Addendum to the determination of recombination and polarity correction factors, kS and kP, for small cylindrical ionization chambers in pulsed filtered and unfiltered beams: PTW 31023.

This addendum provides correction factors for the recombination and the polarity effect for the new ionization chamber PTW PinPoint (type 31023). The measurements were made in filtered (WFF) and unfiltered (FFF) high-energy photon beams. It could be confirmed that both the initial and the general recombination effect of the chamber mainly depends on dose per pulse at the point of measurement and is independent of the filtration of the photon beam.

Determination of recombination and polarity correction factors, kS and kP, for small cylindrical ionization chambers PTW 31021 and PTW 31022 in pulsed filtered and unfiltered beams.

The aim of this technical communication is to provide correction factors for recombination and polarity effect for two new ionization chambers PTW PinPoint 3D (type 31022) and PTW Semiflex 3D (type 31021). The correction factors provided are for the (based on the) German DIN 6800-2 dosimetry protocol and the AAPM TG51 protocol. The measurements were made in filtered and unfiltered high-energy photon beams in a water equivalent phantom at maximum depth of the PDD and a field size on the surface of 10cm×10cm. The design of the new chamber types leads to an ion collection efficiency and a polarity effect that are well within the specifications requested by pertinent dosimetry protocols including the addendum of TG-51. It was confirmed that the recombination effect of both chambers mainly depends on dose per pulse and is independent of the filtration of the photon beam.

[In-phantom dosimetric measurements as quality control for brachytherapy: System check and constancy check]. / Messungen im Festkörperphantom als Qualitätskontrolle in der Brachytherapie - Systemprüfung und Konstanzprüfung.

In brachytherapy dosimetric measurements are difficult due to the inherent dose-inhomogenieties. Typically in routine clincal practice only the nominal dose rate is determined for computer controlled afterloading systems. The region of interest lies close to the source when measuring the spatial dose distribution. In this region small errors in the postioning of the detector, and its finite size, lead to large measurement uncertainties that exacerbate the routine dosimetric control of the system in the clinic. The size of the measurement chamber, its energy dependence, and the directional dependence of the measurement apparatus are the factors which have a significant influence on dosimetry. Although ionisation chambers are relatively large, they are employed since similar chambers are commonly found on clincal brachytherapy units. The dose is determined using DIN 6800 [11] since DIN 6809-2 [12], which deals with dosimetry in brachytherapy, is antiquated and is currently in the process of revision. Further information regarding dosimetry for brachytherapy can be found in textbooks [1] and [2]. The measurements for this work were performed with a HDR (High-Dose-Rate) (192)Ir source, type mHDR V2, and a Microselectron Afterloader V2 both from Nucletron/Elekta. In this work two dosimetric procedures are presented which, despite the aforemention difficulties, should assist in performing checks of the proper operation of the system. The first is a system check that measures the dose distribution along a line and is to be performed when first bringing the afterloader into operation, or after significant changes to the system. The other is a dosimetric constancy check, which with little effort can be performed monhtly or weekly. It simultaneously verifies the positioning of the source at two positions, the functionality of the system clock and the automatic re-calculation of the source activity.

Visualization of data in radiotherapy using web services for optimization of workflow.

BACKGROUND: Every day a large amount of data is produced within a radiotherapy department. Although this data is available in one form or other within the centralised systems, it is often not in the form which is of interest to the departmental staff. This work presents a flexible browser based reporting and visualization system for clinical and scientific use, not currently found in commercially available software such as MOSAIQ(TM) or ARIA(TM). Moreover, the majority of user merely wish to retrieve data and not record and/or modify data. Thus the idea was conceived, to present the user with all relevant information in a simple and effective manner in the form of web-services. Due to the widespread availability of the internet, most people can master the use of a web-browser. Ultimately the aim is to optimize clinical procedures, enhance transparency and improve revenue. METHODS: Our working group (BAS) examined many internal procedures, to find out whether relevant information suitable for our purposes lay therein. After the results were collated, it was necessary to select an effective software platform. After a more detailed analysis of all data, it became clear that the implementation of web-services was appropriate. In our institute several such web-based information services had already been developed over the last few years, with which we gained invaluable experience. Moreover, we strived for high acceptance amongst staff members. RESULTS: By employing web-services, we attained high effectiveness, transparency and efficient information processing for the user. Furthermore, we achieved an almost maintenance-free and low support system. The aim of the project, making web-based information available to the user from the departmental system MOSAIQ, physician letter system MEDATEC(R) and the central finding server MiraPlus (laboratory, pathology and radiology) were implemented without restrictions. CONCLUSION: Due to widespread use of web-based technology the training effort was effectively nil, since practically every member of staff can master the use of a web-browser. Moreover, we have achieved high acceptance amongst staff members and have improved our effectiveness resulting in a considerable time saving. The many MOSAIQ-specific parts of the system can be readily used by departments which use MOSAIQ as the departmental system.

Correction factors kE and kQ for LiF-TLDs for dosimetry in megavoltage electron and photon beams.

For the determination of absorbed dose to water D,using thermolumeniscence (TL) probes in a beam different from that used for calibration, correction factors for radiation type and radiation quality kE and kQ are needed. Values for kE and kQ for two different shapes of LiF probes (rods and disks) were obtained for high-energy photon and electron beams. The relation between the absorbed dose to the medium (water) D, measured by ion-chambers according to DIN 6800-2, 2008 and TL-probes having a (60)Co-calibration factor, leads for each shape and each batch of LiF probes to correction factors for radiation type and radiation quality kE and kQ.. The influence of the shape on the correction factor of the probes amounts in our experiment up to 2%. Therefore, it is recommended that the correction factors kE and kQ for rods and disks should be checked for each batch of LiF-detectors.

Some aspects of quality management in deep regional hyperthermia.

The hyperthermia effect is based on its thermal influence on tumours. Therefore a controlled heating of the tumours must be achieved. In order to guarantee this, two points must be fulfilled at least: First, the hyperthermia equipment must have the necessary power and steering capability. Second, the distribution of the 'hyperthermic drug', the heat, has to be measured and controlled over the whole treatment time. To reach this aim both a sophisticated technique and a staff trained in hyperthermia are required. In treating patients such as those with cervical cancer, the volume to be exposed and the dosage must be clarified. This means that very special technical and medical conditions must be fulfilled in hyperthermia. To reach and maintain a certain level of quality, hyperthermia is embedded in a framework of procedures. These procedures are defined in the modules of quality management. Therefore quality management must contain specific guidelines for each application, i.e. coordinated standards have to be defined. When adapting these standards in hyperthermia, comparable and comprehensible results of the treatment are guaranteed. Furthermore, an analysis of the treatments under a scientific point of view will be possible and finally result in improvements of this method.

VMAT and step-and-shoot IMRT in head and neck cancer: a comparative plan analysis.

PURPOSE: Rotational IMRT is a new technique, whose value still has to be assessed. We evaluated its adequacy for the treatment of head and neck (H&N) cancer compared to the well-established step-and-shoot IMRT. MATERIALS AND METHODS: A total of 15 patients, who were treated with either IMRT (13 patients) or VMAT (2 patients) in the H&N region, were chosen. For each patient, a treatment plan with the respective other technique was calculated. To compare the resulting dose distributions, the dose-volume histograms (DVHs) were evaluated. To quantify the differences, a new quality index (QI) was introduced, as a measure of the planning target volume (PTV) coverage and homogeneity. A conformity function (CF) was defined to estimate normal tissue sparing. RESULTS: The QI for VMAT amounts to 36.3, whereas for IMRT the mean value is 66.5, indicating better PTV coverage as well as less overdosage for the rotational technique. While the sparing of organs at risk (OAR) was similar for both techniques, the CF shows a significantly better sparing of healthy tissue for all doses with VMAT treatment. CONCLUSIONS: VMAT results in dose distributions for H&N patients that are at least comparable with treatments performed with step-and-shoot IMRT. Two new tools to quantify the quality of dose distributions are presented and have proven to be useful.

Quality assurance for clinical studies in regional deep hyperthermia.

BACKGROUND: A guideline is provided for the implementation of regional deep hyperthermia treatments under strict rules of quality assurance. The objective is to guarantee a comparable and comprehensible method in the treatment and scientific analysis of hyperthermia. The guideline describes regional deep hyperthermia (RHT) and MR-controlled partial body hyperthermia (PBH) of children, young and adult patients. According to this guideline, hyperthermia treatment is always applied in combination with chemotherapy and/or radiotherapy. METHODS: The guideline is based on practical experience from several hyperthermia centers. The procedure allows applying jointly coordinated standards and quality control in hyperthermia for studies. RESULTS: The guideline contains recommendations for hyperthermia treatments, including indication, preparation, treatment, and standardized analysis.

[Department and patient management in radiotherapy. The Freiburg model]. / Abteilungs- und Patientenmanagement in der Strahlenheilkunde. Das Freiburger Modell.

BACKGROUND AND PURPOSE: The activities in radiotherapy are mainly affected by numerous partly very complex operational procedures which have to be completed while high safety requirements have to be fulfilled. This fact and steadily increasing economic pressure are forcing us to develop new strategies which help us to optimize our operational procedures and assure their reliability. As there are not so many radiotherapeutic institutions and the main focus, up to now, was mainly stressed on the acceleration systems (radiation planning, acceleration control), only few industrial systems are available which could also support the economic, organizational and administrative needs of radiotherapy. METHODS: During the building operations for the "new clinic for radiotherapy" at the University Hospital Freiburg, Germany, the staff of the clinical and administrative information and the medical physicists developed, in close cooperation with the physicians, a comprehensive concept to control and organize a radiotherapeutic institution. This concept was examined during the construction phase of the new clinic and the adjoined HBFG ("Hochschulbauförderungsgesetz") process by the "Deutsche Forschungsgemeinschaft" and financed totally by federal funds. RESULTS AND CONCLUSION: The precondition for the goal to operate a homogeneous and comprehensive management of a clinic for radiotherapy was the direct connection of the acceleration area with the organizational/administrative surrounding. The thus developed common basic dates and consistence created transparency and allowed us for the first time to control all operational procedures by EDV-technical means. After 2 years full-time operation and implementation of numerous particular projects we are now ready for film- and paperless digital work.

Long-term results after intraoperative radiation therapy for gastric cancer.

PURPOSE: We retrospectively analyzed the impact of intraoperative radiation therapy (IORT) on long-term survival in patients with resectable gastric cancer. METHODS AND MATERIALS: From 1991 to 2001, a total of 84 patients with gastric neoplasms underwent gastectomy or subtotal resection with IORT (23 Gy, 6-15 MeV; IORT-positive [IORT(+)] group). Patients with a history of additional neoadjuvant chemotherapy, histologically confirmed R1 or R2 resection, or reoperation with curative intention after local recurrence were excluded from further analysis. The remaining 61 patients were retrospectively matched with 61 patients without IORT (IORT-negative [IORT(-)] group) for Union Internationale Contre le Cancer (UICC) stage, patient age, histologic grading, extent of surgery, and level of lymph node dissection. Subgroups included postoperative UICC Stages I (n = 31), II (n = 11), III (n = 14), and IV (n = 5). RESULTS: Mean follow-up was 4.8 years in the IORT(+) group and 5.0 years in the IORT(-) group. The overall 5-year patient survival rate was 58% in the IORT(+) group vs. 59% in the IORT(-) group (p = 0.99). Subgroup analysis showed no impact of IORT on 5-year patient survival for those with UICC Stages I/II (76% vs. 80%; p = 0.87) and III/IV (21% vs. 14%, IORT(+) vs. IORT(-) group; p = 0.30). Perioperative mortality rates were 4.9% and 4.9% in the IORT(+) vs. IORT(-) group. Total surgical complications were more common in the IORT(+) than IORT(-) group (44.3% vs. 19.7%; p < 0.05). The locoregional tumor recurrence rate was 9.8% in the IORT(+) group. CONCLUSIONS: Use of IORT was associated with low locoregional tumor recurrence, but had no benefit on long-term survival while significantly increasing surgical morbidity in patients with curable gastric cancer.

Effect of demineralization and remineralization on microhardness of irradiated dentin.

The aim of this in vitro study was to evaluate the effects of irradiation and fluoridation on the demineralization and remineralization patterns of root dentin. From the cervical regions of 84 bovine incisors, each of four dentinal blocks were prepared and randomly assigned to four groups: 1) no irradiation; 2) irradiation of specimens up to 60 Gy (2 Gy/d, 5 d/w); 3) no irradiation, but fluoridation of specimens for 5 min/d with Elmex Gelée; and 4) irradiation and daily fluoridation of specimens for 5 min/d. Subsequently, the specimens were demineralized for 2, 4, 6 or 8 days with acidulated hydroxyethylcellulose (n = 21), and Knoop hardness numbers (KHN) were determined before, as well as after the demineralization period. Then seven specimens from each group were fluoridated with one of three fluoride gels (Elmex Gelée [1.25%], STOP [0.4%], Fluoridgel [1.25%]; 2 x 15 min/d, 10 d), and immersed in synthetic saliva at a temperature of 37 degrees C. Finally, KHN for all specimens were determined. Irradiation resulted in a significant decrease in microhardness. There was a reduction in microhardness with increasing demineralization time in all groups. The highest percentage decrease in microhardness could be observed with group 1. Due to the preceding decrease of KHN in the irradiated specimens (group 2), these samples showed less percentage reduction in microhardness during demineralization when compared to group 1 (ANOVA; p < 0.001). The decrease in microhardness was significantly hampered by fluoridation in the non-irradiated, as well as in the irradiated samples (groups 3 and 4; p < 0.001). The remineralization with Fluoridgel resulted in the greatest increase in microhardness. It is concluded that demineralization can be hampered by regular fluoride application in irradiated dentin. However, due to the considerable irradiation effect, this benefit might be negligible.