Pr, Br, Rad Pharm, TBI, TSET Flashcards
What’s the typical energy range of proton beams?
- 70-250 MeV
- Lower energies (60 MeV) exist for tx of ocular melanomas
What’s the formula for the range of protons in the tissue?
Range (cm) = 0.033E + 0.0005E2
When does the skin dose from a proton beam increase?
When you increase the SOBP
How do you create a SOBP?
Using a range modulator wheel, which has thicker and thinner parts and can change the range of the protons as they pass through the different parts.
What controls the range of the proton beam?
- Beam energy
- Can be controlled using a range shifter
What controls the modulation of a proton beam?
Range modulator wheel
What’s the fx of a compensator for proton beams?
- A compensator custom-made, beam-shaping device used to absorb some energy so that it stops just on the distal edges of the target or tumor
- It can also compensate for
– the presence of tissue inhomogeneities (bone, lung, etc)
– Irregularities of patient body contours/surface
What devices go into the beam path of a double scattered proton beam?
- First, second Scatterers: Widen the beam
- Shifter: Determines where the beam will stop
- Modulator: Creates the SOBP to cover the entire length of the tumor.
- Aperture: Shapes the lateral edges of the beam. Custom-made from thick brass.
- Compensator: Shapes the beam to conform to the distal edge of the tumor. Typically made from low Z materials (wax, plastic, etc) to reduce scatter.
Is there an advantage to using protons over photons considering lateral penumbra?
No, it is very similar to a photon beam (≥ 6 MV)
What’re some of the advantages and disadvantages of a PBS?
- Advantages
– Sharper penumbra
– Low neutron dose 2/2 fewer devices in the beam path - Disadvantages
– More susceptible to intrafraction patient motion
How are protons accelerated in the cyclotron?
- Magnetic field
- Charged particles move in a spiral, gaining energy w/ each revolution
– Continuously bent by the magnetic field
– As they gain energy, the radius of their revolutions increase - Gives a continuous supply of protons
How are protons accelerated in a synchrotron?
- Beam travels around in a circular path in a vacuum
- Bending magnets bend the beam
- Accelerating cavity accelerates the beam using RF electric fields (akin to a Linac)
- Once the beam reaches desired energy, it’s extracted from the synchrotron
- Outputs protons in bursts
How do the PTV margins differ for protons vs. photons?
- Proton PTV margins depend on the beam direction
– They are non-isotropic, unlike photon beams
What’s an advantage and a disadvantage of a carbon ion beam vs. a proton beam?
- Adv: Sharper penumbra
- Dis: ↑ dose past Bragg peak 2/2 nuclear spallation
What’re the features of a planar Quimby brachy system?
- Uniform source activity
- Non-uniform dose distribution
– Higher dose at the center
What’re the features of a planar Manchester (Patterson-Parker) brachy system?
- Uniform source spacing (1 cm)
- Non-uniform source activity
– Peripheral sources have higher activity - More uniform dose distribution 0.5 cm around sources (±10%) mainly 2/2 ↑ activity of the peripheral sources
What’s the formula for the range of protons in the tissue?
Range (cm) = 0.033E + 0.0005E2
What’s the typical energy range of proton beams?
70-250 MeV
What are the units of air kerma strength?
- 1 μGy × m2 / h
- Also represented as 1U
What are the dose rates for LDR, MDR, and HDR brachytherapy?
- LDR - 0.4 - 2 Gy/h
- MDR: 2-12 Gy/h
- HDR: >12 Gy/h
How’re unsealed sources given?
- Usually given systemically or injected
Between LDR and HDR, which technique has more normal (biological) tissue sparing?
- LDR: More normal tissue sparing 2/2 ↑ sublethal DNA damage repair
- HRD: Less normal tissue sparing 2/2 high dose rates and fx given over time shorter than that required for DNA repair
– Geometric sparing is used to compensate for ↓ biological tissue sparing
What’re the key dosimetric considerations for TBI?
- Uniform dose throughout the body
- Limit lung dose
- Limit dose rate (5-15 cGy/min at midplane)
What’s the purpose of a lung block, beam spoiler, and compensator in TBI?
- Lung block reduced lung dose
- Spoiler: Increase the skin dose by increasing e- contribution to dose
- Compensator: Make the dose more homogenous throughout the body (by reducing the dose to thinner (ankles, neck, etc) parts of the body
– Custom-designed for each patient, and can either be attached to the Linac or to the beam spoiler
What’s the advantage of using higher beam energies for AP/PA TBI tx? How does normal tissue dose depend on pt thickness?
- ↑ energy → ↓ normal tissue dose
- ↓ thickness → ↓ normal tissue dose
What’s the formula for calculating TBI dose homogeneity?
Dosepeak / Dosemid
How does dose homogeneity vary w/ beam energy, SSD, and patient thickness for a TBI tx?
- ↑ homogeneity w/
– ↓ thickness
– ↑ energy
– ↑ SSD
— ↓ PDD fall-off w/ ↑ SSD`
What’s the Rx for I-125 prostate implant monotherapy and when coupled w/ EBRT?
- Mono: 145 Gy
- w/ EBRT: 110 Gy
What’s the Rx for Pd 103 implant monotherapy and when coupled w/ EBRT??
- Mono: 125 Gy
- w/ EBRT: 100 Gy
- Lower Rx doses than I-125 2/2 higher dose rate leading to ↑ BED
What imaging modality is normally used for a post-LDR-implant-prostate study?
CT scan
How do you verify LDR seed activity after receiving seeds from the manufacturer?
- Well chamber
- Test at least 10 seeds
– Activity should be within ±3%
If you order pre-loaded seeds for LDR, how do you verify their spacing?
Using radiographs
How does post-LDR-implant prostate swelling impact the dose?
- Dose higher on day 1 (w/ swelling)
- Dose lower on day 30 (swelling resolved)
What’re the Rx points for tandem & ovoid applicators?
- Point A: 2 cm above ovoids, 2 cm lateral to the tandem
- Point B: 3 cm lateral to the tandem
- Dose goals:
– Point B = 30-40% of point A dose
– Rectum < 4.1 Gy / fx (<70% Rx)
– Bladder < 4.6 Gy / fx (<75% Rx)
– Mucosa < 120 Gy (<140% of point A dose)
How is I131 made?
Nuclear reactor
How is I131 made?
Nuclear reactor
What’re the indications for I-131 use?
- Indications:
– Thyroid Ca
– Hyperthyroidism - Doses
– Post Op: 65-150 mCi
– Nodal: 150-200 mCi
– Mets: > 200 mCi - Delivery
– 30% dose trapped in thyroid
– rest cleared in urine
Why is Y-90 injected intra-arterially?
- 80% of the tumor blood supply comes from the arteries
- 80% of the normal liver blood supply comes from the veins
What’re the patient release criteria for I-131?
- < 7 mCi and survey <2 mrem/hr at 1m → release w/ no instructions
- <33 mCi and survey <7 mrem/hr at 1m → release no instructions
When can you not release a pt who has received radionuclide therapy?
When any member of the public is likely to receive > 5 mSv
After HDR source exchange, the activity of the source should be within what % of the manufacturer’s certificate?
±3%
For castration-resistant prostate cancer, how is the dose for 223Ra calculated?
- 1.49 μCi/kg
- We use mass to calculate the dose
What’s the max allowable deviation between measured and intended dwell positions and step-size spacing b/w dwell positions?
±1mm
Do you need to measure the HDR source output daily?
- No; it’s a laborious process involving a well chamber
- Only measure it at the time of source exchange or annually
- On a daily basis, use decay tables and TPS to calculate source activity
How does the dose at a point vary w/ distance, r, for a line source?
Dose ∝ 1/r
As it relates to the medium, what properties dictate the range of protons traversing it?
- Atomic number (Z)
- Tissue density (ρ)
How does the penumbra of the PBS compare to that of double-scattering protons?
- PBS has a less sharp penumbra
- PBS systems lack a physical aperture close to the patient, which worsens their penumbra
How does the RBE of protons vary throughout the SOBP?
RBE is highest at the end of the SOBP 2/2 end-range effects
What factors affect the penumbra of a proton beam?
- Depth
- Proton energy
- The air gap between the aperture and the patient
How often do brachytherapy sources need to be exchanged per regulations?
- There are no regulations
- Seeds are usually exchanged after 1 T1/2 2/2 increasing tx times
Why is a vaginal cylinder, as opposed to a naked source, used in brachytherapy?
- Dose fall off within the first few cms would result in a very heterogeneous dose distribution for tissues immediately adjacent to the naked source
- A cylinder pushes tissues away, and the dose fall-off isn’t as rapid from its surface into the tissues
– improved dose heterogeneity
What’s range straggling?
Small fluctuations in the amount of energy lost by individual protons lead to a sigmoidal Bragg peak
What’s range uncertainty?
Uncertainties in proton range 2/2 uncertainties in tissue composition and stopping power