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T Kron

Publications and source records attributed to T Kron.

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

Evaluation of a second set of lateral lasers for easier patient positioning in radiotherapy.

On modern linear accelerators patient set-up is often awkward due to the height of the isocentre. A second set of lateral lasers was mounted approximately 20 cm below the isocentre allowing patient positioning at an ergonomical height. A small randomised study involving 16 heavy patients treated for pelvic malignancies demonstrated that using the lower lasers for patient set-up is not only likely to reduce strain on staff but also speed up the set-up process.

Aged↗
PubMed1999

Selective in vivo dosimetry in radiotherapy using P-type semiconductor diodes: a reliable quality assurance procedure.

Since 1994, our center has conducted entrance dose measurements on selected patients receiving 6MV x-ray therapy by utilizing a commercial set of p-type semiconductor diodes. We report on three years results representing 386 patients having 1005 measurements and the usefulness of such a system in a radiotherapy department. The 386 patients represent approximately 20% of our total radical treatments. Minimal disruption to patient treatment was achieved. Measurements showed an average variation from expected dose of 0.5% +/- 2.2%. Specific treatment site groups were investigated. Our results show that in vivo dosimetry on a selected group of patients is an effective method of providing an independent verification of dose delivery accuracy.

Humans↗
PubMed1999

Uncertainty analysis in polymer gel dosimetry.

Verification of advanced radiotherapy treatment modalities requires measurement of three-dimensional absorbed dose distributions with high spatial resolution and precision. Polymer gel dosimeters combined with magnetic resonance imaging may be able to fulfil this requirement. However, verification requires that the uncertainty in the dosimeter is well known. One method of estimating the overall uncertainty in polymer gel dosimeters involves the propagation of the uncertainty in the R2 (nuclear magnetic resonance relaxation rate) map and the uncertainties in the calibration data. This work shows that using this method with current data suggests that the lowest uncertainty currently obtainable is about 3% at 8 Gy and 7% at 2 Gy. Furthermore, the most significant reductions in overall uncertainty will be achieved by reducing the noise in the R2 map.

Acrylic Resins↗
PubMed1999

Monitor unit calculations using a 3D computerised treatment planning system: verification in an anthropomorphic phantom.

The aim of this work was to assess the monitor unit calculation accuracy of a new 3D computer planning system in a volume containing significant lung heterogeneity. An anthropomorphic phantom drilled to accommodate a cylindrical ionisation chamber was used for measurements. Results were also compared to an older 2D system and a manual calculation method. Only a slight improvement was achieved with the new system and an energy dependence was evident. This type of test is recommended before implementing a new 3D planning system.

Algorithms↗
PubMed1998

Junctioning of lateral and anterior fields in head and neck cancer: a dosimetric assessment of the monoisocentric technique (including reproducibility).

PURPOSE: The matching or junctioning of two lateral fields with an anterior field is commonly performed in the treatment of head and neck cancer. A monoisocentric technique utilising asymmetric collimation is potentially associated with improved dosimetry in the plane of the junction due to decreased reliance on operator skill and the avoidance of couch movement. The aim of this study was not only to assess the average dose delivered in the plane of the junction, but also the reproducibility of this dose for the monoisocentric technique and two other commonly used techniques. METHODS AND MATERIALS: An anthropomorphic head and neck wax phantom was fashioned to allow the placement of 22 TLD chips in a 2-mm thick transverse plane positioned superior to the potential site of the larynx. Three different treatment techniques were used with the phantom being treated by four different operators a minimum of 20 times for each technique: (1) "straight fields"--using isocentric laterals with an anterior field junctioned in the midline. This technique makes no allowance for divergence; (2) "angled fields"--couch and gantry rotation are used to account for divergence; (3) "monoisocentric"--using asymmetric collimators to create a single isocenter. RESULTS: For an applied dose of 1 Gy the monoisocentric technique produced a mean dose measured of 1.01 Gy compared with 1.23 and 0.92 Gy for techniques 1 and 2. The reproducibility of the mean dose measured was better for the monoisocentric technique by a factor of 2. The superior reproducibility of the monoisocentric technique was not found to be operator dependent. CONCLUSIONS: A monoisocentric technique for the treatment of two laterals and an anterior field in head and neck cancer is likely to be associated with more accurate and reproducible dosimetry in the plane of the junction. Our center has subsequently adopted this technique for matching such fields.

Head and Neck Neoplasms↗
PubMed1998

Dose response of various radiation detectors to synchrotron radiation.

Accurate dosimetry is particularly difficult for low- to medium-energy x-rays as various interaction processes with different dependences on material properties determine the dose distribution in tissue and radiation detectors. Monoenergetic x-rays from synchrotron radiation offer the unique opportunity to study the dose response variation with photon energy of radiation detectors without the compounding effect of the spectral distribution of x-rays from conventional sources. The variation of dose response with photon energies between 10 and 99.6 keV was studied for two TLD materials (LiF:Mg,Ti and LiF:Mg,Cu,P), MOSFET semiconductors, radiographic and radiochromic film. The dose response at synchrotron radiation energies was compared with the one for several superficial/orthovoltage radiation qualities (HVL 1.4 mm Al to 4 mm Cu) and megavoltage photons from a medical linear accelerator. A calibrated parallel plate ionization chamber was taken as the reference dosimeter. The variation of response with x-ray energy was modelled using a two-component model that allows determination of the energy for maximum response as well as its magnitude. MOSFET detectors and the radiographic film were found to overrespond to low-energy x-rays by up to a factor of 7 and 12 respectively, while the radiochromic film underestimated the dose by approximately a factor of 2 at 24 keV. The TLDs showed a slight overresponse with LiF:Mg, Cu, P demonstrating better tissue equivalence than LiF:Mg, Ti (maximum deviation from water less than 25%). The results of the present study demonstrate the usefulness of monoenergetic photons for the study of the energy response of radiation detectors. The variations in energy response observed for the MOSFET detectors and GAF chromic film emphasize the need for a correction for individual dosimeters if accurate dosimetry of low- to medium-energy x-rays is attempted.

Biophysical Phenomena↗
PubMed1998

High dose behind inhomogeneities during medium-energy x-ray irradiation.

Medium-energy x-rays from orthovoltage treatment units are used for a variety of radiotherapy treatments ranging from cutaneous malignancies in the head and neck region to bone metastases. It was the aim of the present study to investigate the dose distribution due to secondary electrons close behind inhomogeneities in these radiation qualities. The dose was assessed in a solid water phantom using three plane-parallel ionization chambers (NE 2532/2, 'Markus' and 'Attix' chamber) and sheets of aluminium, copper, zinc, platinum, lead and bone equivalent material. The depth dose distribution directly behind the inhomogeneity was assessed using sheets of 15 microm thick polyethylene foil. A dose increase was found directly behind inhomogeneities of high atomic number with a rapid dose fall-off over the first 100 microm. The dose downstream of the inhomogeneity was found to increase with increasing beam quality from 120 kVp (HVL 2.8 mm Al) to 250 kVp (HVL 2 mm Cu). In the latter the dose was increased directly behind lead and platinum sheets by up to a factor of eight compared with a solid water depth of similar attenuation. The results of the study demonstrate the importance of using appropriate materials if shielding is in contact with the patient.

Bone Neoplasms↗
PubMed1998

Variation of patient dose in head CT.

CT dose varies with both equipment related and operator dependent factors. Thermoluminescence dosimetry (TLD) was employed in two phantoms to investigate the variation in absorbed dose for head CT scans, using a cylindrical head CT dose phantom. Dose profiles were plotted and the computed tomography dose index (CTDI) calculated for a single 10 mm thick slice on 14 CT scanners. An anthropomorphic head phantom was also scanned from the base-of-skull to the vertex using 10/10 mm slices. The absorbed dose measured at the centre of the scan series is reported (Dmid). The mean CTDIw for the 14 scanners was 60.0 mGy, while the mean Dmid was 45.8 mGy. Dmid better represents the absorbed dose in human tissues. The CTDIw and Dmid normalized to mAs varied by up to a factor of 2.2 for the different scanners. Equipment related factors contribute to such variations. However, variations due to operator dependent factors such as the choice of exposure factors, scanning protocol and positioning technique must also be considered. When such factors are taken into account the absorbed dose received by the patient can vary considerably, by as much as 16.2 for lens dose. Increased awareness of the factors influencing CT dose and the standardization of scanning protocols is recommended.

Anthropometry↗
PubMed1997

Response of human hair cortical cells to fractionated radiotherapy.

Hair cortical cell counting (HCCC) represents a non-invasive, in-vivo measure of cell kill in the human integument. Sixty-six patients undergoing conventionally fractionated, external beam radiotherapy for early stage carcinoma of the prostate had groin hair samples counted. This technique is a sensitive and reproducible measure of radiation effect and may have applicability as an in-vivo prediction tool or in the field of biological dosimetry. A repopulative follicular response occurring at 3-4 weeks may explain flattening of the dose response curve.

Dose-Response Relationship, Radiation↗
PubMed1997

An independent check of treatment plan, prescription and dose calculation as a QA procedure.

In many radiotherapy centres where planning for external beam treatments is performed by radiation therapists, the treatment sheet and its calculations are independently checked by staff from a different educational background, typically a radiotherapy physicist. The benefits of this practice were evaluated in a radiotherapy department with two linear accelerators, one combined superficial-orthovoltage unit and one telecaesium unit. Within the 19 months of the investigation period, 2328 checks were performed on the treatment sheets of 1579 patients. In six cases, errors in excess of 5% were detected, which if uncorrected, could potentially have affected local tumour control or caused normal tissue complications. It was found that an independent check of treatment sheets assists in keeping these errors as low as can be achievable in clinical practice, and suggests that treatment sheet checking and in vivo dosimetry play a complementary role in this aim. Independent treatment sheet checking is an important quality assurance (QA) activity, with additional advantages such as improved communication in the department, education of staff and in vivo dosimetry targeting. Therefore the advantages of the procedure seem to outweigh the additional workload of approximately 0.3 full-time staff per 1000 patients per year.

Adult↗
PubMed1997

Fast T1 imaging of dual gel samples for diffusion measurements in NMR dosimetry gels.

Diffusion of iron is one of the major problems limiting the usefulness of NMR gel dosimetry. This was studied in dual gel samples using a 4.7T micro-imaging MR scanner and a fast T1 imaging sequence which allowed the acquisition of a 64 x 128 x 8 data sets (phase encoding x frequency encoding x number of inversion times) in less than 15 min. The procedure enabled us to obtain relative relaxation times for any region of interest within the sample. After the two differently doped gels were brought into contact in the dual gel samples (diameter 12 mm), the diffusion could be observed on subsequent images as a function of time. An inverse square root function was used to fit the change of 1/T1 across the junction between the two gel phases. A diffusion constant of 0.014 +/- 0.003 cm2/h was determined for Fe3+ in a typical dosimetry gel (1.5% agarose, 50 mM H2SO4). This could be lowered by adding a chelating agent such as xylenol orange to the gel. It was also found that diffusion was slower in gelatine gels, however these gels tended not to set properly when H2SO4 was added as required for NMR dosimetry. From the present results we propose that a gel consisting of 1.5% agarose (for stability), 3% gelatine and 0.1 mM xylenol orange (to combat diffusion and allow a visual evaluation) is a suitable base for NMR dosimetry gels. The use of a fast T1 imaging sequence reduces acquisition times and therefore the potential impact of diffusion.

Chelating Agents↗
PubMed1996

In situ rigidity of a new sliding rod for management of the growing spine in Duchenne muscular dystrophy.

STUDY DESIGN: This biomechanical, in vitro laboratory study determined the static stiffness of a new telescoping rod and the axial motion of this implant during various loading conditions. OBJECTIVES: To compare the stability of the new telescoping rod with the classic Luque instrumentation, and to determine whether the sliding rod elongates or contracts during spine motion. SUMMARY OF BACKGROUND DATA: A new telescoping rod was developed to stabilize the spine in children with Duchenne muscular dystrophy and to provide capacity for spinal growth. METHODS: The stability of 11 instrumented calf spines was determined in flexion, extension, lateral bending, and torsion to determine the stiffnesses of the spines instrumented with these two implants. The telescoping motion in the left and right rod was measured in the new rod system. RESULTS: In flexion, the spines with the telescoping rods were stiffer than those with the Luque implant. However, no significant differences in the stiffness coefficients were found for extension, lateral bending, or torsion. The restoring force of the telescoping system was greater than that of the Luque system in all directions. All modes of loading produced an accommodating change of length in the construct. CONCLUSIONS: The dynamic telescoping system provides stiffness comparable with that of established systems while allowing elongation during growth of the young patient.

Animals↗
PubMed1996

Assessment of mucosal underdosing in larynx irradiation.

PURPOSE: Mucosal underdosing as a result of electron disequilibrium at the air cavity may affect local recurrence rates for T1 and T2 larynx cancers. Secondary build-up properties of high-energy beams have been demonstrated in a slab phantom. It was the aim of this investigation to determine whether significant surface underdosing exists for the mucosa under clinical conditions. METHODS AND MATERIALS: Measurements were made using a thermoluminescent dosimetry (TLD) extrapolation technique in an anatomic larynx phantom. The larynx phantom was constructed using tissue and cartilage equivalent material, based on patient cross-sectional anatomy. Three different thicknesses of LiF ribbons, 0.14, 0.39, and 0.89 mm, were placed reproducibly at 12 different positions at the anterior, posterior, and lateral walls on the endolarynx surface. Measured doses were plotted and an extrapolation was made back to the mucosal depth to obtain the dose received at each of the positions. Results were obtained for two different field configurations, opposed laterals and oblique fields, for 6-MV X rays and opposed lateral fields from a telecesium unit. In addition, the larynx surface doses of field sizes from 4 x 6 cm2 to 7 x 6 cm2 were investigated. RESULTS: Surface underdosing was observed owing to the secondary build-up and build-down effect of the air cavity, and the dose measured for the three extrapolation TLDs at any position varied by up to 18%. An average variation of 6% was observed. The surface underdosing was most apparent for the 6-MV opposed lateral beam technique, where mucosa doses down to 76% of the prescribed dose were observed. Mucosal underdosing at the measurement positions was less marked with oblique techniques, telecesium treatment, and increasing field size. CONCLUSION: Because of underdosing, some surface positions receive < 80% of the prescribed dose. This may contribute to the potential for higher recurrence rates observed with high-energy photons.

Air↗
PubMed1996

Underprediction of human skin erythema at low doses per fraction by the linear quadratic model.

BACKGROUND AND PURPOSE: The erythematous response of human skin to radiotherapy has proven useful for testing the predictions of the linear quadratic (LQ) model in terms of fractionation sensitivity and repair half time. No formal investigation of the response of human skin to doses less than 2 Gy per fraction has occurred. This study aims to test the validity of the LQ model for human skin at doses ranging from 0.4 to 5.2 Gy per fraction. MATERIALS AND METHODS: Complete erythema reaction profiles were obtained using reflectance spectrophotometry in two patient populations: 65 patients treated palliatively with 5, 10, 12 and 20 daily treatment fractions (varying thicknesses of bolus, various body sites) and 52 patients undergoing prostatic irradiation for localised carcinoma of the prostate (no bolus, 30-32 fractions). RESULTS AND CONCLUSIONS: Gender, age, site and prior sun exposure influence pre- and post-treatment erythema values independently of dose administered. Out-of-field effects were also noted. The linear quadratic model significantly underpredicted peak erythema values at doses less than 1.5 Gy per fraction. This suggests that either the conventional linear quadratic model does not apply for low doses per fraction in human skin or that erythema is not exclusively initiated by radiation damage to the basal layer. The data are potentially explained by an induced repair model.

Aged↗
PubMed1996

TLD extrapolation for skin dose determination in vivo.

Prediction of skin reactions requires knowledge of the dose at various depths in the human skin. Using thermoluminescence dosimeters of three different thicknesses, the dose can be extrapolated to the surface and interpolated between the different depths. A TLD holder was designed for these TLD extrapolation measurements on patients during treatment which allowed measurements of entrance and exit skin dose with a day to day variability of +/-7% (S.D. of mean reading). In a pilot study on 18 patients undergoing breast irradiation, it was found that the angle of incidence of the radiation beam is the most significant factor influencing skin entrance dose. In most of these measurements the beam exit dose contributed 50% more to the surface dose than the entrance dose.

Breast Neoplasms↗