Edwin C. McCullough

Photon attenuation in computed tomography.

The analysis and understanding of results of computed tomography (CT) require an understanding of photon attenuation in matter. The high sensitivity and resolution of these devices coupled with the use of a polychromatic photon source require a level and breadth of understanding about photon attenuation not usually required in any particular subspecialty of radiological physics. With this goal in mind, a discussion of narrow-beam photon attenuation in matter is given and related to those problems currently underway in the field of computed tomography. Measurements and calculations of tissue properties are presented. Calculations of descriptive quantities relevant to polychromatic source attenuation and CT scanning are described and presented.

A dual source photon beam model used in convolution/superposition dose calculations for clinical megavoltage x‐ray beams

A realistic model of photon beams generated by clinical linear accelerators has been incorporated in a convolution/superposition method to compute dose distributions in photon treatment fields. In this beam model, a primary photon source represents photons directly from the target, and an extra-focal photon source represents scattered photons from the primary collimator and the flattening filter. Monte Carlo simulation was used to study clinical linear accelerators producing photon beams. From the output of the Monte Carlo simulation, the fluence and spectral distributions of each photon component, as well as the geometrical characteristics of each photon source with respect to its distance to the isocenter and its source distribution, were analyzed. These quantities were used to reproduce realistic photon distributions in treatment fields, and thus to compute dose distributions using the convolution method. Our results showed that compared to the primary photon fluence, the extra-focal photon fluence from the primary collimator and the flattening filter was 11%-16% at the isocenter, among which 70% was contributed by the flattening filter. The variation of extra-focal photons in different treatment fields was predicted accurately by accounting for the finite size of the extra-focal source. Compared to measurements, dose distributions in photon treatment fields, including those of asymmetric jaw settings and at different SSDs were calculated accurately, particularly in the penumbral region, by using the convolution method with the new dual source photon beam model.

The use of a radiochromic detector for the determination of stereotactic radiosurgery dose characteristicsa)

The measurement of absorbed dose as well as dose distributions (profiles and isodose curves) for small radiation fields (as encountered in stereotactic surgery) has been difficult due to the usual large detector size or densitometer aperture (> 1 mm) relative to the radiation field (as small as 4 mm). The radiochromic direct-imaging film, when read with a scanning laser microdensitometer (laser beam diameter 0.1 mm), overcomes this difficulty and has advantages over conventional film in providing improved precision, better tissue equivalence, greater dynamic range, higher spatial resolution, and room light handling. As a demonstration of suitability, the calibrated radiochromic film has been used to measure the dose characteristics for the 18-, 14-, 8-, and 4-mm fields from the gamma-ray stereotactic surgery units at Mayo Clinic and the University of Pittsburgh. Intercomparisons of radiochromic film with conventional methods of dosimetry and vendor-supplied computational dose planning system values indicate agreement to within +/- 2%. The dose, dose profiles, and isodose curves obtained with radiochromic film can provide high-spatial-resolution information of value for acceptance testing and quality control of dose measurement and/or calculation.

Patient Dosage in Computed Tomography

The maximum surface dosage in most clinical CT scans seems to range from 2–10 rads/study but much larger dose per study values seem possible with both rotate-translate and rotary geometry designs. The CT scanner type in itself does not significantly reduce doses. Secondary radiation dose values were measured for critical organs and indicate that dosage from secondary radiations may be reduced significantly by external shielding. Dose values in the vicinity of most CT scanners are typically 1–2 mrad/scan at 1 meter at the parameters of a typical clinical scan.The maximum surface dosage in most clinical CT scans seems to range from 2-10 rads/study but much larger dose per study values seem possible with both rotate-translate and rotary geometry designs. The CT scanner type in itself does not significantly reduce doses. Secondary radiation dose values were measured for critical organs and indicate that dosage from secondary radiations may be reduced significantly by external shielding. Dose values in the vicinity of most CT scanners are typically 1-2 mrad/scan at 1 meter at the parameters of a typical clinical scan.

The Use of CT Scanners in Megavoltage Photon-Beam Therapy Planning

Several problems related to the true value of quantitative information from CT scanners in improving estimates of photon-beam isodose distribution remain unanswered. The authors conclude that two widely used correction factors provide satisfactory isodose corrections behind heterogeneities of simple geometry. Lateral perturbations were found to be small for megavoltage photon beams, indicating that complex computational schemes are uncalled for. It appears doubtful that the use of CT information in megavoltage photon-beam isodose curve generation requires (a) larger computers than those currently available either in existing therapy planning systems or on the scanner itself or (b) direct access to the CT numbers.

Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the Radiation Therapy Committee, American Association of Physicists in Medicine.

Intraoperative radiation therapy (IORT) is a treatment modality whereby a large single dose of radiation is delivered to a surgically open, exposed cancer site. Typically, a beam of megavoltage electrons is directed at an exposed tumor or tumor bed through a specially designed applicator system. In the last few years, IORT facilities have proliferated around the world. The IORT technique and the applicator systems used at these facilities vary greatly in sophistication and design philosophy. The IORT beam characteristics vary for different designs of applicator systems. It is necessary to document the existing techniques of IORT, to detail the dosimetry data required for accurate delivery of the prescribed dose, and to have a uniform method of dose specification for cooperative clinical trials. The specific charge to the task group includes the following: (a) identify the multidisciplinary IORT team, (b) outline special considerations that must be addressed by an IORT program, (c) review currently available IORT techniques, (d) describe dosimetric measurements necessary for accurate delivery of prescribed dose, (e) describe dosimetric measurements necessary in documenting doses to the surrounding normal tissues, (f) recommend quality assurance procedures for IORT, (g) review methods of treatment documentation and verification, and (h) recommend methods of dose specification and recording for cooperative clinical trials.

Performance Evaluation and Quality Assurance of Computed Tomography Scanners, with Illustrations from the EMI, ACTA, and Delta Scanners

Performance evaluation of equipment for computed tomography (CT) involves the integration of: (a) establishing performance criteria; (b) designing and implementing test procedures; and (c) reconciling test results in terms of desired performance. Precision (noise), contrast scale, linearity, accuracy, spatial independence, spatial resolution, artifacts, reproducible performance, and patient exposure are several parameters discussed, as are problems of measurement with regard to non-water bath scanners. Performance and quality control tests for the ACTA, Delta, and EMI scanners are outlined. Guidance for the prospective purchaser of CT equipment is presented as a summary of the ideas discussed.

Calculating output factors for photon beam radiotherapy using a convolution/superposition method based on a dual source photon beam model

A realistic photon beam model based on Monte Carlo simulation of clinical linear accelerators was implemented in a convolution/superposition dose calculation algorithm. A primary and an extra-focal sources were used in this beam model to represent the direct photons from the target and the scattered photons from other head structures, respectively. The effect of the finite size of the extra-focal source was modeled by a convolution of the source fluence distribution with the collimator aperture function. Relative photon output in air (Sc) and in phantom (Scp) were computed using the convolution method with this new photon beam model. Our results showed that in a 10 MV photon beam, the Sc, Sp (phantom scatter factor), and Scp factors increased by 11%, 10%, and 22%, respectively, as the field size changed from 3 x 3 cm2 to 40 x 40 cm2. The variation of the Sc factor was contributed mostly by an increase of the extra-focal radiation with field size. The radiation backscattered into the monitor chamber inside the accelerator head affected the Sc by about 2% in the same field range. The output factors in elongated fields, asymmetric fields, and blocked fields were also investigated in this study. Our results showed that if the effect of the backscattered radiation was taken into account, output factors in these treatment fields can be predicted accurately by our convolution algorithm using the dual source photon beam model.

Acceptance testing computerized radiation therapy treatment planning systems: direct utilization of CT scan data.

The availability of computerized radiation therapy treatment planning systems that utilize computed tomography (CT) scan data requires testing additional to that routinely needed for non-CT systems. These additional items include dimensioning verification, establishing CT number-to-tissue property conversions, verifying the accuracy of heterogeneity corrected dose predictions and autocontouring. One testing protocol is presented and sample results from an Atomic Energy of Canada Theraplan L system are presented.

Modeling photon output caused by backscattered radiation into the monitor chamber from collimator jaws using a Monte Carlo technique

Dose per monitor unit in photon fields generated by clinical linear accelerators can be affected by the backscattered radiation into the monitor chamber from collimator jaws. Thus, it is necessary to account for the backscattered radiation in computing monitor unit setting for a treatment field. In this work, we investigated effects of the backscatter from collimator jaws based on Monte Carlo simulations of a clinical linear accelerator. The backscattered radiation scored within the monitor chamber was identified as originating either from the upper jaws (Y jaws), or from the lower jaws (X jaws). From the results of Monte Carlo simulations, ratios of the monitor-chamber-scored dose caused by the backscatter to the dose caused by the forward radiation, R(x,y), were modeled as functions of the individual X and Y jaw positions. The amount of the backscattered radiation for any field setting was then computed as a compound contribution from both the X and Y jaws. The dose ratios of R(x,y) were then used to calculate the change in photon output caused by the backscatter, Scb(x,y). Results of these calculations were compared with available measured data based on counting the electron pulses or charge from the electron target of an accelerator. Data from this study showed that the backscattered radiation contributes approximately 3% to the monitor-chamber-scored dose. A majority of the backscattered radiation comes from the upper jaws, which are located closer to the monitor chamber. The amount of the backscatter decreases approximately in a linear fashion with the jaw opening. This results in about a 2% increase of photon output from a 10 cm x 10 cm field to a 40 cm x 40 cm field. The off-axis location of the jaw opening does not have a significant effect on the magnitude of the backscatter. The backscatter effect is significant for monitor chambers using kapton windows, particularly for treatment fields using moving jaws. Applying the backscatter correction improves the accuracy of monitor-unit calculation using a model-based dose calculation algorithm such as the convolution method.