Long term stability of a 50 kV X-ray unit for stereotactic irradiation

A low-energy (50 kV) X-ray tube used for the stereotactic irradiation of intracranial lesions has been in use since 1999. The unit is calibrated prior to every procedure and during periodic quality assurance (QA) tests. The unit uses an internal and an external scintillation detector to monitor dose as well as a conventional timer. The records of these calibrations were reviewed to see whether a change in the output had occurred over that period. Using time as the reference, it was found that both the internal radiation monitor (IRM) and the beam output, determined with a parallel plate ionization chamber, dropped by variable amounts over the given period. The beam output dropped significantly more than the IRM, while the external radiation monitor (ERM) showed no significant deviation from its initial value. The beam output dropped to about 90% of its initial value after about 200 days but remained relatively constant thereafter. The IRM dropped steadily to about 96% to 97% of its initial value at 1000 days, but recovered to about 98% after that. Calibration prior to each procedure is strongly recommended.