Measured and Monte Carlo simulated surface dose reduction for superficial X-rays incident on tissue with underlying air or bone.

PURPOSE: Measurement of surface dose reduction effects for superficial x-rays incident on tissue with underlying air or bone and comparison with Monte Carlo simulations of such effects. Further to investigate the correlation between surface dose reduction and changes in Compton backscatter spectra with tissue-bone separation. METHODS: An Advanced Markus chamber with entrance window facing downstream on the surface of a solid water phantom was used to investigate changes in surface dose with an underlying air or bone interface located at various depths below the surface. Chamber readings were obtained for interface depths ranging from 1 to 100 mm using the 50 kV, 100 kV and 150 kV beams of an Xstrahl 150 x-ray unit, with field diameters (ϕ) = 2.5 cm and 5 cm. For each beam quality and field size the dose correction factor, DCF(t), namely the ratio of measured dose (t) to dose (t = 100 mm) was determined. Monte Carlo simulations of DCF(t) for air and bone interfaces in tissue are used to validate corresponding measured data. For a given beam and field size, the difference between simulated spectra with an air or bone interface at t = 3 mm was used to determine the Compton backscatter from bone at the surface. RESULTS: For air, DCF(t < 40 mm) is less than unity and for a given t DCF(t) decreases as beam energy increases from 50 kV to 150 kV. Conversely for bone DCF(t < 40 mm) increases for a given t with increasing beam energy. In particular for t = 1 mm, ϕ = 5 cm, DCF for air(bone) are 0.90(0.92) and 0.86(0.96) for 50 kV and 150 kV, respectively. For the same tube potentials corresponding factors, ϕ = 2.5 cm, for air(bone) are 0.94(0.96) and 0.92(0.99). Calculated DCF(t) based on Monte Carlo simulations are consistent with experimental observations to within 2%. Monte Carlo simulations of x-ray spectra demonstrate the presence of Compton backscatter from underlying bone in tissue. With bone at 3 mm depth calculated backscatter spectra at the tissue surface suggest that surface dose is influenced by the proximity of bone and that this effect depends on beam quality. CONCLUSIONS: This work demonstrates the feasibility of using an Advanced Markus chamber with entrance window facing downstream to investigate surface dose reduction with underlying air or bone in tissue. As the field size decreases and beam quality increases surface dose with underlying bone tends to full backscatter values even though tissue thicknesses are below those normally associated with full backscatter. Conversely with underlying bone close to the surface dose will increasingly fall below full backscatter values as the beam energy is reduced and field size is increased.

Feasibility of 3D printed air slab diode caps for small field dosimetry.

Commercial diode detectors used for small field dosimetry introduce a field-size-dependent over-response relative to an ideal, water-equivalent dosimeter due to high density components in the body of the detector. An air gap above the detector introduces a field-size-dependent under-response, and can be used to offset the field-size-dependent detector over-response. Other groups have reported experimental validation of caps containing air gaps for use with several types of diodes in small fields. This paper examines two designs for 3D printed diode air caps for the stereotactic field diode (SFD)-a cap containing a sealed air cavity, and a cap with an air cavity at the face of the SFD. Monte Carlo simulations of both designs were performed to determine dimensions for an air cavity to introduce the desired dosimetric correction. Various parameter changes were also simulated to estimate the dosimetric uncertainties introduced by 3D printing. Cap layer dimensions, cap density changes due to 3D printing, and unwanted air gaps were considered. For the sealed design the optimal air gap size for water-equivalent cap material was 0.6 mm, which increased to 1.0 mm when acrylonitrile butadiene styrene in the cap was simulated. The unsealed design had less variation, a 0.4 mm air gap is optimal in both situations. Unwanted air pockets in the bore of the cap and density changes introduced by the 3D printing process can potentially introduce significant dosimetric effects. These effects may be limited by using fine print resolutions and minimising the volume of cap material.

A unique approach to high-dose-rate vaginal mold brachytherapy of gynecologic malignancies.

PURPOSE: Patients with cervical and vaginal cancer sometimes have a less straightforward approach for choice of brachytherapy treatment owing to the tumor's location and clinical presentation. The staff at Royal Brisbane & Women's Hospital in Queensland, Australia, is trying to solve this problem by the use of an old technique in a new approach called vaginal molds. With a patient-specific vaginal mold, the appearance of the applicator and the dose distribution can be customized to provide an optimal treatment for each patient. METHODS AND MATERIALS: The technique used at the Royal Brisbane & Women's Hospital uses a flexible two-part putty, moulded to the shape of the vagina, in which standard catheters (flexible implant tubes) are incorporated, in a pattern designed to permit a dose distribution more conformal to the target volume. RESULTS: The presented technique is efficient and improves the accuracy of a homogeneous target cover and sparing of organs at risk for vaginal mold brachytherapy treatments at our institution. CONCLUSION: This technique offers a customizable option when traditional cylindrical- or dome-type applicators cannot be used, or provide inadequate dose coverage. Molds to match the patient anatomy can be created quickly, while allowing flexibility in positioning of catheters to achieve the desired dose distribution.

Evaluation of MegaVoltage Cone Beam CT image quality with an unmodified Elekta Precise Linac and EPID: a feasibility study.

In order to increase the accuracy of patient positioning for complex radiotherapy treatments various 3D imaging techniques have been developed. MegaVoltage Cone Beam CT (MVCBCT) can utilise existing hardware to implement a 3D imaging modality to aid patient positioning. MVCBCT has been investigated using an unmodified Elekta Precise Linac and iView amorphous silicon electronic portal imaging device (EPID). Two methods of delivery and acquisition have been investigated for imaging an anthropomorphic head phantom and quality assurance phantom. Phantom projections were successfully acquired and CT datasets reconstructed using both acquisition methods. Bone, tissue and air were clearly resolvable in both phantoms even with low dose (22 MU) scans. The feasibility of MVCBCT was investigated using a standard linac, amorphous silicon EPID and a combination of a free open source reconstruction toolkit as well as custom in-house software written in Matlab. The resultant image quality has been assessed and presented. Although bone, tissue and air were resolvable in all scans, artifacts are present and scan doses are increased when compared with standard portal imaging. The feasibility of MVCBCT with unmodified Elekta Precise Linac and EPID has been considered as well as the identification of possible areas for future development in artifact correction techniques to further improve image quality.