Technical exhibits.
Explore the source record for details and available documents.
Diagnostic Imaging↗
Biomedical subjects
B R Thomadsen
Publications and source records attributed to B R Thomadsen.
The transit dose component of high dose rate brachytherapy: direct measurements and clinical implications.
PURPOSE: To measure the transit dose produced by a moving high dose rate brachytherapy source and assess its clinical significance. METHODS AND MATERIALS: The doses produced from source movement during Ir-192 HDR afterloading were measured using calibrated thermoluminescent dosimeter rods. Transit doses at distances of 0.5-4.0 cm from an endobronchial applicator were measured using a Lucite phantom accommodating 1 x 1 x 6 mm thermoluminescent rods. Surface transit dose measurements were made using esophageal and endobronchial catheters, a gynecologic tandem, and an interstitial needle. RESULTS: No difference was detected in thermoluminescent dosimeter rod responses to 4 MV and Ir-192 spectra (427 nC/Gy) in a range of dose between 2 and 300 cGy. The transit dose at 0.5 cm from an endobronchial catheter was 0.31 cGy/(Curie-fraction) and followed an inverse square fall-off with increasing distance. Surface transit doses ranged from 0.38 cGy/(Curie-fraction) for an esophageal catheter to 1.03 cGy/(Curie-fraction) for an endobronchial catheter. Source velocity is dependent on the interdwell distance and varies between 220-452 mm/sec. A numeric algorithm was developed to calculate total transit dose, and was based on a dynamic point approximation for the moving high dose rate source. This algorithm reliably predicted the empirical transit doses and demonstrated that total transit dose is dependent on source velocity, number of fractions, and source activity. Surface transit doses are dependent on applicator diameter and wall material and thickness. Total transit doses within or outside the desired treatment volume are typically < 100 cGy, but may exceed 200 cGy when using a large number of fractions with a high activity source. CONCLUSION: Current high dose rate brachytherapy treatment planning systems calculate dose only from source dwell positions and assume a negligible transit dose. Under certain clinical circumstances, however, the transit dose can exceed 200 cGy to tissues within and outside the prescribed treatment volume. These additional, unrecognized doses could increase potential late tissue complications, as predicted by the linear quadratic model. To enhance the clinical safety and accuracy of high dose rate brachytherapy, total transit dose should be included in calculated isodose distributions. Significant transit doses to tissues outside the treatment volume should be documented.
Algorithms↗
Radiographic visualization of vaginal cylinders in gynecologic high dose rate brachytherapy.
PURPOSE: To develop a marker system allowing an accurate determination of vaginal applicator dimensions and geometry from a radiograph. METHODS AND MATERIALS: The markers consist of two sets of gold seeds embedded into each cylinder identifying the cylinder diameter, and a thin stainless steel disk interposed between adjacent cylinders identifying their interface. An evaluation of the dosimetric properties of the markers was undertaken. An applicator was assembled using four cylinders (4 cm diameter) surrounding a stainless steel uterine tandem with a stainless steel disk 0.05 mm thick and 3.6 cm in diameter interposed between each consecutive pair of cylinders. The assembly was placed on a film and an Ir-192 high dose rate source was programmed to a single dwell position within the applicator. The markers were removed and a second film was exposed with the same dwell position and time. This procedure was repeated with various dwell positions along the applicator. A scanning densitometer was used to measure the density profiles and isodensity distributions of each film. RESULTS: The optical density profiles and isodensity distributions with and without the markers in place were identical for all source dwell positions except when the source was centered in the plane of one of the stainless steel disks, where a maximum decrease of less than 2% in the dose rate was measured. The disks had no effect on the profiles measured along axes more than 2 cm from the projection of the applicator central axis on the film. CONCLUSION: The markers provide geometrical information about the position of the applicator relative to the anatomy necessary for optimized treatment planning. Slight dose perturbations resulting from the markers do occur, but only for dwell positions that center the source in the plane of a disk, and even then only at points very close to the disk. The markers can therefore be ignored from a dosimetric point of view.
Administration, Intravaginal↗
High dose rate intracavitary brachytherapy for carcinoma of the cervix: the Madison system: I. Clinical and radiobiological considerations.
The decision to use five high dose rate intracavitary (HDR-ICR) insertions at weekly intervals for invasive carcinoma of the cervix treated at the University of Wisconsin Comprehensive Cancer Center (UWCCC) was made clinically. It was based on practical considerations and on previous clinical experience worldwide which showed that between 2 and 16 insertions have been used with apparently acceptable results. Although radiobiological considerations favor a large number of small doses, such a large number of HDR-ICR insertions is not clinically practical. Our strategy was to keep the biological effects of external beam and intracavitary insertions in the same ratio as used on a large series of patients treated here with low dose rate (LDR) therapy. This means keeping the same external beam treatment scheme and finding high dose rate (HDR) doses that are biologically equivalent to the previous LDR therapy, as far as possible. External beam and HDR intracavitary dose schedules for the Madison System of treating cervical carcinoma are described in detail. Because there is more repairable damage in late-reacting normal tissues, there is a bigger loss of sparing in these tissues than in tumors when changing from LDR to HDR, so total doses should be reduced more for equal late complications than for equal tumor control. The clinical decision was made to aim at equal tumor control. The possible increase in late complications has to be avoided by reducing the doses to critical normal tissues using extremely careful anatomic positioning of the HDR sources. Critical normal tissues must be kept further away from the radiation sources so that their doses are about 20% lower than with LDR geometry. This requires an extra separation of some millimeters depending on the anatomy and geometry of the individual insertion. The strategy is that the unfavourable radiobiological effects of a few large fractions must be counteracted by better physical dose distributions with HDR-ICR than with the previous LDR insertions. These good distributions are obtainable with the short exposures at HDR.
Brachytherapy↗
High dose rate intracavitary brachytherapy for carcinoma of the cervix: the Madison system: II. Procedural and physical considerations.
The loss in therapeutic ratio accompanying a conversion from low dose-rate (LDR) to high dose-rate (HDR) intracavitary brachytherapy (ICR) requires increased attention to the precision and accuracy of dose distribution calculations and treatment delivery. While the HDR-ICR treatment unit allows better custom-tailored dose distributions compared to LDR, it also requires more attention to detail to achieve the distribution desired. Because the relative biological effectiveness of different isodose levels in a dose distribution varies with the absolute dose (as described in Part 1 of this article), the relative dose distribution used with LDR must be modified for HDR to produce the same expected biological effect. Because of the difference in the radiobiology and physical positioning, simply duplicating applications as performed with LDR misses opportunities for dose distribution improvement as well as opens possibilities for significant complications. Due to differences in positioning the applicator (e.g., retraction of the cervix low in the pelvis instead of packing the applicator high), traditional definitions of points of interest (such as point A) apply poorly with HDR-ICR, compelling new systems of dose specification. With HDR-ICR, irreparable mistakes can happen very quickly, and quality assurance for the treatment plan and calculated dwell times prove much more important than with LDR. Key features of the dose distribution and constant relationships involving doses and dwell times help screen planned treatments for mistakes. This paper details the procedural and physical consideration of the Madison system for HDR-ICR brachytherapy for carcinoma of the cervix.
Brachytherapy↗
A new re-entrant ionization chamber for the calibration of iridium-192 high dose rate sources.
A re-entrant (well-type) ionization chamber has been designed and fabricated at the University of Wisconsin for use with iridium-192 high dose-rate (HDR) remote after-loading brachytherapy devices. The chamber was designed to provide an ionization current of about 10(-8) ampere with a nominal 10 curie iridium-192 source. A narrow opening is provided into the sensitive volume of the chamber to insert a Nucletron MicroSelectron catheter, or catheters with similar diameters from other HDR manufacturers. The chamber exhibits a flat response (+/- 0.1%) for any source position within +/-4 mm of the chamber center. A 300 volt chamber bias yields a 99.96% ion collection efficiency. The chamber is capable of being calibrated directly with an iridium-192 source which has in turn been calibrated with thimble-type ion chambers. Reproducibility for readings in the current mode for 10 consecutive insertions of the MicroSelectron iridium-192 HDR source is within 0.02% or less. Two thimble chambers calibrated by the U.S. National Institute of Standards and Technology provide calibration traceability of iridium-192 HDR sources and re-entrant chambers to a primary national standards laboratory. Results of activity measurements of 6 commercial iridium-192 HDR sources are reported.
Calibration↗
High-dose-rate brachytherapy for cervical carcinoma.
Explore the source record for details and available documents.
Brachytherapy↗
Evaluation of the reconstruction of brachytherapy implants in three-dimensions from stereo radiographs.
The precision and the accuracy of the stereo-shift method for reconstruction of brachytherapy implants were evaluated. Analysis of shift films was performed by measuring the coordinates of the seeds in an experimental set-up in the laboratory, by manually calculating the coordinates of the seeds from the projection distances on the stereo-shift radiographs, and by using a computer-aided treatment planning system. The resultant reconstructed coordinates agreed well with each other. The uncertainties in precision for the coordinates were expressed as the standard deviation of the measurements. The standard deviation of the computer and manual measurements agreed well with predicted values by an analysis of the random uncertainties in the reconstruction parameters. The uncertainties were within 0.2 mm for the coordinates parallel to the plan of the film and were within 0.4 mm for the coordinate perpendicular to the plane of the shift film. The uncertainties in the accuracy of the reconstruction were compared with the values obtained in clinical practice as well as with the values reported in the literature. Suggestions are made to improve the accuracy.
Brachytherapy↗
Magnetic modification of electron beam dose distributions.
A 10 kG magnetic field has been used to modify the conventional electron beam isodose distributions. Isodose curves of modified distributions for single and multiple beams measured in a polystyrene phantom are presented. The results suggest a potential use of this technique to achieve dose distributions adjusted to the various tumor contours and corrected for heterogeneity effects.
Electromagnetic Fields↗
Principles in positioning cross-projecting lasers.
With the increased sophistication of lasers used for patient positioning in radiotherapy comes increased possibilities for mistakes in installing the lasers, which can result in serious patient positioning errors. Two principles must be followed when mounting cross-projecting lasers: (1) the horizontal line must be on the same level as the treatment unit isocenter, and the vertical line must be coplanar with the gantry rotation, and (2) If one of the lines of the cross rotates, it must be the line which is perpendicular to the line joining the two holes from which the laser beams exit the laser casing.
Humans↗
Perturbation of electron beam doses as a function of SSD due to the use of shielding blocks on the Clinac-18a.
Many radiotherapy linear accelerators use electron beam applicators which extended close to the patient's surface when treating at the regular distance. The relatively large size of these applicators often necessitates the use of a larger SSD than that designed by the manufacturer. In such cases, the addition of shielding blocks to the applicator can significantly alter the factors which should be used to calculate the dose rate at the new SSD as compared with the unshielded beam condition. In some typical clinical situations, errors of greater than 60% may result from failure to account for this perturbation. This paper presents the proper correction of the dose vs SSD function for the presence of such shielding blocks for the Clinac-18 linear accelerator.
Electrons↗
Some phantom designs for radiation dosimetry and CT applications.
Solid phantoms designed with nesting, rotatable cylinders, allow increased flexibility in the positioning of dosimeters or test objects, permitting continuous movement as in a water phantom, but with increased ease of handling. Using such phantoms, measurements can be made at almost any point in the cross section of a phantom, an ability not achievable with currently existing solid or water phantoms. A separate phantom design allows easy measurement at points along circles or radii in a phantom.
Equipment Design↗
Calibration of 192Ir high-dose-rate afterloading systems.
A method is described for calibration of 192Ir high-dose-rate (HDR) brachytherapy afterloading systems. Since NIST does not offer calibration of ionization chambers with the gamma-ray spectrum of iridium-192, an interpolation procedure is employed, using calibrations above (137Cs, 662 keV) and below (250 kVcp, 146-keV x rays) the exposure-weighted average 192Ir energy of 397 keV. The same total wall + cap thickness must be used for both calibrations, and for the 192Ir measurements. A wall + cap thickness of 0.3 g/cm2 is recommended to assure charged particle equilibrium and to exclude secondary electrons emitted from the source encapsulation. Procedures are described for determining the corrections for source-chamber distance and room scatter during the source calibration in inverse-square-law geometry. A new well-type ionization chamber has been designed specifically for convenient routine use with the HDR afterloading system. It can be calibrated by means of a previously calibrated 192Ir source, and offers a simple means for verifying the decay rate and for calibrating 192Ir replacement sources.
Brachytherapy↗
Thermal and scatter effects on the radiation sensitivity of well chambers used for high dose rate Ir-192 calibrations.
High dose rate (HDR) iridium sources must be calibrated regularly because of the short half-life of Ir-192. High dose rate sources can now be calibrated using a new well-type chamber that allows easy, reproducible source calibrations. The chamber includes a styrofoam insulator that surrounds the source in the well. A study of the radiation sensitivity of the well chamber exposed to an HDR Ir-192 source at two different activities (300 and 230 GBq) revealed that the sensitivity of the chamber varies by as much as 1.1% as the chamber is moved toward a scattering surface. Second, with the styrofoam insulator removed, the air temperature within the ion collecting volume increased during exposure, causing a gradual decrease in chamber sensitivity of 0.15% in 30 min. This temperature increase was caused by heat transfer from radiation emitted by the Ir-192 source, and diminished as the source decayed. However, with the styrofoam insulator around the central aluminum tube in the well, the source cannot heat the collecting volume and thus thermal equilibrium between the ion collecting volume and its environment is maintained throughout an exposure. The radiation sensitivity of the commercial well chamber was found to be constant for exposure times of 30 min.
Aluminum↗
On the cause of the variation in tissue-maximum ratio values with source-to-detector distance.
While tissue-maximum ratios (TMR) for 60cobalt treatment units have been shown to be independent of source-to-axis distance (SAD), high-energy photon beams demonstrate variations in their TMR as a function of SAD. Some authors have asserted that the distance dependence of the TMR stems from electron contamination in the beams, while others have suggested low-energy, scattered photons as the cause. Using a magnet to sweep contaminant electrons out of the photon treatment beam eliminates any variation in TMR with distance. Thus, electron contamination accounts for all of the distance dependence, and any low-energy, scattered photons behave indistinguishably like the high-energy photons.
Cobalt Radioisotopes↗
Evaluation of the reconstruction of seed positions from stereo and orthogonal radiographs for routine radiotherapy planning.
Brachytherapy, which refers to short-distance treatment via implanted sources, requires an accurate knowledge of the dose distribution in the implant volume. A critical step in the determination of the dose distribution involves an accurate reconstruction of seed positions. Stereo and orthogonal radiographs offer two distinct imaging techniques for determining the seed positions in the implant volume. This work is an attempt to study the effects of random errors associated with the three-dimensional reconstruction of a two-plane seed implant from stereo and orthogonal radiographs. The uncertainty in coordinates is expressed as the standard deviation of the measurements. To assess the geometric accuracy of the stereo and orthogonal methods, the computer-reconstructed coordinates of each seed are compared with the measured and manually calculated coordinates. The uncertainties in the coordinates and relative positions of seeds are also estimated by considering the propagation of errors in the reconstructed parameters. The isodose contours surrounding the implant are obtained for both methods. Using a sonic digitizer to input the data, it was found that seed coordinates and relative seed positions can be obtained satisfactorily from stereo radiographs. The uncertainties were compared with the values reported in the literature. Suggestions are made to reduce the uncertainties in the reconstruction of coordinates with the stereo method.
Brachytherapy↗