The production of off-focus x rays in the head of a 6 MV linac has been investigated using the EGS4 Monte Carlo code. The purpose of the study was to identify the sources of off-focus radiation and the relative contribution for each source. Even though a particular energy and linac were modeled, the broad conclusions are expected to be general since the effects of head scatter are similar for most conventional head designs, regardless of manufacturer, energy, and model. The head components that were modeled include the exit window of the accelerating structure, target, beam stopper, flattening filter, monitor chamber, primary and secondary collimators, and air. Monoenergetic 6 MeV electrons were followed through the exit window, target, and beam stopper until all energy was expended. Primary- and higher-order x rays produced throughout the head were followed until they were either absorbed or passed through a plane at the isocenter. Sites of off-focus radiation were found to be diffusely distributed throughout the head, with the most intense sources being the primary collimator, flattening filter, and beam stopper. Data analysis shows that the collimator effect is determined primarily by the volume of the extended head-scatter source that is exposed to the point of measurement through the collimating system. The results of this study provide a rationale for developing extended source models to calculate the collimator factor for fields defined by arbitrary collimation. An additional advantage is an improvement in the agreement between measured and calculated isodose distributions.

Seven years of experience in compensator intensity-modulated radiotherapy (IMRT) clinical implementation are presented. An inverse planning dose optimization algorithm was used to generate intensity modulation maps, which were delivered via either the compensator or segmental multileaf collimator (MLC) IMRT techniques. The in-house developed compensator-IMRT technique is presented with the focus on several design issues. The dosimetry of the delivery techniques was analyzed for several clinical cases. The treatment time for both delivery techniques on Siemens accelerators was retrospectively analyzed based on the electronic treatment record in LANTIS for 95 patients. We found that the compensator technique consistently took noticeably less time for treatment of equal numbers of fields compared to the segmental technique. The typical time needed to fabricate a compensator was 13 min, 3 min of which was manual processing. More than 80% of the approximately 700 compensators evaluated had a maximum deviation of less than 5% from the calculation in intensity profile. Seventy-two percent of the patient treatment dosimetry measurements for 340 patients have an error of no more than 5%. The pros and cons of different IMRT compensator materials are also discussed. Our experience shows that the compensator-IMRT technique offers robustness, excellent intensity modulation resolution, high treatment delivery efficiency, simple fabrication and quality assurance (QA) procedures, and the flexibility to be used in any teletherapy unit.

Two intensity modulation radiotherapy (IMRT) delivery systems, the "step & shoot" multileaf collimator (MLC) auto-sequence and the use of an intensity modulator, are compared with emphasis on the dose optimization quality and the treatment irradiation time. The intensity modulation (IM) was created by a dose gradient optimization algorithm which maximizes the target dose uniformity while maintaining dose to critical structures below a set tolerance defined by the user in terms of either a single dose value or a dose volume histogram curve for each critical structure. Two clinical cases were studied with and without dose optimization: a three-field sinus treatment and a six-field nasopharyngeal treatment. The optimization goal of the latter case included the sparing of several nearby normal structures in addition to the target dose uniformity. In both cases, the target dose uniformity initially improved quickly as the IM level increased to 5, then started to approach saturation when the MLC technique was used. In the absence of the both space and intensity discreteness intrinsic to the MLC technique, the modulator technique produced greater tumor dose uniformity and normal structure sparing. The latter showed no systematic improvement with increasing IM level using the MLC technique. For the sinus tumor treatment of 2 Gy the treatment irradiation time of the modulator technique is no more than that of the conventional treatment. For the MLC technique the irradiation time increased rapidly from 4.4 min to 12.4 min as the IM level increased from 2 to 10. Both clinical cases suggested that an IM level of 5 offered a good compromise between the dose optimization quality and treatment irradiation time. We showed that a realistic photon source model is necessary for dose computation accuracy in the MLC-IM treatments.

No abstract

No abstract