Accurate dosimetry of the narrow beam tends to be difficult to perform due to the absence of lateral electronic equilibrium and the steep dose gradient, as well as the finite size of detectors. Thus, although the high dose rate 6 MV beam on the VARIAN Trilogy accelerator is increasingly utilized for stereotactic radiosurgery (SRS) treatment, there is no general agreement in the SRS beam output factor values among the Trilogy user community. Trilogy SRS beams are confined by cone collimators and the available collimator sizes range from 5 and 10 to 30 mm, in every 2 mm increment. A range of the relative output factors are in clinic use. This variation may impair observations of dose response and optimizations of the prescribed dose. It is necessary to investigate an accurate, easily performable, and detector independent method for the narrow beam output factor measurement. In this study, a scanning beam/scanning chamber method was proposed to overcome the limitation/difficulty of using a relatively large detector in narrow beam output factor measurement. Specifically, for the scanning beam method, multiple narrow beams are used for the dose measurement using a finite size chamber. These multiple scanning beams form an equivalent large uniform field which provides lateral electron equilibrium condition. After the measurement, the contributions from neighboring beams are deconvolved and the value is used for output factor determinations. For a Linac that cannot move a beam laterally, the scanning chamber method can be used to achieve the same result. The output factors determined in such a method were compared to chambers (a 0.015 cc PTW PinPoint ion chamber and a 0.125 cc PTW ion chamber) and film measurement, as well as with Monte Carlo simulation. Film and Monte Carlo results are found to be in excellent agreement with the measurement using the scan beam method. However, the VARIAN recommended output factors measured directly by Wellhöfer CC01 chamber and Scanditronix photon field diode are consistently higher for all the cones. Especially for the 5 mm cone, the difference is more than 10%. Overall, the results suggested that the new method can help overcoming the detector volume averaging effect and the positioning uncertainties, which constitute the major challenge in small radiosurgical beam output factor measurement, and provide reliable output factors.
The purpose of this study is to evaluate the treatment plan adequacy and delivery efficiency among volumetric-modulated arc therapy (VMAT) with one or two arcs and the conventional static-field dynamic multileaf collimator (dMLC) intensity-modulated radiation therapy (IMRT) in patients undergoing oropharyngeal carcinoma. Fifteen patient cases were included in this investigation. Each of the cases was planned using step-and-shoot IMRT, VMAT with a single arc (Arc1) and VMAT with double arcs (Arc2). A two-dose level prescription for planning target volumes (PTVs) was delivered with 70 Gy/56 Gy in 30 fractions. Comparisons were performed of the dose-volume histograms (DVH) for PTVs, the DVH for organs at risk (OARs), the monitor units per fraction (MU/fx), and delivery time. IMRT and Arc2 achieved similar target coverage, but superior to Arc1. Apart from the oral cavity, Arc1 showed no advantage in sparing of OARs compared with IMRT, while Arc2 obtained equivalent or better sparing of OARs among the three techniques. VMAT reduced MU/fx and shortened delivery time remarkably compared with IMRT. Our results demonstrated that for oropharyngeal cases, Arc2 can achieve superior target coverage and normal tissue sparing, as well as a significant reduction in treatment time.
Summary: Heterotopic brain outside the cranial vault is uncommon. lt occurs most frequently in the nasal region, although rests elsewhere in the aerodigestive tract have been reported. We describe a case of heterotopic brain in the pterygopalatine fossa.
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