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      The role of Cobalt-60 in modern radiation therapy: Dose delivery and image guidance

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          Abstract

          The advances in modern radiation therapy with techniques such as intensity-modulated radiation therapy and image-guided radiation therapy (IMRT and IGRT) have been limited almost exclusively to linear accelerators. Investigations of modern Cobalt-60 (Co-60) radiation delivery in the context of IMRT and IGRT have been very sparse, and have been limited mainly to computer-modeling and treatment-planning exercises. In this paper, we report on the results of experiments using a tomotherapy benchtop apparatus attached to a conventional Co-60 unit. We show that conformal dose delivery is possible and also that Co-60 can be used as the radiation source in megavoltage computed tomography imaging. These results complement our modeling studies of Co-60 tomotherapy and provide a strong motivation for continuing development of modern Cobalt-60 treatment devices.

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          A technique for the quantitative evaluation of dose distributions.

          D A Low, W B Harms, S Mutic … (1998)
          The commissioning of a three-dimensional treatment planning system requires comparisons of measured and calculated dose distributions. Techniques have been developed to facilitate quantitative comparisons, including superimposed isodoses, dose-difference, and distance-to-agreement (DTA) distributions. The criterion for acceptable calculation performance is generally defined as a tolerance of the dose and DTA in regions of low and high dose gradients, respectively. The dose difference and DTA distributions complement each other in their useful regions. A composite distribution has recently been developed that presents the dose difference in regions that fail both dose-difference and DTA comparison criteria. Although the composite distribution identifies locations where the calculation fails the preselected criteria, no numerical quality measure is provided for display or analysis. A technique is developed to unify dose distribution comparisons using the acceptance criteria. The measure of acceptability is the multidimensional distance between the measurement and calculation points in both the dose and the physical distance, scaled as a fraction of the acceptance criteria. In a space composed of dose and spatial coordinates, the acceptance criteria form an ellipsoid surface, the major axis scales of which are determined by individual acceptance criteria and the center of which is located at the measurement point in question. When the calculated dose distribution surface passes through the ellipsoid, the calculation passes the acceptance test for the measurement point. The minimum radial distance between the measurement point and the calculation points (expressed as a surface in the dose-distance space) is termed the gamma index. Regions where gamma > 1 correspond to locations where the calculation does not meet the acceptance criteria. The determination of gamma throughout the measured dose distribution provides a presentation that quantitatively indicates the calculation accuracy. Examples of a 6 MV beam penumbra are used to illustrate the gamma index.
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            BEAM: a Monte Carlo code to simulate radiotherapy treatment units.

            D W O Rogers, B. A. Faddegon, G X Ding … (1995)
            This paper describes BEAM, a general purpose Monte Carlo code to simulate the radiation beams from radiotherapy units including high-energy electron and photon beams, 60Co beams and orthovoltage units. The code handles a variety of elementary geometric entities which the user puts together as needed (jaws, applicators, stacked cones, mirrors, etc.), thus allowing simulation of a wide variety of accelerators. The code is not restricted to cylindrical symmetry. It incorporates a variety of powerful variance reduction techniques such as range rejection, bremsstrahlung splitting and forcing photon interactions. The code allows direct calculation of charge in the monitor ion chamber. It has the capability of keeping track of each particle's history and using this information to score separate dose components (e.g., to determine the dose from electrons scattering off the applicator). The paper presents a variety of calculated results to demonstrate the code's capabilities. The calculated dose distributions in a water phantom irradiated by electron beams from the NRC 35 MeV research accelerator, a Varian Clinac 2100C, a Philips SL75-20, an AECL Therac 20 and a Scanditronix MM50 are all shown to be in good agreement with measurements at the 2 to 3% level. Eighteen electron spectra from four different commercial accelerators are presented and various aspects of the electron beams from a Clinac 2100C are discussed. Timing requirements and selection of parameters for the Monte Carlo calculations are discussed.
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              Tomotherapy: a new concept for the delivery of dynamic conformal radiotherapy.

              T R Mackie, T Holmes, S Swerdloff … (1993)
              Tomotherapy, literally "slice therapy," is a proposal for the delivery of radiation therapy with intensity-modulated strips of radiation. The proposed method employs a linear accelerator, or another radiation-emitting device, which would be mounted on a ring gantry like a CT scanner. The patient would move through the bore of the gantry simultaneously with gantry rotation. The intensity modulation would be performed by temporally modulated multiple independent leaves that open and close across the slit opening. At any given time, any leaf would be (1) closed, covering a portion of the slit, (2) open, allowing radiation through, or (3) changing between these states. This method would result in the delivery of highly conformal radiation. Overall treatment times should be comparable with contemporary treatment delivery times. The ring gantry would make it convenient to mount a narrow multisegmented megavoltage detector system for beam verification and a CT scanner on the treatment unit. Such a treatment unit could become a powerful tool for treatment planning, conformal treatment, and verification using tomographic images. The physical properties of this treatment delivery are evaluated and the fundamental design specifications are justified.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Med Phys
                Journal ID (publisher-id): JMP
                Title: Journal of Medical Physics / Association of Medical Physicists of India
                Publisher: Medknow Publications (India )
                ISSN (Print): 0971-6203
                ISSN (Electronic): 1998-3913
                Publication date (Print): Jul-Sep 2009
                Volume: 34
                Issue: 3
                Pages: 133-136
                Affiliations
                [1 ]Department of Medical Physics, Cancer Centre of Southeastern Ontario (CCSEO), Kingston, ON, Canada
                [2 ]Departments of Oncology and Physics, Queen's University, Kingston, ON, Canada
                Author notes
                Address for correspondence: Dr. L. John Schreiner, Department of Medical Physics, Cancer Centre of Southeastern Ontario at Kingston General Hospital, 25 King Street West, Kingston, Ontario K7L 5P9, Canada. E-mail: john.schreiner@ 123456krcc.on.ca
                Article
                Publisher ID: JMP-34-133
                DOI: 10.4103/0971-6203.54846
                PMC ID: 2807677
                PubMed ID: 20098559
                SO-VID: 9bb3d3de-6de9-44e0-823c-c0a0946ba3c9
                Copyright © © Journal of Medical Physics
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 January 2009
                Date revision received : 23 March 2009
                Date accepted : 11 April 2009
                Categories
                Subject: Invited Paper

                ScienceOpen disciplines: Medical physics
                Keywords: cobalt-60,image guidance,tomotherapy,megavoltage computed tomography,intensity-modulated radiation therapy
                Data availability:
                ScienceOpen disciplines: Medical physics
                Keywords: cobalt-60, image guidance, tomotherapy, megavoltage computed tomography, intensity-modulated radiation therapy

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