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The Presbyterian-University Hospital of Pittsburgh installed the first clinically designated Leksell gamma knife in the U.S. in August 1987. Gamma knife radiosurgery involves stereotactic target localization with the Leksell frame and subsequent closed-skull single-treatment session irradiation of a lesion with multiple highly focused gamma ray beams produced from 60Co sources. The hemispherical array of sources, the large number of small-diameter beams, and the steep dose gradients surrounding a targeted lesion make physical characterization of the radiation field complex. This paper describes the physical features and the operation of the gamma knife as well as the calibration procedures of the very small, well-collimated beams. The results of studies using in-phantom ion chamber, diode, film, and lithium fluoride thermoluminescent dosimetry were all in close agreement. Both single-beam and multiple-beam dose profiles were measured and reported for the interchangeable helmets, which have 4-, 8-, 14-, and 18-mm-diameter collimators. We also describe the dose calculation and treatment planning algorithm in the treatment planning system. Measurements of the accuracy of mechanical and radiation alignment are also performed and discussed.

A five-field conformal technique with three-dimensional radiation therapy treatment planning (3-DRTP) has been shown to permit better definition of the target volume for lung cancer, while minimizing the normal tissue volume receiving greater than 50% of the target dose. In an initial study to confirm the safety of conventional doses, we used the five-field conformal 3-DRTP technique. We then used the technique in a second study, enhancing the therapeutic index in a series of 42 patients, as well as to evaluate feasibility, survival outcome, and treatment toxicity. Forty-two consecutive patients with nonsmall-cell lung carcinoma (NSCLC) were evaluated during the years 1993-1997. The median age was 60 years (range 34-80). The median radiation therapy (RT) dose to the gross tumor volume was 6,300 cGy (range 5,000-6,840 cGy) delivered over 6 to 6.5 weeks in 180-275 cGy daily fractions, 5 days per week. There were three patients who received a split course treatment of 5,500 cGy in 20 fractions, delivering 275 cGy daily with a 2-week break built into the treatment course after 10 fractions. The stages of disease were II in 2%, IIIA in 40%, IIIB in 42.9%, and recurrent disease in 14.3% of the patients. The mean tumor volume was 324.14 cc (range 88.3-773.7 cc); 57.1% of the patients received combined chemoradiotherapy, while the others were treated with radiation therapy alone. Of the 42 patients, 7 were excluded from the final analysis because of diagnosis of distant metastasis during treatment. Two of the patients had their histology reinterpreted as being other than NSCLC, 2 patients did not complete RT at the time of analysis, and 1 patient voluntarily discontinued treatment because of progressive deterioration. Median follow-up was 11.2 months (range 3-32.5 months). Survival for patients with Stage III disease was 70.2% at 1 year and 51.5% at 2 years, with median survival not yet reached. Local control for the entire series was 23.3+/-11.4% at 2 years. However, for Stage III patients, local control was 50% at 1 year and 30% at 2 years. Patients who received concurrent chemotherapy had significantly improved survival (P = 0.002) and local control (P = 0.004), compared with RT alone. Late esophageal toxicity ofor =Grade 3 occurred in 14.1+/-9.3% of patients (3 of 20) receiving combined chemoradiotherapy, but in none of the 15 patients treated with RT alone. Pulmonary toxicity limited to Grades 1-2 occurred in 6.8% of the patients, and none developedor =Grade 3 pulmonary toxicity. Patients with locally advanced NSCLC, who commonly have tumor volumes in excess of 200 cc, presenta challenge for adequate dose delivery without significant toxicity. Our five-field conformal 3-DRTP technique, which incorporates treatment planning by dose/volume histogram (DVH) was associated with minimal toxicity and may facilitate dose escalation to the gross tumor.

It is known experimentally that a wedge transmission factor depends upon the field size and depth of measurement in particular. Dependence of the transmission upon depth has been attributed to a hardening of the incident beam through the filter, which preferentially absorbs the low-energy photon of the bremsstrahlung component of that beam. We have attempted to separate this hardening effect from that of increased phantom scatter due to dose gradient induced by the wedge filter. Using an experimental wedge machined from cerrobend, the filter transmission at depth is measured and redefined relative to an "equally hardened" beam, obtained by filtering through a flat slab of equal thickness at the center of the wedge. Results of the Co-60, 4-, and 8-MV wedged beams indicate that nearly half of the increase in the transmission at depth is due to the effect of dose-gradient scatter in polystyrene phantom. Based on a simple relationship between primary and scattering radiation, an algebraic presentation is indeed in support of the dose gradient resulting in apparent increase in the wedge factors, at depth.

Abutment of unmodified electron fields to irradiate large areas can lead to significant dose inhomogeneities in the region of junction of the fields. In this paper we describe the design and dosimetric characteristics of a device developed to broaden the electron beam penumbra and thereby to improve the dose uniformity in the overlap region. The device is a high‐density triangular‐toothed comb capable of reducing the beam intensity without seriously degrading the beam energy. The effect of the comb is such that a single device will generate a beam penumbra which is broad and very nearly linear at all depths for all clinically used beam energies. Results are shown for various field configurations and energies. With a gap of 5.0 cm between the treatment cone and phantom surface the dose ‘‘ripple’’ in the region beneath the teeth was found not to exceed ±5% at 0.5‐cm depth.

We measured neutron time-of-flight spectra from 90 MeV protons and 140 MeV alpha particles bombarding thin targets of Al, Ni, Zr, and Bi at laboratory angles between 20\ifmmode^\circ\else\textdegree\fi{} and 135\ifmmode^\circ\else\textdegree\fi{}. The lowenergy (5 to 45 MeV) portions of the spectra were measured with 5 cm diameter by 5 cm deep NE-213 counters at 1 m flight paths with n-$\ensuremath{\gamma}$ pulse-shape discrimination. The high-energy (35 to 150 MeV) portions of the spectra were measured with 12.7 cm diameter by 10.2 cm deep NE-102 counters at flight paths of 2.0 to 5.0 m. The proton-induced measured neutron spectra reveal three distinct energy regions: a low-energy evaporation region, a high-energy region dominated by the quasifree scattering process, and an intermediate-energy region dominated by multistep, preequilibrium processes. In the latter two regions, the spectra show strong angular dependence. The alpha-particle induced neutron spectra show these same distinct energy regions plus an exponential falloff above the beam energy per nucleon. The neutron spectra are compared with earlier proton spectra produced also by 90 MeV protons and 140 MeV alpha particles. It is observed that the high-energy portions of the forward-angle neutron and proton cross sections are in ratios consistent with the idea that single nucleon-nucleon scattering dominates. For the heavy-mass targets, the low-energy evaporation regions show neutron yields larger than proton yields. The proton-to-neutron ratios observed in the high-energy continua are interpreted with a quasifree calculation fitted simultaneously to the proton and the neutron spectra. Preequilibrium calculations with the exciton model and the hybrid model reproduce the shape of the experimental angle-integrated energy spectra down to lower energies than the quasifree calculations. The exciton model calculations underestimate the magnitudes of the cross sections, while the hybrid model provides better absolute agreement. One of the preequilibrium calculations uses the method of Mantzouranis and Weidenm\"uller to predict angular distributions; we find that the predicted angular distributions overestimate the neutron yields at forward angles. The intranuclear-cascade model predicts proton-to-neutron ratios much smaller than experimentally observed in the high-energy forward-angle continua.NUCLEAR REACTIONS $^{27}\mathrm{Al}$, $^{58}\mathrm{Ni}$, $^{90}\mathrm{Zr}$, $^{209}\mathrm{Bi}$(p,n), ($\ensuremath{\alpha}$, n), ${E}_{\mathrm{p}}=90$ MeV; ${E}_{\ensuremath{\alpha}}=140$ MeV; ${\ensuremath{\theta}}_{L}=20\ifmmode^\circ\else\textdegree\fi{}\ensuremath{-}135\ifmmode^\circ\else\textdegree\fi{}$; measured $\frac{{d}^{2}\ensuremath{\sigma}}{d\ensuremath{\Omega}\mathrm{dE}}$; compared with available experimental proton spectra and with theoretical calculations including PWIA quasifree scattering, preequilibrium exciton, geometry-dependent hybrid, and intranuclear-cascade models.

Polyacrylamide-based tissue-equivalent phantoms simulating cortical bone and muscle are described. The equivalency is based upon similar elemental composition and density, and partial similarity in the morphology of bone. Satisfactory results were obtained when the phantoms were tested at low (20 keV) and high (15 MeV) gamma radiation. Applicability of this phantom material to neutron transport is discussed. The material can be molded and shaped and its composition is easily modified by altering the proportions of the constituents. Trace elements or radionuclides are easily added. Details of the physical and radiation characteristics of the formulated systems are given together with the manufacturing procedures.

Polyacrylamide-based tissue-equivalent phantoms simulating cortical bone and muscle are described. The equivalency is based upon similar elemental composition and density, and partial similarity in the morphology of bone. Satisfactory results were obtained when the phantoms were tested at low (20 keV) and high (15 MeV) gamma radiation. Applicability of this phantom material to neutron transport is discussed. The material can be molded and shaped and its composition is easily modified by altering the proportions of the constituents. Trace elements or radionuclides are easily added. Details of the physical and radiation characteristics of the formulated systems are given together with the manufacturing procedures.

Abutment of unmodified electron fields to irradiate large areas can lead to significant dose inhomogeneities in the region of junction of the fields. In this paper we describe the design and dosimetric characteristics of a device developed to broaden the electron beam penumbra and thereby to improve the dose uniformity in the overlap region. The device is a high-density triangular-toothed comb capable of reducing the beam intensity without seriously degrading the beam energy. The effect of the comb is such that a single device will generate a beam penumbra which is broad and very nearly linear at all depths for all clinically used beam energies. Results are shown for various field configurations and energies. With a gap of 5.0 cm between the treatment cone and phantom surface the dose "ripple" in the region beneath the teeth was found not to exceed +/- 5% at 0.5-cm depth.

Comments are given on the new TG‐21 protocol for the calibration of absorbed dose from electron beams. The technique for determining the energy of electron beams is discussed in detail and suggestions are made regarding removal of inconsistencies and ambiguities in the determination of electron beam energy. (AIP)