Tx planning - dose metrics/isodose distribution Flashcards
Materials wedges are made from.
Lead, copper, steel
Distance hard wedge should be from skin, why?
> 15cm; e’ contamination
New def of Wedge Angle:
angle defined by wedge at depth of 10cm
What effect does depth have on Wedge Angle, why?
WA decreases with depth; Scatter fills in (wedge scatter increases
How does a hard wedge effect PDD?
it creates Beam Hardening - PDD increases by 1-2%
Equation to solve for Wedge Angle:
WA = 90 - (Hinge Angle / 2)
Where do hotspots occur when using a wedge, what causes this?
Under the thin part of wedge (toe); Increase with FS and Angle, Differential Attenuation
How do you correct for an incorrect Wedge used?
look this up
What are common clinical uses for a wedge?
- Parotid Wedge Pair
- Breast
- 3-Field Rectum
If wedged properly, where does the hotspot occur for a 3-field rectum?
Posteriorly (pt is prone), due to the PA beam
What are the Air-Gap correction types?
- Effective Attenuation
- Effective SSD
- TAR Method
- Isodose Shift Method
Most accurate Air-Gap Correction, why?
TAR Method; uses ratio of TARs or TMRs as correction factor
What is the equation used for TAR-Method air-gap correction?
Db = Da x (TMRb / TMRa)
2 characteristics related to tissue inhomogeneity
- Change in absorption of primary & scatter
2. Change of secondary electron fluence
Where does event 1 for tissue inhomegeneity dominate?
Near the boundary
Where does event 2 for tissue inhomegeneity dominate?
Away from and In
What is TERMA
Total Energy Released in MAtter
What is the difference between TERMA and KERMA?
TERMA contains bremmstrahlung
Explain the 2 types of Convolution:
- Basic - kernal is spatially invariant (same tear-drop), not good with inhomogeneity, not good with divergence;
- Fancy (or Collapsed Cone Convolution)- kernal is spatially variant, better with divergence, better with inhomogeneity by scaling densities
Example of Superposition
Monte Carlo
Four things 3D Methods account for:
- Primary and Secondary Radiations
- 3D Proximity of Inhomogeneity
- 3D Contour Irregularities
- 3D Inhomogeneity shape
Correction Factors not accounting for tissue density change is measured as _____:
% per cm
What are the correction factors for lung in relation to beam energy?
Orthovoltage: +8-10% Co-60: +4-5% 4 MV: +3-4% 10 MV: +2-3% 18 MV: +1-2%
What are the correction factors for bone in relation to beam energy?
Orthovoltage: - 10-15% Co-60: - 5-7% 4 MV: - 3-4% 10 MV: - 2-3% 18 MV: - 1-2%
How to solve for tissue correction factor?
Multiply the depth by the correction factor;
ex. lung - 10 MV beam at 10cm = 10cm x 2%/cm = 20% or 20% over dose beyond the lung
* *bone would result in an under dose
Explain how dose points near an Air Cavity is affected:
- Upstream: Decreases - as dose approaches an air cavity it will be less due to lack of back scatter;
- In Cavity: Increases - once in cavity dose will be greater due to fluence;
- Distal Interface: Decreases - as dose exits the cavity, it will be less due to RE-buildup Region;
- Beyond Cavity: Increases - dose will be greater due to fluence
Explain how dose points near a bone is affected:
- Upstream: Increases - as dose approaches bone, it increases due to back scatter;
- In Bone: Initially increases, then Decreases (**NOT Important)
- Beyond Bone: Decreases - lower dose due to attenuation from bone
As photon energy _____, surface dose ______
increases; decreases
As e’ energy ______, surface dose _____
increases; increases
How does bolus effect surface dose for photon and electron fields
Increases dose for both
Properties of bolus for Photon fields:
- Increases surface dose
- takes out irregular contours
- bolus used for chest wall cases
Properties of bolus for e’ fields:
- Increases surface dose
- takes out irregular contours
- Maintains lateral scatter
Properties of Spoilers for photon fields:
- Increases surface dose
- as air gap increases, surface dose decreases
- Accounts for transmission is large distance away
Common uses of beam spoiler for photon fields:
degraders - used for inflammatory breast and TBI
Properties of Spoilers for e’ fields:
- Increase surface dose
- Increase penumbra
- PDD shifts, dmax goes to surface
- Changes energy spectrum
How is penumbra defined on a dose profile?
by lateral distance; either 80/20 or 90/10
For electrons, as gap increases, penumbra _____
increases
What creates Geometric Penumbra?
a finite source. ie. Co-60
Low energy e’ (< 10 MeV) scatter more or less than high energy e’ (> 10 MeV)
More
Factors affecting Penumbra:
- as FS increases, Penumbra increases
- as SCD increases, Penumbra decreases
- as SSD increases, Penumbra increases
- as depth increases, Penumbra increases
What energy ranges has the sharpest penumbra
4 MV to 6 MV
What causes penumbra outside the field
Compton Scattering and Pair Production
When should Arcs not be used?
- Large Volume
- Not a cylinder
- Off center
What is Past Pointing, when is it used?
When the isocenter is placed beyond the center of the target when utilizing a partial arc; used to avoid hot spots close to the surface
When using arcs, what is the relationship between FS and Fall-off
As FS decrease, dose fall-off increases
Dose outside the field is caused by what?
leakage, scatter from tx head, Pt scatter
What is the predominant source of dose based on distance from field edge?
- < 10cm - Pt Scatter and Collimator
- 10 - 20cm - Pt Scatter
- 20 - 30cm - Pt Scatter and Leakage
- > 30cm - Leakage
What percentage of dose is given based on distance from field edge
- 0cm - 50% (edge of field light = 50% dose)
- 2cm - 5.0%
- 10cm - 1.0%
- 30cm - 0.2%
- 100cm - 0.1%
By what factor can a wedge increase dose?
2 to 3%
As FS increases, dose _____
increases
e’ density of prothesis
- Stainless steel - 7
- Co-Cr-Mo - 7
- Titanium - 4
Should Physical or e’ density be used when planning around prothesis?
electron
GTV
Gross Tumor Volume: Malignant and Macroscopic - Gross Disease
CTV
Clinical Target Volume: GTV + Microscopic
PTV (ICRU Report 50)
Planning Target Volume: CTV + Margin (pt motion, tumor motion, beam setup, location of OAR)
Treated Volume
Volume Enclosed by Rx Isodose Line
Irradiated Volume
Volume Receiving Significant Dose (>50%)
Mean Dose:
Average dose in Target/Tumor
ITV (ICRU Report 62)
CTV + IM (internal motion)
PTV (ICRU Report 62)
ITV + SM (Setup margin)
Define Conformity Index (CI) mathmatically
CI = Treated Volume / PTV Volume
**implies that tx’d vol totally encompasses the PTV