A study of the performance of five commercial radiotherapy treatment planning systems (TPSs) for common treatment sites regarding their ability to model heterogeneities and scattered photons has been performed. The comparison was based on CT information for prostate, head and neck, breast and lung cancer cases. The TPSs were installed locally at different institutions and commissioned for clinical use based on local procedures. For the evaluation, beam qualities as identical as possible were used: low energy (6 MV) and high energy (15 or 18 MV) x-rays. All relevant anatomical structures were outlined and simple treatment plans were set up. Images, structures and plans were exported, anonymized and distributed to the participating institutions using the DICOM protocol. The plans were then re-calculated locally and exported back for evaluation. The TPSs cover dose calculation techniques from correction-based equivalent path length algorithms to model-based algorithms. These were divided into two groups based on how changes in electron transport are accounted for ((a) not considered and (b) considered). Increasing the complexity from the relatively homogeneous pelvic region to the very inhomogeneous lung region resulted in less accurate dose distributions. Improvements in the calculated dose have been shown when models consider volume scatter and changes in electron transport, especially when the extension of the irradiated volume was limited and when low densities were present in or adjacent to the fields. A Monte Carlo calculated algorithm input data set and a benchmark set for a virtual linear accelerator have been produced which have facilitated the analysis and interpretation of the results. The more sophisticated models in the type b group exhibit changes in both absorbed dose and its distribution which are congruent with the simulations performed by Monte Carlo-based virtual accelerator.

The data of this study suggest that the majority of long-term survivors of brain tumours develop GH deficiency following radiotherapy in childhood and that the adverse effects of radiotherapy may be directly related to the biologically effective dose. With longer follow-up fewer patients might respond normally to GH stimulation tests.

Children with brain tumors are at high risk of developing growth hormone deficiency (GHD) after cranial irradiation (CI) if the hypothalamus/pituitary (HP) axis falls within the fields of irradiation. The biological effective dose (BED) of irradiation to the HP region was determined, since BED gives a means of expressing the biological effect of various irradiation treatment schedules in a uniform way. Hypothalamic versus pituitary damage as cause of GHD was distinguished in 62 patients by comparing the growth hormone (GH) peak response to an insulin tolerance test (ITT)/arginine stimulation test and the GH response to a growth hormone-releasing hormone (GHRH) stimulation test. Peak GH response to a GHRH test was significantly higher (median 7.3 mU/l; range: 0.5–79.0 mU/l) than that of an ITT/arginine test (median 4.7 mU/l; range: 0.01–75.0 mU/l) (p = 0.017). Peak GH after a GHRH test was significantly inversely correlated to follow-up time (r_s = –0.46, p < 0.0001) and to BED (R_s = –0.28, p = 0.03), and both were found to be of significance in a multivariante regression analysis. We speculate that a significant number of patients developed hypothalamic radiation-induced damage to the GHRH secreting neurons, and secondary to this the pituitary gland developed decreased responsiveness to GHRH following CI in childhood.

Purpose: This paper describes our experiences of implementing systematic in vivo dosimetry at the Norfolk and Norwich Hospital and reviews the results of 2,254 entrance dose measurements made over a 17-month period.Methods and materials: Entrance dose measurements using p-type diodes were performed on all new planned patients. The calibration procedure and correction factors applied are described. A 4% tolerance was applied.Results: The results of all measurements indicated a small mean deviation from expected entrance dose of ϩ0.77% and a standard deviation of 2.85%. 16.7% of all measurements exceeded the 4% tolerance with 9.2% exceeding a 5% level. The estimated overall errors for 578 treatments were calculated using the weighted averages of all beams. A narrower SD of 1.96% combined with only 4.8% of all treatments exceeding a 4% tolerance show that large deviations from a single field do not always translate into significant overall errors.Conclusions: Global dosimetric accuracy was within clinically acceptable limits and variations between measured and expected doses were mainly attributable to factors affecting diode reading. A number of errors in calculating deviations and the inconsistent application of the protocol suggest the need for interfacing the diode system with software control. KeywordsIn vivo dosimetry; diodes; quality assurance Systematic in vivo dosimetry for quality assurance using diodes

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