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The purpose of this study is to establish protocols for simulation and external-beam radiotherapy of pituitary tumors and to examine the performance of a new 3-dimensional treatment planning system (3-D RTP). The asymmetric collimation feature of a dual-energy photon beam linear accelerator allows the user to set up half-beam treatment fields posterior to the orbits with no divergence to anterior structures. Treatment planning was performed with a relatively new Food and Drug Adminisration (FDA)-approved 3-D RTP system. Computerized tomographic (CT) scans used by this system to generate isodose distributions and dose-volume histograms were obtained directly from the scanner which is connected via ethernet cabling to the 3D treatment planning system. These were used for evaluating the dose distribution to the treatment volume, clinical target volume, gross tumor volume, and certain critical organs. Using 6 and 18 MV photon beams, different configurations of standard treatment techniques for pituitary tumors, i.e., a 190° flying wedge arc, 3-fields (an anterior plus a lateral wedged pair), and a pair of lateral fields, were studied and the resulting dose distributions were analyzed. Real-time dose measurements on patients using diode dosimetry were made and compared with computed dose values. With regard to minimizing radiation dose to surrounding structures, (i.e., lens, temporal lobes, spinal cord, etc.) the 190° flying wedge arc technique gave the best isodose distributions, followed by 3 fields (an anterior plus a lateral wedged pair). The opposing lateral fields gave the highest integral dose to the temporal lobes. The dose measured on the patient during the treatment agrees to within ±2% with the computed dose. The protocols presented in this work for simulation, immobilization, and treatment planning of patients with pituitary tumors provide the optimum dose distributions in the target volume with reduced irradiation of surrounding non-target tissues, and can be easily implemented in a radiation oncology department. The presence of a real-time dose-measuring system plays an important role in verifying the actual delivery of radiation dose. © 1995 Wiley-Liss, Inc.

Purpose : To analyze the effect that immobilization devices used in conjunction with beam modifiers may have on the dose to the skin and build-up region. Methods and Materials : Central axis depth dose measurements were made in a polystyrene phantom in the build-up regions using the 6 and 15 MV photon beams, at two different source-to-phantom distances, and various field sizes. The effects of acrylic blocking trays, lead wedges, and cerrobend blocks were assessed in conjunction with the enhancement of dose in the build-up region due to immobilizing devices using plaster and thermoplastic casting materials of different thicknesses. Results : For the 6 MV photons, solid (3 mm) thermoplastic casting material was found to have the greatest effect on surface dose: for a 12 × 12 cm field we measured 79% of maximum dose when treating through the material versus 22% of maximum dose when no beam modifiers or immobilization devices are used. Measurements were also made to evaluate the effect of the immobilization of patients receiving three-dimensional conformal treatments using a 15 MV photon beam. Conclusions : The relevance of these results to treatments in the pelvis, breast, and head and neck regions is discussed. For 6 MV beams, special consideration should be given if the need arises to treat through the immobilization device, as unacceptable skin reactions may result.

Two-dimensional relative dose distributions have been measured around 125I brachytherapy seeds. The two seed models studied, models 6711 and 6712, were manufactured by the 3M Company. Silicon detectors immersed in water phantoms were used to measure the dose. A computerized data acquisition system that controlled the radial position of the diode and the angular rotation of the seed, as well as a manually controlled system were used to collect and store the data. Our results show that the two seed models have relative dose distributions which are quite similar; however, the absolute dose distributions are sufficiently different to warrant separate look-up tables for the two seed models. Additionally, our results are compared with dose distribution data previously obtained for the model 6711 seed.

This paper describes the beam characteristics and dosimetry measurements performed on the 6-MV photon beam of a new model of linear accelerator, three of which were recently introduced and installed in our institution. Percent depth dose and tissue maximum ratio tables for a variety of field sizes and depths, as well as other parameters used for treatment planning are presented. These accelerators are the first of their kind using both hardware and software tools to control interlocks. Checking procedures for these interlocks are available from the authors upon request. Comparison of characteristic parameters between these three new 6-MV linear accelerators and with the 6-MV beams of two other accelerators is also made.

Purpose: Electron beam radiotherapy is frequently administered based on clinical setups without formal treatment planning. We felt, therefore, that it was important to monitor electron beam treatments by in vivo dosimetry to prevent errors in treatment delivery. In this study, we present our clinical experience with patient dose verification using electron diodes and quantitatively assess the dose perturbations caused by the diodes during electron beam radiotherapy. Methods and Materials: A commercial diode dosimeter was used for the in vivo dose measurements. During patient dosimetry, the patients were set up as usual by the therapists. Before treatment, a diode was placed on the patient's skin surface and secured with hypoallergenic tape. The patient was then treated and the diode response registered and stored in the patient radiotherapy system database via our in-house software. A customized patient in vivo dosimetry report showing patient details, expected and measured dose, and percent difference was then generated and printed for analysis and record keeping. We studied the perturbation of electron beams by diodes using film dosimetry. Beam profiles at the 90% prescription isodose depths were obtained with and without the diode on the beam central axis, for 6–20 MeV electron beams and applicator/insert sizes ranging from a 3-cm diameter circular field to a 25 × 25 cm open field. Results: In vivo dose measurements on 360 patients resulted in the following ranges of deviations from the expected dose at the various anatomic sites: Breast (222 patients) −20.3 to +23.5% (median deviation 0%); Head and Neck (63 patients) −21.5 to +14.8% (median −0.7%); Other sites (75 patients) −17.6 to +18.8% (median +0.5%). Routine diode dosimetry during the first treatment on 360 patients (460 treatment sites) resulted in 11.5% of the measurements outside our acceptable ±6% dose deviation window. Only 3.7% of the total measurements were outside ±10% dose deviation. Detailed investigations revealed that the dose discrepancies, overwhelmingly, were due to inaccurate diode orientation and positioning, especially in the regions with rapidly changing contours and/or sloping surfaces. The presence of a diode in the treatment field was found, in some cases, to cause significant dose reduction, most noticeable with smaller fields and lower energy beams. The reduction in dose ranged from 16% (for a 6 MeV beam and a 3 cm diameter circular field) to 4% (for a 12 MeV beam and a 10× 10 cm field). Conclusions: Diode dosimetry was found to be convenient and valuable for verifying in real time the dose delivery accuracy of electron beam treatments, but with some caveats. When treating a small field by low energy electrons, frequent use of diodes is undesirable, because it might result in appreciable reduction of dose to the target volume.

The purpose of this work is to improve the quality of patient care in radiation therapy by implementing a comprehensive quality assurance (QA) program aiming to enhance patient in vivo dosimetry on a routine basis. The characteristics of two commercially available semi-conductor diode dosimetry systems were evaluated. The diodes were calibrated relative to an ionization chamber-electrometer system with calibrations traceable to the National Institute of Standards and Technology (NIST). Correction factors of clinical relevance were quantified to convert the diode readings into patient dose. The results of dose measurements on 6 patients undergoing external beam radiation therapy for carcinoma of the prostate on three different therapy units are presented. Field shaping during treatments was accomplished either by multileaf collimation or by cerrobend blocking. A deviation of less than ±4% between the measured and prescribed patient doses was observed. The results indicate that the diodes exhibit excellent linearity, dose reproducibility, minimal anisotropy, and can be used with confidence for patient dose verification. Furthermore, diodes render real time verification of dose delivered to patients.

Purpose : To study the attenuation and scattering effects of ocular implants, made from different materials, on the dose distributions of a 6 MV photon beam, and 6, 9, and 12 MeV electron beams used in orbital radiotherapy. Methods and Materials : Central axis depth-dose measurements were performed in a polystyrene phantom with embedded spherical ocular implants using film dosimetry of a 6 MV photon beam and electron beams of 6, 9, and 12 MeV energy. The isodose distributions were also calculated by a computerized treatment planning system using computerized tomography (CT) scans of a polystyrene phantom that had silicone, acrylic, and hydroxyapatite ocular implants placed into it. Results : Electron beam dose distributions display distortions both on the measured and calculated data. This effect is most accentuated for the hydroxyapatite implants, for which the transmissions through ocular implants are on the order of 93% for the 6 MV photon beam, and range from 60% for 6 MeV electrons to 90% for 12 MeV electrons. Conclusion : We studied the effect of ocular implants of various materials, embedded in a polystyrene phantom, on the dose distributions of a 6 MV photon beam, and 6, 9, and 12 MeV electron beams. Our investigations show that while 6 MV photons experience only a few percent attenuation, lower energy electron beam with 60% transmission is not a suitable choice of treating tumors behind the ocular implants.

The relative dose distribution around the 103Pd model 200 implant seed was measured with a computerized data acquisition system employing a p-n junction silicon diode immersed in a water phantom. Data are acquired in polar coordinates by computer control of (1) the diode distance from the seed center and (2) the rotation angle of seed about a transverse axis. Transverse axis data are compared with thermoluminescent dosimeter (TLD) measurements and a Monte Carlo calculation by others.