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Radiation Dose in Radiotherapy from Prescription to Delivery

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Radiation Dose in Radiotherapy from Prescription to Delivery IAEA-TECDOC-896 XA9642841 Radiation dose in radiotherapy from prescription to delivery INTERNATIONAL ATOMIC ENERGY AGENCY The originating Section of this publication in the IAEA was: Dosimetry Section International Atomic Energy Agency Wagramerstrasse 5 P.O. Box 100 A-1400 Vienna, Austria RADIATION DOSE IN RADIOTHERAPY FROM PRESCRIPTION TO DELIVERY IAEA, VIENNA, 1996 IAEA-TECDOC-896 ISSN 1011-4289 © IAEA, 1996 Printed by the IAEA in Austria August 1996 The IAEA does not normally maintain stocks of reports in this series. However, microfiche copies of these reports can be obtained from INIS Clearinghouse International Atomic Energy Agency Wagramerstrasse 5 P.O. Box 100 A-1400 Vienna, Austria Orders should be accompanied by prepayment of Austrian Schillings 100, in the form of a cheque or in the form of IAEA microfiche service coupons which may be ordered separately from the INIS Clearinghouse. FOREWORD Cancer incidence is increasing in developed as well as in developing countries. However, since in some advanced countries the cure rate is increasing faster than the cancer incidence rate, the cancer mortality rate is no longer increasing in such countries. The increased cure rate can be attributed to early diagnosis and improved therapy. On the other hand, until recently, in some parts of the world - particularly in developing countries - cancer control and therapy programmes have had relatively low priority. The reason is the great need to control communicable diseases. Today a rapidly increasing number of these diseases are under control. Thus, cancer may be expected to become a prominent problem and this will result in public pressure for higher priorities on cancer care. The creation of adequate treatment facilities and the training of the necessary personnel will take time, in some cases 10 to 15 years. In some relatively advanced developing countries radiation therapy is applied in about 50% of all detected cancer cases. Approximately half of these treatments have curative intent. Surgery and radiotherapy applied individually or combined result in the cure of about 40% of all patients. The application of chemotherapy alone has curative effects only on a small percentage of the cancer patients. Moreover, palliative radiotherapy is often excellent in providing prolonged life and increased life quality for patients with incurable cancer. It is encouraging to note that the results achieved by radiation therapy show continuous improvement. This can be traced back to a number of developments: increased knowledge regarding tumour and normal tissue response to radiation, early diagnosis with improved tumour localisation, improved dosimetry and dose planning. The introduction of modern equipment (CT-scanners, “Co-units, linear accelerators, computerised treatment planning systems, etc.) has been crucial in these developments and makes possible a more accurate target delineation, better treatment planning resulting in irradiation of the Planning Target Volume (PTV) with a highly uniform dose and, simultaneously, a reduction in dose to healthy tissues outside the PTV. Experience shows that high quality radiotherapy can only be achieved if it is conducted by a skilled team working closely together with good communication between various categories of staff. The team must consist of radiation oncologists, radiation physicists and radiographers. It is also shown that dose prescribed and dose delivered have to agree within +/- 5 % in the PTV to achieve a controlled cure rate without excessive complications to normal tissue. Due to the increasing demands for high accuracy in dose delivery, one of the goals of the seminar was to deal with all the different steps in treatment procedure from the decision of treatment strategy to the quality assurance of the treatments. In some advanced developing countries - especially in Latin America - the trend now is to move from “Co-units to linear accelerators. Absolute doses as well as dose distributions from the latter type of therapy machines vary and can easily be altered through service actions or faulty parts. Therefore, seminars and training courses covering all aspects of quality control in radiotherapy and dosimetry are of great importance and should be held regionally or nationally on a regular basis. EDITORIAL NOTE In preparing this publication for press, staff of the IAEA have made up the pages from the original manuscripts as submitted by the authors. The views expressed do not necessarily reflect those of the governments of the nominating Member States or of the nominating organizations. Throughout the text names of Member States are retained as they were when the text was compiled. The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. The authors are responsible for having obtained the necessary permission for the IAEA to reproduce, translate or use material from sources already protected by copyrights. CONTENTS L ACCURACY REQUIREMENTS IN RADIOTHERAPY Tumor and normal tissue responses to fractionated non-uniform dose delivery ............... 9 P. Kallman, A. Agren, A. Brahme Converting dose distributions into tumour control probability ..............................................27 A.E. Nahum Definition of treatment geometry in radiation therapy .......................................................... 41 P. Aaltonen Dosimetric precision requirements and quantities for characterizing the response of tumors and normal tissues ..................................................................................................... 49 A. Brahme IL EQUIPMENT REQUIREMENTS Lessons learned from accidents in radiotherapy .......................................................................69 P. Ortiz-Lopez, J. Novotny , J. Haywood Review of WHO/PAHO/IAEA recommendations concerning radiotherapy facilities . 83 G.P. Hanson Alternative designs for megavoltage machines for cancer treatment in developing countries ...................................................................................................................................... 93 C. Bonds, H. Svensson, G.P. Hanson Simulation and radiation treatment in external radiotherapy .............................................. 101 E. Singer Analysis of variations in the dose delivered in radiation therapy ....................................107 D. B. Feld m(a). INTERCOMPARISON The role of SSDL-Helsinki for dosimetry and quality audit in radiotherapy ..................113 P. Aaltonen SSDL Argentina: Dosimetric intercomparison programme for cobalt 60 therapy units .............................................................................................................................123 M. Saravi, S. Papadopulos, H. Mugliaroli A program on quality assurance and dose calibration for radiation therapy units in Venezuela ..................................................................................................................................135 M.C. de Padilla, L. Carrizales, J. Diaz, F. Gutt, A. Cozman 111(b). DOSIMETRY PROCEDURES Radiation dosimetry with plane-parallel ionization chambers: An International (IAEA) Code of Practice [Invited Paper] ...............................................143 P. Andreo, P.R. Almond, O. Mattsson, A.E. Nahum, M. Roos An algorithm to include the bremsstrahlung component in the determination of the absorbed dose in electron beams .........................................................................................159 S.C. Klevenhagen Clinical dosimetry with plastic scintillators - almost energy independent, direct absorbed dose reading with high resolution .....................................................................165 U. Quest, D. Fluhs, H. Kolanoski Absorbed dose beam quality factors for cylindrical ion chambers: Experimental determination at 6 and 15 MV photon be ams ................................................................ 171 C. Cqporali, A.S. Guerra, R.F. Leatano, M. Pimpinella Displacement correction factor versus effective point of measurement in depth dose curve measurements at 60Co gamma rays ................................................................179 A. Bruna, G.R. Velez, M. Brunetto An analysis of some aspects of the attenuation-scatter functions in brachytherapy dosimetry ............................................................................................................................... 185 S.C. Klevenhagen Standardization of iridium-192 coiled source in terms of air kerma output ...................... 199 A. Shanta, K. Unnikrishntm, U.B. Tripathi, A. Kcmnan, P.S. Iyer Calibration of 192 Ir high dose rate brachytherapy sources ................................................... 203 M.H. Marechal, C.E. de Almeida, C.H. Sibata Quality control of Ir-192, Cs-137 and Ra-226 sources for use in brachytherapy .......... 207 C.H. Oyarzun Cortes, AM. PalmaD., H. Pefialoza C., M. Tomicic IV. QUALITY ASSURANCE NETWORK IN RADIOTHERAPY Quality Assurance Network: the European pilot study ........................................................ 213 J Chavaudra, A. Dutreix, S Derreumaux, A. Brider, E. van der Schueren
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