The merits of intensity-modulated very-high energy electron therapy (VHEET) and intensity-modulated proton therapy (IMPT) in relation to intensity-modulated x-ray therapy (IMXT) with respect to the treatment of the prostate have been quantified. Optimized dose distributions were designed for 5-11 beams of 250 MeV VHEET and 15 MV IMXT as well as 1-9 beam ports of IMPT. In the case of the comparison between 250 MeV VHEET and 15 MV IMXT, it was found that the quality of target coverage achievable with VHEET was comparable to or sometimes better than that provided by IMXT. However, VHEET provided an improvement over IMXT in the dose sparing of the sensitive structures and normal tissues. Compared to IMXT, VHEET decreased the mean rectal dose and bladder dose by up to 10% of the prescribed target dose, while reducing by up to 12% of the prescribed target dose the integral dose to normal tissues. In quantifying the merits of IMPT relative to IMXT, it was found that using intensity-modulated proton beams for inverse planning instead of intensity-modulated photon beams improved target dose homogeneity by up to 1.3% of the prescribed target dose, while reducing the mean rectal dose, bladder dose, and normal tissue integral dose by up to 27%, 30% and 28% of the prescribed target dose respectively. The comparison of optimized planning for IMPT and VHEET showed that the quality of target coverage achievable with IMPT is comparable to or better (by up to 1.3% of the prescribed target dose) than that provided by VHEET. Compared to VHEET, IMPT delivered a mean rectal dose and a bladder dose that was lower by up to 17% and 23% of prescribed target dose respectively, and also reduced the integral dose to normal tissues by up to 17% of the prescribed target dose. These results indicate that of the three modalities the greatest dose escalation will be possible with IMPT, then VHEET, and then IMXT. It follows that IMPT will result in the highest probability of complication-free tumour control, while IMXT will provide the lowest probability.
This work evaluates the potential of very high energy (50-250 MeV) electron beams for dose conformation and identifies those variables that influence optimized dose distributions for this modality. Intensity-modulated plans for a prostate cancer model were optimized as a function of the importance factors, beam energy and number of energy bins, number of beams, and the beam orientations. A trial-and-error-derived constellation of importance factors for target and sensitive structures to achieve good conformal dose distributions was 500, 50, 10 and I for the target, rectum, bladder and normal tissues respectively. Electron energies greater than 100 MeV were found to be desirable for intensity-modulated very high energy electron therapy (VHEET) of prostate cancer. Plans generated for lower energy beams had relatively poor conformal dose distributions about the target region and delivered high doses to sensitive structures. Fixed angle beam treatments utilizing a large number of fields in the range 9-21 provided acceptable plans. Using more than 21 beams at fixed gantry angles had an insignificant effect on target coverage, but resulted in an increased dose to sensitive structures and an increased normal tissue integral dose. Minor improvements in VHEET plans utilizing a 'small' number (< or =9) of beams may be achieved if, in addition to intensity modulation, energy modulation is implemented using a small number (< or =3) of beam energies separated by 50 to 100 MeV. Rotation therapy provided better target dose homogeneity but unfortunately resulted in increased rectal dose, bladder dose and normal tissue integral dose relative to the 21-field fixed angle treatment plan. Modulation of the beam energy for rotation therapy had no beneficial consequences on the optimized dose distributions. Lastly, selection of beam orientations influenced the optimized treatment plan even when a large number of beams (approximately 15) were employed.
In this work, leakage radiation from EA200 series electron applicators on Siemens Primus accelerators is quantified, and its penetration ability in water and/or the shielding material Xenolite‐NL established. Initially, measurement of leakage from 10×10−25×25 cm2 applicators was performed as a function of height along applicator and of lateral distance from applicator body. Relative to central‐axis ionization maximum in solid water, the maximum leakage in air observed with a cylindrical ion chamber with 1 cm solid water buildup cap at a lateral distance of 2 cm from the front and right sidewalls of applicators were 17% and 14%, respectively; these maxima were recorded for 18 MeV electron beams and applicator sizes of ≥20×20 cm2. In the patient plane, the applicator leakage gave rise to a broad peripheral dose off‐axis distance peak that shifted closer to the field edge as the electron energy increases. The maximum peripheral dose from normally incident primary electron beams at a depth of 1 cm in a water phantom was observed to be equal to 5% of the central‐axis dose maximum and as high as 9% for obliquely incident beams with angles of obliquity ≤ 40°. Measured depth‐peripheral dose curves showed that the “practical range” of the leakage electrons in water varies from approximately 1.4 to 5.7 cm as the primary electron beam energy is raised from 6 to 18 MeV. Next, transmission measurements of leakage radiation through the shielding material Xenolite‐NL showed a 4 mm thick sheet of this material is required to attenuate the leakage from 9 MeV beams by two‐thirds, and that for every additional 3 MeV increase in the primary electron beam energy, an additional Xenolite‐NL thickness of roughly 2 mm is needed to achieve the aforementioned attenuation level. Finally, attachment of a 1 mm thick sheet of lead to the outer surface of applicator sidewalls resulted in a reduction of the peripheral dose by up to 80% and 74% for 9 and 18 MeV beams, respectively. This sidewall modification had an insignificant effect on the clinical depth dose, cross‐axis beam profiles, and output factors.PACS numbers: 87.53.Bn, 87.56.bd, 87.56.J‐
The energy spectra and the dose to a Cu plate/Gd2O2S phosphor portal imaging detector were investigated for monoenergetic incident beams of photons (1.25, 2, and 5 MeV). The Monte Carlo method was used to characterize the influence of the patient/detector geometry, detector material and design, and incident beam energy on the spectral distribution and the dose, at the imaging detector plane, of a photon beam scattered from a water phantom. The results show that radiation equilibrium is lost in the air gap and that, for the geometries studied, this effect led to a reduction in the exit dose of up to 40%. The finding that the effects of the air gap and field size are roughly complementary has led to the hypothesis that an equivalent field size concept may be used to account for intensity and spectral changes arising from air gap variations. The copper plate preferentially attenuates the low-energy scattered photons incident on it, while producing additional annihilation, bremsstrahlung, and scattered photons. As a result, the scatter spectra at the copper surface entrance of the detector differs significantly from that at the Cu/phosphor interface. In addition, the mean scattered photon energy at the interface was observed to be roughly 0.4 MeV higher than the corresponding effective energy for 2 MeV incident beams. A comparison of the dose to various detector materials showed that exit dosimetry errors of up to 24% will occur if it is assumed that the Cu plate/Gd2O2S phosphor detector is water equivalent.
Inverse planning for intensity- and energy-modulated radiotherapy (IEMRT) with proton beams involves the selection of (i) the relative importance factors to control the relative importance of the target and sensitive structures, (ii) an appropriate energy resolution to achieve an acceptable depth modulation, (iii) an appropriate beamlet width to modulate the beam laterally, and (iv) a sufficient number of beams and their orientations. In this article we investigate the influence of these variables on the optimized dose distribution of a simulated prostate cancer IEMRT treatment. Good dose conformation for this prostate case was achieved using a constellation of I factors for the target, rectum, bladder, and normal tissues of 500, 50, 15, and 1, respectively. It was found that for an active beam delivery system, the energy resolution should be selected on the basis of the incident beams' energy spread (sigmaE) and the appropriate energy resolution varied from 1 MeV at sigmaE = 0.0 to 5 MeV at sigmaE= 2.0 MeV. For a passive beam delivery system the value of the appropriate depth resolution for inverse planning may not be critical as long as the value chosen is at least equal to one-half the FWHM of the primary beam Bragg peak. Results indicate that the dose grid element dimension should be equal to or no less than 70% of the beamlet width. For this prostate case, we found that a maximum of three to four beam ports is required since there was no significant advantage to using a larger number of beams. However for a small number (< or = 4) of beams the selection of beam orientations, while having only a minor effect on target coverage, strongly influenced the sensitive structure sparing and normal tissue integral dose.
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