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Zürich (Kreis 7) / Hirslanden, Switzerland

Halg R.A.,Radiotherapie Hirslanden AG | Besserer J.,Radiotherapie Hirslanden AG | Boschung M.,Paul Scherrer Institute | Mayer S.,Paul Scherrer Institute | And 2 more authors.
Radiation Oncology | Year: 2012

Background: Due to the substantial increase in beam-on time of high energy intensity-modulated radiotherapy (>10 MV) techniques to deliver the same target dose compared to conventional treatment techniques, an increased dose of scatter radiation, including neutrons, is delivered to the patient. As a consequence, an increase in second malignancies may be expected in the future with the application of intensity-modulated radiotherapy. It is commonly assumed that the neutron dose equivalent scales with the number of monitor units.Methods: Measurements of neutron dose equivalent were performed for an open and an intensity-modulated field at four positions: inside and outside of the treatment field at 0.2 cm and 15 cm depth, respectively.Results: It was shown that the neutron dose equivalent, which a patient receives during an intensity-modulated radiotherapy treatment, does not scale with the ratio of applied monitor units relative to an open field irradiation. Outside the treatment volume at larger depth 35% less neutron dose equivalent is delivered than expected.Conclusions: The predicted increase of second cancer induction rates from intensity-modulated treatment techniques can be overestimated when the neutron dose is simply scaled with monitor units. © 2012 Hälg et al.; licensee BioMed Central Ltd. Source


Halg R.A.,Radiotherapie Hirslanden AG | Besserer J.,Radiotherapie Hirslanden AG | Schneider U.,Radiotherapie Hirslanden AG | Schneider U.,University of Zurich
Medical Physics | Year: 2012

Purpose: Contemporary radiotherapy treatment techniques, such as intensity-modulated radiation therapy and volumetric modulated arc therapy, could increase the radiation-induced malignancies because of the increased beam-on time, i.e., number of monitor units needed to deliver the same dose to the target and the larger volume irradiated with low doses. In this study, whole-body dose distributions from typical radiotherapy patient plans using different treatment techniques and therapy machines were measured using the same measurement setup and irradiation intention. Methods: Individually calibrated thermoluminescent dosimeters were used to measure absorbed dose in an anthropomorphic phantom at 184 locations. The dose distributions from 6 MV beams were compared in terms of treatment technique (3D-conformal, intensity-modulated radiation therapy, volumetric modulated arc therapy, helical TomoTherapy, stereotactic radiotherapy, hard wedges, and flattening filter-free radiotherapy) and therapy machine (Elekta, Siemens and Varian linear accelerators, Accuray CyberKnife and TomoTherapy). Results: Close to the target, the doses from intensity-modulated treatments (including flattening filter-free) were below the dose from a static treatment plan, whereas the CyberKnife showed a larger dose by a factor of two. Far away from the treatment field, the dose from intensity-modulated treatments showed an increase in dose from stray radiation of about 50 compared to the 3D-conformal treatment. For the flattening filter-free photon beams, the dose from stray radiation far away from the target was slightly lower than the dose from a static treatment. The CyberKnife irradiation and the treatment using hard wedges increased the dose from stray radiation by nearly a factor of three compared to the 3D-conformal treatment. Conclusions: This study showed that the dose outside of the treated volume is influenced by several sources. Therefore, when comparing different treatment techniques, the dose ratios vary with distance to the isocenter. The effective dose outside the treated volume of intensity-modulated treatments with or without flattening filter was 10-30 larger when compared to 3D-conformal radiotherapy. This dose increase is much lower than the monitor unit scaled effective dose from a static treatment. © 2012 American Association of Physicists in Medicine. Source


Halg R.A.,Radiotherapie Hirslanden AG | Besserer J.,Radiotherapie Hirslanden AG | Schneider U.,Radiotherapie Hirslanden AG | Schneider U.,University of Zurich
Medical Physics | Year: 2012

Purpose: The full benefit of the increased precision of contemporary treatment techniques can only be exploited if the accuracy of the patient positioning is guaranteed. Therefore, more and more imaging modalities are used in the process of the patient setup in clinical routine of radiation therapy. The improved accuracy in patient positioning, however, results in additional dose contributions to the integral patient dose. To quantify this, absorbed dose measurements from typical imaging procedures involved in an image-guided radiation therapy treatment were measured in an anthropomorphic phantom for a complete course of treatment. The experimental setup, including the measurement positions in the phantom, was exactly the same as in a preceding study of radiotherapy stray dose measurements. This allows a direct combination of imaging dose distributions with the therapy dose distribution. Methods: Individually calibrated thermoluminescent dosimeters were used to measure absorbed dose in an anthropomorphic phantom at 184 locations. The dose distributions from imaging devices used with treatment machines from the manufacturers Accuray, Elekta, Siemens, and Varian and from computed tomography scanners from GE Healthcare were determined and the resulting effective dose was calculated. The list of investigated imaging techniques consisted of cone beam computed tomography (kilo- and megavoltage), megavoltage fan beam computed tomography, kilo- and megavoltage planar imaging, planning computed tomography with and without gating methods and planar scout views. Results: A conventional 3D planning CT resulted in an effective dose additional to the treatment stray dose of less than 1 mSv outside of the treated volume, whereas a 4D planning CT resulted in a 10 times larger dose. For a daily setup of the patient with two planar kilovoltage images or with a fan beam CT at the TomoTherapy unit, an additional effective dose outside of the treated volume of less than 0.4 mSv and 1.4 mSv was measured, respectively. Using kilovoltage or megavoltage radiation to obtain cone beam computed tomography scans led to an additional dose of 8-46 mSv. For treatment verification images performed once per week using double exposure technique, an additional effective dose of up to 18 mSv was measured. Conclusions: Daily setup imaging using kilovoltage planar images or TomoTherapy megavoltage fan beam CT imaging can be used as a standard procedure in clinical routine. Daily kilovoltage and megavoltage cone beam computed tomography setup imaging should be applied on an individual or indication based protocol. Depending on the imaging scheme applied, image-guided radiation therapy can be administered without increasing the dose outside of the treated volume compared to therapies without image guidance. © 2012 American Association of Physicists in Medicine. Source


Halg R.A.,Radiotherapie Hirslanden AG | Besserer J.,Radiotherapie Hirslanden AG | Boschung M.,Paul Scherrer Institute | Mayer S.,Paul Scherrer Institute | And 4 more authors.
Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment | Year: 2012

In order to quantify the dose from neutrons to a patient for contemporary radiation treatment techniques, measurements inside phantoms, representing the patient, are necessary. Published reports on neutron dose measurements cover measurements performed free in air or on the surface of phantoms and the doses are expressed in terms of personal dose equivalent or ambient dose equivalent. This study focuses on measurements of local neutron doses inside a radiotherapy phantom and presents a field calibration procedure for PADC track etch detectors. An initial absolute calibration factor in terms of Hp(10) for personal dosimetry is converted into neutron dose equivalent and additional calibration factors are derived to account for the spectral changes in the neutron fluence for different radiation therapy beam qualities and depths in the phantom. The neutron spectra used for the calculation of the calibration factors are determined in different depths by Monte Carlo simulations for the investigated radiation qualities. These spectra are used together with the energy dependent response function of the PADC detectors to account for the spectral changes in the neutron fluence. The resulting total calibration factors are 0.76 for a photon beam (in- and out-of-field), 1.00 (in-field) and 0.84 (out-of-field) for an active proton beam and 1.05 (in-field) and 0.91 (out-of-field) for a passive proton beam, respectively. The uncertainty for neutron dose measurements using this field calibration method is less than 40%. The extended calibration procedure presented in this work showed that it is possible to use PADC track etch detectors for measurements of local neutron dose equivalent inside anthropomorphic phantoms by accounting for spectral changes in the neutron fluence. © 2012 Elsevier B.V. All rights reserved. Source

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