Design optimization of intraoperative radiotherapy cones

Research opportunities in intraoperative radiation therapy: the next decade 2013-2023

The reality of intraoperative radiation therapy (IORT) practice is consistent with an efficient and highly precise radiation therapy technique to safely boost areas at risk for local recurrence. Long-term clinical experience has shown that IORT-containing multi-modality regimens appear to improve local disease control, if not survival in many diseases. Research with IORT is a multidisciplinary scenario that covers knowledge from radiation beam adapted development to advance molecular biology for bio-predictability of outcome. The technical parameters employed in IORT procedures are important information to be recorded for quality assurance and clinical results analysis. In addition, specific treatment planning systems for IORT procedures are available, to help in the treatment decision-making process. A systematic revision of opportunities for research and innovation in IORT is reported including radiation beam modulation, delivery, dosimetry and planning; infrastructure and treatment factors; experimental and clinical radiobiology; clinical trials, innovation and translational research development.

Monte Carlo techniques for scattering foil design and dosimetry in total skin electron irradiations

Total skin electron irradiation (TSEI) with single fields requires large electron beams having good dose uniformity, dmax at the skin surface, and low bremsstrahlung contamination. To satisfy these requirements, energy degraders and scattering foils have to be specially designed for the given accelerator and treatment room. We used Monte Carlo (MC) techniques based on EGS4 user codes (BEAM, DOSXYZ, and DOSRZ) as a guide in the beam modifier design of our TSEI system. The dosimetric characteristics at the treatment distance of 382 cm source-to-surface distance (SSD) were verified experimentally using a linear array of 47 ion chambers, a parallel plate chamber, and radiochromic film. By matching MC simulations to standard beam measurements at 100 cm SSD, the parameters of the electron beam incident on the vacuum window were determined. Best match was achieved assuming that electrons were monoenergetic at 6.72 MeV, parallel, and distributed in a circular pattern having a Gaussian radial distribution with full width at half maximum = 0.13 cm. These parameters were then used to simulate our TSEI unit with various scattering foils. Two of the foils were fabricated and experimentally evaluated by measuring off-axis dose uniformity and depth doses. A scattering foil, consisting of a 12 x 12 cm2 aluminum plate of 0.6 cm thickness and placed at isocenter perpendicular to the beam direction, was considered optimal. It produced a beam that was flat within +/-3% up to 60 cm off-axis distance, dropped by not more than 8% at a distance of 90 cm, and had an x-ray contamination of <3%. For stationary beams, MC-computed dmax, Rp, and R50 agreed with measurements within 0.5 mm. The MC-predicted surface dose of the rotating phantom was 41% of the dose rate at dmax of the stationary phantom, whereas our calculations based on a semiempirical formula in the literature yielded a drop to 42%. The MC simulations provided the guideline of beam modifier design for TSEI and estimated the dosimetric performance for stationary and rotational irradiations.