Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumors.

PURPOSE: Setup accuracy is an important factor influencing the definition of the planning target volume (PTV). The purpose of this study was to compare the setup accuracy of three different thermoplastic masks used for immobilization of patients with brain or head and neck tumors. MATERIALS AND METHODS: Thirty patients with brain or head and neck tumors were consecutively assigned to one of three different thermoplastic masks (Posifix): head mask with three fixation points (3 FP, ten patients), head and shoulder mask with four fixation points (4 FP, ten patients), head and shoulder mask with five fixation points (5 FP, four fixations plus an additional one on the top of head, ten patients). Once a week, during the session with a 6 MV linac (Elekta), orthogonal (antero-posterior and lateral) portal images were acquired for three fictitious isocenters placed during the simulation at the level of the head, the neck and the shoulders. Portal images and digitized simulator films were compared using the PIPS pro software, and displacements in antero-posterior (A-P), cranio-caudal (C-C) and medio-lateral (M-L) directions were calculated. From these displacements, 2D or 3D errors were also calculated. RESULTS: A total of 915 portal images were obtained, of which 98% could be analyzed. For the whole population, total displacements reached a standard deviation (SD) of 2.2 mm at the level of the head and the neck. Systematic and random displacements were in the same order of magnitude and reached a SD of 1.8 mm. Patient setup was slightly worse at the shoulder level with a total displacement of 2.8 mm (1 SD) for both the C-C and the M-L directions. There again, the systematic and the random components were in the same order of magnitude below 2.4 mm (+/-SD). For isocenters in the head and in the neck, there was no substantial difference in the setup deviation between the three masks. The setup reproducibility was found to be significantly worse (P=0.01) at the level of the shoulders with the 3 FP mask. For the 2D random error, 1 SD of 2.3 mm was observed compared to 0.8 and 1.2 mm for the 4 and 5 FP masks, respectively. Lastly, 90% of the 3D total deviations were below 4.5 mm for the head and the neck. In the shoulder region, 90% of the 2D total deviations were below 5.5 mm. CONCLUSION: Thermoplastic masks provide an accurate patient immobilization. At the shoulder level, setup variations are reduced when 4 or 5 FP masks are used. These data could be used for the assessment of margins for the PTV.

Entrance and exit dose measurements with semiconductors and thermoluminescent dosemeters: a comparison of methods and in vivo results.

BACKGROUND AND PURPOSE: In order to compare diodes and TLD for in vivo dosimetry, systematic measurements of entrance and exit doses were performed with semiconductor detectors and thermoluminescent dosemeters for brain and head and neck patients treated isocentrically with external photon beam therapy. MATERIAL AND METHODS: Scanditronix EDP-20 diodes and 7LiF thermoluminescent chips, irradiated in a 8 MV linac, were studied with similar build-up cap geometries and materials in order to assure an equivalent electronic equilibrium. Identical calibration methodology was applied to both detectors for the dose determination in clinical conditions. RESULTS: For the entrance dose evaluation over 249 field measurements, the ratio of the measured dose to the expected dose, calculated from tabulated tissue maximum ratios, was equal to 1.010 +/- 0.028 (1 s.d.) from diodes and 1.013 +/- 0.041 from thermoluminescent crystals. For the exit dose measurements, these ratios were equal to 0.998 +/- 0.049 and 1.016 +/- 0.070 for diodes and TLDs, respectively, after application of a simple inhomogeneity correction to the calculation of the expected exit dose. CONCLUSIONS: Thermoluminescence and semiconductors led to identical results for entrance and exit dose evaluation but TLDs were characterised by a lower reproducibility inherent to the TL process itself and to the acquisition and annihilation procedures.

Response analysis of TLD-300 dosimeters in heavy-particle beams.

In vivo dosimetry is recommended as part of the quality control procedure for treatment verification in radiation therapy. Using thermoluminescence, such controls are planned in the p(65) + Be neutron and 85 MeV proton beams produced at the cyclotron at Louvain-La-Neuve and dedicated to therapy applications. A preliminary study of the peak 3 (150 degrees C) and peak 5 (250 degrees C) response of CaF2:Tm (TLD-300) to neutron and proton beams aimed to analyse the effect of different radiation qualities on the dosimetric behaviour of the detector irradiated in phantom. To broaden the range of investigation, the study was extended to an experimental 12C heavy ion beam (95 MeV/nucleon). The peak 3 and 5 sensitivities in the neutron beam, compared to 60Co, varied little with depth. A major change of peak 5 sensitivity was observed for samples positioned under five leaves of the multi-leaf collimator. While peak 3 sensitivity was constant with depth in the unmodulated proton beam, peak 5 sensitivity increased by 15%. Near the Bragg peak, peak 3 showed the highest decrease of sensitivity. In the modulated proton beam, the sensitivity values were not significantly smaller than those measured in the unmodulated beam far from the Bragg peak region. The ratio of the heights of peak 3 and peak 5 decreased by 70% from the 60Co reference radiation to the 12C heavy-ion beam. This parameter was strongly correlated with the change of radiation quality.