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Title: Beam Attenuators and the Risk of Unrecognized Large-Fraction Irradiation of Critical Tissues

Abstract

The use of radiation beam attenuators led to radiation injury of the spinal cord in one patient and of the peripheral nerve in another due to unsuspected large-fraction irradiation. The anatomic distribution of radiation dose was reconstructed in the sagittal plane for the patient who developed radiation myelopathy and in the axial plane for the patient who developed peripheral neuropathy. The actual dose delivered to the injured structure in each patient was taken from the dose distribution and recorded along with the time, number of fractions, and dose per fraction. The patient who developed radiation myelopathy received a total of 46.5 Gy in twenty-three 2.1 Gy fractions in 31 days to the upper cervical spinal cord where the thickness of the neck was less than the central axis thickness due to cervical lordosis and absence of a posterior compensating filter. The patient who developed peripheral neuropathy received 55 Gy in twenty-five 2.2 Gy fractions in 50 days to the femoral nerve using bolus over the groins and an anterior one-half value layer Cerrobend pelvic block to bias the dose anteriorly. Compensating filters and other beam attenuators should be used with caution because they may result in unsuspected large-fraction irradiation andmore » total doses of radiation that exceed the tolerance of critical structures.« less

Authors:
;
Publication Date:
OSTI Identifier:
22577830
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 19; Journal Issue: 1; Other Information: Copyright (c) 1994 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 62 RADIOLOGY AND NUCLEAR MEDICINE; ANIMAL TISSUES; BEAMS; HEALTH HAZARDS; IRRADIATION; NECK; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIATION INJURIES; SPINAL CORD; THICKNESS; TOLERANCE

Citation Formats

Luka, S., and Marks, J.E.. Beam Attenuators and the Risk of Unrecognized Large-Fraction Irradiation of Critical Tissues. United States: N. p., 2015. Web. doi:10.1016/0958-3947(94)90028-0.
Luka, S., & Marks, J.E.. Beam Attenuators and the Risk of Unrecognized Large-Fraction Irradiation of Critical Tissues. United States. doi:10.1016/0958-3947(94)90028-0.
Luka, S., and Marks, J.E.. Thu . "Beam Attenuators and the Risk of Unrecognized Large-Fraction Irradiation of Critical Tissues". United States. doi:10.1016/0958-3947(94)90028-0.
@article{osti_22577830,
title = {Beam Attenuators and the Risk of Unrecognized Large-Fraction Irradiation of Critical Tissues},
author = {Luka, S. and Marks, J.E.},
abstractNote = {The use of radiation beam attenuators led to radiation injury of the spinal cord in one patient and of the peripheral nerve in another due to unsuspected large-fraction irradiation. The anatomic distribution of radiation dose was reconstructed in the sagittal plane for the patient who developed radiation myelopathy and in the axial plane for the patient who developed peripheral neuropathy. The actual dose delivered to the injured structure in each patient was taken from the dose distribution and recorded along with the time, number of fractions, and dose per fraction. The patient who developed radiation myelopathy received a total of 46.5 Gy in twenty-three 2.1 Gy fractions in 31 days to the upper cervical spinal cord where the thickness of the neck was less than the central axis thickness due to cervical lordosis and absence of a posterior compensating filter. The patient who developed peripheral neuropathy received 55 Gy in twenty-five 2.2 Gy fractions in 50 days to the femoral nerve using bolus over the groins and an anterior one-half value layer Cerrobend pelvic block to bias the dose anteriorly. Compensating filters and other beam attenuators should be used with caution because they may result in unsuspected large-fraction irradiation and total doses of radiation that exceed the tolerance of critical structures.},
doi = {10.1016/0958-3947(94)90028-0},
journal = {Medical Dosimetry},
number = 1,
volume = 19,
place = {United States},
year = {Thu Jan 15 00:00:00 EST 2015},
month = {Thu Jan 15 00:00:00 EST 2015}
}