ISODOSE DISTRIBUTIONS

Isodose Chart Measurements of isodose curves Parameters of isodose curves

Beam quality Source size, SSD and SDD the penumbra effect Collimation and flattening filter Field size Wedge Filters

ISODOSE DISTRIBUTIONS
Combination of radiation fields
Parallel opposed fields Multiple fields

Isocentric techniques
Stationary beams Rotation therapy

Wedge Fields Techniques Tumor dose specification

Isodose Chart

SSD

SAD

Isodose Chart

Isodose Chart

Measurements of isodose curves

3D water phantoms

Parameters of isodose curves

200 kvp

60Co

4 MV

10 MV

Parameters of isodose curves

Source Size
S
A B

SDD

SSD

d
D E

Homework: Derive the penumbra (DE) as a function of other parameters

Parameters of isodose curves

Flattening Filter Flatness defined at 10 cm depth Horns at dmax Below 10 cm, rounding off of the profiles Energy off axis is lower than central axis

Parameters of isodose curves

Field size
SSD technique: the field size is defined at the surface SAD technique: the field size is defined at the depth Field size defined as the 50% line, normalized to the central axis value at the depth.

Wedge Filters
Normalized at dmax A: with wedge B: without wedge

Wedge Filters

Wedge Angle
Refers to the complement of the angle the isodose line is tilted in relation to the central axis, for a given depth. This depth is normally defined as 10 cm (ICRU 24).

Wedge Transmission Factor

Measured at some depth beyond the dmax, usually 10 cm. Old 60Co isodose curves were normalized to the dmax without the wedge. The isodose curves already included the wedge factor. With advent of TPS, we normally input the isodose curves normalized to the dmax with the wedge, and introduce a wedge factor to account for the transmission factor of the wedge. Wedge factor depends on the depth and field size.

Wedge Systems
Wedge for selected field sizes, were used for 60Co units because of limited output of the units.

Design of Wedge Filters

Universal Wedges
Elekta provide this technique in their linacs. It is a 60 wedge which is mounted in a carrousel that goes in and out of the photon beam. If you need a different wedge angle, the linac automatically weight treatment to provide for the angle needed (e.g., 30 wedge is done by assigning 50% of the treatment with an open beam and 50% of the treatment with the 60 wedge)

Dynamic or Virtual Wedges

To be discussed separately

Combination of Radiation Fields

Different weights

Parallel Opposed Fields

Multiple Fields

N -> = Rotation Therapy

Stationary Beams

Rotation Therapy
4 MV Field Size = 7x12 cm 100 degrees 180 degrees

360 degrees

Wedge Fields Technique

= 90 / 2
o

Wedge Fields Technique

ICRU 50 AND 62

Treatment Planning Process

Gross Tumor Volume (GTV) palpable or imaged Clinical Target Volume (CTV) GTV + subclinical multiple CTVs possible Planning Target Volume (PTV) CTV + margin (internal+setup)

Treatment Planning Process

Gross Tumor Volume (GTV) GTV is the gross demonstrable extent and location of the malignant growth The GTV consists of primary tumor (GTV Primary) and possibly metastatic lymphadenopathy (GTV nodal) or other metastases (GTV M).

Treatment Planning Process

Clinical Target Volume (CTV) CTV is a tissue volume that contains demonstrable GTV and/or subclinical malignant diseases that must be eliminated. This volume has to be treated adequately in order to achieve the aim of radical therapy.

Treatment Planning Process

Clinical Target Volume (CTV) Description of treatment of subclinical extension adjacent to a GTV Clinical experience indicates that outside the GTV there is generally subclinical involvement that can not be detected by the staging procedures. This CTV is then usually denoted by CTV 1.

Treatment Planning Process

Clinical Target Volume (CTV) Description of treatment of subclinical extension at a distance from a GTV Additional volumes (CTVs) with presumed subclinical spread (e.g. Regional lymph nodes) may be considered for therapy. They are then designated by CTV II, CTV III, etc.

Treatment Planning Process

Internal Target Volume (CTV) ICRU 62 recommends that an internal margin (IM) be added to CTV to account for internal physiological movements and variation in size, shape, and position of the CTV during therapy in relation to na internal reference point and its corresponding coordinate system.

Treatment Planning Process

Planning Target Volume (PTV) The volume that includes CTV with an IM As well as a set-up margin (SM) for patient Movement and set-up uncertainties is called The planning target volume (PTV). To Delineate PTV, IM and SM are not added Linearly but are combined subjectively.

Treatment Planning Process

CTV GTV PTV

Treatment Included

CTV GTV Irradiated Volume PTV Treated Volume

Treatment Planning Process

Planning Organ at Risk Volume (PRV) The organ at risk (OR) needs adequate protection just as CTV needs adequate treatments. Once the OR is identified, margins need to be added to account for its movements, internal as well as set-up.

Treatment Planning Process

Treated Volume Additional margins must be provided around the target volume to allow for limitations of the treatment technique. Thus the minimum target dose should be represented by an isodose surface which adequately covers the PTV to provide that margin. The volume enclosed by this isodose surface is called the treated volume.

Treatment Planning Process

Irradiated Volume The volume of tissue receiving a significant dose (e.g., >= 50% of the specified target dose) is called the irradiated volume.

Specifications of Target Dose

Maximum target dose (larger than 2 cm2)

Minimum target dose

ICRU Volumes and Margins

Specification of Target Dose

The ICRU Reference Point
The point should be selected so that the dose at this point is clinically relevant and representative of the dose throughout the PTV The point should be easy to define in a clear and unambiguous way The point should be selected where the dose can be accurately calculated The point should not lie in the penumbra region or where there is a steep dose gradient

Specification of Target Dose

Stationary Photon Beams
For single beam, the TD should be specified in the central axis of the beam placed within the PTV For parallel opposed, equally weighted beams, the point of TD specification should be on the central axis midway between the beam entrances For parallel opposed, unequally weigthed beams, the TD should be specified in the central axis placed within the PTV For any other arrangement of two or more intersecting beams, the point of TD specification should be at the intersection of the central axes of the beams placed within the PTV

Specification of Target Dose

Rotation Therapy
For full rotation or arcs of at least 270 degrees, the TD should be specified at the center of the rotation in the principal plane. For smaller arcs, the TD should be stated in the principal plane, first at the center of rotation and, second, at the center of the target volume. This dual point specification is required because in small arc therapy, past point techniques are used that give maximum absorbed dose close to the center of the target area.

Specification of Target Dose

Additional Information
The specification of TD is only meaningful if sufficient information is provided regarding the irradiation technique. Radiation quality, SSD or SAD, field sizes, beam modification devices, beam weighting, correction for inhomogeneities, dose fractionation and patient positioning should be included as well.

Lab - 6 MV photon beam

Output in air (Sc)
Field sizes at 100 cm 4,6,8,10,12,14,17,20,25,30,40 Distance to chamber = 100 cm Copper buildup cap

Output in phantom (Sc,p)

Field sizes at 100 cm 4,6,8,10,12,14,17,20,25,30,40 Distance to chamber = 100 cm

At dmax depth (1.5 cm)

PDD for a 10x10 cm 100cm SSD

At dmax, 5, 10 and 15 cm depth

TAR for a 10x10 cm

At dmax, 5, 10 and 15 cm depth