S Cora

Total scatter factors of small beams: A multidetector and Monte Carlo study

The scope of this study was to estimate total scatter factors (S(c,p)) of the three smallest collimators of the Cyberknife radiosurgery system (5-10 mm in diameter), combining experimental measurements and Monte Carlo simulation. Two microchambers, a diode, and a diamond detector were used to collect experimental data. The treatment head and the detectors were simulated by means of a Monte Carlo code in order to calculate correction factors for the detectors and to estimate total scatter factors by means of a consistency check between measurement and simulation. Results for the three collimators were: S(c,p) (5 mm) = 0.677 +/- 0.004, S(c,p) (7.5 mm) = 0.820 +/- 0.008, S(c,p) (10 mm) = 0.871 +/- 0.008, all relative to the 60 mm collimator at 80 cm source-to-detector distance. The method also allows the full width at half maximum of the electron beam to be estimated; estimations made with different collimators and different detectors were in excellent agreement and gave a value of 2.1 mm. Correction factors to be applied to the detectors for the measurement of S(c,p) were consistent with a prevalence of volume effect for the microchambers and the diamond and a prevalence of scattering from high-Z material for the diode detector. The proposed method is more sensitive to small variations of the electron beam diameter with respect to the conventional method used to commission Monte Carlo codes, i.e., by comparison with measured percentage depth doses (PDD) and beam profiles. This is especially important for small fields (less than 10 mm diameter), for which measurements of PDD and profiles are strongly affected by the type of detector used. Moreover, this method should allow S(c,p) of Cyberknife systems different from the unit under investigation to be estimated without the need for further Monte Carlo calculation, provided that one of the microchambers or the diode detector of the type used in this study are employed. The results for the diamond are applicable only to the specific detector that was investigated due to excessive variability in manufacturing.

Use of a new type of radiochromic film, a new parallel-plate micro-chamber, MOSFETs, and TLD 800 microcubes in the dosimetry of small beams

The dosimetry of the fields usually employed in radiosurgery requires the use of small detectors to measure Total Scatter Factor (Sc,p), Tissue Maximum Ratio (TMR), Percentage Depth Dose (PDD), and Off Axis Ratio (OAR). In this paper new dosimeters are investigated: a new type of radiochromic film, a micro parallel-plate chamber (filled with both air and tetramethylsilane, TMS), MOSFETs, and TLD-800 microcubes. Their behavior has been compared with the response of radiographic film and with the values obtained with BEAM Monte Carlo simulation. The experimental data confirm that dosimetry with radiochromic films and TLDs gives consistent results for all beam diameters. The parallel-plate micro chamber underestimates the Sc,p for the smallest field diameters (4.4 mm and 6.7 mm); MOSFETs show an over-estimation for the Sc,p of the 4.4 mm, 6.7 mm, and 10.5 mm field diameters. BEAM Monte Carlo simulation employing a parallel beam and a standard 6 MV x-ray spectrum has been used to obtain a correction factor as a function of the field size for both the parallel-plate micro chamber and MOSFETs. High accuracy measurements of PDD and TMR have been made in a water phantom both with radiochromic film and with the micro parallel-plate chamber and have been compared with the data computed by BEAM Monte Carlo simulation. The latter dosimeter is preferred because of the quicker and simpler use and because it gives immediate readout. Measurements of OAR made with radiochromic films and with radiographic films give differences in the 80%-20% penumbra width within 0.6 mm for field diameters ranging from 4.4 mm to 19 mm.

Calculation of kQclin,Qmsrfclin,fmsr for several small detectors and for two linear accelerators using Monte Carlo simulations

PURPOSE The scope of this study was to determine a complete set of correction factors for several detectors in static small photon fields for two linear accelerators (linacs) and for several detectors. METHODS Measurements for Monte Carlo (MC) commissioning were performed for two linacs, Siemens Primus and Elekta Synergy. After having determined the source parameters that best fit the measurements of field specific output factors, profiles, and tissue-phantom ratio, the generalized version of the classical beam quality correction factor for static small fields, k(Q(clin),Q(msr) ) (f(clin),f(msr) ), were determined for several types of detectors by using the egs_chamber Monte Carlo user code which can accurately reproduce the geometry and the material composition of the detector. The influence of many parameters (energy and radial FWHM of the electron beam source, field dimensions, type of accelerator) on the value of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) was evaluated. Moreover, a MC analysis of the parameters that influence the change of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) as a function of field dimension was performed. A detailed analysis of uncertainties related to the measurements of the field specific output factor and to the Monte Carlo calculation of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) was done. RESULTS The simulations demonstrated that the correction factor k(Q(clin),Q(msr) ) (f(clin),f(msr) ) can be considered independent from the quality beam factor Q in the range 0.68  ±  0.01 for all the detectors analyzed. The k(Q(clin),Q(msr) ) (f(clin),f(msr) ) of PTW 60012 and EDGE diodes can be assumed dependent only on the field size, for fields down to 0.5 × 0.5 cm². The microLion, and the microchambers, instead, must be used with some caution because they exhibit a slight dependence on the radial FWHM of the electron source, and therefore, a correction factor only dependent on field size can be used for fields ≥ 0.75 × 0.75 and ≥ 1.0 × 1.0 cm², respectively. The analysis of uncertainties gave an estimate of uncertainty for the 0.5 × 0.5 cm² field of about 0.7% (1σ) for k(Q(clin),Q(msr) ) (f(clin),f(msr) ) factor and of about 1.0% (1σ) for the field output factor, Ω(Q(clin),Q(msr) ) (f(clin),f(msr) ), of diodes, microchambers, and microLion. CONCLUSIONS Stereotactic diodes with the appropriate k(Q(clin),Q(msr) ) (f(clin),f(msr) ) are recommended for determining Ω(Q(clin),Q(msr) ) (f(clin),f(msr) ) of small photon beams.

CYBERKNIFE RADIOSURGERY FOR BENIGN MENINGIOMAS : SHORT-TERM RESULTS IN 199 PATIENTS

OBJECTIVETo present initial, short-term results obtained with an image-guided radiosurgery apparatus (CyberKnife; Accuray, Inc., Sunnyvale, CA) in a series of 199 benign intracranial meningiomas. METHODSSelection criteria included lesions unsuitable for surgery and/or remnants after partial surgical removal. All patients were either symptomatic and/or harboring growing tumors. Ninety-nine tumors involved the cavernous sinus; 28 were in the posterior fossa, petrous bone, or clivus; and 29 were in contact with anterior optic pathways. Twenty-two tumors involved the convexity, and 21 involved the falx or tentorium. One hundred fourteen patients had undergone some kind of surgical removal before radiosurgery. Tumor volumes varied from 0.1 to 64 mL (mean, 7.5 mL) and radiation doses ranged from 12 to 25 Gy (mean, 18.5 Gy). Treatment isodoses varied from 70 to 90%. In 150 patients with lesions larger than 8 mL and/or with tumors situated close to critical structures, the dose was delivered in 2 to 5 daily fractions. RESULTSThe follow-up periods ranged from 1 to 59 months (mean, 30 months; median, 30 months). The tumor volume decreased in 36 patients, was unchanged in 148 patients, and increased in 7 patients. Three patients underwent repeated radiosurgery, and 4 underwent operations. One hundred fifty-four patients were clinically stable. In 30 patients, a significant improvement of clinical symptoms was obtained. In 7 patients, neurological deterioration was observed (new cranial deficits in 2, worsened diplopia in 2, visual field reduction in 2, and worsened headache in 2). CONCLUSIONThe introduction of the CyberKnife extended the indication to 63 patients (>30%) who could not have been treated by single-session radiosurgical techniques. The procedure proved to be safe. Clinical improvement seems to be more frequently observed with the CyberKnife than in our previous linear accelerator experience.OBJECTIVE To present initial, short-term results obtained with an image-guided radiosurgery apparatus (CyberKnife; Accuray, Inc., Sunnyvale, CA) in a series of 199 benign intracranial meningiomas. METHODS Selection criteria included lesions unsuitable for surgery and/or remnants after partial surgical removal. All patients were either symptomatic and/or harboring growing tumors. Ninety-nine tumors involved the cavernous sinus; 28 were in the posterior fossa, petrous bone, or clivus; and 29 were in contact with anterior optic pathways. Twenty-two tumors involved the convexity, and 21 involved the falx or tentorium. One hundred fourteen patients had undergone some kind of surgical removal before radiosurgery. Tumor volumes varied from 0.1 to 64 mL (mean, 7.5 mL) and radiation doses ranged from 12 to 25 Gy (mean, 18.5 Gy). Treatment isodoses varied from 70 to 90%. In 150 patients with lesions larger than 8 mL and/or with tumors situated close to critical structures, the dose was delivered in 2 to 5 daily fractions. RESULTS The follow-up periods ranged from 1 to 59 months (mean, 30 months; median, 30 months). The tumor volume decreased in 36 patients, was unchanged in 148 patients, and increased in 7 patients. Three patients underwent repeated radiosurgery, and 4 underwent operations. One hundred fifty-four patients were clinically stable. In 30 patients, a significant improvement of clinical symptoms was obtained. In 7 patients, neurological deterioration was observed (new cranial deficits in 2, worsened diplopia in 2, visual field reduction in 2, and worsened headache in 2). CONCLUSION The introduction of the CyberKnife extended the indication to 63 patients (>30%) who could not have been treated by single-session radiosurgical techniques. The procedure proved to be safe. Clinical improvement seems to be more frequently observed with the CyberKnife than in our previous linear accelerator experience.

Photon dose calculation of a three-dimensional treatment planning system compared to the Monte Carlo code BEAM.

The purpose of this work is to compare the photon dose calculation of a commercially available three-dimensional (3D) treatment planning system based on the collapsed cone convolution technique against BEAM, a Monte Carlo code that allows detailed simulation of a radiotherapy accelerator. The first part of the work is devoted to the commissioning of BEAM for a 6 MV photon beam and to the optimization of the linac description to fit the experimental data. This step also involves a comparison with radiochromic film data on an inhomogeneous phantom built to simulate electronic nonequilibrium conditions. Commissioning the selected photon beams required a careful description of the treatment head and the fine tuning of physical parameters such as electron beam energy and radius. The second part shows the dose comparison for real patients CT data sets: A mediastinal treatment and a breast treatment were simulated. Doses in terms of absolute values per monitor unit were calculated based on the BEAM simulation of the CT data sets. For comparisons of real-patient cases, differences between the treatment planning system and BEAM ranged from 0 to 2.6% and were within +/-2 standard deviations for the dose calculated at the prescription point. Dose-volume histogram analysis indicated that there is no consistent difference between the Monte Carlo and the convolution calculations. On the basis of the results presented in this study, we can conclude that the CCC algorithm is capable of giving results absolutely comparable to those of a Monte Carlo calculation, as far as common 3D radiotherapy planning is concerned.

Use of motion tracking in stereotactic body radiotherapy: Evaluation of uncertainty in off-target dose distribution and optimization strategies

Spatial accuracy in extracranial radiosurgery is affected by organ motion. Motion tracking systems may be able to avoid PTV enlargement while preserving treatment times, however special attention is needed when fiducial markers are used to identify the target can move with respect to organs at risk (OARs). Ten patients treated by means of the Synchrony system were taken into account. Sparing of irradiated volume and of complication probability were estimated by calculating treatment plans with a motion tracking system (Cyberknife Synchrony, Sunnyvale, CA, USA) and a PTV-enlargement strategy for ten patients. Six patients were also evaluated for possible inaccuracy of estimation of dose to OARs due to relative movement between PTV and OAR during respiration. Dose volume histograms (DVH) and Equivalent Uniform Dose (EUD) were calculated for the organs at risk. In the cases for which the target moved closer to the OAR (three cases of six), a small but significant increase was detected in the DVH and EUD of the OAR. In three other cases no significant variation was detected. Mean reduction in PTV volume was 38% for liver cases, 44% for lung cases and 8.5% for pancreas cases. NTCP for liver reduced from 23.1 to 14.5% on average, for lung it reduced from 2.5 to 0.1% on average. Significant uncertainty may arise from the use of a motion-tracking device in determination of dose to organs at risk due to the relative motion between PTV and OAR. However, it is possible to limit this uncertainty. The breathing phase in which the OAR is closer to the PTV should be selected for planning. A full understanding of the dose distribution would only be possible by means of a complete 4D-CT representation.

Calculation of for several small detectors and for two linear accelerators using Monte Carlo simulations

PURPOSE The scope of this study was to determine a complete set of correction factors for several detectors in static small photon fields for two linear accelerators (linacs) and for several detectors. METHODS Measurements for Monte Carlo (MC) commissioning were performed for two linacs, Siemens Primus and Elekta Synergy. After having determined the source parameters that best fit the measurements of field specific output factors, profiles, and tissue-phantom ratio, the generalized version of the classical beam quality correction factor for static small fields, k(Q(clin),Q(msr) ) (f(clin),f(msr) ), were determined for several types of detectors by using the egs_chamber Monte Carlo user code which can accurately reproduce the geometry and the material composition of the detector. The influence of many parameters (energy and radial FWHM of the electron beam source, field dimensions, type of accelerator) on the value of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) was evaluated. Moreover, a MC analysis of the parameters that influence the change of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) as a function of field dimension was performed. A detailed analysis of uncertainties related to the measurements of the field specific output factor and to the Monte Carlo calculation of k(Q(clin),Q(msr) ) (f(clin),f(msr) ) was done. RESULTS The simulations demonstrated that the correction factor k(Q(clin),Q(msr) ) (f(clin),f(msr) ) can be considered independent from the quality beam factor Q in the range 0.68  ±  0.01 for all the detectors analyzed. The k(Q(clin),Q(msr) ) (f(clin),f(msr) ) of PTW 60012 and EDGE diodes can be assumed dependent only on the field size, for fields down to 0.5 × 0.5 cm². The microLion, and the microchambers, instead, must be used with some caution because they exhibit a slight dependence on the radial FWHM of the electron source, and therefore, a correction factor only dependent on field size can be used for fields ≥ 0.75 × 0.75 and ≥ 1.0 × 1.0 cm², respectively. The analysis of uncertainties gave an estimate of uncertainty for the 0.5 × 0.5 cm² field of about 0.7% (1σ) for k(Q(clin),Q(msr) ) (f(clin),f(msr) ) factor and of about 1.0% (1σ) for the field output factor, Ω(Q(clin),Q(msr) ) (f(clin),f(msr) ), of diodes, microchambers, and microLion. CONCLUSIONS Stereotactic diodes with the appropriate k(Q(clin),Q(msr) ) (f(clin),f(msr) ) are recommended for determining Ω(Q(clin),Q(msr) ) (f(clin),f(msr) ) of small photon beams.

Application of a Monte Carlo‐based method for total scatter factors of small beams to new solid state micro‐detectors

The scope of this work was to apply a method for estimation of total scatter factors of the smallest beams of the Cyberknife radiosurgery system to newly available solid‐state detectors: the PTW 60008 diode, the SunNuclear EdgeDetector™ diode, and the Thomson and Nielsen TN502RDM micromosfet. The method is based on a consistency check between Monte Carlo simulation of the detectors and experimental results, and was described in a recent publication. Corrected total scatter factors were in excellent agreement with the findings of the former study. The results showed that the diodes tend to overestimate the total scatter factor of small beams, probably due to excessive scatter from the material surrounding the active layer. The correction factor for diodes and for the micromosfet, however, was found to be independent of the electron beam width. This is a desirable characteristic because it allows standard correction factors to be used for treatment units of the same type, without the need of case‐by‐case Monte Carlo simulation. PACS numbers: 87.55.kh; 87.55.ne; 87.56.Fc.

Stereotactic body radiation therapy for a new lung cancer arising after pneumonectomy: dosimetric evaluation and pulmonary toxicity

OBJECTIVE To evaluate the tolerance of stereotactic body radiation therapy (SBRT) for the treatment of secondary lung tumours in patients who underwent previous pneumonectomy. METHODS 12 patients were retrospectively analysed. The median maximum tumour diameter was 2.1 cm (1-4.5 cm). The median planning target volume was 20.7 cm(3) (2.4-101.2 cm(3)). Five patients were treated with a single fraction of 26 Gy and seven patients with fractionated schemes (3 × 10 Gy, 4 × 10 Gy, 4 × 12 Gy). Lung toxicity, correlated with volume (V) of lung receiving >5, >10 and >20 Gy, local control and survival rate were assessed. Median follow-up was 28 months. RESULTS None of the patients experienced pulmonary toxicity > grade 2 at the median dosimetric lung parameters of V5, V10 and V20 of 23.1% (range 10.7-56.7%), 7.3% (2.2-27.2%) and 2.7% (0.7-10.9%), respectively. No patients required oxygen or had deterioration of the performance status during follow-up if not as a result of clinical progression of disease. The local control probability at 2 years was 64.5%, and the overall survival at 2 years was 80%. CONCLUSION SBRT appears to be a safe and effective modality for treating patients with a second lung tumour after pneumonectomy. ADVANCES IN KNOWLEDGE Our results and similar literature results show that when keeping V5, V10 V20 <50%, <20% and <7%, respectively, the risk of significant lung toxicity is acceptable. Our experience also shows that biologically effective dose 10 >100 Gy, necessary for high local control rate, can be reached while complying with the dose constraints for most patients.

A simple method to verify in vivo the accuracy of target coordinates in linear accelerator radiosurgery

PURPOSE A simple method that verifies the coincidence of the isocenter with the center of the target volume in radiosurgery treatment conditions is described. The accuracy is compared to that of accepted computerized procedures employing fiducial markers. METHODS AND MATERIALS The center of the beam is identified by a cylindrical localizer, fixed to the plate of the supplemental collimator, with a 2 x 50 mm tungsten rod coincident with the beam axis and is projected onto the x-ray portal verification films. Prior to irradiation, the coordinates of the intersection of the beams axes, which is in a known spatial relationship with the isocenter, are read directly on portal x-ray films and their coincidence with the coordinates set during patient positioning, is checked. RESULTS The mean displacement in AP, Lat, and Vert coordinates respectively, over 84 patients, between the coordinates calculated by the computerized procedure employing fiducial markers and the coordinates calculated by using the rulers was 0.3 +/- 0.4 mm. CONCLUSIONS From the results obtained with the two methods we can conclude that rulers method can be used as a fast indirect control of the position of the radiation isocenter. Moreover, the dimensions of the radiation field and the correct alignment of the tertiary circular collimator can be also documented.