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B J Mijnheer

Publications and source records attributed to B J Mijnheer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Cardiac and lung complication probabilities after breast cancer irradiation.

PURPOSE: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and lung (radiation pneumonitis) complications on treatment technique and individual patient anatomy. MATERIALS AND METHODS: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)-medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM-MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM-MS fields. Dose-volume histograms (DVHs) and normal tissue complication probabilities (NTCPs) for the heart and lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. RESULTS: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69-99%) than using Technique B (mean: 98%, range: 82-100%) or for the tangential field technique (mean: 98%, range: 91-100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. CONCLUSIONS: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart complications compared with tangential irradiation of the breast only. Irradiation toxicity for the lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.

Breast Neoplasms↗
PubMed2000

Phantom materials for boron neutron capture therapy.

The aim of this work was to establish which reference phantom material is most suited for dosimetry under reference conditions of neutron beams for boron neutron capture therapy (BNCT). For this purpose, phantoms of dimensions 15 x 15 x 15 cm3 and 30 x 30 x 30 cm3, composed of water, tissue-equivalent (TE) liquid, polyethylene (PE), polymethyl methacrylate (PMMA) and water containing 10 microg g(-1) and 30 microg g(-1) 10B were irradiated using the Petten BNCT beam. Activation foils and a diode detector were used for the determination of the thermal neutron fluence rate. The gamma-ray dose rate and the fast neutron dose rate were determined using paired ionization chambers. In water, PMMA and TE liquid the absolute dose and fluence values agreed within 3% at a reference depth of 2 cm, with the exception of the gamma-ray dose rate in PMMA, which was 12% lower than in water. Due to a higher hydrogen concentration in PE compared with water, the dose and fluence values in PE differed more than 30% from those in water. Only minor differences were observed between the percentage depth dose curves for the various dose components in water, PMMA and TE liquid. The addition of 10 microg g(-1) and 30 microg g(-1) 10B to water resulted in a decrease in the absolute thermal neutron fluence at 2 cm depth of about 2% and 8%, respectively, and a decreased penetration of thermal neutrons at depth for the 30 microg g(-1) 10B concentration. For reference dosimetry of an epithermal neutron beam for BNCT, both water and TE liquid are suitable phantom materials. For practical reasons, water is therefore proposed as reference phantom material. For measurements requiring a solid phantom, PMMA is proposed. The lower gamma-ray dose in PMMA compared to water, however, needs to be taken into account.

Boron↗
PubMed1999

Beam intensity modulation to reduce the field sizes for conformal irradiation of lung tumors: a dosimetric study.

PURPOSE: In conformal radiotherapy of lung tumors, penumbra broadening in lung tissue necessitates the use of larger field sizes to achieve the same target coverage as in a homogeneous environment. In an idealized model configuration, some fundamental aspects of field size reduction were investigated, both for the static situation and for a moving tumor, while maintaining the dose homogeneity in the target volume by employing a simple beam-intensity modulation technique. METHODS AND MATERIALS: An inhomogeneous phantom, consisting of polystyrene, cork, and polystyrene layers, with a 6 x 6 x 6 cm3 polystyrene cube inside the cork representing the tumor, was used to simulate a lung cancer treatment. Film dosimetry experiments were performed for an AP-PA irradiation technique with 8-MV or 18-MV beams. Dose distributions were compared for large square fields, small square fields, and intensity-modulated fields in which additional segments increase the dose at the edge of the field. The effect of target motion was studied by measuring the dose distribution for the solid cube, displaced with respect to the beams. RESULTS: For the 18-MV beam, the field sizes required to establish a sufficient target coverage are larger than for the 8-MV beam. For each beam energy, the mean dose in cork can significantly be reduced (at least a factor of 1.6) by decreasing the field size with 2 cm, while keeping the mean target dose constant. Target dose inhomogeneity for these smaller fields is limited if the additional edge segments are applied for 8% of the number of monitor units given with the open fields. The target dose distribution averaged over a motion cycle is hardly affected if the target edge does not approach the field edge to within 3 mm. CONCLUSIONS: For lung cancer treatment, a beam energy of 8 MV is more suitable than 18 MV. The mean lung dose can be significantly reduced by decreasing the field sizes of conformal fields. The smaller fields result in the same biological effect to the tumor if the mean target dose is kept constant. Intensity modulation can be employed to maintain the same target dose homogeneity for these smaller fields. As long as the target (with a 3 mm margin) stays within the field portal, application of a margin for target motion is not necessary.

Film Dosimetry↗
PubMed1999

In vivo dosimetry during external photon beam radiotherapy.

In this critical review of the current practice of patient dose verification, we first demonstrate that a high accuracy (about 1-2%, 1 SD) can be obtained. Accurate in vivo dosimetry is possible if diodes and thermoluminescence dosimeters (TLDs), the main detector types in use for in vivo dosimetry, are carefully calibrated and the factors influencing their sensitivity are taken into account. Various methods and philosophies for applying patient dose verification are then evaluated: the measurement of each field for each fraction of each patient, a limited number of checks for all patients, or measurements of specific patient groups, for example, during total body irradiation (TBI) or conformal radiotherapy. The experience of a number of centers is then presented, providing information on the various types of errors detected by in vivo dosimetry, including their frequency and magnitude. From the results of recent studies it can be concluded that in centers having modern equipment with verification systems as well as comprehensive quality assurance (QA) programs, a systematic error larger than 5% in dose delivery is still present for 0.5-1% of the patient treatments. In other studies, a frequency of 3-10% of errors was observed for specific patient groups or when no verification system was present at the accelerator. These results were balanced against the additional manpower and other resources required for such a QA program. It could be concluded that patient dose verification should be an essential part of a QA program in a radiotherapy department, and plays a complementary role to treatment-sheet double checking. As the radiotherapy community makes the transition from the conventional two-dimensional (2D) to three-dimensional (3D) conformal and intensity modulated dose delivery, it is recommended that new treatment techniques be checked systematically for a few patients, and to perform in vivo dosimetry a few times for each patient for situations where errors in dose delivery should be minimized.

Calibration↗
PubMed1999

In vivo dosimetry during conformal radiotherapy: requirements for and findings of a routine procedure.

PURPOSE: Conformal radiotherapy requires accurate knowledge of the actual dose delivered to a patient. The impact of routine in vivo dosimetry, including its special requirements, clinical findings and resources, has been analysed for three conformal treatment techniques to evaluate its usefulness in daily clinical practice. MATERIALS AND METHODS: Based on pilot studies, routine in vivo dosimetry quality control (QC) protocols were implemented in the clinic. Entrance and exit diode dose measurements have been performed during two treatment sessions for 378 patients having prostate, bladder and parotid gland tumours. Dose calculations were performed with a CT-based three-dimensional treatment planning system. In our QC-protocol we applied action levels of 2.5% for the prostate and bladder tumour group and 4.0% for the parotid gland patients. When the difference between the measured dose at the dose specification point and the prescribed dose exceeded the action level the deviation was investigated and the number of monitor units (MUs) adjusted. Since an accurate dose measurement was necessary, some properties of the on-line high-precision diode measurement system and the long-term change in sensitivity of the diodes were investigated in detail. RESULTS: The sensitivity of all diodes decreased by approximately 7% after receiving an integrated dose of 10 kGy, for 4 and 8 MV beams. For 34 (9%) patients the difference between the measured and calculated dose was larger than the action level. Systematic errors in the use of a new software release of the monitor unit calculation program, limitations of the dose calculation algorithms, errors in the planning procedure and instability in the performance of the accelerator have been detected. CONCLUSIONS: Accurate in vivo dosimetry, using a diode measurement system, is a powerful tool to trace dosimetric errors during conformal radiotherapy in the range of 2.5-10%, provided that the system is carefully calibrated. The implementation of an intensive in vivo dosimetry programme requires additional staff for measurements and evaluation. The patient measurements add only a few minutes to the total treatment time per patient and guarantee an accurate dose delivery, which is a prerequisite for conformal radiotherapy.

Humans↗
PubMed1999

A consistent formalism for the application of phantom and collimator scatter factors.

A coherent system for the use of scatter correction factors, determined at 10 cm depth, is described for dose calculations on the central axis of arbitrarily shaped photon beams. The system is suitable for application in both the fixed source-surface distance (SSD) and in the isocentric treatment set-up. This is in contrast to some other proposals where only one of these approaches forms the basis of the calculation system or where distinct quantities and data sets are needed. In order to derive the relations in the formalism, we introduced a separation of the phenomena related to the energy fluence in air and to the phantom scatter contribution to the dose. Both are used relative to quantities defined for the reference irradiation set-up. It is shown that dose calculations can be performed with only one set of basic beam data, obtained at a reference depth of 10 cm. These data consist for each photon beam quality of measured collimator and phantom scatter correction factors, in combination with a set of (percentage/relative) depth-dose or tissue-phantom ratio values measured along the central axis of the beam. Problems related to measurements performed at the depth of maximum absorbed dose, due to the electron contamination of the beam, are avoided in this way. Collimator scatter correction factors are obtained by using a mini-phantom, while phantom scatter correction factors are derived from measurements in a full scatter phantom in combination with the results of the mini-phantom measurements. For practical reasons the fixed SSD system was chosen to determine the data. Then, dose calculations in a fixed SSD treatment set-up itself are straightforward. Application in the isocentric treatment set-up needs simple conversion steps, while the inverse approach, from isocentric to fixed SSD, is described as well. Differences between the two approaches are discussed and the equations for the conversions are given.

Cobalt Radioisotopes↗
PubMed1998

New method to obtain the midplane dose using portal in vivo dosimetry.

PURPOSE: The aim of this study was to develop a method to derive the midplane dose [i.e., the two-dimensional (2D) dose distribution in the middle of a patient irradiated with high-energy photon beams] from transmission dose data measured with an electronic portal imaging device (EPID). A prerequisite for this method was that it could be used without additional patient information (i.e., independent of a treatment-planning system). Second, we compared the new method with several existing (conventional) methods that derive the midline dose from entrance and exit dose measurements. METHODS AND MATERIALS: The proposed method first calculates the 2D contribution of the primary and scattered dose component at the exit side of the patient or phantom from the measured transmission dose. Then, a correction is applied for the difference in contribution for both dose components between exit side and midplane, yielding the midplane dose. To test the method, we performed EPID transmission dose measurements and entrance, midplane, and exit dose measurements using an ionization chamber in homogeneous and symmetrical inhomogeneous phantoms. The various methods to derive the midplane dose were also tested for asymmetrical inhomogeneous phantoms applying two opposing fields. A number of combinations of inhomogeneities (air, cork, and aluminum), phantom thicknesses, field sizes, and a few irregularly shaped fields were investigated, while each experiment was performed in 4-, 8-, and 18-MV open and wedged beams. RESULTS: Our new method can be used to assess the midplane dose for most clinical situations within 2% relative to ionization chamber measurements. Similar results were found with other methods. In the presence of large asymmetrical inhomogeneities (e.g., lungs), discrepancies of about 8% have been found (for small field sizes) using our transmission dose method, owing to the absence of lateral electron equilibrium. Applying the other methods, differences between predicted and measured midplane doses were even larger, up to 10%. For large field sizes, the agreement between measured and predicted midplane dose was within 3% using our transmission dose method. CONCLUSIONS: Using our new method, midplane doses were estimated with a similar or higher accuracy compared with existing conventional methods for in vivo dosimetry. The advantage of our new method is that the midplane dose can be determined in the entire (2D) field. With our method, portal in vivo dosimetry is an accurate alternative for conventional in vivo dosimetry.

Humans↗
PubMed1998

Effect of set-up uncertainties on the dose distribution in the match region of supraclavicular and tangential breast fields.

BACKGROUND: The objective of this paper is to illustrate the effect of a gap of 5 mm, an overlap of 5 mm and a perfect match on the dose distribution across the junction of tangential breast fields and adjacent supraclavicular and axillary fields. MATERIALS AND METHODS: For this purpose film dosimetry was applied to measure relative dose distributions in two sagittal planes in an anthropomorphic breast phantom having cork lungs, simulating a radiation therapy treatment of the breast and adjacent supraclavicular lymph nodes. Two different treatment techniques, an SSD match technique and a geometrically exact isocentric match technique, as routinely applied in the two institutes were examined. The three-dimensional treatment planning system of each institute was used to calculate the dose distribution in the match region of the supraclavicular fields and the two opposing tangential fields. The measured and calculated dose distributions were evaluated and compared along lines in two sagittal planes from the supraclavicular fields down to the tangential fields crossing the match planes. These dose distributions in the match region were extremely dependent on the set-up of the fields. RESULTS: Although the reproducibility of the film measurements was within 2%, it became clear that the set-up of the fields to achieve a gap of 5 mm, a perfect match or an overlap of 5 mm required a lot of attention, even when using a phantom. CONCLUSIONS: It can be concluded that in clinical practice, these set-up difficulties do influence the dose distribution in the match region much more than the systematic uncertainties in the dose calculation algorithms of the treatment planning systems and the type of treatment technique.

Breast Neoplasms↗
PubMed1998

A fast and accurate treatment planning method for boron neutron capture therapy.

BACKGROUND AND PURPOSE: The aim of this study was to test the applicability of conventional semi-empirical algorithms for the treatment planning of boron neutron capture therapy (BNCT). MATERIALS AND METHODS: Beam data of a clinical epithermal BNCT beam obtained in a large cuboid water phantom were introduced into a commercial treatment planning system (TPS). For the calculation of thermal neutron fluence distributions, the Gaussian pencil beam model of the electron beam treatment planning algorithm was used. A simple photon beam algorithm was used for the calculation of the gamma-ray and fast neutron dose distribution. The calculated dose and fluence distributions in the central plane of an anthropomorphic head phantom were compared with measurements for various field sizes. The calculation time was less than 1 min. RESULTS: At the normalization point in the head phantom, the absolute dose and fluence values agreed within the measurement uncertainty of approximately 2-3% (1 SD) with those at the same depth in a cuboid phantom of approximately the same size. Excellent agreement of within 2-3% (1 SD) was obtained between measured and calculated relative fluence and dose values on the central beam axis and at most off-axis positions in the head phantom. At positions near the phantom boundaries, generally in low dose regions, local differences of approximately 30% were observed. CONCLUSIONS: A fast and accurate treatment planning method has been developed for BNCT. This is the first treatment planning method that may allow the same interactive optimization procedures for BNCT as applied clinically for conventional radiotherapy.

Algorithms↗
PubMed1998

Consistency in quality control programmes for electron accelerators in radiotherapy centres.

BACKGROUND AND PURPOSE: To gain insight into the current practice of quality control (QC) of medical electron accelerators and to reduce possible variations in test frequencies and test procedures. MATERIALS AND METHODS: An extensive questionnaire on QC procedures of medical electron accelerators was distributed and completed by all (21) radiotherapy institutions in The Netherlands. The questions were related to safety systems, mechanical parameters, beam profiles, beam energy, absolute dosimetry, wedge filters, the dose monitor system and radiation leakage. The data of the questionnaire were compared with recommendations given in national and international reports on QC of electron accelerators. RESULTS: Large variations in time spent on QC exist, especially for accelerators having dual energy photon beams and several electron beam energies. This diversity is mainly due to differences in philosophy with regard to QC and the differences in resources and machine time available. Furthermore, large variations in test frequencies and test methodologies were observed. The staffing level involved in the QC measurements was evaluated and compared with recent recommendations provided by EFOMP-ESTRO. CONCLUSIONS: From these recommendations and the results of the questionnaire, a set of minimum guidelines for a QC programme could be formulated and implemented in all radiotherapy institutions in The Netherlands.

Guidelines as Topic↗
PubMed1998

Quality assurance of the dose delivered by small radiation segments.

The use of intensity modulation with multiple static fields has been suggested by many authors as a way to achieve highly conformal fields in radiotherapy. However, quality assurance of linear accelerators is generally done only for beam segments of 100 MU or higher, and by measuring beam profiles once the beam has stabilized. We propose a set of measurements to check the stability of dose delivery in small segments, and present measured data from three radiotherapy centres. The dose delivered per monitor unit, MU, was measured for various numbers of MU segments. The field flatness and symmetry were measured using either photographic films that are subsequently scanned by a densitometer, or by using a diode array. We performed the set of measurements at the three radiotherapy centres on a set of five different Philips SL accelerators with energies of 6 MV, 8 MV, 10 MV and 18 MV. The dose per monitor unit over the range of 1 to 100 MU was found to be accurate to within +/-5% of the nominal dose per monitor unit as defined for the delivery of 100 MU for all the energies. For four out of the five accelerators the dose per monitor unit over the same range was even found to be accurate to within +/-2%. The flatness and symmetry were in some cases found to be larger for small segments by a maximum of 9% of the flatness/symmetry for large segments. The result of this study provides the dosimetric evidence that the delivery of small segment doses as top-up fields for beam intensity modulation is feasible. However, it should be stressed that linear accelerators have different characteristics for the delivery of small segments, hence this type of measurement should be performed for each machine before the delivery of small dose segments is approved. In some cases it may be advisable to use a low pulse repetition frequency (PRF) to obtain more accurate dose delivery of small segments.

Biophysical Phenomena↗
PubMed1998

Dosimetric verification of the 95% isodose surface for a conformal irradiation technique.

In the treatment planning of conformal radiotherapy, field shapes are often designed in such a way that a high-value isodose surface fully encompasses the target volume. Therefore, knowledge about the accuracy with which the treatment planning system calculates the position of that isodose surface is essential to prevent field shapes which are either too large or too small. To determine this accuracy for a conformal multi-field technique, the dose in the high-dose region must be measured with a high spatial resolution. A method is presented to reconstruct and evaluate the experimental high-dose region from a set of water phantom scans. This method, which assesses combined dose profiles for multi-field irradiation techniques, can be used for the commissioning and/or quality assurance of a 3-D treatment planning system. For a specific conformal technique, the measured and calculated 95% isodose positions along lines in several directions have been compared. It is shown that different dose values of single beam profiles determine the resulting 95% isodose position, which is important to recognize for quality assurance of treatment planning calculations. It is further found that the uncertainty in the calculated 95% isodose surface can be described by a standard deviation in dose value, which relates to a positional uncertainty through the local dose gradient. Thus the confidence region of the calculated 95% isodose can be indicated in the treatment plan by plotting isodoses at the 95% level plus and minus its standard deviation. Such a procedure is recommended instead of plotting the 95% isodose with a constant width. In addition, restrictions for the cumulative dose-volume histogram of acceptable treatment plans can be formulated, based on the sensitivity of the actual target coverage on the uncertainty with which the prescribed isodose surface is calculated.

Brachytherapy↗
PubMed1997

Clinical dosimetry of an epithermal neutron beam for neutron capture therapy: dose distributions under reference conditions.

PURPOSE: The aim of this study was to asses the dose distribution under reference conditions for the various dose components of the Petten clinical epithermal neutron beam for boron neutron capture therapy (BNCT). METHODS AND MATERIALS: Activation foils and a silicon alpha-particle detector with a 6Li converter plate have been used for the determination of the thermal neutron fluence rate. The gamma-ray dose rate and the fast neutron dose rate have been determined using paired ionization chambers. Circular beam apertures of 8, 12 and 15 cm diameters have been investigated using a 15 x 15 x 15 cm3 solid polymethyl-methacrylate phantom, a water phantom of the same dimensions and a 30 x 30 x 30 cm3 water phantom at various phantom to beam-exit distances. RESULTS: The effect of phantom to beam-exit distance could be modeled using an inverse square law with a virtual source to beam-exit distance of 3.0 m. At a reference phantom to beam-exit distance of 30 cm, three-dimensional dose and fluence distributions of the various dose components have been determined in the phantoms. The absolute thermal neutron fluence rate at a reference depth of 2 cm in the 15 cm water phantom increased by 43% when the field size was increased from 8 to 15 cm. Simultaneously the gamma-ray dose rate increased by 46% while the fast neutron dose rate increased by only 5%. CONCLUSION: A reference treatment position at 30 cm from the beam exit allows convenient patient positioning with a relatively small increase in irradiation time compared to positions very close to the beam-exit. A more homogeneous distribution of thermal neutrons over a target volume, a higher absolute thermal neutron fluence rate and a lower contribution of the fast neutron dose to the total dose will result in improved treatment plans when using a 12 cm or 15 cm field compared to a 8 cm field. The dose distributions will be used as benchmark data for treatment planning systems for BNCT.

Boron Neutron Capture Therapy↗
PubMed1997

Quality assurance of the EORTC Trial 22881/10882: boost versus no boost in breast conserving therapy. An overview.

BACKGROUND: The initial quality assurance programme of the EORTC Radiotherapy Cooperative Group in trial 22881/10882 is described. The implications of its results for quality assurance in future trials are discussed. METHODS: In the EORTC trial 22881/10882 patients with stage I or II breast cancer are treated with tumor excision, axillary dissection, 50 Gy whole breast irradiation and then randomized to receive a boost dose of 15 Gy or no boost following complete tumor excision or between 10 Gy or 25 Gy in case of incomplete excision. To avoid or diminish protocol deviations and to quantify inevitable variations an extensive initial quality assurance programme was conducted. The programme consisted of a dummy run procedure an individual case review procedure, in vivo dosimetry studies and phantom dosimetry studies. RESULTS: This combination of quality assurance procedures allows a good estimation of patient to patient and inter-institutional variations, and early detection of (potential) systematic protocol deviations of 3 types: 1. Deviations due to ambiguities in the protocol prescriptions. 2. Deviations not known to the institution, such as mistakes in implementation of treatment planning algorithms resulting in a systematic overdosage or underdosage. 3. Inability of an institution to cope with (precise) protocol prescriptions for technical or logistic reasons. DISCUSSION: The first 2 types of deviations may be corrected or avoided by direct discussions and recommendations. With respect to the third type it is up to the trial coordinator to accept participation or not, depending upon the relative importance of the particular deviation(s) for the trial end points. To be effective, such a quality assurance programme must be implemented as early as possible in the course of a clinical trial.

Breast Neoplasms↗
PubMed1997

Comparison between dose values specified at the ICRU reference point and the mean dose to the planning target volume.

BACKGROUND AND PURPOSE: To compare dose values specified at the reference point, as recommended by the International Commission on Radiation Units and Measurements, ICRU, and the mean dose to the planning target volume, PTV. MATERIAL AND METHODS: CT-based dose calculations were performed with a 3-D treatment planning system for 6 series of patients treated for bladder, brain, breast, lung, oropharynx and parotid gland tumour. All patients were arbitrarily chosen from a set of previously treated patients irradiated with a two- or three-field technique using customised blocks. Appropriate wedge angles and beam weights were chosen to make the dose distribution as homogeneous as possible. RESULTS: The dose at the ICRU reference point was generally higher than the mean dose to the PTV. The difference between the ICRU reference dose and the mean dose to the PTV for an individual patient was less than 3% in 88% of cases and less than 2% in 72% of the cases. The differences were larger in those patients where the dose distribution is significantly influenced by the presence of lungs or air gaps. For each series of patients the mean difference between the ICRU reference dose and the mean dose to the PTV was calculated. The difference between these two values never exceeded 2%. Because not all planning systems are able to calculate the mean dose to the PTV, the concept of the mean central dose, the mean of the dose values at the centre of the PTV in each CT slice, has been introduced. The mean central dose was also calculated for the same patients and was closer to the mean dose to the PTV than the ICRU reference dose. CONCLUSION: The mean dose to the PTV is well estimated by either the ICRU reference dose or the mean central dose for a variety of treatment techniques for common types of cancer.

Dose-Response Relationship, Radiation↗
PubMed1997

Is there a need for a revised table of equivalent square fields for the determination of phantom scatter correction factors?

The use of the British Journal of Radiology (BJR) (supplement 17) tables of equivalent square fields for dose calculations is widespread. A revised version of the supplement was published recently, with a more elaborate discussion, but without changes in data given in these tables (Br. J. Radiol. suppl 25). The tables were generated for use in dose calculations, with relative beam data such as PDD, BSF, PSF, all with d(max) as the reference depth. However, the current philosophy in dose calculational methods is based on quantities defined at a reference depth, d(ref) = 10 cm, on a separation of phantom and head scatter, and on the use of the relative depth-dose or tissue-phantom ratios normalized at d(ref). By using these quantities as a starting point, problems at shallow depths related to the influence of contaminating electrons in the beam can be eliminated. Recently, a comprehensive set of phantom scatter factor data with d(ref) = 10 cm has been published for a set of square field sizes and a wide range of photon beam energies, showing that phantom scatter is a smoothly varying function of field size and quality index. It is not a priori evident that the conventional concept of equivalent squares for rectangular fields is also fully applicable for phantom scatter factors and phantom scatter related quantities at a depth of 10 cm. It was questioned whether or not new tables of equivalent square fields are needed for this purpose. In this paper, new tables have been constructed for four photon beam energies in the range of Co-60 to 25 MV (quality index from 0.572 to 0.783). The small differences between the outcome of these new tables allowed the construction of one averaged table of equivalent square fields. Phantom scatter factors were calculated for rectangular fields based on the use of the BJR table and on the use of the newly constructed tables and the differences were quantified. For Co-60 no improvements could be shown when using the new averaged table, but for beam energies of 6 to 10 MV small improvements of the order of 0.5 to 1.0% were found. For a higher beam energy of 25 MV the improvement is smaller. Deviations resulting from the BJR table are within the limits of accuracy as stated by the authors. Therefore, for clinical use, the continued use of the BJR table of equivalent squares for phantom scatter factors and phantom scatter related quantities of rectangular fields is justified, irrespective of photon beam energy.

Calibration↗
PubMed1997

A convolution model to convert transmission dose images to exit dose distributions.

The aim of this study is to develop a model which computes exit dose values from transmission dose data obtained during patient treatment with an electronic portal imaging device (EPID). The proposed model convolves the primary dose distribution, derived from transmission dose distributions at large air gaps, with a scatter kernel to obtain the exit dose. The influence of inhomogeneities on the scatter contribution is taken into account by using a radiological path length model. To determine the parameters of the model, an extensive set of transmission dose measurements was performed behind various phantoms in an 8 MV beam using a liquid-filled EPID. The influence on the transmission dose of field size, phantom thickness, air gap between phantom and detector, and source-phantom distance was investigated. At air gaps larger than 50 cm the distribution of scattered dose is almost flat and its contribution to the total dose is relatively small, thus allowing an accurate separation of the primary and scattered dose by subtraction. Scattered dose distributions for air gaps smaller than 50 cm were obtained by subtracting the primary dose (corrected for divergence) from the measured total transmission dose. The resulting scattered dose distribution behind homogeneous phantoms has a Gaussian shaped profile, which becomes wider with increasing air gap. The relative contribution of scattered dose depends on the phantom thickness and is maximal for a thickness of about 10 cm. Using these results, the parameters of the convolution model (i.e., the shape of the scatter kernel) were determined. With the model the absolute exit dose is predicted with an accuracy of about 2% (1 s.d.) within the entire radiation field for homogeneous phantoms. Inhomogeneities are taken into account by calculating the radiological path length from the measured primary dose, i.e., without using CT data. By using the measured radiological path length the exit dose can be determined for inhomogeneous phantoms with an accuracy of 2.5%. It is concluded that, using our convolution model, EPID measurements at large air gaps can be used to estimate absolute exit doses in an 8 MV beam with an accuracy of 2.5%.

Algorithms↗