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267270, 1998
Copyright 1998 American Association of Medical Dosimetrists
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Original Contribution
INTRODUCTION
compensator were acquired through Moire fringe photographs of the phantom.2 Each fringe is equivalent to a 1.0
cm change in separation in the phantom and each step of
the compensator is from 1 to 2 cm wide. A custom
polylead step-wedge compensator was constructed from
a technique described by Spicka, et al.3 A standard
nasopharynx field (with blocks) was set-up to analyze
doses for typical treatment sites: larynx, nasopharynx,
cervical spinal cord, and anterior/posterior cervical neck
nodes. Computer isodose plans were generated using the
GE Target treatment planning computer. The energies
studied were from a Theratronics Cobalt-60 gamma ray
teletherapy unit and 6 & 18 MV x-rays from a Varian
Clinac 1800 linear accelerator. These plans were calculated with/without compensators.
In addition, to simulate position errors or patient
movement, the lateral fields were moved anterior/posterior 61.0 cm.
RESULTS
A comparison of isodose plans normalized to isocenter without compensators with the compensated isodose plans for photon energies of Cobalt-60 (Fig. 1), 6
MV (Fig. 2), and 18 MV (Fig. 3) show that, i) the dose
decreases in the thinner laryngeal region, ii) there is a
slight over-compensation seen in most regions, iii) the
hot spot shifts from the larynx region to the anterior neck
Reprint requests to: Dr. S. C. Sharma, Sparrow Hospital, Department of Radiation Oncology, 1215 East Michigan Ave., Lansing MI
48909.
Poster presentation at the 37th annual meeting of ASTRO, Miami, Florida, October 1995.
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Medical Dosimetry
Fig. 1. Isodose plans for Co-60 uncompensated field (left panel) and compensated field (right panel).
Fig. 2. Isodose plans for 6 MV uncompensated field (left panel) and compensated field (right panel).
Clinical considerations in the use of missing tissue compensators for head & neck cases S. C. SHARMA and M. W. JOHNSON
269
Fig. 3. Isodose plans for 18 MV uncompensated field (left panel) and compensated field (right panel).
not only decreases the Hot Spot, but the overall dose
variation in the treatment volume is decreased. This is
primarily because of the general symmetry of the
treated region, unlike the thorax which can only be
compensated from the anterior and has major organs
of concern that are not in the calculated plane of
compensation.4 With regard to patient movement,
when the incremental shift is about the width of the
compensator step, there is still some change in dose
distribution. Therefore, it is emphasized that reproducible immobilization is necessary when using compensators.
Larynx
Nasopharynx
Anterior
Neck Nodes
Posterior
Neck Nodes
Cervical
Cord
Hot Spot
Figure
Reference
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65%
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66%
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62%
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65%
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64%
109
105
62%
Figure 1
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112
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Figure 2
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Figure 3
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Medical Dosimetry
REFERENCES
1. Ellis, F.; Hall, E.J.; Oliver, R. A compensator for variations in
tissue thickness for a high energy beam. British Journal of Radiology 32:421; 1959.
2. Boyer, A.; Goitein, M. Simulator mounted moire tomography for
constructing compensator filters. Medical Physics 7(1):1926; 1980.