Positioning accuracy for lung stereotactic body radiotherapy patients determined by on-treatment cone-beam CT imaging.

Stereotactic body radiotherapy for early stage non-small cell lung cancer is an emerging treatment option in the UK. Since relatively few high-dose ablative fractions are delivered to a small target volume, the consequences of a geometric miss are potentially severe. This paper presents the results of treatment delivery set-up data collected using Elekta Synergy (Elekta, Crawley, UK) cone-beam CT imaging for 17 patients immobilised using the Bodyfix system (Medical Intelligence, Schwabmuenchen, Germany). Images were acquired on the linear accelerator at initial patient treatment set-up, following any position correction adjustments, and post-treatment. These were matched to the localisation CT scan using the Elekta XVI software. In total, 71 fractions were analysed for patient set-up errors. The mean vector error at initial set-up was calculated as 5.3 ± 2.7 mm, which was significantly reduced to 1.4 ± 0.7 mm following image guided correction. Post-treatment the corresponding value was 2.1 ± 1.2 mm. The use of the Bodyfix abdominal compression plate on 5 patients to reduce the range of tumour excursion during respiration produced mean longitudinal set-up corrections of -4.4 ± 4.5 mm compared with -0.7 ± 2.6 mm without compression for the remaining 12 patients. The use of abdominal compression led to a greater variation in set-up errors and a shift in the mean value.

Optimal clinical implementation of the Siemens virtual wedge.

Installation of a modern high-energy Siemens Primus linear accelerator at the Northern Centre for Cancer Treatment (NCCT) provided the opportunity to investigate the optimal clinical implementation of the Siemens virtual wedge filter. Previously published work has concentrated on the production of virtual wedge angles at 15 degrees, 30 degrees, 45 degrees, and 60 degrees as replacements for the Siemens hard wedges of the same nominal angles. However, treatment plan optimization of the dose distribution can be achieved with the Primus, as its control software permits the selection of any virtual wedge angle from 15 degrees to 60 degrees in increments of 1 degrees. The same result can also be produced from a combination of open and 60 degrees wedged fields. Helax-TMS models both of these modes of virtual wedge delivery by the wedge angle and the wedge fraction methods respectively. This paper describes results of timing studies in the planning of optimized patient dose distributions by both methods and in the subsequent treatment delivery procedures. Employment of the wedge fraction method results in the delivery of small numbers of monitor units to the beam's central axis; therefore, wedge profile stability and delivered dose with low numbers of monitor units were also investigated. The wedge fraction was proven to be the most efficient method when the time taken for both planning and treatment delivery were taken into consideration, and is now used exclusively for virtual wedge treatment delivery in Newcastle. It has also been shown that there are no unfavorable dosimetric consequences from its practical implementation.

Behavior of the Siemens Virtual Wedge following an interruption to beam delivery.

Investigations were made into the beam profile shape and dose delivered by the Siemens Virtual Wedge trade mark under standard operational conditions compared with those following delivery interruption on two Siemens Primus linear accelerators (Type 7445 and 8067) running different versions of control software (7.2 and 7.0, respectively). The shape of the Virtual Wedge trade mark profiles was found to be unaffected by beam delivery interruption. An increase in the dose delivered to the central axis was found when delivery was interrupted and subsequently resumed using information recorded in a recall data file on one of the accelerators. This dose increase was attributed to a difference in delivered monitor units recorded in the recall data file compared to those displayed on the linear accelerator control console.

A practical method of measuring electron isodose curves using a linear detector array for validation of treatment planning system data.

A practical method of measuring electron isodose curves for validation of treatment planning system data using a linear detector array in a water phantom is described. The detector array was used to measure both the profile and depth dose data required. A depth-dependent correction was required, determined from a comparison with diode-measured depth dose. Application of this correction enabled accurate reconstruction of isodose curves. Isodose curves were also measured with diodes, to verify the array measurements. The two were found to be in good agreement. The advantage of the array-based method is a substantial saving in linear accelerator time when compared with point-by-point detector measurements. Although the data reproduced here are specific to the linear detector array of one manufacturer, the overall measurement technique is generally applicable.

Validation of treatment planning system data: variation in the modelling of three 6 MV beams for extreme rectangular fields.

The validation of photon beam data on the Helax-TMS treatment planning system at the Northern Centre for Cancer Treatment takes the form of profile and depth dose comparisons against measured data for square fields. With a view to using Helax-TMS to plan fixed source-to-surface distance spine fields, validation of extreme rectangular fields was undertaken, based on guidelines published by the American Association of Physicists in Medicine Radiation Therapy Committee (Task Group report 53). The accuracy with which the Helax-TMS-generated profiles matched those measured varied between treatment machines. For three 6 MV beams in the department, two beams showed agreement to within 2% in the central portion of the field, while the third beam demonstrated differences of up to 4.4% in this region. The disparities were attributed to the modelling of the primary dose for each beam by Helax-TMS.

The use of high density metal foils to increase surface dose in low-energy clinical electron beams.

BACKGROUND AND PURPOSE: This paper describes a practical method of elevating the surface dose of clinical electron beams in the energy range 3-12 MeV using thin high density metal foils (tin and lead) as an alternative to tissue equivalent bolus. Because, relative to water, these materials exhibit a high scattering power to stopping power ratio, the desired dose elevation may be achieved with less energy loss than conventional bolus and consequently a gain in therapeutic interval. METHODS: The foil thickness required to raise the surface dose to 90% off peak, for a given electron energy, was calculated using published scattering and stopping power data. An empirical expression is derived to facilitate calculation of foil thickness (tin or lead) to produce a given surface dose. RESULTS AND CONCLUSIONS: Measurements were made to confirm the predictions of the derived expression and were found to be in good agreement.