Measurement of off-axis and peripheral skin dose using radiochromic film

A radiotheraphy skin dose profile can be obtained with radiochromic film. The central axis skin dose relative to Dmax for a 10 x 10 cm2 field size was found to be 22%, 17% and 15.5% for 6 MV, 10 MV and 18 MV photon beams. Peripheral dose increased with increasing field size. At 10 MV the skin dose 2 cm outside the geometric field edge was measured as 6%, 10% and 17% for 10 x 10 cm2, 20 x 20 cm2 and 30 x 30 cm2 field sizes respectively. Off-axis skin dose decreased as distance increased from central axis for fields with Perspex block trays. For a 20 x 20 cm2 field, an approximately 5-8% drop in percentage skin dose was observed from central axis to the beam edge.     

Calculating dose and output factors for wedged photon radiotherapy fields using a convolution/superposition method

To account for clinical divergent and polychromatic photon beams, we have developed kernel tilting and kernel hardening correction methods for convolution dose calculation algorithms. The new correction methods were validated by Monte Carlo simulation. The accuracy and computation time of the our kernel tilting and kernel hardening correction methods were also compared to the existing approaches including terma divergence correction, dose divergence correction methods, and the effective mean kernel method with no kernel hardening correction. Treatment fields of 10 x 10-40 x 40 cm2 (field size at source to axis distance (SAD)) with source to source distances (SSDs) of 60, 80, and 100 cm, and photon energies of 6, 10, and 18 MV have been studied. Our results showed that based on the relative dose errors at a depth of 15 cm along the central axis, the terma divergence correction may be used for fields smaller than 10 x 10 cm2 with a SSD larger than 80 cm; the dose divergence correction with an additional kernel hardening correction can reduce dose error and may be more applicable than the terma divergence correction. For both these methods, the dose error increased linearly with the depth in the phantom; the 90% isodose lines at the depth of 15 cm were shifted by about 2%-5% of the field width due to significant underestimation of the penumbra dose. The kernel hardening effect was less prominent than the kernel tilting effect for clinical photon beams. The dose error by using nonhardening corrected kernel is less than 2.0% at a depth of 15 cm along the central axis, yet it increased with a smaller field size and lower photon energy. The kernel hardening correction could be more important to compute dose in the fields with beam modifiers such as wedges when beam hardening is more significant. The kernel tilting correction and kernel hardening correction increased computation time by about 3 times, and 0.5-1 times, respectively. This can be justified by more accurate dose calculations for the majority of clinical treatments.     

A dual source photon beam model used in convolution/superposition dose calculations for clinical megavoltage x-ray beams

A realistic photon beam model based on Monte Carlo simulation of clinical linear accelerators was implemented in a convolution/superposition dose calculation algorithm. A primary and an extra-focal sources were used in this beam model to represent the direct photons from the target and the scattered photons from other head structures, respectively. The effect of the finite size of the extra-focal source was modeled by a convolution of the source fluence distribution with the collimator aperture function. Relative photon output in air (Sc) and in phantom (Scp) were computed using the convolution method with this new photon beam model. Our results showed that in a 10 MV photon beam, the Sc, Sp (phantom scatter factor), and Scp factors increased by 11%, 10%, and 22%, respectively, as the field size changed from 3 x 3 cm2 to 40 x 40 cm2. The variation of the Sc factor was contributed mostly by an increase of the extra-focal radiation with field size. The radiation backscattered into the monitor chamber inside the accelerator head affected the Sc by about 2% in the same field range. The output factors in elongated fields, asymmetric fields, and blocked fields were also investigated in this study. Our results showed that if the effect of the backscattered radiation was taken into account, output factors in these treatment fields can be predicted accurately by our convolution algorithm using the dual source photon beam model.     

Dose variation at bone/titanium interfaces using titanium hollow screw osseointegrating reconstruction plates

PURPOSE: To evaluate dose variations at bone/titanium interfaces in an experimental model designed to simulate postoperative radiotherapy in patients with mandibular reconstructions using a titanium hollow-screw osseointegrating reconstruction plate (THORP) system. MATERIALS AND METHODS: The model consisted of a 25 x 25 x 10 mm3 block of fresh bovine femoral diaphysis, to the surface of which a segment of THORP system reconstruction plate was fixed by means of a solid titanium screw 4 mm in diameter and 10 mm in length. Using specially designed thermoluminescent dosimeters (TLD) 2 mm in diameter and 0.13 mm in thickness, dose measurements were carried out at four distances from the screw axis (0.1, 0.3, 0.6, and 1 mm). 60Co and 6-MV photon beams were used at incidences both perpendicular and parallel ("axial") to the screw axis. RESULTS: For 6-MV X-ray beams incident perpendicular to the screw axis, the maximum dose enhancement (due to backscatter) and the maximum dose reduction (due to attenuation) at the bone/titanium interface were 5% (+/- 2%) and 6% (+/- 2%), respectively. The corresponding values for 60Co beams were 6% (+/- 5%) and 10% (+/- 5%). For the axial incidences, a maximum dose enhancement of 5-7% was noted for both 6-MV X-rays and 60Co for beams incident on the surface containing the THORP plate segment, whereas beams incident on the opposite surface induced only a very small dose enhancement (2-3%). CONCLUSION: Using a new experimental model, TLD measurements showed only marginally significant dose variations at bone/titanium interfaces around THORP screws, all measured values being very close to the uncertainty limits (+/- 5%) associated with the method. For both 60Co and 6-MV beams, dose variations appeared smaller for axial than for perpendicular incidences. Because photon beams used in head and neck cancer treatment are most often directed parallel to the screw axes, these results suggest that failures of prosthetic osseointegration are unlikely to be explained by an overdosage at the bone/titanium interface.     

Microdosimetric analysis of radiation from a clinical mammography machine using realistic breast phantoms and a miniature proportional counter

We have measured the microdosimetric spectra of a Senographe 600T mammography machine employing an Mo target with 0.8 mm Be inherent filtration and 0.03 mm Mo added filtration, giving a half-value layer of 0.35 mm A1 at 28 kVp. In all of our measurements a large collimator producing a 24 cm x 30 cm field at 65 cm was used. Two different phantom compositions differing in the ratio of adipose to fibroglandular tissue were compared, using simulated breast material from Nuclear Associates. Spectra were taken at various depths and locations in simulated breasts of 3.4 and 5 cm thickness. The detector used was a miniature proportional counter having outer dimensions of 5 cm x 1.8 cm diameter, with a sensitive volume 0.5 mm x 0.5 mm. The small dimensions of the counter and the cavity allowed total embedding in the breast material with minimal disturbance of the photon and secondary electron spectrum. Our results show that there can be changes in the radiation quality amounting to as much as 17% (as measured by the dose mean lineal energy. yD) between breasts of different thickness, at the same relative position within the breast. There is little difference due to breast composition.     

Monte Carlo calculations of electron beam output factors for a medical linear accelerator

The purpose of this study was to investigate the application of the Monte Carlo technique to the calculation and analysis of output factors for electron beams used in radiotherapy. The code EGS4/BEAM was used to obtain phase-space files for 6, 12 and 20 MeV clinical electron beams from a scattering-foil linac (Varian Clinac 2100C) for a clinically representative range of applicator and square or rectangular insert combinations. The source-to-surface distance used was 100 cm. The field sizes ranged from 1 x 1 cm2 to 20 x 20 cm2. These phase-space files were analysed to study the intrinsic beam characteristics and used as source input for relative dose and output factor computations in homogeneous water phantoms using the code EGS4/DOSXYZ. The calculated relative central-axis depth-dose and transverse dose profiles at various depths of clinical interest agreed with the corresponding measured dose profiles to within 2% of the maximum dose. Calculated output factors for the fields studied agreed with measured output factors to about 2%. This demonstrated that for the Varian Clinac 2100C linear accelerator, electron beam dose calculations in homogeneous water phantoms can be performed accurately at the 2% level using Monte Carlo simulations.     

Measurements of phantom scatter factors for small field sizes in high energy x rays

An alternate method to measure the phantom scatter factor in small fields is provided for high energy photon beams. The measurement technique is based on the density scaling theorem described by O'Connor [Phys. Med. Biol. 1, 352-369 (1957)]. The phantom scatter factor (Sp) is measured in balsa and cedar wood to give effective field sizes in 3 x 3 to 0.5 x 0.5 cm2 water. The extrapolated zero area phantom scatter factor from the average data of balsa and cedar is 0.45. This indicates that the variation of output is largely due to a sharp decrease in the phantom scatter factor for small field sizes.     

Correction factors for Farmer-type chambers for absorbed dose determination in 60Co and 192Ir brachytherapy dosimetry

This paper presents two methods for absorbed dose determination with ionization chambers at short distance from 60Co and 192Ir brachytherapy sources. The methods are modifications of the Bragg-Gray and large cavity principles given in the IAEA code of practice for high- and medium-energy photon beams. A non-uniformity correction factor to account for the non-uniform electron fluence in the air cavity is introduced into the methods. The absorbed dose rates were determined from ionization chamber measurements at distances between 1.5 and 5.0 cm from the brachytherapy sources. The agreement between the two methods is excellent in 60Co brachytherapy dosimetry. For 192Ir dosimetry, the difference is less than 2.5% at all distances. In absorbed dose rate calculations with the 60Co brachytherapy source, the ratios between calculated and experimentally determined absorbed dose rates are 0.987 and 0.994 depending on the method used for absorption and scatter correction. In 192Ir dosimetry, the large cavity principle gives almost identical values to those which can be obtained with the AAPM recommendations. Using the chambers according to the Bragg-Gray principle in 192Ir dosimetry, the agreement with AAPM calculated absorbed dose rates is within 2.5% at all distances. The uncertainty, expressed as one standard deviation, in the experimentally determined absorbed dose is estimated to be between 3 and 4%.     

Theoretical and experimental determination of phantom scatter factors for photon fields with different radial energy variation

The output factor used for monitor unit determination in radiotherapy can be divided into two factors: the head scatter factor and the phantom scatter factor. Theoretical and experimental phantom scatter factors have been compared for different beam qualities between 4 MV and 50 MV and field sizes from 5 cm x 5 cm to 30 cm x 30 cm. The theoretical data were obtained through a convolution method based on Monte Carlo calculated energy spectra and dose kernels. The calculations have been performed both for accelerators with a rather large energy variation within the field and for accelerators with a constant energy distribution in the field. Deviations between theoretical and experimental data were found to be less than 1%.     

Radiation dose perturbation at tissue-titanium dental interfaces in head and neck cancer patients

PURPOSE: To determine the dose perturbation effects at the tissue-metal implant interfaces in head and neck cancer patients treated with 6 MV and 10 MV photon beams. METHODS AND MATERIALS: Phantom measurements were performed to investigate the magnitude of dose perturbation to the tissue adjacent to the titanium alloy implants with (100 mu and 500 mu thick) and without hydroxylapatite (HA) coating. Radiographic and radiochromic films were placed at the upper (and lower) surface of circular metal discs (diameter x thickness: 15 x 3.2, 48 x 3.2, 48 x 3.8 mm2) in a solid water phantom and were exposed perpendicular to radiation beams. The dosimeters were scanned with automatic film scanners. Using a thin-window parallel-plate ion chamber, dose perturbation were measured for a 48 x 3.2 mm2 disc. RESULTS: At the upper surface of the tissue-dental implant interface, the radiographic data indicate that for 15 x 3.2 mm2 uncoated, as well as 100 mu coated discs, dose perturbation is about +22.5% and +20.0% using 6 MV and 10 MV photon beams, respectively. For 48 x 3.2 mm2 discs, these values basically remain the same. However, for 48 x 3.8 mm2 discs, these values increase slightly to about +23.0% and +20.5% for 6 MV and 10 MV beams, respectively. For 48 x 3.2 mm2 discs with 500 mu coating, dose enhancement is slightly lower than that obtained for uncoated and 100 mu coated discs for each beam energy studied. At the lower interface for 15 x 3.2 mm2 and 48 x 3.2 mm2 uncoated and 100 mu coated discs, dose reduction is similar and is about -13.5% and -9.5% for 6 MV and 10 MV beams, respectively. For 48 x 3.8 mm2 discs, dose reduction is about -14.5% and -10.0% for 6 MV and 10 MV beams, respectively. For 48 x 3.2 mm2 discs with 500 mu coating, the dose reduction were slightly higher than those for uncoated and 100 mu coated discs. CONCLUSIONS: For the beam energies studied, dose enhancement is slightly larger for the lower energy beam. The results of dose perturbation were similar for 100 mu coated and uncoated discs. These results were slightly lower for the 500 mu coated discs but are not clinically significant. The dosimetry results obtained from radiochromic films were similar to the ones obtained from radiographic film. The dose enhancement results obtained from ion chamber dosimetry are higher than those obtained from film dosimetry. The ion chamber data represent the data at "true" tissue-titanium interface, whereas the ones obtained from film dosimetry represent the data at film-titanium interface.     

The FE-lspd model for electron beam dosimetry

The FE-lspd model is a two-component electron beam model that distinguishes between electrons that can be described by small-angle transport theory and electrons that are too widely scattered for small-angle transport theory to be applicable. The two components are called the primary beam and the laterally scattered primary distribution (lspd). The primary beam component incorporates a simple version of the Fermi-Eyges model and dominates dose calculations at therapeutic depths. The lspd component corrects erros in the lateral spreading of the primary beam component, thereby improving the accuracy by which the FE-lspd model calculates dose distribution in blocked fields. Comparisons were made between dose profiles and central-axis depth dose distributions in small fields calculated by the FE-lspd, Fermi-Eyges and EGS4 Monte Carlo models for a 10 MeV beam in a homogeneous water phantom. The maximum difference between the dose calculated using the FE-lspd model and EGS4 Monte Carlo is about 6% at a field diameter of about 1 cm, and less than 2% for field sizes greater than 3 cm diameter. The maximum difference between the Fermi-Eyges and Monte Carlo calculations is about 18% at a field diameter of about 2.5 cm. A comparison was made with the central-axis depth dose distribution measured in water for a 3 cm diameter field in a 10 MeV clinical electron beam. The errors in the dose distribution were found to be less than 2% using the FE-lspd model but almost 18% using the Fermi-Eyges model. A comparison was also made with pencil beam profiles calculated using the second-order Fermi-Eyges transport model.     

Cavitation at grain and phase boundaries during superplastic flow of an aluminum bronze

Cavities have been observed to form at grain and phase boundaries under certain strain rate conditions during superplastic tensile deformation of a Cu-9.5 pct Al-4 pct Fe aluminum-bronze. The cavities form preferentially at α-β interfaces or triple junctions involving both phases. The process of cavitation is associated with grain boundary sliding and cavity nucleation probably occurs at points of stress concentration in the sliding interfaces. The ductility is not markedly impaired by the cavities because the high strain-rate sensitivity of the material inhibits the interlinkage of cavities at high strains. A range of strains and strain rates for superplastic forming processes has been determined at which the volume fraction of cavities present was tolerable.     

The secretory intestinal transport of some beta-lactam antibiotics and anionic compounds: a mechanism contributing to poor oral absorption

PURPOSE: To measure the effect of silicon diode detectors used for in vivo dosimetry on beam characteristics and determine whether this effect is clinically significant. METHODS AND MATERIALS: Commercially available photon and electron diodes were placed on the central axis of photon and electron beams. The beam characteristics were measured for 6- and 10-MV photon and 6-20-MeV electron energies from a Varian Clinac 1800 medical linear accelerator. Water was used for the medium, and measurements were made for various clinically common field sizes and depths. RESULTS: Beam attenuations along the central axis were 10 and 7.5% for 6- and 10-MV photons, respectively. Electron beam dose reductions were between 13 and 25% for 20-6-MeV electrons. Photon beam flatness varied up to 7% at different depths, but the symmetry was not affected much. Electron beam flatness and symmetry were significantly changed to as much as 18 and 6%, respectively. CONCLUSION: Use of diode detectors on central axis of photon and electron beams for in vivo dosimetry causes significant attenuation and alteration of the beam characteristics. The percentage of the volume affected is significant (e.g., 23% of the volume in a 4 x 4 field gets 10% less dose for a 6-MV photon beam), especially if these diodes are used for in vivo dosimetry on the central axis every day for every treatment, as is done in some clinics. Other beam parameters such as penumbra and skin dose are also affected. It is therefore recommended that the diodes be used only as needed.     

Build-up cap materials for measurement of photon head-scatter factors

The suitability of high-Z materials as build-up caps for head-scatter measurements has been investigated. Build-up caps are often used to enable characterization of fields too small for a mini-phantom. We have studied lead and brass build-up caps with sufficiently large wall thicknesses, as compared to the range of contaminating electrons originating in the accelerator head, and compared them with build-up caps made of ionization chamber equivalent materials, i.e. graphite. The results were also compared with measurements taken using square and cylindrical polystyrene mini-phantoms. Field sizes ranging from 3 cm x 3 cm up to 40 cm x 40 cm were studied for nominal photon energies of 4, 6, 10 and 18 MV. The results show that the use of lead and brass build-up caps produces normalized head-scatter data slightly different from graphite build-up caps for large fields at high photon energies. At lower energies, however, no significant differences were found. The intercomparison between the two different plastic mini-phantoms and graphite caps showed no differences.     

Dentistry''s role in obstructive sleep apnoea. Review and case report

Percentage dose at the surface and at 1 mm depth for megavoltage photon beams are increased through the influence of block trays. This represents a decrease in skin sparing properties for both the epidermal and dermal layers. The increase in percentage dose varies with type and thickness of block tray material. At 6MVp, 20cm x 20cm field size, the percentage surface dose is 26%, 26.5%, 33% and 35% for open, steel honeycomb tray, 6mm perspex and 10 mm perspex block trays respectively. At 1 mm depth these values are 52%, 52.5%, 61%, 60% respectively. A similar effect is seen at higher energies. Results show that care should be taken when selecting an appropriate block tray if skin sparing is of importance.     

Test procedures for verification of an electron pencil beam algorithm implemented for treatment planning

The calculation of an electron dose distribution in a patient is a difficult problem because of the presence of tissue and surface inhomogeneities. Verification of the dose planning system is therefore essential. In this investigation, a novel method is used to evaluate a commercially available system (Helax-TMS), at electron energies between 10 and 50 MeV, both for a conventional treatment unit and an MLC-collimated scanned beam unit with a helium-filled treatment head. First, the experiments were designed to verify the local beam database and some fundamental characteristics of the electron beam calculations. Secondly, a number of generalised situations that would be encountered in the clinical treatment planning were evaluated oblique incidence, field shaping with multi-leaf collimator, bolus edges, and air cavities. Dose distributions in two generalised anatomical phantoms simulating a neck and a nose were also analysed. The results have, when so possible, been presented as the dose ratio within the 'flattened area' for dose profiles and down to the 'treatment depth' (80% dose level) for depth doses. In the penumbra region and in the dose fall-off region, the comparison has been represented by the distance deviation between calculated and measured dose profiles or depth doses. A new tool, 'volume integration', was used to evaluate the deviations from a more clinical point of view. Most results were within +/- 2% in dose for volumes larger than a sphere with a diameter of 15 mm, or +/- 2 mm in position. Dose deviations were generally found for oblique incidences and below heterogeneities such as small air cavities and bolus edges in limited volumes.     

Oligosaccharides of recombinant mouse gelatinase B variants

To determine absorbed dose to water it is essential that the radiation quality of the x-ray beam is known accurately. The unique method of defining the beam quality is to acquire a detailed knowledge of the photon spectrum at the point of measurement in water, but this is impractical. The aim of this work was to investigate a quality index that uniquely defines the ratio of mass-energy absorption coefficients of water to air at 2 cm deep in water ([(mu en/rho)w/a]z = 2,phi). Three parameters, HVL, mean energy at 2 cm deep in water and the ratio of the doses at 2 and 5 cm deep in water (D2/D5) were investigated as functions of [(mu en/rho)w/a]z = 2,phi. The quality index that best defines [(mu en/rho)w/a]z = 2,phi is the ratio of doses at 2 and 5 cm depth in water.     

Head scatter modelling for irregular field shaping and beam intensity modulation

Scattered radiation from within the treatment head can contribute significant dose to all parts of a radiotherapy treatment field. A multileaf collimator may be used to create an arbitrarily shaped field, and may also be used, under dynamic control, to modulate the beam intensity over the field. This method of intensity modulation is effectively a superposition of a large number of fields which have the same beam direction, but different shapes, and some of these shapes may have unusually small dimensions, particularly in the direction of the leaf movement. Two models for predicting the head scatter under these conditions have been investigated. These are a first-order Compton scatter approximation from the flattening filter, and an empirical fit to measured data using an exponential function. The first model only considers scatter from the flattening filter and has been applied to field sizes between 2 cm by 2 cm and 10 cm by 10 cm, where agreements are all within 1%. However it is not satisfactory at larger field sizes where small scatter contributions, from scattering sources other than the flattening filter, are integrated over large areas. The second model uses measured data between 4 cm by 4 cm and 30 cm by 30 cm to optimize the exponential function and is used to calculate the head scatter contribution for all field sizes. In this case good agreement is achieved over the full field size range, and hence this is a more generally applicable model. Results are presented for static irregularly shaped fields and intensity modulated beams created using a Philips multileaf collimator.     

Cavitation during hot-torsion testing of Ti-6Al-4V

Hot-torsion testing was used to establish the cavitation behavior of a typical alpha/beta titanium alloy, Ti-6Al-4V, with a colony microstructure, during simple-shear deformation. For this purpose, sections of deformed specimens were examined by optical metallography, and by scanning and orientation-imaging microscopy (OIM). It was found that cavity nucleation occurred along prior beta boundaries as well as at triple points; in particular, most cavities nucleated along boundaries perpendicular to the axial direction of the specimen. Extensive growth was observed for cavities surrounded by both hard and soft orientations, with the soft colonies accommodating more of the imposed strain. At high degrees of deformation, dynamic globularization of the colony microstructure adjacent to the cavities was also observed. In addition, the metallographic observations revealed that the cavities did not grow in an equiaxed mode, but in an elliptical manner. A tensor describing the cavity-growth rate along the axial, radial, and hoop specimen directions was determined using measurements of individual cavity sizes. The cavity-growth behavior in torsion was compared to previous observations from hot-tension tests. This comparison indicated that the rate of cavity growth in shear was approximately one-tenth that in uniaxial tension. This finding is in broad agreement with models predicting the variation of the cavity-growth rate as a function of the ratio of the mean stress to the hydrostatic stress.