An experimental investigation on reduced radiological penumbra for intermediate energy x-rays: Implications for small field radiosurgery

Current day external beam radiation therapy typically uses x-ray energies in the megavoltage (6--18 MV) or in the superficial/orthovoltage (80--350 kVp) energy ranges. It has been found that intermediate energy x-rays (those greater than orthovoltage but sub-megavoltage) may offer an advantage in the field of high precision radiation therapy such as in radiosurgery. This advantage is a reduction in the radiological penumbra associated with small (less than about 3 cm) radiation dose fields. A consequence of reduced radiological penumbra is a more homogenous, conformal dose distribution in the patient with dose escalation and organ sparing made more feasible. The objectives of this thesis were as follows: to produce and to characterize an intermediate energy x-ray beam, to establish a method of accurate penumbra measurement at the micron level for millimeter size fields, to measure the radiological penumbra of single small intermediate energy x-ray fields, and to show the clinical consequences of a multiple beam irradiation in a stereotactic head phantom.;Penumbra widths were compared for 1.2 MV versus 6 MV for identical irradiation conditions. In some instances, there was a five-fold reduction in the radiological penumbra of single 1.2 MV x-ray beams. A multiple beam arc irradiation demonstrated that the advantages seen with single beams carry over to multiple beams. The benefits of reduced radiological penumbra for intermediate energies and small fields will only be realized with consideration for minimizing geometrical penumbra, providing superior immobilization and imaging, and using the appropriate tools for the quality assurance of such steep gradients.;A maximum photon energy of 1.2 +/- 0.1 MeV was determined for the intermediate energy x-ray spectrum at the expense of a low dose rate. A digital microscope with a computer controlled translation stage was investigated for its ability to resolve steep dose gradients in Gafchromic EBT film for field sizes as small as 1 mm and for photon energies as low as 100 kVp. The microscope-film system resolved gradients to within about 30 mum, limited by the inherent spatial resolution of the film, the noise of the system, and the uncertainties of measurement.