Shirish K. Jani

Leakage radiation from electron applicators on a medical accelerator

The leakage characteristics of electron applicators on our Clinac 2500 linear accelerator have been measured. The leakage radiation in the patient plane and at the surface of the electron applicators has been measured for applicator sizes from 6 cm×6 cm to 25 cm×25 cm and beam energies from 6 to 22 MeV. For certain applicator/energy combinations the leakage radiation was significant. The leakage radiation, relative to the central axis dose, was found to be up to 7% in the patient plane and up to 39% at the applicator surface. Reducing the collimator setting or adding lead at select locations on the applicator surface was effective in reducing the magnitude of the radiation leakage.

Brachytherapy for Malignant Recurrent and Untreated Gliomas

Twelve consecutive patients with recurrent malignant glioma were treated with brachytherapy. Thereafter, a prospective randomized study involving 35 patients was undertaken. Although additional study is necessary, preliminary recommendation calls for treatment at diagnosis rather than at recurrence.

Effect of Collimator Setting on the Output of Rectangular Fields from Linear Accelerators

The output (cGy/mu) of a rectangular field from a linear accelerator is not always the same as that of its equivalent square field. We have summarized output variations with upper and lower collimator setting for 4, 6, and 24 MV X-rays. It is concluded that an error in output on the order of a few percent is introduced for elongated fields if lower set of collimator jaws is used for setting the longer dimension of the field, and computing the output using equivalent square method. It is recommended that specific guidelines be developed regarding rectangular field setting on high energy linacs.

Megavoltage radiation field matching on uneven surface

Large radiation fields adjacent to each other require proper field matching to avoid overdosage at their junction. Various methods of determining optimum field separation have been discussed in the literature. However, these methods consider a perfectly flat surface of incidence throughout the irradiated area. In reality, it is more common for the patient thickness to vary within large fields, thus creating an uneven surface of incidence. In this paper, we have discussed the approach to gap calculation for an uneven surface of incidence. Dose measurements were made at the junction of two fields for 60Co, and 4, 6, and 24 MV X ray beams to verify this approach. Beam profiles measured under uneven surfaces indicated that the 50 percent dose decrement line did not shift towards the central axis for frequently encountered variations in patient thickness. Thus, careful geometric considerations could provide an optimum field separation. Ignoring the surface inhomogeneity may lead to field overlap and overdose at the junction.

Choice of Radioisotope in Stereotactic Interstitial Radiotherapy of Small Brain Tumors

In stereotactic interstitial radiotherapy, small radioactive sources are placed within the brain tumor to deliver locally high radiation doses. The choice of the radioisotope depends upon the dose distribution around the isotope, energy of the emitted radiation, relative biological effectiveness, and finally, the cost and availability of the isotope. We have analyzed 198gold, 125iodine and 192iridium in terms of these four factors. Our results have shown that 125I is superior to the other two isotopes due to its soft X-rays and dosimetric as well as radiobiological properties. Unfortunately, it is the most expensive of these radioisotopes, and can be difficult to obtain in specific activities.

Interstitial Radiation in Recurrent Malignant Gliomas

Twelve patients with recurrent supratentorial gliomas were treated with implanted 125I seeds. The interval from initial surgery to interstitial radiation ranged from 3 months to 9 years. The techniques for brachytherapy included volume implantation by craniotomy in one, stereotactic implantation with low-activity seeds in 7 and high-activity seeds in 4 patients. The total dose received ranged from 5,500 to 27,000 cGy. CT scans performed sequentially on all patients showed progressive attenuation in areas previously enhancing, suggestive of tumor necrosis produced by the interstitial sources. The mean and median survival of these patients was 23 and 22 weeks, with the 4 most recent patients still alive.

Dosimetric aspects of a rotating beam splitter used in tangential field breast treatment

A rotating beam splitter was designed and fabricated for use in treating tangential breast fields on an AECL Theratron-80 cobalt teletherapy unit. Its dosimetric properties were studied using a 0.6-cm3 Baldwin-Farmer ionization chamber with Keithley electrometer and a Scanditronix RFA-3 three-dimensional water phantom scanner with semiconductor detector. An aluminum plate, which held the semicircular rotating 5-HVL (half-value layer) lead block, extended to the phantom surface (80-cm source-surface distance). The beam was blocked directly along the central axis and also at distances up to 7.5 mm off-axis, corresponding to the projected extent of the 1.5-cm-diam source. The penumbra at the central ray and at each off-axis point was measured at dmax and at 5-cm depth in water. A reduction in the penumbra from 8 to about 2 mm for 20 X 20 cm2 beam was observed regardless of the off-axis distance of the block. Isodose distributions obtained for various field sizes indicated that the percent depth doses of the split fields agree well with the equivalent squares of the irradiated field sizes. Output measurements in water and in air indicated that scatter from the aluminum plate more than compensates for the reduction in backscatter factor, due to the decrease in irradiated area when the beam splitter is used. Isodose curves in various planes were obtained at clinically useful rotational angles of the beam splitter. Computer generated isodose curves have been obtained that match the measured curves to be used in treatment planning.

Normal Brain Irradiation during Stereotactic Brain Implants Using Radioactive Iodine-125

Stereotactic interstitial brain implants deliver locally high radiation doses to treat malignant gliomas. Dose to the surrounding normal brain from an 125I implant has been compared with the dose from an external irradiation technique. Results show that an implant offers a higher dose gradient around the tumor and hence a lower dose to the normal brain. Moreover, some irregular-shaped tumors, while ideal for a stereotactic implant, may be very difficult to treat with external beams without delivering a significant radiation dose to the normal brain. An implant seems to be dosimetrically superior to external irradiation for delivering large tumor doses.