Technical management of a pregnant patient undergoing radiation therapy to the head and neck.

The fetal dose in a pregnant patient undergoing radiation therapy to the head and neck region was investigated. Implicit in this study was the design and evaluation of a shield used to minimize the fetal dose. To evaluate the fetal dose, a phantom was irradiated with the fields designed for this patient's therapy. The peripheral dose was measured for each field individually, both without and with a custom shield designed to be placed about the patient's abdominal and pelvic regions. The total dose at the location of the fetus over the course of this patient's radiation therapy was then estimated from peripheral dose rate measurements made at several points within the simulated uterus. With no shielding, the total dose within the uterus of the patient would have ranged from 13.3 cGy at the cervix to 28 cGy at the fundus. With the shield applied, the uterine dose was significantly less: 3.3 cGy at the cervix to 8.6 cGy at the fundus. In fact, at every measurement point, the peripheral dose with the shield in place was 30% to 50% of the dose without the shield. Some data suggest that the rate of significant abnormalities induced by irradiation in utero increases with increasing dose within the range of total peripheral doses incurred during most radiation treatment courses. It is therefore prudent to make reasonable attempts at minimizing the dose to the lower abdominal and pelvic regions of any pregnant patient. The shield designed in this work accomplished this goal for this patient and is flexible enough to be used in the treatment of almost all tumor volumes.

Characterization of the response of commercial diode detectors used for in vivo dosimetry.

The response of a commercially available diode-based in vivo dosimetry system was studied over a selection of clinically relevant photon beam setups. The dosimetry system consists of a dedicated multichannel electrometer with several diode detectors differing only in their equivalent wall buildup. Each detector is calibrated for a specific nominal beam energy and used clinically with that energy only. To study dosimeter response, a diode taped to the surface of a solid water phantom was irradiated simultaneously with an end-window chamber placed at a depth of dmax inside the same phantom. Photon beams with energies of Co-60, 6 and 18 MV were used. For each beam energy, the response of the diode relative to the given dose as measured by the end-window chamber was evaluated for open and wedged fields (0 degree to 60 degrees) with source-to-surface distances (SSDs) ranging from 75 to 120 cm and collimator settings from 5 x 5 to 40 x 40 cm2. It was found that diode response, i.e., diode reading per cGy of given dose, varies significantly with treatment beam setup. For example, increasing field size for a constant SSD causes a decrease of up to 15% in diode response relative to the given dose for 6 and 18 MV beams, while for Co-60 an increase in response of up to 5% results. Furthermore, increasing SSD for a fixed collimator setting results in decreased diode response (up to 10%) for all beams. The complicated dependence of diode response on beam setup necessitates the use of empirical response curves, similar to those evaluated in this work, to accurately convert clinical dosimeter reading to dose at depth.

A well-type ionization chamber geometric correction factor.

To correct for the influence of source configuration on the measured activity of spherical and cylindrical brachytherapy sources, a geometric correction factor was calculated for the Standard Imaging HDR-1000 well-type ionization chamber. A Fortran program modelled each source as a lattice of point sources. Because of the cylindrical symmetry of the well chamber, it could be uniquely modelled by point detectors along the perimeter of the radial plane of the detection volume. Path lengths were calculated and attenuation factors were applied to each source-detector point combination individually. The total dose rate at each detection point was found through a Sievert summation of the point source contributions. For 137Cs sources with identical activities, a correction factor of 0.965 +/- 0.005 was calculated, equal to the ratio of the dose rate of the cylindrical source to that of the sphere. Experimental verification using a Nuclear Associates 67-809 series cylindrical sources and an Amersham spherical 137Cs source yielded a correction factor of 0.958 +/- 0.016.