Intraoperative radiation therapy at the National Cancer Institute: technical innovations and dosimetry

The technical complexity of intraoperative radiotherapy (IORT) requires modification of the standard physical and dosimetric methods used in external electron beam therapy. At the National Cancer Institute, a number of technical innovations have been integrated into ongoing clinical studies of IORT. These include: (1) an electron beam applicator system that is significantly different from other IORT systems and includes customized "squircle" applicators; (2) peripheral dose shields; (3) a modified surgical table replacing the standard radiation treatment couch; and (4) routine use of multiple IORT fields that necessitates field matching. The IORT applicator system and related devices and techniques are dosimetrically characterized in detail both for use in the IORT program and in order to illustrate many useful facets of electron dosimetry.