ;4: 1 1 2 . 3 4 . J o n e s C H . Q u a l i t y a s s u r a n c e i n b r a c h y t he r a p y us i ng t he S e l e c t ro n L D R / M D R a n d M i c r o S e le c t ro n - H D R . S e l e c t ro n Br a c hy t he r a p y 1 9 90 ; 4 : 48 . 35. Ezzell GA. A c c ep t a n c e t e s ti ng a nd q ua l it y a s s ur a nc e of hi g h dose r a te a f t e r lo a di n g s y s te m s . In : M a r t i n e z A A , O r to n C G , M o ul d R F , e d s . Br a c h y t he r a p y H D R a n d L D R . C o l u m b i a , M D : N u c l e t ro n, 1 99 0 : 13 8 . 3 6 . A A P M . R e m o t e a f te r lo a d i n g t e c hno lo g y , R e p o rt N o . 4 1 C ol c he s t e r , V T : A ID C , 1 9 93 . 3 7 . A l d ri c h J E , S a m a n t S . A t e s t p ha nt o m f o r H D R d a i l y q ua li t y c o nt r ol . A c t i v it y 1 9 92 ; 6 : 82 . 3 8 . G o et s c h S J , A t ti x F H , D e W e r d L A , et a l ., A ne w r e - e nt r a nt ioni z a t i o n c ha m be r for the c a l ib r a ti o n of Ir - 1 9 2 HDR s o ur c e s . I nt J Radiat O nc o l Bi ol P hy s 1 9 92 ; 2 4 :1 67 . 3 9 . G o et s c h S J , A t t i x F H , P e a r s o n D W , e t a l . , C a l i b r at io n o f a f t e r lo a di n g s y s t e m s . M e d P h y s 1 9 9 1 ; 18 : 462 . 4 0 . E z z e l l G A . E v a l u a t io n o f c a li b r at io n tec hni q ue f o r a hi g h do s e r at e re m ote a f t e r lo a di n g i r id i u m - 19 2 s o u r c e . E nd o c ur i ethe r H y p e r t he r m i a O nco l 19 9 0 ;6 : 10 1 . 41. der Rosenow G i e s se n UF, PH, Dannhausen van Kleffens HW, HJ, L ub b e r t et al., K, et al . , Q ua l i t y a s s ur a nc e of t he in t r e at m e n t p l a n n i n g : re p o rt f r om t he G e r ma n T a s k G r o up . In: B r ui nv i s IA D , V a n eds. P r o c ee d i ngs ni n t h i n t e r n a ti o n al c o n f e r e n c e o n t h e us e o f c o m p ut e r s i n r a d io t he r apy . S i l v e r S p r i ng , M D : IE E E C o m p u t e r S o c i et y , 1 9 87 . 4 2 . J a c k y J , W h i te CP . T e s t i n g a 3 -D r a dia t io n t he r ap y p l a nni ng p ro g r a m . I nt J R a d i a t O n c ol B i ol P h y s 1 9 9 0 ;1 8 :2 5 3 .
192

Ir hi g h d o s e r a te

WWW.MEDRAD.IR

4 3 . C u r r a n B , S t a r k s c h a l l G . A p ro g r a m f o r q ua li t y a s s ur a nc e o f d o se pl a nni ng c o m p u te r s . In : S t a r k s c h a l l G , H o rt o n J , ed s . Q ua l it y a s s ur a nc e i n r a di ot he r a p y p h y s i c s . M a d i s o n , W I: M e d i c a l P h y s i c s , 1 9 91 : 2 07 . 4 4 . V a n D y k J , B a r n e t t R , C y g l e r J , e t a l . , C o m m i s s io ni ng a nd Q A o f t r e a t m e nt p l a n n i n g c o m p u te r s . In t J R a d i a t O nc o l Bio l P hy s 1 9 9 3 ; 2 6 :2 61 273 . 4 5 . F r a a s B A . Q u a l i t y a s s u r a n c e f o r 3 - D t r ea t m e nt pl a nni ng . In: M a c k i e T R , P a l t a JR, eds. T e l et h e r a p y: present a nd f ut ure . M a d i s o n, W I: A d v a nc e d M e d i c al P u b l i s h i n g , 1 99 6 : 25 33 0 2 . 4 6 . N R C . C o d e o f f ed e r a l re g u l ati o ns , 1 0 C F R P a r t 0 50 W a s hi ng to n, D C : U . S . G o v e r n m e n t P r i n ti n g O f f i c e , 1 9 9 3 . 4 7 . A m e ri c a n N a ti o n al S t a n d a rd s Ins t i t ut e . G ui d el i ne s fo r m a i nta i ni ng c ob a lt - 60 and A cesium-137 center te let h e r a p y or e q ui pm e nt . is ANSI N 4 4 9 . 1 1 97 4 f r om LS New York: Co . , ANSI, A t ho l , 1 9 74 .
1

finder

w i g g le r

a v a il ab l e

S t a r re t t

Massachusetts.

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part II - Classical Radiation Th erapy > 18 - Total Body Irr adiation

18 Total Body Irradiation

T o t a l b o d y i rr a d i at io n ( T B I) w i t h m e g a v o lta g e p hot o n b e a m s i s m o s t c o m mo nl y u s e d a s p ar t o f t h e con d i t io n i n g r e gi m e n fo r b o ne m a r r o w t r a ns pla nt a t io n w hi c h i s u s e d i n t h e t r e at m e n t o f a v a r i e t y o f d i s e a se s s uc h a s l e uk e m i a , a p l a s ti c a ne m i a, l y m p h o m a , m u lt ip le my e l o m a , a ut oi m m une d i s e a se s , i nbo r n e r ro rs o f m et a bo li s m , a n d s o o n . T h e ro le of T B I i s t o de s t ro y t he r e ci p ie nt ' s bo ne m ar r o w a nd t umo r c e l l s , a n d t o i m m u n os u p p r e s s t he p a ti e nt s uf f i c i e nt l y to a v oi d r e j e ct io n o f t he d o n o r b o n e m a r ro w tr a n s p l a n t . U s ua ll y t he p at ie nt und e r go e s a c he m ot he r a p y c o n d it io n i n g p r og r a m b e fo r e the T BI a nd bo ne m a rr o w t r a ns p l a nt . Al t ho ug h c h e m o t h e r ap y a l o n e c a n b e u s e d a s a c ond i t io ni ng re g im e n, a d d it io n o f T BI i s c o n s i d er e d be n e f i ci a l f o r c e r t ai n d i s e a se s a nd c l i ni c a l co nd it ions . F o r e x a m p l e , T B I a l l o w s t h e d el i ve r y o f a h o m o ge ne ous d o s e to t he e nt i re b od y i nc l ud i ng s a n c t u a r y a r e a s w h e r e c h e m ot he r a p y m ay no t b e e f f e c ti v e . A ls o , s e l e ct ed p a rt s o f t h e b od y ( e . g . , l u n g s , k i d n e y s , he a d ) c a n b e s hi e l de d , i f d e si re d .

18.1. TECHNIQUES AND EQUIPMENT

N u m e r o u s t e c h n i q u e s h a v e b e e n us e d to d e li v e r T BI. D e t a il s o f s o m e o f t he c o m m o n l y u s e d t e c hn i q u e s a n d t he a s so ci a t ed d o si m et r y a r e d i s c us s e d i n t he l it e r at u r e a v a i l a bl e ( 1 , 2 ,3 , 4 , 5 ). e q u ip m e n t , The choice of a p a r t i c ul a r te c hni q ue d e pe nd s on t he s i ze , p h o to n be a m e ner g y , m a x i m um po s si b le f ie ld

t r e at m e n t d i st a n c e , do s e r at e , p a ti e nt di me ns i o ns , a nd t he need to se l e cti v e l y s h i e l d c e rt ai n b o d y s t r u c t u r e s . A n a nt e r o po s t er io r ( A P / P A ) t e c hni q ue g e ne r al l y p r o v id e s a be tt e r do se u n i f o r m it y a l o ng t he l o ng it ud i nal b od y a x is b ut t he p at ie nt p o s it io n i n g , ot h e r t ha n standing up r i g ht , may pose p ro bl e ms . Bi l a t e r al T BI ( t r e at i n g f ro m le f t a nd r i g ht ) c a n b e mo r e c o m f o rt a b le to t he p at i e nt i f s e at ed o r l a y i n g do w n s u p i n e o n a T B I c o uc h, b ut p r e s e nt s g re a te r v ar i a ti o n i n b od y t h i c k n e s s a lo n g t h e pa t h o f t h e be a m . C omp e ns a t or s a r e r eq ui r ed to a c hie v e d o se u n i f o r m i t y a lo n g t he b o d y a x i s t o w it hi n + 1 0 % , a lt ho ug h e x t re m it i e s a nd so me n o n c r i t i c al s t r u c t u re s m a y e x c e e d t hi s s pe c if i c a t io n.

A. Beam Energy
L o w e r e n e rg y m e g a v olt a g e be a m s ( e . g . , c o ba l t - 60 ) ha v e b e e n us ed t o de li v e r T BI, e s p e ci a ll y f o r p ro to col s i n v ol v i n g lo w do s e r a t e o f 5 t o 1 0 c G y /m i n. A r e v i e w o f t h e s e t e c h n i q u e s a n d t h e mo d i fi c a ti o ns req ui r e d to a c hi e v e l a rg e ho mo ge ne o us f i e l d s wi t h t h e se m a ch i n e s i s s u m m a r i z e d in t he A A P M R e p o r t No. 1 7 ( 3 ) . Be c a us e l i n e a r a c c el e r at o r i s t h e m o s t co m m o nl y us e d e q ui p me nt f o r ra d i a tio n t he r a p y , c u r r e n t T B I t e c h n i q u es h a v e b ee n a do pt e d f o r li na c s . T he c hoi c e o f p ho to n be a m e n e r g y i s di c t at e d b y p a t ie n t t h i c k ne s s a nd t he s pe c i f i c at io n o f d os e ho mo g e nei t y. In a d d i t i o n to t h e t h ic k n e s s v a r i a t i o n a l o ng t he a x i s o f t he p a t i e nt , t he p a ti e nt

WWW.MEDRAD.IR

d i a m et e r al o n g t h e pa t h o f b e a m a l so a f f e c t s do s e uni f o r mi t y , d e p e ndi ng up o n b e a m e n e r g y . A s di s cu s s e d i n C h a p te r 11 , S e c t io n 1 1 .5 A , t he t hic k e r t he pa ti e nt , t h e h i g h er i s t h e be am e n e r g y r e q ui re d to p r o d uc e a c c ep t a bl e dos e uni f o r mi t y f o r p a r a l le l -o pp o se d f i el ds . A t e r m t i s s ue l at e ra l e f f e c t ha s b e e n us ed t o de s c r ib e t he s i t u a ti o n i n P.456 w h i c h l o w e r e n e r g y or a t h i c k e r p at i e nt t rea t e d w it h p a r a ll el - op po s e d b e a m s c a n g i v e r i se t o a n e x c es s i v e l y h i g h e r do s e to t he s ub c ut a ne o us ti s s ue s c o m p a re d w i t h t h e m i dp oi n t d o se . F i g u r e 18 . 1 s ho w s t ha t t he r a tio o f t he m a x i m um d o se to t h e m id li n e do s e i s a f u n c t i o n o f e ne rg y a nd p a ti e nt t hi c k nes s w he n p a r a l l el o p po s ed be a m s a re us e d . No t co ns id e r i ng t he i ni ti a l do s e b ui ld- up e f f e c t , i t i s seen that higher the beam e n er g y , g r ea t e r is t he do s e uni f o r m it y for a ny t h i c k n e s s p a ti e n t . If t h e m a x i m u m t hi c k nes s o f t he p a ti e nt p a ra l l el to t he be a m c e n t r a l a xi s i s l e s s t h a n 3 5 c m a nd so ur c e -t o - s ur f a c e do s e ( S S D ) i s a t l e a st 300 c m , a 6 - M V b e a m c a n b e u s e d f o r p a r a ll el -o p po s ed T BI f i e l d s w it ho ut i nc r e a si ng t h e p e ri p h e r al d o s e to g r e at e r t ha n 1 1 0% o f t he m i d li ne d o se . F o r p a t ie nt s o f t h i c k n e s s g re a te r t h a n 3 5 c m , e ne rg i e s hi g he r t ha n 6 M V s houl d be us ed t o m i n i m i z e t h e t i s s u e l at e r al e f f e c t .

F I G . 1 8 . 1 . A p l o t o f th e r a t i o o f d o s e a t d m a x t o t ha t a t t he mi d pl ane a s a f unc t i o n o f p a ti e n t t hi c k n e s s f o r a n u m b e r o f b e a m ene r g i e s . T he s ha d e d re g io n r e p re s e nts a 1 5 % s p r e ad i n t h e r a t io . R e gi o ns A a nd B r e p r e se nt t he r a ng e o f a d ult p at ie nt t h i c k n e s s i n t h e A P a n d l a t e r al d i re c ti o ns , r e s p e c ti v el y . S S D , s o ur c e - to - s ur f a c e d i s t a n c e i n ce n t i me ter s . ( F r o m A me r i c a n A s s o c i a tio n o f P hy s i c is t s i n Me d i ci ne .

WWW.MEDRAD.IR

T h e p h y s i c a l a sp e c t s o f to t al a n d ha l f b ody p ho to n i r r ad i at io n. A A P M R e p o r t N o . 1 7 . C o l c h e st e r , V T : A I D C , 1 9 8 6 , w i t h p er m i ss i o n. )

B. Initial Dose Build-up

S u r f a c e o r s k i n do s e in m e g a v ol t a ge be a m s i s s ub s t a nt i al l y l e s s t ha n t he do s e at t h e p oi n t o f m a x i m u m d o s e ( D m a x ) , a s ha s b e e n d i s c us s ed i n C ha p t e r 1 3 , S e c ti o n 1 3 . 3 . T h e d o se b u il d -u p c h a r a c t e r i st i c s de pe nd o n m a ny f a c t o r s s uc h a s e ne r g y , f i e l d si z e , S S D , a n d b e a m a n g l e r el a ti v e t o t he s ur f a c e . D o se b ui l d - up d at a o b t ai n e d at n o r m al SSDs (e.g., 100 c m) does not a pp l y a cc ur a t e l y at T BI d i s t a n c e s ( e . g . , 40 0 c m ) b e c a u s e o f t he lo ng e r d i st a nc e a nd the i nt e r v e ni ng a i r ( 1 ) . H o w e v e r , mo s t T B I p r o to c ol s do not r eq ui r e s k i n sp a r i ng . Ins t e a d , a bo l us or a b e a m s po il e r i s s pe c i f ie d t o b ri ng t he s ur f a c e d o se t o a t le a s t 9 0% o f t he p r e s c r ib ed T B I d o s e . A l a r g e s po il e r s c re e n o f 1 - t o 2 - cm t hi c k ac r y l i c i s s uf f i c i e nt t o m ee t t h e se r e q u i r em e n t s , p r o v id e d t he sc r e e n i s p l a c ed a s c l os e a s p o s s i bl e to t h e p a ti e n t s u r f a c e .

C. Patient Support/Positioning Devices

Patient s u pp o rt and p o s it io n i n g d e vi c e s are d e s ig ne d to im p l em e nt a g i ve n t r e at m e n t t e c h n i q u e . Im p o r t a n t c ri t er i a inc l ud e p a ti e nt co m f or t , s t a bi li t y , a nd r e p r od u c i bi li t y o f s e t -u p a n d t r e at m e nt g eom e t r y t hat a ll o w s a c cur a t e c a l c ul at io n and d e l i ve r y of d o se in a c c o r d a nc e w i th t he T BI p r o t o co l . T he f o l l o w i ng t e c h n i q u e s a r e c u r re n t l y i n u s e a t t he U ni ve r s it y o f M i nne s o t a and a r e p r e se nt ed h e r e a s e x a m pl e s . T he a s s o ci at e d eq ui p ment ha v e be e n de s ig ned to m e et v a ri o us p r ot o co l c r it e ri a , b a s ed p r i n c i pa ll y o n t w o t ec hni q ue s : A P / P A a nd b i l at e r al .

C.1. Bilateral Total Body Irradiation

A t e c h n i q u e i n v o l v i n g l e f t a n d r i g ht l at e r al op p o si ng f ie l d s w i t h t he p at i e nt s e at ed o n a c o u c h i n a s e m i - f e t al p o si ti o n w a s d e s i g ned b y K ha n e t a l . ( 1 ) . Ba s i c t r e at m e n t ge o me t r y i s P.457 i ll u s t r a te d i n Fi g . 1 8. 2 . A s pe c i al T BI c ouc h a l l o w s t he p a ti ent to b e se a ted c o m f o rt a b l y w it h t h e b a c k s u p p o rt e d a nd l eg s s e m i - col l a p se d a s s e e n i n F i g . 1 8 . 3. T h e a r m s a r e p o si ti o ne d l a t er a ll y to f ol lo w the b od y c o nto ur a nd p l a c ed i n co nt a ct w i t h t h e b o d y a t t h e m i d A P - t h i c k ne s s l e v el . C a r e i s t a k e n t o a s s ur e t ha t t he a r m s s h a d o w t h e l u n g s i n st e a d o f t h e s pi na l c ol um n l o c a te d po st e r ior l y . T he p a t ie nt set-up is re c o rd e d in terms of d i st a nc es m e a s ur e d b et w e e n e x t e r na l bo ny l a n d m a r k s a s s h o w n i n F i g . 1 8 . 4 . T he s o ur c e - to - b od y a x i s d i s t anc e i s m e a s ur e d b y a s a g i t t al l a s e r li gh t i n s t a l le d i n t he c e ili ng t o m a r k t he T BI d i s t a nc e . T he l a s e r l i g h t al so h e l p s t o po s it io n t h e p at ie nt ' s s a g i tt a l a xi s a t ri ght a ng l e s to t he b e a m ' s c e n t r al a x i s .

WWW.MEDRAD.IR

FIG.

18.2.

Schematic

d ia g r a m

i ll us t r at ing

p a ti e nt

se t - up

ge o m et r y

for

t he

b i l at e r al T B I t e c h n i q ue . ( F r o m K ha n F M , W il li a m s o n J F , S e w c ha nd W , e t al . Ba s i c d a t a f o r d o s ag e c a l cu l a t io n a n d c o m pe ns a t io n. 1 9 80 ; 6 : 74 5 7 51 , w i t h p e r m i s si o n . ) L a t e r al bo d y t h i c k n e ss a l o n g t he p a ti e nt ax i s v a r i e s c o ns id e r ab ly i n t he b il a te r al T B I t e c h n i q u e . T o ac h i e v e d o se uni f o r mi t y w i t hi n a pp r o x im a te l y + 1 0 % al o ng t he s a g i tt a l a xi s o f t h e bod y , c o m p e n s a to r s a r e d e s i g ned f o r he a d a nd ne c k , l ung s ( i f n e e d ed ) , and le g s . The r e f e r e nc e t hi c k ne s s for co m p e ns at ion is t he l a te r a l d i a m et e r o f t h e bo d y a t t h e l e v el o f um b il i cus ( no t i nc l ud i ng t he a r m s ) , a s s um i ng t h a t t h e p r ot o co l sp e ci f i e s do s e p r e s c ri pt io n t o be a t t he mi d po i nt a t t he le v e l o f u m b i li c u s . C o m p e n s at o r s can be d e s ig ned o ut of a ny m a t e ri a l , b ut at t he U n i v e r s it y o f M i n n e s o t a t h e y a r e c us t o m -m a d e o ut o f a l um i num . A s p e c i a l t r a y a n d c l a m p s a r e u s e d to h o l d t h e s e c o mp e nsa t o r s i n pl a c e ( F ig . 1 8. 5 ) . F i e l d l ig ht P.458 i s u s e d to c a st a s h a do w o f t h e co m pe ns a t or o nt o t he p at ie nt ' s bo d y . A l ig nm e nt is c h e c k e d u s i n g s h a d o ws o f p o si ti o ni ng p e gs o n t he c o mp e ns a to r s a nd t he p a ti e nt ' s r e f e r e n c e bo n y l a n d m a r k s . I nt J R a d i at O nc o l Bi ol P hy s

WWW.MEDRAD.IR

F I G . 1 8 . 3 . P h o t og r ap h d e mo n s t r a ti ng pa ti e nt se t - up o n t he TBI c o uc h f o r t he b i l at e r al te c h n i q u e .

F I G . 1 8 . 4 . P a t ie n t pos i ti o n i n g m e a s ur e me nt s . ( F r o m K ha n F M , K im T H . T o t al bo d y i r r a di a ti o n. In : P a li w a l B R , G r ie m ML , eds . S y l l a b us : a c a t e g o r i c al c o ur s e i n r a d i at io n therapy. Oakbrook, IL : R a d io lo g i ca l S o ci et y of North A m e r ic a , 1 9 86 : 1 11 1 1 6 , w it h p e r m i s si o n . )

C.2. AP/PA Total Body Irradiation

The p a ti e n t is i r r a di a t ed a n te r op o st e ri o rl y by p a r al le l -o pp o se d f ie ld s w hile p o s it io n e d i n a s t a n d in g u p r i g h t p o si ti o n a t t he T BI d i s t a nc e . T hi s t e c hni q ue w a s d e v e lo pe d a t t h e M e mo r i al S l o a n K et te r i ng H o s p it a l i n N e w Y o r k ( 6 ) a nd a d o pt ed a t t h e U n i v e r si t y o f M i n n e s o t a . D et a il s o f t he t e c hni q ue a nd the m o d i fi c a ti o ns

WWW.MEDRAD.IR

m a d e to it to a c co mm o d at e s h i el di ng o f sp e c i f i c o r g a ns s uc h a s l ung s , k i d ne y s , and brain, are d e s c ri b ed b y D us e nb e r y a nd Gerbi ( 5 ) . T he p r i nc i pl e o f t he t e c h n i q u e i s t h a t t h e s t a n d i n g T B I a l l o w s shi e l di ng o f c e rt a i n c r it i c al o r g a ns f r o m p h o to n s a n d bo o st i ng o f s u pe r f i c i al t i s s ue s i n t he s ha do w o f t he b lo c k s w i t h e l e ct r o n s . Fo r e x a m ple , d o se to t he l ung s c a n b e r ed uc e d us i ng l ung b lo c k s o f a b o u t o n e h a l f - v a l u e t h i c k n e s s a nd t he c he s t w a l l und e r t he b l o c k s c a n b e b o o st ed w i t h e le c t ron s o f a p p r o p r ia t e e ne r g y . F o r a s p e c i al g r o up o f p a ti e nts t r e at e d for i n bo r n error of m e t ab ol i s m s uc h as H ur l e r ' s s y nd r o m e , a d r e n ol e u k o d y s t ro p h y a n d m e t a c hro m a ti c le uk o d y s t r op hy , T BI c a n b e d el i ve r ed A P / P A w i t h t h e h e a d t u r n e d s i d e w a y s a nd t he b r a i n P.459 s h i e l de d w it h f i v e h a l f- v a l u e l a y e r b lo c k s . T he s hi e ld e d s k ull a r ea i s t he n b oo s te d w i t h e l e ct ro n s o f a p p ro p r ia t e e n e r g y to s p a re t he b r a i n.

F I G . 1 8 . 5 . P h o t o gr a ph o f T B I c o m p e ns a t o rs i n a c t ua l us e . C o m p e ns a t io n p ie c e s a r e m o u n t e d o n t h e T B I t r a y i n s e r t e d i nto he a d o f t he m a c hi ne .

WWW.MEDRAD.IR

F I G . 1 8 . 6 . P a t ie n t i n t h e st a n d i n g T BI po s iti o n w it h t he he a d t ur ne d si d e w a y s fo r s h i e l di n g o f t h e b r ai n. A 5 - H V L c e r r ob e nd b l o c k i s mo unt e d o n a n a c r y l i c pl a te a t t a c h ed to t h e T B I s t a n d . ( F r o m D us e nb e ry K E , G e r b i BJ . T ot a l b o d y i r r a di a ti o n i n c o n d it io n i n g r e gi me n s f o r b o ne m a r ro w t r a ns p l a nt at io n. In: L e v i tt S H , K ha n F M , P o t i s h R A , e t a l . , e d s . P h i l ad el p hi a : L ipp i nc ot t Wi ll i am s & W ilk i ns , 1 9 99 : 4 99 5 1 8 , w i t h pe r m i s si o n .) T h e A P / P A t e c h n i q u e c a n a l s o b e a d o pt ed f o r t r e a ti ng s m a ll c hi l d r e n i n t he r e c l i ni n g p o si tio n . T h e p a ti e n t i s t re a te d in t he s up i ne a nd p os t e ri o r po si ti o ns w h i l e l a y i n g do w n o n a l o w - h e i g ht c o uc h, w i t h t he c o uc h to p o nl y a f e w i nc he s o f f t h e f lo o r . T h e s h i el di n g bl o c k s a re pl a c ed on t o p o f a n a c r yl i c b ox t r a y a t a s ho rt d i s t a n c e f r o m t h e p at ie n t ' s s u r f a c e . T he t r ay , w hi c h i s a b o ut 1 cm t hi c k , a l so a c ts a s a b e am s po il e r to b u i l d u p t he s k i n do se to at le a s t 9 0% o f t he p re s c r ip ti o n

WWW.MEDRAD.IR

d o s e w h e n t r e at ed w it h p a r a l le l -o pp o se d TBI f i e l d s . F i g ur e s 18 .6 a nd 1 8 . 7 s ho w A P / P A t e c h n i q u e f o r s t a n d i n g a n d r e c l i ni ng T BI, r e s p e c t i v el y .

D. Dosimetry Data
D e t ai l s o f m a c h i n e ca l i b r ati o n , do s im e tr y , a nd mo ni to r unit c al c ul a ti o n fo r T BI h a v e b e e n di s c u s s e d i n t h e l it e r at ur e ( 1 , 2 ,3 , 4 , 5 ) . A di r e ct o ut put c a l ib r a ti o n o f t h e m a c h i n e f o r T B I m a y b e p e r f o r me d b y m e a s ur i ng d o se p e r mo ni to r uni t us i ng a 0.6 cm3 F ar m e r ty p e io n i z a ti o n c ha m b e r
3

p l a ce d

in

water

p ha nt o m

of

d i m e n si o n s a pp r o x im at e l y 4 0 4 0 4 0 c m . T he p o si ti o n o f t he cha m b e r i s f i x e d a t t h e T B I d i s t a n c e ( so u r c e - to - bo d y a x i s di st a nc e ) . T he c o ll i m ato r i s o pe ne d t o i t s m a x i m u m s i z e a n d t he c h a m b e r d ep t h i s va r i e d b y mo v i ng t he c ha m b e r a nd t he p h a n t o m w h i l e k e ep i ng t h e s o u r c e -t o - c ha mb e r d i st a nc e P.460 c o n s t a n t ( = T B I d i s t an c e ) . A t a b l e o f o ut put f a c t o r s ( d o s e pe r M U ) i s g e ne r a t ed a s a f u n c t i o n o f de pt h t h a t c a n be us e d t o ca l c ul a te m o ni to r uni t s f o r a p at ie nt of g i v e n m id li n e de pt h at t h e p r e s c ri pt io n po int . It i s a s s um ed i n thi s c a s e t ha t t he p a t ie n t is do s im et r ic a l l y eq u i v a le nt to t he p ha nto m , w hi c h is not a b ad a p p r o xi m a ti o n c o n s ide r i n g t h e f a c t t ha t tis s ue m a x i m a l r a ti o s ( T M R s ) f o r l a r g e f i e l d s (e . g . , > 3 0 3 0 c m ) a r e n o t v e r y s e ns i ti v e t o f ie ld d i me ns io ns .

F I G . 1 8 . 7 . P e d i a tr i c p a t ie n t i n t he r e cl i ning T BI p o s i ti o n o n t he f l oo r . T he le gs are p l a c ed in the frog l eg ge d p o si ti o n t o c o v e r t he e nti r e p a t i e nt i n t he r a d i at io n f i e l d w it h a d e q u a te m a r g i ns . Br a in- s p a r i ng s hi e ld i ng blo c k i s p l a c ed o n t o p o f a n a c r y l i c t r a y t o s h a d o w t he c e nt r a l p a r t o f t he s k ul l w i t h t he he a d t ur ne d sideways.

WWW.MEDRAD.IR

A l t e r n a ti v e to di r e ct o u t p u t f a c t o r m e a s ure m e nt s , i s t he c a l c ula t io n f o r m al i s m b a s e d o n T M R s , S c , S p , a n d t h e i nv e r s e s q ua r e l a w f a c t o r ( s e e C ha p t e r 1 0 ) . T he b a s i c e q u at io n t o c a l cu l a t e do s e pe r m o nit or uni t ( D / M U ) i s :

w h e r e D i s d o se i n c Gy , k i s 1 c G y / M U und er r e f e r e nc e ca li b r at io n c o nd it io ns , T M R i s t h e t i s s u e - m a xi m u m r a t io a t d ep t h d and f i e l d si z e e q ui v a lent t o t he p at ie nt ( r e ) , S c i s t h e co ll i m at o r s c a tt e r f a c to r f o r t he f i el d si z e p ro j e ct e d a t i so c e nter ( r c ) , S p i s t h e p h a n t om s c a t te r f a c to r f o r the p a ti e nt -e q ui v a le nt f i e l d s i z e ( r e ) , f i s t h e s o u r c e - to - c al i b r ati o n p oi n t d i st a nc e , f i s t he s o ur c e -t o - pa ti ent a x i s d i s t a nc e at the p r e s c ri pt io n p o i nt , OAR is o f f - a xi s r a ti o at de pt h d, a nd TF is t he t r a n s m i s s io n f a c t o r f or t h e b l o c k t r a y , b e am s p o il e r or a ny o t he r a b s o r be r p l a ced b e t w ee n t h e m a c h i n e d i a p h r a g m a nd t he pat i e nt . T h e e q u i v a le n t f ie ld a t t h e po i n t o f c al c ul a ti o n me a ns t ha t it i s do s i me t ri c a ll y e q u i v a le n t t o t h e p at i e nt i n t e rm s o f s ca t t er . In t he o r y o ne c o ul d de te r m i ne e q u i v a le n t f i e ld by doing C l a r k so n i nt e gr a t io n (see C ha p t e r 9 ) of a scatter f u n c t i o n ( e . g . , s c a t t er - a i r r a ti o , S A R , o r s c a t te r - m a x i m um r a tio , S M R ) a t t he p o i nt o f c a l c u l at io n in t h e p at ie nt a nd c om p a r i ng i t w it h t he a v e r a g e s c at ter f u n c t i o n c a l c u l at e d a t t h e s a m e d ep t h f or a s q ua r e f i el d i n a w a ter p ha nt o m . S uc h c a l c u l a ti o n s d o n e fo r a s t a n d a r d R a nd o p ha nt o m e xp o se d t o a T BI f i e l d ha v e b ee n r e p o rt ed i n t h e l it e r at u r e ( 7 ) a n d a re p re se nt e d i n T a bl e 1 8 .1 . F o r e x a mp l e , f o r t h e u m b i li c u s p oi n t , t h e R a n d o p ha nt o m -eq ui v a l e nt f ie l d i s 2 8 2 8 c m o n t he a v e r a g e . A lt h o u g h p at i e nt d im e n s io ns v a r y , s c a t t e r f a ct o r s ar e no t to o se ns it i v e t o f i el d s i z e v a r i at io n f o r l a r g e f i el d s . T he re f o r e , it i s r e a s o na ble t o us e a f i x e d e q u i v a le n t f ie ld si z e fo r T B I. A 4 0 40 c m f i el d fo r l a r ge p at ie nt s a nd a 30 30 c m f i e l d f o r p ed i at r ic p a t i e n t s s ee m to b e r e a s o na bl e a p pr ox i m a t io ns ( w i t hi n a p p r o xi m a te l y 2 % o f d o s e a c c u r a c y ) . T h e T M R d a t a o b t ai n ed u n d e r s t a nd a r d c o nd i ti o ns ( a t i so c e nte r ) m us t b e c he c k e d f o r it s v a li di t y at t h e T B I d i s t a nce . In a d d it io n, t he i nv e r s e s q ua r e l a w f a ct or m u s t a l s o b e v e ri f i ed f o r t h e T BI d i s t a nc e . A l t e r na ti v e l y , D /M U c a l c ul a t ed b y E q u a t i o n 1 8 . 1 u s i n g st a n d a r d T M R s , S c , S p a nd i nv e r s e s q ua r e l a w f a c t o r s m a y b e c o m p a re d w i t h di r e ct ly P.461 m e a s u r e d o u t p u t f a c to r s ( D / M U ) a t t he T BI d i s t a nc e . If t he d i f fe r e nc e i s w it hi n + 2 % , E q u a t io n 1 8 .1 m a y b e u s ed f o r T BI a s it i s us e d fo r r eg ul a r i so c e ntr ic t r e at m e n t s . La r g e r d if f e r e n c e s s ho ul d b e inv e s t i g at e d a nd , i f ne c e s s a r y , d i re c tl y m e a s u r e d o u tp u t f a c to r s a t t h e T BI d i s t a nce s ho ul d b e us e d .

TABLE 18.1. EQUIVALENT FIELD AT VARIOUS POINTS OF CALCULATION IN A RANDO PHANTOM IRRADIATED WITH TBI FIELD USING DIFFERENT BEAM ENERGIES

WWW.MEDRAD.IR

S i d e of E qu i v a le n t S q u a r e ( c m ) P h ot on E n e r g y Head Neck C h e st Umbilicus Hips

Co-60

17

22

31

30

28

4 MV

16

20

30

29

23

6 MV

18

23

29

27

26

10 MV

17

22

33

27

26

18 MV

>18

>18

>18

>18

>18

Mean

17

22

31

28

26

L a t e r al d i m e n si o n

15

1 2 1 6

31

27

31

Equivalent length

19

30

31

29

20

F r o m K i rb y H T , H a n s o n W F , C a t e s D A . V e r i f i c at io n o f to t al bo d y p hot o n i r r a di a ti o n d o si m et r y t e c h n i q u e s . M e d P hy s 1 9 88 ; 1 5 :3 64 , w i t h p er m i s s io n.

E. Compensator Design
M o s t T B I p r o t o co l s re q u i r e do s e ho mo g e ne i t y a lo ng t he b od y a x i s t o b e w i t hi n + 1 0 % . T h i s r e q u i r e men t c a n n o t b e m e t w i t ho ut t he us e o f c o m p ens a t o r s . G e ne r a l p r i n c i pl e s thickness, of co m pen s a t o r of d e s ig n ha v e b ee n d i s c us s ed a nd in C ha p t e r 12. C o m p e n s a to r d e si g n f o r T B I i s c o m p l i c at ed b e c a us e o f l a rg e va r i a ti o n i n b od y lack c o m p le te bo d y im m o bi li z a t io n, i nt e r na l t i s s ue h e t e ro g e n ei ti e s . C o n si d e ri n g o n l y t he l ung i nho m o g e nei t y a nd c ha ng e i n b o d y t h i c k n e s s , c o m pe n s a to r s c a n b e de s i g ned t o de li v e r t he d o se w i t hi n a c c e pt a bl e uniformity. The design to of TBI c o m p e n s at o r s de p t h is at d i s c us s e d t he in t he li te r a t ure po i nt , (1,3,8). of T he t he t h i c k n e s s o f co m p e n sa t o r re q u i re d al o ng a r a y - l i ne d e pe nd s o n t he ti s s ue de f i c it c o m p a re d the re f e r e n c e p r e s c r ip ti o n m a t e ri a l c o m p e n s at o r (e . g . , its d e n s it y ) , d i st a nc e o f t he co m pe ns a t o r f r o m t he po i nt o f d o s e co m pe n s a t io n , de p t h o f t h e po i nt o f do s e co m p e ns at io n, f i e ld s i z e , a nd be a m energy ( s ee C h a p ter 12). B e c a us e t he c o mp e ns a to r is d e s ig ne d to be

WWW.MEDRAD.IR

d o s im e tr i c al l y eq u i v a le n t to a bo l us (o f t hic k ne s s e q ua l to t he tis s ue d e f i ci t ) b ut p l a c ed a t a d i s t a n c e f r o m t h e s k i n s ur f a c e , t he b o l us - e q ui v a l e nt t hi c k ne s s o f t he c o m p e n s at o r i s r ed u c e d to c om p e ns at e f o r r e d uc t io n i n s c a tt e r re a c hi ng t he poi nt o f d o s e co m pe n s a t io n . T h e r e q u i r e d t hi c k nes s o f a t i s s ue - e q ui v a le nt c o m pe ns a to r t h a t gi v e s t h e sa m e d o s e at t h e po i nt o f int e r e st a s w o ul d a bo l us o f t hi c k ne s s e q u a l t o t h e ti s s u e def i c i t , i s c a ll ed t he t hi ck ne s s r a t io ( ) ( 9 ) . The d e pe nd s o n many variables b ut for of a TBI an average is v a l ue of 0.70 p r o v id e s a go od all a p p r o xi m a ti o n fo r al l b e a m e n e r gi e s a nd c om p e ns a ti o n co nd it io ns ( 1 ) . T he o v e r all d o s im e tr i c accuracy c o m p e ns a to r a p p r o x i m at el y +5% c o ns i d e ri ng v a r i a b le s ( 1 , 9 ) . T h e t h i c k ne s s o f a c o m p e n s a to r , t c , a t a ny p o i nt i n t he f i e ld i s giv e n b y :

w h e r e T D i s t h e t i s s ue d e fi c it a n d c i s t he d e ns it y o f t he co m pens a t o r . E q ua ti o n 1 8 . 2 g i v es c o m pe n s a t o r t h i c k n e s s b a s ed o n t i s s ue d e f i ci t a t a g i v e n p o i nt b ut d o e s n ot t a k e i n to a c co u n t c r o s s - b e am p r o fil e o r o f f - a x i s r a t io . A n a l t e r n a ti v e m et h od o f d et e r mi ni ng c o mp e ns a t or t hi c k ne s s , t c , a t a ny p o i nt i n t h e f i e ld i s b a s ed o n th e f o l lo w i n g e q ua ti o ns ( 3 ) :

P.462

and

w h e r e I o a n d I a re t he d o se s a d mi ni s te r ed b e f o r e a nd a ft e r t he c o m p e ns at o r i s added, T(AR, dR) and T(A,d) are t he ti s sue - p ha nt o m r at io s or T M R s f o r t he r e f e r e n c e bo d y s e ct ion a n d t h e s e c t io n to be c o m pe ns a t ed f o r equi v a l e nt f i el d s A R a n d A a t m id li n e d ep th s d R a n d d , O A R d i s the o f f - a x i s r a t io at d ep t h d r el a ti v e to t h e p r e s c ri p tio n p o i n t, a n d e f f i s t he e f f e c t i v e li ne a r a tt e nua t ion c o e f f i c i e nt f o r t h e c o m pe n s a t or m a t er i a l m e a s u r ed und e r T BI c o nd i t io ns .

WWW.MEDRAD.IR

F I G . 1 8 . 8 . S c h e m a t i c d i a g r a m s ho w i ng a r ea s o f c o m p e ns a ti o n. ( F r o m K ha n F M , W i l li a m so n JF, Sewchand W, et al. Ba s i c data for do s a g e c a l c ul a t io n a nd c o m p e n s at io n . I n t J R a d i a t O n c ol Bi ol P hy s 1 9 80 ; 6 : 74 5 7 51 , w i t h p e r m i s si o n. ) D e p e n di n g o n t h e ti s su e d e f i ci t s e nc o unt e red i n a p a r ti c ul a r T BI te c hni q ue ( A P / P A o r bi la t er a l ) , co m pe n s a t o r m a te r i al s ho ul d be s el e ct e d so t ha t t he c o mp e ns a to r i s n o t to o b u l k y o r o f t oo h i g h a d e ns i t y tha t s m a l l e r ro r s i n m a c hi ni ng w o ul d amount to l a rg e er r o r s in dose. Be ca us e of t he s e a nd o t he r p r a c ti c al c o n s i d er a ti o n s , a l u m in u m c o m p e ns a t o r s a re us e d a t t he U ni v e r si t y o f M i nne s ot a . T h e c o m p e n s a to r s a re d e si g n e d i n t w o di m e ns io ns ( v a r y i ng in t hi c k ne s s o nl y a l o n g t h e s ag it t al bod y a x i s ) a n d a re he ld i n t he b e a m b y c l amp s a tt a c he d t o a c o m p e n s at o r t r a y ( F i gs . 1 8 . 5 , 1 8 . 8 ) . C o m p e n s a to r s c a n b e d e si g n e d no t o nl y to ta k e i nt o a c c o unt ti s s ue de f i c it b ut a l s o ti s s u e i n h o mo g en e i ti e s s u c h a s l ung s . In t he l a t t e r c a s e , a b ul k d e ns i t y c o r r e ct io n i s u s e d t o ca l c u l a te r a d io lo gi c p a th l e ng t h t hr o ug h t he inho m o g e nei t y .

F. In Vivo Patient Dosimetry

A f t e r a p a r t i c u l ar T B I t e c h n i q u e ha s b e e n e s t a b li s he d a nd c o m m i s si o ned f o r c l i n i c al u s e , i t i s r e com m e n d e d t ha t a n i n v i v o d o si m et r y c he c k b e p er f o r m ed o n t h e f i r s t 20 o r s o p a tie n t s . T h e r m o l umi ne s ce nt d o si m et e r ( T LD ) c a p s ul e s o r c hip s , s u r r o u n d e d b y s u i t a bl e b u il d - u p bo l us , ma y b e p l a c ed o n t he p a t ie nt s k i n a t s t r a te g i c lo c a ti o n s an d d o se s m e a s ure d fo r t he a c t ual t re a tme nt s gi v e n. T L D r e s u l t s s h o u ld b e co mp a r e d w it h e x p e ct e d do s e s , c a l c ul at ed b y s um m i ng e nt r a nc e a n d e x i t d o se s a t t h e lo c a ti o n o f t he T LD s a nd t a k i ng i nt o ac c o unt t hi c k ne s s v a r i a t io n , c o mp e n s a tio n , a n d o f f - a x i s r ati os a t t he d e pt h o f T L Ds . A n a g r e e me nt o f + 5 % be t w ee n t h e c a l c u l a te d a nd m e as ur e d do s e s i s c o nsid e r ed r e a so na b l y g o od . A n o v e r al l d o se u n i f o r m it y o f + 10% i s co ns i de r ed a c ce p t ab le f o r m o st p r ot o co l s .

WWW.MEDRAD.IR

P.463

G. Total Body Irradiation Program Implementation

The use of TBI in conjunction with b o ne marrow t r a ns p la nt a t io n i nv o l v es n u m e r o u s p r oto c ol s , sp e c i f y i n g m a ny d i f f e re nt r eg i me ns : s i ngl e f r a c t i o n wi t h l o w d o s e r at e , s i n gl e f r a c ti o n w i t h h i g h d o se r a te , f r a c t i o nat e d T BI, h y p e r f r a c t io na te d T B I, AP/PA t e c h n i qu e , b i la t er a l t e c hniq ue , us e of co m pe ns a t o r s or no c o m p e n s at o r s , b lo c k i n g o f c r iti c a l o r g a ns o r no b lo c k i ng , a nd so on. E a c h o f t he s e p r o c ed u r e s i n v ol v e s pe c i a l e q u ip m e nt o r t re a t m e nt a i d s , c us to m d o s i me t r y , a nd r i g or o u s q u a li t y a s s u r a n c e . B e f o r e e m b a r king o n a T BI p r o g r a m , i ns t it ut io ns m us t d e s ig n a c a r e f u l p l a n o f i mp le m e nt at io n. One o f t he m o st i mp o rt a nt p a rt o f t hi s plan s h o ul d be to form a TBI team, i n c l ud i ng r a d ia ti o n o nc o lo g i st , m e di c al p h y s i c i s t , me d i ca l do si m et r i st , a nd r a di a ti on t he r a p i st . K e y m emb e r s o f t hi s t e a m s h o u l d v i s i t a n ot h e r i n s t it u t io n t ha t ha s a n a c t i v e T BI p r o g r a m , t o l e a r n a ll a s p e c t s o f t h e T B I p r o c e d u r e , do w n t o t he m o s t m i nut e d et a il s s uc h a s p a t i e nt measurements, p at ien t set-up, do s i me t r y, q ua l i t y a s s ur a nc e p r o c ed ur e s , a nd w o r k s h e e t s s p e ci f i c al ly d e s i g n e d f or T BI. G e ne r a l T BI p r i nc i p le s a r e p r e s e nt e d i n t h i s c h a p te r al o n g wit h s e le c te d re f e r e nc es i n t he l it e r at ur e f or f ur t he r d et a il s . B u t a s i d e f r o m a c q u i rin g p e r t i n e nt k no w l e d ge f r o m t he l it e r at ur e , i t i s e mp ha s i z ed t h a t t h e T B I t e a m n e e d s p r a ct i c al t r ai ni ng , w hi c h m a y b e o b ta i ne d a t a not he r i n s t it u t io n w i t h a w e l l- e s t a bl i s h ed T BI p r o g ra m .

REFERENCES
1 . K h a n F M , W i l l i a m son J F , S e w c ha nd W , e t a l . , Ba s i c d a t a fo r dos a g e c a l c ula ti o n a n d c o m p e n s a ti o n . I n t J R a d i a t O nc o l Bio lo gy P hy s 1 9 8 0 ; 6 :7 45 75 1 . 2 . G l a s g o w G P . T h e d o s i me t r y o f f i x e d , si ng l e so ur c e he m ib o d y a nd t o tal b o d y i r r ad i at o r s . M ed P h y s 1 9 8 2 ; 9 : 31 1 3 23. 3 . A m e r i c a n A s s o ci a tio n o f P h y s i c i s t s i n M e d i ci ne . T he p hy s i c a l a s p e c t s o f to t al a n d h a l f b o d y p h o to n i r r a d i at io n . A A P M R e p o rt N o . 1 7 C ol c he s ter , V T : A m e r i c a n In s t i t u t e o f P h y s i c s , c / o A ID C , 1 9 8 6 . 4 . K h a n F M , K i m T H . T o t a l b od y i r r a d i ati o n. In: P a l i w a l BR , G r e i m M L , e d s . Syllabus: a c a t e go r ic a l course in r a d i a tio n t he r a p y t r e at m e nt p l a nni ng . Oak B r o o k , IL : R a d i ol o gi c al S o c i et y o f N o rt h A m e r i c a , 1 98 6 :1 1 1 11 6 . 5 . D u s e n b e r y K E , G e r b i B J . T o t a l b od y i r ra d i a tio n i n c o nd i t io ning r e g i m e ns f o r b o n e m a r r o w t r a n s pla n t a t io n . In: L e v i t t S H , K ha n F M , P o t i s h R A , e t a l . , e d s . T e c h n o l og i c al b a si s of r a d ia ti o n t he r a p y . P hi l a de l p hia : Li p pi nc o tt W il li a m s & W i l k i n s , 1 9 99 : 49 9 5 18 . 6 . S h a n k B , C h u F C H , D i n s mo r e R , et al . , H y p e r f r a c t io na te d t ot a l b od y i rr a d i at ion for bone ma r r o w tra n s p l a n t a ti o n: r e s ul ts in s e v e nt y l e uk e mi a p a ti e nt s with a l lo g e n ei c t r a n s pl a n t s. I n t J R a d i a t O nc o l Bio l P hy s i c s 1 9 83 ; 9 :1 6 07 16 1 1 . 7 . K i r b y T H , H a n s o n W F , C a t e s C A . V e r i f i c a t io n o f t ot a l bo d y pho t o n i r r ad i at io n d o s im e tr y t e c h n i q u e s . M e d P h y s 1 9 8 8 ; 1 5 :3 64 36 9 . 8 . G a l v i n J M , D ' A n g i o G J , W a l s h G . U se o f t i s s ue c om p e ns at o r s to im p ro v e t he dose u n i f o r mi t y for t o t al bo d y i r r a di a ti o n. I nt J R a d i at O nc o l Bi ol P hy s 1 9 80 ; 6 : 76 7 7 71 . 9 . K h a n F M , M o o r e V C , B u r n s D J . T he c o ns t r uc t i o n o f c o mp e ns a t o r s fo r co b a lt t e le t h e r ap y . R a d i ol ogy 1 9 7 0 ; 96 : 18 7 .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part III - Modern Radiation Therapy > 19 - Three-Dimensional Con formal Radiation Therapy

19 Three-Dimensional Therapy
19.1. INTRODUCTION

Conformal

Radiation

B y t h r e e - d im e n s io n a l c o n f o r m a l r ad io t her a py ( 3 - D C R T ) , w e m e a n t r e at m e nt s t h a t a r e b a s e d o n 3 - D a n a t o m i c i n f o r ma ti o n a nd us e d o s e di s t ri b uti o ns t ha t c o nf o r m a s c l o s el y a s p o s si bl e to t h e t a r ge t v o l um e i n t e r m s o f a d eq ua t e do s e t o t he t um or a n d m i n i m u m po s s ib le do s e t o no r m a l ti ss ue . T he c o nc e pt o f c o nf o r m a l do s e d i s t ri b u tio n maximizing has also been e x t e nde d p r o ba b il it y to i nc l ud e a nd c li ni c a l o b je c t i ve s s uc h as tumor co n t r ol (T C P ) m i ni m i zi ng no r m al ti s s ue

c o m pl i c at io n p r ob a b il it y ( N T C P ) . T h us , t he 3 - D C R T t e c hni q ue e nc o m p a s s e s b ot h t h e p h y s i c a l a n d b io log i c r a ti o n a le s i n a c hi ev i ng t he d e s i re d c li ni ca l r e s ul t s . A l t h o u g h 3 - D C R T c a lls f o r o pt i ma l do s e d i st r i b ut io n, t he r e a re ma ny o b s t a c le s to a c h i e v i n g t h e se ob j e ct i v e s . T h e mo s t m aj or l i mi t at io n i s t he k no w l ed g e o f t he t u m o r e x te n t . D e s pi t e t h e m o d e r n a d v a nc e s i n i m a g i ng , t he c l i ni ca l t a r g et v o l ume ( C T V ) i s o f te n n o t f ul l y di s c e r n ib le . D ep e nd i ng o n t he i nv a s i v e c a p a c it y o f t he d i s e a se , w h a t i s i m a ge d i s u s u a l l y no t t he C T V . It m a y b e w ha t i s c a l l e d t he g ro s s t u m o r v o l u me ( G T V ) . T h u s , i f t h e C T V s d r a w n o n t he c r o s s - s e ct io na l i m ag e s do n o t f u l l y i n c l u d e t h e m i c r o s co pi c s p r e ad o f t he d i se a s e , t he 3- D C R T l o s e s it s m e a n i n g o f b ei n g con f o r m a l . If a ny p a r t o f t he di s e a s ed t i s sue i s mi s s e d o r s e r io u s l y u n d e r do s e d , i t wi ll i n e v it a bl y r e sul t i n f a il ur e d e s pi te a l l t he c a r e a nd e f f o r t e x pe n d e d i n t rea t m e n t pl a nni ng , t r e at m e nt de li v e r y , a nd q ua l i t y a s s ur a nc e . F r o m t h e T C P po i n t o f v i e w , a c c u r a c y i n l o ca l i z a ti o n o f C T V i s m or e c r it i c al i n 3 -D CRT than in t e c h n iqu e s that use ge ne r ous l y wide f i el d s a nd s i m pl e r b ea m a r r a n g e m e n t s t o c o mpe n s a t e f o r t he unc e r t ai nt y i n t um o r lo c a li z a ti o n. In a d d i t io n to t h e di f f i c u l ti e s i n t he a s s e s sm e nt a nd lo c a li z a t io n o f C T V , t he r e a r e o t h e r po te n t i al e r ro r s t h a t m u s t b e c o ns i de r e d be f o r e pl a nni ng 3 - D C R T . P a t i e nt m o ti o n , i n c l u d i n g t ha t o f t u m o r v o l um e , c r i t i c al o r g a ns a nd e x t e r na l f i d uc i al m a r k s d u r i n g i m a gi n g, s i m u l a t io n, a nd t r e at m e nt , c a n g i v e ri s e to s y s t e m at i c a s w e l l a s r a n do m e r r o rs t h a t m u s t b e a c c o unt e d fo r w he n de s ig ni ng t he pl a nni ng t a r g et v ol u m e of ( P T V ). PTV, If s u f f i c i e nt be a m m a r gi ns are ha v e t he n b ee n a ll ow e d to for in t he a nd l o c al i z a ti o n the a pe r t ur es s ha p ed co nf o r m

a d e q u a te l y c o v e r t h e P T V ( e . g . , w i t hi n 9 5 % t o 1 05 % i so do s e sur f a c e r e l a t i ve t o p r e s c r ib ed d o se ) . In t h e d e si g n o f co nf o rm a l f i el d s t o ad e q uate l y t re a t t he P T V , c o n s i d er a ti o n m u st be gi v e n to t he c r o s s- b e a m p r o fi le , pe num b r a , a nd l a te r al r a d i at io n t r a n s po r t as a f u n c t i o n o f de p t h, r a d i al di s t a nc e , a nd ti s s ue de ns i t y . T h e r e f o r e , s u f f i c i e n t m a r g i n s m u s t b e gi v en b e t w e e n t he P T V o ut li ne a nd t he f i e ld b o u n d a r y t o e n s u r e a de q u a t e do s e t o P T V a t e v e r y t r e a t me nt s e s sio n.

WWW.MEDRAD.IR

E v e n i f t h e fi e ld s h a ve be e n o p ti m al l y de s ig ne d , bi ol og i c r e s po ns e o f t he t um o r a n d t h e n or m a l ti s s u es n e e d s to be co ns i der e d i n a c hi e v i ng t he go a l s o f 3 - D C R T . In o t h e r w o r d s , t h e op t im i z a ti o n o f a t re a tm e nt pl a n ha s t o b e ev a l ua t e d not o nl y i n t e r m s o f do s e di s t ri b u t io n ( e . g . , do s e vol um e hi s to g r a m s) b ut a l s o i n t e r m s o f d o s e - re s po n s e c h a r a ct e ri s ti c s o f t he gi v en d i s e a s e a nd t he i rr a d i at e d no r m a l t i s s u e s . V a r io u s m o de l s i n v o l vi n g T C P a n d N T C P ha v e b e e n p r o po s e d , b ut t he c l i n i c al d a t a t o v a li d a te t h e s e m od el s a r e s ca r c e . P.468 U n t i l mo r e r el i ab le d at a a r e a v a i l ab l e , c a utio n i s ne e d ed i n us i ng t he s e c o nc e pt s t o e v a l u a t e t re a t me n t pl a n s . T h i s i s e sp ec i a ll y i m po rt a nt i n co ns i d er i ng do s e e s c a l at io n s c h e m e s th a t i n v a r i a bl y te s t the l im it s o f no r m al t i s s ue to l er a nc e w i t h i n o r i n p r o xi m it y t o t h e P T V . N o t w it h s t a n d i n g t h e f o r m id a bl e o b st a c le s i n d e f i ni ng a nd o ut li ni ng t he t r ue e x te nt o f t h e d i se a s e , t h e cl i n i ci a n m u s t f ol lo w an a na l y t i c p l a n r e com m e nd e d b y t he In t e r n a t i o n al Various C o m mi ss i o n vo l u me s on (GTV, R a di a tio n CTV, U ni t s a nd M e a s ur e ment s be ( IC R U ) (1). t a r g et PTV, etc.) s ho ul d c ar e f ul l y de s ig ne d

c o n s i d er i n g t h e i n h e r e n t li m it at io ns o r unce r t ai nt ie s a t e a c h st ep o f t he p ro c e s s . T h e f i n a l P T V s h o u l d b e b a s e d no t o nl y o n t he g i v e n i m a gi ng d a t a a nd ot he r d i a g n o st i c s t u di e s b ut a l s o t h e c li ni c al e x pe r i e nc e t ha t ha s be e n o bt a i ne d i n t he m a n a g e m e n t o f t h a t d i se a s e . Ti g hte ni ng o f f ie ld m a r gi ns a ro und i m ag e - b a se d GTV, with l i tt le a tte n t io n to o c c ul t d is e a s e , p at i e nt m ot io n, or t e c hni c al l i mi t at io n s o f do s e de li v e r y , i s a m i s use o f 3 - D C R T c o nc e pt t hat m us t b e a v oi de d a t a ll co s t . It s ho u ld b e r e co g ni z ed t ha t 3 - D C R T i s no t a ne w m o d al it y o f t r e at m e n t , n o r i s it s y n o n y m o u s w i t h b e tt e r r e s ul t s t ha n s uc c e s s f ul a nd w e l l t e s te d c o n v e n ti o n al r a d i at io n t he r a p y . It s s up e r i o ri t y r e st s e nt i re l y on ho w a c c u r a t e t h e P T V i s an d h o w m u c h b e tt e r the d o se di s t ri b uti o n is . S o , i ns t e ad o f c a l li n g i t a n e w m od a li t y , i t s h o u ld b e co ns id e r ed a s a s up e r io r too l f o r t r e at m e nt p l a n n i n g w i t h a p ot e n ti a l o f a c h i e v i ng b e tt e r r e s ul t s .

19.2. TREATMENT-PLANNING PROCESS

The main di st i n c ti o n b et w e e n t r e at m e nt p l a nni ng of 3-D CR T a nd t ha t of c o n v e n t i o n al r a di at io n t h e r a p y i s t ha t t he fo r m e r r e q ui r e s t he a va i l a bi li t y o f 3 - D a n a t o m i c i n f o r m a tio n a n d a t r e a tm e nt - pl a nni ng s y s t e m t ha t a ll o ws o p ti m i z at io n o f dose which d i st r ib u t io n can be in accordance to w it h the c l i ni c al ob j e ct i ves . in a ny T he or a na t o m i c in t hr e e i n f o r m a ti o n i s u s u a l l y o bt a i n e d i n t he fo r m o f c lo s e l y sp a c e d t r ans v e r s e i m a ge s , p r o c es s e d r e co ns t r uc t a na t o m y p l a ne , d i m e n si o n s . D e pe n d i ng o n t h e i m ag i ng mo da l it y , v i s i b le t umo r , c r i ti c a l s tr uc t ur e s , a n d o t h e r r e le v a n t la n d m a r k s a r e o ut l i ned s l i c e -b y - s l i ce b y the p l a nne r . T he r a d i at io n o n c ol og i st d r a w s t h e t a r ge t v olum e s i n e a c h sl i ce w i t h a p pr o pr i at e m a r g i n s to i n c l u d e v i si b le t u mo r , t he s us pec t e d t um o r sp r e ad , a nd p a ti e nt m ot io n u n c e r t a i n t ie s . This process of d e li ne a ting t a r g et s a nd r e le v a nt a na t o m i c s t r u c t u r e s i s c a ll ed s eg m e n t at io n . T h e n e x t s t e p i s to f o ll o w t h e 3 - D tr e at me nt - p l a nni ng so f t w a r e t o de s ig n f i e ld s a n d b e a m a r r a n g e me n t s . O n e o f t he m o st us e f ul f e a t ur e s o f t he se s y s t e m s i s t he c o m p u te r graphics, which allow b e a m s -e y e - v i e w ( BE V ) v i s ua l i z a ti o n of t he d e li n e a te d t a rg et s a n d o t h e r s t r uc t ur e s . The t e r m BE V d e no t e s d i s p l a y o f t he

WWW.MEDRAD.IR

s e g m e n te d t a r ge t a n d n o r m a l s t r uct ur e s i n a p l a ne pe r p e ndi c ul ar t o t he c e nt r al a x i s o f t he b e a m , a s i f b e i n g v i e w ed f r om t he v a nt a g e p oi nt o f t he r a d i at io n s o u r c e . U s i n g t h e B E V o p t io n , f i e l d m a rg i ns ( d i s t a nc e b et w e e n f ie l d ed g e a nd t he P T V o u t li n e ) a r e s et t o co v e r t he P T V d o si m et r i c al l y w it hi n a suf f i c i e nt l y hig h i s o do s e le v e l (e . g . , 9 5 % o f t h e p r e s c ri be d do s e ) . O rd i na ri l y a f i e ld m a rg i n o f a p p r o xi m a te l y 2 c m i s c o n si d e re d s uf f i c ient to a c hi e ve t hi s , but i t m a y ne ed f u r t h e r a d j u s t me n t s d e pe n d i n g o n t he gi ve n b e a m p ro f il e a nd t he p re s e nc e o f c r i ti c a l s t r u ct u r e s i n th e v i c i n i t y o f t he P T V . N o n e t h el e s s , it is im p o rt a n t to re m e mbe r t ha t each beam ha s a p hy s i c a l p e n u m b r a ( e .g . , r e gio n b et w e e n 9 0% a nd 2 0% i s o do s e le v e l ) w he r e t he do s e v a r i e s r a p id l y a n d t h a t t h e d o se a t t he f i e l d ed g e i s a pp r o x ima t e l y 50 % o f t he d o s e a t t h e c e nt e r o f t h e f i el d . Fo r a uni f o rm a nd a d eq ua t e i r r a dia t io n o f t he P T V , the f i el d pe n u m b r a should l ie s uf f i c i ent l y o ut s id e t he PTV to o f f s et a ny u n c e r t a i n t ie s i n P T V . O p t im i z a ti o n o f a t rea t m e n t pl a n r e q ui r e s no t o nl y t he d e si g n o f o pt i m al f ie ld a p e r t u r e s , b u t al s o a pp r o p ri a te b e a m d i r ec tio ns , num b e r o f f i e l d s , b e a m w e i g ht s , and i n t e n s it y m o di fi e r s ( e .g . , wedges, c o m p e ns at o r s , d yna m i c m ul ti l e a f c o ll i m at o r s , e t c . ) In a f o r w a r d - p l a nni ng sy s t e m , t he se p a r a met e r s a re s e le c te d i t er a ti v e l y o r o n a t ri a l - a n d - er r o r b a si s a nd t he re f o re , f o r a c om p l e x c a s e , t he w h o l e p r o ce s s c a n be co m e ve r y l ab o r i nte ns i v e i f a hi g h d eg r e e of o pt i mi z a t io n is d e s i re d . In p r a c t i c e , h o w e v e r , m o st p l a nne rs s t a r t w i t h a P.469 s t a n d a r d te c h n i q u e a n d o p ti m i z e i t f o r t he g i v e n p a ti e nt us i ng 3 - D t r e at m e nt planning t oo l s s u c h a s B E V , 3-D dose di s p l a y s , no n- c o pl a na r b e a m o pt io ns , i n t e n s it y m o d u l at io n , a n d d o s e - v ol um e hi s to g r a m s . T he t i me r e qui r e d to p l a n a 3 D C R T t r e at m e nt de pe n d s o n t h e c om p le x it y o f a g i v e n c a se , ex p e r i e nc e o f t he t r e at m e n t -p l a n n i n g t ea m , a n d t h e s p e e d o f t he t r e a t me nt - pl a nning s y s t e m . T he final p r od u c t , the the field t re a t m e nt of ap e r t u r e s , p l a n, do s e is a s g o od data, as it s plan i ndi v i dua l c o m po ne nt s , i m a ge plan a nd namely, q u a l it y input p a t ie nt i m a ge s e gm e nt a ti o n, e v a l ua t io n,

r e g i st r a tio n , o p ti mi z a t io n .

co mp ut a ti o n,

A. Imaging Data
A n a t o m i c i m a ge s o f h i g h q u a l it y a r e r e qui r e d t o a c c ur a t el y d e li ne a te t a r g et v o l u m e s a n d n o r m al st r u c t u r e s . M o de r n i m ag i ng m od a li ti e s f or t r ea t m e nt p l a nni ng include c o mp u t ed (US), to m og r a p h y s i ng l e p ho to n (CT), m a g ne t i c re s o na nc e im a g i ng a nd ( M R I) , p o s it r o n ultrasound e m i s si o n t o mo g r a p hy (SPECT),

e m i s si o n t om o gr a p h y ( P E T ) . A l t h o ug h C T a nd M R I a r e t he m o s t c o m mo nl y us e d p r o c ed u r e s , ot h e r m od a l it ie s o f f e r s pe c i al a d v a nt a g e s i n i m ag i ng c e r t ai n t y p e s o f t u m o r s . A b ri e f r e v ie w o f i m a ge c ha r a c te r i sti c s o f t he s e mo d al it ies i s p re s e nt ed to e l u c i d at e p a r ti c u l a r advantages a nd li mit a ti o ns with r eg a r d to t he i r us e in t r e at m e n t pl a n n i n g .

A.1. Computed Tomography

A s d i s c u s s e d i n C h a p te r 1 2 , a C T i m a ge i s re c o ns t r uc te d f r o m a m a t r i x o f re l at i ve l i n e a r at t e n u a ti o n c oef f i c i e n t s m e a s ur ed b y t he C T s c a nne r . T he m a t r i x t y pi c a ll y c o n s i s t s o f 1 , 0 24 1 ,0 2 4 p i ct u r e el e m e nt s , c a l l ed pi x e l s . E a c h p ix e l i s a me a s ur e

WWW.MEDRAD.IR

o f r e l at i v e li n e a r a tt en u a t i o n c o e f f i ci e nt o f t he t i s s ue f o r t he s c a nni ng b e a m us e d i n t h e C T s c a n n e r . B y a p p r o pr i at e c a li b r at io n o f t he C T s c a nne r us i ng p ha nt o m s c o n t a i n i n g t i s s u e s u bs t it u t e s ( C T p ha nt o ms ) , a r e l a ti o ns hi p be tw e e n p i x e l v a l ue ( C T n u m b e r s ) a n d t i ss u e d e n s i t y c a n b e es t a b li s he d . T hi s a l lo ws p i x e l b y p i x el c o r r e ct io n f o r t i s s u e in h o m o g e n ei ti e s i n c om p ut i ng do s e di s t ri b ut io ns . One of the i m po r tan t features of 3-D t r e at m e nt p l a nni ng is t he a bi li t y to r e c o n s t r u c t im a g e s i n p l a n e s o t he r t ha n tha t o f t he o r i gi na l t ra ns v e r s e i m a g e . T h e s e a r e c al le d t h e d i gi t al l y re c o nst r uc t ed r a di og r a p hs ( D R R s ). A n e x a m p l e i s s h o w n i n F i g . 1 9 . 1 . To o bt a i n h ig h- q ua l it y D R R s , no t o nl y im a g es o f hi g h c o nt r a st a n d r e s o l u ti o n a r e r eq u i r e d , t h e s li c e t hi c k ne s s m us t a l s o b e s uf f i c i e ntl y s m a l l . A s l i c e t h i c k n e s s o f 2 t o 1 0 mm i s co m monl y us e d d ep e ndi ng o n t he nee d , f o r e x a m p le , t h i n n e r s li ce s f o r t u mo r lo c a li z at io n o r hi g h- q ual it y D R R s a nd t hi c k e r s l i c e s f o r re gi o n s o u ts i d e t h e t um o r v ol um e . T he s p i r a l o r hel i c al C T s c a nne r s a l lo w c o n ti n u o u s ro t at io n o f t h e x - r a y t ube a s t he p a ti e nt i s t ra ns l a t e d t hro ug h t h e s c a n n e r a p e rt u r e . T h i s s u b s t a nt i al l y r ed uc e s t he o ve r a ll s c anni ng t i m e a nd t h e r e f o re al lo w s a c q ui s it io n o f a l a r ge num b e r o f t hi n sl i ce s re q ui r ed f o r hi g hq u a l it y C T i m a g e s a n d t h e D R R s . Besides h i g h - i m ag e - qu a l i t y CT s c a nni ng , t r e at m e nt p l a nni ng re q ui r e s s p e ci al c o n s i d er a ti o n s s u c h a s p a t ie n t po s iti o ni ng , i m m ob il i z a ti o n, a nd ex t e r na l m a r k i ngs t h a t a r e v i si b le i n t h e i m a g e s . F or t r e at m e nt p l a nni ng , t he C T c ouc h m us t b e f l a t a n d t h e p at ie n t m u s t b e se t u p i n t he s am e po s it io n a s f o r ac t ua l t re a tm e nt. Im m o b il i z a ti o n de v i ces a r e e s s e nt i al f o r 3 -D C R T a nd s ho ul d b e the s a m e a s t ho se f o r C T a s u s e d i n t h e t r e at m e n t . F i d uci a l p o i nt s m a r k e d o n t he p a t ie nt s k i n o r m a s k s s h o u l d be v i s ib l e i n t h e C T i m a g e s b y us i ng r a di o p aq ue m a r k e r s s uc h a s p l a s ti c c a t h et e r s . B e c a u s e C T i m a g e s c an b e p r o c e s se d t o ge ne r a t e D R R s i n a ny p l a ne , c o nv e nt i o nal s i m u l a ti o n m a y be r ep l a c ed b y C T s i m ul ati o n. A C T s i m ul a to r is a C T s c a nne r e q u i pp e d w it h s o m e a d d it io n a l ha r d w a r e s uc h a s l a s e r l o c al i z e rs t o s e t up t he t r e at m e n t i so c e n te r , a f l a t t a b le o r c o uc h ins e r t , a nd i m a g e r eg is t r a ti o n d e v i ce s . A c o m p u t er w o r k s t at io n w i t h s p e ci al s o f t wa r e to p ro c e s s a C T d a t a , pl a n b e am d i r e ct io n s a n d g e n e ra t e B E V D R R s , a l l o ws C T s i m ul a t i o n f il ms w i t h t he s a m e g e o me t r y a s t h e t r e at m e n t b e am s . F or a p r a c t i ca l d et a il o f C T s i m ul at io n, t he r e a d e r i s r e f e r r ed to C o i a et a l . ( 2 ) .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

FIG.

19.1.

An

example

of

di gi t al

r e co ns t r uc t ed

r a di og r a phs

c r e a t ed

f r om B is

t r a n s v e r s e c o m p ut e d t o m og r a p h y s c a ns . Im a g e l a t er a l . P.470

A i s f r o nt a l a nd i m a g e

P.471

A.2. Magnetic Resonance Imaging

P r i n c i p le s o f M R I a r e d i s c u s s e d i n C ha p t e r 1 2 . In t r e a tm e nt p l a nni ng , M R I i m a g e s may be used a lo n e or in c o n j unc t io n with CT i m a ge s . In g e ne r al , MRI is c o n s i d er e d s u p e ri o r to C T i n so f t ti s s ue dis c r i m i na ti o n s uc h a s C N S t um o r s a nd a b n o r m a li ti e s i n t h e b r a i n . A l so , M R I i s w e l l s uit e d to i m a gi ng he a d a nd ne c k c a n c e r s , s a r c o m a s , t h e p ro s t at e g l a nd , a nd l y m p h no d e s . O n t he o t he r ha nd , i t i s i n s e n s i ti v e t o c a l ci f i ca t io n a n d bo ny s t r uc tur e s , w hi c h a r e be s t i m a g ed w it h C T . A l t h o u g h i m po r ta n t d if f e r e n c e s e x i s t be t w ee n C T a nd M R I i m a g e c ha r a c t e r i st i c s, t h e t w o a r e co n s i d er ed c o m pl e me nt a r y i n t he i r r ol e s i n t re a t me nt p l a nni ng . T h e m o s t b a s i c d i f f e re n c e b et w e e n C T a nd M R I i s t ha t t he fo rm e r i s re l at ed to e l e ct r o n d e n s it y and a to m i c while num b er t he ( a c t ua l l y s ho w s re p r e se nt i ng proton d e ns i t y x-ray l i ne a r a t t e n u a ti o n c oe f f i c i en t s ) l a tt er d i st r ib ut io n.

A l t h o u g h t h e be s t s pa t i al r e sol u t io n o f b ot h m od a li ti e s i s si m ila r ( ~ 1 m m ) , M R I t a k e s m u c h lo n g e r t ha n C T a n d , t he r e f or e , i s s us c ep ti bl e t o a r ti fa c t s f r o m p at ie nt m o v e m e n t . O n t h e a dv a n t a g e o u s s id e , M R I c a n b e us e d t o d i re c tly g e ne r a te s c a ns i n a x i a l , s a g it t al , c o r on a l , o r o b li q ue pl a ne s . O n e o f t h e mo s t i mpo r t a n t r eq u i r e me nt s in t r e at m e nt pl a nni ng i s t he g eo m et r i c a c c u r a c y . O f a l l t h e im a g i n g m od a li ti e s , C T p r o v i de s t he b e st g eo m et r i c a c c ur a c y a n d , t h e r e f o r e , C T im a g e s a r e co ns i de r ed a r e f e r e nc e f o r a na t o mi c l a nd m a r k s , w h e n c o m p a r e d w i t h th e o t h e r m od a li t y i m ag e s . F u n c t i o n a l M R I ( f M R I ) a l s o h a s p o te nt i al to b e us e f ul i n t r e at me nt p l a nni ng b y s h o w i n g p h y s i o lo gi c a c t i v it y a s i t ha p pens a nd , t he r e f o r e , m a y b e us e f ul i n o u t li n i n g of the t a rg e t v o l u me s a nd c r it i c al st r uc t ur e s fo r hi g hl y c o nf o r m al r a d i at io n t h e r a p y s u c h a s i n t h e b r a i n.

B. Image Registration
T h e t e r m r e gi s t ra ti o n a s a p p l ie d to i m a ge s c o nno t e s a p ro c es s o f c o r r e l at i ng d i f f e r e n t i m a ge d at a s e t s t o i de nt i f y c o r res p o nd i ng st r uc t ur e s or r e gi o ns . Im a g e r e g i st r a tio n f a c i li t at e s c o m p a ri so n o f i m a g es f r o m o ne st ud y to ano t he r a nd f us es t h e m i n to o n e d at a s e t t h a t co u l d be us e d f o r t r e a tm e nt pl a nni ng . F o r e x a m p l e, c o m p u te r pr o gr a m s a r e n o w a v ai l a bl e t ha t al lo w i m ag e f us i ng , f o r e x a m pl e , m a p p i n g o f s t r u c t u r es s e e n i n M R I o nt o t he C T i m a g e s . V a ri o us r e gi s t r ati o n t e c h n i q u e s i n c l u d e po i n t -t o -p oi n t f itt i ng , i nt e r a ct i v el y s up e ri mp o s i ng i m ag e s i n t h e t w o d at a s et s , a n d s u r f a c e o r t o po g ra p hy m a t c hi ng . A n e x a m p l e o f i m a ge f u s i o n o f a C T a n d M R I s t u d y i s s ho w n i n F i g . 1 9 . 2 ( s ee c ol o r i ns e r t ) . F o r f ur t he r

WWW.MEDRAD.IR

d i s c u s s io n o n i m a g e r e g i st r a tio n, t he r e a de r i s r e f e r r ed to K e ss l e r et a l . ( 3 ) , P e l i z z a r i et a l . ( 4 ) , a n d A u s t i n - S e y m o ur e t al . ( 5 ) .

C. Image Segmentation
The term image of se gm e n t a ti o n re g io n s in no rm a l in of t r e at me nt i nte re s t , a na to m i c p l a nni ng f or re f e r s et c . be to sl i ce - b y - s li c e c o nto ur s , s e g me nt ed in BE V d e li n e a ti o n t a r g et s , r e g io n s can a n a tom i c be e x a mp l e , a nd can e xt e r na l T he viewed

c ri ti c a l

s tr u c t u r e s ,

l a nd m a r k s ,

r e nd e r ed

d i f f e r e nt

c o lo r s

c o n f i g u r a ti o n o r i n oth e r p l a n e s us i ng D R Rs . S e g m e nt a ti o n i s als o e s s e nti a l f or c a l c u l a ti n g d o se - v ol u m e h i s t og r a m s ( D V H s ) f o r t he s e l e ct ed r e gi ons o f i nt e r e s t . Im a g e s eg m e n t at io n i s o n e o f t he mo s t la b o ri o us b ut im p o rt ant p r o ce s s e s i n t r e at m e n t p l a n n i n g . Al t h o u g h t h e p ro c e s s ca n b e a id ed f o r a ut om a t i c d el i ne at io n b a s e d o n i ma g e co n tr a s t n e a r t he bo und a r i e s o f s t r uct ur e s , t ar g e t de li ne a tio n r e q u i r e s cl i n i c al j u d gm e n t , w h i c h c a n no t b e a ut o m at ed o r c om p l et el y i m a ge b a s e d . No r s h o u l d it be de le g a te d to p e r so nne l o t he r t ha n t he p hy s i c i a n i n c ha r g e o f t h e c a s e , t h e r a dia t io n o n c olo g i st . Fi g ur e 19 . 3 ( se e c ol o r i ns e r t ) s ho w s a n e x a m p le o f a s e g m e n te d i m a ge f o r p ro s t at e g l a nd t re a t me nt p l a nni ng .

D. Beam Aperture Design

A f t e r i m a ge s e g me n t at io n h a s b e e n c o m p le te d , t he t r e at me nt p l anne r g e t s t o t he t a s k o f s el e ct i n g b e am d i re c ti o n a nd de s ig ni ng b e a m a p er t ur es . T hi s i s g re a tl y a i d ed b y t h e B E V P.472

P.473 c a p a b il it y o f t h e 3 -D t r e at m e n t -p l a nni ng s y s t e m . T a r g e t s a nd c r i ti c a l no r m al s t r u c t u r e s m a d e v i si bl e i n d i f f e r e nt c o lo r s t hr o ug h s e g m e nt ati o n c a n b e v i e w e d f r o m d i f f e r e nt d i re c ti on s i n p l a n e s p e r p e ndic ul a r t o t he be a m s c ent r a l a x i s . Be a m d i r e ct io n s t h a t c r e at e g r e a t er s e p a r at io n b e t w e e n t a rg et s a nd c r i ti c a l s t r uct ur e s a r e g e n er a ll y p r e f er r ed u n l e s s ot he r co ns t ra i nt s s uc h a s ob s t r uct io ns i n t he p a t h o f t h e be a m , g a n t r y c o ll i si o n w i t h t he co uc h o r p a ti e nt , e t c ., p r e c l ud e t ho se c h o i c e s . B E V c a p a b il ity , c o m b i n e d wi t h D R Rs , i s a p o w e r f ul t oo l in s e l e c ti ng be a m d i r e ct io n s a n d s h a p i n g f i e ld s a r o und t he t ar g e t .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

F I G . 1 9 . 2 . A n e x a m p l e o f f u s i o n b et w e en C T ( A ) a nd M R ( B ) i m a g e s . T hr ee p o i nt s of c o r re l at io n were s e le c te d for f us i o n. Split sl i ce im a g e (C) s ho w s c o r r el a ti o n at t h e i n te r f a c e o f t wo i m a g e s. F us e d i m a g e ( D ) (s e e co lo r i ns e rt ) s h o w s s l i c e o v e rl a y w it h C T a s r e d a nd M R a s g r e e n. B e a m a p e r t u r e s c a n b e d e si g n e d a uto m a ti c a ll y o r m a nua l l y d e p e ndi ng o n t he p r o x i mi t y o f t h e c r it ic a l s t r u c t u r e s a nd t he unc e r t a i nt y i nv ol v ed i n t he al lo w ed m a r g i n s be t we e n t h e C T V a n d P T V . In t he a uto m a ti c o pt io n, t he us e r se t s a u n i f o r m m a r g i n a r o u nd t h e P T V . A no nuni f o r m m a r g i n r eq ui r e s ma nua l d r a w i ng o f t h e f i e ld o u tl i n e . A c o n s i d er a b le g i v e a nd t a k e o c c ur s b et w e e n t a r g et c o v e r ag e a n d s p a r i n g o f c r it i c al s t r u c t u r e s i n c a s e s w he r e t he s p a c e s be tw e e n t he t a r get and and c r i ti c a l f i e ld st r u c t u r es a r e t ak i n g ti g h t , t hus r eq ui r i ng a c co unt the f i e ld m a nua l de s ign o f t he a nd t he beam a p e r t u r e s . In s i m pl e r c a s e s , a u t o m at i c m a rg i ns m a y b e a s si g ne d b e t w ee n t he P TV e d ge s , i n to p e num b r a re q ui red m i n i m u m i s o do s e c o ver a g e o f t he P T V . G e ner a l l y , a 2 - c m m a r gi n be t w e e n P T V a nd t h e f i e ld e dg e a s s u r e s b e tt e r t h a n 9 5% i so do s e c o v er a g e o f t he P T V b ut t hi s m us t b e a s c e rt a i n ed t h ro u gh a c t u a l c o mp ut a ti o n o f t he do s e d i st r ib uti o n. F i g ur e 1 9 .4 (see co lo r i n s er t ) shows e x a m p le s of BE V of beam ap er t ur e s a nd do se d i s t ri b u tio n s i n t r a n s ve r s e , s a gi tt a l , a nd c or o na l pl a ne s . T he s agi tt a l a nd c o ro na l i m a g e s a re d e ri v e d f ro m D R R s .

E. Field Multiplicity and Collimation

T h r e e - d i me n s i o n al t re a t m e nt pl a nni ng e nc o ur a g e s t he us e of m ul t ip le f i el ds b e c a u s e t a rg et s a n d c r i ti c a l st r uc t ur e s c an b e v i e w e d i n t he BE V c o nf i g ur a t i o n i n d i v id u a l l y f o r e a c h f i e l d . M u lt ip li c it y o f f ie l d s al s o r e mo v e s t he ne e d fo r us i ng u l t r a h i g h - e n e rg y b e am s ( > 1 0 M V ) w hi c h a r e r e q uir e d w he n t re at i ng t ho r a c i c o r p e l v i c t u m o r s w it h o n ly t w o p a r a l le l -o pp o sed P.474 f i e l d s . In g e n e r a l , g r ea t e r t h e n u m b e r o f f ie l d s , l e s s s t ri ng e nt i s t he re q ui re m e nt o n b e a m e n e r g y be c au s e t h e do s e o ut s id e t he P T V i s di s tr i b ute d o ve r a l a rg e r v o l u m e . T h e 3 - D t r ea t m e n t p l a nni ng a l so a l lo w s no n- c op l a na r b e a m d ir e c tio n, t h a t i s , t h e be a m c e nt r a l a x i s l ie s i n a pl ane ot he r t ha n t he t r ans v e r s e p l a ne o f t h e p at ie n t . No n - c o pla n a r b e a m d i re c ti o ns c a n b e us e f ul i n cer t a i n c a se s , f o r e x a m p le , brain t u m or s , head a nd ne c k a nd o t he r r e gi o ns w he r e a c r i t i c al s t r u c t u r e c a n b e a v o id e d b y c h oo s i ng a no n- c o pl a na r b e a m di re c t io n. T o us e a n o n - c o p l a n a r b e a m , th e c o u c h i s rot a te d ( k i c k e d ) t hr o ug h a s p e ci f i ed a ng le , m a k i n g s u r e t h a t i t w il l n o t co ll id e w i t h t he g a nt r y . Using a large number of fields ( g re a te r t ha n f o ur ) creates t he p r o b le m of d e s ig n i n g a n e x c e s s i v e n u m b e r o f b e a m s ha p i ng b lo c k s a nd r e q ui r i ng lo ng e r s et u p t i me s a s e a c h blo c k i s i n d i vi d ua ll y i ns e r t ed i nt o t he a c c es s o r y m o unt a nd v e r i f i ed f o r co r r e ct pla c e m e n t o f t he fi el d on t he p a ti e nt . C a r r y i ng s o m a ny he a v y b l o c k s , p at ie n t a f te r pa t i e nt , c r e at e s a nui sa nc e f o r t he r ap i st s w ho ha v e t o g ua r d a g a i n s t d ro p pi n g a b loc k a c c i d e n t a ll y o r us i ng a w r o ng b l o c k . A g o od a lt e r n a ti v e to m u l t ip l e fi el d bl o c ki ng i s t he us e o f a m ult il e a f c ol li m a to r ( M L C ) ( C h a p t e r 1 3 ) . M L C s c a n b e us e d w i t h g r e a t e a s e a nd c o nv e ni e nc e t o s ha pe

WWW.MEDRAD.IR

f i e l d s el e c tr o n i c al l y . A f i e l d d r a w n o n a sim ul a t o r f i l m o r a BE V p r i nt o ut c a n be d i gi ti z e d to s et t h e M L C s e t ti n g . BE V f i e l d o utl i ne s c a n a l s o b e t r a ns m i tted e l e ct r o ni c a ll y t o t h e a c c e l e r ato r t o p r og r am t he M L C . Be c a us e M L C f i e l d s c a n b e s e t a t t h e c o n t ro l co n s o l e a s p r og r a m m ed , a l a r g e num b e r o f f i e ld s c a n b e t r e ated e f f i c i e n tl y a n d r e p r odu c i b l y . C o m b i n a ti o n o f M L C s a n d i n d e pe nd e nt j a w s p r o v id e s al m o st unl im i te d c a p ab il it y of d e si g n i n g f i el d s of any shape. C us tom d e si g ned bl o c k s are s ti ll us e f ul , h o w e v e r , i n t re a ti n g sm a l l fi e ld s ( unl e s s m ini - M L C s w i t h ul tr a s ma l l st ep s i z e a r e a v a i l a bl e ) , mi d - fi e ld b l o c ki n g ( i sl a nd bl oc k s ) , o r co m pl e x f ie ld m a t c hi ng . T hus , i n 3 - D c o n f o r m al r a dia t io n t h e r a p y , w he r e t he us e o f s ha p e d m ult i pl e - fi e ld s i s t he n o r m , M L C p r o v i de s a l o gi s ti c s ol ut io n t o the p r o bl e m o f de s ig ning , c a r r y i ng , a nd s t o ri n g a l a r g e n u m b e r o f h e a v y b l o c k s . F o r f ur t he r d e t ai l s o n M L C us e a nd c h a r a c t e r i st i c s , t h e rea d e r i s r e f e rr e d t o Boy e r ( 6 ) .

F. Plan Optimization and Evaluation

C r i t e ri a f o r a n o p t im al p l a n i n c l u d e bo t h t he b i ol og i c a nd t he p hy s i c a l a s p e ct s o f r a d i at io n o n c o lo g y . B y d e f i n i t io n , a n o p t i ma l p l a n s ho ul d d el i v e r t um o r i ci d a l do se t o t h e e n ti r e t u m o r an d s p a r e al l t he no r ma l ti s s ue s . T he s e go a ls c a n b e s et , b ut are not a tt a i n a bl e p r ob a bi li t y data in the a b s ol ute no r m a l te rm s . t i ss ue To a c hi e v e q uant i t at i v e p rob a b il it y a nd , b io lo gi c (NTCP). e n d p oi n t s , m od e l s h av e b e e n d e v el op e d i nv o l v i ng bi ol og i c i ndi ce s s uc h a s t um o r c o n t r ol Clinical (T C P ) to and c o m p li c a ti o n a re r e q ui r ed v a l id a te t he se m o de l s scarce t he r e f o re ,

c u r r e n t l y m o s t e v a l u a t io n s a r e c a r r i ed o ut o n t he b a s i s o f p hy s i c a l e nd po i nt s, n a m e l y , d o s e d i st ri b ut io n w i t h i n t he s p e c i f ie d t a r ge t v ol um e s a nd d o s e to o r g a ns d e s ig n a t ed a s c r i ti c a l. D i s c u s s i o n o f b io lo gi c m o de l s i s b e y o nd the s c o p e o f t hi s b o o k . T h e re a d e r i s re f e r r e d to K ut c he r a nd J a c k s o n ( 7 ) f o r a re v i e w . P hy s i c a l a s p e c t s o f p l a n o pt i miz a t i o n a n d e v a l ua ti o n a r e d i s c us s e d b e lo w .

F.1. Isodose Curves and Surfaces

T r a d i ti o n al l y t re a tm en t p l a n s a r e o pt im i z ed i te r at i v el y b y us i ng m ul t ip le f i el d s , beam by m o di f ie r s ( e . g. , wedges curves in a nd c o m p e ns a t o r s , s li c e s , e tc . ) , beam w e i g ht s , pl a ne s a nd a p p r op r i at e b e am di r ec t io n s . D o se di s tr i b ut io ns o f co m pe ti ng pl a ns a r e e v a l ua te d viewing i so do s e i nd i v id ua l o rt ho go na l (e . g . , t r a n s v e r s e , s a git t al , a n d c o ro n a l ) , o r 3 - D i s o do s e s ur f a c e s . T he l at t er r ep r e se nt s u r f a c e s o f a d e si g n a te d do s e v al ue c o v e ri ng a v o l ume . A n i s o do se s ur f a c e c a n b e r o t at e d to a s s e s s v olu m e t r i c d o se c o v e r age f r o m di f f e r e nt a ngle s . F i g ur e 19 . 5 ( s e e c ol or i n s e rt ) i s an e x a m p l e o f i so d o se c ur v e s d i s pl a y e d i n o rt ho go na l pl a ne s and an i s o d o se surface just c o v e ri ng t he t a r ge t v ol um e . O ne of t he m a jo r a d v a n t a g e s o f 3 -D t re a t m e nt p l a nni ng i s the d i s pl a y o f d o se d is t r i b ut io n, w hi c h c a n b e m a n i p u l a t ed w i t h e a s e t o s ho w v o l um et r i c do s e c o v era g e i n i nd i v id ua l s l i c e s , or t h og o n a l pl an e s , o r a s 3 - D i s o do s e s ur f a c e s . P.475

T h e d o s e d i st r ib u t io n i s u s u a l l y no r m al i z ed t o b e 1 00 % a t t he p oi nt o f d o se p r e s c r ip ti o n ( s ee IC R U ) ( 1 ) s o t ha t t he i so d o se c ur v e s r ep r e s ent l i ne s o f e q ual d o s e a s a pe r c e nt a g e o f t h e p r e s c ri be d dos e . F o r a t re a t me nt pl a n i nv o l v i ng o ne o r m o re b oo st s ( i n c r e a s e d d o se to c e rt a i n p a r t s o f t he t ar g et , us ua l l y t he G T V ) ,

WWW.MEDRAD.IR

a c o m po s it e i so do s e p l a n i s u s e f ul , w hi c h c a n a g a i n b e d i sp l ay e d b y i s od o se d i s t ri b u tio n i n i n d i v i du a l s l i c e s , o rt ho go na l p l a ne s , o r a s i so do s e s ur f a c e s .

F.2. Dose-volume Histograms

D i s pl a y o f d o s e di s t ri bu t i o n i n t h e f o r m o f i so d o se c ur v e s o r s ur f a c e s i s us e f ul no t o n l y b e c a u s e i t s ho w s r e g io n s o f uni f o r m d o s e , hig h d o se , o r lo w d o se b ut al so t h e i r a n a to mi c lo c a ti on a n d e x t e nt . In 3 - D tr e a t me nt pl a nni ng , t hi s i nf o r m at io n is e s s e n t i al b u t s ho u l d b e s u p pl e m e nt e d b y d o s e - vo l um e hi st og r am s ( D V H ) f o r t he s e g m e n te d s t r u ct u r e s, f o r e x a m p l e , t a r ge ts , c r i t i c al s t r uc t ur e s , e t c . A D V H no t o n l y p ro v i de s q u a n ti ta t i v e i n f o r m at io n w i t h r e g a rd to ho w m uc h d o s e i s ab s o rb ed i n h o w m u c h v o l u m e b u t a l so s um m a r i z es t he e nti r e d o se d is t r i b ut io n i nto a s i n g l e c u r v e f o r e a c h a n a t o m i c st r uc t ur e o f i nt e r e st . It i s , t he r e f o r e , a g r e a t too l f o r e v a l u a t i n g a gi v e n p l a n o r c o m p a ri ng c om p e ti ng p l a ns . T h e D V H m a y b e r e p re s e n t ed i n t w o f o r m s : t he c um ul a t i v e i nt egr a l D V H a nd t he d i f f e r e n ti a l D V H . T h e c u m u l a t i v e D V H i s a pl ot o f t he v ol um e o f a g i v e n st r uc t ur e r e c e i vi n g a ce r t ai n do s e o r h ig h e r a s a func t i o n o f d o se ( Fi g . 1 9 . 6 ) ( s ee co lo r i n s e r t ) . A n y po i n t o n t h e c u m u l at i v e D V H c ur v e s ho w s t he v ol um e t hat r e ce i v e s t h e i n d i c at e d do s e o r h i g h e r . T h e d i f f e r e nt ia l D V H i s a p l o t o f v ol um e r e c ei v i ng a d o s e wi t h i n a sp e c i fi ed d o se i nt e r v a l (o r d os e b i n) a s a f unc t io n o f d o se . A s s e e n i n F i g . 19 . 6 E ( s ee c olo r i n s e rt ) , t he d i f f e rent i a l fo r m o f D V H s ho w s t he e x te nt o f d o s e v a r i at io n w i t h i n a g i v e n s t r uc t ur e . F o r e x a m p le , t he d i f f er e nt i al D V H o f a u n i f o r m l y i r r a di a te d st r u c t u r e i s a si ng l e ba r o f 1 0 0% v o l ume a t t he s t a te d do s e . O f t h e t w o fo r m s o f D V H , t h e c u m ul a ti v e D V H ha s b e e n fo und to be mo r e us e f ul a n d i s m o r e c om m o n l y u s e d t h a n t he d i f f e r ent i a l f o r m .

19.3. DOSE COMPUTATION ALGORITHMS

S e m i - e mp i ri c a l m et h od s s u i ta b le fo r t he c alc ul a t io n o f do s e at a p o i nt i n a p a ti e nt h a v e b e e n d i s c u s s e d in C h a p t e r 1 0 . C o r r e c tio ns f o r c o nt o ur i r r eg ul a r it y a nd t i s s ue h e t e ro g e n ei t y were also p re s e n te d in C ha p t e r 12. S o me e le m e nt s of t he se m e t h od s h a v e b e e n a d o pt ed i n t o do s e com p ut a ti o n al go r it hm s i n so m e o f t he c o m m e r ci a ll y a v a i l a ble c o m p u te r t r e at me nt- p l a nni ng s y s t e m s . M o d e r n t re a t me nt p l a n n i n g s y s te m s h a ve u p g r ad e d t he s o ft w a r e a dd it io na l l y f o r 3 -D d at a i np ut a nd p r o c e s si n g , do s e c alc u l a t io n , a n d s p e ci a l 3 - D g r a p hi c s . So m e 3 - D t r e at m e nt p l a n n i n g s y s t e m s c on t i n u e t o u s e b a s i c al l y t w o - di m e nsi o na l d o s e c om p ut at io n a l g or it h m s ( c a l c u l at ion o f do s e d i st r ib ut io n i n a g i v e n sl i ce be i ng una f f e c t e d b y c h a n g e s i n t i s s u e com p o si ti o n i n t he a d ja c e nt sl i c e s ) b ut r e nd e r ed i nt o t hr ee d i m e n si o n s t h r o u g h in t e r po l at io n. In t he c a s e o f ti s s ue he te ro g e nei ti e s , i t i s a s s u m e d t h a t t h e a d ja c e n t s li c e s a r e i de nti c a l i n t he ti s s ue c om p o si ti o n to t he s l i c e i n w h i c h t h e d o s e i s b e i n g c al c ul a te d. T hi s a s s um p t i o n i s o b v io us l y w r o ng b u t i s n o t a s b ad a s i t s o u n d s . L at e r al s c a t t er f r o m a d j a ce nt s lic e s i s us ua l l y a s e c o n d o r de r e f f e ct ex c e p t f or s it ua t io ns in w hi c h s m a l l f i el d s a r e us e d t o t re at t u m o r s o r s t r u c t u r e s s u r r o u n d e d b y l ung o r l a r g e a i r c a v i ti e s . O n t he o t he r ha n d , b y a s s u m i n g t h e s a me c o m po si ti o n f or t he ad j a c e nt s li c e s , si m pl er a l go ri t hm s c a n b e u s e d t h a t g r e at l y s p e e d u p t he d o s e c o m p ut at io n p r o c e s s . H o w e v e r , i n 3 - D CRT, where n o n - c o p la n a r beams are o f te n us e d a nd d o se d i s t ri b utio ns are e v a l u a t ed i n m u lt ip l e p l a n e s o r v ol um e s , it i s e s se nt i al t hat t he d o s e c al c ul at io n a l g or it h m h a s a c c e p ta b l e a c c u r a c y ( w i t hi n 3 % f o r ho m o g e ne ous a nd 5 % f o r h e t e ro g e n eo u s t i s s u es s u c h a s l ung ) . Be c a us e p l a n o p ti m i z a ti on i s a n i t e r a ti ve

WWW.MEDRAD.IR

p r o c e s s , s p ee d o f c alc u l a t io n i s o f p a r a mo unt i mp o rt a nc e . T her e f o r e , t he b e st c o m p u t at io n a l balanced. Dose c al c u l a tio n a l go r it h m s for c o mp ut er i z e d t r e at m e nt p l a nni ng ha v e been e v o l v i n g s i n c e t h e m id d le o f t h e 19 5 0 s . In b r o ad t e r m s t he a lgo r it hm s f a ll i nt o t h r e e c a te go r ie s : P.476 ( a ) c o r r e cti o n - b a s ed , ( b ) m od el - b a s ed , a nd ( c ) d ir e c t M o nte C a r lo . E i t he r o ne o f t h e me t h od s c a n be u s e d f o r 3 - D t re a t ment p l a nni ng , al t ho ug h w i t h a v a r y i ng d e g re e o f a c c u r a c y an d s p ee d . H o w e ve r , t he mo d el - b a se d al go r it hm s a nd t he d i r e ct M o nt e C a r lo a r e b e c om i n g mo r e a nd m o r e t he a lg o ri t hm s of t he f ut ur e . T hi s i s b e c a u s e o f t he i r abi li t y to si m ul a te r a di at io n t r a ns p or t i n t hr ee d im e ns io ns a nd t h e r e f o re , m o r e a c c u ra t e l y p re di c t do s e di st r i b ut io n und e r c o nd i ti o ns o f c ha r g e d p a r t i cl e di s eq u i li b ri u m , w h i c h c a n o c c ur in l o w - de ns i t y ti s s ue s s uc h a s l ung a nd h e t e ro g e n eo u s ti s s u e i n t e r f a c e s . A l t ho ug h c ur r e nt l y t he y ar e p l a g ued b y sl o w s p e ed , t h i s li m it a ti o n i s f a s t d i s ap pe a r i ng wi t h t he e v er - i nc r e a si ng s p ee d a nd d ata s t o r ag e c a p a ci t y o f mo d e r n c o mp ut e r s . a lg o ri th m is the o ne in w hi c h a c c ur a c y a nd speed a re w e ll

A. Correction-based Algorithms
T h e s e a l g o ri t h m s a r e s e m i - em p ir i c al . T he y a r e b a s e d p ri m a r il y on m e a s ur e d d a t a ( e . g . , p e r c e n t de pt h d o s e s a n d c ro s s - b e am p r o f il e s , et c . ) o bta i ne d i n a c ub i c w a t e r p h a n t o m . V a ri ou s c o r r e ct io ns i n t he f o r m o f a na l y ti c f unc t io ns o r f a c to r s a r e a p pl ie d t o c al c u l at e do s e d i st r ib ut io ns i n a p a ti e nt . T he co r re c t io ns t y pi c a ll y c o n s i s t o f a ( a ) a t te n u a t i o n c o r re c ti o ns f o r c o nt o ur i r re g ula r i t y ; ( b ) s c a tt er c o r r e ct io n s as a f u n c t io n of s c a t te r i ng vo l um e , f ie l d si z e , s ha p e a nd r a di al d i s t a n c e ; ( c ) g eo m etr i c c o r re c ti o ns f o r sour c e t o poi nt o f c a l cul a t io n d i st a nc e b a s e d o n i n v e r s e s qu a r e l a w ; ( d ) a t t e nua t io n c o r r e c tio ns f o r b e a m i nt e ns it y m o di f i e r s s u c h a s w e d g e f il te r s , c o m pe ns a t o r s , bl o c k s , et c . ; a nd ( e ) a tt e nua t io n c o r r e ct io n s f o r t i s s ue h e t e ro g e nei ti e s b as e d o n r a d io lo gi c p at h l e ng t h ( uni t d e n s i t y eq u i v a l e n t d ep t h ) . C o r r e c ti o n - b a se d a lg or i t h m s r e p re s e nt a v a r i et y o f m e t ho d s r ang i ng f r o m t ho se t h a t s i m pl y i n t er p ol ate m e a s u r e d de pt h- d o se d a t a to s pe c i al l y f o rm ul a t ed a na l y t i c f u n c t i o n s t h a t p r e di c t t h e v a r i o u s c o r r e c tio n f a c t o r s und e r s p ec i f i e d co nd it io ns . T h e d o s e a t a n y p o i n t i s u s u a l l y a na l y z e d i n t o p ri m a r y a nd s c a t t er e d c o m po ne nt s , which are c o m p u te d s e p a r at e l y a nd t hen s um m e d to ob t ai n t he to t al do s e. E q u a t i o n s 9 . 31 a n d 10 . 1 4 a r e e x a m pl e s o f c a l c ul a ti o ns t hat m ea s ur e d q ua nt it ie s s u c h a s p e r c e n t d ep th d o s e s , T A R s , T M R s , e t c . , a nd t he C l ar k s o n s m e t hod ( s ee C h a p t e r 9 ) o f do s e in t e g r at io n f o r a ny s ha p e d f i el d . C o nt o ur c o r r e ct io ns a nd t i s s u e h e t er o ge n e it y co r r e ct io n s a r e di s c us s e d i n C ha p t er 12 . T hes e m et ho d s c a n b e u s e d f o r m a n u a l c a l c u l a ti o n s a s w e ll a s m a d e p a rt o f a c o r r e ct io n- b a s e d c o m p u te r a l go r it h m f or t h e c a l c u l a ti o n o f a bs o r b ed d o se a t a p oi nt i n a p a t i e nt . A s p o i n te d o u t p r e vi ou s l y , t h e a c c ur a c y o f c o r r e ct io n- b a s e d al gor i t hm s i s l i mi te d f o r 3 - D h et e ro ge n e ity c o r r e c tio ns i n l ung a nd ti s s ue i nte r f ac e s e s pe c i al l y i n s i t u a ti o n s w h e r e e le c tr o n i c e q u il ib r i um i s not f ul l y e s t a bl i s hed .

B. Model-based Algorithms
WWW.MEDRAD.IR

A m o de l -b a s e d a lg o rit h m c o mp u t e s do s e di s t ri b uti o n w it h a p hy s i c a l m o de l t h a t s i m u l a te s t h e a c t u a l r a d i at io n t r a ns po r t . Be c a us e o f i t s ab il it y to m od el p ri m a r y p h o to n energy fluence i n c i d e nt at a po i nt a nd t he di s t ri but i o n of e ne r g y s u b s e q u e n t to p r i m ary p h o t o n i n t e r a cti o n, i t i s a bl e to s i m ul at e t he t r a ns p o rt o f s c a t te r e d p h ot o n a n d e l e ct r o n s a w a y f r om the i nt e r a cti o n s it e . A c l a s s o f m o de l b a s e d a l go ri t h m s , c al le d co n v o l u ti o n- s up e rpo s it io n, ha s b ee n und e r de v e lo p me nt s i n c e t h e m id 1 9 80 s (8 , 9 , 1 0 , 11 ) . A n e x a m pl e o f s uc h m et ho d s i s d i s c us s e d b el o w. F o r a l it e r at u r e r e v ie w t h e r e a d e r i n r e f e r r ed t o M a c k i e et a l . ( 12 , 1 3 ) .

B.1. Convolution-superposition Method

A c o n v o l u t io n - s u p e r po s it io n m e t hod i nv ol v e s a c o nv o l uti o n e q ua t io n t ha t s e p a r a te l y co n s i de r s t h e t r a n s po rt o f p r i ma r y p ho to ns a nd t ha t o f t he s c a tt er p h o to n a n d e l e ct r o n em e r g i n g f r om t he p rim a r y p ho t o n i nte r a c tio n. T he d o s e D (

) at a point

is given by:

P.477

w h e r e / i s t h e m a s s a t t e n u a ti o n c o e f f i ci e nt , p (

) i s t h e p r i m a r y p h oto n e n e r g y f l ue nc e , a nd A (

) i s t h e c o n v ol u t io n k e r n e l ( a m a t ri x o f do s e di s t ri b uti o n de pos i t ed b y s c a tt e r p h o to n s a n d e le c t ro n s s e t i n mo ti o n a t the p r i m a r y p hot o n int e r a c ti o n s it e ) . F i g u r e 1 9 . 7 s ho w s t he g eo m et r y o f t he r ad i a ti o n t r a ns po r t . T he p r od uc t o f m a s s a t t e n u a ti o n c oe f f i c i e nt a n d t h e p r i m a r y e ner g y f l ue nc e i s c a l l ed te r m a , T p (

) , w h i c h s t a n d s f o r t o t al e n e r g y re l e a se d p e r uni t m a s s . T e r m a i s a na l og o us to k e r m a , w h i c h r e p r e s e n t s t h e k i n e t i c e ne r g y r e l e a s ed p e r uni t m as s i n t he f o r m o f e l e ct r o n s s et i n mo tio n b y p h o to ns ( s e e C ha p t e r 8 ) . K e r nel i s t he d o se m a t ri x g e n e r a te d p e r u n i t ter m a a t t h e i nte r a ct ion s i te . T he p r od uc t of t e r m a a nd t he d o s e k e r n a l w h e n i n t eg r a t ed ( c o n v o l ve d ) o ve r a v o l um e g i ve s t he d o s e D (

) as given in Equation 19.1.

WWW.MEDRAD.IR

F I G . 1 9 . 7 . G e o m et r y o f p h o to n i nte r a c ti o n a nd r a d i at io n t r a ns po r t f ro m t he si te o f i n t e r a ct io n . ( F r o m M a c k i e T R , p e r s o na l co m m uni c a ti o n. ) T h e c o n v o l u t io n k e r n e l , A (

) , c a n b e r e p r e s e n t ed b y a d o s e s p r e a d a r ra y o b t a i ned b y c a l c ul at io n o r b y d i r e ct measurement. The most co m mo nl y us e d m e t ho d is t he Mo nt e C a r lo w hi c h s i m u l a te s i n t er a c ti o n s o f a l a r g e num b e r o f p r i m a r y p ho to ns a nd d e te r m i ne s do s e d e po s it e d i n a l l d i re ct io n s b y e l e c t ro ns a nd s c a t t e re d p hot o ns or i g i nat i ng a t t he primary p h o to n i nt e ra c t io n s it e . Fi g ur e 19 . 8 s ho w s a

60

Co

ke r ne l

fo r

w a te r

g e n e r a te d b y a Mo n te C a r lo p ro g r a m ( E G S 4 M o nt e C a r lo co d e ). E x a m i na t i o n o f d o s e d i st r ib u t io n i n t he k e r n e l i n d i c at e s t ha t t he do s e d ep o si ti o n b y t he k e r ne l i s f o r w a r d p e a k e d , a s e xp e c te d f o r a m e g a vo lta g e p hot o n b e a m . M o d el i n g o f p ri m a r y p h o to n t r a ns po r t a nd t he c al c ul a ti o n o f do s e k e r nel fo r a l i n e a r a c c el e r at o r x - ra y b e a m r e q ui r e s t he k no w l e d ge o f p ho to n e ne r g y s p e c tr um . A g a i n , M o n t e C a rl o m a y b e u s e d t o c al cul a t e t he e ne rg y s p ec t r um o f a li na c b e a m . M o h a n a n d C h u i ( 1 4 ) u s e d E G S 4 co d e t o c a l c ul a t e e ne r g y sp e c t r um o f l i na c x - r a y b e a m s . S u c h s p e c t r a c a n be us e d b oth f o r t he t r a ns p o rt o f p r i m a r y p ho to ns a n d t h e g e n e r a ti o n o f a d o s e k e r ne l b y t he M o nt e C a r l o m et hod . T hus , t he M o nt e C a r l o ge n e r a te d e n e rg y s p e c t r u m a nd t he k e r ne l a r e e s se nti a l ing r e d ie nt s o f t he c o n v o l u ti o n eq u a t io n t o co m p ut e d o se a t a ny p o i nt i n t he p at ie nt . O ne o f t he i m po r t a n t tasks of c o m m i s si o ni ng a t r ea t m e nt -p l a nni ng s y ste m t ha t us e s a c o n v o l u ti o n e q u at io n s u c h a s E q u a t i o n 1 9 . 1 i s t o mo di f y ( t w e a k ) t he M o nt e C a rl o g e n e r a te d e n e r g y s p ec t r u m i n o r de r t o f it t he mo d el ed b e a m w it h t he m e a s ur ed

WWW.MEDRAD.IR

d e pt h d o s e di s t ri b u ti on a n d c r o s s - b e a m d os e p r o f il e s a s a f unc t i o n o f f i e ld s i z e and depth. A c o n v o l uti o n for e q u a tio n e le c t ron when density m o di f i ed re l at i ve f or to r a d io lo gi c a l w a te r ) is p at h le ng t h the ( di s t a nc e c o r r e ct e d c a ll ed c o nv o l uti o n-

s u p e r p o si ti o n eq u a t ion :

P.478

where

i s t h e r ad io lo g i c p a th l e n g t h f r o m t he s o ur c e to t he pr i m a r y p ho to n i nt e r a ct io n site and

) i s t h e r ad io lo g i c p at h l e n gt h f r o m t he si te o f p ri m a r y p hot o n int e r a c ti o n to t he s i t e o f d o s e d e po s it ion . T h e d o s e k e r ne l A (

) ) c a n b e c a l c ul a t ed b y u s i n g r a ng e s c al ing b y e le c t ro n d e ns ity o f t he M o nt e C a r l o g e n e r at ed k e r n e l i n w a t e r . F i g ur e 1 9 .9 s ho w s t ha t t he k e r n e l o bt a i ned w i t h t h e r a n ge s c al i n g me t h o d co m p a re s w el l w i t h t ha t g e ne r at ed b y M o nt e C a r l o d i r e ct l y f o r t h e h et e rog e n e o u s m ed i um .

WWW.MEDRAD.IR

FIG.

19.8.

C o b a l t -60

d o se

k e r ne l s

fo r

water

c o mp ut ed
-1

with
-1

M o nte

Carlo

s i m u l a ti o n . T h e i s o v al u e li n e s a re i n uni ts o f c G y M e V

p ho to n . T o p : p r im a r y

c o n t r ib u t io n b y e l e ct ro n s s e t i n m o ti o n b y p r i m a r y p ho to ns . M i d d le : t he f i r s t s c a t te r c o n t ri b u ti o n . B o t to m : t h e s um o f p ri m a r y a nd s c a t te r c o nt r i b ut io ns . ( F r o m Mackie TR, B i el a je w AF, R o ge r s DWO, et al . G e ne ra ti o n of p ho to n e ner g y d e po s it io n k e r n e l s u s in g t h e E G S 4 M o nt e C a r l o C o de . P hy s M e d Bi o l 19 8 8; 3 3 :1 2 0 , w i t h p e r mi s s io n . )

B.2. Direct Monte Carlo

The uses P.479 Monte C a r lo te ch n i q u e l aw s of consists of physics to a c o m p ute r de t e rm i ne p ro g r a m (MC code) that of s i m u l a te s t h e t r a n s p or t o f m il li o ns o f p ho to ns a nd p a rt i cl e s t hro ug h m a tt e r . It fundamental p ro b ab il it y d i s t ri b uti o ns i n d i v id u a l i n t er a c ti o n s o f p h o t o n s

WWW.MEDRAD.IR

and

p a r t i cl e s .

The

la r g e r

the

num b er

of

s i m ul a te d

p a rt i cl e s

( hi s t o ri e s ) ,

t he

g r e a te r t h e a c c u r a c y o f p r e di c ti n g t hei r di st r i b ut io ns . H o w e v e r , a s t he num b e r o f s i m u l a te d pa r ti c le s i s i n c r e a s e d , t he c om put a t io na l t i me b e co me s p r o hi b it i ve l y l o n g . S o t h e c h a l le n g e i n w r i ti ng a n M C c o de i s t ha t o f b e ing a b le to us e a r e l at i v el y s m a ll sa m pl e o f r a n do m l y s el e ct e d p a rt i cl e s to p r e di c t t he a v e r a ge b e h a v i o r o f t h e p a rt ic l e s i n t h e b e a m . T he d o s e d i st r ib ut io n i s c a l c ul a te d b y a c c u m u l a t i n g ( s c or i n g) i o n i z i n g e v e nt s i n bi ns ( v o x e l s ) t hat g i v e r i s e to e ne rg y d e po s it io n i n t h e m ed i u m . It i s e s ti m at e d t ha t t he t r a ns po r t of a f e w hund r e d m i ll io n t o a b il li o n h i s t o ri e s w il l b e r equi r e d f o r r ad i at io n the r a p y t r e at m e nt p l a n n i n g w i t h a d eq u a te p r e c i sio n .

F I G . 1 9 . 9 . C o m p a r i son o f M o n t e C a r lo - ge ner a t e d 6 - M e V p ri m a r y p ho to n k e r ne l i n a water p h a n to m c on t a i n i n g a ri ng of ai r . T he c o nti nuo us l ine is a k e r nel c o m p u te d e x p r e s sl y f o r t h e h e t e ro ge ne o us s i t ua t io n. T he d a s he d l i ne i s a k e r ne l m o di f i ed f o r t h e h ete r o ge n e o u s p ha nto m us i ng r a ng e s c a li ng . ( F r o m W oo M K , C u n n i n g h a m J R . T h e v a l i di t y o f t he de ns ity s c a l i ng m e t ho d i n p r i m a r y el e ct r o n t r a n s p o rt for p h o to n and e l e c t ro n b e a ms . Med P hy s 1 9 9 0 ;17 : 1 87 19 4 , with p e r m i s sio n . ) A n u m b e r o f M C c o d e s h a s b e e n us e d i n r a d i a ti o n t r a ns po rt s i m ul a ti o n a nd , m o r e r e c e n tl y , i n t r e a t me n t p l a n n i n g : E l e c t ro n G a m m a S ho w e r v e r s i o n 4 ( E G S 4 ) ( 1 5 ) , E T R A N / IT S (16), M on t e C a r lo N -p a r ti c le (MCNP) (17), P E NE L O P E (18) a nd P E R E G R IN E ( d e v e l op ed a t L a w r e nc e L i v er mo r e N at io na l L a bo r a tor y ) ( 1 9 ) . Fo r a d e t ai le d r e v ie w a n d b ib l io g r ap h y o f M C c o d e s , t he r e a d e r i s re f e r re d to ( 2 0 , 21 ) .

WWW.MEDRAD.IR

N o t w it h s t a n d i n g i no r di n a t e a m o u nt s o f com p ut a ti o na l ti m e s , Mo nt e C a r l o i s t he m o s t a c c u r at e me t ho d o f c a l c u l at i ng do s e di s t ri b uti o n i n a p a ti e nt . S a m p le pl a ns d o n e wi t h M o nt e C a rlo s im u l a ti o n ha s s ho w n s i g ni f i c a nt g ai ns i n a c c ur a c y o f d o se c a l c u l a ti o n , e s pe c i al l y a t i n te r f a c e s o f het er o g e neo us ti s s ue s a nd i n l ung w he r e p a r t i cl e d i se q u i li b ri um c a n o c c u r und e r c e r t ai n c o nd it io ns . W i th t he c o nt i nui ng a d v a n c e m e n t i n co m pu t e r te c h n o l og y a nd c o m p ut at io n a l go r it hm s , i t no w s ee m s p r o b ab le t h at the Mo n t e C a rl o m e t ho do lo g y w il l b e i m pl e ment e d f o r r o uti ne t r e at m e n t pl a n n i n g i n t h e n o t to o di s t a nt f ut ur e .

REFERENCES
1 . IC R U . P r e s c r i b i n g , r e c o r di n g , a nd r e po r ting p ho t o n b e am t he ra p y . R e p o r t No . 50. P.480 B e t he s d a , MD: In t e r n a t i o na l Co mm i s s io n on R a d i at io n U ni t s a nd M e a s u r e m e n t s , 1 99 3 .

2 . C o i a L R , S c h u t h e i s s T E , H a n k s G E , e d s . A p r a c t i c a l g uid e to C T s i m ul a t io n . M a d i s o n , W I: A d v a n c e d M e d i c al P ub l i s hi ng , 1 9 95 . 3 . K e ll e r ML , P i tl u c k S , P e t ti P , e t a l . Int eg r a t io n o f m ult im od a li t y i ma g i ng d a ta f o r r a di ot h e r a p y t r e atm e n t pl a n n i ng . I nt J R a d i a t O nc ol Bio l P hy s 1 99 1 ; 21 : 16 5 3 1 6 67 . 4. P e li z z a r i CA, Chen GTY, S p e l b r i ng DR , et al. A c c ur a te thr e e - d i me ns io na l r e g i st r a tio n o f P E T , C T , a n d M R i m a g e s o f t he b r ai n. J C o m put A s s i s t To m og r 1 9 89 ; 1 3 :2 0 2 7 . 5. Austin-Seymour M, Chen GTY, R o s e nm a n J, et al. Tumor a nd t a r ge t d e li n e a ti o n : c u r r e n t re s e a r c h a n d f ut ur e c h a l l e nge s . I nt J R a d i a t O nc o l Bi o l P hy s 1 9 95 ; 3 3 :1 04 1 1 05 2 . 6 . B o y e r AL . B a s i c a pp l i c at io n s o f a m ulti l ea f c o ll i m ato r . In: M a c k i e T R , P a lt a J R, e d s . T el et h e r a p y : p r es e n t a n d f u t ur e . Co ll eg e P a r k , M D : A me r i c an A s s o c i a ti o n o f P h y s i c i s t s i n M e d i ci n e , 1 9 9 6 . 7 . K u t c h e r G J , J a c k s o n A . T r e a t m e nt p l a n e v a l ua t io n. In: K ha n F M , P o t i s h R A , e d s . T r e at m e n t p l a n ni n g i n r a di at io n o nc ol og y . Ba l t im o re : W il lia m s & W il k i ns , 1 9 98 . 8 . M a c k i e T R , S c r i m g e r J W , B a t t i s t a J J . A c o nv o l uti o n m e t ho d o f c a l c ul a t i ng do s e f o r 1 5 M V x - r a y s . M e d P h y s 1 9 8 5 ; 1 2 :1 8 8 19 6 . 9 . B o y e r A L , M o k E C. A p h o to n d o se di s tr i b uti o n mo d el em p loy i ng c o nv o l uti o n c a l c u l a ti o n s . M e d P h y s 1 9 8 5 ;1 2 :1 6 9 17 7 . 1 0 . M o h a n R , C h u i C , L i do f s k y L . Di f f e r e nti al pe nc i l be a m d o se com p ut a ti o n mo de l f o r p h o to ns . M e d P h y s 1 9 8 6 ;1 3 :6 4 7 3 . 1 1 . A h n e s j o A , A n d reo P , B r a h m e A . C a l c ul a ti o n a nd ap pl i c at io n o f po i nt s p re a d f u n c t i o n s f o r t r e a t men t p l a n n i n g w i t h hi g h e ne r g y p ho t o n b e am s . A c t a O nc o l 1 9 87 ; 2 6 :4 9 5 6 . 1 2 . M a c k i e T R , R e c k w e r d t P , M c N ut t T , e t a l . P ho t o n b e a m do s e c o m p ut at io n. In: M a c k i e T R , P a l t a J R , e d s . T el et he r a p y : pr e s e nt a nd f ut ur e . Co ll e ge P a r k , M D : A m e r i c a n A s s o c i at io n o f P h y s i c i s t s i n M e d i cine , 1 9 9 6 .

WWW.MEDRAD.IR

1 3 . M a c k i e T R , H el en H L , M c C u l l o ug h E C . T r e a t m e nt pl a nni ng a l go r it hm s . In: K h a n F M , P o t i s h R A , e d s . T r e at m e nt pl a nni ng i n r a d i at io n o nc o lo g y . Ba lt i mo r e: W i l li a m s & Wi l k i n s , 1 99 8 . 1 4 . M o h a n R , C h u i C . E n e r g y a n d a ng ul a r d i s t ri b utio ns o f p ho t ons f r o m m e d i c al l i n e a r a c c el e r at o r s . Me d P h y s 1 9 8 5 ; 12 : 59 2 5 97 . 1 5 . N el s o n W R , H i r a y am a H , R o g e r s D W O . The E S G 4 c o d e s y s t e m . S t a nf o r d Li ne a r A c c e l e r at o r C e n te r R ep o rt S L A C - 2 6 5 . S t a nf or d , C A : S L A C , 1 9 8 5 . 1 6 . B e r ge r M J , S el t ze r S M . E T R A N , M o nt e C a r l o co de s y s te m fo r el e ct r o n a nd p h o to n t r a n s p o rt t h r o u g h e x t e n d e d me d ia . D o c um e nt a ti o n f o r R S IC C o m p ut e r P a c k a g e C C C - 1 0 7 . O a k R i d g e , T N : O a k R i d ge N a t io na l L a bo r a to r y , 1 9 7 3 . 1 7 . H e n d ri c k s J S . A Mo n t e C a rl o c od e fo r pa r t i cl e t r a ns po r t . L o s A l a m o s S ci e nti f i c L a b o r at or y R e p o rt 1 994 ; 2 2 :3 0 4 3 . 1 8 . S a l v a t F , F e r n a n de z - V e r a J M , Ba r o J , et a l . J . P E N E L O P E , A n a l g o ri t hm a nd c o m p u te r c od e f or M on t e C a r lo s i m ul at io n of e l e ct r o n- p hoto n s ho w e r s . Ba r c e l o na: In f o r m e s T c n i c o s C i em a t , 1 9 96 . 1 9 . W a ll i n g R , H a r t ma n S i a n t a r C , A l b ri g ht N , et al . C l i nic a l va l i d at io n o f t he P E R E G R IN E M o n t e C a r l o d o se c a l c ul a ti o n sy s t e m f o r p hot o n be am t he r a p y . M ed P h y s 1 9 9 8 ; 2 5 : A1 2 8 . 2 0 . R o ge r s D W O , B iel a j e w A F . M o nte C a r lo te c hni q ue s o f el e ctr o n a nd p ho to n t r a n s p o rt f o r r a di a ti on d o s i me t r y . In: K a se K R , B r ng a r d BE , At ti x F H , e d s . T he d o s im e tr y o f i o n i z i n g r a d i at io n . S a n D i e g o : A c a d e m i c P r e s s , 19 9 0: 4 2 7 5 39 . 2 1 . L i J S , P a w l i c ki T , D e n g J , e t al . V a l id at io n o f a M o nt e C a rl o d o s e c al c ul a ti o n t oo l f o r r a di ot h e r a p y tr e a t me n t p l a nni ng . P hy s M e d Bi o l 20 0 0 ;4 5 :29 6 9 2 96 9 .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part III - Modern Radiation Therapy > 20 - Intensity-Modulated Radiation Therapy

20 Intensity-Modulated Radiation Therapy

20.1. INTRODUCTION
In t h e t r a di tio n a l e xte r n a l be a m p ho to n r ad i a ti o n t he r a p y , mo st t r e at m e nt s a re d e li v e r ed w i t h r a di a ti o n b e a ms t ha t a re o f uni f o r m i nt e ns it y a c r o s s t he f ie ld ( w i t h i n t h e f la t n e s s sp e c i f i ca ti o n li m it s ) . Oc c a s i o na ll y , w e d ge s or c o m pe ns a t o rs a r e u s e d t o m od i f y th e i n t e n s it y p ro f il e to o f f s et co nt o ur i r r eg ul a r it ie s a nd / or p r o d u c e mo r e u n i f o rm c o m p o si te d os e d i st r i b ut io ns s uc h a s i n t e c hni q ue s us i ng w e d g e s . T h i s p r o c e s s o f c h a n g i n g b e a m i nte ns i t y p r o f il e s to m e et t he g o al s o f a c o m po s it e m o d er n The any pl a n is ca l l ed i n te n s i t y mo d ul a ti o n. T hus , t he c o m p e ns a to r s suc h to as a a nd w e d g e s m a y b e c a ll ed a s i n t e n s it y m od ula t o r s , al be it m uc h s im p l e r t ha n t he c o m p u te r - c on t r o ll ed i n te ns i t y mo d ul at io n systems d y na m i c r ad i at io n d o se m u l t il e a f c ol li m a to r s . t e r m i n te n s i t y -m o d u l at e d given p o s i ti o n of the r a di a ti o n t he r a p y b ea m to ( IM R T ) op ti m i z e r e f e rs t he t h e r a p y t e c h n i q u e i n w h i c h n o n uni f o r m f l u e nc e i s d e li v e r ed t o t he p a ti e nt f r o m t r e at m e nt c o m p o si te d i s t ri b u tio n . T h e t r e a t m e n t c r it e ri a f o r p la n o p t i mi z a ti o n a r e s p e c i f ie d b y t he p l a n n e r a n d t h e o pt im a l f l u e n c e p ro f i le s fo r a g i v e n se t o f b e am d i re c ti o ns a re d e te r m i n ed t h r o u g h i n v e r s e p l a nni ng . T he f l ue nc e f i l e s t hus g e ne r a te d a re e l e ct r o ni c a ll y t r a n s m it t ed t o t h e l i ne a r a c ce l e r ato r , w hi c h i s com p ut e r - co nt r ol le d , that The is, e q ui p pe d wi t h the r eq ui r ed of IM R T so f t w a r e r equi r e s a nd at ha rd w a r e two to de li v e r t he a i n t e n s it y - m o d ul a te d be a m s ( IM B s ) a s c a l c ul a t e d . c l i n i c al i m pl e men t a t io n le a s t systems: (1 ) t r e at m e n t -p l a n n i n g com p u t e r s y st e m t ha t ca n c a l c ul a te no nuni f or m f l ue nc e m a p s f o r m u l t ip l e be a m s di r e ct e d f r o m di f f e r e nt d i r e c ti o ns to m a x i mi z e d o s e t o t he t a r g et v ol u m e w h il e m i n i m i zi n g do s e t o t he c r it i c al no r m al st r uc t ur e s , a nd ( 2 ) a s y s t e m o f d el i v e ri n g th e n o n u n i f o r m f l ue nc e s a s pl a nne d . E a c h o f t he s e s y s t e ms m u s t b e a p p ro p ri a te l y t e s te d a n d c o m mi s s ione d b e f o re a c t ua l c li nic a l us e .

20.2.

INTENSITY-MODULATED

RADIATION

THERAPY

PLANNING
T h e p r i n c i pl e o f IM R T i s to t re a t a p a ti e nt f r o m a num b e r o f di f f e r e nt di r e ct io ns (or c o nt i n u o u s arcs) with b ea m s of nonuni f o r m f l ue nc e s , w hi c h ha v e been o p ti mi z e d t o de li v e r a h i g h do s e to t he t a rge t vo l um e a nd a c c ep ta b l y lo w do s e to t h e s u r r o u n d i n g n o r m a l s t r u c t u r e s . T he t r ea t m e nt -p l a nni ng p r ogr a m d i v i de s e a c h b e a m i n t o a l a r ge n u m b e r o f be a m le t s a nd d et e rm i ne s o pt i m um s e tt i ng o f t he ir f l u e n c e s o r w ei g h t s . T h e o p ti m i z at io n p r o ce s s i nv o l v e s i nv e r s e p l a nni ng i n w hi c h b e a m le t w ei g h t s o r i n t e n s it i e s a r e a dj us t ed t o s at i s f y p r ed e f i ned d o s e d i st r ib ut io n c r i te r i a f o r t h e co m pos i t e p l a n .

WWW.MEDRAD.IR

A n u m b e r o f c o m p u t e r m e t h o d s ha v e b e e n de v i s e d to c a l c ul at e opt i m um i nte ns i t y p r o f il e s ( 1 , 2 , 3 ,4 , 5 , 6 ,7 , 8 , 9 , 1 0 ) . T he s e m et ho d s , w hi c h a re b as e d on i nv e r se p l a n n i n g , c a n b e d i v i de d i n to t w o b ro a d c ate g o ri e s :

A n a l y t i c m et h o d s . T he s e i nv ol v e m a t hem at i c al t e c hniq ue s i n w hi c h t he d e s i re d do s e di s t ri b u ti o n i s i nv e r te d b y us ing a b a c k p r o j e c ti o n a l g or it hm . In e f f e c t , t h i s i s a r e v e r s e P.482

o f a co m p u te d t om og r a p h y ( C T ) r e co ns t ruc t i o n al go r it hm i n w hi c h t w o d i m e n si o n a l functions. If i m a ge s one are r e co ns t r uc t ed t ha t t he f ro m o ne -d i me ns io na l is t he i nt e ns it y r e s ul t of a ss u m e s d o se di s t ri b uti o n

c o n v o l u ti o n s o f a po i nt - d o se k e r nel a nd k e rne l d e nsi t y , t he n t he r e v e r s e i s a l s o p o s si bl e , n a me l y , b y de c o nv ol v i ng a dos e k e r nel f r o m t he des i r e d do s e d i s t ri b u tio n , o n e c a n o bt a i n k e r nel de ns i ty o r f l ue nc e d i st r ib uti o n i n t he p a t ie n t . T h e s e fl u e n c e s c a n t he n be p ro j e ct e d o nto t he b e am geo m et r y to c r e a t e i n c i de n t b e a m in t e n s i t y p ro f i le s . O n e p r ob le m w it h a n a l y t i c al me t hod s i s tha t , unl i k e C T r e co ns t r uc t io n, e x a c t a n a l y ti c a l so l u ti o n s do no t e x i st f o r d e te r m i ni ng i nc id e nt f l ue nc e s t h a t w o u l d p r od u c e t he d e si r e d d o se di s t ri but i o n w it ho ut a ll o wi ng ne g a t i v e beam w e ig h t s . The p r o bl e m can be ci r cum v e nt e d by s e tt i ng ne g a t i ve w e i g h t s to z e r o b ut n o t w i t ho ut p e na lt y in t e r m s o f unw a nt e d d e v i a ti o ns f r o m t h e d e si r e d go al. S o s o m e a l go r it hm s ha v e b e e n d e v i s e d to i nv o l v e b o t h a n a l y ti c a l a n d it er a t i v e p ro c ed ur e s .

It e r a ti v e m e t ho d s . O p t im i z a ti o n t e c hniq ues ha v e b e e n d e v i s e d i n w hi c h b e a m le t w ei g h t s f o r a g i v e n num b e r o f b ea m s a r e i te r a ti v e l y ad j us t ed to m i n i m i z e t h e v a l u e o f a c o st f unc t io n, w hi c h q ua nt i t a ti v el y r e p r e se nt s d e v i at io n f r o m t h e d es i r e d g o al . F o r e x a m pl e , t he co st f unc t i o n m a y b e a l e a s t sq u a r e f u n c t i o n o f t h e f o r m :

w h e r e C n i s t h e c o s t at t h e n t h i t e ra ti o n, D o (

) i s t h e d e s ir e d do s e a t s o m e po i nt

i n t h e p a ti e n t , D n (

WWW.MEDRAD.IR

) i s t h e c o m p u te d do se a t t he s a m e po i nt , W (

) i s t h e w ei g h t (r e l ativ e i m po r t a nc e ) f a ct o r i n t e r m s o f c o nt r i b uti o n to t he c o s t f ro m di f f e r e n t str u c t u r e s a nd t he s um i s t a k e n o v e r a l a r ge N num b e r of the do s e p oi n t s . Thus, c r it i ca l for t a r g et s t he co s t is t he t he cost r oo t is m e an t he s q ua r ed mean d i f f e r e n c e be t w ee n t h e d e s i re d ( p re s c r ib e d ) d o s e a nd t he r e al i z e d d o s e . F or d e si g n a t ed normal s tr uc t ur e s, ro ot s q u a r e d di f f e r e n c e bet w e e n z e r o d o se ( o r a n a c c e p t a bl e l o w dos e v a l ue ) a n d t h e r e al i z ed do se . T h e o v e r a ll co s t is t he s um o f t he cos t s f o r t he t a r g et s a n d t h e n o r m al s t r uc t ur e s , b a s ed o n t he i r r e s pe c ti v e w e ight s . T h e o pt i mi z a ti o n al go ri t h m at te m pt s t o m i nim i z e t he o v e r a ll co s t a t e a c h i te r a tio n u n t i l t h e d e si r e d g o al ( c lo s e to a p re de f ine d d o se d i st ri b uti o n) i s a c hi e v e d . A quadratic minimum. m u l t ip le co s t f u n c t io n such as t ha t given b e am t he to by E q ua t i o n for 20.1 al l the ha s o nl y o ne f ro m it is An However, when o p t im i z i ng in w e i g ht s beams

d i f f e r e n t di r e ct io n s to r e a c h a g l o b al m i nim um , t he s a m e c o s t f unc t i o n e x hi b it s lo c al to mi n i ma . a c ce pt a Therefore, higher i te r a tio n p r o ce s s in oc c a s i o na ll y lo c a l necessary c o st av o i d t r ap pi ng mi ni m a .

o p ti mi z a t io n p r o ce s s , c a l l ed s i m ul at ed a nne a l i ng ( 3 ,1 0 ) ha s be e n d e v i se d t h at a l lo w s t h e s y s t e m to ac c e p t so m e hi g he r co st s i n p ur s ui t o f a g lo ba l m i ni m um . S i m u l a te d annealing takes its na m e f r om t he process by w hi c h metals are a n n e a l e d . T h e a n n e a l in g p r o c e s s f o r me t al s i nv o l v e s a c o nt ro ll ed p r o c e s s o f s l o w c o ol i n g t o a v oi d a mo r p h o u s s t at e s , w hi ch c a n d e v e l o p i f t he t e mp e r at ur e i s a l lo w e d t o d e cr e a s e to o f a st . In t he a na log o us p ro c e s s o f si m ul a t ed a nne a li n g , t h e d e ci s io n to a c ce p t a c h a n g e i n c o st i s co nt r ol le d b y a p ro b a bil it y f unc t i o n. In o t h e r w o r d s , If C n < 0 , t h e c h a n g e i n t he va r i a b le s i s al w a y s a c ce p te d . But i f C n > 0 t h e c h a n g e i s a c c e p te d w i t h a n a c c e pt anc e p r o b a bi li t y , P a c c , gi v e n b y :

where Cn = Cn - Cn

- 1

, T n i s a n a lo go us to t he r m al e ne rg y a t i te r a ti o n n ( it ha s

t h e s a m e d i me n s i o n s a s C n ) , T n m a y b e t ho ug ht o f a s t e m pe r a t ur e a nd a s B o l t z m a n n c o n s t a n t . 1 A t t h e s t a rt o f s i m ul ate d a nne a l i ng , t he t her m a l e ne r g y i s l a r g e , r e s u lt i n g i n a l a r g e r p ro b ab il it y o f a c c e p ti ng a c ha ng e i n v a r i a b l e s t h a t g i v e s r i se t o a h i g h e r c o s t . A s P.483 the o pt i mi z a ti o n p ro c e s s p ro c ee d s , t he a c c e pt a nc e p r ob ab i li t y de c r e a se s

e x p o n e n ti a ll y i n a c co rd a n c e w i t h E q ua tio n 2 0 . 2 a nd t hus d r i ve s t he s y s t em to a n o p ti m al s ol u t io n . T h e p r o c e s s i s de s c r ib e d b y W e b ( 10 ) a s b ei ng a na l o go us to a s k i e r d e s ce n d i n g f r o m a h i l l to p to t he lo w e st p oi nt i n a v a l l e y . T h e p a t i e n t i n p u t d a ta f o r t h e i nv e r s e p l anni ng a l g o r it hm i s t he s a m e a s t h a t n e e d ed f o r f o r w a r d p l a n n i n g , a s d i s c us se d i n C ha p t er 1 9 . Thr e e - d i me ns io na l i m a g e d a t a , i m ag e r eg i s t r ati o n , a nd s e g m ent a t io n a r e a l l re q ui red w he n p l a nni ng f o r IM R T . F o r e a c h t a rg e t ( P T V ) t he us e r e nt e r s t he p l a n c ri te r i a : m a x i m um do s e ,

WWW.MEDRAD.IR

m i n i m u m d o se , a n d a d o s e - v ol um e hi s to gr a m . F o r t he c r i ti c a l s t r uc t ur e s , t he p r o g r am such as r e q u i re s beam the d e s i re d beam li m it i ng do s e a nd a of d o s e - v olum e i t e r at ions , hi s t o g r am . etc., before D e p e n di n g o n t h e IM R T s o f t w a r e , t he us e r m a y b e r e q ui re d to p ro v i de o t he r d a ta energy, d i re c ti o ns , num b e r p r o c ee di n g t o o p ti miz i n g i n t e n s i t y p ro f il es a nd c a l c ul a t i ng t he r e s ul ti ng d o se d i s t ri b u tio n . T h e e v a l u a t i o n o f a n IM R T t re a t m e nt p la n a l s o req ui r e s t he s a m e c o n s i d er a ti o n s a s t h e c o n v e n t i o na l 3 -D C R T p l a ns , na m e l y , v i e w i ng i so do s e curves in o r t h o g o n al planes, i nd i v i d ual slices, or 3 -D v o l ume s ur f a c e s . T he i s o do s e di s tr i b ut io n s a r e u s u a l l y s up p l e me nt e d b y do s e - v ol um e his t o gr a m s . A f t e r a n a c c e pt a b le IM R T p l a n ha s b e e n g e ne r a te d , t he i ntens i t y p r o fi l e s ( o r f l u e n c e m a p s ) f o r e a c h b e a m a r e e l e ct ro ni c a ll y t r a ns m i tt ed t o t he tr e a tm e nt a c c e l e r ato r f i tt e d w ith a p p r o p ri a te ha r d w a r e a nd s o f t w a r e to d el i v e r t he p l a nned i n t e n s it y - m o d ul a te d be a m s . T h e t re a t me nt -p l a nni ng a nd de li v e r y s y s t e m s m us t b e i n t e g ra t ed to e n s u r e a c c u r a t e a nd e f f i c i ent d e li v e r y o f t he pla nne d t r e a tm e nt . B e c a u s e o f t h e b l a c k b o x n a t u r e o f t he ent i r e p r o ce s s , ri g or o us v e r i f i c at io n a nd q u a l it y a s s u r a n c e p r o c e d u r e s a r e r eq ui r ed to i m pl e me nt IM R T .

20.3.

INTENSITY-MODULATED

RADIATION

THERAPY

DELIVERY
R a d i a ti o n t h er a p y a c ce l e r ato r s n o r m a ll y g ene r a t e x - r a y b e a m s tha t a r e f l a tt e ned ( m a d e u n i f o r m b y t h e u s e o f f l a t t e ni ng f i lte r s ) a nd c o ll i m at ed by f o ur m o v e a b l e j a w s t o p ro d u c e r e cta n g u l a r f i el d s . P re c ol li m a ti o n d o se r at e c a n b e c ha ng ed uniformly within the beam but no t s p at i al l y , a l t ho ug h t he s c a nni ng beam a c c e l e r ato r s ( e . g . , M ic r o t ro n ) h a v e t he c a p a b il it y o f m o d ul at i ng t he i nt e ns it y o f e l e me n t a r y s c a n n i n g b e a m s . T o p r od uc e i nt e ns i t y - mo d ul at ed f l ue nc e p r o f i le s , p r e c a l c u la t ed b y a tr e a t me n t p l a n, t he a c c e l e r ato r m us t b e e q ui pp e d w it h a s y s t e m t h a t c a n c h a n g e t h e gi v e n b e a m p rof i l e i nto a p r o fi le o f a r b i t r ar y s ha p e . M a n y c l a s s e s o f i n ten s i t y - m o d ul a t ed s y s tem s ha v e b e e n de v i s ed . T he s e i nc l ude c o m p e n s at o r s , w e dg es , t r a n s m i s s io n b l o c k s, d y na m i c j a w s , m o v i ng b a r , m ul t il e a f c o ll i m at o r s , t o mo t h e ra p y c o l li m at o r s , a nd s c a nne d e l e me nt a r y be a m s o f v a r i a bl e i n t e n s it y . Of t h e se , only the last fi v e a l lo w d y na m i c i ntens i t y m od ul a ti o n. C o m p e n s a to r s , w ed g es , a n d t r a n s mi s s io n bl o c k s a re m a nua l t e chni q ue s t ha t a re t i me c o n s u m i n g , i n e ff i c i e n t , a n d do no t b e lo ng to t he mo d e rn c l a s s o f IM R T s y s t e m s . D y n a m i c j aw s a r e s u i te d fo r c r ea t i ng w ed g ed s ha p ed d i st r ib ut io ns b ut a r e n o t s ig n i f i c a n tl y su p e r io r to co nv e nt io na l m et a l w e d ge s . A lt ho ug h a s c a nni ng b e a m a c c e le r at o r c a n d e l i v er i n t e ns it y - m od ul a t ed e le m e nt a r y be a m s ( 1 1 ) , t he G a u s s i a n h a l f - w i d t h o f t h e p h o t o n p e nc il a t t he i so c e nt er c a n b e a s l a r g e a s 4 c m a n d t he r e f o re d o es n o t h a v e t he d e si r ed r e so l utio n b y i t s el f f o r f ul l i nte ns i ty m o d u l at io n . H o w e v e r , s c a n n i n g b e a m m a y b e us e d to ge t he r w it h a d y na m i c M L C t o o v e r c o me t h i s p r ob l e m a n d p r o v id e a n a d d it io na l de g r ee o f f r e e d om f o r f ul l d y n a m i c i n t e n si t y m od u l a ti o n . T he c a s e o f d y na m i c M L C w i t h up s t r e am f l ue nce m o d u l at io n i s a p o w er f u l b u t c o m p le x t e c hni q ue t ha t i s c ur r e nt ly p o s s i bl e o nl y w i t h s c a n n i n g b e a m a c c e l e r ato r s s uc h a s m i c r o t ro ns ( 1 2 ) . F o r li n e a r ac c e le r a to rs i t s ee m s t he co m p ute r - c o nt ro ll ed M L C i s the m o st p r a ct i ca l device f or d el i v e ri n g i n t e n s it y - m o d ul at ed beams ( IM B) . C o m p e ti ng with t hi s t e c h n o lo g y a r e t h e to m ot h e r a p y - b a se d co ll i m at o r s o ne e mb od ie d b y t he M IM i C

WWW.MEDRAD.IR

c o ll i m at o r o f t h e N O M O S C o r p o r a ti o n a nd t he o t he r d e si g ned f o r a t o mo t he r ap y m a c h i n e u n d e r c o n s t ru c t i o n a t t h e U ni v er s ity o f W i s c o ns i n. P.484

A. Multileaf Collimator as Intensity Modulator

A c o m p u t e r -c o n t ro ll ed m u l ti le a f c o ll i ma to r i s no t o nl y us e f ul in s ha p i ng b e a m a p e r t u r e s f o r co n v e n t io n a l r a di ot he r a p y i t c a n a l s o be p ro g r am m e d t o d el i v er IM R T . T h i s h a s b e e n d o n e i n t h r e e di f f e r e nt w a y s :

A.1. Multisegmented Static Fields Delivery

T h e p a t i e n t i s t re a te d b y m u l t i p le f i e ld s a nd e a c h f i e l d i s s ub d i v id e d i nto a s e t o f s u b f i e l d s i r r ad i at e d w it h u n i f o r m b e am i ntens i t y l e ve l s . T he s ub f ie l d s ar e c re a te d b y t h e M L C a n d d el iv e r e d i n a s t a c k a r ra ng e m e nt o ne at a ti m e i n s e q ue nce w i t h o u t o pe r a to r i n te rv e n t i o n . T h e ac c e le r a to r i s t ur ne d o f f w hi l e t he le a v e s m o v e t o c r e at e t h e n e x t s ub f i e ld . T h e c o m po s it e o f d o s e i nc r e m e nt s de l i v er e d t o e a c h subfield c re a te s t h e i n t e n s it y m o d ul at ed b e a m a s p la nne d by t he t r e at m e nt p l a n n i n g s y s t e m . T h i s m e t h o d o f IM R T d e l iv e r y i s a l s o c a l le d s te p - a nd - s hoo t o r s t o p - a n d - s h oo t . T h e t h e o r y o f c r e at i ng sub f i e l d s a nd le a f - s e tti ng s e q ue nc e to g e n e r a te t h e de s i re d i n t e n s it y m od ul a ti o n ha s b e e n di s c us s e d by Bo r t f e ld et al . (13). The me t h od is i ll u s t r at e d in Fi g . 20.1 for o ne - di m ens i o na l i nt e ns it y m o d u l at io n i n w h i c h a l e a f - p ai r t a ke s up a num b e r o f s t at i c loc a t io ns a nd t he r a d i at io n f r o m e a c h st a ti c f i el d t hus d e f i ned i s de li v e r ed a t d i s cr e t e i nt er v a l s o f f l u e n c e ( s h o w n b y d o t t ed li n e s ) . In t hi s e x a m p l e te n s e p a r at e f i e l d s ha v e b ee n s t a c k e d i n a le a f - s e tt i n g a r r a n g em e nt k no w n a s t he c l o s e -i n t e c hni q ue ( F i g. 2 0 . 2 A ) . A n ot h e r a r r a ng e m e n t c a ll ed t he lea f - s w e e p i s a l so s how n ( F i g . 20 . 2 B) . T h e t w o a r ra n g e m e nts a r e e q u i v a le nt a nd t a k e t he s a me num be r o f c um ul at i v e m o n i to r u n it s . In f a c t, i f N i s t h e num b e r of s ub f i e ld s st a c k e d , i t ha s b ee n s ho w n t h a t t h e re a r e ( N! ) 2 po s s i bl e e q u i v a le nt a r ra ng e m e nt s (1 4 ) . T he t w o - di m e ns io na l i n t e n s it y m o d u l at io n is r e a l i z ed a s a c o m bi na t io n o f m ul t ip le s ub f ie l d s o f d i f f e r e nt s i z e s a n d s h a p e s c r e at e d b y t h e e nt i re M L C . T h e a d v a n t a g e o f st ep - a n d - s h o ot me t hod is t he e a s e o f im p le me nt a ti o n f r om t he e n g i n e e ri n g a n d s a f e ty p o i n t s o f v i e w . A po s s i bl e d i s ad v a nt a g e i s t he i nst a bi li t y o f s o me a c c el e r at o r s w h e n t h e b e a m i s s w it c he d o f f ( to r e se t t he le a v e s ) a nd o n w i t h i n a f r a c t i on o f a s e c o nd . T he us e o f a g r i d de d pent o d e g un c o ul d o v e r c o me t h i s p ro bl em a s i t a ll o w s m o nito r i ng a nd te r m i na tion o f d o s e w i t hi n a b o u t o n e - h u n d r e dt h o f a m o n i to r uni t , M U . H o w e v e r , no t a l l m anuf a c t ur e r s ha v e t h i s t y p e o f e l e ct ro n g u n o n t h e i r l i ne a r a c ce l e r ato r s .

WWW.MEDRAD.IR

F I G . 2 0 . 1 . G e n e r a ti on o f o n e - d i m e ns io na l i nt e ns i t y - mo d ul at io n p r o f i le . A l l le f t l e a f s et ti n g s o c c u r at p o s it io n s w he r e t he f l ue nc e i s i nc r e a si ng a nd a l l ri g ht l e a f s e t ti n g s o c c u r w h e r e t h e f l u e n c e i s d e c r ea s i ng . ( F r o m W e b S . T he p hy s i c s o f c o n f o r m a l r ad io t h e r apy . B r i s t o l , UK : Ins t i tut e o f P hy s i c s P ub l i shi ng , 1 9 97 : 1 31 , w i t h p e r mi s s io n . )

F I G . 2 0 . 2 . T e n s e p a ra t e f ie ld s a r e st a c k e d t o g e ne r at e t he be a m p r o f il e s ho w n i n

WWW.MEDRAD.IR

F i g . 2 0 .1 . M u l t il e a f co ll i m at o r l e a v e s a re s ho w n s c he m a t i c a ll y b e lo w t he f ie l ds ; (A) leaf s e tt i n g as close-in t e c hni q ue ; (B) leaf s e tt i ng s as l e a f - s w e e p t e c h n i q u e . ( F r o m W eb S . T h e p hy s i c s o f c o nf o r m a l r a d io t he ra p y . Br i s t o l , U K : In s t i t u t e o f P h y s i c s P u b l i s h i n g , 19 97 : 1 32 , w i t h p e r m i s si o n. ) P.485

A m i x e d m od e o f IM B d e l i v e r y , c a ll ed d y na m i c - s t ep - a nd - s ho ot, ha s a l s o b e e n u s e d . In t h i s m e t h o d t h e r a d i at io n i s o n a l l t he t i me , e v e n w he n t he l e a v e s a re m o v i n g f r o m o n e st at i c s u b f ie ld p o si tio n t o t he ne x t . T hi s tec hni q ue ha s t he a d v a n t a g e o f b l u r ri n g t h e i n c r e me nt al s tep s i n t he d el i v e r y o f s t a ti c s ub f i el d s (15). B o r t f e ld et al . ( 1 3) h a v e d e mo n s t r at e d t hat r el a ti v e l y s m al l num b e r o f s t ep s ( 10 t o 3 0 to c o ve r a 2 0 - cm w i d e f i el d ) c a n b e us e d to de li v e r a n i nte ns i t y - m od ul a te d p r o f il e w it h a n a c c u r a c y o f 2 % to 5 % . A nine - f i e ld p l a n co ul d b e d e li v e r ed i n l e s s t h a n 2 0 m i n u te s , i n c lu d i n g e x t r a t i me a llow e d f o r g a ntr y r o t atio n ( 1 3 ) . F ig ur e 2 0 . 3 i s a n e x a m pl e o f i n t e n s it y - m od ul a te d fl ue nc e p ro f i le ge ne r a te d b y t he s te p a n d - s h o o t me t h od a n d c o m p a r ed w i t h c a l c ula t e d a nd m e a s ur ed d os e .

A.2. Dynamic Delivery

In t h i s t e c h n i q u e t h e c o r r e s po n di ng ( o p po s ing ) l e a v e s s w e e p s i mul t a ne o us l y a nd u n i d i r e ct io n a l l y , e a c h w i t h a d i f f e r e nt v e l oc i t y a s a f u nc t i o n o f t i me . T he p e r i od t h a t t h e a pe r t u r e b etw e e n l e a v e s r e ma i ns o p e n ( d w el l t i me ) a ll ow s t he d e li v e r y o f v a r i a b le i n te n s i t y t o d i f f e r e n t p oi nt s i n t he f i e l d . T he me t hod ha s b e e n c a ll ed b y several names: the s l i di n g wi nd o w , l e a f - c ha s i ng , c a m e r a - s hut t e r , a nd s w e e p i n g v a r i a bl e g ap . T h e l e a v e s o f a d y n a m i c M L C a r e m ot o r d ri v e n a nd a r e c a p a bl e o f m o v i ng w it h a s p e ed o f g r e at e r t h an 2 c m p e r s e c o nd . T he m o t io n i s und e r t he c o nt ro l o f a c o m p u te r , w h i c h a l so a c c u r a t el y m o nito r s t he l e a f p o si ti o ns . T he p r ob le m o f d e te r m i ni n g le a f v e lo c it y p r o fi le s ha s be e n s ol v e d by s e v er a l i nv e st i g ato r s ( 1 2 , 1 6 ,1 7 ) . T h e s ol u t io n i s n o t uni q ue but r a t he r c o ns i st s o f a n o p t im i z a ti o n a l g or it h m t o a c c u r a t ely d e li v e r t h e p l a nne d i nt e ns it y - m o d ul a te d pr o f i le s und e r t he c o n s t r a i n t s o f m a x i mu m p o s s ib le le a f v e loc i t y a nd mi ni m um pos s i b le t re a tm e nt t i me . T h e b a s i c p r i n c ip l e of d y n a m i c c ol li m a ti o n i s il l ust r a te d i n F i g . 2 0 . 4 . A p a i r o f l e a v e s d e fi n e s a n a p er t u r e w i t h t he le a d i ng l e a f 2 m o v i ng w i t h v e l o ci t y V 2 ( x ) a nd t h e t r a il i n g l e a f 1 P.486 with v e l o ci t y V1(x). Assuming t ha t t he beam o utp ut is co ns t a nt with no

t r a n s m i s s io n t h ro u g h t h e l e a v e s , p e num br a o r s c a tt e ri ng , t he p r o fi l e i nt e ns it y I ( x ) a s a f u n c t io n o f p o s it io n x i s gi v e n b y t he c um ul at i v e b e a m- o n ti m e s , t 1 ( x ) a n d t 2 ( x ) , i n t e r m s of c u m u l a t i v e M U s t hat t he i ns id e e d ge s o f l e a v e s 1 a nd 2 , r e s p e ct i v el y , r e a c h p oi n t x , t h a t i s :

WWW.MEDRAD.IR

F I G . 2 0 . 3 . C o m p a r i son o f c a l c u l a te d f l ue nce , m e a s ur e d d o se , a nd c a l c ul at e d d o se f o r t h e i n t e n s it y m odu l a t e d p ro f i le ge ne r a te d b y st e p - a nd - s ho ot m e t hod . ( F r o m B o r t f e ld T R , K a h le r DL , W a l d ro n T J , e t a l . X - r a y f i e l d co mp e ns a ti o n w it h m ul ti le a f c o ll i m at o r s . I nt J R a d ia t O n c o l B i ol P hy s 1 9 94 ; 2 8 :7 2 3 73 0 , w i t h pe r m i s si o n. )

WWW.MEDRAD.IR

FIG.

20.4.

Il l u s t r a tio n

of

dynamic

m ul t i l e a f

c ol li m at o r

m ot io n

to

g e ne r ate

i n t e n s it y - m o d ul a te d pr o f i le . A p a ir o f le a v es w i t h t he l e a di ng l e af 2 m o v i ng w it h v e l o ci t y V 2 ( x ) a n d t h e t r a i li n g l e a f 1 w i t h v e l o ci t y V 1 ( x ) . In t he r i s i ng p a rt o f t he f l u e n c e p r o fi l e , l e a f 2 m o v e s w it h t he m a x im um s p e e d V m a x a nd in t he f a l li ng p a rt o f t h e f l u e n c e , le a f 1 m o v e s w it h V m a x . (A d a p t ed f r o m W eb S. T he p hy s i c s o f c o n f o r m a l r a di ot h e r a py . B r i s t o l , U K : Ins t i t ute o f P hy s i c s P ub l i s hi ng , 1 9 9 7 :1 04 . ) D i f f e r e n ti a ti n g E q u a t io n 2 0 . 3 w i t h r e s pe c t to x g i v e s :

or

T o m i n i mi z e t h e to t al t r e at m e n t t im e , t he o p ti m al s ol ut io n i s t o m o v e t he f a s t er o f t h e t wo l e a ve s a t th e m a x i m u m a l lo w e d s p e ed , V m a x a nd mo d ula t e t he i nt e nsi t y w i t h t h e s lo w e r l ea f . I f t h e g r a d ie nt o f t he pr o f i le d I ( x ) / d x i s z e r o, t he n a c c o r d i ng t o E q u a ti o n 20 . 5 , t he t w o sp e ed s a r e e qua l a nd s ho ul d be s et to V m a x . If t he g r a d ie n t i s po s it i v e , t h e n t h e sp e ed o f lea f 2 i s hi g he r t ha n tha t o f l e a f 1 a nd t h e r e f o re it i s s e t eq u a l t o V m a x ; a nd i f t he P.487 g r a d ie n t i s n e g at i v e th e n t h e s p e e d o f l e a f 1 i s s e t e q ua l to V m a x . O nc e t he s p e ed o f t h e f a s t er l e a f i s s e t to V m a x , t he sp e ed o f t he sl o w e r l e a f c a n b e uni q ue l y d e te r m i n ed f r o m E q u a t io n 2 0 . 5 , t ha t i s :

WWW.MEDRAD.IR

and

In s u m m a r y , t h e D M L C a l g o r it h m i s b a s ed on t he f o l l o wi ng p r i nc ipl e s :

i f t h e g r a di e n t o f t h e i n t e ns it y p r o f il e i s po s it i v e (i nc r e a s i ng f l ue nc e ) , t he l e a di n g l e a f s h o u ld m o v e at t he m a x i m um s p ee d a nd t he t ra i li ng le a f s h o u l d p r o vi d e t h e r eq u i r e d i nt e ns it y m o d ula t io n;

i f t h e s p at i al

g r ad ien t

o f t he i nt e ns it y p r o f il e i s neg a ti v e

(d e c r e a si ng

f l u e n c e ) , t h e tr a il i n g l e a f s ho uld m o ve at t he m a x i m um s pe ed a nd t he l e a di n g l e a f s h o u l d p ro v i de t he r e q uir e d i nte ns i t y m od ul a ti o n.

A.3. Intensity-modulated Arc Therapy

Yu et al. (14) have d e v el o pe d an i ntens i t y - m o d ul a t ed arc t he r a p y ( IM A T ) t e c h n i q u e t h at u s e s th e M L C d y n a m i c a l l y to s ha p e t he f ie ld s a s w e l l a s ro t at e t he g a n t r y i n t h e a r c t h er a p y m od e . T he m e t ho d i s si m il a r t o t he st e p - a nd - s ho ot i n t h a t e a c h f i e ld ( p o si tio n e d a lo n g t he a r c ) is s ub d i v i d ed i nto s ub f i e l d s o f uni f o r m i n t e n s it y , w h i c h a r e s u p e r i m po s ed t o p ro duc e t he d e si r ed i nt e ns i t y mo d ul at io n. H o w e v e r , t h e M L C m ov e s d y n a m i c a l l y to s ha p e e a c h s ub f i el d w hil e t he ga nt r y i s r o t at i n g a n d t h e be am i s o n al l t he t i me . M ul t i pl e o v e rl a p pi ng ar c s a r e de li v e r ed with the le a v e s mo vi n g to new po s it io ns at a r eg ul a r a ng ula r i nte r v a l , for e x a m p le , 5 d e g re e s . E a c h a r c i s p r o g r am m e d to d el i v e r o ne s ub f i e l d a t e a c h g a n t r y a n g l e . A n e w a r c i s s t a r te d to d el i v er t he ne x t s ub f i e l d a nd s o o n unt i l a ll the planned arcs and their P.488 s u b f i e l d s h a v e b ee n d e li v e r ed . T he m a g nitud e o f t he i nte ns i t y s t e p p e r a r c a nd t h e n u m b e r o f a r c s r eq u i r e d d e pe nd o n t he c o m pl e x it y o f t he t r e at m e nt . A t y pi c al t r e at m e n t t a k e s t h re e to f i v e a r c s a nd t he o p e r at io na l c o mp le x i ty i s co m p a r ab le t o c o n v e n ti o n a l a r c t h e r a p y ( 1 8 ) .

WWW.MEDRAD.IR

FIG.

20.5.

Stacking

of

t h re e

s ub f ie ld s

us i ng

m ul ti pl e

arcs.

D i f f e r e nt

d e c o mp o si ti o n p at te rn s a r e p o s s ib l e b ut o nl y t hr e e a r e s how n

( b , c , d) t o

g e n e r a te p ro f i le s h o wn i n ( a ) . ( F r o m Y u C X . Int e ns i t y m o d ul at ed a r c t he r a p y : a n e w m e t h od f o r d el i ve r i n g co n f o r m a l r a di at io n t he r ap y . In: S t e rni c k E S , e d . T he theory a nd p r a ct i ce of i n t e n s it y m od ula t e d r ad i at io n t he r ap y . M a d i s o n, W I: A d v a n c e d M e d i c al P u b l i s h i n g , 1 99 7 :1 0 7 12 0, w i t h p e r m i s si o n. ) T h e IM A T a l g o r i t h m di v i d e s t h e t wo - di m e ns i o na l i nt e ns it y d i st r ib ut io n ( o bt a i ned through inverse t re at m e n t p l a nni ng ) i nto m ul ti p le o ne - di m e ns i o na l i nte ns i t y p r o f il e s to be d el i v e re d b y p a i r s o f o pp o si ng l e a v e s . T he i nte ns i t y p ro f i le s a re t h e n d e c o m po s ed i n t o d i s c r e te i nt e ns it y l ev e l s t o b e de li v e r ed b y s ub f i e l d s i n a s t a c k a r r a n g e me n t u si n g m u lt i pl e a r c s a s sho w n i n F i g . 20 . 5 . T he le a f po s it io ns f o r e a c h s u b f i e ld a r e d e te r m i n ed b a s ed o n t he d e co m po s it io n p a tt e r n s e le c te d . A s d i s c u s s e d e a r li e r , t h er e a r e ( N! ) 2 po s s ib le d e c o mp o si ti o n pa tt e r ns f o r a n N - l e v el p r o f il e (t o b e d el i v e red b y N a r c s ) o f o nl y o ne p ea k . F o r e x a mp le , a s i mp l e c a s e o f o n e - d im e n s io n a l pr o f i le w i t h t hr e e l e v el s ( F i g . 2 0 .5 A ) , t he r e a r e ( 3 ! ) 2 = 3 6

WWW.MEDRAD.IR

d i f f e r e n t de c o mp o si tio n p a t te r n s o f w hi c h o nl y t hr e e a r e s ho wn ( F i g . 2 0 . 5 B- D ) . The d e c o m po s it io n p a t t er n s are d e t er m i ne d by a c o m p ut e r al g o rit hm , w hi c h c r e a t e s f i el d a pe r t u res b y p o si ti o ni ng l e ft a nd r i g ht e d ge s o f e ac h l e a f p a i r . Fo r e f f i c i e n c y , e a c h e d g e i s u s e d o n c e f o r l e af p o s i ti o ni ng . F r om a l a r g e num b e r o f d e c o mp o si ti o n leaves. A s d i s c u s s e d e ar li e r , t h e s u p e r im po s it io n o f s ub f i e ld s ( t hro ug h m ul t i pl e a r c s) c r e a t e s t h e i nt e n s it y m o d u l at io n o f f i el d s a t e a c h b e am a ng l e . W he r e a s a o ne d i m e n si o n a l p ro f i le i s g e n e r a te d b y st a c k i ng o f f ie ld s d e f i ned b y one l e a f p ai r , t he t w o - di m e n s io n a l p r o fil e s a re c re a te d b y r ep e a ti ng t he w hol e p ro c e s s fo r al l t he leaf pairs of the MLC. p a tt e rn s a v a i l a b le , t he alg o r it hm favors t ho se in w hi c h t he s u b f i e l d s a t a dj a c e n t b e a m a n gl e s r eq ui r e the l e a st d i st a nc e o f t ra v e l b y t he M L C

B. Tomotherapy
T o m ot h e r a p y i s a n IMR T t e c h n i q u e i n w hi c h t he p a ti e nt i s t re a te d s l i ce b y s li c e b y i n t e n s it y - m o d ul a te d b e a m s i n a m a nne r a na l o g o us to l o n gi t u di n a l a x i s o f P.489 t h e p a ti e n t . In o n e d e v i c e t h e c o uc h i s i nd ex e d o ne t o t w o s li c e s a t a t i m e a nd i n t h e ot h e r t h e co u c h m o v e s c o nt i nuo us l y a s i n a he l i c al C T . T he f o r m e r w a s d e v e lo pe d b y t h e N OM O S C o r p o r a ti o n2 a nd t he l a tt e r b y t he m e d i c al p hy s i c s g r o u p a t t h e U ni v e r s ity o f W i s c o n s i n. 3 C T im a g i ng . A s p e c ia l c o ll i m at o r i s d e si g n ed to g e n e r at e t he IMBs a s t he g a nt r y ro ta t e s a ro und t he

WWW.MEDRAD.IR

FIG.

20.6.

M u l t il e af

i n t e n s it y - m o d ul a ti ng

c ol li m a to r

co ns i sti ng

of

lo ng

t r a n s v e r s e sl it ap e rtu r e w i t h t w o b a nk s o f 20 l e a v e s e a c h. (F r o m C ur r a n B. C o n f o r m a l r a di at io n th e r a p y u s i n g a m ul ti le a f i nt e ns it y m od ul at ing c o ll i m at o r . In: S t e r n i c k E S , e d . T h e th e o r y a n d p r a ct i ce o f i nt e ns it y m od ul a te d ra d i a tio n t he r a p y. M a d i s o n , W I: A d v a n c e d M e d i c al P ub l i s hi ng , 1 9 97 : 7 5 90 , w i t h p e rm i s s io n. )

B.1. The Peacock System

The NOMOS c o ll i m at o r The d e v i ce and is t he c a ll ed t he m ul ti le a f t o ge t he r i nte ns i t y - m od ul a ti ng ar e k no w n as t he c o ll i m at o r ( M IM i C ) a n d i s u s e d i n c o nj unc t io n w i t h a t r e at m e nt p l a nni ng s y s t e m , PEACOCKPLAN. M IM i C PECOCKPLAN P E A C O C K s y s t e m . O th e r i m po rt a nt a c ce s so r ie s i ncl ud e a s pe c ia l i nde x i ng t a bl e c a l l ed t h e C R A N E , a p a t ie n t - f i x a tio n d e v i ce c a l le d t he T A L O N and a n ul t r a s o und

WWW.MEDRAD.IR

b a s e d t a rg et l o c al i z ati o n s y s t e m c a ll ed t he BA T ( a l l N O M O S p r o d uc t s a r e na m e d a f t e r b i rd s ) .

Multileaf Intensity-modulating Collimator

T h e M IM i C c o l l i m a to r c o n s i s t s o f a l o ng t r ans v e r s e s l i t a pe r t ur e p r o v id e d w it h t w o b a n k s o f 2 0 l e a v e s ea c h ( F i g . 20 . 6 ) . E a c h l e a f c a n be mo v e d ind e p e nd e nt l y a nd c a n p r o v id e a n o pe n i n g ( a t i so c e nte r ) o f ei the r ( 1 c m 1 c m ) o r ( 1 c m 2 c m ) . E a c h b a n k c a n t h e r e f or e tr e a t 1 - o r 2 - c m t hi c k s li c e s o f t i s s ue 20 c m i n di a me t er ; b e c a u s e t h e re a r e t w o s u c h b a n k s , P.490 a 2 - o r 4 - c m sl i c e o f t i s s u e c a n be t re a te d a t o ne t i me . F o r e x tend i ng t he l e ngt h o f t r e at m e n t v ol u m e b e y o n d 4 c m , t he c o uc h i s m o v e d to t re a t t he a dj a c e nt s l i c e s . T h i s g i ve s r i s e t o f i el d j u n c ti o ns , w hi c h i s o f c o nc e r n i n M I M i C - b a s e d IM R T . T h e M IM i C l e a v e s a re m a de o f t ung st e n a nd a p p ro x i m at el y 8 c m t hi c k i n t he d i r e ct io n o f t h e b e a m. T h e t r a n s m i tt e d i nte ns i t y t hro ug h a l e a f i s a p p ro x i m at el y 1 % f o r 1 0 - M V x - r a y s. T h e l e a f i nt e r f a c e s a r e m ult i - st ep p ed to li m it i nt e rl e a f l e a k a g e to w i t h i n 1 % . E a c h l e a f c a n b e s w i tc he d i n 1 00 to 15 0 mil li s e c o nd s , t hus a l lo w i n g a r a p i d c h a n g e i n b e a m a p e rt ur e s a s t he g a nt r y r o t a te s . C o ns i d e r i ng t he n u m b e r o f po s s i bl e fi e ld a pe r t ur e s at e ac h g a nt r y a ng l e a nd t he num b e r o f i n t e n s it y s t e p s t h a t ca n b e d e l i v e re d a t ea c h g a nt r y p o s i t io n, i t i s p o s si bl e to c r e a t e mo r e t h a n 1 0 1 3 b e a m c o n f i g ur a t io ns f o r e a c h a r c ( 1 9 ) . T h us t he i nt e ns i t y m o d u l at io n o f b e a m s c a n b e f i n e l y c o nt r ol led b y t he M IM i C t e c hno l o g y . A p ot e n ti a l p r ob le m with M IM i C - b a s ed IM R T is t he po s s ib ili t y of m i s m at c h b e t w ee n a d j a ce n t sl i ce p ai r s n ee d ed t o t r ea t a l o ng t a rg et v ol um e . C a r ol et al. ( 2 0 ) h a v e s t u di e d t h e p r ob le m a nd s ho w n tha t p e r fe c tl y m at c he d s l i ce s g a v e ri se t o 2 % to 3% d o s e in h o m o g e n ei t y a c ro s s t he j unc t i o n. H o we v e r , e v e n a 2 - mm e r r o r i n i n de x i n g t h e c o u c h r e s u l t e d i n d o se i nho m o ge ne it y o f t he o r de r o f 4 0% . N O M O S s o l v e d t h i s pr o b le m b y d e si g ni ng a c c ur a t e t a bl e i nd ex i ng a nd p at i e nt f i x a t io n d e v i c e s .

Crane
B e c a u s e o f t h e po t e nti a l f ie l d m at c hi ng p rob l e m s i n t he us e o f MIM i C f o r t r e a ti ng a d j a c e n t sl i ce p a ir s a lo n g t h e l e ng t h o f t he p a t ie nt , it i s i m pe r a ti v e to m o v e t he c o u c h w i t h e x t r e me ac c u r a c y . A s p e c i a l i nde x i ng t a bl e c al le d t he C R A N E ha s b e e n d e s ig n e d b y N O M O S , w h i c h i s c a p a b l e o f m o v i ng t he co uc h l o ng i t udi na ll y w i t h a 3 0 0 -l b w e ig h t to di s t an c e s o f 0 . 1 t o 0 . 2 mm . W i t h s uc h a c c ur a c y i t i s po s s i bl e t o r e d u c e t h e j u n c t io n a l d o s e i n h o m o ge ne it y to w i t hi n 3 % ( 2 0 ) .

Talon
B e c a u s e o f t h e s t r i ng e n t m a t c h li ne r e q ui re m e nt s , N O M O S s up p l i e s a n i nv a s i v e h e a d f i x a t io n s y s t e m c a l l ed t h e T A L O N . T he d e v i c e i s a tt a c ha bl e t o t he C T o r t he t r e at m e n t u n i t c o u c h a n d f i x e s t he he a d p o s it io n b y t he i ns e rt io n o f t w o b o ne s c r e w s i n t o t h e i n n e r t a b le o f t h e s k ul l . O nc e t he b o ne s c r e w s ha v e b e e n i ns e r te d , the TALON can be re m o v ed or re a tt a c hed q ui c k l y as ne ed e d. An e v a c ua t e d h e a d r e s t c a n a l so b e u s e d t o a s s i st i n r e pos i ti o ni ng a t e a c h t r e atm e nt s e s s io n. F o r f u r t h e r d et a il s on t h e P E A C O C K s y s t e m o f IM R T t he r e a d er i s r e f e r r ed to r e f e r e n c e 19 .

WWW.MEDRAD.IR

B.2. Helical Tomotherapy

M a c k i e e t al . ( 2 1 ) h av e p r o po s ed a m et hod o f IM R T d e l i ve r y i n w hi c h t he l i na c h e a d a n d g a n t r y ro ta t e w h il e t he p at i e nt i s t r a ns l at e d t hro ugh t he do ug hnut s h a p e d a p e rt u r e i n a m a n n e r a n a l o g o us to a he l i c a l C T s c a nne r . In t hi s f o r m o f t o mo t h e r ap y , t h e p r ob l e m o f i n te r - s li c e ma t c hl i ne s i s m i ni m i z ed b e c a us e o f t he c o n t i n u o u s h e l i c al m oti o n o f t h e b e am a r o und t he l o ngi t udi na l a x i s o f t he p a t ie nt . A s c h e m a t i c d i ag r a m o f t h e t o mot he r a p y uni t p r op o se d b y M a c k ie e t a l . i s s ho w n i n F i g . 2 0 .7 . T h e l i n ea r a c c e l er a to r i s mo unt e d o n a C T - li k e g ant r y a nd r o t at es t h r o u g h a f u l l c i r c l e . A t t h e s a m e t i m e the p a t i e nt c o uc h i s t r a ns l a t ed s l o w l y t h r o u g h t h e a p e rt u r e , t h u s c r e a t i ng a he l i ca l m o ti o n o f t he be am w i t h r e s p e ct t o t h e p at ie n t . T h e u n i t i s a l so eq ui pp e d w i th a d i a g no st i c C T s c a nne r f o r t a r get l o c al i z a ti o n and t re at m e n t p l a nni ng . T he uni t is a bl e to per f o r m bo t h t he d i a g n o st i c C T a n d t h e m e g a v ol t ag e C T . T h e i n t e n s it y - m o d ul at io n o f t h e f a n be am i s c r e at ed b y a sp e c i al l y de s ig ne d c o ll i m at o r : a t e mp o r al l y m od u l a te d M L C cons i s t i ng o f a l o ng , nar r o w s l it w it h a s e t o f m u l ti p le le a v e s a t r ig h t a n g le s . T he l ea v e s c a n b e m o v ed d yna m i c a l l y und e r c o m p u te r c o n t ro l , i n a n d o u t o f t he sl it a p e r t ur e t o d e f i ne a o ne - d i me ns io na l p r o f il e o f t h e IM B a s w i t h t h e M IM i C . T he m a j o r d i f f e r e nc e be tw e e n t he M IM i C b a s e d t om ot h e r a p y an d t h e h e li c a l to m ot he r a p y i s t ha t i n t he f o r m e r c a se t he p a t ie n t co u c h i s s t at io n a r y w h i l e t he g a nt ry r o t a te s to t r e at e a ch s l i c e pa i r at a t i me a n d i n t h e l a tt e r c a s e t h e p a ti e nt i s t r ans l a t e d co nt i nuo us l y al o ng P.491 w i t h t h e g a n t r y r o t ati o n . T h e f i e l d m a t c h p r o b le m s a r e t hus m i ni m i z ed i n t he h e l i c al t o mot h e r a p y .

WWW.MEDRAD.IR

F I G . 2 0 . 7 . A s c h e ma t i c d i ag r a m o f t he t o mo t he r ap y uni t . ( Fr o m M a c k ie T R , H o l m e s T , S w e r dl o f f S , e t a l . T om ot he r a py : a ne w c o nc e p t f o r t he d el i v er y o f c o n f o r m a l r a di ot h e r ap y u s i n g d y na m i c c o ll i m at io n. M e d P hy s i c s 1 9 9 3 ;2 0 :1 7 09 1 7 19 , w i t h p e r mi s s io n . )

20.4.
IM R T is

COMMISSIONING
an i n t e g r ate d pl a n n i n g a nd

OF
de li v e r y

INTENSITY-MODULATED
system of i nte ns i t y - m od ul a te d

RADIATION THERAPY
b e a m s , w h i c h a r e o p t im i z e d to c r e a te hi g hly c o nf o r m a l d o s e di s tr i b uti o ns f o r t he t r e at m e n t o f p l a n n i n g t a r g et v ol um e . It s c li ni c a l i m pl e me nt a ti o n r e q ui r e s c ar e f ul t e s ti n g o f i t s co mp o ne n t s y s te m s : t he IM R T t r e at m e nt - p l a nni ng s y s t e m ( T P S ) a nd t h e i nt e n s it y - m o d u l ate d be a m ( IM B) d el i ver y s y s t e m . In g e ne r al, t hi s w il l i nv o l ve a c q u i s it io n a n d i n p u t o f a p p ro p ri a te be a m d a t a i nt o t he co m p ute r a s r eq ui r ed b y t h e T P S a l g o ri t h m , m e c h a n i c a l c he c k s o f t he IM B d e l i v e r y s y s t em a nd d o s i me t ric v e r i f i c a tio n o f s e l e c ted IM B s a n d IM R T p l a ns . S o m e o f t he t e s t s a r e r e p e a te d a t s c h e d u l e d i nt e r v a l s a s p a r t o f a q ua l it y a s s ur a nc e p r o g r a m . A s a m a t te r o f p ri n c ip l e , n a ti o n a l o r i nt e rna t i o na l p r oto c ol s s ho ul d be f ol lo w ed w i t h r eg a r d t o c om mi s s io n i n g a nd Q A . How e v e r , i n t he a b se nc e o f e s t ab li s he d p r ot o co l s , t h e u s e r i s a d v i s e d to w o r k c l o se ly w i t h t he e q ui p m e nt m a nuf a c t ur e r a s w e l l a s r e vi e w t h e r ele v a n t li te r a t ur e to d es i g n a pp r op r i at e p r og ra m s . M a ny o f t he e s s e n t i al te s t s a r e dev i s e d b y m a nuf a c t ur e r s w ho a r e m o r e t ha n w i l l i ng t o a s s i st t h e p h y s i c i s t i n a c c e p t a n c e te s ti ng a nd c o m m i s si o ni ng b e c a use i t i s i n t he i r i n t e re s t t o e n s u r e s a fe op e r at io n a nd us e of t he eq ui p me nt . T he f i na l a p p ro v a l f o r c l i n i c al a p p li c a tio n i s t h e r e s p o ns i bi li t y of t he p hy s i c i s t a nd t he p hy s i c i a n i n charge. A l t h o u g h t h e co m mi ss i o n i n g a n d Q A p ro ce d ur e s w il l v a r y d epe nd i ng up o n t he IM R T s y s t e m to b e im p l em e n t ed , ( e .g . , st e p - a nd - s ho ot , s li di ng w i nd o w , IM A T , t o mo t h e r ap y ) t h e c ri tic a l i s s u e i s t he co nf i r m a t io n t ha t t he a p p rov e d t r e at me nt o f a p a ti e n t is d e li v e re d s a f el y a nd w it h a c c e pt a b le a c c ur a cy . T he f o l lo w i ng d i s c u s s io n p e r t ai n s t o t h e s l i di n g w i nd o w IM R T t e c hni q ue , a s a n e x a m p l e . P.492

A. Mechanical Testing of Dynamic Multileaf Collimator

T o a s s u r e a c c u r a t e d el i v e r y o f IM Bs w i t h t he d y na m i c m ult il e a f co ll i m at o r ( D M L C ) , i t i s e s s e n ti a l t h a t t he s p e ed , a c c e le r a tio n, a nd p o s it io n o f l e a ves a r e c o nt ro ll e d p r e c i se l y and a c c u ra t e l y as p l a nne d by t he TPS. C hui et al. (2 2 ) ha v e r e c o m me n d e d t h e f o llo w i n g f i v e te s t s a s a c he c k o f t he m e c ha ni c a l a c c ur a c y o f D M L C , w h i c h i s f u n d a m e n t a l to t h e a c c ur a te d e li v e r y o f IM Bs .

A.1. Stability of Leaf Speed

In d i v i d u a l p a i r s o f o pp o s ed l e a v e s s ho ul d b e t e st ed f o r s t a bi lity o f t he i r s p ee d . T h i s c a n b e a c co m pli s h e d b y i ns t r uc ti ng t he o p po s ed le a f pa i r s to mo v e at different but co n s t a nt s p ee d s . If t he l e af speeds are st a bl e , t he ge ne r a te d i n t e n s it y p r o f il e s w il l b e u n i f o r m . F i g ur e 20 . 8 s ho w s d o s e p ro f ile s g e ne r at e d b y

WWW.MEDRAD.IR

d i f f e r e n t l e a f p ai r s w h i c h w e r e m a de to m o ve a t di f f e r e nt s pe ed s . T he p r o f il e s a re m e a s u r e d u s i n g f il m p l a c ed p e rp e ndi c ul a r t o c e nt r a l a x i s a nd at a d e pt h g r e at e r t h a n t h a t o f m a x i m um d o s e i n a p ha nt o m. A ny f l uc t ua t i o ns (o v e r a nd a b o v e t he f i l m v a r i a ti o n o r a rt i f ac t s ) s h o u l d i ndi c a te i ns t a b il it y o f l e a f m ot ion.

F I G . 2 0 . 8 . D o s e p r o fil e s ob t ai n e d w it h t e st 1 t o c he c k t he st a b il it y o f l e a f s p ee d . ( F r o m C h u i C S , S p i r o u S , L o S a s s o T . T e s ti ng o f d y na m i c m ult ile a f c o ll i m at io n. M e d P h y s 1 9 9 6 ; 23 : 635 64 1 , w i t h p e rm i s si on. )

A.2. Dose Profile Across Adjacent Leaves

T h e f i l m o b ta i n e d w i th t h e t e st de s c r ib ed a b o v e m a y b e s c a nned i n t he d i re c ti o n p e r pe n d i c u l a r to l e a f m o ti o n . S i n c e t he i nte ns i t y w it hi n t he w id th o f e a c h l e a f i s u n i f o r m , t h e i n te n s i ty p r o f il e a c r o s s t he l e a f pa i r s i s e x p e ct ed to b e a st ep function i n d i c at i n g di f f e r e n t s pe ed s or int e ns i t y l e v el s for each leaf p ai r . H o w e v e r , t h e d o s e p ro f i le m e a s ur e d i n a p ha nt o m w i l l s ho w a w a v y p a t t e r n a s s e e n i n F i g . 2 0 . 9 . T h e s m e a r i n g o f t he i nt ens i t y s t e p s i s c a us e d b y l a t e r al s c a t ter o f p h o to n s a n d e l e c tr on s i n t h e p ha nt o m . In t h i s te s t o n e s h ou l d loo k f o r a ny i r r eg ul a r it y i n t he e x p e ct e d do s e p r o fi le p a t te r n i n t h e d i re c ti on p e r p e n d i c ul a r t o t he p a t h o f l e a f m ot io n.

A.3. Leaf Acceleration and Deceleration

In a normal d e li v e ry of i n t e n s i t y - m od ula t e d be a m s with DM L C , leaves are i n s t r u c t ed to mo v e a t d i f f e r e n t s p ee d s f rom o ne s eg m e nt o f t he f i e ld to a not he r . D i s c o nt i n u i ti e s i n P.493 p l a n n e d i n te n s it y p r of i l e s co u l d po s s ib l y o c c ur a s a r e s ul t o f a c c e l e r at io n o r d e c el e r at io n o f l e a v es d u e to i n e r ti a . T he e x t e nt o f a ny s uc h p r o bl e m m a y b e

WWW.MEDRAD.IR

d e te r m i n ed b y r ep e a ti n g t h e te s t i n A . 1 a nd i nt e nti o na ll y i nte r rup t i ng t he b e am s e v e r a l t im e s . A s t h e b e a m i s t u r ne d o f f , t he le a v e s de c el e r at e t o s t op . S i mi l a rl y , w h e n t h e b e a m i s r e s u m e d , t h e l e a v e s a cc e l e r at e to r e a c h t hei r no r m a l s p ee d . D o s i me t ri c c o n s e q u en c e s of leaf a c c e l e ra t io n a nd d e c e l e r at io n can t hus be o b s e r v ed i n t h e f o r m o f d i s co n ti nui t ie s i n d o s e p ro f i le s a t t he p oi nt s o f b e am i n t e r r u pt io n . F i g u r e 20 . 1 0 s ho w s no f l uct ua t io n b e yo nd no r m al unc e r t a i nt y i n f il m d o s im e tr y .

F I G . 2 0 . 9 . D o s e p r of i l e re s u l ti ng f r o m te s t 2 to c he c k d o se p r o f il e b et w e e n a d j a c e n t l e a v e s . T h e e x p o s ed f i l m i s s c a nne d a c r o s s t he l e a ve s i n t he d i re c ti o n p e r pe n d i c u l a r t o t h e le a f m o ti o n . D ue t o the s p r e a d o f s e co nd ar y e l e ct r o ns a nd s c a t te r e d p h ot o n s , t he r e i s n o f l at d o se re g io n w i t hi n t he w id th o f t he l e a v e s . ( F r o m C h u i C S , S p i r o u S , L o S a s s o T . T e s ti ng o f d y na m i c m ult ile a f c o ll i m at io n. M e d P h y s 1 9 9 6 ; 23 : 635 64 1 , w i t h p e rm i s si on. )

WWW.MEDRAD.IR

F I G . 2 0 . 1 0 . D o s e p rof i l e s re s u l ti ng f r o m l ea f a c c e l e r at io n a nd de c e le r a ti o n (t e s t 3 ) . A do s e v a ri a ti o n of 1 % i s s ho w n b y da s he d li ne s . ( F ro m C hui C S , S p i r o u S, L o S a s s o T . T e s ti n g o f d y n a m i c m ul t i le a f c o ll i m at io n. M e d P hy s 1 9 9 6 ; 23 : 6 35 6 4 1, w i t h p e r mi s s io n . )

WWW.MEDRAD.IR

F I G . 2 0 . 1 1 . D o se pro f i le re s u l ti ng f ro m te s t 4 t o c he c k po s iti ona l a c c ur a c y a nd t h e e f f e c t o f r o u n d ed l e a f e n d . A ho t sp ot of a p p r o x i m at el y 5 % i n d o s e i s s ee n i n a l l p ro f i le s . ( F r o m C h u i C S , S p i r o u S , L o S a s s o T . T e s t i ng o f d y na m i c m ul t il e a f c o ll i m at io n . M e d P h y s 1 9 96 ; 2 3 :6 35 64 1 , w i th p e r m i s s io n. ) P.494

A.4. Positional Accuracy of Leaves

T o t e st t h e p o si ti o n a l a c c u r a c y o f l e a v e s , the l e f t a nd ri g ht l e a ve s o f a n o p po s ed p a i r a r e m a d e t o t r av e l a t t h e s a m e sp e ed b ut w it h a t i me l ag b et w e e n t he m. E a c h l e a f i s i n s t r u c t ed t o s to p at t he s a m e p o s it io n f o r a f i x e d dur a t i o n o f b ea m o n t i me a n d t h e n c o n ti n u e s i t s m ot io n a s b ef o r e . D i f f e r e nt p a i r s ar e i ns t r uc te d to s t o p a t d i f f e r e nt po si ti o n s . T h e uni f o r m ity o f d o s e p ro f i le s in t hi s c a s e w il l i n d i c at e a c c u r a t e l e a f p o s it io n i n g . If a ny o f t he l e a v e s w e r e t o und e r - t r a v e l o r o v e r - t r a v el , t h e re w ou l d b e a h o t s po t o r c o l d sp ot c r e a te d de pe nd i ng up o n i f a g a p o r o v e rl a p o c c u r re d b et w ee n t he op p o si ng l e a v e s at t he s to pp a g e poi nt s . T he M L C d e s i g n ed w i t h rou n d e d e n d s w i ll na t ura l l y gi v e r i se to ho t sp o t s b e c a us e o f e x t r a r a di at io n l e a k age a t t h e m a t c h po s it io ns . T hus t he p r e se nc e o f hot o r co ld s p o t s i n d o s e pr o f il e s i n d i c a te s p o si ti o nal ina c c ur a c y e x c e p t f o r t he no r m a l hot s p o t s c a u s e d b y t h e ro u n d e d e n d s o f t he le a v e s . F i g ur e 2 0 . 11 s ho w s t he r e s ul t s i n d i c at i n g h o t s pot s du e t o r o u n d ed e nd s b ut no ne d ue t o po s it io na l e r r o r s .

A.5. Routine Mechanical Check

A n o v e r a l l c h e c k o f t h e m e c h a n i c a l a c c ur a c y o f D M L C ha s a l s o b een r e c o m m e nde d ( 2 2 ) , w h i c h m a y b e i nc o r po r a te d i nto a r o uti ne Q A p r og r a m (e . g . , d a il y o r o n t he d a y o f D ML C u s e ) . T h e te s t i s si m il a r to A . 4 e x c ep t t ha t t he st op po s it io ns o f t he o p po s i n g le a v e s a r e sh i f t e d w i t h r e s pe c t t o e a c h o t he r to c r e a te a 1 - m m g a p . A s a r e s u l t , a h ot s pot a pp e a r s at t h e g a p po si ti o ns . D ri v i ng a ll t he l e a ve s i n f i x e d s t e p s ( e . g . , 2 c m ) a n d c r e at i n g 1 - m m - wi de g ap s at t he st o p po s it io ns w i ll g i ve r i s e to a p a t te r n o f s t r a i g ht d a r k l i ne s on a n i r r a d i a t e d f il m a s s ho w n i n F i g . 2 0 . 1 2 . A n y v a r i a t i o n in t h e l o c a t io n o r t he w i d t h o f t he d a r k l i nes w o ul d i nd i c a te p o s it io n a l e r ro r o f a l e a f . T h i s c a n b e a s se s s e d b y v i s ua l i ns pec t io n o f t he fi l m image. The p r e ci s io n of this p r o ce d ur e is a p p ro x i m a te l y 0.2 mm, w hi c h is a p p r o xi m a te l y t h e to le r a n c e a l lo w e d i n t he l e a f c a l ib r a ti o n.

B. Dosimetric Checks
A s e r i e s o f do s i me t ric c h e c k s h a v e b e e n r e c o m me nd e d b y L o Sa s s o e t al . ( 2 3 ) s p e c i f i ca ll y f o r t h e sl i di n g w i n do w te c hni q ue . T he s e i nc l ud e me a s ur e m e nt s o f MLC transmission, t ra n s m i s s i o n t hr o ug h leaf e nd s , he a d s c a t t er , a nd dose d i s t ri b u tio n i n s e l e ct ed i n t e n s it y m o d ul at ed f i e l d s .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

F I G . 2 0 . 1 2 . R o u t i n e m e c h a n i c a l c he c k ( t e st 5 ) . A l l 2 6 p a i r s p ro duc e d a r k l i ne s o n f i l m a t e q u a ll y p l a ced p o si ti o n s . If t he r e i s a p o si ti o nal e r ro r i n a ny l e a f , t he l o c at io n o r wi dt h o f th e d a r k li n e s w o uld di f f e r f r o m t he o t he r pa i r s . A : N o r m al c o n d it io n w i t h n o di s ce r n i b le p o si ti o na l e r ror . B : S hi f t o f d a r k l i ne s c a us e d b y a n i n t e n ti o n a l e r r o r o f 1m m i n t r od u c e d i n t hre e l e a f p ai r s . ( F r o m Chui C S , S p i r o u S , L o S a s s o T . T e s ti n g o f d y n a m i c m ul t i le a f c o ll i m at io n. M e d P hy s 1 9 9 6 ; 23 : 6 35 6 4 1, w i t h p e r mi s s io n . )

FIG.

20.13.

The

m id l e a f

and

i nt e rl e a f

t r a ns m i s s io n

me a s ur e d

w it h

f il m

at

i s o c e nt e r . T r a n s m i s s io n i s t h e r a ti o o f d o se w i t h t he m ul ti le a f c o ll i m at o r b lo c k ed t o t h a t w it h t h e f i el d o pe n . F i el d si z e = 10 1 0 c m 2 a nd d ep th = 1 5 c m . ( F r om L o S a s s o T , C h u i C S , L i n g C C . P hy s i c a l a nd d o s i me t ri c a s p e cts o f a m ul t i le a f c o ll i m at io n system used in the d y na m i c mode for i mp le me nt i ng i nte ns i t y m o d u l at e d r ad io t h e r ap y . M e d P h y s 1 9 9 8 ; 2 5: 1 9 19 19 27 , w i t h p e rm i s s io n. ) P.495

P.496

B.1. Multileaf Collimator Transmission

T r a n s m i s s i o n t h ro u g h t h e M L C m a y b e d et e r mi ne d b y m e a s uring d o s e / M U i n a p h a n t o m w it h t h e M LC c l o se d a n d di v i di ng i t b y d o se / M U me a s ur e d w it h t he M L C o p e n . B e c a u s e t h e me a s u r e m e n t s a re r el ati v e , t he r at io o f d et ec t o r re s po ns e s i s e q u a t ed t o t he r a t io o f d o s e s . Be c a us e o f t he d i f f e r e nc e t hr o ug h t he l e a f a nd i n t e rl e a f t ra n s m i s s io n s , t h e r e a di ng s ho uld b e a v e r ag e d wi t h t he d et e ct o r ( e . g . , i o n c h a m b e r s ) at d i f fe r e n t po s it io ns und e r t he l e a v e s . A f il m ma y a l s o b e us ed p r o v id e d it s r e s po n s e i s c o r r e c te d f o r t he se ns i to m et r i c c ur v e d et e r mi ne d f o r t he

WWW.MEDRAD.IR

g i v e n be a m e n e r g y an d d e pt h i n t he p ha nt o m . Fi g ur e 2 0 .1 3 s ho w s t he r e s ult s o b t ai n e d f o r a V a r i a n M L C . It i s se e n t ha t t he M L C t r a ns m i s si on v a r i e s be t w ee n 1 . 7 % a t mi dl e a f t o 2 . 7 % b et w e e n le a v e s . A n a v e r a g e t r a ns m i s si on o f 2 % m a y b e a s s u m e d i n t h i s c a s e f o r t h e p u r po s e o f t re at m e nt pl a nni ng c a l c ula t io ns . Several m a n u f a c t u r e rs offer MLCs with ro und e d le a f e nd s . Thi s is do ne to m a i n t a i n a c o n s t a n t ge o m et ri c p e num b r a a t d i f f e r e nt l e a f po s it ions i n t he b e a m . A s a n e x a m p l e , Fi g . 2 0 . 1 4 s h o w s t he vi ew s o f a V a r i a n M L C fr o m t he s id e a nd f r o m t h e f r o n t . E a c h le a f i s 6 - c m t hi c k a nd ha s a r o und e d e nd . T he c e nt r a l 3 cm o f t h e e n d i s c i r c u l ar w i t h a n 8 . 0 - cm r ad i us o f c ur v a t ur e . T he r e st o f e nd i s s t r a i g ht a t a n a n g le of 1 1 . 3 d eg r ee s r el a ti v e t o t he v e rt i c al a x i s . It ha s a l s o b ee n s u g g e s te d t h at t h e ef f e c t o f r o und e d l e a f e d g e s ma y b e a pp ro x i m a te d i n t he t r e at m e n t pl a n n i n g a lg o r it h m a s a n o f f s e t of l e a v e s b y 1 m m ( 2 3 ). T h e l e a k a g e b e t we e n t h e a d j a ce n t le a v e s i s m i ni m i z ed b y d e si g ning t he l e a v e s so t h a t t h ei r si de s p a rt i al l y o ve r l ap , t ha t i s , one s i de o f t he l e a f p ro t r ude s o ut w a rd s ( t o n g u e ) a n d t h e o th e r r e c e s se s i nw a r d ( g r o o v e ) so t ha t t he c e nt r a l p a rt s o f t h e a d j a ce n t l e a v e s fi t l i k e a j ig s a w p uz z l e . T hi s o v e r l ap o f t he l ea v e s r e d uc e s t he e x t e n t o f r ad i at io n lea k a g e t h ro ug h i nte r lea f g a p s , w hi c h a r e ne c e s s a r y f o r le a f m o ti o n r e l ati v e t o e a ch o t h e r . T h i s s o c a l l e d t o ng ue a nd g r o o v e e f f e c t g i v e s r ise t o hi g h e r r a d i at io n l ea k a g e t h a n t ha t t hr o ug h m i dd le bo d y o f t he le a v e s b ut l e s s t h a n w h a t i t w o u ld b e i f t h e le a f s i de s w e r e d e si g ned pl a ne -f a c e d . A s s ho w n e a r li e r , i n t e rl e a f t r a ns m i s s io n w i t h t he t ong ue a nd g r o o v e i s b e t w ee n 2 . 5 % to 2 . 7 % ( F ig . 2 0 . 1 3 ) .

B.2. Head Scatter

D e f i n it io n a n d m e a s u r e m e n t o f c ol li m a to r o r he a d s c at te r f a c tor ( S c ) ha s b e e n d i s c u s s e d i n C h a p t e r 1 0 . If t h e M L C i n t he l i na c he a d is i ns t al le d c lo s e r t o t he p a t ie n t s u r f a c e t h a n t h e c o l li m a to r j a w s ( as i n V a r i a n a c c e l e r a tor s ) t he S c f a c t o r d e pe n d s p re do m i n a te ly o n t h e j a w op e ni ng a nd no t o n t he ML C o pe ni ng . In t he u s e o f s t ati c M L C i n c o n v e n t io n a l r ad io t he r a p y , S c fo r a g i v e n j a w op e ni ng i s a f f e c t e d v e r y l itt l e b y t h e M L C s e t ti ng f o r f i el d s P.497 l a r g e r t h a n 4 4 c m . H o w e v e r , a s t he M L C a p e rt ur e i s re d uc e d to m uc h s m a ll er o p e n i n g s , S c f a c to r co u l d d ro p s ig ni f i c a ntly ( e . g . , b y 5 % f o r a 1 1 c m f i e l d ) . T h e r e d u c ti o n i s c a u s ed b y t h e M L C a pe r t ur e a p p ro a c hi ng t he ge om e t ri c pe num b r a ( r a d i at io n s o u r c e h a s a f i n i t e si z e ) . O n the o t he r ha nd , i f t he M L C i s lo c a te d a b o v e t h e c ol li m a to r j a w s , t h e h e a d s c a t t er w o ul d b e a f f e c t e d m o r e b y t he M L C s e t ti n g t h a n t h e j a w o p e n i n g . In ei t he r c as e , t he t r e at m e nt -p l anni ng a l g o ri t hm m u s t a c c o u n t fo r t h e S c f a c to r s de p e ndi ng up o n t he ML C g eo me tr y a nd t he IM R T technique used.

WWW.MEDRAD.IR

F I G . 2 0 . 1 4 . V i e w s o f t h e l e a v e s ( t op ) f r o m t he s i de a n d ( b ot to m ) f r o m t he f r o nt . ( F r o m Lo S a s s o T , C h u i C S , L i n g C C . P hy s i c a l a nd d os i me t ri c a s p ec t s o f a m ult il e a f c o ll i m at io n system used in t he d y na m ic mode fo r i mp le me nt i ng i nt e ns it y m o d u l at e d r ad io t h e r ap y . M e d P h y s 1 9 9 8 ; 2 5: 1 9 19 19 27 , w i t h p e rm i s s io n. ) In t h e s l i di n g w i n d o w t e c h n i q u e w it h t he Va r i a n D M L C , t y p i c al l y 1 - to 4 - c m w id e m o v i n g g a p s a re u s e d. T h e o v e r a l l e f f e ct of t he he a d s c a t te r a s a p e r c e nt a ge o f the t a rg et do s e is minimal. A c o mp a r a ti v e i nf l ue nc e of he ad s c a tt e r , M LC t r a n s m i s s io n , a n d t h e r o u n d e d e d ge t r a ns mi s s io n i s s ho w n i n F i g . 2 0 . 1 5 . A s p a r t o f t h e c o m mi s s io n i n g p r o c e d u re , t he s e d ata s ho ul d b e m e a s ur ed a nd a c c o unt e d for in the TPS.

B.4. Treatment Verification

A f t e r b a s i c c h e c k s h av e b e e n m a de w i t h r eg a r d to t he me c ha ni ca l a nd d o si m et r i c accuracy of DMLC, the f o l lo w i ng c he c k s are ne e d ed to v e rif y relative do s e d i s t ri b u tio n a s w e l l a s a b s o l u te d o s e de li v e r e d b y D M L C f o r s e le c t ed f i e ld s a nd t r e at m e n t pl a n s :

WWW.MEDRAD.IR

F I G . 2 0 . 1 5 . R e l a t i ve c o n t r ib u t io n o f m ulti l e a f co ll i m ato r t r a nsm i s s io n t hr o ug h m i d le a f , r o u n d e d e dge a n d o v e r al l hea d s ca t t er . ( F r o m L o S a s so T , C hui C S , L i ng C C . P h y s i c a l a n d d o s im e t ri c a s pe c t s o f a mul t il e a f c ol li m at io n s y s t e m us ed i n t he dynamic m od e for im p l em e n ti n g i nt e ns ity m o d ul at ed r a di ot he r a p y . Med P hy s 1 9 98 ; 2 5 :1 91 9 1 92 7 , w i t h p e r mi s s io n. ) P.498

S l i di n g A p e rt u r e F i el d. U s i n g a f i l m p l a c ed p e r pe nd i c ul a r to c e nt ra l a x i s a nd a t a s u i t a bl e de p t h i n a ph a n t o m ( e . g . , 1 0 c m ), d o s e di s t ri b uti o n f or a 1 0 1 0 c m f i e l d ge n e r a te d b y a s l i di n g M L C a p e rt ur e ( e . g . , 5 - m m w i de ) ma y b e co m p a red w i t h a 10 1 0 cm s ta t i c fi el d . A b so l ute dos e m a y a l so b e ve r i f ie d b y co mp a r i ng o p ti c a l d e n si ti e s ( re l at e d to do s e t hr o ug h a f i l m se ns i t ro me ti c c ur v e m e a s ur e d at t h e s a m e d ep t h ) o r b y a n i o n c h a m b e r i n a w a t e r p ha nt o m .

WWW.MEDRAD.IR

FIG.

20.16.

Comparison

of

c a l c ul a te d

and

m e a s ur e d

do s e

d i s t ri b utio n

with

c o r r e ct io n s f o r m u lt il ea f c o l li m at o r t r a ns m i ss i o n a nd he a d s c at te r. ( F r o m Lo S a s s o T , C h u i C S , L i n g C C . P h y s i c a l a nd d o s i m et r i c a s pe c t s o f a m ul t il e a f c ol li m a ti on system used in the dynamic mo d e for i m pl e me nt i ng i nte ns i t y mo d ul at ed r a d io t h e r ap y . M e d P h y s 1 9 9 8 ;2 5 :1 9 19 1 9 27, w i t h p e r m i s si o n. )

TABLE 20.1. IMRT QUALITY ASSURANCE PROGRAM a

WWW.MEDRAD.IR

Frequency

P r oc e d u r e

T ol e r a n c e

Before first t r e at m e n t

In d i v i d u a l v e r i f i c a tio n

f ie ld

v e r i f i c a tio n,

plan

3% dose), per

( po i nt o t he r c li ni c a l

s i g ni f i c a nc e

Daily

D o s e to a t e st po i nt i n e a c h IM R T f i e l d

3%

Weekly

S t a t i c f ie ld v s . s l i d i ng w i nd o w f i e ld d o se d i s t ri b u tio n a s a f unc t io n o f g a nt r y a nd c o ll i m at o r a n gl e s

3%

in

do s e

d e li v e r y

Annually

A l l co m mi s s io n i ng p r oc e d ur e s : st a bi li t y o f leaf s p ee d , le a f leaf a c c e l e r at io n po s it io na l a nd d e c el e r at io n , t r a n s m i s s io n , m ul t il e a f c o ll im a to r a c c ur a c y ,

3% per

in

do s e o t he r c li ni c a l

d e li v e r y ,

s i g ni f i c a nc e

s t a ti c f i el d v s . s l id i ng w i nd o w f i el d a s a f u n c t i o n o f g a n t r y a nd c o ll i m at or a ng l e s , s t a n d a r d pl a n v e r i f i c at io n

A s a n e x a m p l e f o r a s l i di n g w i nd o w IM R T p r o g r am .

P.499

In d i v i d u a l IM R T f i el d s g e n e r at ed b y t he t rea t m e nt pl a nni ng s y s t em c a n b e v e ri f i ed by film do s i me t r y in a are cubic p ha nt o m at a s ui t ab l e d ep t h (e.g., 10 cm). of C o m m e r ci a l s y st e m s a v ai l a bl e w hi ch a l lo w s id e - b y - si d e c o m p ar i so n

c a l c u l a te d v s . m e a s u r e d d o se d i st r ib ut io ns . E x p o s e d f i l m s a r e sc a nne d i nt o t he c o m p u te r , w h i c h h a s t h e s o f t w a r e to c o nv er t o pt i c al d e ns it ie s i nt o do s e b y us i ng an two. M u l t i pl e Fi el d P l a n . A m u l t ip l e fi el d IM R T p l a n m a y b e ge ne r a te d i n a c ub i c o r c y l i n d r i c al p h a n to m an d t h e do s e d i st ri b uti o n a s w el l a s a b so l ut e d o se m a y be v e r i f i ed u s i n g f il m or a n i o n c h a m b e r . A lt e rna t i v e l y , a n IM R T p l an o f a p a r ti c ul a r p a t ie n t (e . g . , p r o st a te p l a n ) m a y be s et up o n a c y l i nd ri c a l o r a cub i c p ha nt o m to c o m p a re t h e c a l c u l at ed v s . m e a s ur e d d i s tr ib ut io n. F i g ur e 2 0 . 16 is a n e x a m p l e o f such a comparison. a p p r o pr i at e se n s i to m et r i c c ur v e . The c a l c ul a te d a nd m e a s ur e d d o se d i s t ri b u tio n s a r e c o m pa r e d s id e b y s id e o r by v i e w i ng t he di f f e r e nc e s b et w e e n t he

C. Quality Assurance
WWW.MEDRAD.IR

A f t e r t h e IM R T t e c h n iq u e h a s be e n co m m i s si o ne d it i s e s s e nti a l to s e t up a q ua li t y a s s u r a n c e p r og r a m t o m a i n t ai n o ri gi na l a c cur a c i e s , to le r a nc e s , and s p e ci f i c a ti o ns o f t h e s y s te m . B e c a u s e o f t h e c o mp l e xi t y o f t he IM R T b e a m s a nd t he d i f f i c ul t y of v e r i f y i n g t r e at m e n t do s e s b y m a nua l c a l c ul a t io ns , i t i s g e ne r al l y r e c o m me nd e d to d o pl a n v e ri f i c a ti o n an d p r e -t r e at m e nt c hec k s i n a d di ti o n t o t he p e ri o di c t e st i ng of the s y st e m . A fe w of t h e se t e st s are li s te d in T a b le 20.1, w hi c h are r e c o m me n d e d u n t il s u p e r s ed e d b y na t io na l /int e r na t io na l Q A p r ot oc o l s . P l a n v e r i f i c a ti o n p r o ce d u r e i s d i s c us s ed i n s e c t io n B. 2 a b o v e . T hi s c he c k s ho ul d b e pe r f o r me d b e f o re t h e f i r st t re a t me nt i s d e li v e re d . In t he d ail y p r e -t r e at m e nt c h e c k , e a c h IM R T f i e l d s h o u l d b e s p ot - c hec k e d i n a p ha nt o m b y m e a s ur i ng d o s e t o a t e st po i nt . D et ec t o r s y st e m s t ha t a re r o ut i nel y us e d fo r da i l y li na c o utp ut c o n s t a n c y c h e c k o r in v i v o p at ie nt d o se m o ni to r i ng ( e . g . , io n c ha m b e r m a t ri x , d i od e s y s te m ) c a n a l s o b e u s e d f o r t hi s m ea s ur e m e nt .

20.5. DOSE CALCULATION ALGORITHMS

D o s e c a l c u l at io n al g ori t h m s f or IM R T a r e b as i c a ll y t he s a m e a s t ho s e fo r st a nd a r d 3 - D t r e at m e nt p l a n n in g ( s e e C ha p t e r 1 9 ) e x c e p t f o r t he d y na m i c f e a t ur e s o f m u l t il e a f c ol li m at io n . In - a i r f l u e nc e d i s t r ibut i o n i s f i r st c a l c ul ate d b a s ed o n t he t i me ( o r M U s ) a p o i n t i s e x p o s e d t o i n t he o p e n p a rt o f t he M L C w i nd o w a nd t he t i me i t i s s h i el de d b y t h e l e a v e s . Fo r s i mpl i ci t y , t he c a l c ul a te d f l ue nc e m a y b e r e p r e se n t ed P.500 f i e l d . Re f i n e me n t s a re a d de d b y t a k i ng i nt o a c co unt le a f - e dg e p e num b r a ( e . g . , o f f s e t f o r r o u n d ed ed g e s ) , i n te r le a f t r a ns m i s s io n ( e . g . , t o ngue a nd g r o o v e e f f e c t ) a n d h e a d s c a t te r a s a f u n c t i o n o f M L C a p e r t ur e a nd j a w p os i ti o n. by a s te p f u n c t i o n, ha v i ng f ul l i nt e ns it y in t he open a nd o nl y t r a n s m i tt ed i n t e n si t y in t h e s h i e l d ed p a r t o f t he

A. In-air Fluence Distribution

The any in-air instant p ho to n of fluence The i n f o r m at io n a l g o ri t hm for an i nte ns i t y - mo dul a t e d t he f l ue nc e b e am is by i m b ed d ed i n a c o m p u te r f i l e , w h i c h s p e c i f i es t he p o s it io n o f e a c h l e a f a nd j a w a t t i me . r e cons t r uc t s d i s t ri b uti o n i n t e g ra ti n g a n o u t p u t f u n c t i o n , w hi c h i s d e pe nd e nt o n w he t he r t he p oi nt i s i n t he o p e n po r ti o n o f t h e f ie l d o r u n d e r t he M L C , f o r e x a m p le ,

w h e r e ( x , y ) i s t h e p h o to n e n e rg y f l ue nc e i n ai r at a po i nt ( x , y ) a nd I a i r ( x , y , t ) i s t h e b e a m i nt e n s it y o r e n e r g y f l ue nc e r a t e a t ti m e t ; T ( x , y , t ) i s t he l e a f t r a n s m i s s io n f a c to r at a n y t i me t , b ei ng uni t y w he n t he p oi nt i s i n t he op e n p o rt io n o f t h e f i e ld a n d a t r a n s m i s s io n f r a c t i o n w he n und e r a j a w o r l e a f .

B. Depth-dose Distribution
O n c e t h e p h ot o n e n er g y f l u e n c e d i st r ib ut io n i nc i de nt o n t he pa t i e nt ha s b ee n c a l c u l a te d , a n y o f t h e m e t h o d s di s c us s e d i n C ha p t e r 1 9 m a y b e us e d to c o m p ut e d e pt h - d o se di s t ri b u ti on . B e c a u s e t he si z e a nd s ha p e o f t he b e am a p e rt ur e s are g r e a tl y v a r i ab le a n d fi e ld di me n s i o ns o f 1 c m o r l e s s m a y be f re q ue nt l y r e q uir e d to p ro v i de i n te n s i t y m o d u l at io n , t he most co m m o nl y us e d m e t hod s of do se c a l c u l a ti o n i n IM R T a r e t h e p e n c il b e a m a nd t he c o nv o l uti o n- s up er p o s iti o n. M o nte

WWW.MEDRAD.IR

C a r l o te c h n i q u e s a r e a l s o u n d e r de v e lo p ment b ut a r e c o ns id e r ed f ut ur i s t i c a t t hi s t i me b e c a u s e o f t h ei r l i mi t at io n o n c o m p ut at io n s p e e d .

C. Monitor Unit Calculations

M a n u a l c a l c u l a t io n s o f m o n i to r uni t s f o r IM R T i s d i f f i c ul t , i f no t i m po s s i bl e . R e l i a n c e i s u s u a l l y ma d e o n t h e T P S to ca l c ul a te m o nit o r units , f o l lo w i ng t he same and al g or it h m the as us e d may in be the c a l c ul at ion b ut of de p t h- do s e MU di s tr i b uti o n. are S o me a d d it io n a l d at a ( e . g . , S C , S P , T M R s , r e f e r e nce d o se / M U ) s p e ci f i c t o t he a c c e le r a to r a lg o ri t h m r eq ui r ed t he c al c ul at io ns p er f o r m ed i n t e r n a ll y b y t h e T P S i n p a r a l l el w i t h do s e c a l c ul at io ns . T hi s p r a c t i ce s e e ms c o n t r a r y to t h e l o n g - st a n d i n g p ri nc i pl e t ha t t he m o nito r uni t s m us t b e c al c ul at ed o r c h e c k e d i n de pe n de n t l y o f t h e T P S . IM R T , ho w e v e r , i s g iv e n a n e x c e p t io n b e c a u s e o f i t s c o mp l ex i t y , c a u s e d p ri m a r il y b y i nt e ns it y mo d ul ati o n. T he us e r is encouraged to d e v elo p or a c q u i re an i nd e pe nd e nt MU c al c ula t io n system, if a v a i l a bl e co m m er c i al ly . T h e l a t te r w il l re qui r e r ig o ro us c o m mi s si o ni ng o f it s o w n b e f o re it c o u ld b e u se d a s a c h e c k o n t he T P S . N o ne t he l e s s , i t i s i nc um b e nt o n the user to verify MUs either by i nd ep e nd e nt c al c ul a ti o ns or by p ha nt om m e a s u r e m e n t s . T h e se c h e c k s a r e p a rt o f p a t ie nt - s pe c i f i c q ua li ty a s s ur a nc e a nd s h o u l d be co n d u c t e d in a d d it io n to t he i nit ia l c om m i s si o ni ng o f IM R T ( e v e n t ho ug h c o m m i s si o ni n g i n c l u de s e x p e ri me nt a l v e ri fi c a ti o n o f M U ca l c ul at io ns b y t he T P S u n d e r b e n c h m a r k c o n d i ti o n s ) . In v i e w o f t h e f a c t s t h a t t h e IM R T t re a t me nt pl a nni ng s y s t e m i s li k e a b l a ck b o x , t h a t m a n u a l c a lc u l a t io n s a r e i mp r a c tic a l a nd t ha t pa ti e nt - sp e c i f i c d o si m et r y is l a bo r intensive, A the few need reports for i nd e p e nde nt ha v e MU c a l c ula t io n t hi s c a nno t p r o bl e m be b ut o v e r e mp h a s i z e d . ( 24 , 2 5 ) addressed

c o m m e r ci a l so f t w a r e n e e d s to be de v e lo p ed a s a n a d j unc t to t he T P S t o p r o v ide a n i n d e p e n d e nt v e r i f i ca t io n o f M U s . M e t h o d s o f c al c u l a ti n g M U s to de li v e r a cer t a i n do s e ar e i nv e r s e o f t he m et ho ds u s e d i n t h e c a l c u l at ion o f d o s e w he n a p a t i e nt i s i r r ad i at e d w ith a g i v e n b e a m weight P.501 c o n d it io n s u s e d b y t h e a lg o ri t h m c a n be re l a te d to t he c al ib r a ti o n co nd it io ns to p r o v id e M U s . In IM R T , b e c a u s e b ea m i nte ns i t y w it hi n t he f iel d i s m od ul a te d ( b e a m p ro f il e i s n o lo n g e r u n i f o r m ) , p e nci l be a m o r c o nv ol ut io n- s up e r po s it io n a l g or it h m s a r e t h e m et h o d s o f c h o i ce f o r d os e c a l c ul a ti o ns . H o w ev e r , t he y a r e no t s u i t a bl e f o r m a n u a l c a l c u l a ti o n o f m o nito r uni t s . It i s m o r e p r ac t i c al t o w r it e a s e p a r a te co m p u te r p ro g r a m , w h i c h si m pl i f ie s t he se o r o t he r mod e l s a nd a pp li e s them m o re t ra n s p a re n t l y to t he p r ob lem of m o nit o r unit c a l c ul a ti o n. Ba s i c p r i n c i pl e s o f t h i s a p p ro a c h a r e p r e s e nt e d bel o w a s e x a m p le s . or fluence. Although doses in a TPS are c a l c ul a t e d as r el a ti v e d i s t ri b u tio n s , t h e n o r m a l i z i n g

C.1. Finite-size Pencil Beam

In s t e a d o f g e n e r at i ng a n i n f i n i t e s im a ll y s m a l l pe nc i l be a m ana l y t i c a ll y , i t i s p o s s ib le t o m e a s u r e a f i n i te - s i z e pe nc i l be a m ( F S P B) e x pe r i ment a l l y . T he l a tt e r c o n s i s t s o f m e a s u r ed d e p t h - do s e di s t ri b utio n a nd p r o f i l e s f o r a s m a l l f i e ld s i z e ( e . g . , 1 1 c m 2 ) . I n t h e F S P B d o s e c a lc ul a t io n f o r m a li s m , a g i v e n i nt e ns it y m o d u l at e d fi e ld i s di v id e d i nt o f i nit e - si z e ele m e nt s ( 1 1 c m 2 ) and t he d o se f r o m

WWW.MEDRAD.IR

a l l t h e F S P B s i s i nt e gr a t e d , t a k i ng i nt o a c co unt t he re l at i v e we ig ht f o r t he to t al f l u e n c e f o r e a c h pe n c il be a m . T h e fo ll o w i ng e q ua ti o n s um m a ri z e s t he re l at io ns hi p b e t w ee n m o n it o r u n it s ( M U ) a n d d o s e D i ( P ) a t a p oi nt P a t d ep t h d c o nt ri b ute d b y the nth FSPB:

w h e r e K i s t h e c a li br a t io n f a c t o r o f t he a c c e l e r ato r ( d o se / M U und e r r e f e r e nc e c o n d it io n s ) ; T M R ( d ) is t h e ti s s u e - m a x i m um r a t io a t d ep t h d f or the F S P B; S C , P i s t h e o u t p u t f a c to r a t th e r e f e r e n c e d ep t h o f m a x i m um d o s e f o r t he F S P B r e l a t i v e to t h e c a li b r at io n f i el d siz e ( 1 0 1 0 c m 2 ) ; T i is t he tr a ns m i s s io n f a c t o r ( T i i s a s m all f r a c t i o n w h e n P i s u n d e r t h e l e a f a nd i s e q ua l t o uni t y w he n P i s i n t he o p e n) ; IS F i s t h e i n v e r s e s q u a r e la w f a c t o r t o a c c o unt fo r c ha ng e i n di s t a nc e f r o m t he s o ur ce to p oi n t P versus th e d i st a n c e f ro m t he s o ur ce to t he r e fe r e nc e p oi nt of c a l i b ra ti o n ; a n d O A R i ( d ) i s t h e o f f - a x i s r a t io a t po i nt P re l at iv e t o t he ce nt r al a x i s o f F S P B i . It s h o u l d b e n ot ed t ha t t he a b o v e eq ua ti o n i s sim i l a r t o t he o ne u s e d f o r t r ad it io n a l r ad i a ti o n t h e r ap y b e am s ( s e e C ha p t e r 10 ) . T ota l do s e a t po i nt P i s c a l c u l a t ed b y s u m m i n g t h e c o nt ri b uti o n o f a l l F S P Bs t o t he po int P . The above m et h o d of c a l c u l at i ng TPS, d o se d i st r ib ut io n of t he ha s be e n us e d ha v e by a c o m m e r ci a ll y a v a il a ble CORVUS4. De t a il s al go r ithm b ee n

p u b l i s h ed b y S t er n i c k e t a l . ( 26 ) . Be c a us e t he m et ho d i nv o l ve s c o nv o l ut io n o f F S P B s a n d m a n y o t h e r c o r re c ti o ns re l at ed t o p a ti e nt c o nto ur s a nd t he s pe c i f i c IM B c o l l i m at or , i t i s n o t po s s ib l e to a do pt i t a s s uc h f o r m a nua l c a l c ul at io ns . H o w e v e r , w i t h a f e w re a s o n a bl e ap p ro x i m ati o ns , a si m pl e r c o mp ut e r p r og r a m c a n be w r it te n to p ro v i de an i n d ep e nd e nt ve r i f i c at io n of mo ni tor uni t s . S uc h a p r o g r am h a s b e e n d e ve l op ed b y K ung e t a l . ( 2 5 ) a nd i s b r ie f l y d i sc us s e d b e lo w . K u n g e t al . s me t h od i s b a s e d o n t he co nc e p t o f mo di f ie d C la rk s o n i nt eg r a ti o n ( s e e C h a p te r 9 ) i n wh i c h t h e C l a r k s o n i nte g r a ti o n i s c a r ri ed out o v e r a nnul a r s e c t or s i ns t e ad o f p ie s e c to r s . A g i v e n IM R T f i e l d i s di v i de d i nt o c o nc e nt ri c c i r c l e s , c e n te r ed at ce n t r a l a x i s . It i s a s sum e d t ha t t he f l ue nce c o nt r ib ut e d to c e n t r a l a x i s f ro m s ub f i e ld s l o c at ed at r ad i us r i s t he s a me a s w o ul d b e b y u n i f o r m l y i r r a di a te d s u b f i e l d s o f a v e r a g ed f l ue nc e a t r a d i us r . In o t he r w o r d s , f l u e n c e o r M U s d el i ve r e d t o s u b f i el d s at r a d i us r c a n be a v e ra g e d t o c a l c ul at e t h e i r co n t ri b u ti o n to s c a t te r e d d o se al o ng c e nt r a l a xi s , b e c a us e o f t he a z im ut ha l symmetry. D e t ai l s o f mo n i to r u n i t s t o b e d el i v er e d to s ub f i e ld s a r e c o nt ai ne d i n t he D ML C f i l e . C om p o si te o f w e ig h t e d MU s o f e a c h s ub f i e ld gi v e s a fl ue nc e m a p i n t e r m s o f MU(x, y). Average fluence,

U ( r ) , a t t h e c i r c u m f e re n c e o f a c i r c l e o f r a di us r i s g i v e n b y :

WWW.MEDRAD.IR

F I G . 2 0 . 1 7 . S c h e m a t i c o f mo di f i ed

C l a r ks o n m et ho d i n w hi ch i nt e gr a ti o n i s

c a r r i e d o ut o ve r a n n u l a r s e ct or s . T he do s e c o nt r ib ut ed b y a n a nnul us ( d ot t ed ) i s t h e d i f f e r e n c e be t w een t h e d o s e s f r o m t he c i r c ul a r f i e ld s o f r a di i r + r a nd r . (Redrawn from Kung JH, Chen GTY, K uc hni r F K . A m o ni t o r uni t v e r i f i c a ti o n c a l c u l a ti o n i n i n t e n s ity m o d u l a t ed r a d io t he ra p y a s a d o s i m e t r y qua l i t y a s s ur a nc e . M e d P h y s 2 0 0 0 ; 27 : 222 6 2 2 30 . ) P.502

T h e c o n t r ib u t io n o f s ca t t er e d D s to ce nt r a l a x i s a t d e pt h f r o m a n a nnul us b e t w e e n r a d i i r a n d r + r , u n i f o r m l y i r r a di a te d b y

U(r), is given by:

w h e r e K i s t h e d o se /M U u n d e r r e f e r e nc e c o nd it io ns o f c a l i b ra ti on, S C i s t he he a d s c a t te r ( c o r r e sp o n di n g to jaw o pe ni ng , ig no r i ng MLC s c a t te r) ; SP a nd TMR ( d e f i n e d i n C h a p t e r 10 ) c o r r e s po nd to a c i r c ul a r f i e l d o f r a di us r w hi c h c a n b e d e r i v ed f r o m eq u i v a len t r e c t a n g ul a r f ie ld da t a ( s e e C ha pt e r 9 ) ; a nd IS F i s t he i n v e r s e s q u a r e r l a w f a c t o r , d e fi n e d e a rl ie r . T o t a l d o se , D ( d ) , a t th e c e n t e r o f a n a nnul us i s t he s um o f p r i ma r y d o s e D P , a nd s c a t te r e d do s e ; D S .

R e f e r r i n g to F i g . 20 . 17 , D P i s c a l c ul a te d f r om

U ( 0 ) , w h i c h i s o bt ai n e d b y a v e r a gi ng M U ( x, y ) o v e r a s m al l c e nt r a l c i r c ul a r a r e a (e.g., r = 1 cm).

WWW.MEDRAD.IR

T h e t ot a l s c at te r e d d os e a t c e nt r a l a x i s , D S , i s c a l c ul at ed b y C l a rk s o n i nt e g r at io n over all annuli:

K u n g e t a l . (2 5 ) h a v e t e st e d t h e a bo v e al go r it hm f o r a num b e r of IM R T c a s e s a nd found an agreement within 3% with CORVUS.

C.2. Convolution Algorithms

T h e c o n v o l u t io n m e t h o d i n v o l v e s r a di a tio n t r a ns p o rt i n w hi c h p r i m a r y i nt e r a c ti o ns a r e c a l c u l at e d se p a r at e l y f r o m t he i nte r a ct io n o f s e c o nd a r y p ar t i cl e s ( c ha r g ed p a r t i cl e s P.503 with do s e k e r n el s (s e e C h a p te r 19 ) . T he c o nv ol ut io n do s e e ng i ne b a s i c al ly and s c a tt e re d p h o to n s ) . T he dose in a p ha nt o m is c a l c ul a t ed by c o n v o l v i n g t h e t e r m a d i s t ri b u tio n

c a l c u l a te s do s e pe r u n i t e n e rg y f l ue nc e . S i nc e t he i nc i d e nt e ne r g y f l ue nc e i s p r o po r tio na l to M U s , t h e d o s e c a n b e s c a le d t o g i v e d o s e/ M U . A s u i t a bl e fo r m a li s m for the c a l c ul a ti o n of mo ni to r uni ts us i ng c o nv ol ut io n a l g or it h m c o u l d be b as e d o n do s e pe r uni t e ne r g y f l ue nc e . F o r ex a m p l e , t he b a s i c e q u a t io n u s e d b y A D A C P i n n a c l e 5 t r e at m e nt p l a nni ng s y s t e m i s o f t he f o r m :

w h e r e D d i s t h e p r e s c ri b ed do s e a t d ep t h d a nd N D i s t he no r m al iz e d do s e f a c t o r. N D i s t h e r at io o f d os e p e r u n it e ne r g y f lue nc e a t t he p r e s c ri pt io n p oi nt to t he d o s e pe r u n i t e n e r g y fl u e n c e a t t he r e f e re nc e p oi nt o f c a l ib r a ti o n. It c a n b e s h o w n t h a t f o r a no r m a ll y i nci d e nt b e a m i n a w a t e r p hant o m , N D = T M R S p . L e t C d e n o te t h e f i e ld s i z e d e f i ned by c o l l im a to r j a w s ; C o b e t he r e f e re nc e f i e l d si z e ( 1 0 1 0 c m 2 ) ; a n d b e t he p ho to n e ne r g y f l ue nc e . B y d e f i n i t io n , a t t h e pr e s c r i pt io n p oi nt :

or,

F r o m t h e de f i n i tio n s o f T M R , S C , S p a nd S C , p ( s ee C ha p t e r 10 ) , E q ua t i o n 2 0 . 17 b e c o me s :

or,

T h u s t h e M U c a l c u l a ti o n f o r m a li s m b a s ed o n d o s e p e r uni t ene r g y f l ue nc e i s c o n s i s te n t w it h t h e t ra d i ti o n al s y s te m us i ng T M R , S C , S p , et c . T he a d v a nt a g e o f u s i n g d o s e p e r u n i t en e r g y f l u e n c e i s t ha t t he M U s a r e c al c ul a ted s i m ult a ne o us l y w i t h d o se c om p u t at ion b y t h e c o nv o l ut io n d o s e e ng i ne fo r w hi c h t he r a w o utp ut is t h e d o se p e r u n i t e n e rg y f l u e n c e .

WWW.MEDRAD.IR

M a c k i e et al . ( 27 ) ha v e s u g g e st ed c a li b ra t io n o f t he a c ce le r at o r i n t e r m s o f i n c i d e nt e n e r g y f l u e nc e p e r mo nit o r unit ( P ) / M U a t a d e f i ned p oi nt P ( e . g . , r e f e r e n c e p oi n t o f c ali b r a tio n ) . If D m e a s i s the m e a s ur e d d o se i n a w a t e r p ha nto m a t P a n d D c a l c i s t h e ca l c u l a te d do s e ( b y c onv o l ut io n a l go r it hm ) a t t he s am e po i nt i n a s i m ul a te d w a te r p h a n t o m , und e r t he s a m e i r r a di a ti o n co nd i ti o ns , t he n t he e n e r g y f l u e n c e c a l ib r at io n f a c t o r i s gi v e n b y :

T h e c o m p u te d d o se pe r i n c id e n t e ne r g y fl ue nc e D ( x , y , z ) / ( P ) a t a ny p oi nt c a n t h u s b e c o n v e r t ed to d o s e pe r m o nito r uni t D ( x , y , z ) / M U u s i ng t he e ne rg y f l u e n c e c a l i b r ati o n f a c t o r gi v e n b y E q ua t i o n 2 0 . 2 0 :

As

discussed

e a r li e r,

for

c o nv e nt i o na l

r a d io t he r ap y

b e a m,

m o ni t o r

uni ts

c a l c u l a te d b y co n v o l u ti o n a lg o ri t hm s c a n b e v e r i f i ed b y us i ng t r ad i ti o nal c o nc ep ts of TMRs and measured P.504 o u t p u t f a ct o r s . In IM R T , w h e r e t he f i el d s a r e i r r ad i at e d w i t h i nt e ns it y - m o d ul at ed b e a m s , t h e t r ad it io n al f o r m al i s m s b re a k d ow n unl e s s t he f i el d i s s ub d i v id e d i nto e l e me n t a r y f ie ld s o f u n i f o r m i n te ns i t y b ut d i f f e re nt f l ue nc e s . A m e t ho d l i ke t he m o di f i ed Clarkson i n t e g r at io n c o ul d t he n b e a p p li e d us i ng TM R s a nd o ut p ut f a c t o r s f or t h e r e f e ren c e e le m e nt a r y b e a m, a s d e s c ri be d e a r li e r. S i nc e m a nua l v e r i f i c a tio n i s s ti ll di ff i c u l t , t h e nee d fo r i nd e pe nd e nt co m p ute r c o d e s c a nnot be a v o i de d .

20.6. CLINICAL APPLICATION

IM R T c a n b e u s e d f o r a n y t r e a t m e nt fo r w hi c h e x t e r na l b e am r a d ia t io n t he r a p y is a n a p p r op r i at e c ho i ce . T h e b a s i c di f f e r e nc e b et w e e n co nv e nt iona l r a d io t her a p y ( i n c l u d i n g 3 -D C R T ) a n d IM R T i s t ha t t he l a tt e r p r o v id e s a n e x t r a d eg r e e o f f r e e do m , t h a t i s , i n ten s i t y m o d ul a ti o n, i n a c hi e v i ng do s e co nf o rm i t y . E s p e ci a ll y t a r g et s of concave shape s u r r o und i ng se ns i ti v e s t r uc t ure s can be t r ea t ed c o n f o r m l y w i t h s t ee p d o s e g r ad ie nt s o ut si de t he t a r ge t bo und a r ie s a t a s k t ha t i s a l m o st i m po s s ib le t o a c c o m pl i s h w i t h c o nv e nt io na l t e c hni q ue s . Fi g ur e 2 0 .1 8 ( s ee c o lo r i n s e rt ) i s a n e x a m p l e o f s u c h a t a r g e t . F o r l o c al i z ed l e si o n s in a n y p a r t o f t he b o dy , IM R T c o m p a r e s w e ll w i t h o r e x c e ed s t h e c a p a bi li ti e s o f ot h e r t e c h n iq u e s o r m o da l it i e s . In t re a ti ng b ra i n l e si o ns , IM R T c a n g e n e r at e d o se dis t r i b ut io n s c o mp a r a ble to t ho s e o b t ai ne d w i t h s te r eo t a ct i c r a d i at io n t h e r ap y u s in g x - r a y k ni f e o r g am m a k ni f e . F i g ure 20 . 1 9 ( se e col o r i n s e r t ) s ho w s a f e w ex a m p l e s o f he a d a nd ne c k t um o r s . A d di tio na l l y , IM R T i s n ot l i mi te d b y t a r ge t si z e o r i t s l o c at io n. IM R T c a n a l s o c o m p ete w e l l wi t h p ro to n b ea m t he r a p y f o r al l di se a s e s it e s , a lb ei t w i t h s o me s u b tl e d i f fe r e n c e s r ad io b iol o gi ca l l y b ut no t so s ubt le d i f f e r e nc e s c o st w i s e . T h e p r i c e o f IM R T c a p a b i li t y i s o nly a s m a l l f r a c t io n o f t ha t o f a p r ot o n b e a m f a c i li t y . S u p e r f i c i al di s e a s e s it e s (e . g . , p a ro ti d , ne c k no d e s , c he st w a ll ) , o f te n t re a te d w i t h e l e ct ro n s , c a n also be t r e at ed w i t h IM R T a s e f f e c t i v e l y, i f no t b e tt e r . H o w e v e r , p r a ct i c al con s i d e r at io n s m a y p rec l ud e so m et i me s t he us e o f IM R T f o r

WWW.MEDRAD.IR

c a s e s w h e r e e l e ct r o n s o f f e r a t e c hni c a l l y s im p l e r o p tio n, e . g . , s k i n c a nc e r s , t o t a l s k i n i r r a d i at io n , s u p e r f i c i a l b re a s t boo s t , etc . IM R T i s c o m p a r a b le t o b r a c h y t h e r ap y i n d o s e co nf o r m it y b ut i t i s a di f f e r e nt m o d al it y r a d io bi ol og i ca l l y . S o t h e c ho i ce b et w e e n IM R T a nd b r a c hy t he r a p y s ho uld b e b a s ed n o t o n l y o n t h e t e c h n i c a l o r d os im e t ri c c o ns i de r at io ns , b ut a l s o o n t he r a d io b io lo gi c p r op e rt ie s o f b r a c hy t he r a p y v e r s us e x t e r na l b e am . F o r e x a m p l e, t r e at m e n t o f p r o st at e w i t h s e e d i m pl a nt s ha s a d i f f e r e nt r at io nal e t ha n it i s f or IM R T a l t h o u g h do s e co n f o r m it y i s c om p a r a bl e i n te r m s o f d o se f a ll o f f b e y o nd t he p r o st a t e vo l u m e . R ad i ob io lo g y of t he tw o m o d al it ie s is obv i o us l y d i f f e re nt b e c a u s e o f d i f f e re n c es i n d o s e h o m og e nei ty a nd d o s e r a t e o r f ra c t io na t io n ( e . g . , c o n t i n u o u s v s . f r a c t i on a t e d do s e d el i ve r y ) . O f a l l t h e si te s s u i t ab l e f or IM R T , t he p r os t a t e g l a nd ha s r e ce iv e d t he g re a te st a t t e nt io n be c a u s e o f th e g r e at e r de g r ee o f d o s e c o nf o r mit y t ha t c a n b e a c hi e v ed c o m p a re d t o t h e c o nv e n t i o n a l t e c hniq ue s , i nc l ud i ng 3 - D co nf o rm a l ( F ig . 2 0 . 20 ) ( s e e c ol o r i n s e rt ) . H o w e v e r , i t i s d e b at ab l e w he t he r a hi g he r d e g r ee o f d o se c o n f o r m it y r a t io n a l e c o r r el a te s fo r do s e with b e t te r t r e at me nt r e a de r o ut c om e s ho ul d or if in it is a s uf f i c i e nt t ha t d o se e s c a l at io n . T he bear m i nd

c o n f o r m it y i s a do u b l e -e d ge d s w or d , w it h m o r e no r m a l t i s s ue s p a r i ng o n t he o n e h a n d a n d g r e a t e r p o s s i bi li t y o f t a rg et m i s s o n t he o t her . A s d i s c us s e d e a rl ie r i n c o n j u n c t i o n w it h 3- D C R T ( s e e C ha p te r 1 9 ) , a n i m ag e - b a sed t r e at me nt pl a n cannot fully account for (a) t he t r ue ex t e nt of c li ni c al t a rg e t v ol um e , (b) a c c u r a t e l y a p pl i c ab l e T C P a n d N T C , a nd ( c ) na t ur a l m o t io n o f t a r g e t v ol um e a nd o r g a n s a t r i s k . B e c a u s e o f t h e s e una v o i d ab le unc e r t a i nti e s , to o muc h e m p ha s i s o n d o s e c o n f o r mi t y c a n ba c k f i r e , r e s ult i ng i n ina d e q ua t e t a rg e t c o ve r a g e o r i nc r e a se in normal tissue co m pl i c at io n The reader e s p e ci a lly is w he n to f o l l o w i ng L e v it t a nd ag g r e s si v e Kha n (28) d o se for a e s c a l at io n gland. IM R T is an elegant t r e a tm e n t pl a nni ng a nd d e li v e r y t e c hni q ue . It a ll o w s p r a c t i ca ll y u n l i m i te d c o n t r ol o v e r s ha p i ng o f d o s e d i st r ib ut io n t o f i t t um or s o f c o m pl e x s h a p e w h i l e P.505 s p a r i n g c r iti c a l n o r m al t is s u e s i n c lo s e p rox i m i t y . U ndo ub t ed l y , t he IM R T i s t he u l t i m at e to ol i n e x te rn a l b e a m r a di a ti o n the r a p y a nd i s e x pe c te d t o s up e r s ed e o t h e r te c h n i q u e s i n c lu d i n g 3 - D C R T a nd s t e r e ot a ct i c r a di a ti o n the r a p y . H o w e v e r , i t s h o u l d be r e c og n iz e d t h a t t e c hni c al pr e c i s io n a l o ne i n d os e p l a nni ng a nd d e li v e r y d oe s n ot e n su r e s u p e r io r c li ni c a l re s ul t s . O f e q ua l o r g re a t e r i m po rt a nc e a r e t h e d e si g n o f P T V, l o c al i z a ti o n o f o rg a ns a t ri s k , p a ti e nt i m mo b il i z at io n, a nd o n - l i n e po rt a l i m a gi n g . In s h o r t , t he s uc c e s s o f IM R T w he n i n d i c a te d do e s n ot d e pe n d o n i f i t i s a pp li e d b u t r at he r ho w i t is a p p l ie d . schemes. r e f e rre d

c a u t i o n a r y n ot e o n co n f o r m a l r a di ot he r a py a nd d o se e s c a l at ion i n t he p r o st at e

REFERENCES
1 . B r a h m e A . O p t i miz a t i o n o f s t a ti o na r y a nd m o v i ng be a m r ad i a ti o n t he r a p y t e c h n i q u e s . R a d io t h er O n c o l 1 9 88 ; 12 : 1 29 14 0 . 2 . K l lm a n P , L i n d B , E k l o f f A , e t a l . S hap i ng o f a r b it r a r y do se d i st r ib ut io n b y d y n a m i c M u l t il e a f c o ll im a t io n . P h y s M e d Bi o l 1 9 8 8 ;3 3 :1 2 91 1 3 00 .

WWW.MEDRAD.IR

3 . W e b S . O pt i mi z a tio n o f c o n f o r m al do s e d i s tr i b ut io ns b y s i mul a t e d a nne a l i n g . P h y s M e d B i o l 1 9 89 ; 34 : 1 34 9 1 37 0 . 4 . B o r t f el d T R , B u r k e lb a c h J , B o e se c k e R , et a l . M e t ho d s o f im a ge r e co ns t r uc ti o n f r o m p r o je c ti o n s a p pl ie d to c o n f o r m a ti o n t he r a p y . P hy s M e d Bi o l 1 9 9 0 ;3 5 :1 4 23 1 4 34 . 5 . R o s e n II, L a n e R G , M o r r i l l S M , e t a l . T r e a t me nt p l a nni ng o pt i mi z a t io n us i ng l i n e a r p ro g r a mm i n g . M e d P h y s 1 9 9 1 ; 18 : 141 15 2 . 6 . C o n v e r y D J , R o se n b l oo m M E . T he g e ne ra t io n o f i nt e ns it y - m od ul a t ed f ie ld s f or c o n f o r m a l r ad io t h e r ap y b y d y n a m i c c o ll im a t io n. P hy s M e d Bi o l 19 92 ; 3 7 :1 35 9 1 3 74 . 7 . M o h a n R , M a g e r a s G S , B a l d w i n B, e t al . C l i ni c al l y re l e v a nt opt i mi z a t io n o f 3 D c o n f o r m a l tr e a tm e n t s . M e d P h y s 1 9 9 2 : 9 33 9 4 4 . 8 . H o l m e s T , M a c k i e T R . A f i l t e re d b a c k pr o j e ct io n d o s e c al c ul at io n m e t ho d f o r i n v e r s e t r e at me n t p l an n i n g . M e d P hy s 1 9 9 4 ; 2 1 : 30 3 3 13 . 9 . M a g e r a s G S , M o h an R . A p p l i c at io n o f f as t s i m ul at ed a nne a li ng to op ti m i z a tio n o f c o n f o r m a l r a di a ti o n t r e a t me n t . M e d P hy s 1 9 93 ; 2 0 :6 39 64 7 . 1 0 . W e b S . T h e p h y s i c s o f c o n f o r m a l r a dio t he r ap y . Br i s t ol , U K : IO P P ub l i s hi n g , 1 9 97 . 1 1 . L i n d B , B r a h m e A . D e v e l o p m e nt o f t r e at m e nt te c hni q ue f o r r a d i ot he r a py o p ti mi z a t io n . I n t J I ma g i n g S y s T e c hno l 1 995 ; 6 : 33 42 . 1 2 . S pi r o u S V , C h u i C S . G e n e r a t io n o f a rb i t r ar y i nte ns i t y pr o f il e s b y c o m bi ni ng t h e s c a n n i n g b e a m w i th d y n a m i c M ul t i l e a f c ol li m a ti o n. M e d P hy s 1 9 9 6 ;2 3 : 1 8 . 1 3 . B o rt f e ld T R , K a h l e r DL , W a ld r o n T J , e t al . X - r a y f i e ld com p e ns a ti o n w it h m u l t il e a f c ol li m a to r s . I n t J R a d i a t O nc ol Bi ol P hy s 1 9 9 4 ; 2 8 :7 2 3 73 0 . 1 4 . Y u C X . In t e n s i t y m o d u l at e d a r c t he r a py w i t h d y na m i c M ult ile a f c ol li m a ti o n: a n a l t er n a t i v e t o to mo t h er a p y . P h y s M e d Bi o l 19 9 5 ;4 0 : 14 35 14 49 . 1 5 . Y u C X , S y m o n s M , D u M N , e t al . A m etho d f o r i m pl e me nt i ng d y na m i c p hot o n b e a m i n t e n si t y mo d ul a ti o n u s i n g i nde p e nd e nt j a w s a nd a M ult il e a f co ll i m at or . P h y s M e d B i o l 1 9 95 ; 40 : 7 69 78 7 . 16. 173. 1 7 . S v e n s s o n R , K l lm a n P , B r a h m e A . A na l y t i c al so l uti o n fo r t he d y na m i c co nt ro l o f M u l t il e a f c o ll im a to rs . P h y s M e d Bi o l 19 9 4; 3 9 : 37 61 . 18. Yu CX. I n t e n s i ty m o d u l a t ed arc t he r a p y : a ne w m e t ho d for d el i v e ri ng c o n f o r m a l r a di a ti o n th e r a p y . In : S t e r ni c k E S , e d . T he t heo r y a nd p r a ct i ce o f i n t e n s it y m o d u l at ed r a d io t h e r ap y . M a d i s on, W I: A d v a nc e d M e d i c a l P ub li s hi n g , 1 9 97 : 1 07 1 2 0 . 1 9 . C u r r a n B . C o n f o r m a l r a di a ti o n t he r a p y us i ng a m ul ti le a f i nte ns i t y mo d ul at i ng c o ll i m at o r . In : S t e r n ic k E S , e d . T he t he o ry a nd p r a ct i ce o f i nte ns i t y mo d ul ated r a d io t h e r ap y . M a d i s o n, W I: A d v a nc e d M e d i ca l P ub l i s hi ng , 1 99 7 :7 5 9 0 . 2 0 . C a r o l M P , G r a n t W , B l e i e r A R , e t a l . T he f i e l d - m at c hi ng p rob l e m a s it a p pl ie s t o t h e P e a co c k t h r e e -d i m e n si o n a l c o nf o rm a l s y s t e m f o r i nt e ns it y m o d ul at io n. I nt J R a d i a t O n c ol B i ol P h y s 1 9 9 6 :1 83 18 7 . S t ei n J, B o r t f e ld T, Drshel B, et al. D y na m i c x-ray c o m p e ns at io n for c o n f o r m a l r ad io t h e r ap y b y d y n a m i c c ol lim a t io n. R a d io t he r O nc o l 19 94 ; 3 2: 1 63

WWW.MEDRAD.IR

2 1 . M a c k i e T R , H o l m es T , S w e r d l o f f S , e t a l. T o m o t he r ap y : a ne w c o nc e p t f o r t he d e li v e r y of c o n f o r ma l r a d io t h e r ap y us i ng d y na m i c c o l li m at io n. Med P hy s 1 9 93 ; 2 0 :1 70 9 1 71 9 . 2 2 . C h u i C S , S p i r o u S , L o S a s s o T . T e st i ng o f d y na m i c m ult il e a f c o ll i m at io n. M e d P h y s 1 9 9 6 ; 2 3 :6 35 641 . 2 3 . Lo S o s s o T , C h u i C S , L i n g C C . P hy s i c a l a nd d o s im et r i c a sp ec t s o f a M ul ti le a f c o ll i m at io n system used in t he d y na m ic mode fo r i mp le me nt i ng i nt e ns it y m o d u l at e d r ad io t h e r ap y . M e d P h y s 1 9 9 8 ; 2 5: 1 9 19 19 27 . 2 4 . B o y e r A , X i n g L , M a C - M , e t a l . T heor e ti c a l co ns i de r a tio ns o f mo ni to r unit c a l c u l a ti o n s P.506 for i n t en s i t y m o d ul at e d bea m t r e a t me nt p l a nni ng . Med P hy s 1 9 99 ; 2 6 :1 87 19 5 .

2 5 . K u n g J H , C h e n G T Y , K u c h n i r F K . A m o ni to r uni t v e ri f i c a tion c a l c ul a t io n i n i n t e n s it y m o d ul a t ed r a d io t h e r ap y a s a d os i m et r y q ua l it y a s s ur a nc e . M e d P hy s 2 0 00 ; 2 7 :2 22 6 2 23 0 . 2 6 . S t e r n i c k E S , C a r o l M P , G r a n d W . Int e n s i t y - m od ul a te d r a di othe r a p y . In: K ha n F M , P o t i s h R A , e d s . T r e a t m e nt p l a nni ng i n ra d i a tio n o nc o lo g y . Ba lt i mo r e : W il li a m s & W i l k i n s , 1 99 8 :1 8 72 1 3 . 2 7 . M a c k ie T R , R e c h we r d t P , M c N ut t T , et al . P ho to n be a m d o se co m p ut at io ns . In: Mackie TR, P a lt a J R, eds. T el et he r a p y : p r e se nt a nd f ut ur e . M a d i so n, W I: A d v a n c e d M e d i c al P u b l i s h i n g , 1 99 6 :1 0 3 13 5. 2 8 . L e vi tt S H , K h a n F M . T h e r u s h t o j ud gm e nt : do e s t he e v id enc e s up p o rt t he enthusiasm over t hr e e - di m e n s io na l c o nfo r m a l r a di at io n t he r a p y a nd dose e s c a l at io n i n t h e t rea t m e n t o f p r o st a te ca nc e r ? . I nt J R a d i at O nc o l Bi ol P hy s 2 0 01 ; 5 1 :8 71 87 9 .
1 2 3 4 5

B o l t z m a n n c o n s t a n t is d e r i v e d f ro m t he t heo r y o f e x p a ns i o n o f g as s e s . N O M O S C o r p o r at io n , S e w i c k l e y , P e nns y l v a n i a . U n i v e r s it y o f W i s c o n si n , M a d i s o n , W i s c o ns in. P r o d u c e d b y N O M O S C o r p o r at io n , S e w i c k l ey , P e nns y l v a ni a . A D A C L a b o r a to ri e s , M i l pi t a s , C a li f o r ni a .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part III - Modern Radiation Therapy > 21 - Stereotactic Radiosurgery

21 Stereotactic Radiosurgery
21.1. INTRODUCTION
S t e r eo t a ct i c r a di o s u r ge r y ( S R S ) i s a si ng le f r a c t io n r a di a ti o n t he r a p y p ro c ed ur e f o r t r e ati n g i n t r a c r a nia l le s io n s us i ng a c om b i na ti o n o f a st e re ot a c ti c a p p ar a t us a n d n a r r o w m u l t ip le b e a m s de li v e r ed t hr oug h no nc o p l a na r i so ce nt r i c a r c s . T he same p ro c e d u r e w h en used for d el i v e ri ng Bo t h m ul ti p le do s e i nv o l v e f r ac t io ns is c a ll ed s t e r eo ta c ti c r a di ot h er a p y (SRT). t e c hni q ue s thr e e - d i me ns io na l

i m a gi n g to l o c al i z e t he le s io n a n d de li v e r i ng t re a t me nt t ha t co nc e nt r a te s t he do s e i n t h e t a r ge t v o l u m e a n d s p a re s a s m uc h a s po s s i bl e t he no rm a l b r ai n. A hi g h d e g re e o f d o se c o n f or m i t y i s a ha l l m a r k of S R S , w hi c h i s g e ne r a l l y a c hi e v e d b y u s i n g a p p r op r i at e ci rc u l a r b e a m s t o fi t the l e s io n, o pt im i z i ng a r c a ng l e s a nd w e i g h t s a n d u s i n g m ul ti p le i s o ce nt e r s o r d y na m i c a l l y s ha pi ng t he f i e ld d uri ng a r c r o t at io n s w i t h m i n i ( or m i c r o ) m u lt il e a f c o ll im a t o r s . A c c u r a c y o f b e a m d e l iv e r y i s a n o t he r ha l l ma r k o f S R S . It i s s t r i ct l y c o nt ro ll e d b y a s p e c i a ll y d e s ig n e d st e r eo ta c ti c a p p a r at us , w hi c h i s us e d t hr o ug h a l l s t e p s o f t he p r o c e s s : i m ag i n g , t a rg e t l o ca li z a t io n, he a d i m m ob il i z at io n, a nd tr e a t me nt s et - up . Because of the c r itic a l nature of b ra i n t i s s ue , el a bo r a te qua l i t y a s s ur a nc e p r o c ed u r e s a r e o b se rv e d . T h e b e s t a c hi e va b l e me c ha ni c a l a c c ur a c y i n t e r m s o f i s o c e nt e r di s p l a ce m e nt f r o m t h e d e f i ned c ent e r o f t a r g et i m ag e is 0 . 2 m m 0 . 1 m m , a l t ho u g h a m a x im u m e r r o r o f 1 . 0 mm i s co m mo nl y a c c ep te d i n v i e w o f t he u n a v o i d a b le u n c e r t a i nt i e s i n t a r g et lo c a li z a ti o n. T h e t e r m r ad io s u r g e r y w a s c o i n e d b y a ne ur o s ur g eo n L a r s L e k se ll i n 1 9 51 ( 1 ) . H e d e v e lo pe d t h e p ro c edu r e i n t h e l a te 19 40s t o d e st r o y d y s f unc t i o na l l o ci i n t he b r a i n u s i n g o rt h o v ol t ag e x - r a y s a nd p a rt i cl e a c c e le r a to r s . Hi s l at er w o r k i nv ol v ed t h e u s e o f a s pe c i al ly d e s ig n e d c ob a lt unit , c a ll ed t he g a m m a k ni f e . C ur r e nt l y t h e r e a re t h r e e t y p e s o f r a d i ati o n us e d i n SR S a nd S R T : he a v y - c ha r g e d p ar ti c l e s , c o b a lt - 60 g a mm a r a y s , a n d m e g a v ol t ag e x - r a y s . O f t he s e , t he m o s t co m mo nl y u s e d m o d a lit y i s t h e x - r a y s p r o d uc e d b y a l i ne a r a c c e l e r at o r. I n a na l o g y t o g a m m a k n i f e , t h e l i na c - b a s e d S R S uni t ma y b e c a ll e d x - r a y k ni f e . A l t ho ug h t he c l i n i c al d i f f e re n c e s be t w e e n t he g a m m a kni f e a nd x - r a y k ni f e a r e i ns i g ni f i c a nt , t h e c o s t o f t h e f o r m er i s a b o u t te n t i me s t ha t o f t he l at te r ; b ot h a r e s ub s t a nt ia ll y c h e a p e r t h a n a h e a v y p a r t i c le a c c el e r at or . O f c o ur s e , m o s t o f t he r a d i at io n g e n e r a to r s u s e d f o r SR S a r e a l s o us e d f o r o t he r r a di ot he r a p y p ro c e d ur e s w it h t he e x c e p ti o n o f g a m m a kn i f e , w h i c h i s d e d i c a ted s o le l y f o r S R S .

21.2. STEREOTACTIC RADIOSURGERY TECHNIQUES

T w o S R S t e c h n i q u e s a r e d e s c ri b ed i n t hi s c ha p t e r : li na c - b a s ed x - r a y k ni f e , a nd g a m m a k n i f e . G r e at e r d et a il s a r e p ro v i de d o n t he mo st f r e q ue nt ly us e d s y s t e m, t h e x - r a y k n i f e , w h i l e a b r ie f r e v i e w i s gi v e n o n t he g a m m a k ni f e f o r g e ne r al

WWW.MEDRAD.IR

i n f o r m a ti o n . E x t e n s i ve li te r a t u r e e x i st s o n S R S t e c hni q ue s . T he re a d e r i s re f e r re d t o A A P M R e p o rt N o . 54 ( 2 ) f o r r e v i e w a nd pe r ti ne nt b ib li o gr a p hy . P.508

A. X-ray Knife
T h e l i n a c - b a s e d S R S t e c h n i q u e c o ns i s t s o f us i ng m ul t i pl e nonc o p l a na r a r c s o f c i r c u l a r ( o r d y n a m i c a ll y s h a p e d ) b e a m s c o nv e r g i ng o n t o t he m ac hi ne i s o c e nte r , w h i c h i s s t e r e ot a c ti c a ll y p l a c e d at t he c e nter o f i m a g e d t a r g et v o lum e . A s p he r i c a l d o s e di st r i b ut io n o bta i n e d i n t hi s c a se c a n b e s ha p e d to f i t t he l e si o n m o re c l o s el y b y m a n i p u l a tin g s e v e r a l p a r a m et er s : s e l e ct i v el y b l o c k ing p a r t s o f t he circular f i el d , s h a p i ng the b e a m s -e y e - a pe r t ur e d y na m i c al l y with a m ul t il e a f c o ll i m at o r , c h a n g i n g a r c a n g l e s a nd w ei g ht s , us i ng mo r e t ha n one i so c e nt er a nd c o m bi n i n g s t at io n a r y b e a m s w it h a r c i ng be a m s . O p ti mi z a t io n of s o m e o f t he s e p a r a m et e r s i s c a r ri e d o u t a u t o m at i c al l y b y the t r e a t me nt - pl a nni ng s o f t w a r e .

A.1. Stereotactic Frame

T h e r e a r e b a s i c a ll y tw o l i n a c - b a s ed S R S s y s t e m s : p e de s t al - mount e d f r a m e a nd c o u c h - m o u n t e d f r a me. T h e f r a m e i n t hi s c a s e r e fe r s to a n a p p a r a t us c al le d s t e r eo ta c ti c f r a m e , wh i c h i s a tt a c ha bl e t o t he p a ti e nt s s k ull as w e l l a s t o t he c o u c h o r p ed e st a l . T hi s p ro v i de s a r ig i dl y f i x e d f r a m e o f c oo r di na t e s f o r r e l at i ng t h e c e n t e r o f i m a ge d t a r g et to i so c e nte r o f t r e a t me nt . S e v e r a l f ra m e s ha v e b e e n d e v e lo pe d f or g e n er al s te r eo t a ct i c ap pl i c at io ns a nd s o me o f the s e ha v e b ee n a d o pt ed f o r S R S . T h e m o s t no t e wo r t hy o f the S R S f r a m e s a r e : Le k s e ll , R i e c he rt Mundinger, T o d d - W ell s , and B r o w n- R o b e r t - W e ll s ( BR W ) . These ha v e been d e s c r ib e d i n de t ai l by G a l lo w a y a nd M a c iuna s ( 3 ) . O nl y t he BR W f r a m e w i ll b e d i s c u s s e d i n t h i s c h a pt e r . F i g u r e 2 1 .1 s h o w s t h e b a s i c s te r eo t a ct i c sy s t e m w i t h t he BR W f r a m e , c o m p ut ed t o mo g r ap h y ( C T ) l o ca l i z e r , a n gi og r a p hi c lo c a li z e r a nd a de v i ce f o r fi x i ng t he f r a m e t o t h e p at ie n t s u p p o r t t a bl e . T he BR W f r a m e ha s t hr e e o r t hog o na l a x e s : a n t e r io r , l at e r al , a n d a x i a l ( F ig . 2 1 .2 ) . T he t hr e e a x e s i nte r s e ct a t t he ce nt e r o f t h e c i r c u l a r f r a me a nd t h e o r ig i n i s d e f i ned 8 0 mm f r o m t he top s ur f a c e o f t he ring. T h e C T l o c a l i z e r f r a me i s e q u i pp ed w i t h ni ne f i d uc i a l r od s , w hi c h a p p e a r a s d o t s i n t h e t r a n s a x i a l s li ce i m a ge . S i nc e t he lo c a ti o n o f t he se p oi nt s i n t he f r a m e s p a c e i s p re c i se l y k n o w n , a n y p o i nt i n t he i m a g e c a n b e de f i ned i n t e r m s o f t he f r a m e c oo r di n a t e s . A p a t ie n t d o c ki ng de v i ce c o upl e s t he f r a m e to t he a c ce l e ra to r t h r o u g h t h e p at ie n t su p p o r t s y st e m (p e de st a l o r c o uc h- m o unt b ra c k e t ) . T he o r ig i n of the frame is a li gn e d with t he l i na c is o c e nte r to w it hi n 0. 2 to 1.0 mm, d e pe n d i n g o n t h e s y st e m (p e de s t al - mo unt ed s y s t e m s t e nd to be m o r e a c c ur a t e than the couch mounted ones). T h e a n g i o g r ap h i c l o c al i z e r f r a me c o ns i st s of f o ur p l a te s a nd a tt ac he s t o t he BR W h e a d r i n g . E a c h p l a t e i s e m b e dd ed w i t h f our l e a d m a r k e r s , w hi c h a c t a s f i d uc i a l m a r k e r s f o r t h e a n g iog r a p h i c i m ag e s . The MRI l o c a li z e r is a s l ig h t l y mo di f ie d version of t he CT l o c al i z e r a nd is c o m p at i bl e w it h m a g n e t i c r e so n a nc e i m a gi ng ( M R I) . It ha s f i d uc i a l r o d s w ho se

WWW.MEDRAD.IR

l o c at io n s a r e p r e ci s e ly k n o w n w i t h r e s p e c t t o t he BR W f r a m e , t hus a l l o w i ng t he l o c al i z a ti o n o f a n y p o in t w i t h i n t h e M R I i m a g e . A s p e c i a l re lo c a t ab le h e a d r i n g , c a l le d t he G i l l - T hom a s - C o s m a n (G T C ) , ha s b e e n d e s ig n e d fo r f r a c ti o n at e d S R T ( F i g . 2 1 . 3 ) . It us e s a bi te bl o c k sy s t e m , he a d re st b r a c k e t a n d V e l c ro s t ra p s a t t a c h ed t o t he BR W f r a m e .

A.2. Linac Isocentric Accuracy

A n e s s e n t i a l el e me n t o f S R S p r o c e d ur e i s t he a l i g nme nt o f s te r e ot a ct i c f r a m e c o o rd i n a te s w i t h t h e li n a c i s o c e n te r ( p oi nt o f i nt e r s e ct io n o f t he a x e s o f r o t a ti o n o f t h e g a n t r y , c ol li m at o r a n d co uc h) . A c c e p t a bl e s pe c i fi c a ti o n of l i na c i s o ce nt ri c a c c u r a c y r e q u i r e s t h at t h e i so c e nte r ( m e c ha ni c a l a s w e l l a s r ad ia t io n i s o ce nt e r ) r e m a i n s w i t h i n a s p h e r e o f r a d i us 1 . 0 m m w i t h a ny c o m b i na t i o n o f g a nt r y , c o ll i m at o r , a n d c o u c h r o t at io n . T he s a m e s pe c i f i c at io n ho ld s goo d f o r a l i na c us ed f o r S R S , w i t h a n a d d e d s ti p u l at io n t ha t t he s t e re ot a c ti c a ll y de t e rm i ne d t a r g et i s o c e nt e r i s c oi n c i den t in the AAPM P.509 with the l i na c i so c e nte r w i t hi n 1 . 0 mm ( 2). Tests r e q u i r ed t o c h e c k t h e l i n a c s pe c i f i ca ti o ns a nd it s i s o ce nt r i c a c c ur a c y a r e de s c r ib ed

P.510 R e p o rt s 4 0 a n d 45 ( 2 , 4 ) . T h e s e r e c o m mend a t io ns , w hi c h a r e a l s o di s c us s e d i n C h a p t e r 1 7 , f o r m t h e b a s i s o f li n a c Q A r e q ui r e d f o r S R S .

WWW.MEDRAD.IR

F I G . 2 1 . 1 . B a s i c s t e re o t a c ti c s y s t e m s ho w ing ( A ) ( s t a rt i ng cl o c kw i s e f r o m upp e r r i g h t ) C T lo c a li z e r , an g i o g r ap h i c lo c al i z e r , p a t ie nt - po s it io ni ng m o unt a nd he a d r i n g w i t h p o st s a n d p in s ; ( B ) a n g i o g r ap hi c l o c al i z e r ; a nd ( C ) C T l o c al i z e r . ( F r om Bova FJ, Meeks SL, r a d i at io n o n c o lo g y . F r i e d m a n W A . L i na c r a d i o s ur ge r y : s y s t e m B a l t i mo r e : W il li am s & W i l k i ns , r e q ui re m e nt s , with p r o c ed u r e s , a n d te s tin g . In : K h a n F M , P o t i s h R A , e d s . T r e at me nt p la nni ng i n 1 99 8 : 21 5 2 41 , p e r m i s sio n . )

A.3. Stereotactic Accuracy

T h e B R W f r a m e s y s t em i n c l u d e s a v e r i fi c at io n d e v i ce c a ll ed t he p ha nt o m b a s e ( F i g . 2 1 .4 ) . It h a s i d en t i c a l co o rd i na te s ( a nt e ro p o st e rio r , l a te r a l , a nd v e r t i c al ) to t h o s e o f t h e B R W f r a m e . A s a s t a nd a l o ne d e v i c e , i t p ro v i de s a n a b s o l ut e f r a m e o f r e f e r e n c e f o r st e re ot ac t i c coo r di na t e s o f t he e nti r e s y s t em : BR W f r a m e , p at ie nt s u p p o r t s y st e m , a n d t h e lo c a li z e r s y s t e ms f o r C T , M R I, a nd a ng i o g ra p hy . T he a c c u r a c y o f p h a n t o m b a s e s h o u l d b e c a re f ul l y m a i nt ai ne d b e c a use i t se r v e s a s a r e f e r e n c e st a n d a r d fo r a ll ot h e r s te p s i n t he s t e re ot a ct i c lo ca l i z a ti o n p ro c e s s . G e r b i et a l . ( 5 ) h a v e c o n s t r u c t e d a s i mp le a nd m e c ha ni c a l l y rug g e d d e vi c e to r o u t i n el y t e st t h e a c cu r a c y o f t h e p ha nt o m b a s e .

WWW.MEDRAD.IR

L u t z e t a l . ( 6 ) h a v e d e s c r i be d a p r o ce d ur e o f us i ng t he p ha nt o m b a s e to c he c k t he a l i g n me n t o f r ad i at io n i s o ce n t e r w it h t he t ar g e t p oi nt de f i ne d b y t he c oo r di na t e s s e t o n t h e B R W p e de s t a l . T h i s t e st i s pe r f o r m ed b y s e t ti ng t he t a r ge t po i nt ( t r e at m e n t i so c e n te r ) c oo r d i n at e s o n t he pha nt o m b a se . T he t ip o f t he p ha nto m b a s e p oi n t e r i s m a t c he d t o t h e ti p o f t he t ra ns f e r p oi nt e r . T he t ap e r ed t i p o f t he t r a n s f e r p oi n t e r i s t h en r e p l a c e d w it h P.511

P.512 a t u n g s t e n b al l , t h u s a s s u r i n g t h a t i t s c e nte r i s l o c at ed e x a ct l y at t he t a pe r ed tip p o s it io n ( F i g . 2 1 . 5 A ) . T h e t r a n s f e r p oi nt e r ( a l s o k no w n a s t a r ge t s im ul a to r ) is t h e n a t t a c h ed to t h e p e de s t al ( a l so k no w n a s i nd e pe nd e nt s up po r t st a nd [ IS S ] ) w h o s e c oo r di n a t e s a re s et t o t he s a m e BR W c o or d i nat e s as tho s e s et o n t he p h a n t o m b a se . A s e rie s o f p o rt f il m s o f t he t ung s t e n b a ll i s t a k en a t a num b e r o f g a n t r y a n d c o u c h a n g l e c o m bi n a t io ns ( F i g . 21 . 5 B) . F i g ur e 2 1 . 5 C sho w s t he r e s ul t s f o r e i g ht g a n t r y - t ab le c o m b i n at io ns . C o nc e nt r i c it y o f t he b al l im a g e w i t hi n t he c i r c u l a r f ie ld i s a n a l y z e d w it h s pe c i al m a g nif y i ng e y e pi e c e c o nt ai ni ng a f i ne s c a le . T h i s t e s t c a n i n d i c at e a l i g n me n t t o w it hi n 0 . 1 m m .

WWW.MEDRAD.IR

F I G . 2 1 . 2 . S c h e m a t i c d r a w i n g o f BR W f r a m e . ( F r o m C ho K H , G e r b i BJ , H a l l W A . S t e r eo t a ct i c r a d io s u r ge r y a n d r a d io t he r ap y . In: L e v i t t S H , K ha n F M , P o t i s h R A , et al., eds. T e c h n o lo gic a l basis of r a di a tio n t he r a p y . P hi l ad elp hi a : L ip pi nc o tt W i l li a m s & Wi l k i n s , 1 99 9 : 14 7 1 72 , w i t h p e rm i s s io n. )

WWW.MEDRAD.IR

F I G . 2 1 . 3 . A : T h e G TC r e lo c a t ab le he a d ri ng w it h bi t e bl o c k a nd V e l c r o s t r ap s . B : T h e G T C h e a d ri n g w o r n b y t h e p at ie nt . ( F r o m C ho K H , Ge rb i BJ , H al l W A . S t e r eo t a ct i c r a d io s u r ge r y a n d r a d io t he r ap y . In: L e v i t t S H , K ha n F M , P o t i s h R A , et al., eds. T e c h n o lo gic a l basis of r a di a tio n t he r a p y . P hi l ad elp hi a : L ip pi nc o tt W i l li a m s & Wi l k i n s , 1 99 9 : 14 7 1 72 , w i t h p e rm i s s io n. )

FIG.

21.4.

S c h e m a ti c

of

the

p ha nt o m

base

(1),

t r a ns f e r

a t t ac hm e nt

( 2 ),

i n t e r c h a n g e ab l e p oi n te r , a n d t a r g et b al l de v i c e s ( 3 ) , a nd t he t r a ns f e r p oi nt er a s s e m b l y ( 4 ) . ( F r o m C h o K H , G e r b i BJ , H a l l W A . S t e r e ot a ct i c r a d io s ur g e r y a nd r a d io t h e r ap y . In : L e v i t t S H , K h a n F M , P o t i sh R A , e t a l . , ed s . T e chno l o gi c a l b a s is o f r a d i at io n t h e r a p y . P h i l a d el p h i a : Li pp i nc ot t W il li a m s & Wi l k i ns , 1 9 9 9 :1 47 17 2 , w i t h p e r mi s s io n . ) In t h e c o u c h - m o u n t e d s y s t e m , t he t ip o f t he p ha nt om po i nt e r i s a l i g ned w it h t he i n t e r se c ti o n p oi n t o f t h e w a l l - m o unt ed la s e r s . A f t e r a p r e c i se a l i g nme nt , t he t a p e re d ti p i s r e pl a c ed w i t h t h e t ung s te n ba l l . T he c e nt e r o f t hi s s p he r e s i m ul at e s t h e t ar g et poi n t w it h in t h e p at ie nt s b r ai n. V e r i f i c at io n f i l m s a r e t he n t a k e n f o r a n u m b e r o f g a n tr y - a n d c o u c h - a n g l e co m bi na t io ns . T hi s t e st a s s ur es t ha t t he t a r get p o i nt , t h e r a di a ti o n is o c e n te r , a nd t he i nt e r s e ct io n p oi nt o f the w a l l - m o unte d l a s e r s a r e a li g n ed r e ga r d l e s s o f t he g a nt r y o r t a bl e po s it io n.

WWW.MEDRAD.IR

A.4. Overall Accuracy

B e f o r e t h e S R S s y s t e m i s d e cl a r ed r e a dy f o r p a t i e nt t r e at me nt s , t he e nt i re r a d io s u r g e r y p r o ce d u re s h o u l d b e t e st ed f or g e o m et ri c a c c ur a c y ( 2 ) . T hi s c a n b e a c c o m pl i s h e d b y u s i ng a s u it a b le he a d p ha nt o m w it h i m ag e ab le hi d de n t a rg et s . T h e t e s t p h a n t om a n d t h e t a r g et s P.513 m u s t b e c o m p at ib le w i t h t h e i m a gi ng m o da l it y us e d . O ne s uc h t e s t p ha nto m f o r C T a n d M R I i s c o m m e r c i al l y a v a i l ab le a nd i s s ho w n i n F i g . 2 1 . 6 . T he p ha nt o m c o n t a i n s t e s t ob j e ct s : a c u b e , s p he r e , co ne a nd c y l i nd e r . T he t op c e nt er po i nt o f e a c h o f t h e s e o b je c ts i s i d e n ti f i ed i n t he C T a nd M R I i m a g e s a nd t he BR W c o o rd i n a te s are rec o n s t r u c t ed by t he t r e at m e nt -p l a nni ng software. T he c o m p a ri s o n o f t h e s e c o o rd i n a te s w i t h t he k no w n c o o r d i na t e s o f t he s e p o i nt s i n t h e p h a n t o m g i v e s t h e g eo m et r i c a c c ur a c y . T he a na l y s i s c a n b e e x t e nd ed s te p b y s t e p t o t h e e nt i re S R S p r o c e s s .

F I G . 2 1 . 5 . A : S c h e m a t i c o f t a rg et s i m ula t o r ( s te el b a ll ) a t tac he d t o t he BR W p h a n t o m b a se . B : T a r g e t si m u l at o r m o unte d o n t he p ed e st a l to v e r i f y t a rg et a l i g n me n t w i t h r a di a ti o n i so c e n t er a s a f u nc t i o n o f t ab le a nd g a nt r y a ng l e s . C : P o r t f i lm s o f t h e t u n g s t e n b a ll f o r e ig ht g a nt r y - b a ll c o m bi na ti o ns . ( F i g ur e 2 1 . 5 A , B a r e r ep r o d u ce d f r om L u t z W , W i ns t o n K R , M a l e k i N . A s y s te m f o r s te r eo t a ct i c r a d io s u r g e r y w it h a l in e a r a c c e le r a to r . I nt J R a d i a t O nc o l Bio l P hy s 1 9 8 8 ;1 4 :3 7 3, w i t h p e r mi s s io n . )

WWW.MEDRAD.IR

F I G . 2 1 . 6 . A h e a d ph a n t o m u s e d fo r t he v e r i f i c at io n o f C T and M R I s c a nne r s . ( F r o m C h o K H , G e r b i B J , H a l l W A . S t e r e o t ac t i c r a di o s ur ge r y a nd r a d io t he r ap y . In: L e v i tt S H , K h a n F M , P o t i s h R A , e t al . , e d s . T e c hno lo gi c a l ba s i s o f r a d ia ti o n therapy. P h i l ad el p h i a: L i pp i n co tt W il li a ms & Wi l k i ns , 19 99 :1 4 7 1 72 , w it h p e r m i s sio n . ) If t h e c h a n g e i n i n di v id u a l c oo r di na t e s i s d eno t e d b y , t he lo c al iz a t i o n e r r o r , L E , is given by:

L u t z e t a l . h a v e a n a ly z e d l o c al i z at io n a c c ur a c y i n t he t re a tm e nt o f 18 hi dd e n t a r g et s i n a t e s t p h a n t o m a n d r e po r te d a v er a g e e r r or s o f 1 3 0 . 5 m m a nd 0 . 6 m m 0 . 2 m m , r e s p e ct i v el y , f o r C T a nd p l a n e f i l m a ng io g r ap hy . T h e g eo m et r i c a c c u r a c y o f t a rg et l o c al i z a tio n f o r M R I i s not a s g o od a s f o r C T o r a n g i o g ra p h y . H o w e v e r, M R I i s a s up e r i o r d ia g no s ti c to ol f o r m a ny t y p e s o f b r ai n l e s io n s . M o re o v e r , i t is o f t e n d e si r a bl e t o us e a ll o f t he t hr e e i ma g i ng mo d al it ie s f o r i m p ro v e d t a rg et l oc a l i z a ti o n . S p e c i al s o ft w a r e i s c o m me r c i al l y a v a i l a b le w hi c h a l lo w s c o r r el a ti o n b et w e e n C T , M R I, a nd a ng i o g r ap hy us i ng a ut o m a ti c i m age f u s i o n ( s e e C h a p t e r 19 ) .

A.5. Beam Collimation

S R S o r S R T i s n o r m a l l y u s e d f o r s m a l l l e sio ns r e q ui r i ng m uc h s m a l le r f i el d s t ha n t h o s e f o r co n v e n t io n a l r a d i at io n t he r a p y . In a d d i t io n, t he g eom e t ri c p e num b r a ( w h i c h i s i n v e r s e l y p r o po r ti o n a l t o s o ur c e- t o - di a p hr a gm d i st a nc e , s e e E q ua t io n 4 . 2 i n C h a p te r 4 ) m us t b e a s s m a ll a s po ss i b le . A t er ti a r y c o ll im a t io n s y s t e m fo r S R S i s t h e r e f o r e d e si gn e d t o b ri n g t he c o ll im a t o r di a p hr a g m c lo se r t o t he s ur f a c e . T h i s h a s b ee n a c h i e v ed , f o r e x a m p le , b y us ing 1 5 - c m -l o ng c i r c ul ar c o ne s m a d e o f C e r r o be n d le a d , e n c as e d i n st a i n le s s s te el . T he c o ne s a r e mo unte d be lo w t he x r a y j a w s , w h i c h p r o v id e a s q u a r e op e ni ng la r g e r t ha n t he i ns id e d i a m et e r o f t he c o n e , b u t s m a ll e n o ug h t o p r e ve nt r a d i at io n e s c a p e f r o m t he s i d e w a ll s o f t he c o n e . A r a n g e o f co n e d i a m et e r s f r o m 5 mm t o 3 0 m m i s ne ed ed f o r t re a ti ng S R S

WWW.MEDRAD.IR

l e s io n s . A f e w c o n e s o f l a r g e r di a m et e r m ay a l s o b e a v a i l a bl e f or t r e a ti ng l a r g er l e s io n s w i t h S R T .

F I G . 2 1 . 7 . S c h e m a t i c o f p a ti e n t t r e at m e nt s e t - up s ho w i ng ga ntr y p o s it io ns a nd IS S s u b g a n t r y t o m a in t a i n i s o ce nt er a c c ur a c y i nd e p e nde nt o f t he li na c i s o ce nt er a c c u r a c y . ( F r o m F r i ed m a n W A , Bo v a F J . T he U ni v e r s it y o f F lor i d a r ad io s ur g e r y s y s t e m s . S u r g N e u r o l 1 9 89 ; 3 2 :3 34 , w i t h p er m i s s io n. ) P.514

A s s t a t e d p re v io u s l y , a t t a c h m e n t o f l o ng c one s b e l o w t he x - r a y j a w s e x t e nd s t he S D D , t h u s r e d u c i n g t h e g e o me t ri c p e num br a . T he c o ne s a r e m o unt e d w i t h t he ir central axes a li g n e d with the beam ce nt r a l axis. As a re s ul t t he r a di a ti on i s o c e nt e r o f t h e b e a m r e m a i n s c e nt er e d w ithi n t he c o ne o pe ni ng a nd f o l lo w s t he s a m e d e v i at io n ( l e s s th a n 1 m m ) a s a l l o we d w i t h g a nt r y r ot a ti on. Is o c e n t r i c a c c u r a c y o f t h e a c c el e r at o r g a ntr y a nd t he a t ta c he d co ne s ha v e b ee n i m p ro v e d b y t h e de s ig n o f a s p e ci a l IS S s ub g a nt r y a t t he U ni ve r s it y o f Fl o ri d a 1 ( F i g . 2 1 .7 ) . T h e c o n e i s r ig id l y a tt a c he d t o t he s ub g a nt r y and , t he r e f o re , i ts i s o c e nt e r r e ma i n s f i x ed a s d e f i n e d b y t he s ub g a nt r y r o t at io n. T he t op e nd o f t he c o n e i s a tt a c h e d t o t h e a c c e le r a to r g a nt r y thr o ug h a g i m b al b e a ring w i t h a s l i di ng m o u n t , w h i c h c o u p l e s t h e l i n a c g a nt r y w i t h t he IS S s ub g a nt r y . T he i s o c e nt r i c s t a b il it y i s t h u s go v e rn e d b y t h e r ot a ti o n o f t he IS S s ub g a nt r y r a t he r t ha n t ha t o f the linac g a nt r y , a lt h o u g h a s l i g ht m is a l i g nme nt may e x is t b et w e e n t he m e c h a n i c a l i so c e n te rs o f t h e t w o g a nt ri es . Be c a us e t he i s o c ent e r o f t he IS S s u b g a n t r y i s mo r e s ta b l e ( b e c a us e it i s li g ht e r ) t ha n t ha t o f t he a c c el e r ato r g a n t r y , t h e a c c u r a c y o f t h i s s y s t e m i s be t te r t ha n t ha t o f t he c o uc h- m o unt e d s y s t e m s a n d , i n f a c t , c o m p a r ab l e t o t he a cc ur a c y a c hi e v a b l e w ith a g a m m a k ni f e ( e . g . , b e tt e r t h a n 0 . 5 m m ) .

WWW.MEDRAD.IR

A s m e n t i o n ed e a rl ie r , t h e S R S f i e l d s c a n b e s ha p e d w it h m ul til e a f c ol li m a to r s ( M L C ) . B r a i n L a b 2 h a s d e s i g n ed a m i c ro - mul t il e a f c ol li m a to r s pec i f i c a ll y f o r S R S , w h i c h s h a p e s t h e f i e ld t o f it t h e b ea m s - ey e - v i e w o ut li ne o f t he t a r ge t a s t he g a n t r y r o t at e s t o d el iv e r t h e t re a t me nt . T he t r e at m e nt - p la nni ng s o f t w a r e s ha p es t h e M L C d y n a m i c al l y at e a c h a n g le to a c hie v e c o nf o r mi t y t o t he out l i ned t a rg et a s w e l l a d j u st a r c w e i g h ts t o o pt im i z e do s e di st r i b ut io n.

B. Gamma Knife
T h e g a m m a k n i f e d e l iv e r s r a d i a ti o n to a t a rg e t le s io n i n t he b r a i n b y s i m ul t a ne o us i r r a di a ti o n w it h a l a r ge n u m b e r o f i s o ce nt r ic g a m m a r a y be a m s . In a m o de r n unit 2 0 1 c ob a lt - 60 s o u r c e s a r e h o u s e d i n a he m i s p he r i c a l s hie ld ( c e nt ra l b o d y ) a nd t he b e a m s a r e c ol li m at e d t o f o c u s o n a s i ng l e p o i nt a t a s o ur c e - to - fo c us d i s t a nc e o f 4 0 . 3 cm ( F ig . 21 . 8 ) . T h e c e n t r a l be a m i s ti lt e d t hr o ug h a n a ng le o f 5 5 de g r ee s w i t h r e s p e ct to t h e h or i z o n t a l p l a ne . T he P.515 s o u r c e s a r e di s tr i b ute d a lo n g t w o hem i s phe r i c a l a r c s : o ne i n t he lo ng it ud i na l p l a n e a n d t h e ot h e r in t h e t r a n s v e r s e p l a ne o f t he t r e at m e nt un i t . T he l o w e r ha l f o f t h e h o u si n g c o nt a in s a s h i e ld e d e nt r a nce do o r . T he o pe ni ng and c l o si ng o f t he d o or a s w el l a s m o v em e n t o f t h e p at ie nt tr e a t me nt t ab le i n a nd o ut o f t he unit a r e c o n t ro ll e d b y a h y d r a u l i c s y s t em .

F I G . 2 1 . 8 . A : C r o s s - s e c t io n a l vi e w o f t he g a m m a k ni f e unit . B : P i c t ur e o f t he L e k s e ll g am m a u n i t . ( F i g u r e 2 1 . 8 A i s r ep ro d uc e d f ro m W u A , M a i t z A H , K a l e nd A M , e t al . P h y s i c s o f g a m m a k n i f e ap p ro a ch o n c o nv e r ge nt b e am s i n st e r eo ta c ti c r a d io s u r g e r y . I n t J Ra d i a t O n c o l Bio l P hy s 1 9 90 ; 1 8 :9 41 , w i t h pe r m i s si o n. F i g ure 2 1 . 8 b i s r e p ro d u c e d co u r t e s y o f E l e k t a Ins tr um e nt s , S t o c k ho l m , S w e d e n. ) B e a m c h a n n e l s m a c h in e d i n t h e c e nt r al bod y p ro v i d e t he p ri m ar y c o ll i m ati o n o f i n d i v id u a l g a m m a r ay b e a m s . F ur t he r c ol li m a ti o n i s a c hie v e d b y o ne o f f o ur i n t e r c h a n g e ab l e h e l me t s w it h c o ll im a to r cha nne l s a l i g ned w i t h t he c e nt r al bo d y channels. The central axes of a ll 20 1 be a m s i nte r s e ct at t he f o c us with a m e c h a n i c a l pr e c i si o n o f 0 . 3 m m . Mi c r o s w i t c he s co nt ro l t he al ignm e nt o f hel m et c h a n n e l s w i t h t h e c e n t r a l bo d y c ha nne l s w i th a p o s i t io ni ng a c c ur ac y o f 0 . 1 m m .

WWW.MEDRAD.IR

E a c h h e l m e t i s c h a r a ct e ri z e d b y i t s c ha nne l d i a m et e r t hat p r o d uces a c i r c ul a r f i e l d o p e n i n g o f 4 , 8 , 1 4 , o r 1 8 m m a t t he f o c us p o i nt . S el e c te d c ha nne l s c a n b e b l o c ke d w i t h p l u g s t o s h i e l d t h e e ye s o r to o pt i mi z e t he do s e d i s t ri b utio n. T he p l u g s a r e m a de o f 6 - cm - t h i c k t u n g s t e n a ll o y. T r e a t m e nt t a r ge t i n th e b r a i n i s l o c a li z e d w i t h t he L e k s e ll s s t er e ot a c ti c f r a m e a t t a c h ed to t h e p at ien t s s k u l l a nd b y p e rf o r m i ng i m a gi ng st ud i e s , s uc h a s C T , M R I o r a n g i o g r ap h y . A f t e r t h e t a r ge t pi nt coo r d i nat e s w it h r e s pe c t t o t he L e k s el l s s t e r eo ta c ti c f r a m e h av e b e e n de te r m i ned thr o ug h t r e a tm e nt p l anni ng , t he f r a m e i s po s it io n e d i n t h e he l m et b y s e tt i ng t he se c oo r di na t e s a nd f i x ing t he f r a m e to t h e t r u n n i o n s o f t h e he l m et . T h i s b r i ng s t he t a r ge t p oi nt t o t he f oc a l po i nt o f t he u n i t . T h e p r o c e s s can b e r e pe a te d i f t he re a r e m ult ip le t a rg e t p o i nt s ( e . g . , to s h a p e t h e d o se di s t rib u t io n ) o r i f m or e t ha n o ne t a rg et i s to be t re a te d i n t he brain. A s s t a t ed p re v i o u sl y , t h e r e a re n o si g ni f i c ant c l i ni c al di f f e r e nc e s b e t w ee n g a m ma k n i f e a n d x - r a y k n i f e t r e a t me n t s . H o w e v e r, g a m m a k ni f e c a n o nl y b e us e d f o r s m a l l le s io n s b e c a u s e o f i t s f i el d s i z e li mi ta t io n ( m a x i m um d i a me t e r o f 1 8 m m ) , a l t h o u g h s e v e r al i s o ce n t e r s c a n b e p l a ce d w i t hi n t he s a m e t a rg e t to e x p a nd o r s h a p e do s e di st r i b ut ion . F o r t r e at i ng m ul ti pl e i s o ce nt e r s o r t a r get s , g a m m a k ni f e i s m o r e p r a c ti c a l t h a n t h e x - r a y k ni f e b e c a us e o f i t s s i mp li c it y of s e t - up . F o r t he s a m e r e a so n s , g a m m a k n i f e c a n p r o d uc e a m o r e co nf o r m a l do s e d i s t ri b utio n t ha n t h a t p o s si bl e w i t h x - r a y k n i f e u nl e s s t he l a tt e r i s eq ui p pe d w it h s p e c i al f i e ld s h a p i n g c ol li m a to r s su c h a s t h e d y na m i c ML C . O n t he ot he r ha nd t he x - r a y k ni f e i s f a r m o re e co n o mi ca l b e c a u se it i s l i na c -b a s e d . Be si d e s , t he l ina c c a n b e us e d for a ll kinds of r ad ia t io n t h e r ap y te c hni q ue s i nc l udi ng SRS, SRT, i nt e ns it y m o d u l at e d r ad i at io n th e r a p y , a n d c o nv e nt i ona l r a d i a ti o n t he r ap y .

21.3. DOSIMETRY
T y p i c a l l y t h e r e a r e th r e e q u a n t it i e s o f i nt e r e st i n S R S d o si m et r y : c e nt r a l a x i s d e pt h d i st r ib u t io n ( % d e pt h d o se o r T M R s ), c r o s s - b e a m p r o fi l e s ( o f f - a x i s r a t io s ) , a n d o u t p u t f a c t or s P.516 (Sc, o r d o se / M U ) . M ea s u r e m e n t o f t he s e q ua nt i ti e s i s co m pl i c at ed b y t w o f a c t o r s :

d e te c to r s i z e r e la ti v e t o t h e f i el d d i me ns io ns a nd a p o s si bl e la c k o f c ha r g e d p a r t i cl e e q u il ib r i u m . In e i t h e r ca s e , t he d ete c t or s i z e m us t be a s s m a l l a s p o s si bl e c o m p a re d to t h e f i el d s i z e . F o r t h e m e a s u r e me n t o f c e n t r a l a x i s d ep t h d o s e , a n e s s e nt i al c r ite r io n i s t ha t t he s e n s i ti v e v ol u m e o f t h e d et e ct o r m us t be ir ra d i a te d wi t h uni f o r m e l e ct r o n f l ue nce ( e . g . , w i t h i n 0 . 5 % ). B e c a u s e i n a s m a l l c i r c ul a r f i el d t he c e ntr a l a x i s a r e a o f u n i f o r m i n t e n s it y d o es n o t e x t e nd be y o nd a f e w m m i n d i a m e t e r , t hi s p ut s a s t r i n g e nt r e q ui r e me n t on the d et e c to r d i a m et e r . Fo r a c ro s s b e a m p r o fi le m e a s u r e m e n t , t h e det e c to r si z e i s a g ai n im p o rt a nt be c a us e o f t he s te ep do s e g r a d ie n t s a t t h e f ie ld e d ge s . T he d o s i met e r , i n s uc h a c a s e , m us t ha v e hi g h s p a t i al r e so l ut io n to accurately m e a s ur e field p e num b r a , w hi c h is c r i ti c a ll y i m po r t a n t i n S R S . S e v e r a l d i f f e re n t t y pes o f d e t e ct or s y s t e m s ha v e b e e n us e d i n S R S d o s i m et r y : io n c h a m b e r s , f i l m , t h er mo l u m i n e s ce nt do s i me te r s , a nd d io d e s . T he re a r e a d v a nt a ge s

WWW.MEDRAD.IR

a n d d i s a d v a n t a ge s t o e a c h o f t he s e s y s t em s . F o r e x a m p l e , io n c ha m b e r i s t he m o s t pr e c i se a n d t he l e a st e n e r g y -d e pe nd e nt s y s t em b ut us ua l l y ha s a s i z e l i mi t at io n ; f i lm h a s t h e be s t sp a ti a l r e so l utio n b ut s ho w s e ne r g y d e pe nd e nc e a nd a g r e at e r st a ti s ti c a l un c e r t a i n t y (e . g . , 3 %) ; t he r m ol um i ne s ce nt d o s im e te r s s ho w l it tl e e n e rg y d e pe n d en c e a n d c a n ha v e a s m a l l si z e i n t he f o r m o f c hi p s b ut s uf f e r f r o m t h e s a me d eg r ee o f s t a ti s ti c a l unc e rt a int y a s t he f i l m ; a nd di o de s ha v e s m a ll s i z e b u t s h o w e n e r gy d e p e n d e n c e a s w ell a s p o s si b le d i re c ti ona l d e p e nde nc e . Thus the c h o i c e o f a n y d e t e ct o r s y s t em f o r S R S do s i me t r y d e pe nd s o n t he q u a n t i t y to b e m e a s u re d a n d t h e m e a s ur e me nt c o nd it io ns .

A. Cross-beam Profiles
T h e e f f e c t o f d e t e ct o r s i z e o n t h e a c c ur a c y o f b e a m p r o f il e s ha s b e e n i nv e s t ig a ted b y D a w s o n e t a l . ( 7 ) a n d R i c e e t al . ( 8 ) . It ha s b e e n s ho w n t ha t w i t h a d e t e ct o r s i z e o f 3 . 5 m m d i a met e r , t he b e am p ro f i le s o f c i r c ul a r f i el d s i n the r a ng e o f 1 2 . 5 t o 3 0 .0 m m i n d i a me te r c a n be me a s ur e d ac c ur a t e l y wi t hi n 1 m m. Be c a us e c r o s sb e a m p r o f il e s i n v ol v e r e l at i v e d o se me a s ur em e nt ( do s e s a r e no r ma l i z e d to ce nt r a l a x i s v a l u e ) a n d t h e re i s li tt le c h a ng e i n t he p ho to n e ne rg y s pe c t rum a c r o s s s m al l f i e l d s , di od e s a n d f i l m a r e t h e d e te c to r s o f cho i c e . B e a m p r o f il e s a t v a r iou s d e p t h s c a n b e m e a s ur e d w i t h a f i l m ( e . g. , K o d a k X - O M A T V ) s a n d w i c h e d p a r al le l t o ce n t r al a x i s b etw e e n s l a b s o f a unit -d e ns i t y p ha nt o m ( e . g . , p o l y s t y re n e o r s o l id w a t e r ) a s d i s cus s e d i n C ha p t e r 1 4 . Be c a us e i n f i l m d o s im e tr y , s p a t i al r e so l u ti o n i s go v e r ne d p ri m a r il y b y t he d e ns it om e t er a p e rt ur e , i t i s re c o m me n d ed t ha t t h e a pe r t ur e s i z e b e 1 m m o r l e s s . D igi t al f il m s c a nne r s a r e c o m m e r ci a ll y a v a il a b le w i t h s p e ci a l do si m et r y s o f t w a r e t ha t a l lo w s t he i np ut o f f i l m s e n s it r om e tr i c d a t a a n d ot he r co r re c t io ns to co nv e r t o pt i c al de ns i t y to dose.

B. Depth-dose Distribution
M e a s u r e m e n t o f c e n tra l a x i s d e pt h d o se i n a s m a l l f i el d re q ui r e s t ha t t he de te c to r d i m e n si o n s s h o u l d b e s m a l l e n o u g h s o t ha t i t l ie s w e l l w it hi n t he c e nt r a l uni f o r m a r e a o f t he b e a m p rof i l e . F o r f i el d si z e s o f d i a m et e r 12 . 5 m m or g r e a te r , i t ha s b e e n s h o w n t h a t t h e c e n t r a l a x i s de pt h d os e c a n b e m e a s ur e d c o r r e ct l y w i t h a p a r a l le l p l at e i o n i z at io n c h a m b e r o f di a m ete r no t e x c e e di ng 3 . 0 m m ( 1 0 ) . S m a ll er d i a m et e r c h a m be r s w il l b e re q u i re d f o r s m a ll e r f i el d s i z e s . F i l m o r di o de s c a n a l so be u s ed f or c e nt r a l a x i s d ep t h d o se d i st r ib ut io n, e s pe c i al l y f o r v e r y s m a ll f i el d siz e s . B e c a u s e t he p rop o rt io ns o f s c a tt e re d p ho to ns o f lo w e r e n e r g y i n c r e a s e s wi t h d e pt h , e n e r g y - d ep e nd e nc e o f t he fi l m o r d i od e s m us t b e t a k e n i n t o a c co u n t . D e pt h d e pe nd e nt co rr e c ti o n f a c t or s c a n b e d et e r mi ne d b y c o m p a ri n g f il m o r d iod e c u r v e s wi t h i o n c ha m b e r c ur v e s us i ng l ar g e r fi e ld s (e . g . , 3 0 to 5 0 m m di a m et e r) . A l t h o u g h T M R s c a n be m e a s u re d d i re c tl y , t he y c a n b e c al c ul at e d f r o m p e r ce nt d e pt h d o s e s a s di s c u s s e d i n C h a p t e r 10 . P.517

C. Output Factors

WWW.MEDRAD.IR

O u t p u t f a c t o r s ( S c , p ) f o r s m a ll f i el d s po s e t he s a m e k i nd s o f p ro b le m s a s f o r b e am p r o f il e s a n d d ep t h - dos e m e a s u r e me nt s . Det e c to r si z e i n re l at io n t o t he f ie ld s i z e i s t he c ri ti c a l p a r a met e r . It h a s be e n s ho wn t ha t fo r f ie ld s o f dia m e t er 12 . 5 m m a n d l a r g er , c y l i n d ri c al o r p a r a ll el - pl a te c ha m b e r s o f 3 . 5 m m d ia m e t er a ll o w t he o u t p u t f a c t o r s to b e m e a s u r e d a c c ur at el y t o wi t hi n 0 . 5 % ( 8 ) . Fi g ur e 2 1 . 9 s ho w s a n e x a m p l e o f o u tp u t f a c t o r s a s a f unc t i o n of f i e l d s i z e .

F I G . 2 1 . 9 . S a m p l e o u t p u t f a c to r s ( c G y / M U ) f o r 1 0 t hr o ug h 4 0 m m d i a me te r c o n e s . T h e x - r a y ja w s w e r e s e t at 8 8 c m . ( F r o m F r ie d m a n W A , Bo v a F J . T he U n i v e r s it y of F lo r i da r a d io s u r g e r y s y s t em s . S ur g N e ur o l 1 98 9 ; 32 : 3 34 , with p e r m i s sio n . ) F o r u l t r a - sm a ll f i el d s ( t h e d i am e te r o f 1 0 m m o r le s s ) , f i l m , T LD s o r di od e s a re the most a pp r op r i ate d e te c to r s for p r of i l e , d ep t h d o se a nd o ut p ut f a c to r m e a s u r e m e n t s . B e c a u s e o f t h e i r s m a ll s i z e , t he s e s y s t e m s o f fe r hi g h s p a t i al r e s ol u t io n , w h i c h i s o f p a r a m o u nt i m po rt anc e i n s uc h m e a s ur e m e nt s . H o w e v e r , t h e y s h o u l d b e p ro p er l y c a li b r at e d a g ai ns t i o n c ha m be r s us i ng a l a r ge e no ug h f i e l d si z e f o r io n c h a m b e r s d o si m et r y ( e . g . , 3 t o 5 c m di a m et e r ) .

21.4. DOSE CALCULATION ALGORITHM

A n y o f t h e d o s e c a l cu l a t io n m e t hod s d i s cus s e d i n C ha p t e r s 1 0 a nd 1 9 c a n b e a d o pt ed f o r S R S d o se c a l c u l a tio ns . T he a p p r o xi m a te s p he r i c al g e o me t r y o f t he h u m a n h e a d a n d h o m o g e n ei t y o f t i s s ue d e ns i t y g re a tl y s i m pl i f y the d e m a nd s o n a d o s e c a l c ul a ti o n a l gor i t h m . O n e o f t he s i m p l e st m et ho d s o f be a m m o de li ng i s b a s e d o n ti s s u e - m a x im u m r a t io s , o f f - a x i s r a t io s , e x po ne nt i al a tt e nua t io n, o ut p ut f a c t o r s a n d i n v e r s e - sq u a r e l a w . T he b e a m d a t a a r e a c q ui re d s pe c i f i c al l y f o r t he b e a m e n e r g y a n d c i r cu l a r f i e l d s , us e d i n S R S , a s d i s c us s e d p r e v ious l y . T h e p a t i e nt s u r f a c e c on t o u r g e om et r y i s d e f ine d t hr e e -d i me ns i o na ll y b y C T s c a ns . T h e m u l ti p le a r c ge om e t ri e s a r e si m ul at ed b y st a ti o na r y b e am s s e p a ra t ed b y

WWW.MEDRAD.IR

a n g l e s o f 5 t o 10 d e gr e e s . T h e c ho i c e o f d os e c a l c ul a ti o n g r id ha s b e e n d i s c us s e d b y N i e mi e r ko a n d Go it e i n (1 1 ) . T he y hav e s ho w n t ha t a 2 -m m g r id s pa c i ng p r o d u c e s a do s e u n c e r t ai n t y o f 1 % to 2% , c o mp a r e d to 3 % t o 4 % unc e r t a i n ty w i t h a 4 - m m g r i d sp a c i n g . O f co ur s e , the accuracy of all d o se c a l c u l at io n r o u t i n e s , g ri d s i z e , pos i ti o n a l a c c ur a c y , e t c . T h e C T a n d M R I s c a n s f o r t r e a t me nt pl a nni ng a r e o bt a i ned w i t h a s l i c e se p a r at io n t y p i c al l y b et w e e n 3 and 10 mm. G r e a te r r e s ol ut io n is r e qui r e d for t a rg et d e f i n it io n . S o a s m a lle r s li c e s e p ar a ti o n o f 1 t o 3 m m i s us e d to s c a n t he le s io n a n d t h e c r i ti c a l s t r u ctu r e s i n P.518 i t s cl o se v i ci n i t y . T a rg e t vo l u m e s a r e o ut line d s li c e b y sl i ce i n the C T i m a g e s a nd c o r r el a te d w i t h M R I s c a n s a n d a n g i o g r a m s thr o ug h f us i o n t e c hni q ue s . C a l c u l a t ed d o se d i st rib u t io n s a r e o v e rl a i d on i nd i v i d ua l C T , M R I, o r a ng io g r a p hi c i m a g e s . Vo l u m et r i c d is p l a y s i n t h e fo r m o f i s o do s e s ur f a c e s a re a l s o us e f ul . Do s e v o l u m e h i st og r a m s (D V H ) o f t h e t a r ge t and no r m a l st r uc t ur e s c o m pl e me nt t he i s o do s e di s pl a y . o v e r al l a c c ur a c y d e pe nd s o n t he be a m mo d el ing , i nt e r po l at io n p a r a me t e r s ,

21.5. QUALITY ASSURANCE

S t e r eo t a ct i c r ad io s u r ge r y o r r a d io t her a p y is a s p e c i a l p r o ce d ur e, w hi c h r e q ui r e s careful c o m mi s s io n i ng f o ll o w ed by a ri go r o us q ua li t y a s s ur anc e p r o gr a m to m a i n t a i n it s or i gi n a l a c c u r a c y s p e c i f i c a tio ns . S e v e r a l Q A p r oto co l s pe r ti ne nt t o S R S h a v e b e e n p u b li sh e d ( 2 , 4) . T he s e p ro to c ol s s ho uld p r o v id e g ui d el i ne s f o r a n i n s t it u t io n t o de s ig n i ts Q A p r o g r a m . Q u a l i t y a s s u r a n c e i n v o l v e s b ot h t he cl i ni ca l a nd p hy s i c al a s pec t s o f S R S . T he p h y s i c s p a r t m a y b e d i v i de d i n to t w o c a teg o r ie s : t r e at m e nt Q A a nd r o uti ne Q A . T h e f o r m e r i n v o l v e s ch e c k i n g o r d o ubl e - c hec k i ng o f t he p ro c e d ure s a nd t re a tm e nt p a r a m et e r s p e rt a i n i ng to i n di v i d ua l p at ie nt s ; a nd t he l at te r is de s i g ne d to p e r io di c a ll y i n s p e c t t h e h a r d w a r e a nd s o f t w a r e p e r f o r m a nc e t o e ns ur e c o m p li a nc e w i t h o r ig i n a l s pe c i f i c at io n s .

A. Treatment Quality Assurance

P a t i e n t t r e at me n t i n v o l v e s m a n y s te p s a nd p r o c ed ur e s . It i s highl y d e s i r a bl e t ha t d e t ai le d c h e c k l i st s a re p r e p a re d to d o c um ent s t he s e s t ep s i n a p r o pe r s e q ue nc e . T h e o b j e ct i v e o f t h e c h e c k l i s t s ho uld b e to e ns ur e p r o ce d ur a l a c c ur a c y a t e a c h s t e p o f t h e w a y a n d t o m i n i mi z e t he c ha nc e o f a t r e a t me nt e r ro r . M a j o r c o m po n e n t s o f t r e a t me n t Q A c o ns i s t o f c he c k i ng ( a ) s t e r e ot a ct i c f r a m e accuracy couch including (b) ph a n t o m im a g i n g of base, d at a C T / M R I/ a ng i o g r a p hi c t r e a t me nt with l o c al i ze r , p e de s t al or mount; t r a ns f er , po i nt pl a n p a r a m e te r s , t a r ge t

p o s it io n , m o n i to r u n i t c a l c u l a ti o ns ; ( c ) f r a m e a l ig nm e nt w i t h g a nt r y a nd c o uc h e c c e n t ri c it y , c o n g r u en c e t a r ge t r a d i at io n i s o ce nt e r , c ol li m at o r s e t ti n g , co n e di a m et er , c o u c h p o si ti o n, p ati e nt i m mo b il i z at io n and s a f e t y lo c k s ; a n d ( d ) t r e at m e nt co n s o le p ro g r a m mi ng o f b e a m e ne r g y , m oni t o r unit s , a r c angles, etc. E x a m p l e s o f t r ea t me n t Q A c h e c k l i s t s ha v e be e n p ub l i s hed ( 2 ) t ha t m a y b e us e d a s r o u g h g u i d e s . It s h o u l d b e r e a li z e d t ha t t he S R S Q A p r o g r a m i nv o l v e s he a l th

WWW.MEDRAD.IR

p r o f e s si o n a l s

in

different

de p a rt m e nt s .

T he r e f o r e ,

pe r s o nne l

c o o r di na ti o n

is

i m po r t a n t f o r s u c c e s s fu l i m p le m e nt at io n o f a Q A p r o g r a m .

B. Routine Quality Assurance

A r o u t i n e Q A p r o g r a m i s d e s i g n e d t o c he c k t he ha r d w a r e / s o f t w a re p e r f o r m a nc e o f S R S e q u i p m e nt o n a s c h e d u l e d f re q ue nc y b a s i s . F o r t he l i ne ar a c c e l e r ato r , t he r e l e v a n t Q A p ro to c ol is t h e A A P M R e po rt N o. 4 0 (4 ) . F o r t he S R S a p p a r at us , t he r o u t i n e Q A s c h e d u l e i s r e c o m m e n de d b y t he A A P M R e p o r t N o . 5 4 ( 2 ) . A Q A p ro g r a m f o r t h e g a m m a k n i f e m us t be c om p li a nt w i t h t he N R C r e g ul at io ns . A n e x a m p l e p ro g r a m , i m p le m e nt e d a t t he Uni v e r s i t y o f P it t sb ur gh i s p ubl i s hed i n t h e A A P M R e p o r t 54 .

21.6. CLINICAL APPLICATIONS

S t e r eo t a ct i c r ad io s u r g e r y w a s o r i gi na ll y d e v e lo p ed f o r t he t r e at m e nt o f b e ni gn l e s io n s o f t h e b r ai n s u c h a s a r t e r i o v e no us m a l f o r m at io ns ( A V M ) , m e ni ng i o m a s , a n d a c o u s t i c n e u r o ma s . It s u s e ha s b e e n e x t e nd e d to t re a t m a ny m a l i g na nt t u m o r s s u c h a s g l i o ma s a n d b r a i n m e t a s t as e s . M o r e r e c e ntl y S R S ha s a l s o b e e n used P.519 to t r e at m a li g n a n t brain t u m or s , e s pe ci a ll y t ho s e in p ro x im i t y to c ri ti c a l to tr e a t f u n c ti o n a l di s o rd e r s , for example, t ri ge m i nal ne ur a l g i a a nd m o v e m e n t d i so r d e r s . F r a c t io n a l S R T i s no w c o m m o nl y be i ng us e d

s t r u c t u r e s s u c h a s br a i n s te m a nd op ti c p a t hw a y s . F o r o v e rv i e w s o f cl i ni c a l r a t io n a l e , t h e re a d er i s r e f e rr e d to M c K e nz ie et a l . ( 1 2 ) , L ux t o n e t al . ( 13 ) , a nd Cho et al. (9). R a d i ob io lo gi c p ri n c i p le s of SRS are c ur r e nt l y no t w e ll und e r st oo d . H o w e v e r, a t t em p ts h a v e b ee n m a d e t o r a ti o na li z e the d e li v e r y o f a s i ngle l a rg e f r a ct io n o f d o s e to a s ma ll - c i r c um s c r i b ed l e si o n ( e .g . , l e s s t ha n 4 c m i n d i a m et e r ) i n t he b r a i n . B e c a u s e t h e i n te n d e d e f f e c t i s to c a us e t hr o mb o si s i n t he c a s e o f A V M a nd r e p r od u c t i ve m a l ig n a n t c e ll d ea t h in the case of a t um o r , t he p ot ent i a l be ne f i t s of of f r a c t i o n at e d r a d ia ti o n t h e r a p y a re no t c o ns id e r ed i n S R S . H o w e v er , i n t he c a s e o f tumors tr e a t ed w it h SRT, t he w e ll - e st a bl i s he d p r i nc i pl e s r a d io b io lo g y , n a m e l y r e p a i r , r eo x y g e na ti o n, r e d i st r i b ut io n a nd r e p o p ul at io n ( i . e . , 4 R s ) a r e co n s i d ere d j u s t a s i m po r t a nt a s i n co nv e nt io na l ra d i a tio n t he r a p y . A c c o r d i n gl y , the f r a ct io n a t io n s c he m e s ar e s i mi l a r d ep e ndi ng on t he t um or v o l u m e a n d t h e r a di o bi ol o gi c c h a r a c t e ri st i c s o f t he d i se a s e . D o s e di s t ri b u tio n a c h i e v a b l e w it h S R S i s hi g hl y c o nf o r m a l . T hi s is m a d e p o s si bl e b y t e rt i a r y c ol li m at ion ( i . e . , c o n e s ) a nd the us e o f m ul t ip le no n- c o pl a na r a r c s . B e c a u s e i n s i n gl e - f r ac t io n r a d io s ur g e r y , no a tt e mp t i s m ad e to s p a re no r m al tissue w it h i n the t ar g e t vo l u m e , d o se c o nf o r m it y is e s s e nti a l to m i ni mi z e i r r a di a ti o n o f t h e n o rm a l b r a i n o ut si de t he t a r ge t . T i g ht m a rg ins b e t w e e n t he t a r g et a n d t h e p r e s c ri p ti o n i so do s e a r e m ad e p o s si bl e b y r i g id im m o bi li z a t io n o f the p at i e nt and t he s t er e ot a ct i c a c c ura c y of t he SRS p ro c e d ur e . In t he f r a c t i o n at e d S R T o f m a l i g n a n t t u mo r s , s a m e c o ns i d e r at io ns a p p l y t o t he de s ig n o f t a r g et v o l u m e (e . g . , p l a n n i n g t a r ge t v ol um e ) a s i n t hr e e - di m ens i o na l c o nf o r m al r a d i at io n t h e r a p y . F igu r e s 2 1 . 10 , 2 1 . 11 ( s ee c o lo r i ns er t ) s ho w sel e c te d e x a m p le s o f c a s e s t r e at e d w it h S R S a n d S R T .

WWW.MEDRAD.IR

F I G . 2 1 . 1 0 . A n e x a mp l e o f st er e ot a ct i c r ad i o s ur ge r y t r e at m e nt o f a r te r io v e no us m a l f o r m at io n . ( A ) A n t e ri o r a n gi og r a p hi c v ie w o f ni d us ; ( B ) l a te ra l v i e w o f ni d us ; ( C ) b e a m a r r a n g e men t u s i n g f i v e no nc o p la na r a r c s ( s e e c o l o r i ns e r t ) ; i so do s e r e g io n ( c ol o r w a s h ) c o r r e s po n di ng to 90% o f t he m a x i m um d o s e i s s ho w n i n a n t e r io r v i e w ( D ) a n d l a t e r al v i e w ( E ) ( s ee c o lo r i ns e rt ) .

REFERENCES
1 . L e k s e ll L . T h e s t e r e ot a c ti c m e t hod a nd r a d i o s ur ge r y o f t he b r a i n. A c t a C hi r S c a n d 1 9 5 1 ;1 0 2 :3 16 3 1 9 . 2. AAPM. S t e r e ot a c tic r a d io s u r g e r y . R e por t No. 54 W oo d b ur y, NY: American In s t i t u t e o f P h y s i c s , 1 9 9 5 . 3 . G a l lo w a y R L , M a c iu n a s R J . S t e r e o ta c ti c ne ur o s ur g e r y . Bi o med i c a l E ngi ne e ri ng 1 9 90 ; 1 8 :1 81 . P.520

4 . A A P M . C o m p r e h e n s i v e Q A f o r r a d i at io n onc o l og y : r e p or t o f t he A A P M R a d i a t i o n T h e r a p y C o m m i tt ee T a s k G r o u p 4 0 . M e d P hy s 1 9 9 4 ;2 1 :5 8 1 61 8 . 5. G e r bi BJ, R o b a ck DM, H u m p he r y SD, et al . M a i nt ai ning a c c ur a c y in r a d io s u r g e r y . I n t J R a d i a t O n c ol Bi ol P hy s 1 9 9 5 ;3 2 : 11 99 12 03 . 6 . L u t z W A , W i n s t o n K R , M a l e k i N . A s y s t e m f o r s t e r eo t a ct i c r a di o s ur ge r y w i t h a l i n e a r a c c el e r at o r . I nt J R a d i a t O nc o l Bio l Phy s 1 9 8 8 ; 14 : 3 73 . 7 . D a w s o n D J , S c h r o e d e r N J , H o y a J D . P e num b r a l m e a s ur e ment s i n w a t e r f o r h i g h - e n e r g y x - r a y s . M e d P h y s 1 9 8 6 ; 13 : 10 1 1 04 . 8 . R i c e K R , H a n s e n J L , S v e n s s o n G K , e t a l. M e a s ur e m e nt o f d o se d i st r ib ut io n in s m a l l be a m s o f 6 M V x - r a y s . P h y s M e d Bi o l 19 8 7 ;3 2 : 10 87 10 99 . 9 . C h o K H , G e r b i B J , H a l l W A . S t e r e ot a c tic r a d i o s ur ge r y a nd r a d i ot he r a p y . In: L e v i tt S H , K h a n F M , P o t i s h R A , e t al . , e d s . T e c hno lo gi c a l ba s i s o f r a d ia ti o n t h e r a p y . P h i l a de l p hi a : L i p pi n c o tt W il li a m s & W i l k i ns , 1 9 99 : 14 7 1 72 1 0 . B j a r n g a rd B E , T s a i J S , R i ce R K . D o se s o n c e nt r a l a x i s o f nar r o w 6 - M V x - r a y b e a m s . M e d P h y s 1 9 90 ; 1 7 :7 9 4 .

WWW.MEDRAD.IR

1 1 . N ie m ie r k o A , G oi te i n M . T h e i nf l ue nc e o f t he si z e o f t he g rid us e d f o r d o se c a l c u l a ti o n o n t h e a c cu r a c y o f d o s e e s ti m a tio n. M e d P hy s 1 9 8 9 ; 1 6: 2 3 9 . 1 2 . M c K e n z i e M R , S o ut h a m i L , Po dg o r s a k E B, e t al . P ho to n r a di o s ur g e r y : a cl i ni c al r e v i e w . C a n a d i a n J N e u r o l S c i 1 99 2 ;1 9 : 21 2 . 1 3 . L u x t o n G , Z b ig n ie w P , J o z s e f G , e t al. S t e r eo t a ct i c r ad io s ur g e r y : p ri nc i pl e s a n d c o m p a r i so n o f t r ea t m e n t m et hod s . N e ur o s ur g e r y 1 99 3 ;3 2 :2 4 1.

1 2

C o m m e r ci a ll y a v a i l a ble f r o m E l e k t a O nc ol o gy S y s t e m s , Inc . , N o r c r o s s , G e o r gi a . B r a i n L a b , In c . , G l e n C o u r t , M o o r e sto w n, N e w J e r s e y .

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part III - Modern Radiation Therapy > 22 - H igh D ose Rate Brachytherapy

22 High Dose Rate Brachytherapy

22.1. INTRODUCTION
M o s t o f t h e cl i n i c al e xp e r ie n c e i n b r a c hy t her a p y ha s b e e n o b t ai ned us i ng l o w d o se r a t e (L D R ) i m pl a n t s , th a t i s , wi t h pr e s c ri p tio n do s e r at e o n t he or d e r o f 0 .5 t o 2 c G y / m i n . IC R U R e p o rt 38 ( 1 ) c l a s si f ie s hi gh d o s e r a te ( H D R ) a s 2 0 c G y / m i n o r h i g h e r . W it h t h e i n t rod u c t io n o f r em ot e a fte r lo a d i ng te c hno l og y , i t i s p o s si bl e t o d e li v e r H D R b r a c h y th e r a p y s a f e l y a nd mo r e p re c i se l y t ha n po s s i bl e w it h t he c l a s s i c al L D R b r a c h y th e r a p y . A l t ho ug h L D R b r a c hy t he r a p y c a n a l s o be de li v e r ed u s i n g r e m ot e a f t er lo ad i n g d e vi c e s , lo gi s ti c p r o bl e m s o f p r ol o nge d t re a t me nt a nd p a t ie n t h o s pi t al i z at io n m a k e L D R l e s s a tt r a ct i v e t ha n H D R . A s d i s c u s s e d i n C h a p t e r 15 , t h e p ri nc i p al a d v a nt a g e o f H D R o ve r L D R i s t ha t it p e r m it s t re a t me n t s on a n o u t p a ti e nt b a si s. F o r t ha t r e a s o n, i t is w e l l s ui t ed f o r t r e at i n g large p a ti e nt p op u l a tio ns . G r e a te r c o nt ro l over do se d i st r ib ut io n is a n o t h e r m aj o r a d v a n ta g e , w h i c h i s be i ng ex p l o re d a s a t oo l f o r d e li v e r i ng hi g hl y c o n f o r m a l do s e to w e l l -l o ca li z e d t um or s , f o r e x a m p le , a s a b o o st o r p ri m a r y t r e at m e n t f o r pr o st a te c a n c e r . A l t ho ug h t he r o le o f H D R i n b r a chy t he r a p y i s no t y e t f u l l y e s t a bl i s h ed , a l l i n d i c at io ns p oi nt t o w a r d it s w i d e sp r ea d us e a s a s o l e p r o c ed u r e o r i n c o n j u n c t i o n w it h e x te r na l be a m . If t he c ur r e nt t re nd s c o nti nue , it i s q u i te p o s si bl e t h at H D R w i l l r ep l a c e al l b ra c hy t he r a p y t e c hni q ue s i n t he no t too d i s t a nt f u t u r e .

22.2. HIGH DOSE RATE UNIT A. Remote Afterloader

A H D R r e m o t e a f t e rl oa d i n g u n i t c o nt ai ns a s i ng l e so ur c e o f hi g h a c t i v it y ( ~ 1 0 C i o r 3 70 G B q ) . A l t h o u gh c o b a l t -6 0 a nd c e sium - 1 3 7 ha v e b e e n us e d i n t he p a st , i r i di u m - 1 92 is the
192

most

c o m mo nl y

us e d

r a d io i so to pe

in

HDR.

For

HDR

brachytherapy, less The s h i el di n g ) .

Ir is t h e b e st c hoi c e bec a us e o f i t s hi g he r s p e c i f i c a c ti v i t y d is a d v a n t a g e , on t he o t he r ha nd , is it s sho r t e r ha l f -l i f e ,

( a l lo w s s m a ll e r so u r ce f o r t h e s a me a c ti v ity ) a nd l o w e r p hot o n e ne r g y ( r eq ui r e s A n e c e s s i ta ti n g s o u r c e re p l a ce m e n t e ve r y 3 t o 4 m o nt hs .
192

Ir s o u r c e u s e d i n H D R i s a s m a l l l i ne s o ur c e w e l de d to t he e nd o f a f l e x i b le

d r i v e c ab le . T h e c a ble w i t h t h e s o ur ce a tta c he d a t t he e nd i s al s o c al le d so ur c e w i r e . T h e d i m e n s io n s o f t h e s o u r c e v a r y b et w e e n 0 . 3 to 0 . 6 m m i n d i a m et e r a nd 3 . 5 t o 1 0 m m i n le n g th , d e p e n d i ng o n t he H D R m o d el . T he s o ur c e w i r e , w he n no t e x t e n d ed , i s s to r ed i n a s h i el d ed s a f e o f t he H D R uni t ( F i g . 2 2 .1) . In c o m p li a nc e w i t h t h e N R C r e g u l at io n s ( 2 ) , t h e l ea k a g e ra d i a tio n l e v el s o ut si de t he uni t do not e x c e e d 1 m R / h a t a d i s ta n c e o f 10 c m f r o m t he ne a re s t a cc e s s i bl e s ur f a ce s u r r o u n d i n g t h e s a f e w i t h t h e s o u r c e i n t he s hi e l d ed p o sit io n.

WWW.MEDRAD.IR

T h e H D R u n i t i s e q u ipp e d w it h s e v e r a l c ha nne l s a nd a n i nd e x e r s y s t e m to d i re c t t h e s o u r c e t o e a c h ch a n n e l . In o ne o f t he m o d el s , 1 c ha nne l s a re p r o v id ed o n a r o t at i n g t u r re t P.522 i n w h i c h a n y c h a n n e l c a n b e a li g ned w it h t he so ur c e w i r e p ath. A p p l i c ato r s o r c a t h e te r s i m pl a n te d in t h e p a t ie nt a r e conne c t e d to t he c ha nne l s b y c a t het e rs c a l l ed t r a n s f e r t u b e s o r t r a n s f e r g uid e s . Bef o r e t he a ct i v e s o ur c e w i r e i s e x t e nded f o r t re a t me n t , a d u mm y w i r e i s e x te nd e d t o v e ri f y t ha t t he p a th i s c l ea r o f a ny o b s tr u c t io n .

F I G . 2 2 . 1 . A p i c t u r e o f V a r i a n h i g h d o s e r at e uni t ( V a r i S o ur ce ) . T h e s o u r c e w i r e ( o r d u m m y w i r e ) c a n b e a d v a nc e d o r r e t r a c te d thr o ug h i nd i v i d ual c h a n n e l s , t r a n s f e r t ub e s a n d ap p li c a to r s by a r e m ot e co m p ut e r c o nt ro ll e d d r i ve m e c h a n i s m c o n s i s ti n g o f s t e p pe r m ot o r s . T he p o s i tio ni ng o f t he s o ur c e a t t he p r o g r am m e d d w e ll po s it io n s in t he a pp li c a to r s is a c co m pl i she d in p r e ci se i n c r e m e n t s b y t h e s te p pe r mo to r s . T he po s it io ni ng a c c ur a c y of t he s o ur c e is s p e c i f ie d a t 1 m m . T h e d o s e c o nt ro l p re c i si o n i s p r o vi d ed b y a 0 . 1 - s e c o nd d w ell t i me r e s ol u t io n . A n u m b e r o f s a f e t y s y s t e m s a r e p ro v i de d f o r t he H D R . F o r e x a m p l e , i nt e r lo c k s p r e v e n t i n it i at io n o f t r e a t me n t i f t he do o r i s op e n o r t he a p p li c a to r i s n o t a t t a c h ed o r t h e c o n ne c t io n s b et w e e n a p ro g r a m me d c ha nne l , the t r a ns f e r t ub e a n d t h e a p pl i c at or a re n o t se c u r e . Ba c k up b a t te r ie s a r e p r o vi de d to t a ke o v e r o p e r at io n i n c a s e o f p o w e r f a i l ur e . A ma nua l s o ur c e r e t r a ct io n m e c ha ni s m i s a v a i l a bl e to w i t h dr a w t h e s o u r c e i nto t he sto r a g e s a f e i f i t ge t s st uc k a nd c a nno t b e r et r a c te d b y t h e e m e r ge n c y s w i t c h. T he t r e at me nt i s ab o rt ed i f t he s y s te m d e te c t s bl o c k a ge o r ex c e s s i v e f r i c ti o n d ur i ng s o ur c e t r a ns it .

B. High Dose Rate Applicators

WWW.MEDRAD.IR

B r a c h y t h e r a p y a p p l i c at o r s u s e d fo r lo w d o se r a t e i m pl a nt s c a n a l s o be us e d f or H D R . F o r e x a m pl e , som e o f t h e mo s t co m mo nl y us e d a pp li c a to r s , f o r a v a r ie t y o f H D R a p p l i c at io n s , a r e : F l e t c h er - S u i t or F let c h e r - S u i t - Del c lo s . T he s e a p p li c a to r s a re us e d for t he t r e at m e n t o f g y n e c olo g i c al m a li g na nc i e s of t he ute r us , c e r v i x a nd p el v i c si de w a l l s . T h e a p p li c a to r s e t t y pi c a ll y c o ns i sts o f t hr e e r ig id i nt r aut e r i ne t a nd e m s , w i t h c u r v a t u r e o f 1 5- , 3 0 - , a n d 4 5 - d eg re e a ng l e s , a nd a p ai r o f o v oi d s o r c o l po st a t s w it h s h i e l ds i n p l a c e to r e d uc e do s e to r e c t um a nd bl ad d e r . V a g i n a l C y li n d e r . T h es e a r e a cr y l i c c y l i nder s ha v i ng a v a r i et y of d i a m et e r s a nd a x i a l l y d r il le d h ol e s to a c c om m od a te a st a inl e s s s te el t a nd e m . Co up li ng c a t het e rs f o r a tt a c h m e n t to t h e t r a n s f e r t ube s a nd m a r k e r w ir e s t o f it t he le ng t h o f t he t a n d e m a r e p r o vi d ed i n t h e s e t . T he a pp li ca t o r i s s ui t ab l e fo r t re a t i ng t um o r s i n the vaginal wall. R e c t a l A pp li c a to r . A c r y l i c c y l i n de r s o f d i f f er e nt d i a me te r s a r e de s i g ned to t r eat s u p e r f i c i al t u m o r s o f t h e re c t u m . S el e ct iv e s hi e ld i ng i s i nc o rp o r at e d to s p ar e n o r m a l ti s s u e . C o u p l i ng c a t h e te r s a nd m a r k e r w i r e s a r e p r o vi d ed in t he H D R s e t . P.523

I n t r a l u m i n al

C a t h e ter .

S u i t a b le

d i a me te r

c a t he t e r s

of are

v a r i ous us e d

l e ng t hs for

are

a v a i l a bl e f o r t re a ti n g in t r a l u m i n a l di s e a se s uc h a s e nd o b r o nc hi a l ca r c i no m a . Nasopharyngeal nasopharyngeal A ppl i c at o r s . T he s e a pp l i c at or s t r e a ti ng t u mor s w i t h H D R . T he a p p li c a to r s et i ncl ud es t r a c he a l t ub e ,

c a t h e te r , a n d a n a s o p h a r y n g e a l c o nne c t o r . B e s i d e s t h e a b o ve ex a m p l e s , H D R a p pl i ca t o r s a nd c a t het e r s a r e a v a i l a bl e f or v i r t u a l l y e v e r y t y pe o f a p p l i c ati o n d ee m e d sui t a bl e f o r i nt r a vi t a r y b r a c hy t he r a p y . I n t e r st it i al I m pl a n t s . H o l lo w , s t ai nl e s s s te el ne e dl e s a r e i mp l a nted i nto t he t um o r f o l lo w i n g st a n d a r d b ra c h y t h e r a p y r ul e s o f i m p la nt ( s ee C ha p te r 1 5 ) a nd c lo s ed e n d e d c at h e te r s a re in s e r t e d to a c co m m oda t e t he H D R so ur c e wi r e . M a r k e r wi r e s are used to plan the d w el l po s it io ns o f t he so ur c e as w it h t he ot he r H DR a p p li c a to r s . E x a m pl e s o f i n t e r st it i al i m pl ant s a r e p ro s t at e g l and , b r e a st , a nd s o m e h e a d a n d n e c k tu m o r s .

C. Facility Design C.1. Shielding

T h e H D R u n i t m u s t b e h o u s e d i n a n a d eq ua t e l y s hie ld e d roo m . T he s hi e l di ng a nd s a f e t y r e q u i re m e n t s ar e m a n d a t ed b y t he Nuc l e a r R e g ul at o r y C om m i s s io n ( 2 ) . T he H D R t r e at m e nt r oo m ca n b e de s ig ne d a s a de d i c at ed f a c il it y ( e . g . , H D R s ui t e ) o r a d o pt ed f r o m a n e x i st i n g
60

Co o r li na c r o om . In e i t he r c a s e , t he s hi e ld i ng m us t

s a t i s f y o r e x c e ed t h e N R C r e q u i r e m e nt s . T h e s h i e l d i n g c al c u l a tio n s a r e b a s e d o n t he d o s e l i mi t s s pe c i f ie d by t he N R C i n 1 0 C F R 2 0 . 1 3 0 1 ( f o r i nd i v i d u al m e m be r s o f t he p ub l i c ) a nd 1 0C F R 2 0 . 1 2 0 1 ( f or o c c u p a ti o n a l pe r so n n e l ) . T h e N R C a nnua l e f f e c t i v e d o s e e q ui v a le nt l i mit s f o ll o w t h e N C R P g u i d e li n e s ( s e e T a b le 1 6 . 5 ) . T he se a r e s um m a r i z e d a s f o ll o w s : P u b l i c : 0 .1 r e m ( 1 m Sv ) i n 1 y e a r f or c o nti nuo us o r f r e q ue nt e xp o s ur e s ; o r 0 .5 r e m ( 5 m S v ) i n 1 y e ar f o r i n f r e q ue nt e x pos ur e . In t he c a s e o f H D R t he li mi t fo r i n f r e q u e n t e x po s u r e , n a m e l y , 0 . 5 r e m i n 1 y e a r i s m o r e r el e v a nt .

WWW.MEDRAD.IR

O c c u p a t io n a l : 5 r e m s ( 5 0 m S v ) i n 1 y e a r . In a d d i ti o n to the annual not l i m it s , e x c ee d t he 2 NRC mr e m r e q ui r e s (20 t ha t in the any d o se 1 in a ny T he u n r e s t r i c te d a re a mu s t mSv) ho ur .

u n d e r l i n e d w o rd s m e an t h a t w i t h t he w o r k lo a d a nd us e f a c t o r ap p li e d , t he d o se r e c e i v ed i n a n u n r e s t r i c t ed a r e a s ha l l not e xc e e d 2 m re m i n a ny 1 ho ur . T h e m e t h o d s o f c a l cu l a t i n g p ri m a r y a nd s e c o nd a r y b a r ri e r s ar e t he s a m e a s d i s c u s s e d f o r me g a v olt a g e be a m s i n C ha p t er 1 6 . E q ua t io ns 1 6 . 4 , 1 6 . 6 , a nd 1 6 . 10 a r e v a li d a l so f o r H DR r oo m d e s ig n, p ro v id e d a p p ro p ri a te f a ct or s r el a t ed t o
192

Ir

s o u r c e a r e u s e d . T h e s e f a c t or s i nc l ud e : a v e r a g e p hot o n e ne rg y = 0 . 3 8 M e V , t e n t h - v a l ue l a y e r ( T V L ) = 5 . 8 i nc he s o f c o nc r et e (d e ns it y 2. 3 5 g c m - 3 ) a nd e x p o s u r e r at e co n s t an t = 4 . 6 9 R c m 2 / m C i - h. T he f o l l o w i ng e xa m p l e s i ll us t r at e t h e m e t h od o f b a r ri e r t h i c k n e s s c a l c ul a ti o n o r e v a l ua ti o n o f a n e x i s ti ng b a r r ie r .

Example 1
C a l c u l a t e b a rr i er t h i c kn e s s a t a d i s t a nc e o f 5 f e e t f r o m t he H D R s o ur c e t o pr ot e ct a c o n t r ol l ed a r e a . Because the HDR so u r c e ,
192

Ir ,

r e q uir e s

less

s hi el di ng

t ha n

m e g a v ol t ag e

t e le t h e r ap y u n i t a n d ca n b e a s s u m ed is ot r op i c ( s a me i nt e ns it y i n a l l di r e ct io ns ) i n t h e co n t e x t o f s h i el d in g d e si g n , it i s re a s ona b l e t o c o nst r uc t al l b a r r ie r s o f t he s a m e t hi c k n e s s . A d d it io n a l l y , a s a c o ns erv a t i v e me a s ur e , o ne c o ul d d e si g n a ll b a r r i er s a s p r im a r y , f o r a m a x i m um t r a ns mi s s io n o f 2 m re m s i n a ny 1 ho ur . O r , e v e n m o r e c o n s e r v a tiv e l y , a l im it o f 2 m r em / h ( i ns t a nt a ne o us do s e r at e ) co ul d be a d o pt ed . Assuming that, f ro m r a d i at io n p ro te c ti on p o i nt of view in t hi s c a se , 1R [ c o n g r u e n t ] 1 c G y [ c o n g r u e n t ] 1 r e m , t he dos e e q ui v a le nt r a te (

) a t a d i s t a n c e o f 5 f ee t f r o m t h e so ur c e i s g i v e n b y P.524 (inverse square law):

If B i s t h e b a r r i e r t r a n s m i s s io n f a c t o r r e q ui re d to r e d uc e

t o 2 m re m / h , t h e n :

If n i s t h e n u m b e r o f T V L s r e q u i r e d f or s hi el d i ng .

or

or

Since TVL = 5.8 inches of concrete (3),

T h u s a n H D R s u i t e i n t h i s c a s e w o ul d ha v e a l l b a r ri e r s ( w a ll s , f lo o r , a nd c ei li ng ) o f t h i c k n e s s a bo u t 18 i n c h e s o f c o nc r et e pr o v i de d a mi ni m um c le a r a nc e , 5 f t i n t h i s c a s e , b et w e e n th e s o u r c e a nd t he a re a to be p rot e c te d i s a s s ur e d . T he s e

WWW.MEDRAD.IR

s h i e l di n g r eq u i r e me n ts c o u l d b e re d uc e d i f a l a r ge r c le a r a nc e i s m a i nt a i ned a nd r e a li s ti c w o r k l o ad a n d o c c u p a n c y f a c t o r s a r e a p p li ed . If n o m a z e i s p r o vi d ed to p re v e n t d i re c t i nc i d e nc e o f r ad i at io n be a m a t t he d oo r , t h e d oo r m u s t be s h i el d ed ( e . g . , w i t h le a d li ni ng ) f o r a t r a ns m i s sio n e q ui v a le nt to t h a t o f 18 i n c h e s o f co n c r e te o r 3 T V L s . Bec a us e t he T V L f o r

192

Ir g a m m a r a y s i n

l e a d i s 2 c m ( 3 ) , t h e e q u i v a l e n t le a d t hi c kne s s m us t b e 2 3 = 6 c m . A b e t t er a l t er n a t i v e i s t o p ro v id e a m a z e o r a d d a s hi e l de d p a r ti ti o n b etw e e n t he so ur c e a n d t h e d o or .

Example 2
W h a t i s t h e d oo r s h iel d i n g r eq u i r ed i f a m az e i s p r o vi d ed f o r a n H D R s ui t e , w i t h s o u r c e t o w a ll ( f a c i n g t h e d oo r ) d i st a nc e o f 1 5 f t a nd m a z e l e ngt h o f 1 0 f t ? W i t h t h e m a z e w a ll t h i c k n e s s o f 18 i nc he s o f co nc r e te , t he t r a ns m i tt ed do s e i n c i d e nt a t t h e d oo r w o u l d b e 2 m r e m / h or l e s s . T he d o s e d ue t o s c a tt e r o f f t he w a l l f a c i n g t h e i n s id e o f t h e d oo r c a n b e c a lc ul a t e d a s f ol lo w s : A s s u m i n g a v e r a g e r e f le c t io n c o e f f i ci e nt ( ) o f 2 1 0 - 2 p e r m 2 f o r a r e a o f s c a t te r a t t h e f a c i n g w a l l t o b e 5 m , t he d o s e r at e (
2 192

Ir ( 4 ) a nd t he

) a t t h e i n s id e o f t h e d o or d u e t o s c at te r i ng w o ul d b e :

w h i c h i s n e g l i gi bl e . Th u s , n o s h i e l di ng i s re q ui r ed f o r t he doo r if a n a p p r o p r i at e m a z e i s p r o v id e d i n a n H D R s u i t e .

Example 3
E v a l u a t e t h e s h i e ld i n g o f a n e x i s t i ng 6 M V l ine a r a c c e l e r at o r f or H D R us e . T r a n s m i t te d do s e f o r e a c h e x i s t i ng b a r r ie r c a n b e c a l c ul a te d us i ng i nv e r s e s q ua re law and TVL for
192

Ir

gamma

rays,

as

d i s c us s e d

a bo v e .

For

example,

if

s e c o n d a r y b a r r ie r f o r P.525 a 6 - M V r o o m i s 40 in c h e s o f c o nc r e t e a nd t he m i ni m um di s t anc e b e t w ee n t he s o u r c e a n d t h e a r e a t o be e v a l ua te d f o r pr o te c ti o n i s 10 f t , t he n t he e f f e c ti v e d o s e eq u i v a le n t r a t e (

) i n t h e a r e a c a n b e c a l c u l a te d a s b el o w : w h i c h i s n e g l i gi bl e . S i m i l ar c a l c ul at io ns ha v e s ho w n t ha t r o o ms d e s i g ned w i t h a d e q u a te s h ie l di n g f or m e g a vo lt a g e te l et her a p y uni t s a r e m o re tha n a d e q ua t e f o r H D R s h i e l di n g ( 5 ) . W h e t h e r i t i s a d e di c at e d H D R s u i te o r a n ex i s t i ng te le t he r ap y v a ul t , t he s hi el d i ng a d e q u a c y o f t h e f a c il it y m u s t b e do c um e nte d b e fo r e a pp l y i ng f or a n H D R l i c e ns e . S i n c e m o s t i n s t it u ti on s u s e e x i s t i ng te le the r a p y r o o m s t o ho us e H D R uni t s , a s h i e l di n g e v a l u at io n r e p o rt m u s t b e s ub mi tt e d w it h t he l i ce ns e a p pl i c at io n a s r e q u i r ed b y t h e N R C .

C.2. Safety Features

S a f e t y r e q u i r em e n t s fo r a d e di c at e d H D R va ul t o r a n e x i st i ng tel e t her a p y r oo m a d o pt ed f o r H D R , a r e m a n d a t e d b y t he N R C ( 2 ) . T he s e i nc l ud e : e le c t ri c a l i nte r lo c k

WWW.MEDRAD.IR

s y s t e m t h a t r et r a ct s t h e so u r c e w he n t he do o r i s o pe ne d a nd do e s not al lo w r e s u m p ti o n o f t h e t r ea t m e n t u n l e s s t he doo r i s cl o s ed a nd t he int e r lo c k i s r e se t ; m e c h a n i s m t o e n s u r e t h a t o n l y o ne d e vi c e c a n b e p l a c e d i n o p e ra t io n a t a g i v e n t i me i f t h e H D R i s in s t a l le d i n a n e x i st i ng te le t he r ap y r oo m ; i na c c e s s i bi li t y o f c o n s o le k e y s to u n a u t h o r i z e d p e r so ns ; a p er m a ne nt r a d i at io n m oni t o r c ap a bl e o f c o n t i n u o u s m o n it or i ng o f t h e so ur c e s t atus ; c o nt i nuo us v i e w ing a nd i nt e r co m s y s t e m s to a l lo w f o r p a t ie n t o b se r v a t io n d ur i ng t r e at m e nt ; a nd r e s t ri c te d a r e a c o n t r ol s such as s ig n s , locks, v i s ib l e / aud i b le a l a rm s , d oo r w a r ni ng l i g ht s i n d i c at i n g R a d i at io n O n , e t c .

22.3. LICENSING REQUIREMENTS

P u r c h a s e r s o f H D R u n i t s m u s t a pp l y f o r a li c e ns e o r l i c e ns e a mend m e nt w i t h t he a p p r op r i at e r eg u l at o ry a g e n c y . I n t he U ni t e d S t a te s , i t i s t he Nuc l e a r R e g ul at o r y C o m m i s si o n Essential p e r io di c ) ; (NRC) or the st at e (a) if it is an A g r ee m e nt S t ate . T he li c e ns i ng t r a i ni ng , safety r e q u i r em e n t s f o r L D R b r a c h y t h e r a p y w e re dis c us s e d i n C ha pt e r 1 6, S e c t io n 1 6 . 10 . i te m s (b) i n c lu d e d a p pl i ca nt s re q ui re m e nts : q ua l i f i c at io ns ALARA ( e d uc a t io n, e x p e r ie n c e ) a n d a des c r i p tio n o f p e r so nne l t ra i ni ng p r og r a m (ini t i al a s we ll a s a d mi ni s t r at i v e program, r a d i at io n o f f i c e r , r a d i at io n s a f e t y c o m m it te e a nd a w r i t te n q ua l it y m a na g e m e nt pr o g ra m ; a n d ( c ) te c h n i c a l r e qu i r e m e n t s : c a li b r at io n a nd s ur v e y i ns tr um ent s , l e a k t e st i ng a n d i n v e n t o r y o f s o u r c e s , c o n d i tio ns f o r p a t i e nt r e le a s e , po s t t rea t m e nt s ur v e y o f p a t ie n t s , a n d po s ti n g o f r ad i at io n s ig ns . If t he a p pl i ca nt al r ea d y ha s a n L D R brachytherapy li c e n se , an a m e nd me nt m us t be r eq ue s te d for t he r em ot e a f t e r lo a di n g d e v i ce b y l i s ti n g l i ce ns e c o ndi tio ns s p e c i f i c t o t he use o f t ha t d e v i ce . T h e i n f o r m a ti o n r e q u ir e d sp e c i fi c a ll y f o r HD R li c e ns i ng i s co nt ai ne d i n t he N R C d o c u m e n t ( 2 ) . A t y p i c al l i ce n s e a p pl i c at io n i nc l ud e s t he f ol lo w i ng i nf o r m a ti o n:

S o ur c e de s c r ip ti o n ( ra d i o n uc li d e , m a nuf a c t ur e r s na m e a nd m ode l num b er , m a x i m u m a c ti v i t y , ma x i m um num b e r o f so ur c e s to b e p o s se s se d at t he f a c i l it y a t a n y g i v e n t im e a nd t he p hy s i c a l co ns t r uc t io n o f t he s o ur c e ) .

M a n u f a c t u r e r s n a m e a n d m o d el o f t he H D R uni t . In t e n d e d u s e ( c a n c e r t r e at m e nt i n hum a ns us i ng i nt e r st iti a l , i nt ra c a v i t a r y , i n t r a l u mi n a l b r a c h y t h e r a p y , e t c . ) A u t h o r i z e d u s e r s ( p hy s i c i a ns ) a nd a ut hor iz e d p hy s i c i st ( s ) , v e rif y i ng t h a t t h e y m e et e d u c a ti o na l a n d e x p e ri e nc e q ua l i f i c at io ns s e t f or t h i n 1 0 C F R 3 5 . 9 40 a n d 1 0 C F R 3 5 .9 6 1 , r e sp e c ti v el y . P.526

A n o u t li n e o f i n it i al t r ai ni ng o f a ut ho ri z e d us e r s a nd d e v i ce o pe r a to r s ( d i d a ct i c training p lu s a m i ni m um of 8 ho ur s of ha nd s o n device o p e r at io n t r a i ni n g . )

D e s c r ip ti o n o f r a d ia ti on d e t e ct io n a nd s ur v e y i ns t r um e nt s t o be us e d .

WWW.MEDRAD.IR

A f l o or pl a n o f t h e f ac i li t y , id e nti f y i ng ro om ( s ) , d oo r s , w i ndo w s , c o nd ui t s, d e n s i t y a n d t h i c k n e s s o f s hi e ld i ng m at e ri a ls o f w a l l s , f lo o r s a nd c e i li ng a nd d i s t a n c e s to t h e a dj ac e n t i nha b it a bl e a r eas w i t h i nd i c at io n o f w he t he r t he a r e a s a r e r e st r i ct e d or u n r e s t r i c te d .

S h i e l di n g c a l c u l at io n s t o s ho w t ha t t he ad j a c e nt a re a s c o mp l y w i t h t he r e g u l at o r y s t a n d a rd s . A r e a s e c u r i t y a n d s a f e t y f e a t ur e s ( S e c ti o n 22 . 2 C . 2 ) C a l i b r at io n p r o c ed u r es a n d f r e q ue nc y , l e a k t e s t p r o ce d ur e s a nd f r e q ue nc y a n d t h e q u a l i f i c at io n s o f t h o s e pe r f o r mi ng the s e t e st s . Quality assurance pr o g r a m , and i nc l udi ng pr e t r ea t me nt (e.g., or da ily q ua l it y

assurance annually).

p r o c e d u r es

p e r i od i c

te s ting

m o nt hl y ,

q ua r t e rl y ,

T r a i n i n g a n d f r eq u e n c y o f r et r a i ni ng o f i nd iv i d ua l o p e r ato r s ( e .g . , a nnua l l y or every 2 years). T r a i n i n g o r c e rt i fi c a tio n o f i nd i v id ua l s p e r fo r m i ng s o ur c e c ha ng es ( no r m a ll y v e n d o r r e p re s e n t at i v e) . P e r s o n n e l r a di a ti o n mo n i to r i ng p ro g r am . E m e r g e n c y p r o c ed u r e s, p o s t i ng s , lo c at io ns . D i s po s a l a r r a n ge m e n ts o f d e c a y e d s o ur c e s (us ua l l y b y r e t ur n t o v e nd o r ) . O p e r a ti n g l o c at io n . In s p e c t i o n a n d s e r v i cin g o f H D R e q ui p m e nt a t i nt e r v a l s not to ex c e e d o ne y e a r , b y t h e m a n u f a c t u r e r o r a p e r so n l i cens e d b y N R C / A g r e e me nt S t a te . R e c o r d s o f i n s p e c ti o n a n d s e r v i c e to b e m a int a i ne d f o r t he d ur at io ns o f t he license for guidance. N o t e : Re q u i re m e n t s of L i c e ns e a p pl i c at io n m a y c ha ng e f r o m t i me t o t i me . T h e a p p l i c a nt s h o u l d co n s u l t t he m o st c ur r ent N R C d o c um e nt . p ro c ed u r e s a n d m a nua l s , t he i r a v a i l a bi li t y to pe r so nne l a nd

A. High Dose Rate Quality Management Program

A s a c o n d it io n f o r a w a r d i n g a n H D R li c e nse , t he N R C r e q uir e s a w r i t te n q ua li t y management p r o gr a m ( Q M P ) as it d oe s f o r t he L D R b r a c hy the r a p y . G e ne r a l r e q u i r em e n t s o f s u c h a p ro g r a m we r e d i s cus s e d i n C ha p te r 16 , S e c ti o n 16 . 1 0 B. A n H D R Q M P i n c l u d e s g e n e r al a s w e ll a s sp e c i f i c te s t s to a s s ure s a f e ap pl i c at io n o f t h e H D R p r o ce d u r e. T h e p ro g r a m i s d e si g ne d b y t he i ns t it utio n a nd m us t be s u b m i tt e d a s p a rt o f t h e l i c e n s e a p pl i c at io n. A s a m p l e H D R Q M P i s d e s c r i bed b e lo w .

A.1. Written Directive

A w r i t t e n di r e ct i v e ( pr e s c r i pt io n ) m us t b e p r o v id e d b y t he a ut ho r i z ed p hy s i c i a n u s e r t h a t i n c l u de s t he n a m e a n d ho s pi t al num b e r o f t he p a ti e nt, t he H D R s o ur c e m a t e ri a l , t h e do s e pe r f r a c t i o n , t he to t al d os e , a nd t he s i t e o f a d m i ni s t r at io n.

A.2. Patient Identification

T h e i d e nt it y o f t h e pa t i e nt m u s t b e v e r i fi ed b y t w o i nd e pe nd e nt m e t ho d s a s t he i n d i v id u a l n a m e d i n t he w r i tt e n d i re c ti v e . T hi s m a y b e a c c o mp li s hed b y a s k i ng t he

WWW.MEDRAD.IR

p a t ie n t hi s / h e r n a m e a n d c o n f i r mi ng t he na m e b y c o mp a r i so n wi t h t he p ati e nt s i d e n ti f i c at io n b r a c e le t o r h o s p it a l id e nti f i c ati o n c a r d .

A.3. Treatment Plan Verification

The authorized physician and t he a ut ho r i z ed p hy s i ci s t m us t c he c k t he t r e at m e n t pl a n t o e n su r e t h a t ( i ) t he p l a n p a r a m et e r s ( e . g . , s o ur c e s p e c i fi c a ti o n, s o u r c e s t re n g t h , so u r c e po s it io n , d o se pe r f r a c t i o n, t ot a l d o se ) ar e c o r re c t a nd i n a c c o r d a n c e w it h t h e w r i tt e n d i re c ti v e ; ( ii ) the t r e a tm e nt p a r a me te r s g e ne r at e d b y t h e p l a n f o r i n p u t i nt o t h e H D R d e v i c e P.527 ( e . g . , c h a n n e l n u m b e r s , s o u r c e p o si ti o ns , d w e l l t i me s ) a r e c or re c t ; a nd ( ii i ) t he d o s e di s t ri b u ti o n ag re e s w it h a n i nd e pe nde nt ( e .g . , m a nua l ) sp o t c he c k w it hi n r e a s o n a bl e li m it s ( e . g. , 5 % ) .

A.4. Pre-treatment Safety Checks

P r e - t r e at m e nt s a f e t y c h e c k s o f t h e H D R e qui p m e nt m us t b e pe r f o r m ed o n a ny d a y t h a t t h e H D R p r o ce d u re i s s c h e d u l e s . A s a m p l e i s p r o v id e d i n s e c ti o n 2 2 . 3 B.

A.5. Treatment Delivery

P r i o r t o t h e i n it i at io n o f t re a t me nt , t he a utho r i z e d o pe r a to r ( a utho r i z e d m e di c a l p h y s i c i s t , d o si m et r i st o r r ad i at io n t he r ap is t ) m us t v er i f y t ha t t he na m e o f t he p a t ie n t , plan. the do s e , th e site of a d m i ni st ra t io n a nd t he t i me s for each dwell l o c at io n s a r e i n ag r e em e n t w i t h t he w r it t e n d i r e ct i ve a nd t he ap pr o v e d t r e at m e nt

A.6. Post-treatment Survey

Im m e d i at e l y a f t e r e ac h t r e a t m e nt , a s ur v e y o f t he a f t e r l o ad i ng d e v i c e a nd t he p a t ie n t m u st be pe r f o r m ed to a s s ur e t ha t t he so ur c e ha s be e n r e t ur ne d to t he fully s h i e ld e d p o si tio n . The s ur v e y will i nc l ud e co nne c to r s a nd a p pl i c at o r a p p a r a t u s , t h e f u l l len g t h o f t h e c at he te r g ui d e t ub e , a nd t he ex t e r na l s ur f a c e o f t h e d e v i ce t o e n s u r e t h a t t h e s o ur c e i s f ul l y r e t r a c te d . T he p a t ie nt s ha l l be s u r v e y e d o v e r t h e bo d y s u r f a c e ne a r t he t r e at m e nt s it e b e f or e r e mo v i ng t he p a t ie n t f r o m t h e t r e atm e n t r oo m .

A.7. Source Replacement and Calibration Check

V e n d o r w i ll c o n d u c t s o u r c e r e pl a c e me nt a nd p e r f o r m so ur c e a nd p e r f o r m a nc e c h e c k s f o l lo w i n g i n s t al l at io n . A c o p y o f t hi s r e po r t w i ll be o n f i le. C a l i b r at io n o f the source w i ll be p e r f o r me d by a ut ho r i z e d p hy s i c i st b e f or e first p a ti e nt t r e at m e n t .

A.8. Recording
T h e o p e r ato r a d mi n i st e ri n g t h e t r e at m e nt w i l l r e co r d a nd i ni tia l t he t r e at m e nt a f t e r c om p le ti o n . F ol lo w i n g t h e t r e at m e nt , he / s he w i l l a s se m bl e a nd f i l e re c o rd s o f t h e p r e s c ri pt io n , p a t ie n t i d e nt i f i c at io n, a nd t r e at m e n t surveys. The records for each t r e at me nt de liv e r y , a nd w it h a p o st t r e a t me nt a lo ng c o m p l et ed

c h e c k l i s t w il l b e k e pt o n f i l e . T he s e re c o rd s w i l l b e m ai nt a i ned i n a n a ud i t a b le f o r m f o r a m i n i m u m of 3 y e a r s .

A.9. Supervision
WWW.MEDRAD.IR

During

a l l p a ti e n t t re a t m e nt s , b ot h t he a ut ho r i z e d

p hy s i ci a n us e r a nd

t he

a u t h o r i z e d m ed i c al ph y s i c i s t w i ll b e p hy si c a ll y p r e s e nt . P hy s i ca l p r e se nc e , f o r t h i s p u r p o se , i s d e f i n ed a s w i t h i n a ud i b le r ang e o f no r m a l hum a n s p e e c h.

A.10. Recordable Event or Misadministration

Any unintended de v ia t io n from t he w ri tte n d i re c ti v e w il l be i de nt i fi e d a nd e v a l u a t ed i n t e r m s o f a r e c o r d a bl e e v e nt or a m i s a d m i ni s t r ati o n. D e f i ni t io ns o f t h e s e te r m s a n d t h e re q u i r ed a c ti o ns a r e t he s a m e a s f o r t he L DR b r a c hy t he r a p y , d i s c u s s e d i n C h a p t er 1 6 , S e c ti o n 1 6 . 10 B.

A.11. Periodic Reviews

B r a c h y t h e r a p y c a s e s w i l l be r e v ie w e d a t i nt e r v a l s no gr e at er t ha n 1 2 m o n t h s b y a n a u t h o r i z e d p hy s i c i a n a nd / o r a n a ut ho r i z e d p hy s i c i s t . A r e p r e se n t a ti v e n u m b er o f P.528

c a s e s , c o r re s po n d i n g t o l ot t ol e r a nc e d e f e cti v e o f 2 % , us i ng t he ac c e p t a nce s a m p li n g t ab le o f 1 0 CF R 3 2 . 11 0 , w il l und e rg o t hi s re v i e w w hi c h w i l l c o ns i st o f c h e c k i n g t h a t t h e d e li v e r ed r a d i at io n do s e w a s i n a c c o r d a nc e w i t h t he w r i t te n d i r e ct i ve a n d p l a n o f t r e at m e nt . If a r e c o r d a b l e e v e n t o r m i s a d mi ni st r a ti o n is unc o v e r e d d ur i ng t he p e r io dic r e v i e w , t h e n u m b e r o f c a s e s t o be r e v ie w e d w i l l be e x p a nd ed t o inc l ud e a l l c a s e s f o r t h a t c a le n d ar y e a r .

The

QMP

will

be

reviewed

on

an

a nn ua l

basis

to

d e te rm i ne

t he

e f f e c t i v e n e s s o f t h e pr o g r a m a nd to i de nt i fy a c t i o ns t o m a k e t he p r o gr a m m o r e e f f e ct i v e .

A w r i t t e n s u m m a r y o f t h i s a nnua l r e v i e w w i l l b e s ub mi tt e d to t he R a d i a t io n S a f e t y O f f i c e r a n d t h e R a d i at io n S a f e t y Co m m it te e fo r r e vi e w a nd f i na l a p p r o v al .

A n y m o d i f i c a ti o n m ade t o t he Q M P w i ll b e re p o rt ed to t he ap p r opr i a te N R C R e g io n a l O f f i c e ( o r th e s t a t e i f go v e r ne d b y A g r e e m e nt S t at e ) w i t hi n 3 0 d a y s a f t e r m o di f i c at io n h a s b e e n m a d e . M i ni s t e ri al c ha ng e s a ut ho r i z ed u n d e r 1 9 C F R 3 5 w i ll n o t r eq ui r e t he not i fi c at io n o f t he N R C .

B. Pre-treatment Safety Checks

T h e H D R p r e - t r e a t men t s a f e t y c h e c k s a r e p e r f o r me d b e fo r e t re at m e nt o n a ny d a y t h a t t h e H D R p r o ce d ur e i s to be c a r ri ed o ut . A s a m pl e i s p r o vi de d be lo w f o r a n H D R u n i t i n s t a l le d i n a 6 - M V l i n e a r a c c e le r at o r ro o m .

V e r i f y t h a t t h e d o u bl e p ol e -d o ubl e t hro w H D R d o o r i nt er lo c k s w i t c h i s t u r n e d t o t he H D R p os i ti o n . T he n v e r i f y t h a t t he 6 - M V l i na c c o ns o l e c a nn o t b e a c ti v a t ed . A c t i v a te t h e H D R c o ns o l e O N .

WWW.MEDRAD.IR

C h e c k r a d i a t io n m o n ito r i n t he t re a t me nt ro o m f o r p r op e r op e r ati o n w i t h a d e di c a te d c h e c k s o u r ce , w hi c h i s l o c at ed i n H D R a f t e r lo a de r s to ra g e r oo m . T h i s c h e c k w i l l v e r i f y e x p e c te d r e ad i ng w ithi n 2 0 % a s w e l l a s a c t i v a ti o n of the warning light.

T h e t w o v i d eo m o ni tor s ( o ne w i t h a lo ng v ie w a nd t he o t he r fo r c l o s e up ) a t t h e H D R co n s ol e w i l l b e v ie w e d t o v er i f y p r o pe r v i s ua li z a tio n b y t he c a m e r a s i n t h e t r e atm e n t ro o m . T he t w o -w a y a ud i o co m m uni c at io n w i ll be c h e c k e d b y o n e p er s on i n t he r o o m at t he l o c at io n o f t he p at ie nt a nd t he o t h e r a t t h e c o n s ol e .

T u r n o n H D R a f t e rl o ad e r a nd po s it io n f o r te s t . V e ri f y t ha t a ll l ight s / s t a t us i n d i c at o r s a r e o p er a tio n a l . C l e a r a n y pe r s o n n el in r o o m , a nd cl o se t r ea t m e nt do o r a s yo u lea v e . V e r i f y that the do o r w a r n in g l i g ht is o p e r at iona l a nd c o ns o l e li ght s / s t a t us i n d i c at o r s a r e o p er a tio n a l . T e s t c o ns ol e pr int e r o pe r a ti o n.

A c t i v a te H D R t e st r u n f r o m c o ns o l e . V e rif y t ha t t he d oo r w a r ni ng l i g ht i n d i c at e s R a d i at io n On. Verify t ha t t he d oo r i nte r lo c k t e r mi na t es t r e at m e n t b y o pe n i n g d oo r d ur i ng t e st r un. R e - c l o se t he d oo r and v e r i f y t h a t t h e H D R u n i t c a n n o t be t ur ne d o n w i t ho ut r e se tt i ng t he H D R a c t i v at io n b u t to n .

If t h e d o o r i n te r lo c k m a l f u nc t i o ns , t he H DR uni t w i l l be lo c k e d in t he o f f p o s it io n a n d n o t u s ed u n t i l t he d oo r i nte r loc k s y s t e m i s r e sto r e d t o p ro pe r o p e r at io n .

C h e c k m e c h a n i c a l i n t e g r it y o f a l l a p pl i c ato r s , s o ur c e g ui d e t ub e s , a nd connectors to be u se d in t hi s t re a t me nt by vi s ua l i ns p e ct io n a nd / or r a d io g r a p h i c s .

C h e c k Q u i c k - C o n n e c t s e ns o r b y pl a c i ng a n i nc o r r e ct l y s e at e d c a t het e r Q u i c k - C o n n e c t w i t h c a t he t er i nto t he HD R t ur r e t . U si ng d um m y w i r e c h e c k t h a t t r e a tm e n t is p r e v e nt ed .

R e s u l t s o f t h e se t e st s w i l l be r e c o rd ed o n t he m o r ni ng c he c k l i st .

C. High Dose Rate Operating Procedures

T h e N R C r e q u i re s H D R o pe r a ti n g p ro c ed ur e s t o b e s ub m it te d a s pa r t o f t he l i ce ns e a p p li c a ti o n p e r s o n n el P.529 t h e o pe r a to r s te p - b y -s t e p i n t h e s a f e o pe ra t io n o f t he e q uip m ent a nd t r e a t me nt d e li v e r y . The fo ll o w in g is a ge ne r i c s am p l e , w hi c h may be a do pt e d w it h a p p r op r i at e mo di f i c a tio n s t o s u i t t he a v a i l a bl e e q uip m e nt a nd p e r so nne l . ( It e m at a 17, Section 2 2 .3 ) . The p r o c ed ur e s on t he m us t be a v a i l ab l e de v i c e , to t he s u i ta b l e lo c a ti o n. D e pe nd i ng p a rt i c ul a r

o p e r at i n g pr o ce d u r e s a r e w r i tt e n t o g ui d e

T h e H D R u n i t w i l l b e s t o re d i n a st o r ag e sp a c e p ro v i de d i n t he d e s ig na t ed s h i e l de d r oo m (e . g . , 6 - M V l i nea r a c c el e r ato r ro o m ) . T he s to r a ge a r e a w i ll b e l o c k ed w h e n t h e u n i t i s una t te nd e d . T he d oo r k e y w i ll be a v ail a b le o nl y t o t h e a u t h o ri z e d o p era t o r ( s ) .

WWW.MEDRAD.IR

P r e - t r e at m e nt s a f e t y c h e c k s w i l l be p e r fo rm e d o n t he d a y o f t he t r e at m e nt ( s e c t io n 2 2 . 3 B ) . O n l y t h e p at ie n t u n de r t re a t me nt wi ll be i n t he t re a t me nt roo m d uri ng a c t i v a ti o n o f t h e H D R u n i t f o r t r e at m e nt. P a t i e nt i d e nti f i c at ion w i l l be v e r i f i ed b y t w o i n d ep en d e n t m e a ns .

T h e f o l l o w i n g p re - t rea t m e nt c he c k s a r e t o b e p e r f o r m ed b e f o re i ni t i at i ng H D R t r e a t me n t :

o o o o o

V e r i f y t h a t t h e s o u r ce a c t i v it y a nd c a l ib r at io n d a t e a re c o r re c t o n t h e p r i n to u t s ; V e r i f y t h e co r r e ct p a ti e nt fi l e na m e i n t he c a s e o f m ul ti pl e p a tie nt f i l e s o n t h e s a me d i s k; V e r i f y t h a t t h e p ri n t out m a t c he s t he o ne sho w n o n t he a f t e rl o ad er p r i n to u t ; The planned that to d w e ll in the t i me s s ho uld be ve r i f ie d b e f o re each i ni ti at i ng is be t r e at m e n t ; Ensure m ul ti p le - c ha nne l cor r e c t m a c hi ne t r e at me nt s c ha nn e l . c a t he te r s ho uld connected C a t het e r s

m a r k e d a n d v e ri f ie d t ha t t he t re a t me nt pl a n a nd t he a f t e rl o ad e r m a t c h a s f a r a s w h i c h c a t he t e r i s w hi c h; V e r i f y c o r r e ct n e s s o f p a t ie nt i nf o r m at io n o n p r i nt o ut s; V e r i f y d w e l l po s iti o n s w i t h c a t he te r m e a s ur em e nt s ; Ensure Before that all c a t he t e r s the are f ul l y s ea t e d i nto t he i nt o t he m a c hi ne t re a tm e nt c o n n e c t o r s , w it h t h e c o nne c t o r pl ung e r f ul l y e x t e nd e d ;

o o o o

po s it io n i n g

active

s o ur c e

p a ti e nt

c a t h e te r , t h e d u m m y s o ur c e w i r e w i ll b e r un i nt o e a c h t r e a tm e nt c a t h e te r to v er i f y t ha t t he c a t het e r i s not bl o c k ed o r k i nk e d . T he H D R a f t e r lo a de r w i ll no t r un t he a c ti v e s our c e i nt o t he c a t het er i f t h e d u m m y w i r e e n c ount e r s r e s i s ta nc e .

F o r e a c h c a t h et e r c h an n e l r un, c he c k t o t a l s o ur c e d w el l ti me us ing m a nua l t i me r a n d v e r i f y t h a t t h e m a nua l t im e r me as ur e m e nt a g re e s w it h t he to t al p r o g r am m e d d w e ll t i me .

T r e a t m e nt p l a n n i n g c o m p ute r d i s k w it h t he p l a n d at a s t or e d f o r e a c h p a t ie n t s t re a t me n t w i ll b e l ab el e d w it h t he c o r r e sp o ndi ng p a ti ent s na m e a n d i de n t i fi c a ti o n n u mb e r . If t he se d i s k s a re r e us e d , t he y wi ll be re - l a be le d i n a c c o r d a n c e w i t h t he m a nuf a c t ur e r s i ns t r uc t i o ns .

Im m e d i at e l y a f t e r e a ch u s e o f t he H D R d e v ic e , t he p hy s i c i st w il l e ns ur e t he s o u r c e h a s be e n re t ur n e d to t he f ull - s hi eld e d p o si tio n a nd w il l p e r fo r m a s u r v e y o f t h e d e v i ce a n d t he p a ti e nt . T he s ur v e y w i l l i nc l ude t he p a ti e nt , c o n n e c t o r s , ap p li c at o rs , f u l l l e ngt h o f g uid e t ub e s , a nd t he e x te r na l s ur f a c e o f t h e d e v i ce t o e n s u r e t h a t t he s o ur c e i s f ul l y r e t ra c t ed .

T h e p o s t - tr e a tm e n t su r v e y w i l l b e r e c o rd ed o n a n a p p r o p r i at e sur v e y f o r m a n d t h e r e p o rt m a i n tai n e d f o r a p e ri od o f a t l e a s t 3 y e a r s . If t h e r a di a ti o n mo n ito r o r p o st - t re a t me nt p a t ie nt s ur v e y i nd i c ate d t ha t t he s o u r c e i s n ot f u ll y r etr a c t e d to a s hi el de d po s it io n i n t he d e v i ce , p e r s o nnel (authorized p h y s i c i an and p hy s i c i s t ) w il l im m e di a te l y i m pl em e nt t he a p p li c a bl e e me r g e n c y p r o c e d ur e s ( po st e d a t t he H D R c o ns o le a nd i n t he

WWW.MEDRAD.IR

t r e at m e n t roo m ) ( s ee s e c ti o n D ) . If ot he r e m e r ge nc i e s o c c ur d ur i ng H D R t r e at m e n t (e . g . , el e ct r i c al po w e r l o s s , a pp l i c at or di s lo d ge , ti me r f a i l ur e) authorized HDR p e rs o n n e l will im m e di at e l y i mp le m e nt t he a p p l i c ab le e m e r ge n c y p r o c ed u r e .

No

t re a t me n t

p ro c edu r e

will

be

co nt i nued

for

w hi c h

d e - co up l ed

or

j a m m e d s o u r c e c a n n o t b e r e mo v e d e x ped i ti o usl y f r o m t he pa t i e nt a nd p l a c ed i n t h e s h i e ld ed c o n t a i ne r a v a il a b le i n t he r o o m .

During

all

p at i e nt

tr e a t me nt s

us i ng

HDR

device,

b ot h

t he

a ut ho r i z e d

physician and P.530

t h e m ed i c al p h y s i c i st m u s t b e p hy s i c a ll y p r e s e nt . P hy s i c al p res e nc e , f o r t h i s p u r p o se , i s d e f i n ed a s w i t hi n a ud i b le r ang e o f no r m a l hum a n s p e e c h.

D. Emergency Procedures
O n e o f t h e li c e n s i n g r e q u i r em e n t s ( Ite m 15 , S e c t io n 2 2 .3 ) i s the s ub m i s s io n o f e m e r ge n c y p r o c ed u r e s p r o ce d u re s , a re p o st i n g s , as a nd l o c at io ns . ( a s s um i ng T he a f o llow i ng p a r tic ul a r e m er g e nc y HDR uni t , p res e n t e d s a mp l e s

V a r i s o u r c e ) . A p p ro p ria t e e me r ge nc y e q ui pm e nt , f o r e x a m pl e , tw o p a i r s o f lo ng h a n d l e d f o r ce p s , s h ie l de d co n t a i ne r , he av y d ut y c a b l e c ut te rs , p a i r o f lo ng handled s c i s s or s , p or t a b le survey meter a nd stop watch or timer, m us t be a v a i l a bl e a t al l ti m e s .

D.1. Improper Source Retraction

If t h e r o o m m o n i to r o r a f t e r lo a de r c o ns ol e i nd i c a t e s t hat t he a c t i v e s o ur c e w i re h a s f a i l e d to r e t ra c t , p r o c ee d a s f o ll o w s :

E n t e r t h e r oo m w it h a p o r ta b le s ur v e y m et e r a nd ob s e r v e t he e m e r ge nc y h a n d w h e e l . If t h e h a n d w he e l i s no t t ur ni ng , a nd r a d i a ti o n i s pr es e nt : t ur n t h e w h e e l c lo c k w i s e t h r o ug h e i g ht r e v ol uti o ns , o r unt il t he i nd e pe nd e nt r a d i at io n m o n it o r n o lo n g e r de te c t s r ad i at ion. If r a d i a t i o n i s st il l d e te c te d , p r o c ee d to p ro c e d u r e ( b ) . If t h e h a n d w h e e l i s tu r n i n g , a nd r a d i at io n is p r e se nt , p ro c ee d to p r o c ed ur e (b).

R e m o v e a ll a p pl i ca to rs / c a t he te r s f r o m t he p a t ie nt w i t ho ut d i s co nne c t io n a t any point and place them is in t he s hi e l de d by c o nt ai ne r . a ny T he removal of a p p li c a to r s / c at h e t er s in the s h i e ld e d a c c o mp li s he d p r o vi d ed . c ut t i ng e x te r na l r em o va l s ut ur e s , of t he

p h y s i c a l l y re m o v i n g th e e n t i re a pp li c a to r / ca t he te r a pp a r a t us a nd p l a ci ng it co n ta i n e r S ur g i c a l to ol s for s u t u r e s a r e l o c at ed i n t h e H D R t r e a t me nt r oo m .

In a l l c a s e s a bo v e , re m o v e t he p at i e nt f ro m t he i m m ed i at e a re a , s ur v e y t h e p at ie n t , a n d i f i t i s s a f e to do so , e v a c ua t e t he p at ie nt f ro m t he r oo m a n d l o c k t h e r oo m . Po s t a w a r ni ng si g n: T hi s r oo m m us t r e m ai n lo c k e d .

WWW.MEDRAD.IR

H D R s o u r c e e x po s ed . D o not e nt e r . N ot i fy a l l e m e r ge nc y c o nta c t s li s te d b e lo w ( e . g . , R a d i at ion S a f e t y O f f i c e r , v e nd o r ) . E s t im a te a nd r e c o r d t he a d d it io n a l do s e t o t h e p a ti e nt . A l so e st ima t e a nd r e co r d a ny ex p o s ur e to h o s p it a l s t a f f .

D.2. Electrical Power Loss

In case of po w e r l os s d ur i ng t r e at m e nt , t he a f te r lo a de r unit ha s an

u n i n t e r r u p t ed p o w e r s u p p l y ( U P S ) t ha t ena b l e s a ll s y s t e m s to c o nt i nue o p e r at io n f o r u p to 3 0 mi nut e s . T hi s w il l e na b l e c o mp le ti o n of a ny H D R t r e at m e n t i n p ro g re s s a t t he ti m e o f A C p o we r f a i l ur e .

If b o t h A C po w e r a n d U P S s y s t e m f a i l to op e r a te , t he H D R a f te rl o a de r uni t i s eq u i p pe d w i t h a n e m e rg e nc y b a c k up s o ur c e re t r a ct ba tt e ry t ha t w ill a u t o m a ti c a ll y re t r a ct th e s o ur c e i nto t he st or a g e p o si ti o n a nd i f a p a t ie nt i s b e i n g tr e at e d , w i ll r e co r d t he d at e a nd ti m e a t w hi c h t he p a t i e nt t r e at m e nt i s i n t e r r u pt ed .

If a l l t h e A C , U P S a n d e m e rg e nc y b a c k up s o ur c e r et r a c t b a tt e r y a l l f a il at t h e s a m e t i me , t h e o p e r ato r m us t f o l lo w t he e m e r g e nc y m a nua l s o ur c e r e t r a ct io n p ro c ed u r e ( s e c t io n 2 2 . 3 D . 1 ) . Fo r a ny o f t he a bo v e e m e r ge nc y o c c u r r e n c e s t h e H D R o p e r ato r m us t no t i f y the e m e r g e nc y c a l l l i st p o s te d a t t h e H D R c o n s o le .

D.3. Applicator Dislodging

In the event that th e a p pl i c at o r di s lo d ge s f r o m t he p at ie nt d ur i ng an H DR t r e at m e n t , o r a s o u r ce g u i de t u b e b e co m es d i s lo dg e d , t he f o ll ow i ng e m e rg e nc y s t e p s m u s t be t a k e n :

A c t i v a te H D R e m e r ge n c y o f f b ut t o n a t c o nt ro l c o nso l e . P.531

If t h e s o u r c e f a i l s t o r e t r a ct , f o ll o w e me rg e nc y m a nua l s o ur c e r e t r a ct io n p r o c ed u r e ( s e ct io n 2 2. 3 D . 1 ) . Im m e d i at e l y c o n s o le . n ot i f y in d i v i d ua l s on E m e r ge nc y call li s t p o st ed at H DR

D.4. Timer Failure

In t h e e v e n t t h a t t h e H D R tr e at m e nt ti me r f a il s to o pe r a te or t e rm i na te t he t r e at m e n t , t h e f ol lo w in g s t e p s m us t b e t a k en:

A c t i v a te H D R e m e r ge n c y O F F b ut t o n a t c o nt ro l c o nso l e . S t o p m a n u a l t i me r a t t i me t ha t e m e rg e nc y O F F b ut to n r e t r a ct s so ur c e ( t his m a n u a l t i m e r is s t a r ted a t t he b eg i nni ng o f e v e r y H D R t r e a t me nt ).

WWW.MEDRAD.IR

If

this

e m e rg e n c y

OF F

b ut to n

fails

to

re t r a ct

t he

s o ur c e ,

fo ll o w

t he

e m e r ge n c y m a n u a l s o u r c e r e t r a c tio n p r o c edur e ( s e c t io n 2 2 . 3 D . 1 ). Im m e d i at e l y c a ll p e r so n s o n e m e r ge nc y c a l l l i s t po s te d a t H D R c ons o l e .

22.4. HIGH DOSE RATE SOURCE CALIBRATION

A s d i s c u s s e d i n C h a p t e r 15 , t h e s t re ng th o f a b r a c hy t he r a p y s o ur c e m a y b e s p e c i f ie d i n t e r m s o f a c ti v i t y , e x p o s ur e r at e at a s pe c i f ie d d i sta nc e , e q ui v a le nt mass of r a di u m , a pp a r e n t a ct i v it y , or air kerma st r e ngt h. T he American A s s o c i a tio n o f P h y s i c is t s i n Me d i ci ne ( A A P M) r e c om m e nd s ai r k e rm a s t r e ngt h ( S k ) . In p r a c t i c e , S k i s de te r m i n e d f r o m e x p o s ure r a te ( X ) m e a s ur ed i n f r e e ai r at a d i s t a n c e o f 1 m f r o m t h e s o u r c e . T he r e l at io ns hi p b et w e e n S k a nd X ha s b e e n d e r i v ed i n s e c ti o n 1 5 .2 . If X i s m e a s u r e d i n R / h a t a d i s t a nc e o f 1 m , t he n E q ua t i o n 1 5 . 6 g i v e s :

T h e N a t i o n a l In s t i t ute o f S t a n d a r d s a nd T e c hno l o g y ( N IS T ) ha s e s t a b li s he d a i r k e r m a ( o r e x p o s u r e ) ca l i b r ati o n s t a nd a r d s f o r t he L D R b r a c hy t he ra p y s o ur c e s , f o r e x a m p le , r a d i u m ,

60

C o,

137

Cs, and

192

Ir . T he N IS T c a l i b r a t e s a w o rk i ng s t a nd a r d o f

e a c h s o u r c e t y p e a n d c o n s t r u c t io n w i t h s phe r i c a l g r ap hi te t himb l e c ha m be r s o f k n o w n v o l u m e u s i n g o p e n - a ir ge o me t r y . Be c a us e t he a i r vo l ume i n t he c ha m b e r c a v i t y i s p r e ci s e l y k n o w n , a n d t he c ha m b e r i s i r r ad i at e d unde r c o nd it io ns o f e l e ct r o ni c eq u i li b ri u m, e x p o s u r e r a te c a n b e me a s ur e d i n a c cor d a nc e w it h it s d e f i n it io n ( 1 R = 2 . 5 8 1 0 - 4 C / k g a i r ) . F o r l o we r e ne r g y L DR b r a c hy t he r a p y sources (e.g., The N IS T

125

I,

103

P d ) , t h e N IS T ha s d e v e l op ed a w i d e - a ng le f r e e - a ir i o ni z a tio n a s p h e r i c al r e -e ntr a nt ( w e ll ) c ha m b e r for c a li b r at i ng

c h a m b e r t h at i s c a p a bl e o f m e a s ur i ng r a di a ti o n f r o m a 2 a r e a o f t he so ur c e ( 6 ). also uses b r a c h y t h e r a p y s o u r c es . T h e c a l i b r a ti o n f a c to r s f o r t he se c ha m b e rs a r e m a i nt a i ned b y c o m p a r at i v e m e a su r e m e n t s w i t h a s p her i c a l t hi m bl e c ha m b e r us e d i n o p e n- a ir g e o me t r y o r t h e w i d e -a n g l e f r e e - ai r c ha m b er , d e p e ndi ng up o n t he s o ur c e t y p e . S e c o n d a r y c a li b r at io n l a bo r a to r ie s s uc h a s t he A c c r e dit e d D o sim e t r y C a li b r at io n L a b o r at or i e s ( A D C L s ) p r o v id e ca li b r at io n o f r e - e nt r a nt w el l ioni z a t i o n c ha m be r s f o r c o m mo n l y u s e d br a c h y t h e r a p y s o ur c e s . T he y c a n a l s o p r o v id e c a li b r at io n o f s t a n d a r d so u r c e s . T h e A D C L c al i b ra ti o ns a re d i re c tl y t r a c e a bl e t o N IS T b e c a use A D C L s p o s s e s s re f e r en c e c l a s s c ha m b e r s or s t a nd a r d s o ur c e s t ha t a r e c a li b r at ed b y t h e N IS T . F o r t h e u s e r s t o h a v e t he i r s o ur c e c a li b r at io ns t ra c e a b le to N IS T , t h e y s h o u l d g e t t h e i r w e l l c h a m b e r c a li b ra t e d b y a n A D C L o r a c q ui r e a n A D C L c a l i b ra t ed st a n d a r d so u r c e o f a g i v e n t y p e a nd d e si g n t o c al i b r at e t he w e ll c h a m b e r . U n li k e t h e L D R so u r c e s , t he NIS T ha s no s t a nd a r d, a s o f y et , f o r c a l i b ra ti n g H D R s o u r ce s . G o et s c h e t a l (7 ) ha v e d e s c r ib e d a m etho d o f c al i br a ti ng a t h i m b le - t y pe c h a m b e r f o r
137 192

Ir H D R s o ur c e s b y i nt e r po l at io n o f i t s r e s p o nse to

C s g a m m a r a y s a n d 2 50 k V p ( m e di um f i l te r ) x - r a y s . T o ens ur e e l e ct r o nic

e q u i li b ri u m , a w a l l p l u s c a p t h i c k ne s s of 0 . 3 g / c m 2 i s r e c om m e nd e d f o r all m e a s u r e m e n t s . A n o pe n - a i r g eo m et r y i s use d a t d i st a nc e s r a ng ing f r o m 1 0 t o 40 c m f r o m t h e s o u r c e i n a l o w s c a t t er P.532 e n v i r o n m e n t . B e c a u s e t h e t h i m bl e c ha m b e r b e a r s a N IS T e x p o s ur e c a li b r at io n f or

WWW.MEDRAD.IR

137

C s a n d 2 50 k V p x - ra y s , t h i s i n t e rp ol a ti v e m et ho d ca n b e c o ns id e r ed a s d i re c tl y

t r a c e a bl e t o N IS T .

A. Re-entrant Chamber
C a l i b r at io n o f
192

Ir H D R s o u r c e s w i t h a t hi mb l e c ha m be r us i ng o pe n- a i r g eo m et r y

i s a ti me - c o n s u m i n g p r o c ed u r e a nd i s not s ui t a bl e fo r ro ut i ne c a l i b ra ti o ns . T he n u c l e a r m e d i ci n e w e ll- t y p e c h a m b e r ( do s e c a l i b r at o r ) , w hi c h i s c o m m o nl y us e d f o r r o u ti n e c a li b r at ion o f L D R s o ur c e s ( sec t io n 1 5 . 2 B) , i s al s o no t s ui t ab le f o r c a l i b ra ti n g HDR s o u rc e s , because of its overly la r g e se ns i tiv e v o l um e a nd , c o n s e q u e ntl y , to o hi gh a s e n s i ti v it y . A w e ll - t y p e r e -e nt r a nt c ha m b e r o f s m al l er v o l u m e h a s b e e n d e sig n e d s p e ci f i c a ll y f o r The University of Wisconsin r e -e nt r a nt
192

Ir H D R s o ur c e s ( 8 ) . c ha m b e r 2 is fi ll ed with air a nd

io n

c o m m u n i c a te s to t h e o u t s id e ai r t hr o ug h a v e nt hol e . T he a c ti v e v ol um e o f t he c h a m b e r i s ap p ro x i ma t e l y 2 4 5 cm 3 , w hi c h f o r H D R m e a s ur e ment s i s j us t l a r g e e n o u g h t o gi v e a n op t im u m i o n i z a tio n c ur r e nt to b e m e a s ure d a c c ur a t e l y w i t h m o s t c li n i c a l el e ct r o me t e r s . A t h i n- w a ll ed al um i num t ub e i s f i tt ed o n t he a xi s of t h e c h a m b e r , w h i c h a ll o w s t h e i n s e rt io n o f H D R s o ur c e c a t het e r unt i l t he e nd o f it t o u c h e s t h e bo tt o m . T h e t h i c k n e s s o f al um i num b e t w ee n t he so ur c e a nd t he io nc o ll e ct i n g v ol u m e o f t h e c h a m b e r e x c e e d s 0 . 3 g / c m 2 , a s re q ui re d f o r at t ai ni ng e l e ct r o ni c eq u i li b ri u m w i t h

192

Ir g a m m a r ay s . T he b i a s vo lt a g e a p pl i ed t o t he Ir s o ur c e .

c h a m b e r i s a bo u t 3 00 V , w h i c h g i v e s io ni c c ol le c ti o n e f f i c ie nc y o f b et te r t ha n 9 9 . 9 6% f o r m e a s u r i n g a 6 . 5 C i ,
192

T h e H D R - s p e c i f i c r e -en t r a n t c h a m b e r i s c a li b r a te d b y a n A D C L us i ng c a l i b r at ed t h i m bl e c h a m b er s i n a n o p e n - a i r ge o me tr y , a s d i s c us s e d p r ev i o us l y . A y e a r l y c a l i b ra ti o n o f t h i s c ha m b e r b y t he A D C L is r e c o mm e nd ed . T he c o ns t a nc y o f it s c a l i b ra ti o n m a y b e ch e c k e d r o ut i nel y ( e .g . , b e f o re e a c h us e ) b y m e a ns o f a s t r o n ti u m - 9 0 y tt r i u m -9 0 o pt h a l m i c a p pl ic a t o r , w hi c h can be p o si ti o ned r e p r od u c i bl y a t t h e top o f t h e w e l l w he n t he c e nt r a l t ub e a s se m bly i s r e m o v e d . T h e i o n i z a tio n c u r r e n t r e ad i n g o f a r e -e nt r a nt c ha m b er i s d ep e nd e nt o n t he p o s it io n o f t h e s o u r ce i n t h e we ll . If t he s o ur c e i s po si ti o ne d a t t he m a x im um r e a d i n g p oi n t , t h e c ha m b e r r e sp o ns e i s t yp i c a ll y c o ns t a nt wi t hin 5 m m o f t he m a x i m u m r e a di n g p o si ti o n . F o r e x a m pl e , i f a s o ur c e c a t het e r i s i ns e r te d i n t he w e l l c h a m b e r ( al l t he w a y ) , t h e H D R s o ur c e m a y b e p r o g r am m e d to d w e ll a t m a x i m u m r e a d i n g pos i ti o n s t o ob t ai n m ul ti p le r e a di ng s . T he m e a n m a x i m um r e a d i n g m a y t h u s b e de t e rm i n e d t o c he c k t he s o ur c e s t re ng t h. T h e c a l i b r at io n f a c t o r f o r t h e c h a m b e r i s gi v e n i n t e r m s o f a i r k e rm a s t r e ng t h p e r u n i t r e a di n g . M e a s u re m e n t s c a n be o f e ithe r c ha r g e or c ur r e nt . In t he c ur r e nt m o d e o f m e a s u r e m e n t,

w h e r e S k i s t h e a ir k er m a s t r e n gt h o f t he so ur c e , I i s t he c ur r e nt r e a di ng , C T , P i s t h e c o r r e cti o n f o r tem p e r at u r e a nd p r e s sur e , N e l i s t he el e ct ro m et e r c a li b r at io n factor, NC is the ch a m b e r at the c a l ib r a ti o n of factor, Aion is t he ion r e c o m b i na ti o n is t he ion c o r r e ct io n factor time c ha m b e r c a l ib r a ti o n, a nd Pion

r e c o mb i n a ti o n co r r e ct io n a t t h e ti m e o f so ur c e c a li b r at io n. In t he i nt e g ra t e m od e, c h a r g e c a n be m ea s u r e d f o r a g i v e n i nt e r v al o r d w el l ti m e . E q uati o n 22 . 2 c a n b e u s e d to d et e r mi n e S k , w h e r e I i s t he i nt e gr a t e d c ha rg e me a s ur ed p e r unit ti m e a n d N C i s t he c h a m b er c a l i b r at io n f a c t o r i n t e r m s o f ai r k e r m a st r e ngt h p e r uni t

WWW.MEDRAD.IR

c h a r g e . F o r a r o u ti n e c a l i b r at io n o f t he H D R s o ur c e , i t i s p r e fe r a b le to us e t he c u r r e n t m o d e o f m e a su r e m e n t b e c a us e i t i s f r e e o f t he s o ur c e tr ans i t e f f e c t . P.533

22.5. TREATMENT PLANNING A. Simulation

T h e H D R t r e a t m e nt p l a n n i n g p r o ce s s s t ar t s w i t h t he p at i e nt p r e p a r at io n a nd p l a c e me n t o f a p pl i c ato r s , c a t h e t er s o r ne ed l e s , d ep e ndi ng up o n t he p r o c e d ur e . T h e p h y s i c i a n p l a ce s t h e i mp l a n t d e v i ce s in t he t r e at m e nt a r e a , no r m a l l y und e r l o c al a n e s t h e s i a , f o r e x a m p le , g y ne c o lo gi c a p p l i c ato r s w i t h p a lpa t io n a nd v i s ua l i n s p e c ti o n , unit such p ro s t at e as a t e m pl a te or and a with ult r a s o und , Marker wires. e nd ob r o nchi a l are t ub e i nto a ll o w w it h t he t he b r o n c h o s c op y g u i d a n ce . T h e p a t ie nt i s t hen s i m ul a t ed us i ng a n i s o c e nt r i c x - r a y C-arm s i m ul a to r . the m ar k e r wires T he se i ns e r t ed a p p li c a to r s a ll t h e w a y t o t h e c lo s e d e nd s . O r t ho go na l r a di o gr a p hs a r e o b t ai ne d t o l o c al i z e the ap pl i c ato r s r a di og r a p hs r a d i at io n o n c o lo gi s t to p l a n t h e t re a t me nt s e g m e nt a nd d w el l lo ca t io ns i n r e l a ti o n t o t h e d i st a l e n d o f t h e a pp li c a to r . N e x t , t he to t al l e ngt h o f t he ca t he te r r eq ui r ed f o r s o u r c e t r a v el i s de t e rm i n e d . T hi s i s a cc o m pl i s he d b y c o nne ct i ng t he t r a ns f e r guide tube to the ap p li c a to r a nd p a s s i ng a me a s ur e m e nt wire t hr o ug h t he c a t h e te r t o t h e d i st a l e n d . A m e a s ur em e nt cl i p i s a tt a c he d to t he w i r e at t he po i nt w h e r e i t e x it s t h e f re e e n d o f t he g ui de t ub e . T he w i r e i s t he n r e m o v e d a nd i n s e r te d i n t o a c al i bra t io n r u l e r unt i l t he m e a s ur e m e nt c li p i s at t he z e r o e nd o f the ruler. The catheter le n g t h is d et er m i ne d by r e a di ng t he t ip of t he m e a s u r e m e n t w i re w i th i n t h e c a t he t e r a g ai ns t t he r ul e r g r ad ua t ion. T h e s i m u l at io n f il m s a r e c ar e f ul l y l a be led w it h p at i e nt na m e, d a te , c a t het e r i d e n ti f i c at io n a n d l e ng t h , m a g n i f i c at io n f a c t o r a nd m a r k e r se ed s c o ns e c uti v e l y f r o m t h e di s t al e n d o f e a c h c at he te r . R eg i o ns o f i nt e re s t i nc lud i ng a na to m i c al s t r u c t u r e s w h e r e d o se c o n t r i b u tio n i s t o be c a l c ul a te d a r e d r a w n o n t he f i l m s .

B. Computer Planning B.1. Orthogonal Radiography-based

T h e c o m p u t er p l a n n i ng s e s s io n s t a rt s w i t h t he i np ut o f p a ti e nt a nd s i m ul a ti o n d a t a . O r t h og o n al f i l ms a r e s c a n n e d i nto t he c o m p ut e r a nd t he ta r g e t vo l um e s a s w e l l a s o rg a n s a t r i sk a r e o ut li ne d o n t he i m ag e s . Se l e ct ed do s e sp e ci f i c a ti on p o i nt s a r e m a r k e d a n d c a n b e u s e d t o op ti m i z e d o se di s tr i b ut ions a c c o r d i ng to constraints. M o s t o pt i mi z a ti o n met h o d s c o n s i st o f ob t ai ni ng de s i re d d o se s a t a num be r o f p o i nt s de s i g n at e d b y t h e pl a n n e r . T he c o des a r e w r it te n to s e a r ch f o r d w e ll t i me s t o de li v e r t h e de s i r ed d o s e s a t t he s e le c te d p o i nt s a s c lo s el y a s p o s s ib le . S e v e r a l a n a l y t i c t e c h n i q u e s o f o pt i mi z a t io n ha v e b ee n d i s c us s e d i n t he l ite r a t ur e i nc l ud i ng l e a s t sq u a r e s m i n i miz a t i o n ( 9 ) , li ne a r p ro g r a m mi ng ( 1 0 ) , s i mul a t e d a nne a li ng ( 1 1 ) , a n d o t h e r s ( 1 2 ,1 3 ) . It s h o ul d b e re a liz e d t ha t a lt ho ug h t hes e te c hni q ue s a re c a p a b le o f m e et i n g t he s p e ci f ie d do s e c o ns tr a i nt s , not a ll re s ul t in t he s a m e d o se d i s t ri b u tio n o r t h e s a m e s e t o f d w el l t i me s .

WWW.MEDRAD.IR

T r e a t m e nt

plans

are

i t e r at i v el y

o p ti m i zed

a nd

e v a l ua t e d

by

v i e w i ng

i s o do s e

c u r v e s i n di f f e r e n t p l an e s . B e c a u s e t he a p pli c a to r s do no t ne c e s s ar i l y l ie i n p l a nes p a r a l le l to t h o se o f t h e o r t h og o n a l f il m s , i t i s i m po r t a nt t hat a p p ro p r ia t e pl a ne s o f c a l c u l a ti o n a r e c h o s e n f o r d o s e s p e c i fi c a ti o n. F o r e x a m p l e , i n a t a nd e m a nd o v o i d c a s e , t h e f r o nt a l p l a ne o f c al c u l a ti o n s ho uld b e r ot a te d t o co i ncid e w it h t he p l a ne t h a t co n t a i n s t h e le n g t h o f t h e t a nd e m (or t he i ni ti a l s t r ai g ht p a r t o f a c ur v ed tandem) and bi s e ct s t h e v a gi n a l so ur c e s. In t he l at e r al v iew , t he pl a ne of c a l c u l a ti o n s h o u l d a ga i n i n c l u d e t he l e ngt h o f t he t a nd e m , w i t h t he v a g i na l s o u r c e s l y i n g a n t e ri or a n d p o s t e ri o r t o t ha t p l a ne . A f t e r p h y s i c i a n s r e v ie w a n d a p p r o v al , t he p l a n i s p ri nt ed o ut w i t h a l l t he i np ut a n d o u t p u t d at a i n c lu d i n g p l a n n e d so ur c e p o s it io ns a nd d w e ll t i m e s . A f lo p p y d i s k e tt e i s p r ep a r e d to e x p o rt t h e pl a n t o the H D R a f t e r l o ad e r c om p ut e r .

B.2. Three-dimensional Image-based

T r a d i ti o n al l y , c om p u te r t re a tm e n t p l a nni ng o f b r a c hy t he r ap y has b ee n b a s ed o n o r t h og o n a l P.534 d i s pl a y e d i n a n y p l a ne , it c a n n o t b e vi e w ed t hr ee - di m e ns io na l l y r e l at i v e to t he p a t ie n t a na t om y . W i th t h e a d v e nt o f t hr e e- d i m e nsi o na l ( 3 -D ) im a g i ng b y m e a ns o f c o mp u t ed t o mo g r aph y ( C T ) , m a g ne t i c r e so na nc e ( M R ) , a nd ult ra s o und s ( U S ) , it i s n o w p o s s i bl e t o per f o r m f u l l - f l ed g ed 3 - D t r e a t me nt p l a nni ng of b r a c hy t he r a p y i m p la n t s . S o f t w a r e h a s b e e n d e v el o pe d t ha t a ll o w s sl i ce - b y s lic e d el i ne at io n o f t a r g et s , a pp li c a to r s , a n d o r g a n s at r i s k . T he s t r uc t ur e s c a n be r e co ns t r uc t ed t h r e e - di m e n si o n a ll y an d v i e w e d i n a ny pl ane w i t h t he o v e r l ai d i s o do s e c ur v e s . T r e a t m e nt pl a n s c a n be e v al u a t e d b y vi e w i ng i so do s e c ur v e s , i so do s e s ur f a c e s , o r d o s e - vo l u m e h i st og r am s . A number of p ap e rs have been p ubl i she d m o st of on 3 -D t re a tme nt pl a nni ng to of LDR brachytherapy ( 1 4 , 1 5, 1 6 ) a l t h o ug h t he s e p r o g r am s pertain r a d io g r aph y . Although dose d i s t ri b utio n is c a l c ul a t ed in t hr e e d i m e n si o n s a n d c a n b e

b r a c h y t h e r a p y i n c l u din g p e r m a n e nt se ed im p l a nt s fo r t he t re a tm e nt o f p r o st a te c a n c e r . S o f t w a r e f o r 3 - D t r e at m e nt pl a nni ng o f H D R i m p l a nts i s und e r a c t i v e d e v e lo p me n t a n d s h o u l d b e co m m e r ci a ll y a v a i l a bl e i n t he v e r y ne a r f ut ur e .

C. Dose Computation
D o s e d i st r ib u t io n a r ou n d a l i n e a r
192

Ir s o ur c e us e d i n H D R a f t er l o ad e r s c a n be

c a l c u l a te d u s i n g a n u m b e r o f m et ho d s s uc h a s S i e v e rt i nt e g r al , T G - 4 3 f o rm a li s m o r M o nt e C a rl o . A s d i s c u s s e d i n C ha p te r 1 5 , t he T G - 43 f o rm a l i s m ( 1 7 ) ha s a d v a n t a g e s o v e r t h e S i e v e r t i n te g r al a p pr o a c h i n t ha t t he e f f e c t s o f v a r i o us p h y s i c a l f a c t o r s o n d o s e d i st r i b ut io n a r e c o ns i d e re d s ep a r a tel y a nd t ha t t he d o s im e tr i c q u a n t it ie s i n v o l v e d c a n b e i ndi v i d ua ll y m e a s ur e d o r c a l c ul a te d us i ng M o n t e C a rl o . T G -4 3 i s e s pe c i al l y s uit a bl e f or s o ur c e s o f co m pl e x d e s ig n o r t ho se i n w h i c h f i l t r at io n e f fe c t s o f t h e s o ur c e o r i t s e nc a p s ul a ti o n c a nno t be a c c ur a te l y m o d el ed a n a l y t i c al l y . B a s i c d a t a fo r a n u m b e r o f c o m me r c i al H D R s o ur c e s ha v e be e n m e a s ur ed o r c a l c u l a te d u s i n g T G - 43 a n d M o n t e C a r lo ( 18 , 1 9 , 20 , 2 1 ) . A lo ng a nd a w a y t a b l e s , dose r at e constant, radial do s e f unc t i o n, a nd a ni s o t r o p y f unc t io n for t he s e s o u r c e s h a v e b e e n p u b l i s h ed . H o w e v e r , a g i v e n H D R t r e a t me nt -p l a nni ng s y s t e m

WWW.MEDRAD.IR

m a y o r m a y n o t i n c o r p o r at e t h e s e d at a . F or e x a m p l e , s o me s y s t e m s a r e b a s e d o n the S i e v e rt i n te g r al or even a p oi nt so ur c e a p p ro x i m at io n, ig no r i ng o b li q ue f i l t r at io n t h r o u g h t h e s o u r c e o r i t s a ni so t rop y . T he us e r o f t he s e s y s t e m s m us t b e a w a r e o f t h e a c c u r a c y l i m it a ti o n s o f s uc h a l g o r it hm s . E v e n i f a s y s t e m u s e s T G - 4 3 f o rm a li s m b a se d o n m e a s ur e d d at a o r M o nte C a r lo , it m a y l a c k f u l l i m pl e me n t a ti o n . F o r e x a mp le , s o m e T G - 43 b a s ed s y s t e m s us e a n a v e r a g e a n i s ot ro p y f a c t o r i n st e a d o f t he a ni s o t ro p y f unc t i o n a s a f unc t i o n o f a n g l e . C o m me r c i al H DR s o u r c e s e x hi b it s ig ni f i c a nt a ni so t ro p y a lo ng t he a x i s , e . g . , i n t h e r a n g e o f 3 5 % to 6 0 % de pe nd i ng o n the s o ur c e m o d el ( 1 9 ,2 1 ) . It s ho ul d be p o i nt e d o ut t h a t e v e n t h e L D R s t e el - c l ad t o 23 % ( 1 7) . T a b l e s h a v e b ee n p u b l i s h ed t h a t g i v e dos e r a t e d i st r ib ut io n a s a f unc t i o n o f d i s t a n c e a w a y a n d a lo n g t h e a v a i l ab le H DR s o ur c e s (1 9 , 21 ) . The s e M o nte C a r lo d a t a c a n b e u s e d a s t h e b a s i s o f a d o s e c o m p ut a ti o n a lg o ri t hm o r a s q ua l i t y a s s u r a n c e o f t r e a t men t p l a n n i n g s y s t e m s fo r a f t e rl o ad e r s t hat us e t he s e so ur c e s . A l t e r n a ti v el y , T G - 4 3 f o r m u l a ( E q ua t io n 1 5 . 16 ) m a y b e us e d w i t h f a c t o r s m e a s ure d o r c a l c u l at ed s p e ci f i ca l l y f o r t h e g i v e n H DR s o ur c e . T he s e f a c t or s f o r t he a bo v e m e n t io n e d s o u r c e s h av e b e e n c a l c ul at e d us ing M o nt e C a r l o co d e s ( 1 9 , 2 1 ) .
192

Ir s e e d s ho w s a x i a l a ni s o t ro p y o f 1 9%

D. Plan Verification
In d e p e n d e n t v er i f i c at io n o f a co m p ute r pl an i s a n e s s e nti a l p a rt o f H D R q ua li t y a s s u r a n c e . S o m e o f th e s e c h e c k s c o ns i st of v e r i f y i ng t he a c c ur a c y o f i np ut d a ta s u c h a s d o s e p re s c r i pt io n , c a t h e te r le ng t hs, d w e l l t i me s , c ur r e nt s o ur c e s t re ng t h, e t c . Ot h e r s i n v ol v e i n d e pe n d e n t sp ot c he c ks o f do s e c al c ul at io n, m a nua l l y o r b y a s e c o n d c o mp u t e r pr og r a m . V e r i f i c at io n o f t he d o se a t t he p re s cr i p tio n p o i nt (o r a n o t h e r s u it a b le po i nt ) w i t h i n 5% i s cons i d e r ed r e a so na b le , c o ns i d er i ng t he s e v e r e do s e g r ad i e nt s e n c o u n t e r e d i n b r a c hy t he r a p y . A n u m b e r o f m a n u a l m e t h od s o f c he c k i ng H D R c o m p ute r c al c ul at io ns ha v e b ee n d i s c u s s e d i n t h e A A P M T a s k G r o u p N o . 5 9 (22 ) . T he r e a d e r i s r e fe rr e d to t he se f o r review P.535 a n d p o s si bl e ad op ti on i n t h e q ua l it y a s sur a nc e p r o gr a m . O ne o f t he si m p le st m e t h od s c o n s i st s o f u s i n g i n v e r s e s q ua r e l a w . T he d o s e i s ca l c ul a te d a t t he p r e s c r ip ti o n po i n t o r a t a p oi n t i n i t s cl o se v i c i ni t y , p r o vi d ed t he d i st a nc e o f t he p o i nt o f c a l c u l at io n f ro m t h e d we ll po s it io ns ( c e nt e r o f s o ur c e ) is a t l e a st t w i c e the a c ti v e l e n gt h of the source. As d i sc us s e d in s e c ti o n 15 . 3 A . 1 , at t he se d i s t a n c e s i n v e r s e s q ua r e l a w c a n b e a s s um e d w i t ho ut s i g ni f i c a nt l o s s o f a c c ur a c y . F o r a p o i nt s o u r c e o f
192

Ir , t h e T G - 4 3 f o r m ula ( s e e E q ua t io n 1 5 . 6 ) r e d uc e s to :

where

i s t h e do s e r at e a t a d i s t a n c e r i n t he me dium , i s t he d o se r at e c o ns t a nt fo r t he s o u r c e , g ( r ) i s t h e r ad i a l do s e f unc t io n a n d a n i s t he a v e r a ge a ni s o t ro p y f a c t o r. A s a f u r t h e r a p p ro x i ma t io n i n a m a nua l c hec k , g ( r ) a nd a n c a n e a c h b e e q ua t ed t o u n i t y . T h e n E q u a t i on 2 2 . 3 s i m pl i f ie s t o :

WWW.MEDRAD.IR

In p r a c t i c e , r i s m e a su r e d f r o m t he ce nt e r o f t he so ur c e at e a c h d w e ll po s it io n. Dose r at e s c al c u l a ted by E q u a t io n 22.4 at t he v a r io us dwell p o si ti o ns a re m u l t ip li e d b y t h e co r re s p o n di n g d w e ll ti m e s a nd s um m a t e d t o gi ve t he t ot al d o se . In t h e u s e o f E q u a tion 2 2 . 4 , c a re m us t b e t a k e n r e g ar d i ng uni t s . If S k i s gi v e n i n u n i t s o f a i r k e r m a st re n g t h ( U ) ( 1U = c G y c m 2 h - 1 i n a i r ) , t he n m us t b e i n t er m s o f d o se r at e i n t h e me d i u m ( w at e r ) p e r unit a i r k e r m a st r e ngt h (c G y h - 1 U - 1 ) . If S k i s gi v e n i n u n i t s o f a p p a r e n t a c ti v it y ( m C i ) , t he n m us t b e i n uni t s o f c G y h - 1 mCi-1. In o r d e r t o a s s e s s a gr e e m e nt w i t h t he c om p ut e r o ut p ut , t he v a l ue o f us e d i n Equation 22 . 4 s h o u ld be the same as us e d by t he c om p ute r p r og r a m . T he f o l lo w i n g v a l u e s h a ve be e n c al c ul a te d f o r t w o o f t he co m m e r ci a ll y a v a i l ab le H DR s o u r c e s u s i n g M o n t e C a r l o c o de s : V a r i S o ur c e ( V a r i a n O nc o l og y S y s t e m s ) , = 1 . 0 4 4 c G y h - 1 U - 1 ( 21 ) ; m i c r o S el e ct ro n ( N uc l e t r o n) , = 1 . 1 1 5 c G y h - 1 U - 1 ( 1 9 ) .

22.6. QUALITY ASSURANCE

A q u a l i t y a s s u r a n c e (Q A ) p r o g r am i s a se t o f p ol i ci e s a nd p r o ce dur e s t o ma i nt ai n t h e q u a li t y o f p at ie n t c a r e . W h e r e a s t he sta nd a r d s o f q ua l it y a re s et c ol le c ti v e l y b y t h e p r o f e s sio n , a Q A p r o g r a m i s d e si g ne d to f o ll o w t he s e s t and a r d s a s c l o se l y as p o s s i bl e wi t h and the m i ni m i z e li c en s e the o c c ur r e nc e T he of t r e a t me nt S t at e s m i st ak e s N ucl e a r c a us e d by e q u i p me n t m al f u n c t i on o r h u m a n e r r o r . T he d e si g n o f s uc h a pr o g r a m fo r H D R starts a p p li c at io n. U ni t ed Re g ul at o r y C o m m i s si o n re q u i re s t h e li c e n s ee t o m ee t c e r t ai n s t a nd a rd s i nc lud i ng pe r s o nne l e d u c a t io n a n d t r a i n i ng , o p e r at i n g pr o c ed ure s , e q ui p me nt s a f e t y c he c k s , r a d i a t io n m o n i to r i n g , e m er g e n cy p r o c ed u r e s , r e co r ding a nd m a i nte na nc e of t r e at m e nt d at a a n d r e po r ti n g o f a n y m i s a d mi n i s t r at io n. A p o li c y a nd g ui d a nc e d i r e ct i v e f o r t he H D R b r a c h y t h e r a p y l ic e n s e h a s b e e n p ub l is he d b y t he N R C ( 2 ) , w hi c h p r o v i d e s a t e m pl a te f o r d e si g n i ng a q u a l i t y m a na g eme nt p r og r a m a c c e pt a bl e to t he N R C ( o r A g r e e me n t S t a te ) . A s u m m a r y r e v i e w o f t he N R C r e q ui r e m e nts w a s p r e s e nt e d e a r li e r i n s e cti o n 2 2 .3 . It s h o ul d b e und er s t oo d t ha t a ll t e st s a nd p r o ce d ur e s w r i t te n i n t h e l i ce n se a p p li c at io n a r e l ega l l y b i ndi ng a nd t he re f o r e , r ep r e s e nt m i n i m u m Q A s t a n d a rd s . T h e s e s t a nd a r d s s ho ul d b e a ugm e nte d b y Q A t e s t s a nd p r o c ed u r e s r e co m m e nd e d b y p ro f e s s io na l o rg a ni z a t io ns , na t i o na l o r i nt e r nat io na l . T h e A A P M h a s p u b l i s h e d s e v e r a l do c um e nt s o n q ua l it y a s s ur a nc e i n r a d i a t io n t h e r a p y . F o r H D R , t h e r e a d e r i s r e f e r re d to T G - 5 9 ( 2 2 ) . A d d it io nal r e p or t s , T G - 5 6 ( 2 3 ) a n d T G -4 0 (2 4 ), a r e a l so us e f ul a nd s ho ul d b e c o ns ult ed . It s ho ul d be r e a li z e d t h a t be c a u s e o f t h e b r o a d r a ng e of H D R a f t e r l o a de r d e si g ns a uni v e r s a l s e t o f Q A t e s t s h a s n o t b ee n f o r m ul a te d . It i s e x p e ct e d t hat e a ch i ns t i t uti o n w i ll d e s ig n it s o w n Q A p ro g r a m , w h i c h ad d r e s se s t he c ha r a c t er i st i c s o f t he s pe c i f ic e q u i p me n t , N R C r e q u ir e m e n t s a n d t re a t me nt s t a nd a r d s s et f o r t he p r o gr a m . P.536

The

AAPM

r e c o m m e nd s

QA

t e st s

at

t hr ee

f r e q ue nc i e s:

d a il y ,

q ua r t e rl y ,

a nd

a n n u a l l y ( 2 3 ) . U n l e s s H D R t r e a t me nt s a r e g i v e n e v e r y d a y , i t i s s uf f i c i e nt to p e r f o r m d a il y Q A tes t s o nl y o n d a y s w he n p a t ie nt s a re t r e at ed. T he s e te s t s a r e d e s c r ib e d in se c ti o n 22.3. The q ua r te r ly QA e s s e nti a ll y c ons i s t s of s o ur ce

WWW.MEDRAD.IR

c a l i b ra ti o n a n d a m or e t h o ro u g h r e v i e w o f e q ui pm e nt f unc t ion. T he q ua r t e r l y i n t e r v a l c oi n c i d e s w i th t h e f r e q u e nc y w i t h w hi c h H D R s o ur c e s a re r e pl a c ed . T he a n n u a l Q A i s a c o m p r e h e n s i v e r e v ie w o f a ll e q uip m e nt , p ro c ed ur e s , a nd p a t ie nt records, ap p ro a c h in g the t ho ro ughne s s of i ni t ia l a c c e p t a nc e t e s ti n g / co m m i s si o n i n g o f t h e s y s t e m .

22.7. CLINICAL APPLICATIONS

H D R b r a c h y t h e r a p y c an b e u s e d e s s e nti a ll y f o r a ny c a nc e r t ha t i s s ui t a bl e f o r L D R brachytherapy. e n d o b ro n c h i a l P.537 o b s tr u c t io n b y l u n g c a n c e r , p o s to p er a ti v e t r e a t me nt o f e ndo me t ri a l c a r c i no m a ( v a g i n a l c u f f i r r a d i atio n ) , a n d l o c al i z ed p ro s t at e c a nc e r . T he use o f H D R i n t he t r e at m e n t o f ce r v i c a l c a r c i n o m a i s no t a s c o m mo n b e c a us e c lini c a l l y i t i s no t e x p e c te d t o o u t pe r f o rm t h e L D R t r e at m e nt in t e r m s o f d i s e a se cont r o l o r s ur v i v a l . H o w e v e r , H D R d o e s o f f e r t h e o re ti c a l ad v a nt a g e s o f be tt e r do se d i st r ib ut io n f o r t h e t a r ge t vo l u m e a nd g r e at e r sp a r i ng o f t he b l ad de r a nd r e ct um t ha n p o s s ib le w i t h t h e LD R . A l t ho u g h H D R i s no t y e t a w e l l -e s t a bl i s hed p ro ce d ur e f o r t r e at i ng c e r v i x c a n c e r , i t h a s t h e p ot e n ti a l to r e pl a c e L D R fo r p r a c ti c al r e a so ns i f not c l i n i c al . F i g u r e 22 . 2 s h o w s a n e x a m p le o f H D R us e in t he t r e at m e nt o f e nd o m et ri a l c a nc e r w i t h f a m i li a r i so do s e d i s t ri b u tio n a r o und o v o i d s . T he s ha p e o f t he i s od o se c ur v e s c a n b e o pt i mi z e d b y ad j u s t i n g d we ll t im e s as d i s c us s e d e a rl ie r . F ig ur e 2 2 . 3 i s a n e x a m p le o f H D R p r o s ta t e i mp l a n t us i ng ul tra s o und f o r g ui d a nc e . T hi s p r o c e d ure i s d i s c u s s e d i n C h a p t e r 2 3 . F o r f u r t he r r e v iew o f c l i ni ca l ap p li c at io ns o f H D R , t he r e a d e r i s r e f e r r ed to r e f e r e n c e 24 . The most co m m o n us e s of HDR are in t he t r e a t me nt of

WWW.MEDRAD.IR

F I G . 2 2 . 2 . A : A n t e r o p o st e rio r v i e w o f ov o i d s i n a s i m ula to r r a d io g r a p h. L a t e r al v i e w o f o v oi d s. C : Is o d o s e di s tr i b ut io n s ho w n i n t hr e e o r tho g o na l v ie w s .

B:

WWW.MEDRAD.IR

F I G . 2 2 . 3 . P r o s t a te gl a n d h i g h d o s e r a te im p l a nt s ho w n i n a t r a ns v e r s e c o m p ut ed t o mo g r ap h y s l i c e .

REFERENCES
1 . IC R U . D o s e a n d vo lu m e s p e ci f i c a ti o ns f or r e po r ti ng i ntr a c a v i t a ry t he r a p y . IC R U R e p o rt No . 38 . B e t hes d a , M D : Int e r na tio na l C o m mi s s io n o n R ad i a ti o n U ni t s a nd M e a s u r e m e n t s , 1 98 5 . 2 . N R C . P o l i c y a n d g u i d a n c e di r e ct i v e , F C - 86 4 ; R e v i sio n 1 : Inf o r m a t io n r e q ui re d for li c e n s i n g r e mo te a f t e rl o ad i ng d e vi c es . N uc l e a r Re g ul at or y C o m m i s si o n. W a s h i n g t o n , D C : U . S . G o v e r n m e n t P r i nti ng O f f i c e , 1 9 9 3 . 3 . N C R P . P r o te c ti o n ag a i n s t r a d i at io n f r om b r a c hy t he r a p y so ur ce s . N C R P R e po r t No. 40. W a s h i n gton DC: N a t io na l C ounc i l on R a di a ti o n P r o te c ti o n a nd M e a s u r e m e n t s , 1 97 2 . 4 . N C R P . S t r u c t u r a l s h i e l di n g d e si g n a nd e v a l ua t i o n f o r m e di c al us e o f x - r a y s a nd g a m m a r a y s o f e n e r gi e s u p to 10 M e V . NC R P R e p o rt N o . 4 9 . W a s hi ng t o n, D C: N a t io n a l C o u n c i l o n Ra d i a tio n P r o t e ct io n a nd M e a s ur e m e nt s , 1 976 . 5 . K l ei n E E , G r i s b y P W , W i l li a m s o n J F , M e i go o ni A S . P r e - i ns ta l l at io n e m pi r i c al t e s ti n g o f ro o m s h i eld i n g f or h i g h d o se ra t e re m ot e a f t e rlo a de r s . I nt J R a di a t O n c o l B i ol P h y s 1 9 9 3 ;2 7 : 92 7 9 31 . 6 . W e a v e r J T , L o f t u s T P , L o e v i n g e r R . N BS m e a s ur e m e nt s e r vi c es : c a l i b r at io n o f g a m m a - r a y - e mi tt i n g b r a c h y t h e r a p y s o ur c es N a t io na l Bur e a u o f S t a nd a r d s ( N IS T ) s p e c i al p ubl i c at io n n o. 2 5 0 1 9 G a it he r s b urg , M D : N a tio na l Bur ea u o f S t a nd a r d s , 1 9 88 . 7 . G o e t s c h S J , A t t i x F J , P e a r s o n D W , e t a l . C a l i b r at io n o f a f t e r lo a di n g s y s t e m s . M e d P h y s 1 9 9 1 : 46 2 46 7 .
192

Ir hi g h- d o s e r at e

WWW.MEDRAD.IR

8 . G o et s c h S J , A t ti x F H , D e W e r d L A , e t al . A ne w w e l l io ni z a ti o n c ha m b e r f o r t he c a l i b ra ti o n o f i r id i u m- 1 9 2 h i g h d o se r a t e s o ur c e s . I nt J R a d i a t O nc o l Bi o l P hy s 1 9 92 ; 2 4 :1 67 17 0 . 9 . A n d e r s o n L L . Pl a n o pt i mi z a ti o n a nd d o se e v a l uat io n i n br a c hy t he r a p y . S e m in R a d i a t O n c ol 1 99 3 ;3 :2 9 0 3 00 . 1 0 . R e n n e r W D , O C o n n e r T P , Be r m ud e z N M . A n a l g o r it hm f o r g e ner a ti o n of i m p la n t p l a n s f o r h i g h- d o s e r at e i r r ad i at or s . M e d P hy s 1 9 9 0 ; 1 7 :3 5 4 0 . P.538

1 1 . S l ob od a R S . O p t im i z a t io n o f b r a c hy t he r a p y d o se di s t ri b utio n b y s i m ul a te d a n n e a l i n g . M e d P h y s 1 9 9 2 ;1 9 : 95 5 9 64 . 1 2 . V a n d e r L a a r s R , P r i u s T P E . Int r o d uc t i on t o H D R b r a c hy t he r ap y o pt i mi z a t io n. In : M o u l d R F , B a t te r ma n n J J , M a r t i ne z A A , et a l . , e d s . Br a c hy t he ra p y f r o m r ad i um t o op ti m i z at io n . V e e n e n d a a l , T h e N e t he rl a nd s : N uc l e t ro n C o r p o r at io n, 1 9 9 4 . 1 3 . E z z e l G A , L u t h e r m a n n R W . C l i ni c a l i mp l e me nt a tio n o f d w e l l t i m e o p ti mi z a t io n techniques for s i n gle s t e pp i n g - so ur c e r em o te a p pl i c at o r s . In: W i l li a m s o n J, T h o m a d s e n B , N a t h R , e d s . B r a c hy t he r a p y p hy s i c s . M a d i s o n, W I: M e d i c al P hy s i c s P u b l i s h i n g , 1 99 4 . 1 4 . M c S h a n D L , T e n H a k e n R K , F r a a s B A . 3 - D t re a t me nt p l a nni ng : IV . I nt e g r a te d b r a c h y t h e r a p y p l a n n in g . In : B r u i m v i s I A D , e t a l . , e d s . P r o c ee d ing s o f t he N i nt h In t e r n a t i o n al 1 9 87 : 2 49 2 5 2 1 5 . S c h o ep pe l SL , L av i g n e M L , M a nte l M K, e t a l . T hr ee di m e ns i o na l t re a t me nt planning of i n te r c av i t y g y n e c o lo gi c i mp l a nt s a na l y s i s of ten cases a nd i m p li c at io n s f o r d o s e s p e c i f i ca ti o n. I nt J R a d i a t O nc ol Bi ol P hy s 1 9 9 3 ;2 8 : 27 7 2 83 . 1 6 . W ee k s K J . B r a c h y t h e r a p y o b je c t -o r ie nte d t r e at m e nt p l a nni ng b a s ed o n t hr ee d i m e n si o n a l 1 9 97 : 7 9 86 1 7 . N a t h R , A n d e r so n L L , L u x t o n G , et al . D o s i me t r y o f i nte r s ti tia l b r a c hy t he r a p y s o u r c e s : r e c om m e n d at io n s o f t h e A A P M R a d i a ti o n T he r a p y C o mm i tt e e T a s k G r o up N o . 4 3 . M e d P h y s 1 9 95 ; 2 2 :2 0 9 23 4 . 1 8 . M u l l er - R u n k e l R , C h o S H . A n i s o t r o p y me a s ur e m e nt s o f a hi g h d o s e r at e Ir - 19 2 s o u r c e i n a i r a n d p ol y s t y r e n e . M e d P hy s 1 9 9 4 ; 21 : 1 13 1 1 13 4 . 1 9 . W il li a m s o n J F , Li Z . M o n t e C a r lo a id e d d o s im e tr y o f t he m i c ro s e le c ti o n p ul s ed a n d h i g h d o s e - r a te dose r a te source
192

C o n f e re n c e :

the

us e

of

c o m p ute r s

in

r ad i a ti o n

t he r a p y .

S c h e v e n i n g e n , T h e N e t h e rl a n d s . N o r t h- H oll a nd : E l s e v i e r S c ie nc e P ub l i s he r s BV ,

i m a ge

gu i d a n c e .

In:

T ho m a d s e n

B,

eds.

C a t e go r i c al

c o ur s e

in

b r a c h y t h e r a p y p h y s i cs . O a k B r o o k , IL : R a d i olo g i c al S o ci e t y o f N o r t h A m e r i c a ,

Ir s o u r c e s . M e d P hy s 1 9 95 ; 2 2 :8 09 81 9 . w it h a m i nia t ur e io ni z a ti o n c ham b e r . M ed P hy s

2 0 . M i s h r a V , W a te r ma n F M , S u n t ha r a l i ng am N . A ni s ot r op y o f a n i ri d i um 1 92 hig h me a s u r e d 1 9 97 ; 2 4 :7 51 75 5 . 2 1 . W a n g R , S lo b od a R S . M o n t e C a r lo do s im e t r y o f t he V a r i So urc e hi g h do s e r at e
192

Ir s o u r c e . M e d P h y s 1 9 9 8 ;2 5 :4 1 5 42 3 . Kubo HD, Glasgow GP, P e t he l TD, et al. High d o s e - r ate b r a c hy t he r a p y

22.

t r e at m e n t de li v e r y : re p o rt o f t h e A A P M R ad i a ti o n T he r a p y C o mm i tt e e T a s k G r o up N o . 5 9 . M e d P h y s 1 9 98 ; 2 5 :3 7 5 40 3 .

WWW.MEDRAD.IR

2 3 . N a t h R , A n d er s on L L , M e li J A , et al . C o d e o f p ra c ti c e f or b r a c hy t he r a py physics: AAPM R a d i a t io n Therapy C o m m i tt e e Task G r o up No. 56. Med P hy s 1 9 97 ; 2 4 :1 55 7 1 59 8 . 2 4 . S t i tt J A , T h o m a d s e n B R . C l i n i c a l a p pl i ca t io ns o f l o w d o s e r a te a nd hi g h d o s e r a t e b r a c h y t h e r a p y . In : L e v i tt S H , K ha n F M , P o ti s h R A , e t al . , eds . T e c hno l og i c al b a s i s o f r a d i at io n t h e ra p y . P h i l a d el p hi a : L ipp i nc ot t Wi ll i a m s & Wi lk i ns , 1 9 9 9 :2 10 219
1 2

V a r i S o u r c e , V a r i a n O n c o l og y S y s t e m s , P a l o A l t o , C a l i fo r ni a . C o m m e r ci a ll y a v a i l a ble a t S t a n d a r d Im a g i ng, M i d d l eto n, W i s c o ns i n.

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Table of Contents > Part III - Modern Radiation Therapy > 23 - Prostate Implants

23 Prostate Implants
23.1. INTRODUCTION
T r e a t m e nt o p ti o n s f or c a r c i n o m a o f t he pr o s t at e i nc l ude r a di ca l p ro s t at e cto m y ( e . g . , n e r v e - s p a r i n g s u r g i c a l p r o ce d ur e ) , e x t e r na l p ho to n b e am i r r a di a ti o n a nd brachytherapy i mp l an t a t io n . The s e le c tio n of a p a rt i c ul a r p r o c ed ur e or a c o m bi n a t io n o f p ro c ed u r e s d ep e nd s o n e st a b li s he d p r og no s ti c f a c t o r s s uc h a s s t a g e , g r ad e , a n d p re- t r e at m e n t p r o st a te - sp e c i f i c a nt i ge n ( P S A ) c o nc e nt r a ti o n. In g e n e r a l , s u r g e r y i s i n d i c a te d i f t he t um o r is c o nf i ne d to t he pr os t a t e gl a nd w it h n o e x t e n s io n t h r o u g h t h e c a p s u l e o r i nt o t he s e m i nal v e s i cl e s . Im p l a nt s a re us e d for early s t a ge cancers, e i t h er a l o ne or in c o nj unc t i o n with e x t e r na l b e am r a d i at io n t h e r ap y . H ow e v e r , p a ti e nt s w i t h e x t e ns i v e t um o r s ( T NM s t a g e T 3 a nd T 4 ) a r e n o t go o d c a n di d a te s f o r i mp l a nt at ion. E x c e p t a s g e n e r al i n f o r m a ti o n , cl i ni c al a spe c t s o f p ro st a t e gl a nd c a nc e r a nd it s t r e at m e n t a r e be y o n d t h e s c o p e o f t hi s b oo k . T he r e a d e r i s r e f e r r ed t o a w e a l t h o f i n f o r m a ti o n o n t h i s s u b j e c t i n t he m e di ca l l it e r at ur e . In t hi s c ha p t e r w e w ill d i s c u s s t h e p h y s i c a l a n d t e c h n o lo g i c a sp ec t s o f p r o st a te g la nd i m p l a nt s us i ng r a d io a c ti v e s e ed s a n d h i g h - d o s e -r a t e b r a c hy t he r a p y .

23.2. SEED IMPLANTS

T w o t y p e s o f s e e d im p l a n t s h a v e b e e n us e d f o r p r o st a te g l and : a t e m p o r a r y i m p la n t a n d a pe r m an e n t i m pl a n t . T he tem p o r a r y i m p la nt s i nvo l v e r ad io i so to pe s o f r e l at i v el y lo n g h a l f - l i f e a n d s u f f i c i e nt d os e r a t e t o d el i v e r t he p r e s c r ib ed t a r get d o s e i n 3 to 4 d a y s . T h e s o u r c e s a re r em ov e d a t t he e nd o f t hat pe r io d . In t he p e r m a n e n t i m pl a n t t h e r a d ioi s ot op e ei t he r ha s a s ho r t ha l f - li f e (e . g . , g ol d - 19 8 ) o r e m it s p h oto n s o f l o w e n o u g h e n e r g y t ha t the r a d i at io n f r o m t he p a ti e nt po s e s no s i g n i f i c a n t h a z a r d t o p e r s o n s i n t he s ur r ound i ng e nv i r o nm e nt . T he s o ur c e s a re l e f t i n t he p at ie n t f ore v e r a n d t he p r e s c ri be d do s e i s d el i v er e d d ur i ng c om p le te d e c a y o f t h e s o u r c es . O f t h e s e t w o t y p e s o f s e e d i m pl a nt s , t he p e r m a ne nt i m p la n t s a r e g a i ni n g m o r e po p u l a ri t y a nd w i ll b e di s c us s e d i n g r ea t e r de t ai l .

A. Permanent Implants
P e r m a n e n t i m pl a n t s w i t h i o di n e - 12 5 o r p al l a di um - 1 03 a r e us e d i n t he t r e a tm e nt o f e a rl y s t a ge p ro sta t e c a n c e r a s t he so l e m od a li t y o r i n co m bi na t io n w i t h e x t e r n a l b e a m r ad i at io n t h e r a p y . T he t a rge t v ol um e f o r i m pl a nt a ti o n i n ei t her c a s e i s t h e p ro s t at e g l a n d i t se l f , w it h mini m a l m a rg i ns al lo w ed to a c co unt f o r u n c e r t a i n t y o f p r o st a te l o c al i z a tio n. W h i t m o re a n d H i l a r i s p i o n ee r ed p r o st a ti c im p l a nt at io n w i t h 1 9 70 s at M e mo r i al -S l o a n K e tt e ri ng C a nc e r C e nt e r .
125

I s e e d s i n t he e a r l y us e d r e t r op ub i c

T he y

a p p r o a c h , w h i c h e n t a il e d a m a jo r s ur g i c al pr o c e d ur e . T he t re a t me nt r e s ul t s w e re d i s a pp oi n t i n g a n d s o , b y t h e m i d - 19 80 s , t he r e t r op ub i c te c hni q ue w a s a b a nd o ne d .

WWW.MEDRAD.IR

T h e m o de r n te c h n i q u e o f i m pl a nt a tio n, w hi c h b e g a n i n t he 19 8 0 s , co ns i st s o f t r a n s p e ri n e a l a pp r o a ch i n w h i c h gland with the P.540 g u i d a n c e o f t r a n s r e cta l u l t r a s o no g r a p hy a nd p e r i ne al t em p l at e . T he p r o c e d ur e i s n o n s u r g i c a l a n d p er f o r m ed o n a n o ut p at ie nt b a s i s . T he im p l ant i s d o ne i n a n a p p r o v ed o pe r a ti n g r oo m w i t h t h e p at ie nt r eq ui r i ng a s p i na l a ne sthe t i c .

125

I or

103

P d s e e d s a re i ns e rt e d int o t he p ro s t at e

A.1. Volume Study

L o c a li z a ti o n o f p r o st a te b y a s e r i e s o f t r a nsv e r s e ul t r a so und i m a ge s c o ns t it ut e s a v o l u m e s t u d y . T h e pa t i e nt i s pl a c ed i n the d o r s a l l it hot o m y p o s it io n a nd t he t r a n s r e c t al u l tr a s o u n d p r o be ( 5 - t o 6 - M H z t r a ns d uc e r ) i s se c ur e ly a nc ho r e d . T he p r o be i s m o v ed p r e ci se l y to ob t ai n t r a ns v e rs e i m ag e s o f t he p ro st a t e g l a nd f r o m b a s e to a p e x a t 5 -m m i n t e r v a l s . A g rid i s s up e ri m po s e d on e a c h i m a g e to r e p r e se n t te m pl a te co o rd i n a te s . T he p r o sta t e gl a nd i s v i s ual i z ed o n e a c h o f t he transverse i m ag e s an d the i m p l a nt a ti o n t a r g et is drawn to e nc o m p a s s t he p r o st a t e . T h e s a g it t al i m a g e i s a l so o bt a i ne d t o me a s ur e t he l eng t h o f t he g l a nd f r o m t h e b a se to t h e a p e x . T h i s p ro v i des a d o ub le c he c k o f t he num b e r o f t r a n s v e r s e i m ag e s a n d t h e n u m b e r o f s e e d s r e q ui r e d f or t he c e nt ra l ne e dl e . P r i o r to t h e vo l u m e st u d y , e v a l ua t io n i s ma d e f r o m co m p ute d to m og r a p hy ( C T ) s c a n s o f t h e p ro s t at e g l a n d s i z e a nd t he p ub i c a r c h i n r el a ti o n t o t he p ro s t at e . If t h e p u bi c a r c h i s too n a r r o w it w o uld p re v e nt t he nee d le s f ro m re a c hi ng t he t a r g et . In t h e c a s e o f a l a r g e g l a nd a nd sig ni f i c a nt p ubi c a r c h int e r f e r e nc e , t he p a t ie n t m a y n e e d h o r m o n a l t h e r a p y f o r a f e w m o nt hs t o s hr i nk t he g l a nd t o a ll o w f o r a n a d e q u a te i mp la n t . S o m e r a di a tio n onc o l og i st s p re f e r ho rm o na l t her a p y i n most cases to r ed u c e the g l a nd s i ze to m i ni m i z e t e c hni ca l p r ob l em s of i m p la n t a ti o n .

A.2. Treatment Planning

A t r e a t me n t - pl a n n i n g s y s t e m s p e ci f i c a ll y d e s ig ne d f o r p ro s t at e g l a nd i m pl a nts a l lo w s center) the and of t a r ge t a ou t l i n e s f ro m of t he 1 v olum e cm. g ri d T he in s t ud y to be dig i ti z e d i nto t he t he c o m p u te r . T h e i m pl a n t i s pl a n n e d w i t h a n i nt e r se e d sp a c i ng o f 1 c m ( c e nt e r to n e e d le s e ed s in spacing the c o m p ut e r each of s o f tw a r e allows p l a c e me n t t e m pl at e t he ul t r a s o und image.

In d i v i d u a l s e ed s c a n b e a d de d o r d el et ed i te r a ti v e l y to op ti m i z e is o d o se c o v er a ge o f t h e t a rg et v o l u me. S e e d s t re ng t h c a n b e a d j ust e d t o d el iv e r a p r e s c ri b ed m i n i m u m p e ri p h e r al d o s e ( M P D ) w hi c h i s t he i s od o se s ur f a c e j us t c o v e r i ng t he p r o st a t e t a rg et v ol u m e . Before t he a v a il a b il it y of co m p ut e r d o si m et r y , s e ed s t r e n gt h a n d t h e r e qu i r e d n u m b e r o f s e eds w e r e d e te r m i ned by t he m e t ho d o f d i m e n si o n a v e r a g i n g u s e d i n c o n j unc t i o n w i t h a p r e c a l c ul a te d nom o g r a m ( 1 ) . T he m o d er n c o m p u te r p rog r a m s a ll o w t he us e o f a ny s e e d st r e ngt h a s w e l l a s f i ne a d j u s t m e nt o f t h i s p ar a m e te r to o bt a i n t he d e s i re d M P D . T y p i c a l s e e d s t re ng t hs r e q u i r ed a re o n t h e o rd e r o f 0 .3 m C i f o r (MPD = 125Gy). B a s e d o n t h e a p p ro v e d c o m p ut e r pl a n, a w o r k s he e t i s p re p a red s p e c i f y i ng t he n u m b e r o f n e ed le s , se e d s i n e a c h nee d le a nd t he t e mp l at e co or d i na te s . F i g ure
125

I ( M P D = 1 4 4 G y ) a nd 1 . 7 m C i f o r

103

Pd

WWW.MEDRAD.IR

2 3 . 1 ( s e e co lo r i n s e r t) s h o w s a n e x a m p l e o f p r e - i mp l a nt tr e at me nt p l a n f o r a l o n g w it h t h e d o s e - vo l u m e h i st o gr a m a nd s t a ti s ti c s .

125

P o s t - im p l a nt do s i me t ry m a y a l s o b e p e r f orm e d us i ng C T s c a ns to a s s e s s s t a bi li t y o f t h e i mp l a n t a ft e r s w e l li n g o f t he p r os t a t e g l a nd ha s go ne d o w n. A m a j or p r o bl e m w it h p e r m a ne n t s e e d i m pl a nt s i s t he us ua l d i s a g r ee me nt b et w e e n t he p r e - i mp l a nt a n d p o st -i m p la n t d o se di s t ri b uti o ns . H o t a nd c ol d s po t s c a n d e v el op a s a r e s u l t o f s o u r ce m o v e m e n t wi t h ti m e ( F i g . 2 3 . 2) ( s e e co lo r i ns e r t ) , le a v i ng o n e to w o n d e r i f t h e pr e s c r i be d d o se w a s d el i v e re d to t he t a rg et ac c ur a t e l y w it h a p a t te r n o f d o se d i st r ibu t i o n a s o r ig i na ll y p l anne d . A n o t h e r e q u al l y s e ri ou s p r o bl e m i s t ha t o f s o ur c e a ni s ot ro p y . Bec a us e o f t he l o w g a m m a r a y e n e r g y e m i tt e d a n d t he de s ign o f t he s o ur c e i n w hi c h r a d i a t io n i s s e v e r e l y a tt e n u a t ed al o n g t h e l e ngt h o f t he s e e d , c ol d sp ot s o f gr e a t er t ha n 50 % ( r e d u c ti o n i n d o se ) e x i s t at t h e e nd s ( s ee Fig s . 1 5 . 4 a nd 1 5 . 6 ) . Thi s a ni s ot r op y i n d o s e d i st r ib u t io n h ow e v e r , i s m or e o f a p r o bl e m i f t he s o ur c e s a r e al ig ne d p e r m a n e n tl y e n d to en d w i t h e a c h ot he r alo ng s t r ai g ht l i ne s . A c e r t ai n d e g re e o f randomness P.541 that n at u r a l l y d e v el op s a f te r i mp l a nta ti o n re duc e s t he o v e r al l a n i s o t ro p y e f f e c t i n a p r o st a t e g l a nd i mp l a nt .

T h e s e e d a n i s o tr o p y h a s b e e n s i g ni f i c a nt l y r e d uc ed b y a ne w l y d e s i g ne d C h a r a c t e r i st i c s o f t h i s s o u r c e h a v e b e e n d i sc us s e d b y N a t h a nd Y ue ( 2 ) .

125

s o u r c e ( m od el L S - 1 B r a c h y S e e d m a nuf a c t ur e d b y D R A X IM A G E I nc . 1 ) . D o s i me t ri c

F I G . 2 3 . 3 . S c h e m a t i c d i ag r a m s ho w i ng ul t ra s o und - g ui d ed t r a ns pe r i ne al te m pl a te i m p la n t p ro c ed u r e . (F r o m G r im P D , Bl a s ko J C , R a g de H . A tl a s o f t he U r ol og i c C l i n i c s o f N o rt h A m e r ic a 1 9 9 4 ;2 : 11 3 1 25 , w i t h p e r mi s s io n. )

A.3. Implant Procedure

T h e i m p l a n t p ro c ed u r e i s c a r r ie d o ut a s a n o ut p a ti e nt t r e at m e nt i n a n o p e r a t i ng r o o m w it h t h e p at i e nt i n t h e do r s a l li t hoto m y po s it io n und e r sp i na l a ne s t he si a . Figure 2 3 .3 shows the i m pl a n t a ti o n a pp a r a t us c o ns i st i ng of a t r a ns r e c t a l

WWW.MEDRAD.IR

u l t r a s o u n d p ro be a n d a t e mp l at e t o g ui de s p e c i f i ca ll y d e si g ne d s t e ri l e 1 8 -g a ug e , 2 1 - c m lo n g n e ed le s . T h e n e e d le s a r e p r el o ad e d w it h t he pl a nne d num b e r o f s e ed s a n d s p a c e r s a n d p l a ce d i n a n e e dl e ho ld e r a t a p p ro p r ia t e t e mp la t e c oo r di na t e s. T h e n e e d l e l o ad i n g p r o c ed u r e i s pe r f o r me d b e hi nd a n L - s ha pe d le a d ed g l a ss b a r r i er . E a c h n e e d l e is e q u i pp e d wi t h a pl ung e r a nd t he t ip i s se a l ed w i t h b o ne w a x t o k e e p t h e s ee d s i n p l a c e u nt i l i m pl a nta t io n. T h e n e e dl e s a re i n s e r te d o n e at a t im e i nto t he p ro s t at e us i ng t he ul t r a so und a nd t e m pl a te g u id a n c e . In each case, u s i ng s a g it t al i m ag es a nd d i s t a nce m e a s u r e m e n t s f r o m th e h u b o f t he nee dl e t o t he t e m pl at e , it i s a s c e r t ai ne d t ha t t h e n e e dl e ti p i s at t h e c o r r e ct p l a ne and d e p t h. A f t e r v e r i fy i ng t he ne e d le p o s it io n , t h e n ee d le i s s l o w l y w it hd r a w n w hi l e t he p l ung e r i s hel d s t a ti o na r y . T hi s a c t io n r e s u lt s i n t h e in j e c t io n o f t he s e ed s a nd t he sp a c e r s i nto the t i s s ue s a lo ng t h e t r a c k o f t h e w i t h dr a w i n g n e e d l e . E a c h u l t r a so und i m a g e i s c ar e f ul l y r e v i e w ed t o a s se s s t h e p o si ti o n o f t h e se e d s . Fi na l ve r i f i c at io n o f t he i mp la nt i s m a de w it h a n t e r op o st e ri o r f l u o ros c o p y . E x t r a s e e d s a r e a v a i l a bl e f o r i m pla nt a t io n i f c o l d s p o t s a r e id e n ti f i ed . C y s t o s c o p y i s p e r f o rme d at t he c o ncl us i o n o f t he p ro c e d ur e t o r et r ie v e a n y s t r a y s e e d s i n t h e bl a dd e r o r t he ur e t hr a . F o r f u r t h e r t e c h n i c a l d e t ai l s o f t he o pe r a tiv e t e c hni q ue a nd i mp l a nt p ro c ed ur e , t h e r e a de r i s r e f e r re d t o G r i m e t a l . ( 3 , 4 ) .

A.4. Radiation Protection

T h e A A P M c o d e o f p r ac t i c e f o r b r a c hy t he r a py ( 5 ) i s a co m p re he ns i v e do c um e nt o n the physics and qu a l i t y a s s ur a nc e of b r a c hy t he r a p y p r oc e d ur e s . Be f o r e i m p le m e nt i n g a p r o st at e P.542 i m p la n t p r og r a m , o n e s h o u l d c o ns ul t t hi s d o c um e nt to ge t he r w i t h t he r e le v a nt N u c l e a r R e g ul a to r y C om m i s s io n r e g ul a ti o ns . T he b a s i c re q ui re m e nt f o r re le a s i ng a p e r m a n e n t i m pl a n t pa t i e nt f r o m t he ho s pit a l i s t ha t t he to t al e x p o s ur e t o a ny o t h e r i n d i vi d u a l f ro m t h e r el e a se d p a ti e nt d o e s no t e x c e ed 0 .5 re m o v e r t he li f e o f t h e i m pl a n t . T h i s c o n d it io n i s e a s i l y m et w i t h a p r o s t a te i m pla nt us i ng
103 125

I or

P d s ee d s . L o w e n e rg y r a d i a ti o n i s l o c al ly a b s o r b ed w i t hi n t he p a ti e nt , po s i ng

l it tl e r i s k t o s u r r o u n di n g o r g a n s o r p eo p le . H o w e v e r , p a t i e nt s ar e i ns t r uc t ed a t t h e ti m e o f d i s c h a r ge to o b se r v e c er t ai n p r e c a uti o ns . F o r e x a m p l e , t he y a re a d v i s e d n ot t o h a v e p r o lo n g ed p hy s i c a l c ont a c t w i t h p r eg na nt w o m e n o r y o ung c h i l d r e n f o r a pe r io d of 2 mo n t h s , to ab s t ai n f r o m se x ua l a ct i v it y fo r 2 w e e k s , a nd t o u s e c o n do m s d u r in g i n t e r c o u r s e f o r t he f i r s t f e w w e e k s i n c a s e a s e e d i s d i s c h a r g ed i n to t h e v a g i n a . D u r i n g t h e im p l a nt p ro c e d u r e , a me di c a l phy s i c i s t o r d o si m et r i st a s si s ti ng i n t he p r o c ed u r e al s o a s s u re s t h at t h e t ot a l num b e r o f se e d s i s a c co unt e d f o r at al l t i me s . A t h i n w i n do w G M t u b e o r a s ci nt il lat io n c o unt e r i s a v ai l ab l e to lo c a te a ny d r o pp e d o r m i s pl a c ed s e e d . P e r so nne l a r e no t a ll o w ed to l e a v e t he o p e r ati ng r o om w i t h o u t be i n g s u r v e y e d to p r e v e nt a c ci d ent a l t r a ns po r t o f a ny s e e d o ut si de t he r o o m . A t t h e c o n c l u s io n o f t h e p r o ce d ur e , the t r a s h, t he r o o m , and t he p e r s o nnel a r e s u r v e y e d f o r a n y m i s p la c e d s ee d .

B. Temporary Implants
WWW.MEDRAD.IR

T e m p o r a r y p r o st at e g la n d i m pl a n t s ha v e alm o s t e x c l us i v el y us e d i r id i um - 19 2 . T he t r e at m e n t i s gi v e n ma i n l y a s a bo o st t o e x t e r na l b e a m t he r apy ( 6 , 7 a nd 8 ) . T r a d i ti o n al l y , t h e s e im p l a n t s h a v e b ee n c a r r i e d o ut a t t he ti m e o f l a p a ro to m y a nd p e l v i c - no d e guidance of s a mp li n g. a The needles are i m p la nt e d Ir i d i um i nt r ao p e r at i v el y in pl as t i c with t he are t r a n sp e r i n e al t e m pl a te . se e d s ri b bo ns

a f t e r lo a de d i n t o t h e ne e dl e s a n d l e f t i n pl ac e f o r a bo ut 3 d a y s . U s ua l l y 1 0 to 15 n e e d le s a r e r e q ui r e d f o r t h e i m pl a nt . T he p a t ie nt i s ho s pi t al i zed a nd b e d - bo und f o r t h e d u r a t io n o f t h e i m p l a n t , r eq ui r i ng a na l g e si a . C u r r e n t r e f i n e m e nt s in t h e t e mp o ra r y i m pla nt a t io n t e c hniq ue i nc l ud e ult r a s o und guidance, a v oi di n g op e n l ap a r ot om y . H ow e v e r , p a ti e nt ho s pit a li z a t io n i s s ti ll r e q u i r ed w it h t h e att en d a n t r a d io p ro te c ti o n p r ob l em s f o r p e r so nne l ad m i ni st e ri ng p o s to pe r a ti v e c a r e .

23.3. DOSIMETRY A. Calibration

B r a c h y t h e r a p y s o u r c es a r e c al ib r a te d b y t he v e nd or be f o r e s hi pm e nt a nd b e a r a c a li b r a tio n c e r t i f i c at e w it h s t a te d l i mi t s o f unc e r t a i nt y , us ua l l y 1 0 % . A l t ho u g h v e n d o r c a l i b r at io ns a r e , i n m o s t c a s e s , t r a c e abl e to t he N a t io n a l In s t i t u te o f S t a n d a r d s a nd T e c hno lo g y ( N IS T ) , t he us e r i s a d v i s ed t o c h e c k t h e c al ib r a tio n v a l u e s o f a s a mp le o f so ur c e s f r o m t he ba t c h a s a m a t te r of q u al it y assurance. A g r e e m e nt w i t hi n 5% w it h t he v e nd or c a l i b ra ti o n i s a c ce pt ab l e , i n w h i c h c a s e t he v e nd o r v a l ue s m a y be us e d f or p a t ie n t do s e c al c u l a tio n s . In c a s e o f a l a r g e r d i s ag r e em e nt , t he us e r m us t r e s ol v e t h e d i f f e re n c e w i t h t h e v e nd o r a nd i f uns uc c e s s f ul , us e t he i nh o u s e c a l i b r at io n , w i th f u l l d o c u m e nt a ti o n of t he p r o c e d ure us e d . T h e N IS T u s e s l a r g e - v o l u m e io n c ha m b e rs i n a o p e n- ai r g eom e t r y to c a l i b ra t e
192

Ir s o u r c e s a n d f r e e - ai r i o ni z a t ion c ha m b e r f o r

125

I (9 ,1 0 ) . T he

s t a t ed u n c e r t ai n t ie s in t h e s e c a li b r at io ns a r e o n t he o r d er o f 2 % . T he N IS T c a l i b r at io n t e c hn i q u e s r eq ui r e c o ns ide r a b le at te nt io n to de t a il a nd a r e n o t p r a ct i c al f o r ro u t i n e u s e . T h e m o st s u it a bl e m et h o d o f ro u ti ne c al i b ra t io n o f b r a c hy t he r a py s o ur c es i s t h e w el l i o n i z at ion o r r e - e n t r a nt c ha m b e r . A s d i s c us s ed i n s e c ti o n 15.2B, axis of a nuclear the m e d i ci n e d o se c a li b r ato r may be c o nv e r ted ho w e ve r , i nt o a b r a c h y t h e r a p y w el l ch a m b e r b y p l a ci ng a s o ur c e - hol di ng t ub e a l o ng the c h a m be r . The c ha m b e r re s p o ns e , d e pe nd s s i g n i f i c a n tl y o n t h e en e r g y o f r ad i at io n, so ur c e co ns t r uc t io n, and s o ur c e p o s it io n a lo n g t h e c h a m b e r a x i s . It i s t her e f o r e e s se nt ia l t hat t he w ell c h a m b e r b e a r s a N IST - t r a c e a bl e c al ib r a ti on s p e c i f i c al l y f o r t he t y p e of s o u r c e t o b e c a li b r at ed . P.543

T h e w e l l c h a mb e r c al ib r a t io n f o r g i v e n t y p es o f s o ur c e s m a y b e o b t ai ned f r o m t h e A c c r e d it ed Do s e C a l ib r a ti o n L a bo ra t o ri e s ( A D C L s ) w hi c h m a i nt a i n t r a c e a bi li t y w i t h t h e N IS T . A l t e r na t i v el y , the c ha m b e r m a y b e ca l i b r ated i n - h o u s e b y u s i n g a s t a n d a r d so ur c e o f t he s a m e t y pe , w hi c h ha s b e e n c a l i b ra t ed b y a n A D CL . T h e st a n d a r d so ur ce s ho uld not o nl y be t he s a me

WWW.MEDRAD.IR

R a d i o n u c li d e b u t al s o h a v e t h e s a m e co ns tr uc t i o n o r m od el . In a d d it io n, t h e c a li b r at io n g e om et r y ( s o u r c e po s it io n a l o ng t he c ha m b e r a x is ) s ho uld b e t h e s a me fo r t h e st a n d a r d so ur c e a s f o r t he s o ur c e to b e c al ib r a t ed . If d i f f e r e n t so u r c e po s iti o n s a r e i n te nd ed a p pr o p ri a te c o r r e ct io ns s ho ul d be d e te r m i n ed a s a f u n c t i o n o f s o u r c e p o si ti o n.

B. Dose Computation
D o s e d i st ri b u ti o n a rou n d
125

I,

103

Pd, or

192

Ir i s not i sot r o pi c . A na l y t i c al

m e t h od s o f d o se c a l cu l a t io n s s u c h a s S i e ve r t i nt eg r a l ar e not sui t a bl e f or t h e s e so u r c e s be c a u s e o f c o mp le x i t y i n s o urc e c o ns t r uct io n, f i l tr a ti o n, a nd l o w e n e rg y o f t h e e mi tt e d r a d ia ti o n. T he AA P M T a s k G r o up 4 3 or s i m pl y T G - 4 3 f o r m al i sm ( 11 ) g et s a ro u n d t hi s p rob l e m b y pa r a m et r i z i ng t he do s e d i s t ri b u tio n around a specific s o ur c e type in terms of a c t ual m e a s u r e m e n t s o r d eta i l ed M o n te C a r l o c alc ul a t io ns . T he g e ne ra l T G - 4 3 e q u a t io n ( E q u a t io n 15 . 1 6 ) f o r t he c a li b r ati o n o f do s e at a p oi nt P ( r , ) w h i c h i n c l u d e s a n i s o t ro p y e f f e c t s , i s a s f o ll ow s :

w h e r e [ D w i t h dot a bo v e ] ( r , ) i s t he d o se r a te a t p oi nt P i n a m e d i um ( e . g . , w a t e r ) , i s t h e d o se r a te c o nst a nt , S k i s t he ai r k e r m a st r e ngt h o f t h e s o u r c e , G i s t h e ge o m et r y f a c t o r , g i s r a d i a l do s e f unc t io n a nd F i s t he a n i s o t ro p y f u n c t i o n . T h e s e q u a n t i ti e s a r e d ef i ne d i n C ha p t e r 1 5 . In order to use E qu a t i o n 23.1 ri go r o usl y for an im p l a nt , t he s ee d o r ie n t a ti o n m u s t b e k n o w n a n d f i x e d . In p r o s t at e gl a nd i m pl a nt s , a l t ho ug h s e e d s a re p l a ce d a lo ng s t r a ig h t li ne s w i t h k no w n c o o r d i na te s , t he i r po s t i m p la n t o r ie n t at io n b e c o me s s o me w ha t r a nd o m i z ed a nd variable w it h t i me . It i s t h e r e fo r e ac c e p t ab le to t r e at t hes e s e e d s a s poi nt s o ur c e s i n a d o s e c al c u l a ti o n f o r ma l i s m . F o r a po i nt so ur c e , E q ua t i o n 2 3 .1 r e duc e s t o :

where

i s t h e a v e r a g e a n i so tro p y f a c t o r . C ur r e nt v a l ue s o f , g ( r ) a nd

f o r p r o st a te i m pl a n t so u r c e s a r e g i ve n i n T a b l e s 23 . 1 , 2 a nd 2 3 .3 .

TABLE 23.1. RECOMMENDED DOSE RATE CONSTANTS IN A WATER MEDIUM

WWW.MEDRAD.IR

Seed

cGy hr-1 U-1

192

Ir

1.12

Ir o n c l a d

125

I m o d e l 67 0 2

0.93

125

I m o d e l 67 1 1

0.88

103

P d m o d el 2 00

0.74

From

Nath

R,

Anderson

LL,

L ux t o n

G,

et

al.

D o si m et r y

of

i nt e r s ti ti a l

b r a c h y t h e r a p y s o u r c es : r e c o m m e nd at io ns o f t he A A P M R a d i a t io n T he r a p y C o m m it t ee T a s k G r o u p n o . 4 3 . M e d P hy s 1 9 9 5 ; 22 : 2 09 2 3 4 , w it h p e r m i s sio n.

TABLE 23.2. RADIAL DOSE FUNCTIONS, g ( r )

R a d i a l D ose F u n c t i on , g ( r ) Distance Along

103

Pd

126

M od e l

125

M od e l

192

Ir

Transverse Axis (cm)

6711

6702

0.5

1.29

1.04

1.04

0.994

1.0

1.00

1.00

1.00

1.00

1.5

0.765

0.926

0.934

1.01

2.0

0.576

0.832

0.851

1.01

2.5

0.425

0.731

0.760

1.01

3.0

0.310

0.632

0.670

1.02

3.5

0.224

0.541

0.586

1.01

WWW.MEDRAD.IR

4.0

0.165

0.463

0.511

1.01

4.5

0.123

0.397

0.445

1.00

5.0

0 . 0 8 93

0.344

0.389

0.996

5.5

0.300

0.341

0.985

6.0

0.264

0.301

0.972

6.5

0.233

0.266

0.957

7.0

0.204

0.235

0.942

7.5

0.927

8.0

0.913

8.5

0.900

9.0

0.891

From

Nath

R,

Anderson G ro u p

LL, no.

L ux t o n 43 .

G,

et

al.

D o si m et r y 1 9 9 5 ;2 2 :

of

i nt e r s ti ti a l with

b r a c h y t h e r a p y s o u r c es : r e c o m m e nd at io ns o f t he A A P M R a d i a t io n T he r a p y C o m m it t ee p e r m i s sio n . Task Med P hy s 2 0 9 2 34 ,

A t r e a t me n t - pl a n n i n g s y s t e m f o r p r o st a te g l a nd i mp l a nt s us ua l ly ha s t he r e f e r e n c e d at a ( , g ( r ) a n d a n ) s t o r ed f o r a num b e r o f c o mm e r c i al l y a v a i l a bl e se ed s . It i s t h e re s po n s i bi li t y o f t he us e r to a s s ur e tha t t he se data pe r t ai n to the type of s o ur c e s to be i mp l a nte d a nd r e p r e se nt c u r r e n t l y a c c e pt e d v a lu e s ( e . g . , p ub l i s he d in p e e r - r e v ie w e d li te r at ur e ) . P.544

B.1. Total Dose

As the so u r c e s de c ay with a ha l f - li f e T1/2, t he d o se r at e de c r e a s es e x p o n e n ti a ll y w i t h t i me t a s :

WWW.MEDRAD.IR

w h e r e [ D w i t h d o t a bov e ] i s t h e d o s e r a te ( d D/ d t ) a nd [ D w i t h d ot a b o v e ] 0 i s t h e i ni ti a l do s e r ate a s g i v e n b y E q ua t ion 2 3 . 2 . T he c um ul a t ed d o se D c i n t i m e t i s o bt ai n e d by i n t e g r a ti ng E q ua t io n 2 3 . 3 :

w h i c h i s t h e s a m e a s E q u a t io n 1 5 .2 8 , si nc e 1 . 44 T 1 / 2 i s t he a v e ra g e l ife ( T a v ) . F o r a p e r m a n e n t i m p l a n t , t he to t al d o s e D t o t a l i s d e li v er e d a f t er c o m pl e te d e c a y o f t h e s o u r c e s ( i . e . , t
T 1 / 2 ) . P.545 In t h a t c a s e , E q u a t i o n 2 3 . 4 r e d u c e s t o :

TABLE SOURCES

23.3.

ANISOTROPY CONSTANTS,

FACTORS, an , FOR

a n ( r ),

AND

ANISOTROPY

INTERSTITIAL

A n i s ot r op y F a c t or s , a n ( r ) Distance, r (cm)
103

Pd

125

M od e l

125

M od e l

192

Ir

6711

6702

0.921

0.944

0.968

0.991

0.889

0.936

0.928

0.947

0.820

0.893

0.897

0.970

0.834

0.887

0.942

0.989

0.888

0.884

0.959

0.998

0.880

0.891

0.949

0.901

0.907

0.965

0.955

0.974

WWW.MEDRAD.IR

A n i s o t ro p y constants an

0.90

0.93

0.95

0.98

From

Nath

R,

Anderson

LL,

L ux t o n

G,

et

al.

D o si m et r y

of

i nt e r s ti ti a l

b r a c h y t h e r a p y s o u r c es : r e c o m m e nd at io ns o f t he A A P M R a d i a t io n T he r a p y C o m m it t ee T a s k G r o u p n o . 4 3 . M e d P hy s 1 9 9 5 ; 22 : 2 09 2 3 4 , w it h p e r m i s sio n.

Example 1
A p r o s t at e g l a n d i m pla n t w i t h
125

I s e ed s del i v e re d a n i nit i al do s e r a t e o f

0 . 0 7 G y / h t o t h e p r o st a t e gl a n d . W ha t wi ll b e t he do s e de li v e r e d a f t e r ( a) 1 m o n t h a n d ( b ) a f t e r c o m p le te d e c a y o f t he s o ur c e s ?

F r o m E q u a t io n 2 3 . 4 :

F r o m E q u a t io n 2 3 . 5 :

T h e i n i ti a l m i n i m u m d o s e r a te i n a p r o sta t e gl a nd i m pl a nt i s v e r y l o w ( e . g . , a p p ro x i m at e l y 7 c G y / h ) a nd a p p ro x im a t el y 3 0% o f t he pr e s c r i bed d o s e i s d el i v e re d i n t he f i r s t m o n t h.

Example 2
R e p e at E x a m p l e 1 f o r
103

P d i mp l a nt w it h a n i ni t i al d o se r a t e o f 0 . 21 G y / h.

F r o m E q u a t io n 2 3 . 4 :

F r o m E q u a t io n 2 3 . 5 :

WWW.MEDRAD.IR

F o r re s p e ct i v e p re s c ri b ed do s e s , t he do se r at e fo r a t y p i c al l y a bo u t t h r ee t i me s t h a t f o r a n because of its s h or t e r h a l f - li f e , t he
125

103

P d im p l a nt i s
103

I i m p l a nt . In t he c a s e o f b ul k of t he p r e s c r ib e d

Pd,

do se

( a p p r o xi m a te l y 7 0% ) is d e l i ve r e d i n t he f i r s t m o nt h.

23.4. HIGH DOSE RATE IMPLANTS

P r o s t at e c a n c e r i s a sl o w l y pr o gr e s s i ve di s ea s e . C o ns e q ue ntl y , t he s up e r io ri t y o f o n e t r e at m e n t t e c h n i qu e o v e r a n o t he r c a nno t be e s t a bl i s he d i n a s ho r t t im e ( e . g . , 5 t o 10 y e a r s ) . P.546 A l t h o u g h t h e r e s ul t s w i t h s ee d i m pl a nt s a re s o f a r e nco ur a g i ng , c a ut i o n i s nee ded t o i n te r p re t t h e se r e su l t s b e c a u s e o f t he r ela t i v e s ho rt t i me o f t he s t ud i e s a nd t he m a n y c o m p e ti n g c a u s e s o f f a i l ur e i n t hes e p a t ie nt s . In a d d i ti o n, t he c l i ni ca l i m p a ct o f d o se i n h o mo g e n ei t y ( c a us e d b y se e d di s pl a c e me nt a nd a ni s o t ro p y ) a nd e x t r e me l y lo w d o se ra t e ( L D R ) i n a p e r ma ne nt i m pl a nt i s not w e l l und e r st oo d . H o w e v e r , t h e a b il it y o f b r a c h y t h e r a p y t o co nc e nt r a te t he do s e in t he t um o r a nd spare s u r ro u n d i n g no r m a l ti s s ue s is w el l re c og ni z e d . Hi g h-d o s e - r at e (HDR) b r a c h y t h e r a p y h a s t h a t a d v a n t ag e a nd , i n a d d it io n, o f f e r s b et ter c o nt ro l o f d o se h o m o ge n e it y a n d d o s e c o n f o r m i t y c om p a r ed t o L D R b ra c hy t he r a p y . P.547

A. Procedure
T h e H D R p r o st a ti c i mp l a n t p r o ce d ur e us i ng t r a ns r e c ta l g ui d a nc e i s s i mi l a r to t he L D R b r a c h y t h e r ap y w it h and r e c e i ve s e pi d u r al
192

Ir ( 12 ) . T he p ati e nt i s pl a c ed i n a li tho t o m y p o si ti o n A t r a ns r e c t al ul t r a so und p ro b e is us e d to

a n e s t h e si a .

e v a l u a t e t h e pr o st a te g l a n d . C o r o na l a nd s a g i tt a l i m a ge s a l lo w the d e t e rm i na ti o n o f p r o s t at e v ol u m e . A p r o s t at e g l a nd t e m pla t e i s s ut ur e d t r a ns per i ne a ll y a nd H D R g u i d e n e e dl e s ar e i mp l a n t ed i n t o t he p r o st a t e gl a nd w it h ul t r as o und g ui d a nce ( F i g . 2 3 .4 a ) . T e n t o f i f t e e n n e ed l e s a re us ua l l y r e q ui re d to c ov e r t he p r o st ate g l a n d . T h e b l ad d e r i s f i l le d wi t h H y p a q ue a nd d um m y so ur c e w i re s a r e l o ad e d i nt o t h e g u id e n e ed le s to o bt a i n i nt r a op e r at i ve x - r a y l o c al i z at io n r a d i og r a p hs . T he p a t ie n t is sent to th e recovery room and s ub s e q ue nt l y s i mul a t e d to ob t ai n o r t h og o n a l f il m s f o r H D R t r e at m e nt pl a nni ng .

WWW.MEDRAD.IR

F I G . 2 3 . 4 . P r o s t a t e i m p la n t p ro c e d ur e usi ng ul t r a so und - g ui de d H D R p r o c ed ur e s h o w i n g ( A ) i m pl a n t n e e d le s i n p l a c e ; ( B) f l e x i b le a d a pt e r s s c re w e d i nto g ui de n e e d le s ; a n d ( C ) f l ex i b l e a d a pt e r s co nnec t e d t o t he H D R re mo t e a f t e rl o ad e r s . ( F r o m S y e d A M N , P u t h a w a l a A A , Ba r t h N , e t a l . H i g h d o s e r a te b r a c hy t he r a p y t r e at m e n t o f t h e p r os t a t e: p r el i mi na r y r e s ul t s . J o ur na l o f Br a c hy t he r a p y I ntl 1 9 97 ; 1 3 :3 15 33 1 , w i th p e r m i s s io n. ) T r e a t m e nt - p l a n n i n g a lg o r it h m s f o r H D R ha v e be e n di s c us s e d i n Cha p t e r 2 2 . T he se p r o g r am s a r e b a s ed o n e it h e r o r t hog o nal f i l m s o r C T d at a . D we l l ti m e s o f t he s o u r c e i n e a c h n ee d le a r e c al c u l at e d to p r ov i d e o pt i mi z e d do s e di s t ri b uti o n. C T based t r e at me n t pl an n i n g p r o v id e s f ull t hr e e - di m e nsi o na l i s o d o se s ur f a c e s , d os e a nd di s t ri b uti o ns d o s e - v ol um e including s li c e - b y - sl ic e i s o do s e c ur v e s ,

h i s t og r a m s . A f t e r t h e t re a t me n t p la n h a s b e e n o pt i mi z ed a nd a pp r o v ed , t he gui d e nee d le s a re c o n n e c t e d to t h e H DR a f t e r lo a de r t hr o ug h a d a p te r s a nd t ra ns f e r c a t he te r s ( F ig . 23.4B,C). The t r e atm e n t is d el i v e re d as p l a nne d . After conc l us i o n of t he

WWW.MEDRAD.IR

t r e at m e n t , t h e t r a n s f e r c a t h et e r s a r e di s co nne c t e d f r o m t he ad a p te r s a nd t he p a t ie n t i s s e n t t o h i s ro o m . A l t h o u g h d o se f r a c t ion a t i o n w i t h H D R i s no t y e t w el l e st a bl i s hed , t he t ot a l do s e t y p i c al l y r a n ge s f r o m 1 0 to 25 G y ( mi ni mum i s o do s e s ur f a c e ) g i v e n i n t hr e e to f o u r f r a c t io n s . T h i s d o s e i s gi v e n i n ad di ti o n t o t he 45 G y of e x t e r na l be a m r a d i at io n t h e r a p y .

REFERENCES
1 . H i l a r i s B S , N o r i D , A n d e r s o n L L . A t l a s of b r a c hy t he r a p y . N e w Y o r k : M a c M i l l a n, 1 9 88 . 2 . N a t h R , Y u e N . D os i m et r i c c h a r a ct e ri z a ti o n o f a ne w l y d e si g ne d e nc a p s ul at ed i n t e r st it i al b r a c h y t h er a p y source of io di ne - 1 25 - m od el LS-1 Bra c hy S e e d . Appl R a d i a t I s ot 2 00 1 ; 55 : 81 3 8 2 1 . 3 . G r i m P D , B l a s k o J C , R a g d e H . U l t r a s o und- g ui d ed t r a ns p e ri ne a l i m p la nt a ti o n o f i o di n e - 12 5 a n d p a ll a di u m - 1 0 3 f o r t he t r e atm e nt o f e a r l y - s t ag e p r o st a t e c a nc e r . A t l a s o f t h e U ro lo gi c C l i n i c s o f N o rt h A m e r ic a 1 9 9 4 ;2 : 11 3 1 25 . 4 . P o r t e r A T , B l a s k o J C , G r i m m P D , e t a l . Br a c hy t he r a p y f o r p r o s t a t e c a nc e r . C A C a n c e r J C l i n 1 9 9 5 ; 45: 1 6 5 1 78 . 5 . N a t h R , A n d e r s o n L L , M e li J A , e t al . C o d e o f p r a c ti c e f or b r a c hy t he r a py physics: AAPM R a d i a t io n Therapy C o m m i tt e e Task G r o up No. 56. Med P hy s 1 9 97 ; 2 4 :1 55 7 1 59 8 . 6 . T a n s e y L A , S h a n b e r g A M , S y e d A M N , e t a l . T r e a t m e nt o f p ros t a ti c c a nc e r b y p e l v i c l y m p h a d e n e ct om y , t e m p o r ar y i r i di um - 1 9 2 i m pl a nt a nd e x t e r na l ir r a d i ati o n. U r o lo g y 19 8 3 ;2 1 :5 9 45 9 8 . 7 . S y e d A M N , P u t h a w a l a A A , T a n s e y L A , e t a l . T e m p or a r y i nt e r st it i al i r r a di a tio n i n the m a n a g e me n t of carcinoma of t he p r o st a t e: c ur r e nt st a t us of a ne w a p p r o a c h . . I n t M e d Sp e c 1 98 4 ; 5: 1 46 1 6 1 . 8 . S y e d A M N , P u t h a w a l a A , A u s t i n P , e t a l . T e m p or a r y i ri d i um -19 2 im p l a nt i n t he m a n a g e m e n t o f c a r c i n o m a o f t h e p ro s t at e . C a nc e r 1 9 9 2 ;6 9 : 25 15 2 52 4 . 9 . W e a v e r J T , L o f t u s T P , L o e v i n g e r R . N BS m e a s ur e m e nt s e r vi c es : c a l i b r at io n o f g a m m a - r a y e mi tt i n g br a c h y t h e r a p y s o ur c e s . N a t io na l Bur e a u o f S t a nd a r d s ( N IS T ) s p e c i al p u bl i c at io n n o. 2 5 0 1 9 . G ai t he r sb urg , M D : N a ti o na l Bur e a u o f S t a nd a r d s , 1 9 88 . 1 0 . L o f t u s T P . S t a n d a r d i z i n g o f 12 5 - I s e ed s us e d f o r b r a c hy t he r a p y . J R e s N a tl B u r e a u S t a n d 1 9 8 4 ; 89: 2 9 5 3 03 . 1 1 . N a t h R , A n d e r so n L L , L u x t o n G , et al . D o s i me t r y o f i nte r s ti tia l b r a c hy t he r a p y s o u r c e s : r e c om m e n d at io n s o f t h e A A P M R a d i a ti o n T he r a p y C o mm i tt e e T a s k G r o up N o . 4 3 . M e d P h y s 1 9 95 ; 2 2 :2 0 9 23 4 . 1 2 . S y e d A M N , P u t h a w a l a A A , B a r t h N , e t a l . H i g h d o se r a te b r ac hy t he r a p y i n t he t r e at m e n t o f c a r c i n om a o f t h e p r o s t at e : pr e l im i na r y r e s ul t s . J Br a c hy t he r a p y I nt 1 9 97 ; 1 3 :3 15 33 1 .
1

D R A X IM A G E , I n c . , 1 6 7 5 1 , R o u te T r a ns c a nd ie nne , K i r k l a nd ( Q ue b ec ) , C a na d a .

WWW.MEDRAD.IR

Editors: Khan, Faiz M. T i t l e : P h y s i c s o f R a d i a t i o n T h e r a p y , T h e , 3 rd E d i t i o n C o p y r i g h t 2 0 0 3 L ip p i nc o t t W i l l i a m s & W i l k i n s

> Table of Contents > Part III - Modern Radiation Therapy > 24 - Intravascu lar Brachytherapy

24 Intravascular Brachytherapy
24.1. INTRODUCTION
C o r o n a r y a r t e r y d i s e a s e i s m o s t c o m m o n ly tr e at e d u s i ng b y p a s s s ur g e r y o r p e r c u t a n e o us transluminal coronary angioplasty (PTCA). A major problem with PTCA, however, is the h i g h i n c i d e n c e o f r e s te n o s i s a n d r e c ur r e n c e o f a r t e r y b lo c k a g e a t t h e s i t e o f t r e a t m e n t . R e s te n o s is i s u s u a l ly a r b i t r a r i ly d e f i n e d as a n ar r o w i ng o f t h e l u m e n b y 5 0 % o r g r e a t e r i n d i a m e t e r c o m p a r e d t o t h e a d j a c e n t n o r m a l a p p e a r i n g s e g m e n t s . A l t h o ug h t h e o c c u r r e nc e of r e s t e no s i s is s i g n if i c a n t l y r e d uc e d by t he implantation of coronary stents, the r e s te n o s is r a t e f o l l o w i n g b a l l o o n a n g i o p l a s ty i n r a n d o m i z e d t r i a l s i s 3 0 % t o 4 0 % (1 ) . M o s t r e s t e no s i s a f t e r a n g i o p l a s t y o r s t e n t i n g i s c a u s e d b y t h r o m b o s i s o r b l o o d c lo t t i n g a t t h e P T C A s i t e , w h i c h c a n b e p r e v e n t e d p ar t i a ll y b y u s i n g a n t i - c l o t t i n g d r ug s . H o w e v e r , a n o t h e r p r o c e s s , w h i c h b e g i n s w i t h i n d a y s af t e r a n g i o p l as t y , i s t h e n e o i n t i m a l g r o w t h o f t i s s u e s p r o m p t e d b y t h e w o u n d h e a l i n g p r o c e s s f o l l o w i ng t i s s u e i n j ur y b y a n g io p l as t y . T h i s c o m p o n e n t o f r e s t e n o s i s c a n n o t b e p r e v e n te d b y a n t i c o a g u l a n t s o r s t e n t s . Intraluminal angioplasty ir r a d i a t i o n a nd / o r of coronary a nd peripheral ar t e r i e s lo w e r s t o g e th e r the rate with of b a l lo o n

stent

implantation

s ig n i f i c a n t l y

neointimal

f o r m a t i o n , t h e r e b y r e d uc i n g t h e r a t e o f r e s t e no s i s t o w e l l b e l o w 1 0 % ( 2 ) . R a d i a t i o n k i l l s cells and inhibits the growth of neointimal tissues in a manner similar to its effect on b e n i g n d i s e a s e s s u c h a s k e l o i d s a n d h e t e r o to p ic b o n e f o r m a t i o n . B as i c r a d i a t i o n b i o lo g y a n d v a s c u l a r p a t h o lo g y a r e d i s c u s s e d b y s e v e r a l a u t h o r s ( 3 ,4 , 5 ) .

24.2. TREATMENT VOLUME A. Arterial Anatomy

T h e a r te r i e s c a r r y b lo o d f r o m t h e he a r t t o v ar i o u s p ar t s o f t h e b o d y . T he m a i n ar t e r y , t h e a o r t a , i s t h e l a r g e s t b l o o d v e s s e l ( 2 to 3 c m i n d i a m e t e r ) a n d c ar r i e s b l o o d f r o m t h e l e f t v e n t r i c le o f t h e h e a r t t o t h e b r a n c h i n g a r t e r i e s a n d c a p i l l a r i e s i n a l l t h e b o d y o r g a ns a n d t i s s u e s , i n c l u d i n g t h e he a r t m u s c l e . T h e c o r o n ar y ar t e r i e s ar e b l o o d v e s s e l s ly i n g o n t h e o u t e r s ur f a c e o f t h e h e a r t a n d t h e p e r ip h e r a l a r t e r ie s s u p p l y b l o o d t o o t h e r o r g a ns a n d t i s s u e s . T h e l u m i n a l d i a m e t e r o f a r t e r i e s r a n g e s f r o m 3 t o 5 m m i n i t i a l l y a n d t ap e r s s l o w l y t h r o u g h t h e ir p a t h l e ng th . W i t h i n t h i s r a n g e , t h e p e r i p he r a l ar t e r ie s t e n d t o b e o f l ar g e r d i a m e t e r t h a n t h e c o r o n a r y a r t e r i e s . T h e m i n i m u m n o r m a l a r te r y d i a m e t e r r e q u i r e d f o r a n g i o p l a s t y a n d s t e n t i n g i s a p p r o x i m a te l y 3 m m . T h e i n s i d e o f t h e a r t e r i e s i s l i n e d w i t h a l a y e r o f c e l l s c a l l e d e n d o t h e l i u m . N e x t t o t he e n d o t h e l i u m i s t h e c o nn e c t i v e t i s s ue l a y e r , t h e i n t i m a , f o l l o w e d b y l a y e r s o f e l a s t ic m e m b r a n e , s m o o t h m u s c l e c e l l s , a n d e l a s t i c t i s s u e s . T h e o u t e r m o s t l a y e r o f t h e a r te r i e s i s c a l l e d a d v e n t i t i a , m a d e u p c h i e f ly o f c o l l a g e n o us f i b e r .

WWW.MEDRAD.IR

B. Angioplasty and Restenosis

The arteries can be partially b lo c k e d due to a t h e r o s c le r o s i s or plaque f o r m a t i o n.

R e d u c t i o n o f t h e i r l u m e n d i a m e t e r c o m p r o m is e s t h e f l o w o f b lo o d an d t h e d e l i v e r y o f o x y g e n to P.549

t h e b o d y t i s s u e s . A s a n a l t e r n a t i v e t o a m a j o r s u r g i c a l p r o c e d u r e s u c h a s b y p a s s s ur g e r y , b a l l o o n a n g io p l a s ty i s u s e d t o d i l a t e t h e l u m e n d i a m e t e r . T h i s s t r e t c h i n g a c t i o n o f t e n r u p t u r e s t h e i n t e r n a l e la s t i c l a m i n a o f t h e w a l l a n d c a u s e s f is s u r e s i n t h e m e d i a l l a y e r s . The acute risk of angioplasty procedure is thrombosis that can be controlled by drugs, as mentioned p r e v i o u s ly . The more p r o t r ac t e d risk, however, is that of restenosis by n e o i n t i m a l h y p e r p l a s i a . T h i s p r o c e s s i n v o lv e s g r o w t h o f n e w t i s s ue s i n t h e c r a c k s a nd c r e v i c e s o f t h e a r t e r i a l w a l l c a u s e d b y a n g io p l as t i c i n j u r y . A l t h o u g h i m p l a n t a t i o n o f s t e n t a n g i o p l a s t y r e d uc e s t h e o v e r a l l r a t e o f r e s t e no s i s b y a p p r o x i m a t e ly 5 0 % , i t d o e s n o t prevent neointimal growth and may, in fact, stimulate the process.

C. Target Volume
Target volume for vascular brachytherapy is c o nf i n e d to the r e g io n of a n g io p l a s ty .

T y p i c a l ly , i t i s 2 t o 5 c m i n l e n g t h o f a r te r y a nd 0 .5 t o 2 m m i n t h i c k ne s s o f ar t e r i a l w a l l . O c c a s i o n a l l y , t h e s e d i m e n s i o n s m a y b e e x c e e d e d d e p e nd i n g o n t h e l o c at i o n a n d e x t e n t o f t h e d i s e a s e . W i t h 3 t o 5 m m o f l u m i n a l d i a m e t e r , t h e r ad i a l r a n g e o f t r e a t m e n t m a y e x t e nd a s f a r a s to a b o u t 5 m m f r o m t h e c e n t e r o f t h e a r t e r y . Because of the s e v e r it y of inverse square fall-off of radiation at short distances,

t r a n s l u m i n a l i r r a d i a t i o n w i t h i n t r a v a s c u l a r b r a c hy t h e r ap y p r o d uc e s h i g h ly c o nf o r m a l d o s e d i s t r i b u t io n , d e l i v e r i n g a h i g h d o s e t o t h e a r t e r i a l w a l l w h i l e s p ar i n g s u r r o u n d i n g no r m a l v e s s e l s o r m y o c a r d i u m . A g a i n , b e c a u s e o f t h e p r e d o m i n a n c e o f i nv e r s e s q u a r e l a w e f f e c t , p e n e tr a t i n g power of radiation, depending on energy a nd modality, is not c r i t i c a l ly i m p o r t a n t , e x c e p t w i t h r e g a r d to d o s e r a t e o r d ur a t i o n o f i m p l a n t a nd r ad i a t i o n p r o t e c t i o n o f p e r s o n n e l i n v o l v e d w i t h t h e p r o c e d u r e . B e t a p a r t i c l e s o u r c e s , i n g e n e r a l , g iv e h i g he r d o s e r a t e s a nd p r o v i d e g r e a t e r r a d i a t i o n p r o t e c ti o n c o m p a r e d t o t h e g am m a r a y s o ur c e s . The depth of dose p r e s c r ip t i o n for i n t r a c o r o na r y irradiation is recommended by t he

A m e r i c a n A s s o c i a t i o n o f P h y s i c i s t s i n M e d ic i n e (A A P M ) ( 6 ) to b e 2 m m f r o m t h e c e n t e r o f t h e s o u r c e a n d f o r t h e p e r i p h e r a l a r t e r i e s 2 m m b e y o n d t h e a v e r ag e l u m e n r a d i u s . F o r e a c h c a s e , d o s e d i s t r ib u t i o n i n a t l e a s t t h r e e p l a n e s p e r p e nd i c u l a r to t h e c a t h e t e r a nd a l o n g i t s l e n g t h s ho u l d b e d e t e r m i n e d . I n a d d i t i o n , a v e r a g e , m a x i m u m , a n d m i n i m u m d o s e s w i t h i n t h e t a r g e t v o l u m e s h o u l d b e r e p o r te d ( 6 ) .

24.3. IRRADIATION TECHNIQUES

I n t r a v a s c u l a r b r a c hy t h e r a p y t e c h n i q u e s m a y b e c l a s s i f i e d i n t o t w o c a te g o r i e s : t e m p o r ar y i m p l a n t s ( s e a l e d s o u r c e s o r l i q u i d -f i l l e d b a l lo o n s ) a n d p e r m a n e n t i m p l a n t s ( r a d i o ac t i v e s t e n t s ) . E a c h m e t h o d ha s i t s a d v a n t ag e s a n d li m i t a t i o n s , b u t t h e c a t he t e r -b a s e d s e a l e d s o u r c e i s t h e m o s t c o m m o n l y u s e d m e t ho d o f t r e a t m e n t . I t i s t h e p r e f e r r e d m e t ho d b e c a us e o f i t s b e t t e r c o n t r o l o f d o s e d e l i v e r y . A v ar i e t y o f a n d - r a y s o u r c e s h av e b e e n u s e d f o r e nd o v a s c u l a r th e r a p y a l t h o u g h t h e c ho i c e o f o n e m o d a l i t y o v e r t h e o t h e r i s y e t n o t c l e a r ly e s t a b l i s h e d . T h e p r o s a n d c o n s o f a f e w s o ur c e s a n d d e v ic e s ar e d i s c u s s e d below.

WWW.MEDRAD.IR

A. Radiation Sources
T y p i c a l d o s i m e tr i c r e q u ir e m e n t s o f a t e m p o r ar y i n t r a v a s c u l a r i m p l a n t ar e : ( a ) t o d e l iv e r a t a r g e t d o s e o f 1 5 t o 2 0 G y t o a 2 - t o 3 - c m l e ng t h o f t h e a r t e r i a l w a l l i n v o lv e d a t a r a d i a l d i s t a n c e o f a b o u t 2 m m f r o m t h e s o u r c e c e nt e r ; ( b ) t o m i n i m i z e t h e d o s e t o t i s s u e s outside the r e g io n of angioplasty; and (c) to take as little a time as possible for completion of the procedure, that is, provide target dose rates on the order of 5 Gy/min o r g r e a t e r . T h e s e r e q u ir e m e n t s s ug g e s t t h e s ui t a b i l i t y o f h ig h - e n e r g y - s o u r c e s s u c h a s s t r o n t i u m -9 0 , y t t r i u m -9 0 , a n d p h o s p ho r u s -3 2 o r h i g h a c t i v i t y - s o u r c e s s u c h a s i r i d i u m 192. The latter c o u ld be a h ig h dose rate (H D R ) a f t e r l o ad i n g unit with the source d i m e n s io n s s m a l l e n o ug h t o a l l o w i n t r av a s c u l a r b r ac h y t h e r a p y . T h e - s o u r c e s h a v e s e v e r a l a d v a n t a g e s o v e r - s o u r c e s : h i g h e r s p e c if ic a c t i v i t y , h i g h e r dose rate, longer half-life, and greater r ad ia t i o n safety for the patient as well as personnel. P.550

T h e m a j o r d i s a d v a n t a g e o f - s o ur c e s , h o w e v e r , i s t h e e x t r e m e l y r a p id r a d i a l d o s e f a l l - o f f w i t h i n t h e t a r g e t r e g i o n; - s o u r c e s s u c h a s activity to y i e ld r e a s o n a b ly w it h high dose

192

Ir provide relatively more uniform target (5 Gy/min). Consequently, Although radiation the HDR

d o s e , g o v e r n e d p r i m a r i ly b y t h e i nv e r s e s q u ar e l a w f a l l - o f f w i t h d i s t a n c e , b u t r e q u ir e h i g h rate p r o t e c t io n p r o b le m s such sources become more s ig n i f i c a n t .

a f t e r lo a d e r s u s i n g g a m m a s o u r c e s c o u l d p r o v id e s u f f i c i e n t l y h i g h d o s e r a t e , t h e y w o u l d r e q u i r e e x p e n s i v e s h i e l d i n g o f t h e c a t h e t e r i z a t i o n l a b o r a to r i e s . Table 24.1 contains a list of possible isotopes that have been or could be used for i n t r a v a s c u l a r b r a c h y t h e r a p y . T h e l a s t c o l u m n s h o w s t h e a c t i v i t i e s r e q u i r e d to o b t a i n a dose rate of 5 Gy/min to a 2 cm length of a vessel at a radial distance of 2 mm from the s o u r c e c e n t e r . I t i s s e e n t h a t t h e - s o ur c e s , b e c a u s e o f l o w e r s p e c i f i c a c t i v i t y , r e q u i r e m u c h h i g h e r a c t i v i t i e s th a n t h e - s o ur c e s f o r a c a t h e t e r - b as e d i n t r a v as c u l a r p r o c e d u r e . O n t h e o t h e r h a nd , a p e r m a n e n t r a d io a c t i v e s t e n t u s i n g the same dose rate.
48

V r e q u ir e s o n ly 1 C i to p r o d uc e

TABLE

24.1.

POSSIBLE

ISOTOPES

FOR

INTRALUMINAL

BRACHYTHERAPY

WWW.MEDRAD.IR

Isotope

Emission

Maximum Energy (keV)

Average Energy (keV)

HalfLife

Activity Required

In-192

Gamma

612

375

74 d

1.0

Ci

(37 GBq)

I o d i n e -1 2 5

X ray

35

28

60 d

3.8 (140.6 GBq)

Ci

Palladium-103

X ray

21

21

19 d

3.9 (144.3 GBq)

Ci

P h o s p ho r us - 3 2

Beta-

1,710

690

14 d

4 0 .0 (1,480 MBq)

Ci

Strontium/yttrium90

Beta-

2,270

970

28 d

3 0 .0 (1,110 MBq)

Ci

Tungsten/rhenium188

Beta-

2,130

780

69 d

3 5 .0 (1,295 MBq)

Ci

Vanadium-48

Beta+

690

230

16 d

1.0 (37 stent

Ci Bq)

From

Amols

HI .

Physics

and

d o s i m e tr y

of

intravascular

b r ac h y th e r a p y .

In:

T h o m a d s e n B , e d . C a te g o r i c a l c o ur s e i n b r a c h y t h e r ap y p h y s i c s . O a k B r o o k , I L : R a d io l o g i c a l S o c i e t y o f N o r t h A m e r i c a , 1 9 9 7 , w it h p e r m i s s i o n .

A l t h o u g h d o s e r a t e p e r u n i t - a c t i v i t y f a v o r s - e m i t t e r s , r ad i a l d o s e d i s t r i b u t i o n i s b e t t e r f o r t h e -s o ur c e s , i f i t i s a s s u m e d t h a t t h e d o s e u n i f o r m i ty a c r o s s t h e t a r g e t v o l u m e is r a d io b io l o g i c a l l y b e n e f i c i a l . T h i s a s s u m p t i o n h a s n o t b e e n c l i n i c a l l y v a l i d a t e d b u t i t s e e m s l o g i c a l , b a s e d o n e x p e r i e n c e i n c o nv e n t i o n a l r a d i a t i o n t h e r ap y . F i g ur e 2 4 . 1 c o m p ar e s

WWW.MEDRAD.IR

r a d i a l d o s e d i s tr i b u t i o n a s a f u n c t i o n o f r a d i a l d i s t a n c e f o r s o m e o f t h e s o ur c e s l i s t e d i n T a b l e 2 4 . 1 . N a t h a n d L i u ( 7 ) h a v e s t u d i e d r ad ia l d o s e f u n c t i o n ( g ) f o r p o i n t s o u r c e s o f p h o t o ns a n d e l e c tr o ns u s i n g M o n t e C a r lo s i m u l at i o n . T h e i r d a t a s h o w t h a t f r o m t h e p o i nt o f v i e w o f a d e q u a t e d e p t h o f p e ne t r a t i o n f o r i n t r a v as c u l a r b r ac h y t h e r ap y , p h o to n s o ur c e s a b o v e 2 0 k e V a n d e l e c t r o n s o ur c e s a b o v e 1 . 0 M e V ar e a c c e p t ab l e .

FIG.

24.1.

Radial

dose

fall

off

with

distance

for

number

of

sources.

Doses

ar e

n o r m a l i z e d t o 1 .0 a t a r a d i a l d i s t a n c e o f 2 . 0 m m . ( F r o m A m o l s HI , Z a id e r M , W e i n b e r g e r J , e t a l . D o s i m e tr i c c o n s i d e r a t i o n s f o r c a t h e t e r - b a s e d b e t a a n d g a m m a e m i t t e r s i n t h e t h e r a p y o f n e o i n t i m a l h y p e r p l a s i a i n h u m a n c o r o n a r y a r te r i e s . I n t J R a d i a t O n c o l B i o l P h y s 1 9 9 6 ; 3 6 : 9 1 3 9 2 1 , w i t h p e r m i s s io n . )

P.551

B. Radiation Delivery Systems

I r r a d i a t i o n o f b l o o d v e s s e l s t o p r e v e n t r e s te n o s i s f o l l o w i n g a ng i o p l a s ty h a s b e e n c ar r ie d o u t u s i n g e x t e r n a l b e a m a s w e l l a s b r a c hy t h e r a p y . C ur r e n t t r e nd s f av o r c a t h e te r -b a s e d e n d o v a s c u l a r b r a c hy t h e r a p y d e v i c e s . W h i l e r e s e ar c h c o n t i n u e s to d e v e l o p n e w s o ur c e s a nd d e l i v e r y t e c h n i q u e s , a n u m b e r o f s y s t e m s h a v e b e c o m e av a i l a b l e c o m m e r c i a l l y . O f t h e s e t h e U . S . F o o d a n d D r ug A d m i n i s t r a t i o n h a s a p p r o v e d o n l y a f e w f o r c l in i c a l u s e . A b r i e f review of some of the available devices is presented below. For more detailed product information literature. a nd specifications, the r e ad e r is referred to the respective company

WWW.MEDRAD.IR

F I G . 2 4 . 2 . T he C o r d i s C H E C K M A T E s y s t e m s h o w i n g d e l i v e r y d e v ic e o n a c a r t . (F r o m A l i N M , K a l u z a G L , R a i z n e r A E . C a t h e t e r -b a s e d e nd o v as c u l a r r a d i a t i o n t h e r a p y d e v ic e s . V a s c R a d io t h e r Mo n i t o r 2 0 0 0 ;2 : 7 2 8 1 , w i t h p e r m i s s io n . )

B.1. Cordis CHECKMATE

The Cordis CHECKMATE System1
192

c o ns i s t s

of

three

components:

(a )

nylon

ribbon

containing an array of

I r s e e d s , ( b ) a d e l iv e r y c a t h e t e r , a n d ( c ) a r i b b o n d e l i v e r y

d e v i c e . T h e I r id i u m s e e d s a r e 3 m m i n l e n g t h a n d 0 . 5 m m i n d i a m e te r . T h e i n t e r s e e d s p a c i ng i s 1 m m a n d t h e o u t e r d i a m e t e r o f t h e n y l o n r i b b o n c o n t a i n i n g t h e s e e d s i s 1 m m . T h e n u m b e r o f s e e d s i n a r i b b o n c a n b e a l t e r e d t o p r o v i d e s o u r c e le n g t hs o f 1 9 t o 8 0 m m . Each
192

I r s e e d h a s a n a c t i v i t y o f a b o u t 3 3 m C i , t h u s m a k i n g i t p o s s i b l e t o k e e p t he

treatment time within 15 to 25 minutes. The ribbon delivery device is mounted on a cart ( F i g . 2 4 .2 ) a n d u s e s a h a n d - c r a nk m e c h a n i s m t o a d v a n c e t h e r i b b o n in t o a c l o s e d - e nd delivery catheter. Although the
192

I r s o u r c e p r o v i d e s b e t t e r d o s e h o m o g e ne i t y b e c a u s e o f t h e l o w e r d e p t h -

d o s e g r a d i e n t ( r a t i o o f s u r f a c e - to - a d v e n t i t i a l d o s e ) , i t s h i g h e r a c t i v it y a n d g a m m a r a y e n e r g y r a i s e r a d i a t i o n p r o t e c t io n c o n c e r ns f o r p e r s o n n e l . L o ng e r i r r ad i a t i o n t i m e s a n d n o n - c e n t e r i n g o f t h e d e li v e r y c a t h e t e r a r e o t h e r d i s a d v a n t a g e s o f t h i s d e v i c e . P.552

WWW.MEDRAD.IR

B.2. Guidant GALILEO

T h e G u i d a n t G A LI L EO S y s t e m 2 u s e s a - s o ur c e ,
32 32

P , f o r i n t r av a s c u l ar b r a c hy t h e r ap y . T h e

P s o u r c e i s he r m e t i c a ll y s e a le d i n t h e d i s t a l 2 7 - m m t i p o f a f l e x ib l e 0 . 0 1 8 - i n c h n i t i n o l

w i r e . A s p ir a l c e n t e r i n g b a l l o o n c a t h e te r (F i g . 2 4 .3 ) , w h i c h c e n t e r s t he s o ur c e w i r e , i s f l e x ib l e t o n a v i g a t e t hr o ug h t h e a r t e r i e s a nd a l s o h a s p e r f u s io n c ap a b i l i t i e s t o l i m i t m y o c a r d i a l i s c h e m i a d ur i n g the source wire. A the procedure. The system s o ur c e d e l i v e r y is provided to unit is c a lc u l a t e an automatic dwell times a f t e r lo a d e r d e v i c e t h a t c a n b e c o n t r o l l e d f r o m a r e m o t e l o c a t io n t o a d v a n c e a n d r e tr a c t treatment-planning r e q u i r e d to d e l iv e r t h e p r e s c r ib e d d o s e .

F I G . 2 4 . 3 . G u i d a n t G A L I L EO s y s t e m : ( A ) s o ur c e w ir e ; ( B ) s o u r c e d e l i v e r y u n i t ; a n d ( C) spiral centering catheter. (From Ali NM, Kaluza GL, Raizner Mo n i t o r AE. C a t h e t e r -b a s e d w i th endovascular p e r m i s s io n . ) r a d i a t io n therapy devices. Vasc R ad i o t h e r 2 0 0 0 ;2 : 7 2 8 1 ,

T h e m a j o r a d v a n t a g e s o f t h e s y s t e m ar e t h e c e n t e r i n g c ap a b i l i t y o f t h e d e l i v e r y c a t h e t e r , a u t o m a t i o n o f t h e a f t e r l o a d e r , a n d a v a i l a b i l i ty o f t h e t r e a t m e n t - p l an n i n g s y s t e m . T h e d i s a d v a n t a g e i s t h e r a p i d d o s e f a l l - o f f r ad i a l l y , w h i c h i s a c h a r ac t e r i s t i c o f a l l t h e sources.

B.3. Novoste Beta-Cath

The Novoste Beta-Cath System3 uses -s o ur c e s of
90

Sr/90Y

i s o to p e .

It

is

manual

a f t e r lo a d e r d e v i c e w i t h a c a t h e t e r - b a s e d d e l i v e r y s y s t e m . T h e s y s t e m c o n s i s t s o f t w o m a i n c o m p o ne n t s : ( a ) a t r a n s f e r d e v i c e f o r h o u s i ng an d h y d r a u l i c d e l i v e r y o f a r a d i a t i o n s o ur c e train, and (b) a delivery catheter to transport the source train.

WWW.MEDRAD.IR

T h e d e l i v e r y c a t h e t e r (F i g . 2 4 . 4 ) h a s t hr e e l u m e n s . T h e f i r s t l u m e n is u s e d f o r t r av e l o f t h e g u i d e w ir e . T h e s e c o n d l u m e n i s f o r tr a n s p o r t o f t h e s o ur c e t r a i n c o ns i s t i n g o f s e a l e d P.553

cylindrical seeds of

90

S r / 9 0 Y . T h e s o u r c e t r a i n i s d e l i v e r e d to t h e d i s t a l e n d o f t h e d e l i v e r y

c a t h e t e r b y a p p ly i n g m a n u a l h y d r a u l i c p r e s s ur e t h r o u g h a s y r i n g e , w h i c h c o n t a i n s s t e r i l e w a t e r a nd i s a t t a c h e d to t h e t r a n s f e r d e v i c e . Th e t h i r d l u m e n , w h i c h i s a l s o a t t a c h e d t o t h e t r a n s f e r d e v i c e , i s d e s ig n e d t o p r o v i d e a n o p p o s i t e h y d r a u l i c p r e s s u r e f o r r e t ur n i n g t h e s o u r c e t r a i n b a c k i n t o t h e s to r a g e p o s i t i o n o f t h e tr a n s f e r d e v i c e .

F I G . 2 4 . 4 . N o v o s te B e ta - C a t h s y s t e m w i t h s o ur c e tr a i n a n d t r a ns f e r d e v i c e . (C o ur t e s y o f N o v o s te : h t t p : / / w w w . n o v o s t e . c o m . )

M a j o r a d v a n t a g e s o f t h e N o v o s t e s y s t e m i s i t s us e o f t h e

90

Sr/90Y source, which is one of

t h e h i g h e s t e n e r g y - e m i t t e r s w i t h a l o n g h a l f - l i f e ( 2 8 y e ar s ) . O t h e r a d v a n t ag e s i n c l u d e h i g h d o s e r a t e ( t r e a tm e n t t i m e a p p r o x i m a t e ly 5 m i n u t e s ) , p a t i e n t a n d p e r s o n n e l s a f e t y , a n d s i m p l i c i ty o f t h e h a n d h e l d tr a n s f e r d e v i c e . T h e m a j o r d i s a d v a n t a g e i s t h e l a c k o f a c a t h e t e r - c e n t e r i ng d e v ic e , w h i c h c o u l d r e s u l t i n e x t r e m e d o s i m e t r i c ho t a n d c o l d s p o ts within the target volume.

B.4. -Emitting Liquid-filled Balloon

A n a l t e r n a t i v e t o c a t h e te r - b a s e d w ir e s a n d s e e d s i s t o i nf l a t e t h e b a l l o o n d i l a t i o n c a t h e t e r w i t h - e m i t t i n g r a d i o a c ti v e l i q u i d . T h e ad v a n t ag e s o f a l iq u i d - f i l l e d b al l o o n a r e i n h e r e n t s o u r c e c e n t e r i n g a n d d o s e u n i f o r m i t y t o t h e v e s s e l w a l l . S e v e r a l - e m i tt i n g i s o to p e s s u c h as
32

P,

90

Y , a nd

188

R e , w h i c h c a n b e o b t a i n e d i n a l i q u i d r ad i o p h a r m ac e u t i c a l p r e p a r a t io n ,

m a y b e u s e d i n t h i s t e c hn i q u e . The major d is a d v a n t a g e s of l iq u i d - f i l l e d balloons include: (a) higher ratio of

s u r f a c e / a d v e n t i t i a l d o s e c o m p a r e d to t h e c a t h e t e r b as e d - s o u r c e s y s te m s ; a n d ( b ) t he p o s s i b i l i t y , a l t h o u g h r e m o t e , o f b a l l o o n r u p t ur e a n d c o n s e q u e n t l y l e ak a g e o f r a d io i s o t o p e within the patient. Of the radioisotopes mentioned p r e v io u s l y , the rhenium-188 f o r m u l a t i o n i s p r e f e r a b le b e c a u s e o f t h e r e d u c e d r a d i a t i o n d o s e t o o r g a n s s u c h as c o l o n

WWW.MEDRAD.IR

a n d t h y r o i d d ue t o i t s r a p i d r e n a l e l i m i n a t i o n i n t h e e v e n t o f b a l l o o n r u p t u r e . h a s a f a v o r a b l e m a x i m um - e n e r g y (2 .1 3 M e V ) .

188

Re also

O n e o f t h e l i q u i d - f i l l e d b a l l o o n d e v i c e s w as d e v e lo p e d a t t h e C o l u m b i a U n i v e r s i t y /O ak R i d g e N a t i o n a l L a b o r a t o r y (8 ) . T h e s y s te m u s e s a l i q u i d p r e p ar a t i o n o f which is obtained at high specific activities from a t u ng s t e n

188

Re (188Re-MAG3), generator a nd

( 188W)

d e l i v e r e d i n t o a p e r f us i o n a n g i o g r a p hy b a l l o o n . A c o m m e r c i a l s y s t e m ( R A D I A N T 4 ) a l s o P.554

uses a

188

R e -f i l l e d b a l l o o n a n d i s s i m i l a r t o c o n v e n t i o n a l b a l l o o n P T C A ( F i g . 2 4 . 5 ) . I t m ay

be used before or after stent placement.

FIG. 24.5. (A)

Schematic

o f R A D I A N T r a d i a ti o n d e l i v e r y s y s t e m ;

(B ) P A S R A D I A N T

i s o l a t e d b e t a s o u r c e b a l l o o n . T o p , i n f l a t e d b a l l o o n . B o t t o m , W R A P b a l l o o n p r o te c t i v e s h e a t h . ( F r o m E i g l e r N , W h i t i n g J S , M a k k ar R , e t a l . I s o l a t e d l i q u i d b e t a s o ur c e b a l l o o n r a d i a t i o n d e l i v e r y s y s t e m ( R A D I A N T ) . I n : W ak s m a n R , S e r r uy s P W , e d s . H a n d b o o k o f

WWW.MEDRAD.IR

v a s c u l a r b r a c hy t h e r a p y . L o n d o n : M a r t i n D u n i t z Lt d , 1 9 9 8 : 1 0 7 1 1 0 , w i t h p e r m i s s io n . )

B.5. Radioactive Stents

B e c a u s e p e r m a n e n t s te n t s a r e f r e q u e n t l y u s e d i n c o n j u n c t io n w i t h b al l o o n a n g io p l as t y , i n c o r p o r a t i o n o f r a d i o a c t i v i t y i n t o t h e s t e n t h as b e e n s u g g e s te d to m ak e i t m o r e e f f e c t iv e i n p r e v e n t i n g r e s t e no s i s ( 9 , 1 0 , 1 1 , 1 2 a n d 1 3 ) .
32

P,

90

Y , a nd

48

V a r e s o m e o f t he s u i t a b le

- e m i t t i n g i s o t o p e s f o r i m p r e g n a t i o n i n t o t h e s te n t . T h e s t e n t i s r e nd e r e d r a d io a c t i v e b y a c t i v a t i o n i n a c y c l o tr o n o r b y io n i m p l a n t a t i o n w i t h t h e r ad i o i s o t o p e . The advantage of a r a d i o a c t iv e stent is primarily the combining of two procedures,

s t e n t i n g a n d i r r a d i a t i o n , i n t o o n e . P r o x i m i ty o f t h e r ad i o ac t i v e s o ur c e w i t h t h e v e s s e l w a l l s m a y b e a n o t h e r a d v a n t a g e , a l t h o u g h t h e g r i d d e d s tr u c t u r e o f t h e s t e n t g i v e s r i s e t o g r e a t e r d o s e i n h o m o g e n e i t y a t t h e v e s s e l s ur f a c e t h a n w i t h a l i q u i d - f i l l e d b a l l o o n o r a c a t h e t e r -b a s e d s o u r c e . F i g ur e 2 4 .6 s ho w s p e a k s a n d v a l l e y s o f d o s e d i s tr i b u t i o n f o r a 1 . 0 Ci
32

P P a l m a z -S c h a t z s te n t . 5

F I G . 2 4 . 6 . C a lc u l a t e d d o s e d i s tr i b u t i o n f o r a 1 .0 C i

32

P Palmaz-Schatz stent, 15 mm in

l e n g t h . D o s e t o t i s s u e is t h a t g iv e n i n 1 4 . 3 d ay s af t e r i m p l a n t . ( F r o m J a n i c k i C , D u g g a n D M , C o f f e y C W , e t a l . R a d i a t i o n d o s e f r o m a p h o s p ho r u s -3 2 i m p r e g n a t e d w i r e m e s h vascular stent. Med Phys 1997;24:437445, with permission.)

T h e i m p l a n t a t i o n te c h n i q u e o f a r a d i o a c t iv e s t e n t i s t h e s a m e a s t h a t r e q u i r e d f o r a no n r a d io a c t i v e s t e n t . B e c a u s e o f t h e v e r y lo w ac t i v i t y ( e .g . , 0 .5 t o 5 .0 C i ) o f t h e r a d io i s o to p e , t h e r a d i o a c t i v e s t e n t p r o c e d ur e is t h e s af e s t f r o m t h e r ad i a t i o n p r o t e c t i o n point of view. However, the dosimetry is much more complicated than that of t he c a t h e t e r -b a s e d s y s t e m s , a s w i l l b e d i s c u s s e d l a te r . P.555

WWW.MEDRAD.IR

24.4. DOSIMETRY A. Dose Calculation Formalisms A.1. Catheter-based Gamma Emitters

T h e A A P M T G -4 3 f o r m a l is m ( 1 3 ) is g e n e r a l l y ap p l i c a b l e t o t he p r o b l e m o f d o s e c a l c u l a t i o n for catheter-based intravascular systems. For a system using photon-emitting sources, the dose D at a point (r, ) is given by:

w h e r e S k i s t h e a i r k e r m a s t r e n g t h , i s t h e d o s e r a t e c o ns t a n t , G i s t h e g e o m e tr y f ac t o r , g i s t h e r a d i a l d o s e f u n c t i o n , F i s t h e a n i s tr o p h y f a c to r , a nd ( r o , o ) a r e t h e p o l ar coordinates of the reference point. A s d i s c us s e d i n C h a p t e r 1 5 , t h e r e f e r e n c e d i s t an c e r o i n c o n v e n t i o n a l b r a c hy t h e r ap y i s 1 c m . F o r i n t r a v a s c u l a r b r a c hy t h e r a p y , t h e A A PM ( 6 ) r e c o m m e n d s r o = 2 m m . E q u a t i o n ( 2 4 .1 ) i s t h e r e f o r e m o d if i e d t o i n c o r p o r a t e t h i s r e f e r e nc e p o i n t s p e c i f i c a ll y :

w h e r e r i s t h e d o s e r a t e c o n s t a n t a t a r e f e r e nc e d i s t a n c e o f r o a n d g r i s t h e r a d i a l d o s e
o o

f u n c t i o n n o r m a l i z e d to th e r e f e r e n c e r a d i a l d i s t an c e r o . D e p e n d i ng u p o n t h e s o u r c e d i m e ns i o n s a nd t he l o c a t io n o f t h e p o i n t ( r , ) , t h e s o u r c e may be considered as a line source or a point source. In the case of the point source, Equation 24.2 can be written as an approximation:

w h e r e a n is t h e a v e r a g e a n i s o tr o p y f a c to r . F o r a u n if o r m l y d i s t r ib u t e d l i n e s o ur c e , t h e g e o m e t r y f a c to r i s g iv e n b y :

w h e r e L i s t h e a c t i v e l e ng t h o f t h e s o ur c e .

A.2. Catheter-based Beta Emitters

Because the quantity air kerma strength does not apply to beta-emitting sources, the A A P M T G - 6 0 r e p o r t r e c o m m e nd s t h e f o l l o w i n g e q u a t i o n f o r t h e c a l c u l a t i o n o f d o s e a t a point P.556

( r , ) f o r t h e b e t a s o ur c e s :

WWW.MEDRAD.IR

where D(ro, o) is the dose rate in water at the reference point ( ro, o). This quantity, D ( r o , o ) m a y b e d e t e r m i n e d b y c a l i b r a t io n o f t he b e t a s o u r c e a t t h e r e f e r e nc e p o i n t o f r o = 2 mm and o = /2.

A.3. Radioactive Liquid-filled Balloons

A m o l s e t a l . ( 1 4 ) h a v e c a l c u l a t e d d o s e a t a p o in t P ( x , y , z ) f r o m a r a d i o a c t iv e l i q u i d f i l l e d b a l l o o n ( F i g . 2 4 .7 ) b y n u m e r i c i n t e g r a t i o n o f a M o n t e C a r lo g e ne r a t e d b e t a d o s e kernel over the volume of the balloon:

w h e r e D ( P ) i s t h e d o s e r a t e ( g r a y s p e r s e c o n d ) a t p o i n t P , k ( r ) = d o s e k e r ne l ( g r ay s p e r d e c a y ) , r ( c m ) = [ ( x - x ) 2 + ( y - s i n ) 2 + ( z - r c o s ) 2 ] , A /V = a c t i v it y p e r u n i t v o l u m e ( b e c q u e r e l s / c m 3 ) , a n d d v = r .d r .d .d x . T h e i n t e g r a t i o n l i m i t s a r e - L / 2 < x < L / 2 , R i < r < R o a n d 0 < < 2 . A s s e e n i n F i g . 2 4 . 7 , t h e c e n t r a l c h a n n e l o f t h e c at h e t e r c o n t a i n s a l u m e n o f r a d i u s R i t o a l l o w p a s s a g e o f t h e g u i d e w ir e .

F I G . 2 4 . 7 . G e o m e t r y o f d o s e c a l c u l a t i o n a t a p o i n t P ( x , y , z ) f r o m a b a l l o o n c a t h e te r w i t h o u t e r d i a m e t e r R o , i n n e r d i a m e te r R i a nd a x i a l l e n g t h L , u n i f o r m ly f i l l e d w i t h b e t a emitting r a d i o is o to p e . (From Amols HI , Reinstein LE, Weinberger J. Dosimetry of a r a d io a c t i v e c o r o n a r y b a l l o o n d i l u t i o n c a t h e t e r f o r t r e a t m e n t o f n e o i n ti m a l h y p e r p l a s i a . M e d P hy s 1 9 9 6 ; 2 3 : 1 7 8 3 1 7 8 8 , w i t h p e r m is s i o n .)

Using a 3-mm diameter and 20-mm long balloon filled with

90

Y - c h l o r id e s o l u t i o n , A m o l s e t

a l . ( 1 4 ) v e r if i e d t h e c a l c u l a t e d d o s e d i s tr i b u t i o n b y m e a s u r e m e n t w i t h G a f - C hr o m i c f i l m . T h e a g r e e m e n t b e t w e e n t h e m e a s u r e d a nd c a lc u l a t e d r ad i a l d o s e d is t r ib u t i o n w as 6 % a t d i s t a n c e s o f 2 . 5 to 5 . 0 m m f r o m t h e c e n t e r o f t h e c a t h e t e r ( o r 1 . 0 to 3 . 5 m m f r o m t he s u r f a c e o f t h e b a l l o o n ). T h e y us e d t h e k e r n e l f o r S i m p k i n a n d M a c k i e ( 1 5 ).
90

Y, which had been calculated by

WWW.MEDRAD.IR

T h e d o s e k e r n e l i s d e f i ne d ( 1 5 ) a s t h e e x p e c t a ti o n v a l u e o f t h e s p a t i a l d i s t r i b u t io n o f t h e e n e r g y d e p o s i t e d i n t a r g e t v o l u m e s c e n t e r e d ab o u t a p o i n t r a d io n u c l i d e s o u r c e p e r u n i t m a s s o f t h e t a r g e t v o l u m e p e r d e c a y o f t h e p o in t s o u r c e . D o s e k e r n e ls f o r a n u m b e r o f beta emitters,
32

P,

67

Cu,

90

Y,

105

Rh,

131

I,

153

S m , an d

188

R e h av e b e e n c a l c u l a t e d u s i n g E G S 4

M o n t e C a r lo c o d e ( 1 5 ) . S o m e o f t h e s e h a v e p o te n t i a l u s e i n i n t r a v a s c u la r b r a c h y t h e r ap y w i t h l i q u i d - f i l l e d b a l l o o ns . P.557

A.4. Radioactive Stents

D o s i m e tr i c a n d r a d i o b i o lo g i c c h a r a c t e r i s t i c s o f r a d i o a c t iv e s t e n t s a r e c o m p l i c a t e d b e c a us e o f t h e g r id d e d s tr u c t u r e o f t h e s t e n t a n d t h e d i f f e r e n c e s i n d o s e r a te s d e l i v e r e d b y s t e n t v e r s u s a n a c u t e c a t h e te r - b a s e d i r r ad i a t i o n . D o s i m e tr i c e v a l u a t i o n o f c l i n i c a l s t u d i e s i n a n i m a l s b y t h e A A P M t a s k g r o u p (6 ) r e v e a l e d a c o nf u s i n g v a r ie t y o f d i f f e r e n t d o s e s p e c i f i c a t i o ns i n r a d io a c t i v e s t e n t i m p l a n t a t i o n . T h e a n a ly s i s o f a g r o u p o f c a s e s a l s o s h o w e d t h a t t h e d o s e d e l i v e r e d p e r u n i t - a c t i v i t y f o r t he s a m e r a d io n u c l i d e v ar i e d b y a l m o s t a f a c t o r o f f o ur . T h u s , t h e u s e r m us t e x e r c i s e c a u t i o n i n u s i n g s te n t a c t i v i t i e s a n d d o s a g e s s p e c i f i e d i n t he c l i n i c a l s t u d i e s r e p o r t e d i n t h e l i t e r a t u r e . T h e A A P M r e c o m m e n d s ( 6 ) t h a t f o r e a c h ty p e o f r a d io a c t i v e s t e n t t h e t h r e e -d i m e n s io n a l d o s e d i s t r i b u t io n s a r o u nd s t e n t s o f v a r i o u s l e n g t h s , d i a m e t e r s , a nd a c t i v i t i e s s h o u ld b e c a r e f u l l y d e t e r m i n e d by benchmark dosimetry studies before clinical implementation. T h e d o s i m e t r i c c a l c u l a t i o n s o f r a d i o ac t i v e s t e n ts h a v e b e e n i n v e s t i g a t e d b y a n u m b e r o f i n v e s t i g a to r s (1 6 ,1 7 ,1 8 , 1 9 ) . A s t e n t i s m o d e le d t h e o r e t i c a l l y a s a c y l i n d r i c a l s h e l l o f water, immersed in water, with the r a d io i s o t o p e (a -emitter) u n if o r m ly d i s t r ib u t e d t h r o u g ho u t t h e s h e l l . T h e s o u r c e i s d i v id e d i n to i n f i n i t e s i m a l e l e m e n t s o f v o l u m e , e a c h r e p r e s e n t i n g a p o i n t s o ur c e . T he d o s e d i s tr i b u t i o n o f a p o i n t s o ur c e i s r e p r e s e n t e d b y t he d o s e - p o i n t - k e r n e l f u n c t io n K (

) , w h i c h i s d e f i n e d a s th e d o s e a t p o i n t

p r o d uc e d b y a p o i n t s o ur c e o f u n i t a c t iv i t y lo c a te d a t

. The dose D(

, t) at a point

o u t s i d e t h e s t e n t , a c c u m u l a t e d o v e r a t i m e t i s c a l c u l a t e d b y c o nv o l u t i o n:

WWW.MEDRAD.IR

where a(

, t ) i s t h e a c t i v i t y v o l um e d e n s i ty . T h e d o s e p o i n t k e r n e l i s d e r iv e d f r o m M o n t e C ar lo s i m u l a t i o n o f e l e c t r o n tr a n s p o r t i n w a te r ( 1 5 ) . F o r m a t h e m a t i c a l d e t a i l s o f t h e a b o v e o r s i m i l a r a l g o r i t h m s , t h e r e ad e r i s r e f e r r e d t o P r e s tw i c h e t a l . (1 6 ) a nd J a n i c k i e t a l . (1 8 ) .

B. Measurement of Dose Distribution

D o s e d i s tr i b u t i o n a r o u nd i n t r a v a s c u l a r b r a c hy th e r a p y s o u r c e s i s b e s t m e a s u r e d b y f i l m d o s i m e t r y . B e c a u s e o f th e h i g h d o s e r a te a n d s t e e p d o s e g r a d i e n ts n e ar t h e s o ur c e , t h e f i l m m u s t h a v e v e r y t h i n e m u l s i o n , s l o w s p e e d , a n d h i g h r e s o l u t i o n . R a d io c hr o m ic f i l m s m e e t t h e s e r e q u i r e m e n ts a n d a r e t h e d e t e c to r s o f c h o i c e f o r m e a s ur i ng d o s e d i s t r ib u t i o n a r o u nd b r a c h y t h e r a p y s o u r c e s i n a c o n t a c t g e o m e t r y ( s e e C h ap t e r 8 ) . G a f C h r o m i c f i l m i s t i s s ue e q u i v a l e n t , h a s a l i n e a r s e n s i t o m e t r i c ( o p t i c a l d e n s i ty v s . d o s e ) r e s p o n s e a nd a l a r g e d y n a m i c r a n g e ( e .g . , s e v e r a l g r a y s t o o b t a i n a n o p t i c a l d e n s i ty b e t w e e n 0 .5 a nd 2 .5 ) . T h e f i l m d o e s n o t r e q u i r e p r o c e s s i n g a f te r i r r a d i at i o n . I n d o s i m e t r i c m e a s ur e m e n t s , t h e f i l m i s s a nd w i c h e d i n a w a t e r e q u i v a l e n t p l a s t i c p h a n t o m o r w r a p p e d a r o u n d a c y l i n d r i c a l p h a n t o m , j u s t l i k e a n y f i l m d o s i m e tr y a r r a ng e m e n t . T h e e x p o s e d f i l m i s a n a ly z e d b y a h i g h r e s o l u t i o n s c a n n i n g d e n s i to m e t e r ( s p a t i a l r e s o l u t i o n o n t h e o r d e r o f 0 . 1 m m ) . O p t i c a l d e n s i t y i s c o n v e r t e d t o d o s e b as e d o n t h e p r e d e te r m i ne d s e n s i t o m e t r i c c ur v e .

C. Calibration C.1. Catheter-based Gamma Sources

T h e s t r e n g t h o f t h e g a m m a - e m i t t e r s o ur c e s i s d e t e r m i n e d b y m e a s ur e m e n t o f e x p o s u r e r a t e i n f r e e - s p a c e a t 1 m u s i n g a f r e e - a ir i o n i z a t i o n c h a m b e r o r a w e l l - t y p e i o n i z a t i o n c h a m b e r , w h i c h b e a r s c a l i b r a t i o n tr a c e ab l e t o t h e N a t i o n a l I n s t i t u t e o f S t a nd a r d s a nd T e c h n o lo g y ( N I S T ) f o r a s o u r c e o f t h e s am e ty p e . T h e a i r k e r m a s tr e ng t h , S k , a t d i s t a n c e i s g iv e n b y :

P.558

where

i s t h e e x p o s u r e r a t e a t d i s t a n c e , a nd

WWW.MEDRAD.IR

i s t h e a v e r a g e e ne r g y a b s o r b e d p e r u n i t c h ar g e o f io n i z a t i o n i n a i r , a s s u m i n g e n e r g y l o s s d u e to b r e m s s t r a h l u n g in a i r t o b e ne g l i g ib l e ( s e e s e c t io n 1 5 . 2 , A .5 ) . T h e c a l i b r a t i o n p r o c e d u r e o f g a m m a - e m i t t i n g s e e d s f o r c o nv e n t i o n a l b r a c hy t h e r ap y h as b e e n d i s c us s e d i n C h a p t e r 1 5 a n d C h a p t e r 2 3 . I n t h e c a s e o f i n t r av a s c u l a r s o u r c e s , t he A A P M (6 ) r e c o m m e n d s th a t t h e d o s e r a t e i n w a te r a t a d i s t a n c e o f 2 m m f r o m t h e c e n t e r o f t h e s o ur c e m us t b e s p e c if i e d . Eq u a t i o n 2 4 . 2 m a y b e u s e d t o c a l c u l a te d o s e r a t e a t t h e r e f e r e n c e p o i n t o f ( 2 m m , / 2 ) . H o w e v e r , a t t h i s p o i n t , t h e d a t a f o r r o a n d g r o a r e no t a v a i l a b l e . A m o l s e t a l . ( 2 0 ) h a v e u s e d e x t r ap o l a t e d v a l u e s o f t h e l i n e s o u r c e f u n c t i o ns g i v e n b y t h e A A P M T G -4 3 ( 1 3 ) t o c a l c u l a t e d o s e d i s t r ib u t i o n a t d i s t a n c e s l e s s t h a n 1 c m . For
192

Ir

source

(0 . 5

mm

diameter,

mm

le n g t h ) ,

they

h av e

compared

calculated

d i s t r i b u t io n s w i t h t h o s e m e a s u r e d w i t h G a f C h r o m i c f i l m a n d s h o w n a n a g r e e m e n t o f 7 % a t d i s t a n c e s o f 1 . 5 t o 5 . 0 m m . T h u s , u n t i l T G - 4 3 f u n c t i o n s ar e a v a i l a b le a t d i s t a n c e s l e s s t h a n 0 . 5 c m , t h e u s e r m a y u s e A m o l s e t a l . s c a l c u l a t i v e o r e x p e r i m e nt a l m e t h o d o l o g y to d e t e r m i n e t h e d o s e r a t e a t t h e r e f e r e n c e p o i n t o f (2 m m , / 2 ) .

C.2. Catheter-based Beta Sources

T h e s t r e n g t h o f b e t a s o u r c e s f o r i n t r av a s c u l a r b r ac h y t h e r a p y i s s p e c if ie d i n t e r m s o f d o s e rate in water at the reference point (ro, o). Accordingly, the r e f e r e nc e point for c a l i b r a t i o n o f t h e s e s o u r c e s s h o u ld a t r o = 2 m m a n d o = / 2 . S o a r e s e t a l . ( 2 1 ) h a v e d e s c r ib e d a m e t h o d o f c a l i b r a t i n g b e t a s o ur c e s u s i n g a n e x t r ap o l a t i o n io n i z a t i o n c h a m b e r t h a t h a s a 1 - m m d i a m e t e r c o l l e c t i n g e l e c tr o d e ( 2 2 ) . T h e a b s o r b e d d o s e r a t e a t a d e p t h c l o s e to 2 m m a v e r a g e d o v e r a 1 - m m d i a m e t e r a r e a i s d e te r m i n e d f r o m m e a s u r e m e n t s i n a A150 plastic phantom. The absorbed dose to A150 plastic is converted to absorbed dose t o w a t e r u s i ng a n a p p r o p r i a t e s c a l i n g f a c to r a n d d e n s i t y c o r r e c t i o n s ( 2 1 ) .

C.3. Radioactive Stents

C a l i b r a t io n o f a r a d i o a c ti v e s t e n t i s c o m p l i c a te d b y t h e f a c t t h a t s t e n t s a r e s h i p p e d u n d e r sterile conditions in acrylic cylinders of wall thickness sufficient to absorb all the beta p a r t i c l e s . A c t iv i t y m e a s u r e m e n ts n e e d t h e r e f o r e b e m a d e w i t h o u t d i s tu r b i n g t h e s t e r i l e e n v i r o n m e n t . A l t h o u g h t h e b e t a p a r t i c l e s ar e c o m p le t e l y ab s o r b e d i n th e a c r y l i c s h i e ld , b r e m s s tr a h l u n g numbers of x-rays escape. The i n t e ns i t y thus of t he s e it x - r ay s is to proportional infer activity to of the the beta particles emitted, making p o s s ib l e

r a d io a c t i v e s t e n t b y e x t e r n a l m e a s ur e m e n t o f b r e m s s tr a h l u n g . T h i s m e t h o d o f as s ay i n g s t e n t a c t i v i t y h a s b e e n d i s c u s s e d b y L ar s o n a nd M o h r b a c he r (2 3 ) a n d C o f f e y a nd D u g g a n (24). Relative using a calibration well-type p r o c e d ur e s i o n iz a t i o n

32

based

on a

bremsstrahlung N aI ( T r )

m e a s ur e m e n t s c o u nt e r ,

are or

av a i l a b l e a liquid

chamber,

scintillation

s c i n t i l l a t i o n c o u n t e r . H o w e v e r , s t a n d ar d s a r e n e e d e d t o f i r s t c a l i b r a te t h e i n s t r u m e n t . N I S T o f f e r s a r e f e r e nc e P s t a nd a r d f o r a c t iv i t y a n a l y s i s a n d ho p e f u l l y m o r e w i l l b e forthcoming for users to calibrate their instruments through transfer techniques. Relative c a l i b r a t i o ns r e q u i r e r e f e r e n c e s t a nd a r d s o f t h e s a m e r ad i o n u c l i d e a nd c o n s t r uc t i o n . L ar g e e r r o r s c a n r e s u l t if o n e c o m p a r e s s o u r c e s o f d if f e r e n t g e o m e t r i e s f o r r e la t i v e c a l i b r a t io n s .

24.5. QUALITY ASSURANCE

A c o m p r e h e n s i v e q u a l i t y a s s ur a n c e (Q A ) p r o g r am s h o u ld a s s u r e a c c u r a te a n d s a f e d e l i v e r y o f i n t r a v a s c u l a r b r a c hy th e r a p y . I n a d d i t i o n , i t s h o u l d b e d e s ig n e d t o s at i s f y t h e r e l e v a n t r e g u l a t i o n s o f t h e N u c l e a r R e g u l a t o r y C o m m i s s io n ( N R C ) o r s t a t e if i t is d e s i g n a t e d as a n Agreement State. A l t ho u g h several QA reports have been p u b l i s he d on the use of

WWW.MEDRAD.IR

conventional below: P.559

b r a c hy t h e r a p y

( 2 5 ,2 6 ) ,

the

report

most

pertinent

to

i n t r a v as c u l a r

b r a c h y t h e r a p y i s t h e A A P M T G - 6 0 ( 6 ) . R e c o m m e n d a t i o ns o f t h i s r e p o r t a r e s u m m ar i z e d

D o c u m e n t r a d i a t i o n s o ur c e p r o p e r t i e s . D e v e l o p p r o to c o l s f o r r e c e i p t o f s o ur c e s , a c c e p t a n c e t e s t i n g , a n d c o m m i s s i o n i n g p r o c e d ur e s . D e v e l o p g u i d e l i n e s f o r s t o r a g e , a c c e s s , a n d i n v e n t o r y o f s o ur c e s . C h e c k p h y s ic a l i n t e g r i t y o f s e a l e d s o u r c e ; p e r f o r m l e ak t e s t i n g a nd o t h e r e s s e n t i a l p r e - t r e a t m e n t Q A p r o c e d u r e s , d e p e n d i ng o n t he s o u r c e o r d e v i c e ( e .g . , r e m o t e a f t e r lo a d e r ) .

V e r i f y s o ur c e a c t i v i ty u s i n g i n - h o u s e e q u i p m e n t s u c h a s d o s e c a l i b r a t o r , r e - e n t r a n t chamber, etc. D e v e l o p m e t ho d s to p r o p e r l y s t e r i l i z e s o ur c e s . D e v e l o p p r o to c o l f o r s a f e t r a ns p o r t a t i o n o f r a d io a c t i v e m a t e r i a l . D e v e l o p p r o to c o l f o r s a f e d i s p o s a l o f s o u r c e s a f te r u s e . A s s ur e a v a i l a b i l i t y o f a nc i l l a r y e q u i p m e n t a t t h e t i m e o f t h e p r o c e d u r e . Develop emergency procedures. D e v e l o p r o l e s a nd r e s p o n s i b i l i t i e s o f e ac h i n d iv id u a l i n v o l v e d w i t h t he p r o c e d u r e . D e v e l o p a p r e s c r ip t i o n f o r m ( w r i t t e n d i r e c t i v e ) . D e v e l o p d o s e c a l c u l a t i o n c h e c k /d o ub l e c h e c k p r o c e d ur e s . Verify c o r r e c t c h o ic e of s o ur c e s and treatment parameters for the patient in

question. M o n i t o r r a d i a t i o n l e v e l s a r o u nd p a t i e n t a nd s u r r o u n d i n g a r e a s d ur i n g t r e a t m e n t . P e r f o r m p o s t - t r e a t m e n t r a d i a t i o n s ur v e y o f t h e p a t i e n t a n d s ur r o u n d i ng a r e a s . P r o v i d e r a d i a t i o n s a f e t y i n s t r u c t i o n s to p a t i e n ts w i t h p e r m a n e n t i m p l a n t s ( e . g . , r a d io a c t i v e s t e n t ) a t t h e t i m e o f p a t i e n t d i s c h ar g e . D e v e l o p e d u c a t i o n a n d tr a i n i n g p r o g r a m f o r p e r s o n n e l .

REFERENCES
1 . F i s h e r m a n D L , L e o n M B , B a i n D S . A r a n d o m i z e d c o m p ar i s o n o f s t e n t p l a c e m e n t a n d balloon a ng i o p l a s t y in the treatment of c o r o n ar y ar t e r y disease. N Engl J Med 1994;331:496501. 2 . W a k s m a n R . R a d i a t i o n f o r p r e v e n t i o n o f r e s te n o s i s : w h e r e ar e w e ? . I n t J R ad i a t O nc o l B i o l P hy s 1 9 9 6 ;3 6 : 9 5 9 9 6 1 . 3 . H a l l E J , M i l l e r R C , B r e n n e r D J . T h e b as i c r a d i o b i o lo g y o f i n t r av a s c u la r i r r a d i a t i o n . I n : W a k s m a n R , e d s . V a s c u la r b r a c h y t he r ap y . A r m o n k , N Y : F u t ur a , 1 9 9 9 . 4. Fajardo LF, B e r t hr o ng M. V as c u l a r lesions following r ad i a t i o n . Pathol Annu

1988;23:297330. 5 . R e i n h o ld H S , F a j a r d o L F , H o p e w e l l J W . T h e v a s c u l ar s y s t e m . I n : A lt m a n K I , L e t t J T , e d s . A d v a n c e s i n r a d i a t io n b io l o g y V o l 1 4 R e l a t iv e r a d i a t i o n s e ns i t i v i t i e s o f h u m a n o r g a n s y s t e m s , P a r t I I S a n D i e g o : A c a d e m i c Pr e s s , 1 9 9 0 : 1 7 7 2 2 6

WWW.MEDRAD.IR

6 . N a t h R , A m o l s H , C o f f e y C , e t a l . I n t r av a s c u l a r b r a c hy t h e r a p y p h y s i c s : r e p o r t o f t he A A P M R a d i a t i o n T he r a p y C o m m i t t e e T a s k G r o up N o . 6 0 . M e d P h y s 1 9 9 9 ;2 6 :1 1 9 1 5 2 . 7 . N a t h R , L u i L . O n t he d e p t h o f p e n e t r a t io n o f p h o to n s a n d e l e c tr o ns f o r i n t r av a s c u l a r b r a c h y t h e r a p y . Me d P h y s 1 9 9 7 ; 2 4 : 1 3 5 8 ( ab s t . ) 8. Weinburger J, Schiff PB, Trichter F, et al. Results of the Columbia Safety and

F e a s i b i l i t y ( C U R E ) t r i a l o f l i q u i d i s o t o p e s f o r c o r o n ar y v a s c u l ar b r a c h y th e r a p y . C i r c u l a t i o n 1999;100[suppl 1] 175. 9 . F i s c he l l T A , K h a r m a B K , F i s c h e l l D R , e t a l . L o w - d o s e b e t a p a r t i c le e m i s s i o n f r o m s t e n t wire results in complete, localized inhibition of smooth muscle cell proliferation. Circulation 1994;90:29562963. 10. Laird JR, Carter AJ, Kuffs WM, et al. I nhibition of neointimal proliferation with a beta particle emitting stent. Circulation 1996;93:529536. 1 1 . H e hr l e i m C , S t i n t z M , K i n s c h e r f R , e t a l. P u r e -p a r t i c l e e m i t ti n g s t e n t s i n h i b i t neointimal formation in rabbits. Circulation 1996;93:641645. 12. Carter AJ, Laird JR. Experimental r e s u lt s with endovascular i r r ad i a t i o n via a

r a d io a c t i v e s t e n t . I n t J R a d i a t O n c o l B i o l P h y s 1 9 9 6 ;3 6 :7 9 7 8 0 3 . 1 3 . N a t h R , A n d e r s o n L , L u x t o n G , e t a l . D o s i m e t r y o f i n t e r s t i t i a l b r ac h y t h e r ap y s o u r c e s : r e c o m m e n d a t i o ns 1995;22:209234. 1 4 . A m o ls H I , R e i n s t e i n L E , W e i n b e r g e r J . D o s i m e t r y o f a r a d io a c t i v e c o r o n ar y b a l l o o n d i l u t i o n c a t h e t e r f o r tr e a t m e n t o f n e o i n t i m a l h y p e r p l a s i a . M e d P h y s 1 9 9 6 ; 2 3 : 1 7 8 3 1 7 8 8 . 1 5 . S i m p k i n D J , M a c k ie T R . E G S 4 M o n t e C ar l o d e t e r m i n a t i o n o f t h e b e t a d o s e k e r n e l i n w a t e r . M e d P hy s 1 9 9 0 ; 1 7 : 1 7 9 1 8 6 . 1 6 . P r e s t w ic h W V , K e n n e t T J , K u s F W . T h e d o s e d is t r i b u t i o n p r o d uc e d b y a s t e n t . M e d P hy s 1 9 9 5 ;2 2 : 3 1 3 3 2 0 . 1 7 . Pr e s t w i c h W V . A n a ly t i c r e p r e s e n t a t i o n o f t h e d o s e f r o m a 1996;23:913. 18. Janicki C, Duggan DM, Coffey CW, et al. Radiation dose from a P a l m a z - S c h a t z w i r e m e s h v a s c u l a r s t e n t . M e d P hy s 1 9 9 7 ;2 4 : 4 3 7 4 4 5 . P.560
32 32 32

of

the

AAPM

R ad i a t i o n

Th e r a p y

Task

G r o up

No.

43.

Med

Phys

P-coated

P - c o a te d s te n t . M e d P hy s

P impregnated

1 9 . D ug g a n D M , C o f f e y C W , L e v i t S . D o s e d i s t r i b u t i o n f o r a I n t J R a d i a t O n c o l B i o l Ph y s 1 9 9 8 ;4 0 : 7 1 3 7 2 0 .

32

P i m p r e g n a t e d c o r o n ar y

s t e n t : c o m p a r i s o n o f t h e o r e t i c a l c a l c u l a t i o ns an d m e a s ur e m e n t s w i t h r a d io c h r o m i c f i l m .

2 0 . A m o l s HI , Z a i d e r M , W e i n b e r g e r J , e t a l . D o s i m e t r i c c o n s i d e r a t i o ns f o r c a t h e t e r - b as e d b e t a a nd g a m m a e m i t te r s i n t h e t he r ap y o f n e o i n t i m a l h y p e r p l a s i a i n h u m a n c o r o n a r y a r t e r ie s . I n t J R a d i a t O nc o l B i o l P h y s 1 9 9 6 ; 3 6 :9 1 3 9 2 1 . 2 1 . S o a r e s C G , H a l p e r n D G , W a n g C K . C a l i b r a ti o n a n d c h ar a c t e r i z a t i o n o f b e t a - p ar t i c l e s o u r c e s f o r i n t r a v a s c u l a r b r a c h y t h e r ap y . M e d P hy s 1 9 9 8 ;2 5 : 3 3 9 3 4 6 .

WWW.MEDRAD.IR

2 2 . S o a r e s C G . C a l i b r a ti o n o f o p h t h a l m i c ap p l ic a t o r s a t N I S T a r e v i s e d ap p r o a c h . M e d P h y s 1 9 9 1 ;1 8 :7 8 7 1 9 3 . 23. Larson IL, M o hr b a c h e r DA. A n a ly s i s of P-32 labeled solutions using integrated

b r e m s s tr a h l u n g r a d i a t i o n . R a d i o a c t R a d io c h e m 1 9 9 2 ;3 : 4 7 . 2 4 . C o f f e y C , D ug g a n D . D o s i m e tr i c c o n s i d e r a t i o n a n d d o s e m e as u r e m e nt a n a l y s i s o f a P 32 radioisotope stent. In: Waksman R, King S, Crocker IA, et al., eds. V a s c u l ar b r a c h y t h e r a p y . T h e N e t he r l a n d s : N uc l e t r o n , 1 9 9 6 : 2 0 7 2 1 6 2 5 . K u t c h e r G J , C o i a J , G i l l i n M , e t a l . C o m p r e he n s i v e Q A f o r r a d i a t i o n o n c o lo g y : r e p o r t o f A A P M R a d i a t i o n T he r a p y C o m m i t t e e T a s k G r o up N o . 4 0 . M e d P h y s 1 9 9 4 ;2 1 :5 8 1 6 1 8 . 2 6 . N a t h R , A n d e r s o n L L, M e l i J A , e t a l . C o d e o f p r ac t i c e f o r b r a c h y t he r a p y p h y s i c s : A A PM R a d i a t i o n T h e r a p y C o m m i t t e e T a s k G r o up N o . 5 6 . M e d P h y s 1 9 9 7 ; 2 4 :1 5 5 7 1 5 9 8 .

1

h t t p : / / w w w . c o r d i s .c o m . h t t p : / / w w w .g u i d a n t . c o m . h t t p : / / w w w . no v o s t e .c o m . P r o g r e s iv e A ng i o p l a s y S y s t e m s , M e n lo P ar k , C a l i f o r n i a . Isocent, Inc., Belmont, California.

WWW.MEDRAD.IR

E d i t or s : K h a n , F a i z M . T i t l e : P h y s i c s o f R a di a t i o n T h e r a py , T h e , 3 r d E d i t i on C o p y r i g h t 2 0 03 L ip pi n c o tt W i ll i am s & W i l kins
> Back of Book > Resources > Appendix

Appendix

Tables

TABLE A.1. RATIOS OF AVERAGE, RESTRICTED STOPPING POWERS FOR PHOTON BEAMS, = 10 keV

TABLE

A.2.

RATIOS

OF

MASS

STOPPING

POWERS

AND

MASS ENERGY ABSORPTION COEFFICIENTS FOR COBALT60 RAYS a

WWW.MEDRAD.IR

TABLE A.3. STOPPING POWER RATIOS, , FOR ELECTRON BEAMS ( = 10 keV)

WWW.MEDRAD.IR

TABLE A.4. STOPPING POWER RATIOS,

, FOR ELECTRON BEAMS ( = 10 keV)

TABLE A.5. STOPPING POWER RATIOS,

, FOR ELECTRON BEAMS ( = 10 keV)

WWW.MEDRAD.IR

TABLE A.6. RATIOS OF MEAN MASS-ENERGY ABSORPTION COEFFICIENTS,

, FOR VARIOUS MATERIALS

TABLE A.7. PHOTON MASS ATTENUATION COEFFICIENTS, /, e n /, AND IN MASS m 2 /kg ENERGY -ABSORPTION FOR ENERGIES 1 keV COEFFICIENTS TO 20 MeV

(MULTIPLY m 2 /kg BY 10 TO CONVERT TO cm 2 /g).

TABLE A.8. COLLISION MASS STOPPING POWERS, S /, IN MeV cm 2 /g, FOR ELECTRONS IN VARIOUS MATERIALS

WWW.MEDRAD.IR

TABLE A.9.1. COBALT-60 PERCENT DEPTH DOSES: 80 cm SSD

WWW.MEDRAD.IR

TABLE A.9.2. COBALT-60 TISSUE-MAXIMUM RATIOS

TABLE A.9.3. COBALT-60 SCATTER-MAXIMUM RATIOS FOR CIRCULAR FIELDS a

WWW.MEDRAD.IR

TABLE A.10.1. 4-MV X-RAY PERCENT DEPTH DOSES: 100 cm SSD

WWW.MEDRAD.IR

TABLE A.10.2. 4-MV X-RAY TISSUE-MAXIMUM RATIOS

WWW.MEDRAD.IR

TABLE

A.10.3.

4-MV

X-RAY

SCATTER-MAXIMUM

RATIOS

FOR CIRCULAR FIELDS

TABLE A.11.1. 10-MV X-RAY PERCENT DEPTH DOSES

WWW.MEDRAD.IR

TABLE A.11.2. 10-MV X-RAY TISSUE-MAXIMUM RATIOS

TABLE A.11.3. 10-MV X-RAY SCATTER-MAXIMUM RATIOS

P.A-3

WWW.MEDRAD.IR

P.A-4

P.A-5

P.A-6

P.A-7

P.A-8

P.A-9

P.A-10

P.A-11

P.A-12

P.A-13

P.A-14

P.A-15

P.A-16

P.A-17

P.A-18

P.A-19

WWW.MEDRAD.IR

P.A-20

P.A-21

P.A-22

T A B L E A . 1 2 . 1 . P A T T E R S O N - P A RK E R PL AN A R I MP L A N T T A B L ES

WWW.MEDRAD.IR

TABLE

A.12.1A.

MILLIGRAME-HOURS

PER

1,000

FOR

WWW.MEDRAD.IR

DIFFERENT AREAS AND VARIOUS TREATING DISTANCES a

TABLE A.12.1B. LARGER AREAS

TABLE A.12.1C. SOME FILTRATION CORRECTORS

P.A-23

T A B L E A . 1 2 . 2 . P A T E R S O N - P AR K E R V O L UM E I M P L A N T T A B L E S

WWW.MEDRAD.IR

TABLE A.12.2A.

WWW.MEDRAD.IR

TABLE A.12.2B.

TABLE A.12.2C. USEFUL FILTRATION CORRECTORS

Colore Plates

WWW.MEDRAD.IR

COLOR PLATE 19.2D.

WWW.MEDRAD.IR

C O L O R P L A T E 1 9 . 3 . Im a g e s e g m e nta ti o n f o r p r o st a te g l a nd t re at m e nt pl a nni ng . P r o s t at e gl a n d , b l a dde r , a n d r e c t um a r e d el i ne at e d i n d i f f e r e nt co lo r s . S e g m e nte d s t r u c t u r e s a r e s h o w n in t r a n s v e r s e ( A ) , l a t er a l ( B ) , a nd c o r o na l (C ) p l a ne s .

WWW.MEDRAD.IR

C O L O R P L A T E 1 9 . 4 . B e a m ' s e y e v i e w o f a nt e r i or - p o st e rio r (A ) a nd l e f t - r ig ht l a t er a l ( B ) f i el d s u s ed i n t h e t r e at me nt o f p r o st a t e gl a nd . C o mpo s it e (i nit i al pl us b o o st ) i so do s e c u r v e s f o r a f o ur - f i e l d p la n a r e d i s p l a y ed i n t r a ns v e r s e s a g i tt a l ( D ) , a n d c o r on a l ( E ) p l a ne s . (C),

C O L O R P L A T E 1 9 . 5 . A c o n f o r m a l s t e r eo ta c t i c t re a t me nt p l a n f o r a p i t ui t a ry t u m o r s ho w i n g i s od o se c u r v e s i n t he t r a ns ve r s e ( A ) , l a te r a l ( B ) , a nd c or o na l ( C ) p l a n e s . P r e s c r ip ti o n i so d o se s u r f a c e s c o v e ring t he t a r ge t v ol um e a r e d i sp l a y ed i n f r o n t a l ( D ) a n d l at e r al ( E ) v i e w s .

WWW.MEDRAD.IR

C O L O R P L A T E 1 9 . 6 . A t h r e e - di m e ns io na l pl a n f o r t he t r e at m e nt o f g li ob l a st o ma i s di s p l a ye d . Is o do s e c u r v e s i n t r a ns v e r se ( A ) , l a te r a l ( B ) , a nd c o r o nal ( C) p l a n e s a r e u s e d t o ev a l u a t e t h e pl a n. C um ul a t i v e D V H ( D ) i s a l s o us e f ul i n t he e v a l u a t io n p ro c e s s . Di f f e r e n t i al D V H ( E ) s ho w n he r e fo r t he t umo r o nl y , i s m or e o f a n a c a d e m i c i n te r es t .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

C O L O R PL A T E 2 0 . 1 8 . A c o n c a v e s ha p e t a r ge t o f a t hy r o i d t um o r i n c l o s e v i c i nit y of spinal c o rd (A) and the i nte ns it y - m od ul a t ed r a di a tio n t he r a p y ge ne r a ted i s o do s e pl a n i n a t r a n s v e r s e s l i ce ( B ) .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

C O L O R P L A T E 2 0 . 1 9 . E x a m p l e s o f IM R T - g e ne r a te d pl a ns f o r he a d a nd ne c k tumors. Is o d o se p l an s (A) a nd (B) s ho w t r a ns v e r s e a nd s a g i tt a l do s e d i s t ri b u tio n s f r o m a n u n k n o w n p r i m a r y i n w hi c h 6 0 G y w e re d el i ve r e d to t he P T V w i t h t h e c o r d re c ei v i n g n o m o r e t ha n 4 2 G y . S a m p l e IM R T p l a ns f o r o p ti c g lio m a ( C ) a n d m ul ti p le b r ai n m et a s t a se s ( D) we r e g e ne r at e d b y C OR V U S t r e at m e nt p l a n n i n g s y s t e m , a co m po n e n t o f t he N O MO S ' s P E A C O C K s y s t e m . ( C o ur t e s y o f N o m o s C o rp o r at io n , S e w i c k l e y , P A . )

C O L O R PL A T E 2 0 . 2 0 . A n e x a m p le o f i nte ns i t y - m od ul a te d r a di a tio n t he r ap y pl a n f o r t h e p r o st a te g l a n d u s i n g f i v e f i e l d s . A ny num b e r o f i nt e ns i t y m o d ul at e d f ie ld s may be used d ep e nd i n g p r ac t i c al u po n t he de g re e of of o pt im i z a ti o n se t - up d e s i re d a nd in d o se d i s t ri b u tio n l i mi t at io n s . and c o n s id e r at io ns p a ti e nt e q ui p me nt

WWW.MEDRAD.IR

C O L O R PL A T E 2 1 . 1 0 . A n e x a m p le o f s te r eo t a ct i c r a d ia ti o n s ur ge r y t re a t me nt o f a r t e ri o v e n o u s m a l fo rm a t io n . ( C ) Be a m a r r a ng e m e nt us i ng f i v e no nc o p l a na r a r c s ; i s o do s e r e gio n ( c o lo r w a s h ) c o r r e s po nd i ng to 90 % o f t he m a x i m um d o se i s s ho w n i n a n t e r io r v i e w ( D ) an d l a t e r al v i e w ( E ) .

WWW.MEDRAD.IR

COLOR

PL A T E

21.11.

F r a c t io na l

s t er e ota c t i c

r a di a ti o n

t he r ap y

of

p it ui t a r y

a d e n o m a . A : B e a m a r r a n g e m e n t w it h f i v e no n- c o pl a na r a r c s . B : P r e s c r i p ti o n s u r f a c e c o v e r i n g t h e pl a n n i n g - t r e at m e nt v o lum e .

WWW.MEDRAD.IR

WWW.MEDRAD.IR

C O L O R P L A T E 2 3 . 1 . A s a m p l e o f p r e -t r e atm e nt p la n w i t h (B) do s e vo l u m e h is t o gr a m for t a rg e t ( p r o st a te

125

I s ee d s s ho w i ng ( A ) a nd no r m a l t i s s ue

s e e d s a n d i s od o se c u r v e s i n f o u r ul t r a so und c r o s s s e ct io ns o f p ros t a t e g l a nd a nd gl a nd ) (rectum).

WWW.MEDRAD.IR

WWW.MEDRAD.IR

C O L O R P L A T E 2 3 . 2 . A s a m p l e o f p o st - tr e at m e nt p l a n o f t he s am e p a ti e nt a s i n F i g . 2 3 . 1 s h o w i n g ( A) s e e d s a nd i so d o se c ur v e s i n t he f o ur ul t r a s o und c r o s s s e c t io n s of the p r o st a t e gl a n d a nd (B) dose v o l ume hi s t og r a m for t a r get ( p r o st a te g l a n d ) a n d n o r m a l ti s s u e ( r e c t um) .

WWW.MEDRAD.IR