Seeds containing radioactive Ytterbium-169 (169Yb) have recently been manufactured for possible application to brachytherapy. Ytterbium-169 emits photons with an average energy of 93 keV (excluding energies less than 10 keV), and decays with a half-life of 32 days. Analytic and Monte Carlo computations have been used to predict physical quantities useful in treatment planning and radiation protection. Analytic calculations based on the primary photon spectrum of 169Yb (excluding energies less than 10 keV) yield an air-kerma rate constant of 0.0427 cGy cm2 h-1 MBq-1, and an exposure rate constant of 1.80 R cm2 mCi-1 h-1 for this radionuclide. Calculated fmed factors are 0.922 cGy/R for soft tissue and 2.12 cGy/R for bone. The first half-value layer in lead is 0.2 mm; the first tenth-value layer is 1.6 mm. Using Monte Carlo simulations, the relative dose distributions around 169Yb seeds (Amersham, prototypes 4 and 5) are provided, and are then compared with those around an 125I seed (3M model 6702). The 169Yb seeds produce more isotropic dose distributions, and for permanent implants, can deliver it at a greater initial dose rate. A value of 1.19 cm-2 was also calculated for the specific dose constant D0, a value which is applicable to both seed types. Radiation protection is not as easily achieved for permanent implants with 169Yb because of the higher energy emissions (vs 125I). However, for temporary implants, Ytterbium-169 may prove to be a useful substitute for 192Ir or 137Cs because of its relatively lower energy emissions. It is concluded that 169Yb merits further investigation, including dosimetry, radiobiological, and clinical studies.
Standard silver-based films are usually too sensitive to be used as direct indicators of dose in dynamic radiosurgery because of optical saturation. This paper describes the use of a new radiochromic film to measure 6-MV radiosurgery doses and dose distributions in a head phantom. Dose calibration of the radiochromic film was performed in the range of 2.3-50.2 Gy using light of 632- and 530-nm wavelengths. Radiosurgery dose distributions were measured using the radiochromic film in a head phantom undergoing the same treatment as a patient, and were compared with the planned distributions. For an example case (nominal 2.0-cm-diam cone), film measurement verified the calculated dose distribution in one plane. The simple measurement technique described led to experimental uncertainties of +/- 0.1 cm for the 90% and 50% isodose lines, +/- 0.3 cm for the 20% line, and +/- 0.5 cm for the 10% line. Isocenter dose was measured with an uncertainty of +/- 3%. Refinements to the technique should allow more precise measurements. It is concluded that the radiochromic film, with some limitations, is a convenient and useful tool for dynamic radiosurgery quality assurance.
The primary definer for Siemens MXE and MDX linear accelerators projects a circular opening with a radius of 25 cm at 100 cm from the target. Our measurements of photon beam profiles, however, indicate that the photon fluence drops to 95% of the central axis value at a radius of 18 cm. The flattening filter for these machines projects a flattened field size that is much smaller than the primary definer would allow. The clinical implications of this mismatch for large rectangular fields and for fields defined by asymmetric jaws are discussed and solutions are considered. A large field flattener was designed for our Siemens MXE 6 MV beam using Monte Carlo simulation of the treatment head and water phantom. The accuracy required of source and geometry details for dose distributions calculation is presented. The key parameters are the mean energy and focal spot size of the electron beam incident on the exit window, the material composition, and thickness profile of the exit window, target, flattener, and primary collimator, and the position of the primary collimator relative to the target. Profiles were more sensitive than central axis depth doses to simulation details. The beam energy and primary collimator position were selected to achieve good agreement between measured and calculated dose distributions. The flattener we designed with Monte Carlo was machined from brass and mounted on our MXE treatment unit. Measurements demonstrate that the large field flattener extends the useful radius of the field out to 22 cm, right into the penumbra cast by the primary collimator.
A modified sector-integration method is presented that can predict the output factors of irregular shaped electron fields even in the case of extended source to surface distance (SSD). The model takes as input measured output factors for circular inserts of various radii. These circular fields were measured at SSDs of 100, 105 and 110 cm to determine the effective source distance as a function of radius (ESD(r)). For an arbitrary electron field at any SSD, the shape is divided into small sectors, and the contribution calculated from the radius and ESD(r). The calculated output factors were verified by direct measurements of various types of electron fields mainly based on clinical use. The energies modelled were 8, 10 and 12 MeV for applicator sizes of 10 cm x 10 cm and 14 cm x 14 cm (defined at 95 cm). The calculated values agreed with the measured data within 1% for the various rectangular cutouts including extended source to surface distance. We retrospectively modelled 97 patient inserts of irregular shape, and found agreement within 2% of measured values.
Radiosurgery using the dynamic rotation technique with a single isocentre was introduced at the Toronto-Bayview Regional Cancer Centre (T-BRCC) in 1988. Since then, over 100 patients have been treated. It was soon recognized that 25-30% of patients were referred with either non-spherical lesions or multiple lesions located sufficiently close together that consideration had to be given to the overlapping dose distributions throughout the treated volume. To treat these more complex targets a multiple isocentre technique was developed which also took account of these effects and the resulting normalization problem. This technique was implemented in September 1992. Comparisons between calculated doses and actual doses delivered have been undertaken using a spherical phantom containing radiochromic film. Measured dose distributions agreed with the planned distributions to within +/- 1 mm. The effect of multiple isocentres on the penumbra of dose distributions has been examined. The methods adopted for the normalization of treatment plans and clinical examples illustrating the application of the multiple isocentre technique are presented.
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