Peter Dunscombe

On the field‐size dependence of relative output from a linear accelerator

The radiation output in air on the central axis of a linac photon beam has been modeled as the sum of two components. These are a point source representing radiation direct from the target and a distributed source representing scatter in the flattening filter and primary collimator. By fitting only two parameters, the ratio of the two components for a 20 x 20 field and a width parameter for the distributed source this semi-empirical model describes the relative outputs of square, symmetric rectangular, and asymmetric rectangular fields with an average error of 0.25% for the field sizes studied.

A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients

PURPOSE To calculate cost-effectiveness and cost-utility ratios for adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients and to place these ratios in the context of generally accepted medical expenditures. MATERIALS AND METHODS A spreadsheet-based activity costing model using 1997 Canadian (cdn) capital, operating, and administrative costs has been used to identify, from the institutional perspective, the incremental cost of adding radiotherapy to surgery and chemotherapy for this group of patients. Outcome data were derived from two recently published clinical trials and were converted to discounted incremental life years and quality-adjusted life years gained. Recommended health economics principles were employed in the quantification of both costs and outcomes, and a sensitivity analysis was performed. Three referenced publications provide a context within which to evaluate the calculated cost-effectiveness and cost-utility ratios. RESULTS The incremental cost of adjuvant radiotherapy for this group of patients is calculated to be approximately

The investigation and rectification of field placement errors in the delivery of complex head and neck fields

7,000cdn in 1997 Canadian dollars and in the Canadian socialized health-care environment. Based on published work the discounted incremental outcome benefit is calculated to be 0.5 life years or 0.45 quality-adjusted life years at ten years. Thus, cost effectiveness and cost-utility ratios are estimated to be

A test tool for the visual verification of light and radiation fields using film or an electronic portal imaging device.

14,000cdn and

Segmented chamfer matching for the registration of field borders in radiotherapy images

15,600cdn, respectively. CONCLUSION Within the context of generally accepted medical expenditures, adjuvant postmastectomy locoregional radiotherapy for premenopausal node-positive breast cancer patients would be regarded as a cost-effective treatment strategy.

The Siemens Virtual Wedge

PURPOSE To evaluate a novel technique for resolving field placement errors into their components and to quantify the improvement in accuracy potentially achievable by translation and rotation of the radiation beam. METHODS AND MATERIALS One hundred and eighty-five films (both simulator and portal) from seventeen patients receiving radiotherapy to the head and neck region were analyzed in pairs. The computer based comparisons of complex fields with curved edges employed the intersections of perpendiculars from two reference points with the field periphery to define field match points. Field placement errors were resolved into those due to patient motion within the immobilization shell and those due to incorrect beam position, orientation, or shape. RESULTS The median and the 95 percentile of the distribution of differences between prescribed (simulator) fields and treated (portal) fields referenced to the patients anatomy were 4.4 mm and 8.9 mm, respectively. The analysis suggests that with appropriate translation and rotation of the beam with respect to the immobilization shell these figures could be reduced to 3.1 mm and 8.2 mm, respectively, confirming the large contribution of patient motion within the shell to field placement accuracy. Comparisons between treated fields indicated smaller variability during treatment than between simulation and treatment. CONCLUSION The perpendicular intersection method described here was found appropriate for the identification of field match points. The distributions of field placement errors were similar to those in a published study of straight edged fields. Translation and rotation of the applied field with respect to the immobilization shell would generally result in only a small improvement in field placement accuracy.

Independent corroboration of monitor unit calculations performed by a 3D computerized planning system

We describe the design and evaluation of a simple test tool which can be used in conjunction with either film or an electronic portal imaging device (EPID) to verify light and radiation fields and their congruence. The precision of the technique is better than 0.5 mm under all conditions tested. When used with film the accuracy or offset of the technique (the difference between test tool observations and a scanned conventional film) is better than 0.5 mm but, with an EPID as the image receptor, the accuracy dropped to, in one trial, 0.86 mm. The offset may be due to a systematic observer bias in determining the 50% O.D. level on the image, compounded, in the case of EPID measurements, by image acquisition and display parameters. Thus, when used with an EPID, calibration of the system will be required if absolute field dimensions are required. When used with film, the test tool method described here is of sufficient accuracy and precision to confirm the compliance of light and radiation field parameters with currently accepted quality control protocols.

An efficient approach to routine TL dosimetry

Optimum conformity between treated and prescribed radiotherapy fields is likely to be achieved when the full versatility of modern therapy equipment is reflected in the field registration method. To allow for independent jaws and custom shielding, chamfer matching has been used to register selected segments of field borders independently. In a study involving 50 clinical prescription-treatment field pairs it is shown that segmented chamfer matching is superior not only to conventional unsegmented chamfer matching but also to several other methods. An example of the clinical value of segmented chamfer matching applied to electronic portal images is given.

A technique for the evaluation of a missing tissue compensator system

A Siemens Virtual Wedge has recently been installed and commissioned at the Northeastern Ontario Regional Cancer Centre. Measurements reported below show that 1) Virtual Wedge factors are within 1.5% of 1; 2) percentage depth doses down to 15 cm for open and virtually wedged fields are identical to within 0.7%; 3) relative cross beam profiles for 60 degrees virtual and physical wedges are very similar except at the toe end where a 5% difference in relative dose has been observed and 4) the peripheral dose from the 60 degrees Virtual Wedge is about half of that from the 60 degrees physical wedge. A clinical protocol requiring combined open and 60 degrees wedged fields has been developed and validated. This protocol, which does not impair the utility of the Virtual Wedge, facilitates the use of on-line portal imaging and significantly reduces the effort required to commission the system.

Preventative maintenance and unscheduled downtime from an economic perspective

The checking of monitor unit calculations is recognized as a vital component of quality assurance in radiotherapy. Using straightforward but detailed computer‐based verification calculations it is possible to achieve a precision of 1% when compared with a three‐dimensional (3D) treatment planning system monitor unit calculation. The method is sufficiently sensitive to identify significant errors and is consistent with current recommendations on the magnitude of uncertainties in clinical dosimetry. Moreover, the approach is accurate in the sense of being highly consistent with the validated 3D treatment planning systems calculations. PACS number(s): 87.53.–j, 87.52.–g