Poster - Thur Eve - 15: Production and assessment of astatine-211 for targeted alpha therapy.

Biologically-targeted alpha-particle radiation is the basis of new and promising treatments for eliminating disseminated micrometastases and the residual microscopic malignancies that remain after surgery or radiation therapy. The short-range alpha-particles are highly cytotoxic and capable of inactivating single, isolated cancer cells which may otherwise cause recurrence. Astatine-211 is a promising alpha emitter for therapy; the 7.2 hour half-life of 211 At provides sufficient time for biological-targeting to take place. However, this radionuclide is in short supply and future treatment strategies still require extensive preclinical evaluation. The present work aims to develop technologies that (1) increase the world-wide availability of 211 At for clinical use, and (2) assess the risks of 211 At-based therapies by quantifying the activity distributions in animal models. At TRIUMF (Vancouver, BC), the feasibility of a novel generator system for 211 At is under investigation which would allow distribution of 211 At across Canada and internationally. Briefly, a longer-lived parent radionuclide of 211 At, radon-211, would be produced and allowed to decay in containment to yield 211 At in solution. Additionally, a supplementary study is underway in collaboration with the University of Washington to evaluate the sub-organ biodistributions of astatinated targeting biomolecules, with cell-level resolution. These measurements involve high resolution quantitative alpha-particle imaging in thin tissue samples and can be done for a selection of applications (eg. lymphoma, metastatic prostate cancer, etc) using animal models. The planned alpha-camera measurements are primarily designed to predict and assess the risk of toxicity associated with 211 At-based therapies and aid in developing the future clinical applications.

Dosimetric validation of Acuros XB with Monte Carlo methods for photon dose calculations.

PURPOSE: The dosimetric accuracy of the recently released Acuros XB advanced dose calculation algorithm (Varian Medical Systems, Palo Alto, CA) is investigated for single radiation fields incident on homogeneous and heterogeneous geometries, and a comparison is made to the analytical anisotropic algorithm (AAA). METHODS: Ion chamber measurements for the 6 and 18 MV beams within a range of field sizes (from 4.0 x 4.0 to 30.0 x 30.0 cm2) are used to validate Acuros XB dose calculations within a unit density phantom. The dosimetric accuracy of Acuros XB in the presence of lung, low-density lung, air, and bone is determined using BEAMnrc/DOSXYZnrc calculations as a benchmark. Calculations using the AAA are included for reference to a current superposition/convolution standard. RESULTS: Basic open field tests in a homogeneous phantom reveal an Acuros XB agreement with measurement to within +/- 1.9% in the inner field region for all field sizes and energies. Calculations on a heterogeneous interface phantom were found to agree with Monte Carlo calculations to within +/- 2.0% (sigmaMC = 0.8%) in lung (p = 0.24 g cm(-3)) and within +/- 2.9% (sigmaMC = 0.8%) in low-density lung (p = 0.1 g cm(-3)). In comparison, differences of up to 10.2% and 17.5% in lung and low-density lung were observed in the equivalent AAA calculations. Acuros XB dose calculations performed on a phantom containing an air cavity (p = 0.001 g cm(-3)) were found to be within the range of +/- 1.5% to +/- 4.5% of the BEAMnrc/DOSXYZnrc calculated benchmark (sigmaMC = 0.8%) in the tissue above and below the air cavity. A comparison of Acuros XB dose calculations performed on a lung CT dataset with a BEAMnrc/DOSXYZnrc benchmark shows agreement within +/- 2%/2mm and indicates that the remaining differences are primarily a result of differences in physical material assignments within a CT dataset. CONCLUSIONS: By considering the fundamental particle interactions in matter based on theoretical interaction cross sections, the Acuros XB algorithm is capable of modeling radiotherapy dose deposition with accuracy only previously achievable with Monte Carlo techniques.

Monte Carlo evaluation of RapidArc oropharynx treatment planning strategies for sparing of midline structures.

The aim of the study was to perform the Monte Carlo (MC) evaluation of RapidArc (Varian Medical Systems, Palo Alto, CA) dose calculations for four oropharynx midline sparing planning strategies. Six patients with squamous cell cancer of the oropharynx were each planned with four RapidArc head and neck treatment strategies consisting of single and double photon arcs. In each case, RTOG0522 protocol objectives were used during planning optimization. Dose calculations performed with the analytical anisotropic algorithm (AAA) are compared against BEAMnrc/DOSXYZnrc dose calculations for the 24-plan dataset. Mean dose and dose-to-98%-of-structure-volume (D(98%)) were used as metrics in the evaluation of dose to planning target volumes (PTVs). Mean dose and dose-to-2%-of-structure-volume (D(2%)) were used to evaluate dose differences within organs at risk (OAR). Differences in the conformity index (CI) and the homogeneity index (HI) as well as 3D dose distributions were also observed. AAA calculated PTV mean dose, D(98%), and HIs showed very good agreement with MC dose calculations within the 0.8% MC (statistical) calculation uncertainty. Regional node volume (PTV-80%) mean dose and D(98%) were found to be overestimated (1.3%, sigma = 0.8% and 2.3%, sigma = 0.8%, respectively) by the AAA with respect to MC calculations. Mean dose and D(2%) to OAR were also observed to be consistently overestimated by the AAA. Increasing dose calculation differences were found in planning strategies exhibiting a higher overall fluence modulation. From the plan dataset, the largest local dose differences were observed in heavily shielded regions and within the esophageal and sinus cavities. AAA dose calculations as implemented in RapidArc demonstrate excellent agreement with MC calculations in unshielded regions containing moderate inhomogeneities. Acceptable agreement is achieved in regions of increased MLC shielding. Differences in dose are attributed to inaccuracies in the AAA-modulated fluence modeling, modeling of material inhomogeneities and dose deposition within low-density materials. The use of MC dose calculations leads to the same general conclusion as using AAA that a two arc delivery with limited collimator opening can provide the greatest amount of midline sparing compared to the other techniques investigated.

A Monte Carlo evaluation of RapidArc dose calculations for oropharynx radiotherapy.

RapidArc, recently released by Varian Medical Systems, is a novel extension of IMRT in which an optimized 3D dose distribution may be delivered in a single gantry rotation of 360 degrees or less. The purpose of this study was to investigate the accuracy of the analytical anisotropic algorithm (AAA), the sole algorithm for photon dose calculations of RapidArc treatment plans. The clinical site chosen was oropharynx and the associated nodes involved. The VIMC-Arc system, which utilizes BEAMnrc and DOSXYZnrc for particle transport through the linac head and patient CT phantom, was used as a benchmarking tool. As part of this study, the dose for a single static aperture, typical for RapidArc delivery, was calculated by the AAA, MC and compared with the film. This film measurement confirmed MC modeling of the beam aperture in water. It also demonstrated that the AAA dosimetric error can be as high as 12% near isolated leaf edges and up to 5% at the leaf end. The composite effect of these errors in a full RapidArc calculation in water involving a C-shaped target and the associated organ at risk produced a 1.5% overprediction of the mean target dose. In our cohort of six patients, the AAA was found, on average, to overestimate the PTV60 coverage at the 95% level in the presence of air cavities by 1.0% (SD = 1.1%). Removing the air cavities from the target volumes reduced these differences by about a factor of 2. The dose to critical structures was also overestimated by the AAA. The mean dose to the spinal cord was higher by 1.8% (SD = 0.8%), while the effective maximum dose (D2%) was only 0.2% higher (SD = 0.6%). The mean dose to the parotid glands was overestimated by approximately 9%. This study has shown that the accuracy of the AAA for RapidArc dose calculations, performed at a resolution of 2.5 mm or better, is adequate for clinical use.

3D ultrasound for prostate localization in radiation therapy: a comparison with implanted fiducial markers.

This study compares prostate localization using three-dimensional ultrasound (3D US) to a standard technique using implanted fiducial markers (FMs) for prostate image guided radiation therapy (IGRT). Two methods to determine prostate position on US were evaluated: Assisted segmentation (prospectively) and manual segmentation (retrospectively). Daily couch shifts to align the prostate into treatment position were measured using each technique. A total of 278 FM couch shifts and 255 and 218 corresponding assisted and manual segmentation US couch shifts were analyzed in each direction: Anterior-posterior, right-left, and superior-inferior. Ninety five percent "limits-of-agreement" (LOA) were used to analyze paired couch shifts and to determine if US can reliably replace FMs. We chose an error tolerance of +/- 3 mm for the LOA analysis. For FM vs assisted-segmentation US, 35.3%, 51.0%, and 48.2% of couch shifts (anterior-posterior, right-left, and superior-inferior, respectively) agreed within +/- 3 mm. Agreement improved using manual segmentation US (corresponding agreements were 45.3%, 64.1%, and 55.2%), however, results still lie markedly below the 95% we consider to indicate clinical equivalence. Based on these results, our experience indicates US cannot replace FMs for prostate IGRT, using either assisted or manual segmentation. US couch shifts showed considerably greater variability than FM measures and US image quality is shown to affect agreement. Planning target volume margins for use with the US system were found to be 15.8, 8.7, and 12.5 mm for assisted segmentation and 13.1, 7.6, and 9.8 mm for manual segmentation. Comparison of these margins to those reported in recent studies for use with FM IGRT indicate FMs offer greater sparing of the rectum and bladder than the US system.

Sci-Fri AM: YIS-03: Simulated annealing optimization of the pre-target electron beam in Monte Carlo virtual linac models.

The purpose of this study is to develop a method for determining the initial parameters of the pre-target electron beam within a Monte Carlo (MC) accelerator model able to produce accurate 18 MV 40×40 cm2 photon field profiles. We have developed a novel method by which the electron beam intensity distribution can be reverse engineered to reproduce measured dose distributions. The method begins from a cylindrically symmetric pre-target electron beam (radius 0.5 cm) of uniform intensity. This beam is subdivided into annular regions of fluence for which each region is individually transported through the accelerator head and into a water phantom. A simulated annealing search is then performed to determine the optimal combination of weights of the annular fluences that provide a best match between measured dose distributions and the weighted sum of annular dose distributions. Remarkably, the intensity distribution converges to a solution that is predominantly Gaussian, with a FWHM=1.1mm. In addition, the solution contains an important secondary "extra focal halo" on the order of 10% of the maximum Gaussian intensity. Agreement of the 40×40 cm2 photon field profiles with measurement was within 0.5%. The method greatly reduces the effort required to commission a MC accelerator model for clinical use and has achieved better agreement with measurement than other methods described in the literature. Our derived value of the electron beam FWHM agrees with that measured by Jaffray et al, 1993, and the "extra focal halo" is in qualitative agreement with their measurements of extra focal radiation.

Azimuthal particle redistribution for the reduction of latent phase-space variance in Monte Carlo simulations.

It is well known that the use of a phase space in Monte Carlo simulation introduces a baseline level of variance that cannot be suppressed through the use of standard particle recycling techniques. This variance (termed latent phase-space variance by Sempau et al) can be a significant limiting factor in achieving accurate, low-uncertainty dose scoring results, especially near the surface of a phantom. A BEAMnrc component module (MCTWIST) has been developed to reduce the presence of latent variance in phase-space-based Monte Carlo simulations by implementing azimuthal particle redistribution (APR). For each recycled use of a phase-space particle a random rotation about the beam's central axis is applied, effectively utilizing cylindrical symmetry of the particle fluence and therefore providing a more accurate representation of the source. The MCTWIST module is unique in that no physical component is actually added to the accelerator geometry. Beam modifications are made by directly transforming particle characteristics outside of BEAMnrc/EGSnrc particle transport. Using MCTWIST, we have demonstrated a reduction in latent phase-space variance by more than a factor of 20, for a 10 x 10 cm(2) field, when compared to standard phase-space particle recycling techniques. The reduction in latent variance has enabled the achievement of dramatically smoother in-water dose profiles. This paper outlines the use of MCTWIST in Monte Carlo simulation and quantifies for the first time the latent variance reduction resulting from exploiting cylindrical phase-space symmetry.

Absolute dose calculations for Monte Carlo simulations of radiotherapy beams.

Monte Carlo (MC) simulations have traditionally been used for single field relative comparisons with experimental data or commercial treatment planning systems (TPS). However, clinical treatment plans commonly involve more than one field. Since the contribution of each field must be accurately quantified, multiple field MC simulations are only possible by employing absolute dosimetry. Therefore, we have developed a rigorous calibration method that allows the incorporation of monitor units (MU) in MC simulations. This absolute dosimetry formalism can be easily implemented by any BEAMnrc/DOSXYZnrc user, and applies to any configuration of open and blocked fields, including intensity-modulated radiation therapy (IMRT) plans. Our approach involves the relationship between the dose scored in the monitor ionization chamber of a radiotherapy linear accelerator (linac), the number of initial particles incident on the target, and the field size. We found that for a 10 x 10 cm2 field of a 6 MV photon beam, 1 MU corresponds, in our model, to 8.129 x 10(13) +/- 1.0% electrons incident on the target and a total dose of 20.87 cGy +/- 1.0% in the monitor chambers of the virtual linac. We present an extensive experimental verification of our MC results for open and intensity-modulated fields, including a dynamic 7-field IMRT plan simulated on the CT data sets of a cylindrical phantom and of a Rando anthropomorphic phantom, which were validated by measurements using ionization chambers and thermoluminescent dosimeters (TLD). Our simulation results are in excellent agreement with experiment, with percentage differences of less than 2%, in general, demonstrating the accuracy of our Monte Carlo absolute dose calculations.

Short communication: Setup variations in locoregional radiotherapy for breast cancer: an electronic portal imaging study.

Recent trials demonstrating a survival benefit with locoregional radiotherapy (LRRT) to the chest wall and regional nodes in women with node-positive breast cancer have led to increased use of complex techniques to match three or more radiation fields, but information on setup reproducibility with LRRT for breast cancer is scarce. This study reports the magnitude and directions of random and systematic deviations in LRRT for breast cancer using an offline electronic portal imaging verification protocol. Electronic portal images (EPIs) of 46 consecutive women treated with LRRT for breast cancer from March 2001 to February 2002 with LRRT were analysed. Comparisons of EPIs to the corresponding digitally reconstructed radiographs were performed offline with anatomy matching. Displacements in mm were recorded in the superior-inferior (SI), medial-lateral (ML), and anterior-posterior (AP) directions. Random errors ranged from 2.0 mm to 2.5 mm for the breast/chest wall tangential treatments and 2.3 mm to 3.9 mm for the supraclavicular nodal treatments. Systematic errors occurred to a greater degree in the AP direction for the tangential fields and in the ML direction for the supraclavicular field. Displacements of > or =10 mm were found in 1.2% of breast/chest wall tangential treatments and in 6.2% of supraclavicular nodal treatments. These data demonstrate that EPI is a useful tool to verify setup reproducibility in LRRT for breast cancer.

Implementation of random set-up errors in Monte Carlo calculated dynamic IMRT treatment plans.

The fluence-convolution method for incorporating random set-up errors (RSE) into the Monte Carlo treatment planning dose calculations was previously proposed by Beckham et al, and it was validated for open field radiotherapy treatments. This study confirms the applicability of the fluence-convolution method for dynamic intensity modulated radiotherapy (IMRT) dose calculations and evaluates the impact of set-up uncertainties on a clinical IMRT dose distribution. BEAMnrc and DOSXYZnrc codes were used for Monte Carlo calculations. A sliding window IMRT delivery was simulated using a dynamic multi-leaf collimator (DMLC) transport model developed by Keall et al. The dose distributions were benchmarked for dynamic IMRT fields using extended dose range (EDR) film, accumulating the dose from 16 subsequent fractions shifted randomly. Agreement of calculated and measured relative dose values was well within statistical uncertainty. A clinical seven field sliding window IMRT head and neck treatment was then simulated and the effects of random set-up errors (standard deviation of 2 mm) were evaluated. The dose-volume histograms calculated in the PTV with and without corrections for RSE showed only small differences indicating a reduction of the volume of high dose region due to set-up errors. As well, it showed that adequate coverage of the PTV was maintained when RSE was incorporated. Slice-by-slice comparison of the dose distributions revealed differences of up to 5.6%. The incorporation of set-up errors altered the position of the hot spot in the plan. This work demonstrated validity of implementation of the fluence-convolution method to dynamic IMRT Monte Carlo dose calculations. It also showed that accounting for the set-up errors could be essential for correct identification of the value and position of the hot spot.

Modelling an extreme water-lung interface using a single pencil beam algorithm and the Monte Carlo method.

The goal of this study was to quantify, in a heterogeneous phantom, the difference between experimentally measured beam profiles and those calculated using both a commercial convolution algorithm and the Monte Carlo (MC) method. This was done by arranging a phantom geometry that incorporated a vertical solid water-lung material interface parallel to the beam axis. At nominal x-ray energies of 6 and 18 MV, dose distributions were modelled for field sizes of 10 x 10 cm(2) and 4 x 4 cm(2) using the CadPlan 6.0 commercial treatment planning system (TPS) and the BEAMnrc-DOSXYZnrc Monte Carlo package. Beam profiles were found experimentally at various depths using film dosimetry. The results showed that within the lung region the TPS had a substantial problem modelling the dose distribution. The (film-TPS) profile difference was found to increase, in the lung region, as the field size decreased and the beam energy increased; in the worst case the difference was more than 15%. In contrast, (film-MC) profile differences were not found to be affected by the material density difference. BEAMnrc-DOSXYZnrc successfully modelled the material interface and dose profiles to within 2%.

The effect of leaf width and sampling distance on the "stair-stepping" of field borders defined by multileaf collimators.

Standard multileaf collimators (MLCs) are now available with 1.0 and 0.5 cm leaf widths. The aim of this work is to compare the dose-undulation and effective penumbra of field edges formed by these MLC leaf widths and to determine how reducing the sampling distance (centre-to-centre distance between adjacent MLC leaves) for the 1.0 cm leaf width compares to the smaller leaf width. The undulation of the 50% isodose line and the 80-20% and 80-30% effective penumbra were compared for a field edge angled at 45 degrees to the MLC leaf motion direction at 8 cm depth. The larger leaf width field was also segmented to form field edges with 0.5, 0.33 and 0.2 cm sampling distance. Random setup variation of 2 mm standard deviation was also incorporated. Dose undulation was 1.5 mm for the 0.5 cm MLC leaf width compared to 4.5 mm for the 1.0 cm width. The 80-20% effective penumbra was 2 mm less for the 0.5 cm leaf width and the 80-30% effective penumbra was approximately 3 mm less. When random setup variation was incorporated the 0.5 cm leaf width isodoses were straight compared with approximately 3 mm undulation for the larger MLC. Reducing the sampling distance for the 1.0 cm MLC leaf width to 0.33 cm resulted in penumbra only slightly greater than the 0.5 cm leaf width and removed the undulation. Effective penumbra and dose undulation are reduced for the 0.5 cm leaf width compared to a 1.0 cm leaf width. Reducing the sampling distance for the 1.0 cm MLC leaf can approximate the 0.5 cm leaf width, at the expense of longer treatment times, and increased quality assurance investment.

A fluence-convolution method to calculate radiation therapy dose distributions that incorporate random set-up error.

The International Commission on Radiation Units and Measurements Report 62 (ICRU 1999) introduced the concept of expanding the clinical target volume (CTV) to form the planning target volume by a two-step process. The first step is adding a clinically definable internal margin, which produces an internal target volume that accounts for the size, shape and position of the CTV in relation to anatomical reference points. The second is the use of a set-up margin (SM) that incorporates the uncertainties of patient beam positioning, i.e. systematic and random set-up errors. We propose to replace the random set-up error component of the SM by explicitly incorporating the random set-up error into the dose-calculation model by convolving the incident photon beam fluence with a Gaussian set-up error kernel. This fluence-convolution method was implemented into a Monte Carlo (MC) based treatment-planning system. Also implemented for comparison purposes was a dose-matrix-convolution algorithm similar to that described by Leong (1987 Phys. Med. Biol. 32 327-34). Fluence and dose-matrix-convolution agree in homogeneous media. However, for the heterogeneous phantom calculations, discrepancies of up to 5% in the dose profiles were observed with a 0.4 cm set-up error value. Fluence-convolution mimics reality more closely, as dose perturbations at interfaces are correctly predicted (Wang et al 1999 Med. Phys. 26 2626-34, Sauer 1995 Med. Phys. 22 1685-90). Fluence-convolution effectively decouples the treatment beams from the patient. and more closely resembles the reality of particle fluence distributions for many individual beam-patient set-ups. However, dose-matrix-convolution reduces the random statistical noise in MC calculations. Fluence-convolution can easily be applied to convolution/superposition based dose-calculation algorithms.

Three-dimensional dose distribution of tangential breast irradiation: results of a multicentre phantom dosimetry study.

BACKGROUND AND PURPOSE: One aspect of good radiotherapeutic practice is to achieve dose homogeneity. Dose inhomogeneities occur with breast tangent irradiation, particularly in women with large breasts. MATERIALS AND METHODS: Ten Australian radiation oncology centres agreed to participate in this multicentre phantom dosimetry study. An Alderson radiation therapy anthropomorphic phantom with attachable breasts of two different cup sizes (B and DD) was used. The entire phantom was capable of having thermoluminescent dosimeters (TLD) material inserted at various locations. Nine TLD positions were distributed throughout the left breast phantom including the superior and inferior planes. The ten centres were asked to simulate, plan and treat (with a prescription of 100 cGy) the breast phantoms according to their standard practice. Point doses from resultant computer plans were calculated for each TLD position. Measured and calculated (planning computer) doses were compared. RESULTS: The dose planning predictability between departments did not appear to be significantly different for both the small and large breast phantoms. The median dose deviation (calculated dose minus measured dose) for all centres ranged from 2. 3 to 5.3 cGy on the central axis and from 2.1 to 7.5 cGy for the off-axis planes. The highest absolute dose was measured in the inferior plane of the large breast (128.7 cGy). The greatest dose inhomogeneity occurred in the small breast phantom volume (median range 93.2-105 cGy) compared with the large breast phantom volume (median range, 100.1-107.7 cGy). There was considerable variation in the use (or not) of wedges to obtain optimized dosimetry. No department used 3D compensators. CONCLUSION: The results highlight areas of potential improvement in the delivery of breast tangent radiotherapy. Despite reasonable dose predictability, the greatest dose deviation and highest measured doses occurred in the inferior aspects of both the small and large breast phantoms.

Evaluation of the validity of a convolution method for incorporating tumour movement and set-up variations into the radiotherapy treatment planning system.

Modern radiotherapy techniques have developed to a point where the ability to conform to a particular tumour shape is limited by organ motion and set-up variations. The result is that dose distributions displayed by treatment planning systems based on static beam modelling are not representative of the dose received by the patient during a fractionated course of radiotherapy. The convolution-based method to account for these variations in radiation treatment planning systems has been suggested in previous work. The validity of the convolution method is tested by comparing the dose distribution obtained from this convolution method with the dose distribution obtained by summing the contribution to the total dose from each fraction of a fractionated treatment (for increasing numbers of fractions) and simulating random target position variations between fractions. For larger numbers of fractions (approximately or > 15) which are the norm for radical treatment schemes, it is clear that incorporation of movement by a convolution method could potentially produce a more accurate dose distribution. There are some limitations that have been identified, however, especially in relation to the heterogeneous nature of patient tissues, which require further investigation before the technique could be applied clinically.

An assessment of the number of CT slices necessary to plan breast radiotherapy.

AIMS: The aim of this study was to evaluate the number of CT slices required to produce satisfactory dose distribution for tangential field irradiation of the chest wall and breast and to assess correlation of this with the volume of breast tissue treated. Forty-six patients underwent a CT scan of the thorax. An optimized plan was produced by assessing dose distribution on the central axis (CAX) slice only. This plan was then recalculated using the entire CT data set without any changes to the beam parameters. A separate optimized plan was generated using the CAX slice and two slices indicative of the upper and lower level of the field. This three-slice plan was then calculated using the entire CT data set. Finally an optimized 3D plan was generated using the entire CT data set. The different planning methods were compared using dose-volume histograms (DVH). Dose inhomogeneity was defined as any treatment volume outside the ICRU 50 dose distribution recommendations. RESULTS: Fifty-two percent of single-slice plans and 21% of three-slice plans (when assessed volumetrically) had greater volumes of breast tissue outside the ICRU 50 report guidelines suggesting that better homogeneity could be achieved by assessing a greater number of slices. Seventy-nine percent of three-slice plans showed no homogeneity improvement if the plan was calculated with the entire 3D data set. CONCLUSIONS: We conclude that a single-slice plan is unsatisfactory in providing sufficient information about the dose variation across the treatment volume and that ideally a 3D plan with DVHs should be produced. If the required data is unavailable then a minimum of three slices should be used as an approximation. We also propose a software tool for treatment planning systems, which calculates the percentage of the total PTV having dose outside the ICRU 50 radiation dose distribution homogeneity guideline range.

An analytical model of a kilovoltage beam phase space.

Our aim in this project was to quantify a kilovoltage beam phase space for use in dose calculations. The phase space was modeled by incorporating the following analytically derived x-ray beam production properties: the intensity variation due to the heel effect, the energy variation due to the differing amount of target material traversed by the photons, and the finite source size. The initial energy spectrum used was generated using a computer program. A Monte Carlo code was adapted in order to examine the validity of the calculated phase space. Dose distributions calculated using the modeled phase space for 10x10 and 20x20 cm2 fields show agreement with experimental values to within 2% and 4%, respectively, for the central 80% of the field size. Within the field but outside this range a maximum of 6% difference (for the 20x20 cm2 field) was observed, however, these values were in a region of sharp gradient and hence small geometric shift. The "tails" of the profiles were underpredicted by up to 6%. Due to uncertainties in experiment (3%) and Monte Carlo (1.5%), the modeled phase space is deemed acceptable for phantom and in-vivo dosimetric calculations within the field boundaries.

A method to predict the effect of organ motion and set-up variations on treatment plans.

Dose distributions calculated by commercial treatment planning systems do not allow incorporation of the effects of patient position variation or organ motion throughout the course of radiation therapy treatment. We have established a convolution-based method, which enables us to display dose distributions using a commercial treatment planning system that can take into account target movement. An example of the method applied to a prostate treatment plan is presented. For the method to be of clinical use it requires assessment of the parameters leading to target movement in a scientific manner in the same treatment department that it is to be used. It is not sufficient to rely on published data especially that relating to set-up accuracy as this has been shown to vary widely from centre to centre. We believe that with appropriate movement data, a convolution-based approach can lead to more optimal radiation margins around clinical target volumes (CTV). Optimal margins will help prevent geometric misses as well as ensure that the amount of critical late reacting normal tissues surrounding the CTV irradiated is minimised. Optimal margins cannot be guaranteed with the more conventionally used "rule of thumb" techniques for placing a planning target volume around the CTV.

Comparison of kilovoltage x-ray and electron beam dose distributions for radiotherapy of the sternum.

The dose distributions for a patient with cancer involving the sternum were calculated for both a kilovoltage x-ray beam and a megavoltage electron beam. The minimum target dose and dose uniformity over the target volume were significantly better using electrons (90%-101%) than kilovoltage x-rays (68%-119%). The calculated lung dose and integral patient dose were also less for electrons than kilovoltage x-rays. For treating cancers of the sternum with radical intent, megavoltage electrons are recommended as the treatment mode of choice rather than kilovoltage x-rays.

Comparing dose calculation algorithms for an orthovoltage beam in a bone phantom.

The aim of this work was to compare dose calculation algorithm results at orthovoltage energies for a phantom composed of a bone slab in water. The calculation methods investigated were: no correction, ETAR, Batho, convolution/superposition and Monte Carlo. All algorithms calculated depth dose curves in a water phantom within 4% of experiment. However in the bone phantom, differences of over 40% between the No Correction/ETAR/Batho/Convolution and Monte Carlo results in the 1 cm thick bone slab were observed. These differences are predominantly because the algorithms do not account for the differing atomic number of the bone compared to water. The increased dose to bone and the tissue adjacent to the bone interface should be considered when treating with orthovoltage photons.