Constancy checks of well-type ionization chambers with external-beam radiation units.

Constancy checks of a well-type ionization chamber should be performed regularly as part of a quality assurance regime. The goal of this work was to test the feasibility of using a linear accelerator and an orthovoltage unit to check the constancy of a well-type chamber's response to an external radiation source. The reproducibility, linearity with dose, variation with dose-rate, and variation between energy-matched units of the well-type chamber response when exposed to 6 MV beams was examined. The robustness to errors in establishing the measurement conditions, including setting the source-to-surface distance and gantry angle, rotation of the chamber around the central axis of the beam, and the effect of changing the length of the chamber cable exposed to the field, were tested. The reproducibility and linearity with dose of the chamber response, and robustness to errors in establishing the measurement conditions for 100 kVp and 250 kVp beams from an orthovoltage unit, were also examined. The combined uncertainty, including contributions from errors in establishing the reference conditions, for well-type chamber measurements using a 6 MV beam from a linear accelerator is 1.0%. The combined uncertainties for measurements using 100 and 250 kVp beams were 1.8% and 1.5%, respectively. When focus-source distance errors were reduced to ≤ 1 mm, the combined uncertainties for the 100 and 250 kVp beams were 1.2% and 1.1%, respectively, when the dose to the chamber was confined to the linear region of the dose-response curve. The response of a well-type chamber should remain constant to within 1.2% when exposed to a constant dose from an external beam unit, if reference conditions can be reproducibly established. However, the uncertainty for establishing reference conditions for output measurements for an orthovoltage unit can be reduced, which would justify a reduction of the tolerance for constancy measurements.

Survival and Toxicity Following Chemoradiation for Carcinoma of the Cervix - Impact of Multiple-phase Treatment and Shielding.

AIM: We report on outcomes and significant grade 3-4 late toxicities between January 1999 and October 2006 following introduction of multi-phase treatment and effect of shielding in treatment of cervical cancer with concurrent chemoradiation. PATIENTS AND METHODS: Radiotherapy dose by phase, recurrence, survival and toxicity data was collated by a retrospective review of clinical notes. Shielding information was retrieved from original planning films. RESULTS: 3-year survival for stages I, II and III disease were 89%,76% and 51% respectively. Local pelvic failure was 9%. Overall significant late toxicity (SLT) rate was 13%, with lower rates for post-operative treatment than primary chemoradiation (4% vs. 16%). SLT with single phase treatment was 29% versus 12% following multiphase EBRT and 16% when <2 areas were shielded versus 6% with ≥3 shielded areas (p=0.01). CONCLUSION: Shielding and multi-phase treatment not only reduce dose to organs at-risk but can also reduce late toxicity without compromising local control or survival.