Dosimetric evaluation of lead and tungsten eye shields in electron beam treatment.

PURPOSE: The purpose of this study is to report that commercially available eye shields (designed for orthovoltage x-rays) are inadequate to protect the ocular structures from penetrating electrons for electron beam energies equal to or greater than 6 MeV. Therefore, a prototype medium size tungsten eye shield was designed and fabricated. The advantages of the tungsten eye shield over lead are discussed. METHODS AND MATERIALS: Electron beams (6-9 MeV) are often used to irradiate eyelid tumors to curative doses. Eye shields can be placed under the eyelids to protect the globe. Film and thermoluminescent dosimeters (TLDs) were used within a specially constructed polystyrene eye phantom to determine the effectiveness of various commercially available internal eye shields (designed for orthovoltage x-rays). The same procedures were used to evaluate a prototype medium size tungsten eye shield (2.8 mm thick), which was designed and fabricated for protection of the globe from penetrating electrons for electron beam energy equal to 9 MeV. A mini-TLD was used to measure the dose enhancement due to electrons backscattered off the tungsten eye shield, both with or without a dental acrylic coating that is required to reduce discomfort, permit sterilization of the shield, and reduce the dose contribution from backscattered electrons. RESULTS: Transmission of a 6 MeV electron beam through a 1.7 mm thick lead eye shield was found to be 50% on the surface (cornea) of the phantom and 27% at a depth of 6 mm (lens). The thickness of lead required to stop 6-9 MeV electron beams is impractical. In place of lead, a prototype medium size tungsten eye shield was made. For 6 to 9 MeV electrons, the doses measured on the surface (cornea) and at 6 mm (lens) and 21 mm (retina) depths were all less than 5% of the maximum dose of the open field (4 x 4 cm). Electrons backscattered off a tungsten eye shield without acrylic coating increased the lid dose from 85 to 123% at 6 MeV and 87 to 119% at 9 MeV. For the tungsten eye shield coated with 2-3 mm of dental acrylic, the lid dose was increased from 85 to 98.5% at 6 MeV and 86 to 106% at 9 MeV. CONCLUSION: Commercially available eye shields were evaluated and found to be clearly inadequate to protect the ocular structures for electron beam energies equal to or greater than 6 MeV. A tungsten eye shield has been found to provide adequate protection for electrons up to 9 MeV. The increase in lid dose due to electrons backscattered off the tungsten eye shield should be considered in the dose prescription. A minimum thickness of 2 mm dental acrylic on the beam entrance surface of the tungsten eye shield was found to reduce the backscattered electron effect to acceptable levels.

Whole-limb irradiation of the lower calf using a six-field electron technique.

The present work demonstrates utilization of electron beam irradiation for the treatment of Kaposi's sarcoma when the full circumference of the lower calf is involved, and when the deep lymphatics are negative for disease. The finite penetration of the electron beam spares deep tissue, preventing the edema associated with photon total limb irradiation. The number of fields with fall-off required to produce a uniform dose to a cylindrical anatomic structure was studied by calculating dose distributions resulting from two-, four-, and six-field techniques for a 5-MeV electron beam and a 9 cm diameter cylinder. The dosimetry and set-up for the six-field technique is demonstrated by a case study. Results show that a six-field electron technique produced a sufficiently uniform dose while remaining relatively easy to set up and use to deliver patient treatment. For the patient case study, dose distributions for the six-field technique showed that (1) the penetration of the 90% dose decreased from 1.5 cm for a single field to approximately 1.0 cm for a 5-MeV beam; (2) the surface dose increased from approximately 70% to 100%, (3) the dose around the circumference of the leg at the depth of 1 cm or less varied from approximately 90% to 120% of the prescribed dose; and (4) the prescribed dose was 2.5 times the maximum central-axis dose from a single field. The six-field treatment was relatively simple to apply and produced an acceptable dose distribution for treatment of Kaposi's sarcoma of the lower calf. This treatment should be applicable to other sites such as the thigh and arms and for other cutaneous diseases such as melanoma.

Results of photon absorbed-dose measurements using the AAPM TG-21 protocol for accelerating potentials up to 26 MV.

The AAPM Task Group 21 protocol for the calibration of high-energy photon and electron beams was produced to accomplish essentially two goals: (1) incorporate the latest physical data available for calculating absorbed dose from ionization measurements and (2) to eliminate inconsistencies in absorbed dose measurements made with various ion chamber and phantom combinations. The ability of the protocol was assessed to consistently determine x-ray absorbed dose from measurements made with four Farmer-type chambers and one parallel-plate chamber in water, polystyrene, and acrylic phantoms. The measurements were performed using seven high-energy x-ray beams from 60Co to 26-MV nominal accelerating potential. The absorbed dose to water calculated from measurements made with the various chamber and phantom combinations were found to be consistent. The doses calculated for the two most common phantom materials, water and polystyrene, were found to be in excellent agreement. This resolved a 1.6% discrepancy in the absorbed dose determined from the two phantoms using the SCRAD protocol. The doses for acrylic phantoms were found to be approximately 1.2%, low for nominal accelerating potentials less than 8.8 MV. For accelerating potentials of 8.8 MV or greater the agreement was considerably better. The mean dose determined for the parallel-plate chamber from measurements in polystyrene was found to be within 0.7% of the mean dose determined using Farmer-type ion chambers in all phantom materials.

Calibration frequency as determined by analysis of machine stability.

Simple statistical analysis is applied to the evaluation of the output measurements of equipment used in radiotherapy. The calibration frequency is calculated based on the stability of the equipment and the performance parameters required by the quality control criteria.

Mailable TLD system for photon and electron therapy beams.

The mailable TLD system developed by the Radiological Physics Center for monitoring calibration of photon beam energies from cobalt 60 to 25 MV and electron beam energies from 6 to 20 MeV has been in use since 1977 for photons and since 1982 for electron beams. Design considerations, proper use of the system and calibration techniques are detailed. The accuracy of the system is comparable to that of ion chamber measurements made in a water phantom, although it shows less precision.

Electron beam central axis depth dose measurements.

Central axis depth dose measurements were made by the Radiological Physics Center on over 70 electron-producing machines used in radiation therapy. These data were consistent for each machine model and nominal energy. However, the data show that depth dose relations can vary significantly among different machine models for electron beams having the same nominal energy. Analysis shows that both the method used to achieve beam flatness and the mean incident electron energy determine the central axis depth dose curve past the depth of maximum dose. A linear relation of depth dose versus mean incident electron energy is used to predict depth dose to within 2 mm for most electron beams used clinically at depths greater than d95.

The implementation of the AAPM Task Group 21 protocol by the Radiological Physics Center and its implications.

The Radiation Therapy Committee of the American Association of Physicists in Medicine appointed Task Group 21 to write a new protocol for the calibration of high-energy photon and electron therapy beams. This protocol updates the physical parameters used in the calculations and is intended to account for differences in ionization chamber design and some differences between phantom materials that were not considered in previous protocols. This paper discusses how the Radiological Physics Center (RPC) intends to implement the new protocol, the changes required in the RPC calibration techniques, and the magnitude of the change in the RPC calculations of absorbed dose resulting from the implementation of the new protocol. Although the change in the RPC absorbed-dose calculations will be only 0%-2% over the range of photon and electron energies of interest, some institutions using specific dosimetry systems may find their absorbed-dose calculations changing by 4% or more.

A comparison of high-energy accelerator depth dose data.

Accurate depth dose information is necessary for the use of high-energy radiotherapy photon beam units. It would be useful, therefore, to have one set of published data available for each different type unit manufactured to which physicists can compare their measured data. Pertinent questions are raised regarding the similarity between accelerators and their central axis depth dose characteristics, the availability of adequate published central axis depth dose data, and the minimum amount of data needed to determine the applicability of published data to a particular machine. Data taken by the Radiological Physics Center (RPC) for 4-10 MV units are analyzed and compared with published data in an attempt to answer these questions.