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Techniques in Dosimetry and 3-D Treatment Planning for Stereotactic Radio Surgery/Radiotherapy

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Techniques in Dosimetry and 3-D Treatment Planning for Stereotactic Radio Surgery/Radiotherapy u þ¡, lB"t2" Techniques in Dosimetry and 3-D Treatment Planning for Stereotactic Radio surgery/Radiotherapy Mostafa Heydarian University of Adelaide April1996 Thesis submitted in fulfilment of the requirements for the Degree of DOCTOR OF PHILOSOPHY at the UNIVERSITY OF ADELAIDE (Department of Physics and Mathematical Physics) ul Contents Title page I Contents lu Abstract lx Preface xr Statement XY Àcknowledgements xvrr chapter 1. Radiotherapy Treatment Planning Dose calculation I 1.1. Introduction 1 1 |.2.[¡teractions of Photon beams 1.2.1. Fluence and energY fluence 2 2 1.2.2. Attenuation coefficient . L.2.2.1. Coherent scattering 3 1.2.2.2. Photoelectric effect 5 1.2.2.3. Compton effect 5 1.2.2.4. Pair production 6 1.2.2.5. Photonuclear reaction 6 1.2.3. Energy transfer and energe absorption coefficients 7 7 1.2.4. Radiation quantities . 1.2.4.1. Exposure 7 1.2.4.2. Kerma and Terma 8 9 1.2.4.3. Absorbed dose . 1.2.4.4. Equivalent dose and effective dose 9 10 1.3 Interactions of electron beams lv 1.3.1. Stopping power 11 1.3.2. Scattering power 12 1.4. Dosimetry parameters . 13 1.4.1. Depth doses 13 1.4.2. Tissue air ratio t6 l-4.3. Scatter air ratio . 77 1.4.4. Collimator output factors 18 1.4.5. Tissue phantom and tissue maximum ratios 18 1.4.6. Scatter-maximum ratio t9 1.5. Electronic equilibrium 19 1.6. Dose distributions . 2t 1.7. Wcdgc filters 22 1.7.1. Dynamic wedge . 25 1.8. Combination of radiation fields . 25 1.9. Conformal therapy 25 1.10. Three dimentional treatment planning 28 1.11. Three dimensional dose calculation techniques .30 1.11.1. Effective path length method . .32 1.11.1.1. Tissue air ratio method . .33 t.rl.2. Power law tissue air ratio method .33 1.11.3. Equivalent tissue air ratio method .34 t.tt.4. The effect of electronic disequilibrium on dose calculation. .35 1.11.5. Density correction factor andCT numbers .38 1. 1 1.6. Superposition and convolution techniques .39 l.ll.7. Photon dose calculation using explicit electron transport .41 1.11.8. Monte Carlo simulation .42 Chapter 2. Stereotactic Radiosurgery 45 2.1. Introduction 45 2.2. Rational for radiosurgical treatment 46 2.3. Gamma Knife 47 2.4.Heavy charged particle SRS . 49 v 2.5.Linac-based SRS 52 2.6. T ar get localization 53 2.7. ,SRS dose calculation . 56 2.7 .1. Dose calculation parameters 57 2.7.2. Calculating the dose distribution . 57 2.8. Choice of optimum energy 59 2.9. Dose fall off outside the target volume 6t 2.10. SR^S quality assurance . 63 2.10.1. Probable risk analysis 64 2.10.2. The routine Q/ 65 2.10.3. The treatment QA 65 2.10.3.1. Laser check 66 2.11. Patient set up and target verification 66 2.12. The accuracy of SRS 67 2.12.1. Diagnostic resolution . 68 2.12.2. Linear accelerator accuracy 68 2.12.3. The centre of the dose distribution 69 2.13. Cost effectiveness of SRS 69 2.14. Discussion and conclusion 70 Chapter 3. Evaluation of Diamond Detectors for Megavoltage Beams 73 3.1. Introduction . 73 3.2. Theory of diamond detector response 74 3.3. Physical properties of. PTIA diamond detectors .76 3.3. 1. Current-voltage response .77 3.3.2. Charge collection efficiency .79 3.3.3. Stability of detector current . 80 3.3.4. Constancy and linearity 81 3.3.5. Directional dependence of response 82 3.3.6. Spatial resolution 85 3.4. Dose rate dependence 88 3.4.t. Changing FSD 89 vr 3.4.2. Changing depth 90 3.4.3. Changing pulse repetition frequency 93 3.5. Evaluation of the diamond detector for photon beam measurements . 94 3.5.1. Introduction 94 3.5.2. Output factors 96 3.5.3. Depth dose curves 97 3.5.4. Summary and discussion 98 3.6. Evaluation of the diamond detector for electron beam measurements 100 3.6.l.Introduction 100 3.6.2. Depth dose curves . 101 3.6.3. Summary and discussion 104 3.7. Dose rate correction 104 3.8. Conclusion 105 Chapter 4. Monte Carlo Dose Calculation 109 4.1. Introduction 109 4.2. Sampling 111 4.3. Random number generation 113 4.4. Monte Carlo particle transport 113 4.4.1. Photon transport tt4 4.4.2. Electron transport tt4 4.5. The EGS4 system It9 4.6. Dependence on electron step-size and energy cutoff parameters tzr 4.7. PRESTA t22 4.8. Variance reduction techniques 124 4.9. Reciprocity technique . t25 4.10. Benchmarking EGS4 t29 4.10.1. Depth doses 129 Chapter 5. Evaluation of Dosimetry Techniques in Stereotactic Radiosurgery 135 5.1. Introduction 135 5.2. Small field dosimetry difficulties r37 vu 5.2.1. Energy spectrum 138 5.2.2. Detector response to.SR.S fields . r40 5.3. Small field dosimetfy parumeters and techniques 143 5.3.1. Depth doses r44 5.3.2. Tissue maximum ratios . 147 5.3.3. Off-axis factors . t48 5.3.4. Collimator outPut factors 151 5.4. Discussion 1-55 Chapter 6. Advances in Stereotactic Radiosurgery/Radiotherapy Treatment Techniques 157 6.1. Review of the existing techniques 157 6.2. Dynamic stereotactic radiosurgery 158 160 6.3. Conformal SRS . r64 6. 4. Cy b e rhífe : Image-guided SRS 6.5. Miniatu re x-ray radiosurgery t66 6.6. Body stereotactic radiosurgery 166 6.7. Radiobiology of radiosurgery t67 168 6.7 .1. Radiobiological principles 6.7.2. Dose response of AVM and benign lesions 171 6.7.3. Dose response of malignancies 173 6.8. Dose to the critical organs 1,7 4 6.9..tRS limitations 174 t76 ó. 10. Stereotactic radiotherapy (SR?) 6.10.1. Patient repositioning techniques 177 178 6.11. Discussion and conclusion Chapter Z. SRS Treatment Planning and MC Dosimetry of Irregular Fields 179 7.1. Introduction 179 7.2.The validity of SRS treatment planning assumptions 180 180 7 .2.1. The effect of tissue heterogeneity on SR^S dose calculation 7.2.2. Assumptions related to the body contour 183 vur 7.2.3.Invariant dose profile with depth 186 7 .3. Treatment planning verification 187 7.4. Optimum number of arcs 193 7.5. Monte carlo dosimetry of irregular field stereotactic radiosurgery . 198 T.5.l.Introduction . 198 7.5.2. Method . 198 7.5.3. Results 200 7 .6. lmage registration and correlation 202 7 .7 . Bioeffect planning 205 7.8. Discussion and conclusion 208 Chapter 8. Discussion and Future Developments 2tt 8.1. Introduction 2lt 8.2. Dosimetry of SRS fields 2tt 8.3. Treatment planning 212 8.4. Dose delivery . 214 Appendix: Publications 2t5 References 2t7 lx Abstract The success of stereotactíc radiosurgery (SRS) as an effective radiation technique for treating intracranial lesions is dependent on the geometric accuracy of the dose delivery. This is because in this technique a high dose (normally 10 to 30 Gy) is released by a small field, in a single-fraction, to destroy the lesion located in a generally critical region. Accurate dosimetry of SRS fields is difficult because of lateral electronic disequilibrium and steep dose gradients which are characteristics of these fields. Accurate dosimetry of SRS fietds is most likety to be achieved using a high resolution tissue-equivalent detector. Monte Carlo techniques and. PTW diamond detectors are added to the commonly used detectors (namely silicon diodes, ionization chambers, film and thermoluminescence dosimetry) to calculate and measure SRS treatment planning requirements and dose distributions. Monte Carlo techniques have been confirmed as reliable references for dosimetry of SRS fields. Also, it will be shown that diamond detectors are potentially ideal for SRS and yield more accurate results than the above traditional modes of experimental dosimetry. This was demonstrated by comparing the diamond response, after correcting for dose rate dependence, with the corresponding results of the ionization chamber (for large fields) and Monte Carlo (for small fields). Advanced techniques in stereotactic radiosurgery and radiotherapy are introduced. Using radiobiological principles it has been shown that SRS is appropriate for treating arteriovenous malformations and most benign lesions, while stereotactic radiotherapy (as a fractionation scheme) is highly recommended for malignancies and large tumours. Bioeffect planning as a new means for assessment of the treatment plans is introduced, by which treatment plans can be assessed according to the bioeffect distribution rather than a physical dose distribution. A method of calculating beam data using sector-integration of Monte Carlo-generated pencil beam kemels has been proposed. This technique can be used both for circular and inegular fields, however it is more useful in calculating dosimetry parameters for irregular fields-where the shape of treatment fields is determined during planning. xl Preface Stereotactic radiosurgery (SRS) is a preferred radiation technique for treating most intracranial lesions, where the lesion is surgically inaccessible or has a high risk operation. Of the most pronounced characteristics of this technique are high geometric accuracy and steep dose gradient outside the target volume. This results in sparing of normal tissue, while the target volume is given a prescribed radiation dose. Using noncoplanar multiple arc techniques results in a dose distribution which drops from 907o isodose line at the edge of the target to 50%ò and 207o in approximately 3 and 7 rrun, respectively. In this way, the target volume receives a uniform dose while the dose to the surrounding healthy tissue is minimal.
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