Clinical use of a wing field with transmission block for the treatment of the pelvis including the inguinal node

Treatment planning of photon and electron beams to include the pelvis and the groin poses a technical difficulty of positioning beams, and a dosimetric problem of abutting fields at the groin. We have analyzed a simpler AP/PA method using a central transmission block. The posterior portal is smaller and opposes only the pelvic portion of the anterior portal under the transmission block, while the anterior extended portion (hence the wing) is unattenuated to treat the inguinal region. By calculating the attenuation thickness according to the patient's separation and the beam quality, the dose distribution is tailored to yield the proper dose to the pelvic mid-plane and the inguinal nodes while minimizing the dose to the femora. Measured dose distribution (6MV) using film dosimetry in a tissue-equivalent phantom indicates that a 30% hot spot is created by the posterior portal diverging into the wings of the anterior field. Therefore, the pelvic attenuator is tapered at its lateral edges, thereby significantly reduced the dose inhomogeneity (5%) at the groin. Clinical methods are outlined for the verification of the patient portal films against possible mismatch in beam divergence.

An assessment of a film enhancement system for use in a radiation therapy department

The clinical uses of a radiotherapy film enhancement system are explored. The primary functions of the system are to improve the quality of poorly exposed simulator and portal films, and to perform comparisons between the two films to determine whether patient or block positioning errors are present. Other features include: the production of inexpensive, high quality hardcopy images of simulation films and initial portal films for chart documentation, the capacity to overlay lateral simulation films with sagittal MRI films to aid in field design, and a mode to zoom in on individual CT or MRI images and enlarge them for video display during chart rounds or instructional sessions. This commercially available system is comprised of a microcomputer, frame grabber, CCD camera with zoom lens, and a high-resolution thermal printer. The user-friendly software is menu driven and utilizes both keyboard and track ball to perform its functions. At the heart of the software is a very fast Adaptive Histogram Equalization (AHE) routine, which enhances and improves the readability of most portal films. The system has been evaluated for several disease sites, and its advantages and limitations will be presented.