Assessment of absorbed dose to thyroid, parotid and ovaries in patients undergoing Gamma Knife radiosurgery

Assessing the Risk of Secondary Cancer Induction in Radiosensitive Organs During Trigeminal Neuralgia Treatment With Gamma Knife Radiosurgery: Impact of Extracranial Dose

Purpose

Gamma knife radiosurgery (GKRS) delivers high-dose external radiation to a small intracranial lesion. However, scattering and leaked radiation can deposit a portion of the dose outside the radiation field, which may pose a risk to radiation-sensitive patients, such as pregnant women. Trigeminal Neuralgia (TN) is treated with one of the highest GKRS doses (80-90 Gy). This study aimed to estimate the risk of secondary cancer induction in the uterus, ovaries, thyroid gland, and eyes of TN patients undergoing GKRS.

Methods

Radiation doses to the uterus, ovary, eyes, and thyroid gland were measured for 25 female TN patients, with a mean age of 35 years, utilizing Thermo Luminescent Dosimeters (TLD).

Results

The mean absorbed dose for the uterus, ovary, thyroid gland, and eyes were .63 ± .24, .471 ± .2, 8.26 ± 1.01, and 10.64 ± 1.08 cGy, respectively. Lifetime Attributable Risk (LAR) has been calculated using BEIR VII (2006) method. LAR for the uterus, ovary, and thyroid gland was 1, 2, and 23, respectively.

Conclusion

The results of this study and its comparison with standard values demonstrate that on average, mean doses to mentioned organs were smaller than their tolerance doses, and there is no limitation to treating patients suffering from TN by GK.

High-Dose-Rate (192)Ir Brachytherapy Dose Verification: A Phantom Study

Background:

The high-dose-rate (HDR) brachytherapy might be an effective tool for palliation of dysphagia. Because of some concerns about adverse effects due to absorbed radiation dose, it is important to estimate absorbed dose in risky organs during this treatment.

Objectives:

This study aimed to measure the absorbed dose in the parotid, thyroid, and submandibular gland, eye, trachea, spinal cord, and manubrium of sternum in brachytherapy in an anthropomorphic phantom.

Materials and Methods:

To measure radiation dose, eye, parotid, thyroid, and submandibular gland, spine, and sternum, an anthropomorphic phantom was considered with applicators to set thermoluminescence dosimeters (TLDs). A specific target volume of about 23 cm³ in the upper thoracic esophagus was considered as target, and phantom planned computed tomography (CT) for HDR brachytherapy, then with a micro-Selectron HDR (¹⁹²Ir) remote after-loading unit.

Results:

Absorbed doses were measured with calibrated TLDs and were expressed in centi-Gray (cGy). In regions far from target (≥ 16 cm) such as submandibular, parotid and thyroid glands, mean measured dose ranged from 1.65 to 5.5 cGy. In closer regions (≤ 16 cm), the absorbed dose might be as high as 113 cGy.

Conclusions:

Our study showed similar depth and surface doses; in closer regions, the surface and depth doses differed significantly due to the role of primary radiation that had imposed a high-dose gradient and difference between the plan and measurement, which was more severe because of simplifications in tissue inhomogeneity, considered in TPS relative to phantom.

Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites

PURPOSE

The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations.

METHODS

The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA).

RESULTS

The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035-2.71 Gy) and 0.34 Gy (range, 0.066-3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03-0.159 Gy) and 0.05 Gy (range, 0.015-0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056-1.97 Gy) and 0.306 Gy (range, 0.065-2.25 Gy).

CONCLUSIONS

Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.

A contemporary review of stereotactic radiotherapy: inherent dosimetric complexities and the potential for detriment

OBJECTIVE

The advantages of highly localised, conformal treatments achievable with stereotactic radiotherapy (SRT) are increasingly being extended to extracranial sites as stereotactic body radiotherapy with advancements in imaging and beam collimation. One of the challenges in stereotactic treatment lies in the significant complexities associated with small field dosimetry and dose calculation. This review provides a comprehensive overview of the complexities associated with stereotactic radiotherapy and the potential for detriment.

METHODS

This study is based on a comprehensive review of literature accessible via PubMed and other sources, covering stereotactic radiotherapy, small-field dosimetry and dose calculation.

FINDINGS

Several key issues were identified in the literature. They pertain to dose prescription, dose measurement and dose calculation within and beyond the treatment field. Field-edge regions and penumbrae occupy a significant portion of the total field size. Spectral and dosimetric characteristics are difficult to determine and are compounded by effects of tissue inhomogeneity. Measurement of small-fields is made difficult by detector volume averaging and energy response. Available dosimeters are compared, and emphasis is given to gel dosimetry which offers the greatest potential for three-dimensional small-field dosimetry. The limitations of treatment planning system algorithms as applied to small-fields (particularly in the presence of heterogeneities) is explained, and a review of Monte Carlo dose calculation is provided, including simplified treatment planning implementations. Not incorporated into treatment planning, there is evidence that far from the primary field, doses to patients (and corresponding risks of radiocarcinogenesis) from leakage/scatter in SRT are similar to large fields.

CONCLUSIONS

Improved knowledge of dosimetric issues is essential to the accurate measurement and calculation of dose as well as the interpretation and assessment of planned and delivered treatments. This review highlights such issues and the potential benefit that may be gained from Monte Carlo dose calculation and verification via three-dimensional dosimetric methods (such as gel dosimetry) being introduced into routine clinical practice.

Consideration of the radiation dose delivered away from the treatment field to patients in radiotherapy

Radiation delivery to cancer patients for radiotherapy is invariably accompanied by unwanted radiation to other parts of the patient's body. Traditionally, considerable effort has been made to calculate and measure the radiation dose to the target as well as to nearby critical structures. Only recently has attention been focused also on the relatively low doses that exist far from the primary radiation beams. In several clinical scenarios, such doses have been associated with cardiac toxicity as well as an increased risk of secondary cancer induction. Out-of-field dose is a result of leakage and scatter and generally difficult to predict accurately. The present review aims to present existing data, from measurements and calculations, and discuss its implications for radiotherapy.

A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction

It has been long known that patients treated with ionizing radiation carry a risk of developing a second cancer in their lifetimes. Factors contributing to the recently renewed concern about the second cancer include improved cancer survival rate, younger patient population as well as emerging treatment modalities such as intensity-modulated radiation treatment (IMRT) and proton therapy that can potentially elevate secondary exposures to healthy tissues distant from the target volume. In the past 30 years, external-beam treatment technologies have evolved significantly, and a large amount of data exist but appear to be difficult to comprehend and compare. This review article aims to provide readers with an understanding of the principles and methods related to scattered doses in radiation therapy by summarizing a large collection of dosimetry and clinical studies. Basic concepts and terminology are introduced at the beginning. That is followed by a comprehensive review of dosimetry studies for external-beam treatment modalities including classical radiation therapy, 3D-conformal x-ray therapy, intensity-modulated x-ray therapy (IMRT and tomotherapy) and proton therapy. Selected clinical data on second cancer induction among radiotherapy patients are also covered. Problems in past studies and controversial issues are discussed. The needs for future studies are presented at the end.

Dosimetry and verification of Co total body irradiation with human phantom and semiconductor diodes

Total Body Irradiation (TBI) is a form of radiotherapy used for patients prior to bone marrow or stem cell transplant to destroy any undetectable cancer cells. The dosimetry characteristics of a ⁶⁰Co unit for TBI were studied and a simple method for the calculation of the prescribed dose for TBI is presented. Dose homogeneity was verified in a human phantom. Dose measurements were made in water phantom (30 × 30 × 30 cm³), using farmer ionization chamber (0.6 cc, TM30010, PTW) and a parallel plate ionization chamber (TM23343, PTW). Point dose measurements for AP/PA irradiation were measured in a human phantom using silicon diodes (T60010L, PTW). The lung dose was measured with an ionization chamber (0.3 cc, TM31013). The validity of the proposed algorithm was checked at TBI distance using the human phantom. The accuracy of the proposed algorithm was within 3.5%. The dose delivered to the mid-lobe of the lung was 14.14 Gy and it has been reduced to 8.16 Gy by applying the proper shield. Dose homogeneity was within ±7% for all measured points. The results indicate that a good agreement between the total prescribed and calculated midplane doses can be achieved using this method. Therefore, it could be possible to use calculated data for TBI treatments.

Radiation exposure during head repositioning with the automatic positioning system for gamma knife radiosurgery

PURPOSE

To measure radiation exposure to a patient during head repositioning with the automatic positioning system (APS) for Gamma Knife radiosurgery.

METHODS AND MATERIALS

A 16-cm diameter spherical solid phantom, provided by the manufacturer, was mounted to the APS unit using a custom-made holder. A small-volume ionization chamber (0.07-cm(3) volume) was placed at the center of the phantom. We recorded the temporal variation of ionization current during the entire treatment. Measurements were made for 3 test cases and 7 clinical cases.

RESULTS

The average transit time between successive shots, during which the APS unit was moving the phantom for repositioning the shot coordinates, was 20.5 s for 9 cases. The average dose rate, which was measured at the center of the phantom and at a point outside the shot location, was 0.36 +/- 0.09 cGy/min when the beam output was approximately 3.03 Gy/min for the 18-mm collimator helmet. Hence, the additional intracranial radiation dose during the APS-driven head repositioning between two successive shots (or APS transit dose) was 0.12 +/- 0.050 cGy. The APS transit dose was independent of the helmet size and the position of shots within the phantom relative to the measurement point.

CONCLUSION

The head repositioning with the APS system adds a small but not negligible dose to the dose expected for the manual repositioning method.

Relative output factor and beam profile measurements of small radiation fields with an L-alanine/K-Band EPR minidosimeter

The performance of an L-alanine dosimeter with millimeter dimensions was evaluated for dosimetry in small radiation fields. Relative output factor (ROF) measurements were made for 0.5 x 0.5, 1 x 1, 3 x 3, 5 x 5, 10 x 10 cm(2) square fields and for 5-, 10-, 20-, 40-mm-diam circular fields. In beam profile (BP) measurements, only 1 x 1, 3 x 3, 5 x 5 cm2 square fields and 10-, 20-, 40-mm-diam circular fields were used. For square and circular field irradiations, Varian/Clinac 2100, and a Siemens/Mevatron 6 MV linear accelerators were used, respectively. For a batch of 800 L-alanine minidosimeters (miniALAs) the average mass was 4.3+/-0.5 (1 sigma) mg, the diameter was 1.22+/-0.07 (1 sigma) mm, and the length was 3.5+/-0.2 (l sigma) mm. A K-Band (24 GHz) electron paramagnetic resonance (EPR) spectrometer was used for recording the spectrum of irradiated and nonirradiated miniALAs. To evaluate the performance of the miniALAs, their ROF and BP results were compared with those of other types of detectors, such as an ionization chamber (PTW 0.125 cc), a miniTLD (LiF: Mg,Cu,P), and Kodak/X-Omat V radiographic film. Compared to other dosimeters, the ROF results for miniALA show differences of up to 3% for the smallest fields and 7% for the largest ones. These differences were within the miniALA experimental uncertainty (-5-6% at 1 sigma). For BP measurements, the maximum penumbra width difference observed between miniALA and film (10%-90% width) was less than 1 mm for square fields and within 1-2 mm for circular fields. These penumbra width results indicate that the spatial resolution of the miniALA is comparable to that of radiographic film and its dimensions are adequate for the field sizes used in this experiment. The K-Band EPR spectrometer provided adequate sensitivity for assessment of miniALAs with doses of the order of tens of Grays, making this dosimetry system (K-Band/miniALA) a potential candidate for use in radiosurgery dosimetry.