One of the major drawbacks to doing stereotactic radiosurgery with a linear accelerator is the long time required to deliver the target dose. Single fractions of 25 Gy delivered at the isocenter and at depth in the skull may require beam times in excess of 15 min for a typical linear accelerator with a maximum dose rate of 250 cGy/min in tissue. In an effort to decrease the treatment time for this technique, the flattening filter has been removed from an AECL Therac-6 linear accelerator and the characteristics of the resulting beam have been measured. Flatness is acceptable for the field sizes used with this technique and the dose rate is increased by a factor of 2.75.
To perform dynamic stereotactic radiotherapy, a number of modifications to the commercial linear accelerator were required and these are described in this report. A couch drive system was added to rotate the couch in synchrony with the gantry. A high dose rate beam for this technique is acquired through a head modification, which allows easy removal of the radiation field flattener. Because of these modifications, a number of changes and additions were required to the linac interlock system, including a complete new chain of interlocks for use with the stereotactic technique.
As part of the commissioning procedure of a linear accelerator at our cancer center, the defining laser lines were aligned with the optical and radiation isocenter of the linac. When a mechanical checkout jig was set up at the same point, a discrepancy of 4 mm resulted when the gantry was moved from 0 degrees to 180 degrees. Extensive measurements, some with custom-designed devices, confirmed the observations and provided an explanation. Even though the mechanical isocenter is within the specified tolerance of 1-mm radius, the clinically observable discrepancy of 4-mm results from the noncoincidence of the mechanical and radiation isocenters. The clinical significance of the final setup is discussed and future commissioning procedures are recommended.
The Therac-25 is a new 25-MeV linear accelerator manufactured by Atomic Energy of Canada, Ltd. The first two units have recently been installed in Toronto, Ontario and Halifax, Nova Scotia. Calculations and measurements of primary and secondary radiation levels were made. Neutron dose-equivalent rates were measured inside and outside the room. The maximum leakage rate at 1 m from the accelerator target was 0.4% Sv per peak photon Gy. The tenth value layer for neutrons from the Therac-25, at the entrance to a one-legged maze was found to be 5.5 cm of polyethylene. Measurements were done to estimate daily technologist exposure due to induced activity in the treatment room.
Dynamic radiosurgery was first developed in Montreal and was subsequently adopted at the Toronto-Bayview Regional Cancer Centre in 1988. At that time radiosurgery was in its infancy in Canada. The opportunity of offering highly conformal radiation treatments for intracranial targets presented numerous technical challenges notably in the area of quality assurance. This review chronicles the development of radiosurgery at the Toronto-Bayview Regional Cancer Centre and summarises the successes and failures of the program over the following two decades.
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