Secondary neutron doses from the delivery of 18 MV conventional and intensity modulated radiation therapy (IMRT) treatment plans were compared. IMRT was delivered using dynamic multileaf collimation (MLC). Additional measurements were made with static MLC using a primary collimated field size of 10 x 10 cm2 and MLC field sizes of 0 x 0, 5 x 5, and 10 x 10 cm2. Neutron spectra were measured and effective doses calculated. The IMRT treatment resulted in a higher neutron fluence and higher dose equivalent. These increases were approximately the ratio of the monitor units. The static MLC measurements were compared to Monte Carlo calculations. The actual component dimensions and materials for the Varian Clinac 2100/2300C including the MLC were modeled with MCNPX to compute the neutron fluence due to neutron production in and around the treatment head. There is excellent agreement between the calculated and measured neutron fluence for the collimated field size of 10 x 10 cm2 with the 0 x 0 cm2 MLC field. Most of the neutrons at the detector location for this geometry are directly from the accelerator head with a small contribution from room scatter. Future studies are needed to investigate the effect of different beam energies used in IMRT incorporating the effects of scattered photon dose as well as secondary neutron dose.
Although Technique C was the best method of RT delivery in midline tumors with respect to kidney doses, this was at a cost of a higher mean dose to the liver, stomach, and spleen. This, together with the theoretical increase in secondary malignancies, should be considered when treating a child with IMRT techniques. IMRT was not found to be better than the conventional AP/PA field for lateralized tumors.
Secondary neutron dose-equivalents were determined for conventional and intensity modulated radiation therapy (IMRT) prostate treatments for 15 and 18 MV X-ray beams. Conventional and IMRT treatment plans were generated to deliver 45 Gy to the prostate, seminal vessicles and external and internal iliac lymph nodes. Neutron spectra were determined by unfolding measurements from a TLD-based Bonner sphere system. Treatments using 18 MV IMRT and conventional plans result in neutron ambient dose-equivalents of 687 and 112 mSv, respectively. Delivery of the 15 MV IMRT and conventional plans results in neutron ambient dose-equivalents of 327 and 52 mSv, respectively. The data illustrate that using lower photon energies for IMRT reduces the secondary neutron dose, while still achieving comparable treatment volume coverage and sparing critical normal tissue.
OBJECTIVE Intracranial aneurysms are vascular abnormalities associated with neurological morbidity and mortality due to risk of rupture. In addition, many aneurysm treatments have associated risk profiles that can preclude the prophylactic treatment of asymptomatic lesions. Gamma Knife radiosurgery (GKRS) is a standard treatment for trigeminal neuralgia, tumors, and arteriovenous malformations. Aneurysms associated with arteriovenous malformations have been noted to resolve after treatment of the malformation. The aim of this study was to determine the efficacy of GKRS treatment in a saccular aneurysm animal model. METHODS Aneurysms were surgically produced using an elastase-induced aneurysm model in the right common carotid artery of 10 New Zealand white rabbits. Following initial observation for 4 years, each rabbit aneurysm was treated with a conformal GKRS isodose of 25 Gy to the 50% margin. Longitudinal MRI studies obtained over 2 years and terminal measures obtained at multiple time points were used to track aneurysm size and shape index modifications. RESULTS Aneurysms did not rupture or involute during the observation period. Whole aneurysm and blood volume averages decreased with a linear trend, at rates of 1.7% and 1.6% per month, respectively, over 24 months. Aneurysm wall percent volume increased linearly at a rate of 0.3% per month, indicating a relative thickening of the aneurysm wall during occlusion. Nonsphericity of the average volume, aspect ratio, and isoperimetric ratio of whole aneurysm volume all remained constant. Histopathological samples demonstrated progressive reduction in aneurysm size and wall thickening, with subintimal fibrosis. Consistent shape indices demonstrate stable aneurysm patency and maintenance of minimal rupture risk following treatment. CONCLUSIONS The data indicate that GKRS targeted to saccular aneurysms is associated with histopathological changes and linear reduction of aneurysm size over time. The results suggest that GKRS may be a viable, minimally invasive treatment option for intracranial aneurysm obliteration.
The major errors in HDR procedures were failures to enter the correct treatment distance, which could be caused by either entering wrong transmission lengths or imprecisely digitizing the dwelling positions. Most of those errors were not easily avoidable by enhancing the HDR management level because they were caused by implementations of nonstandardized applicators utilizing transmission tubes of different lengths in standard HDR procedures. We performed this comprehensive study to include all possible situations with different nonstandardized applicators that frequently occurred in HDR procedures, provide corresponding situations with standard applicator as comparisons, list all possible errors and in planning, clarify the confusions in offsets setting, and provide mathematical and quantitative solutions for each given scenarios. Training on HDR procedures with nonstandardized applicators are normally not included in most residential program for medical physics, thus this study could be meaningful in both clinical and educational purpose. At precision of 1 mm, our study could be used as the essential and practical reference for finding the correct treatment length as well as locating the accurate dwelling positions in any HDR procedure with nonstandardized applicators.
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