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En marzo de 2021, el grupo de trabajo sobre control de calidad de aceleradores de la Sociedad Española de Física Médica remitió a los servicios y unidades de radiofísica una encuesta en línea sobre algunos aspectos relacionados con el objeto de su trabajo. La encuesta se planteó con tres objetivos: ponderar la variabilidad en los planes de control de calidad, conocer el grado de adherencia a las recomendaciones nacionales e internacionales y sintonizar los criterios del grupo de trabajo con los de los servicios y unidades de radiofísica de nuestro ámbito. Los resultados de la encuesta muestran una gran variabilidad de criterio en todos los aspectos y pruebas y confirman la dificultad de establecer un programa de control de calidad de estos equipos que responda a criterios objetivos de priorización y sea aplicable en todas las circunstancias existentes en nuestro ámbito. Un programa de control de calidad debería establecerse sobre un análisis objetivo de los modos de fallo que permita decidir qué pruebas incluir, establecer los recursos necesarios y optimizar su utilización. Elaborar una recomendación de validez general no es sencillo, máxime si tenemos en cuenta la variedad existente en equipos, instrumentos y técnicas terapéuticas desarrolladas.

La radioterapia adaptativa (Adaptive Radiation Therapy, ART) se puede definir como la modificación del plan de tratamiento administrado a un paciente durante el curso de la radioterapia para tener en cuenta los cambios en la anatomía. La aplicación de ART supone un cambio en el proceso radioterápico que implica el uso de numerosos recursos adicionales, no estando implementada de forma general. Así, aun tratándose de una idea introducida hace más de 20 años, todavía a fecha de hoy son objeto de estudio muchos de los aspectos que definen la ART: la decisión de proceder a la nueva planificación del tratamiento, el momento óptimo para adaptar el plan, el umbral dosimétrico o anatómico que define la necesidad de adaptar y la identificación de los pacientes que realmente se beneficiarían de la adaptación del tratamiento. Este informe del Grupo de Trabajo sobre ART de la Sociedad Española de Física Médica (SEFM) tiene como objetivo describir los principios de esta técnica, así como los elementos necesarios para su implementación. Se exponen las dos estrategias principales atendiendo al momento de su aplicación: offline, para actuar ante los cambios progresivos que se observan durante el tratamiento, y online, para mitigar los cambios aleatorios. Se revisa el estado actual de ART aplicado a la práctica clínica para diferentes localizaciones anatómicas. Se describen algunos de los instrumentos clave para su implementación: los algoritmos de registro deformable (Deformable Image Registration, DIR), exponiendo las principales métricas de similitud, los métodos de optimización de la similitud, y los modelos de deformación utilizados, analizando las características de los algoritmos de los softwares más utilizados. Además, dada la importancia que tiene conocer la incertidumbre adicional que introduce el uso de los algoritmos DIR (sobre todo cuando se utilizan para deformar la matriz de dosis absorbida) se dedica un apartado a la validación de estos algoritmos, incluyendo los resultados para los principales softwares comerciales disponibles actualmente. Por último, se presentan unas recomendaciones a la hora de aplicar ART en la práctica clínica.

Background: Utilization of stereotactic radiosurgery (SRS) for brain metastases (BM) has become the technique of choice as opposed to whole brain radiation therapy (WBRT). The aim of this work is to evaluate the feasibility and potential benefits in terms of normal tissue (NT) and dose escalation of volumetric modulated arc therapy (VMAT) in SRS metastasis treatment. A VMAT optimization procedure has therefore been developed for internal dose scaling which minimizes planner dependence. Materials and methods: Five patient-plans incorporating treatment with frame-based SRS with dynamic conformal arc technique (DA) were re-planned for VMAT. The lesions selected were between 4–6 cm 3 . The same geometry used in the DA plans was maintained for the VMAT cases. A VMAT planning procedure was performed attempting to scale the dose in inner auxiliary volumes, and to explore the potential for dose scaling with this technique. Comparison of dose-volume histogram (DVH) parameters were obtained. Results: VMAT allows a superior NT sparing plus conformity and dose scaling using the auxiliary volumes. The VMAT results were significantly superior in NT sparing, improving both the V 10 and V 12 values in all cases, with a 2–3 cm 3 saving. In addition, VMAT improves the dose coverage D 95 by about 0.5 Gy. The objective of dose escalation was achieved with VMAT with an increment of the Dmean and the Dmedian of about 2 Gy. Conclusions: This work shows a benefit of VMAT in SRS treatment with significant NT sparing. A VMAT optimization procedure, based on auxiliary inner volumes, has been developed, enabling internal dose escalation.

Purpose Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. Methods and materials Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. Results Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4–72) minutes. 59.5% of cases presented in 1–4 min, 32.4% in 5–9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). Conclusion Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

Purpose: The ICRU 89 recommends reporting a set of vaginal dose points for cervical cancer treatments in order to quantify the goodness of implant. This vaginal dose reporting method for combined external beam radiotherapy and brachytherapy has been adopted by the EMBRACE II study protocol. Large variations in dose between patients and centers have been reported. The aim of this study was to determine possible discrepancies with consensus observers from the same institution. Therefore, the inter- and intra-observer variability were analyzed. Material and methods: For five patients, five experienced observers reported dose at the proposed vaginal points twice. The effect of inter- and intra-observer variations on total dose was analyzed by estimating biologically equivalent dose EQD(2) (alpha/beta = 3 Gy). Coefficient of variation (CV) was used to provide a measure of data dispersion as a proportion to the mean. Results: The maximum inter-observer deviation among all patients and all points ranged from 0.5 Gy to 24.1 Gy in EQD(2). The higher inter-observer discrepancies were found at points at 3 o'clock and at 6 o'clock, with respect to ovoids. In case of the maximum intra-observer deviation, it ranged from 0.5 Gy to 14.2 Gy, with higher deviation points at 12 o'clock and 9 o'clock, with respect to ovoids. Conclusions: There is a need to ensure consistency in vaginal points reporting. The impact of the dosimetric inter- and intra-observer variability should also be considered when dealing with dose tolerances and limits due to the potential dose gradient.

Purpose: Esteya® (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) is an electronic brachytherapy device used for skin cancer lesion treatment. In order to establish an adequate level of quality of treatment, a risk analysis of the Esteya treatment process has been done, following the methodology proposed by the TG-100 guidelines of the American Association of Physicists in Medicine (AAPM). Material and methods: A multidisciplinary team familiar with the treatment process was formed. This team developed a process map (PM) outlining the stages, through which a patient passed when subjected to the Esteya treatment. They identified potential failure modes (FM) and each individual FM was assessed for the severity (S), frequency of occurrence (O), and lack of detection (D). A list of existing quality management tools was developed and the FMs were consensually reevaluated. Finally, the FMs were ranked according to their risk priority number (RPN) and their S. Results : 146 FMs were identified, 106 of which had RPN ≥ 50 and 30 had S ≥ 7. After introducing the quality management tools, only 21 FMs had RPN ≥ 50. The importance of ensuring contact between the applicator and the surface of the patient’s skin was emphasized, so the setup was reviewed by a second individual before each treatment session with periodic quality control to ensure stability of the applicator pressure. Some of the essential quality management tools are already being implemented in the installation are the simple templates for reproducible positioning of skin applicators, that help marking the treatment area and positioning of X-ray tube. Conclusions : New quality management tools have been established as a result of the application of the failure modes and effects analysis (FMEA) treatment. However, periodic update of the FMEA process is necessary, since clinical experience has suggested occurring of further new possible potential failure modes.

The purpose of this work is to evaluate the absorbed dose to the eye lenses due to the cone beam computed tomography (CBCT) system used to accurately position the patient during head-and-neck image guided procedures. The on-board imaging (OBI) systems (v.1.5) of Clinac iX and TrueBeam (Varian) accelerators were used to evaluate the imparted dose to the eye lenses and some additional points of the head. All CBCT scans were acquired with the Standard-Dose Head protocol from Varian. Doses were measured using thermoluminescence dosimeters (TLDs) placed in an anthropomorphic phantom. TLDs were calibrated at the beam quality used to reduce their energy dependence. Average dose to the lens due to the OBI systems of the Clinac iX and the TrueBeam were 0.71 ± 0.07 mGy/CBCT and 0.70 ± 0.08 mGy/CBCT, respectively. The extra absorbed dose received by the eye lenses due to one CBCT acquisition with the studied protocol is far below the 500 mGy threshold established by ICRP for cataract formation (ICRP 2011 Statement on Tissue Reactions). However, the incremental effect of several CBCT acquisitions during the whole treatment should be taken into account.

Introduction and purpose Dosimetry Check (DC) (Math Resolutions) is a commercial EPID-based dosimetry software, which allows performing pre-treatment and transit dosimetry. DC provides an independent verification of the treatment, being potentially of great interest due to the high benefits of the in vivo volumetric dosimetry, which guarantee the treatment delivery and anatomy constancy. The aim of this work is to study the differences in dose between DC and the Treatment Planning System (TPS) to establish an accuracy level of the system. Material and methods DC v.3.8 was used along with Varian Clinac iX accelerator equipped with EPID aS1000 and Eclipse v.10.0 with AAA and Acuros XB calculation algorithms. The DC evaluated version is based on a pencil beam calculation algorithm. Various plans were generated over several homogeneous and heterogeneous phantoms. Isocentre point doses and gamma analysis were evaluated. Results Total dose differences at the isocentre between DC and TPS for the studied plans are less than 2%, but single field contributions achieve greater values. In the presence of heterogeneities, the discrepancies can reach up to 15%. In transit mode, DC does not consider properly the couch attenuation, especially when there is an air gap between phantom and couch. Conclusions The possibility of this in vivo evaluation and the potentiality of this new system have a very positive impact on improving patient QA. But improvements are required in both calculation algorithm and integration with the record and verify system.

Purpose: The common use of nomograms in Low Dose Rate (LDR) permanent prostate brachytherapy (BT) allows to estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for each clinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adapt ed to High Dose Rate (HDR). This work sets nomograms for LDR and HDR prostate-BT implants, which are applied to three different institutions that use different implant techniques. Material and methods: Patients treated throughout 2010 till April 2011 were considered for this study. This exam ple was chosen to be the representative of the latest implant techniques and to ensure consistency in the planning. A suf ficient number of cases for both BT modalities, prescription dose and different work methodology (depending on the institution) were taken into account. The specific nomograms were built using the correlation between the prostate vo lume and some characteristic parameters of each BT modality, such as the source Air Kerma Strength, number of implanted seeds in LDR or total radiation time in HDR. Results: For each institution and BT modality, nomograms normalized to the prescribed dose were obtained and fitted to a linear function. The parameters of the adjustment show a good agreement between data and the fitting. It should be noted that for each institution these linear function parameters are different, indicating that each centre should construct its own nomograms. Conclusions: Nomograms for LDR and HDR prostate brachytherapy are simple quality assurance tools, specific for each institution. Nevertheless, their use should be complementary to the necessary independent verification. J Contemp Brachyther 2011; 3, 3: 121-124 DOI: 10.5114/jcb.2011.24817

Purpose: TheValenciaHDRapplicatorsareaccessoriesofthemicroSelectronHDRafterloadingsystem(Nucletron) shapedastruncatedcones.Thebaseoftheconeiseither2or3 cmdiameter.Theyareintendedtotreatskinlesions, beingthetypicalprescriptiondepth3 mm.Inpatientswitheyelidlesions,aninternalshieldingisveryusefultoreduce thedosetotheocularglobe.Thepurposeofthisworkwastoevaluatethedoseenhancementfrompotentialbackscatterandelectroncontaminationduetotheshielding. Material and methods: Twomethodswereused:a)MonteCarlosimulation,performedwiththeGEANT4code, 2cmValenciaapplicatorwasplacedonthesurfaceofa waterphantominwhich2 mmleadslabwaslocatedat3 mm depth;b)radiochromicEBTfilms,usedtoverifytheMonteCarloresults,positioningthefilmsat1.5,3,5and7 mm depth,insidethephantom.Twoirradiations,withandwithouttheleadshieldingslab,werecarriedout. Results: TheMonteCarloresultsshowedthatduetothebackscattercomponentfromthelead,thedoselevelraised toabout200%witha depthrangeof0.5 mm.Undertheleadthedoselevelwasenhancedtoabout130%witha depth rangeof1 mm.Two millimetersofleadreducethedoseundertheslabwithabout60%.Theseresultsagreewithfilm measurementswithinuncertainties. Conclusions: Inconclusion,theuseof2 mminternalleadshieldingineyelidskintreatmentswiththeValenciaapplicatorswereevaluatedusingMCmethodsandEBTfilmdosimetry.Theminimumbolusthicknessthatwasneeded aboveandbelowtheshieldingwas0.5 mmand1 mmrespectively,andtheshieldingreducedtheabsorbeddosedeliv eredtotheocularglobebyabout60%. J Contemp Brachyther 2011; 3, 1: 32-35 DOI: 10.5114/jcb.2011.21041

Purpose: In this work a spreadsheet based program is presented that to a large extent independently verifies the calculations of individual plans of brachytherapy treatment planning systems for low dose rate, high dose rate and pulsed dose rate techniques. Material and methods: The verification program has been developed based on workbooks/spreadsheets. The treat- ment planning system output text files are automatically loaded into the new program, allowing the use of the source coordinates, the desired calculation point coordinates, and the dwell times of a patient plan. The source strength and the reference dates are entered by the user and then dose points calculations are independently performed. The pro- gram shows its results in a comparison of its calculated point dose data with the corresponding TPS outcome. Results: Results of 250 clinical cases show agreement with the TPS outcome within a 2% level. Conclusions: The program allows the implementation of the recommendations to verify the clinical brachytherapy dosimetry in a simple and accurate way, in only few minutes and with a minimum of user interactions.

The purpose of this paper is to present a method for volumetric reconstruction, registration and margin assignation applicable to both conventional CT scans and on board CT imaging. This method does not depend on the shape of the organs, the bony anatomy or the use of markers, and we apply it to prostate and bladder. 3D reconstructions are performed by means of spline surfaces and the 3D reconstructed surfaces are registered to a planning surface, using a multidimensional alignment from the Euclidean distance transform and the Levenberg-Marquardt optimization algorithm. Once the reconstructed surfaces are registered, we define a mean surface and obtain the corresponding variances from this mean surface. The method works properly and demonstrates that once translations are insulated by registration, residual uncertainties can be handled with the margin assigned for delineation variation and organ deformation

In this study, the dose rate distributions produced by low dose rate Cs-137 sources loaded in afterloadable dome applicators are studied using the Monte Carlo method. Dose differences between Monte Carlo results and calculations done using the superposition principle are within 1-3% in front of the applicator and between 3 and 10% near and along the longitudinal source axis. Consequently, the real doses to lateral vaginal wall, rectum and bladder are very close to the doses estimated applying the superposition principle, while the dose to the vaginal cuff has been overestimated by up to 10%.

In this paper, we study the feasibility of rare earth doped optical fibers as dosimeters based on the attenuation induced by electron beams under standard conditions in radiotherapy. Neodymium and cerium doped fibers have been irradiated with 10 MeV electrons, the radiation-induced loss and the dynamic response have been measured in the wavelength range 1200–1600 nm. The sensitivity of the fibers is of the order of 0.1 (dB/m)/Gy and has a linear dependence on the dose.

Purpose: A failure mode and effect analysis (FMEA) of skin lesions treatment process using Esteya™ device (Elekta Brachyterapy, Veenendaal, The Netherlands) was performed, with the aim of increasing the quality of the treatment and reducing the likelihood of unwanted events. Methods: A multidisciplinary team with experience in the treatment process met to establish the process map, which outlines the flow of various stages for such patients undergoing skin treatment. Potential failure modes (FM) were identified and the value of severity (S), frequency of occurrence (O), and lack of detectability (D) of the proposed FM were scored individually, each on a scale of 1 to 10 following TG-100 guidelines of the AAPM. These failure modes were ranked according to our risk priority number (RPN) and S scores. The efficiency of existing quality management tools was analyzed through a reassessment of the O and D made by consensus. Results: 149 FM were identified, 43 of which had RPN ≥ 100 and 30 had S ≥ 7. After introduction of the tools of quality management, only 3 FM had RPN ≥ 100 and 22 FM had RPN ≥ 50. These 22 FM were thoroughly analyzed and new tools for quality management were proposed. The most common cause of highest RPN FM was associated with the heavy patient workload and the continuous and accurate applicator-patient skin contact during the treatment. To overcome this second item, a regular quality control and setup review by a second individual before each treatment session was proposed. Conclusion: FMEA revealed some of the FM potentials that were not predicted during the initial implementation of the quality management tools. This exercise was useful in identifying the need of periodic update of the FMEA process as new potential failures can be identified.

Functional fits for the anisotrophy function and the radial dose function, have been studied, in a previous work, in order to characterize dose-rate distributions around some of the high-intensity 192 Ir sources. The purpose of the present work is to complete the previous one in order to include all the existing HDR and PDR 192 Ir sources. The sources addressed here are: the Buchler source from Amersham, the 12i and Plus PDR sources and the 12i and Plus HDR sources from GammaMed, and the new VariSource HDR source wire model VS2000 from Varian Oncology Systems.

To assess the radiation dose to the fetus of a pregnant patient undergoing high-dose-rate (HDR) (192)Ir interstitial breast brachytherapy, and to design a new patient setup and lead shielding technique that minimizes the fetal dose.Radiochromic films were placed between the slices of an anthropomorphic phantom modeling the patient. The pregnant woman was seated in a chair with the breast over a table and inside a leaded box. Dose variation as a function of distance from the implant volume as well as dose homogeneity within a representative slice of the fetal position was evaluated without and with shielding.With shielding, the peripheral dose after a complete treatment ranged from 50 cGy at 5 cm from the caudal edge of the breast to0.1 cGy at 30 cm. The shielding reduces absorbed dose by a factor of two near the breast and more than an order of magnitude beyond 20 cm. The dose is heterogeneous within a given axial plane, with variations from the central region within 50%. Interstitial HDR (192)Ir brachytherapy with breast shielding can be more advantageous than external-beam radiotherapy (EBRT) from a radiation protection point of view, as long as the distance to the uterine fundus is higher than about 10 cm. Furthermore, the weight of the shielding here proposed is notably lower than that needed in EBRT.Shielded breast brachytherapy may benefit pregnant patients needing localized radiotherapy, especially during the early gestational ages when the fetus is more sensitive to ionizing radiation.

The purpose of this study is to find fitted functional forms to the anisotropy function, F(r,θ), and the radial dose function, g(r), in order to characterize dose-rate distributions around all the high-intensity 192 Ir sources currently in use. Dosimetry data are at present available as tables for: the microSelectron HDR (“classic” and “new” design models), the PDR source, and the VariSource HDR source, expressed in terms of the AAPM Task Group No. 43 recommendations. There is only one paper out which introduces a functional form to fit the anisotropy function, but only for symmetric sources with respect to the transverse axis. However, dosimetric data of the HDR and PDR sources mentioned above cannot be reproduced with these functional forms. In our study F(r,θ) and g(r) published data are fitted with functional forms in such a way that appropriate limits are reached for both functions and the maximum fit error approaches the data uncertainty. The average fit error is less than 1% in all cases. These functional forms make handling data easier within the treatment planning system, avoiding the use of tabulated data.

The purpose of this study is to calculate basic dosimetry data for a CSM11 low dose rate 137Cs source in water. This source is widely used in afterloadable dome cylinders designed to homogeneously irradiate the vaginal cuff alone or additional areas of the vagina in hysterectomized patients. In this study, the Monte Carlo simulation code GEANT, incorporating in detail source geometry, is used to investigate the dosimetric characteristics of the source. The calculated data were analyzed using a fitting procedure that is described in detail. Absolute dose rate distributions in water were calculated around this source and are presented as conventional 2D Cartesian lookup tables (classically along-away tables). Also, the dose calculation formalism endorsed by the Interstitial Collaborative Working Group and the AAPM Task Group 43 have been calculated. The calculated dose rate constant for this source is lambda = 1.096 +/- 0.002 cGy h(-1) U(-1). The anisotropy function results in about 50% deviations from isotropy at positions near the long axis of the source. The radial dose function is given as a polynomial that reproduces the calculated data up to 20 cm. Best-fit values of attenuation coefficients suitable for use in Sievert integral calculations have been derived.

Background Modern imaging systems and three-dimensional (3-D) treatment planning systems have led to the development of virtual simulation.

En este trabajo se analiza un metodo de reconstruccion geometrica basado en los escanogramas de la TAC a utilizar en braquiterapia. Se describe asimismo el proceso de planificacion que ha propiciado la introduccion de dicho metodo.

Monte Carlo simulations of absolute dose rate in liquid water are presented in the form of away-along tables for 1 and 5 cm 192 Ir wires of 0.5 and 0.6 mm diameter. Simulated absolute dose rate values can be used as benchmark data to verify the calculation results of treatment planning systems or directly as input data for treatment planning. Best fit value of an attenuation coefficient suitable for use in Sievert integral-type calculations has been derived based on Monte Carlo simulation results. For the treatment planning systems that are based on the TG43 formalism we have also computed the required dosimetry parameters.

Purpose: To estimate the sensitivity of TrueBeam 2.0 Imaging System 6DoF automatic matching tool through the acquisition of cone-beam CT images in different phantoms applying submillimeter translations and rotations of tenths of a degree and registered with image simulation CT. Methods: To evaluate overall system-wide image, we consider two uncertainties source; First, the uncertainty of the manual phantom displacement (e_m). This uncertainty is calculated by a digital caliper (0.01 mm) for vertical (Vrt), lateral (Lat) and longitudinal (Lng). A digital inclinometer (0.01°) for the pitch and roll and the own phantom scale to evaluate the coordinate rotation (Rtn). The second uncertainty is the displacement detected by the algorithm system of matching (σ_d) that we obtain from the standard deviations of the different measurements. We use three different phantoms. The BrainLab Radiosurgery system for supporting masks with an anthropomorphic dummy adapted to allow displacements of 0.1 mm in Vrt, Lat and Lng dimensions and rotations of 0.1° in Pitch dimension. For the analysis of the Rtn and Roll dimensions we use two homemade phantoms (RinoRot and RinoRoll, La Fe Hospital, Valencia, Spain) that allow rotations of 0.3°. Results: In the case of manual displacement of 0.10 ± 0.03 mm in the translations, the system detect 0.10 ± 0.07 mm, 0.12 ± 0.07 mm and 0.13 ± 0.07 mm (mean ± SD) in Lat, Vrt and Lng respectively. In the case of rotational dimension, manual displacement of 0.3 ± 0.1° was detected with 0.19 ± 0.06°, 0.29 ± 0.03° and 0.27 ± 0.06° in Pitch, Roll and Rtn. Conclusion: We conclude that the sensitivity of the automatic matching system is within 0.10 mm in translations and 0.3° in rotations. These values are under the own sensitivity of the software.

Purpose: To describe how we moved to VMAT in the craniospinal radiotherapy planning process, the actual procedure details, and the results for the patients treated. Methods: Twelve patients underwent craniospinal irradiation with the new procedure, based on the paper by Lee et al. (IJROBP 82, 2012), with some additional modifications. Patients were treated in supine position in Varian Clinac iX linacs with 6 MV RapidArc; prescription doses ranged from 23.4 to 40 Gy (13 to 20 fractions); depending on the PTV length, 2 or 3 isocenters were used, all coordinates being equal except the longitudinal one, setting a few centimeter-long overlapping region; 2 arcs (RA) sharing isocentre for the cranial region, RA1 encompassing cranium and superior spinal region, and RA2 intended to improve conformity, only for cranium; for spine, 1 or 2 isocenters were employed; optimization was performed with Eclipse (V 13.0) using AAA algorithm, establishing sets of optimization parameters to give high conformity while sparing OAR. In pediatric patients, homogeneous irradiation of the vertebrae was also required.Conformity (CI) and heterogeneity (HI) indices (same as Lee et al.), and mean and maximum doses for OAR were calculated. Several pre-treatment verification methods were used: Octavius4D (PTW) for each isocentre, point dose at the junction region, Portal Dosimetry (when possible), and independent MU verification software (Diamond, PTW). Results: CI median value was 1.02 (0.99–1.07) and HI, 1.07 (1.06–1.09); a great reduction was observed for CI and OAR mean doses with respect to Lee et al. data; median maximum eye lens dose was 7.3 Gy (4.0–12.0); mean LungV20Gy was 1.9%; in children, vertebrae were homogeneously irradiated (D95%=20.8 Gy, Dmean= 23.2 Gy).All pre-treatment verifications were found within our action levels except for Portal Dosimetry. Conclusion: A RapidArc planning process for craniospinal axis irradiation has been implemented with significant advantages on conformity, homogeneity, feasibility and efficiency. and increase brain tissue sparing. Variations in volume decrease may be related to shape or location of the tumor.

This paper reports on the use of rare earth doped optical fibers for the detection of low dose electron beams in radiotherapy applications. Neodymium and cerium doped singlemode fibers have been irradiated with 10 MeV electron beams and the losses induced by the radiation have been measured in the wavelength range 1200 - 1600 nm, the attenuation has a linear dependence with the applied dose and its order of magnitude is 0.001 dB per meter of fiber and cGy.© (2004) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The CSM3 137Cs type stainless-steel encapsulated source is widely used in manually afterloaded low dose rate brachytherapy. A specially asymmetric source, CSM3-a, has been designed by CIS Bio International (France) substituting the eyelet side seed with an inactive material in the CSM3 source. This modification has been done in order to allow a uniform dose level over the upper vaginal surface when this `linear' source is inserted at the top of the dome vaginal applicators. In this study the Monte Carlo GEANT3 simulation code, incorporating the source geometry in detail, was used to investigate the dosimetric characteristics of this special CSM3-a 137Cs brachytherapy source. The absolute dose rate distribution in water around this source was calculated and is presented in the form of an along-away table. Comparison of Sievert integral type calculations with Monte Carlo results are discussed.

In this study a complete set of dosimetric data is presented for the high dose rate (HDR) source from Amersham used in the Buchler remote afterloading HDR unit. These data have been calculated by means of the Monte Carlo simulation code GEANT taking into account the detailed geometry of the source. Absolute dose rate distributions in water were calculated around this source and are presented as conventional 2D Cartesian look-up tables. All dosimetric quantities recommended by the AAPM Task Group 43 report have been calculated. Quantities determined are: dose rate constant, radial dose function, anisotropy function, anisotropy factor and anisotropy constant. The dose rate distributions of the Buchler HDR source are compared with those of other HDR sources used in brachytherapy, showing that the differences are large in zones near the long source axis due to oblique filtration. These Monte Carlo simulated data in water can be used for clinical applications.

The Amersham CDCS-M-type 137 Cs stainless-steel encapsulated source is widely used in low dose rate brachytherapy with manual afterloading. However there is a need for more accurate dosimetry data. In this study we present Monte Carlo calculations of absolute dose rate in water around this source using the Monte Carlo code GEANT, discuss dosimetric features of these data, and compare them with Krishnaswamy’s results for 137 Cs intracavitary sources. Dose rate distributions are presented in the form of along-away tables and in the TG43 formalism. Simulated absolute dose rate values can be used as benchmark data to verify the treatment planning system calculation results or directly as input data for treatment planning. Best-fit values of attenuation coefficients suitable for use in Sievert integral type calculations have been derived comparing dose rate distributions calculated using this algorithm with those obtained from Monte Carlo calculations.

Monte Carlo calculations of absolute dose rate in liquid water are presented in the form of away-along tables for 1 and 5 cm 192 Ir wires of 0.3 mm diameter. Simulated absolute dose rate values can be used as benchmark data to verify the calculation results of treatment planning systems or directly as input data for treatment planning. Best fit value of attenuation coefficient suitable for use in Sievert-integrals-type calculations has been derived based on Monte Carlo calculation results. For the treatment planning systems that are based on TG43 formalism we have also calculated the required dosimetry parameters.