Matching intraoperative electron-beam fields: dosimetric and clinical considerations.

In the setting of a large or irregularly shaped tumor, adjacent or intentionally overlapped intraoperative electron fields may be required to give adequate coverage of the intraoperative target volume. The matching of such intraoperative electron fields present special dosimetric problems because of the divergence of electron isodose curves with depth. In the intraoperative setting, where large, single-fraction doses are delivered, the low- and high dose areas which result from gaps or overlaps between the diverging isodose curves of electron fields matched at depth or the surface may translate into decreased local tumor control or excessive normal tissue toxicity. This study examines the dosimetry of gapped, adjacent, and overlapped 8 X 9 cm2 rectangular intraoperative fields, for 9 to 18 MeV electrons, using film densitometry. "Ideal" methods of matching rectangular intraoperative electron fields are presented, and include: 1) a 2-mm gap plus surface bolus for adjacent fields, and 2) placing a tenth-value layer shaped lead cutout in the overlap region for intentionally overlapped fields.

Medulloblastoma--prognostic factors and outcome of treatment: review of the Mayo Clinic experience.

From March 1965 through December 1984, 58 patients (35 male and 23 female patients; median age, 17 years) with posterior fossa (PF) medulloblastoma underwent surgical treatment and postoperative radiation therapy at our institution. Radiation fields were the craniospinal axis in 39 patients, PF plus spinal axis in 12, PF in 6, and whole brain in 1. Median radiation doses were 43 Gy (22 to 60 Gy) to the PF and 34 Gy (6.2 to 50 Gy) to the spinal axis. Overall 5- and 10-year survivals were 50% and 33%, respectively; 5- and 10-year relapse-free survivals were 46% and 32%. Treatment failed in 34 patients (59%): in 18 who had irradiation to the craniospinal axis (13 had received 50 Gy or less to the PF) and in 16 who had a radiation field of less than the craniospinal axis. A statistically significant (P less than 0.05) improvement in 10-year survival was associated with the following prognostic variables: PF dose of 50 Gy or more, whole-brain irradiation, and spinal axis irradiation. In comparison with subtotal resection, total resection was correlated with better 10-year relapse-free survival but not overall survival. All five patients with initial treatment failure only in the spine had received a radiation dose of 30 Gy or less to the spinal axis. The 2-year survival after relapse was 46% with salvage chemotherapy or irradiation in 23 patients and 0% in the 11 patients who received no further treatment (P less than 0.01).

A chamber and electrometer calibration factor as determined by each of the five AAPM accredited dosimetry calibration laboratories.

The same calibration grade ionization chamber and electrometer were sequentially sent to all five currently AAPM Accredited Dosimetry Calibration Laboratories (ADCL). A Cesium-137 based check device was utilized to ensure chamber and electrometer factor constancy and showed a maximum deviation of 0.32% (typically less than 0.1%) over the 227 days needed to complete the intercomparison. The chamber and electrometer calibration factor provided by each of the five ADCLs were analyzed for consistency. The maximum percent difference in reported chamber factor between all five ADCLs was 1.40%. The reported electrometer factor had a maximum discrepancy of only 0.50%. System (chamber plus electrometer) factors as provided by three of the five ADCLs had a maximum discrepancy of 1.51%.

A depth dependence determination of the wedge transmission factor for 4-10 MV photon beams.

The depth dependence (up to 25 cm) of the in-phantom wedge transmission factor (WTF) has been determined for three medical linear accelerator x-ray beams with energies of 4, 6, and 10 MV containing 15 degrees-60 degrees (nominal) brass wedges. All measurements were made with a cylindrical ionization chamber in water, for a field size of 10 X 10 cm2 with a source-skin distance of 80 or 100 cm. We conclude that, for the accelerators studied, the WTF factor at depth is less than 2% different from that determined at dmax (for the nominal wedge angles and photon energies studied) unless the depth of interest is greater than 10 cm. Up to the maximum depth studied (25 cm) the relative wedge factor--that is, wedge factor at depth compared to that determined at dmax--was about equal to or less than 1.02 for the 15 degrees and 30 degrees wedges and any of the photon beam energies studied. For the seldom utilized combination of a nominal wedge angle in excess of 45 degrees with a depth greater than 10 cm, the WTF at depth can differ from the WTF determined at dmax, by up to 5%. Since the wedge transmission factor is reflective of relative percent dose data, our results also indicate that it is in error to use open field percent depth doses for certain combinations of wedge angle, photon energy, and depth.

Acceptance testing of an automated scanning water phantom.

The setup of an automated scanning water phantom must be concluded with a methodical functional acceptance test. This test must include mechanical, radiological, and calculational facets. Only after an acceptance test is successfully completed can data collected with a new or repaired system be trusted. An acceptance test outline was written and applied to a newly purchased Wellhofer scanning system. This testing procedure and its results are presented in this paper.

Fetal dose from radiotherapy with photon beams: report of AAPM Radiation Therapy Committee Task Group No. 36.

Approximately 4000 women per year in the United States require radiotherapy during pregnancy. This report presents data and techniques that allow the medical physicist to estimate the radiation dose the fetus will receive and to reduce this dose with appropriate shielding. Out-of-beam data are presented for a variety of photon beams, including cobalt-60 gamma rays and x rays from 4 to 18 MV. Designs for simple and inexpensive to more complex and expensive types of shielding equipment are described. Clinical examples show that proper shielding can reduce the radiation dose to the fetus by 50%. In addition, a review of the biological aspects of irradiation enables estimates of the risks of lethality, growth retardation, mental retardation, malformation, sterility, cancer induction, and genetic defects to the fetus.

Cadmium free lead alloy for reusable radiotherapy shielding.

A low melting point cadmium free fusible lead alloy suitable for custom radiotherapy shielding blocks is described. The alloy, referred to here as Alloy-203, differs in composition from the more common Lipowitz's metal (Cerrobend) by being cadmium free, having a slightly higher lead content and a 203 degrees F melting temperature. Attenuation properties have been studied for 4-18 MV X-rays. Alloy-203 has lower transmission than Lipowitz's metal, primarily due to the higher content of lead and bismuth. Daily use for the past 2 years at Mayo Clinic has not indicated any major problems associated with the use of this cadmium free alloy for custom shield fabrication.