Whole-limb irradiation of the lower calf using a six-field electron technique

Planar dose calculation of electron therapy

Purpose.The aim of this study is to determine the planar dose distribution of irregularly-shaped electron beams at their maximum dose depth (zmax) using the modied lateral build-up ratio (LBR) and curve-fitting methods.Methods.Circular and irregular cutouts were created using Cerrobend alloy for a 14 × 14 cm2applicator. Percentage depth dose (PDD) at the standard source-surface-distance (SSD = 100 cm) and point dose at different SSD were measured for each cutout. Orthogonal profiles of the cutouts were measured atzmax. Data were collected for 6, 9, 12, and 15 MeV electron beam energies on a VERSA HDTMLINAC using the IBA Blue Phantom23D water phantom system. The planar dose distributions of the cutouts were also measured atzmaxin solid water using EDR2 films.Results.The measured PDD curves were normalized to a normalization depth (d0) of 1 mm. The lateral-buildup-ratio (LBR), lateral spread parameter (σR(z)), and effective SSD (SSDeff) for each cutout were calculated using the PDD of the open applicator as the reference field. The modified LBR method was then employed to calculate the planar dose distribution of the irregular cutouts within the field at least 5 mm from the edge. A simple curve-fitting model was developed based on the profile shapes of the circular cutouts around the field edge. This model was used to calculate the planar dose distribution of the irregular cutouts in the region from 3 mm outside to 5 mm inside the field edge. Finally, the calculated planar dose distribution was compared with the film measurement.Conclusions.The planar dose distribution of electron therapy for irregular cutouts atzmaxwas calculated using the improved LBR method and a simple curve-fitting model. The calculated profiles were within 3% of the measured values. The gamma passing rate with a 3%/3 mm and 10% dose threshold was more than 96%.

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

The peculiar and rare clinical condition below clearly requires a customized care approach in the context of personalized medicine. An 80-year-old female patient who was subjected in 2018 to surgical removal of a cutaneous Merkel cell carcinoma (MCC) nodule located on the posterior surface of the left thigh and to three subsequent palliative radiotherapy treatments developed a fourth relapse in October 2020, with fifteen nodular metastases located in the left thigh and leg. Since the overall macroscopic disease was still exclusively regionally located and microscopic spread was likely extended also to clinically negative skin of the thigh and leg, we performed an irradiation of the whole left lower extremity. For this purpose the total target (65.5 cm) was divided into three sub-volumes. Dose prescription was 30 Gy in 15 daily fractions. A sequential boost of 10 Gy in 5 daily fractions was planned for macroscopic nodules. Plans were calculated by means of volumetric modulated arc therapy (VMAT) with the field overlap technique. Thanks to this, we obtained a homogeneous dose distribution in the field junction region; avoidance structures were delineated in the central part of the thigh and leg with the aim of achieving an optimal superficial dose painting and to reduce bone exposure to radiation. This case study demonstrates that VMAT allows for a good dose coverage for circumferential cutaneous targets while sparing deeper organs at risk. A reproducible image-guided set-up is fundamental for an accurate and safe dose delivery. However, local treatments such as radiotherapy for very advanced MCC of the lower extremities might have limited impact due to the high probability of systemic progression, as illustrated in this case. Radiation is confirmed as being effective in preventing MCC nodule progression toward skin wounding.

Output calculation of electron therapy at extended SSD using an improved LBR method

PURPOSE

To calculate the output factor (OPF) of any irregularly shaped electron beam at extended SSD.

METHODS

Circular cutouts were prepared from 2.0 cm diameter to the maximum possible size for 15 × 15 applicator cone. In addition, two irregular cutouts were prepared. For each cutout, percentage depth dose (PDD) at the standard SSD and doses at different SSD values were measured using 6, 9, 12, and 16 MeV electron beam energies on a Varian 2100C LINAC and the distance at which the central axis electron fluence becomes independent of cutout size was determined. The measurements were repeated with an ELEKTA Synergy LINAC using 14 × 14 applicator cone and electron beam energies of 6, 9, 12, and 15 MeV. The PDD measurements were performed using a scanning system and two diodes-one for the signal and the other a stationary reference outside the tank. The doses of the circular cutouts at different SSDs were measured using PTW 0.125 cm(3) Semiflex ion-chamber and EDR2 films. The electron fluence was measured using EDR2 films.

RESULTS

For each circular cutout, the lateral buildup ratio (LBR) was calculated from the measured PDD curve using the open applicator cone as the reference field. The effective SSD (SSDeff) of each circular cutout was calculated from the measured doses at different SSD values. Using the LBR value and the radius of the circular cutout, the corresponding lateral spread parameter [σR(z)] was calculated. Taking the cutout size dependence of σR(z) into account, the PDD curves of the irregularly shaped cutouts at the standard SSD were calculated. Using the calculated PDD curve of the irregularly shaped cutout along with the LBR and SSDeff values of the circular cutouts, the output factor of the irregularly shaped cutout at extended SSD was calculated. Finally, both the calculated PDD curves and output factor values were compared with the measured values.

CONCLUSIONS

The improved LBR method has been generalized to calculate the output factor of electron therapy at extended SSD. The percentage difference between the calculated and the measured output factors of irregularly shaped cutouts in a clinical useful SSD region was within 2%. Similar results were obtained for all available electron energies of both Varian 2100C and ELEKTA Synergy machines.

Dose calculation for electron therapy using an improved LBR method

PURPOSE

To calculate the percentage depth dose (PDD) of any irregularly shaped electron beam using a modified lateral build-up ratio (LBR) method.

METHODS

Percentage depth dose curves were measured using 6, 9, 12, and 15 MeV electron beam energies for applicator cone sizes of 6 × 6, 10 × 10, 14 × 14, and 20 × 20 cm(2). Circular cutouts for each cone were prepared from 2.0 cm diameter to the maximum possible size for each cone. In addition, three irregular cutouts were prepared.

RESULTS

The LBR for each circular cutout was calculated from the measured PDD curve using the open field of the 14 × 14 cm(2) cone as the reference field. Using the LBR values and the radius of the circular cutouts, the corresponding lateral spread parameter [σR(z)] of the electron shower was calculated. Unlike the commonly accepted assumption that σR(z) is independent of cutout size, it is shown that its value increases linearly with circular cutout size (R). Using this characteristic of the lateral spread parameter, the PDD curves of irregularly shaped cutouts were calculated. Finally, the calculated PDD curves were compared with measured PDD curves.

CONCLUSIONS

In this research, it is shown that the lateral spread parameter σR(z) increases with cutout size. For radii of circular cutout sizes up to the equilibrium range of the electron beam, the increase of σR(z) with the cutout size is linear. The percentage difference of the calculated PDD curve from the measured PDD data for irregularly shaped cutouts was under 1.0% in the region between the surface and therapeutic range of the electron beam. Similar results were obtained for four electron beam energies (6, 9, 12, and 15 MeV).

Recommendations for clinical electron beam dosimetry: supplement to the recommendations of Task Group 25

The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of.Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at 60Co energy, N60Co(D,w), together with the theoretical beam quality conversion coefficient k(Q) for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of radiochromic film for electrons is addressed, and radiographic film that is no longer available has been replaced by film that is available. Realistic stopping-power data are incorporated when appropriate along with enhanced tables of electron fluence data. A larger list of clinical applications of electron beams is included in the full TG-70 report available at http://www.aapm.org/pubs/reports. Descriptions of the techniques in the clinical sections are not exhaustive but do describe key elements of the procedures and how to initiate these programs in the clinic. There have been no major changes since the TG-25 report relating to flatness and symmetry, surface dose, use of thermoluminescent dosimeters or diodes, virtual source position designation, air gap corrections, oblique incidence, or corrections for inhomogeneities. Thus these topics are not addressed in the TG-70 report.

Review of electron beam therapy physics

For over 50 years, electron beams have been an important modality for providing an accurate dose of radiation to superficial cancers and disease and for limiting the dose to underlying normal tissues and structures. This review looks at many of the important contributions of physics and dosimetry to the development and utilization of electron beam therapy, including electron treatment machines, dose specification and calibration, dose measurement, electron transport calculations, treatment and treatment-planning tools, and clinical utilization, including special procedures. Also, future changes in the practice of electron therapy resulting from challenges to its utilization and from potential future technology are discussed.