The assessment of the clinical impact of using a single set of radiotherapy planning data for two kilovoltage therapy units.

Kilovoltage therapy units are used for superficial radiotherapy treatment delivery. Peer reviewed studies for MV linear accelerators describe tolerances to dosimetrically match multiple linear accelerators enabling patient treatment on any matched machine. There is an absence of literature on using a single planning data set for multiple kilovoltage units which have limited ability for beam adjustment. This study reviewed kilovoltage dosimetry and treatment planning scenarios to evaluate the feasibility of using ACPSEM annual QA tolerances to determine whether two units (of the same make and model) were dosimetrically matched. The dosimetric characteristics, such as measured half value layer (HVL), percentage depth dose (PDD), applicator factor and output variation with stand-off distance for each kV unit were compared to assess the agreement. Independent planning data based on the measured HVL for each beam energy from each kV unit was prepared. Monitor unit (MU) calculations were performed using both sets of planning data for approximately 200 clinical scenarios and compared with an overall agreement between units of < 2%. Additionally, a dosimetry measurement comparison was completed at each site for a subset of nine scenarios. All machine characterisation measurements were within the ACPSEM Annual QA tolerances, and dosimetric testing was within 2.5%. This work demonstrates that using a single set of planning data for two kilovoltage units is feasible, resulting in a clinical impact within published uncertainty.

Reducing shield thickness and backscattered radiation using a multilayered shield for 6­10 MeV electron beams.

Intraoral and external electron shields used in radiotherapy are designed to minimize radiation exposure to non-treatment tissue. Sites where shields are used include but are not limited to, the treatment of lips, cheeks and ears whilst shielding the underlying oral cavity, tongue, gingival or temporal region. A commonly known and published effect, concerns the enhancement in dose that can occur on the beam side on an electron shield caused by an increase in electron backscatter radiation. In this work a lead shield has been designed incorporating copper, aluminium and wax in a step down filter arrangement to minimise backscatter whilst minimizing overall shield thickness for better clinical setup and ease of use. For electron beams ranging from 6 to 10 MeV, a standard shield design of 4 mm lead, 0.6 mm copper, 1.0 mm aluminium and 1.5 mm wax (3.1 mm added filtration, 7.1 mm total thickness) provided adequate backscatter and transmission reduction to match a standard 4.5 mm lead and 10 mm wax (total thickness 14.5 mm) electron shield. Dose enhancement values of no more than 10 % were measured utilising this shield design with a 50 % reduction in shield thickness. The thinner shield will not only allow easier patient set up but should be tolerated better by patients when mucosal reactions occur as they place less physical pressure on these sites during treatment due to their smaller size.