Photon scatter in portal images: accuracy of a fluence based pencil beam superposition algorithm

The accuracy of a pencil beam algorithm to predict scattered photon fluence into portal imaging systems was studied. A data base of pencil beam kernels describing scattered photon fluence behind homogeneous water slabs (1-50 cm thick) at various air gap distances (0-100 cm) was generated using the EGS Monte Carlo code. Scatter kernels were partitioned according to particle history: singly-scattered, multiply-scattered, and bremsstrahlung and positron annihilation photons. Mean energy and mean angle with respect to the incident photon pencil beam were also scored. This data allows fluence, mean energy, and mean angular data for each history type to be predicted using the pencil beam algorithm. Pencil beam algorithm predictions for 6 and 24 MV incident photon beams were compared against full Monte Carlo simulations for several inhomogeneous phantoms, including approximations to a lateral neck, and a mediastinum treatment. The accuracy of predicted scattered photon fluence, mean energy, and mean angle was investigated as a function of air gap, field size, photon history, incident beam resolution, and phantom geometry. Maximum errors in mean energies were 0.65 and 0.25 MeV for the higher and lower energy spectra, respectively, and 15 degrees for mean angles. The ability of the pencil beam algorithm to predict scatter fluence decreases with decreasing air gap, with the largest error for each phantom occurring at the exit surface. The maximum predictive error was found to be 6.9% with respect to the total fluence on the central axis. By maintaining even a small air gap (approximately 10 cm), the error in predicted scatter fluence may be kept under 3% for the phantoms and beam energies studied here. It is concluded that this pencil beam algorithm is sufficiently accurate (using International Commission on Radiation Units and Measurements Report No. 24 guidelines for absorbed dose) over the majority of clinically relevant air gaps, for further investigation in a portal dose prediction algorithm.     

Photon scatter in portal images: physical characteristics of pencil beam kernels generated using the EGS Monte Carlo code

Pencil beam kernels describing scattered photon fluence behind homogeneous water slabs at various air gap distances were generated using the EGS Monte Carlo code. Photon scatter fluence was scored in separate bins based on the particle's history: singly scattered, multiply scattered, and bremsstrahlung and positron annihilation photons. Simultaneously, the mean energy and mean angle with respect to the incident photon pencil beam were tallied. Kernels were generated for incident photon pencil beams exhibiting monoenergetic spectra of 2.0 and 10.0 MeV, and polyenergetic spectra representative of 6 and 24 MV beams. Reciprocity was used to generate scatter fractions on the central axis for various field sizes, phantom thicknesses, and air gaps. The scatter kernels were further characterized by full width at half-maximum estimates. Modulation transfer functions were calculated, providing theoretical estimates of the limit of performance of portal imaging systems due to the intrinsic scattering of photon radiation through the patient.     

Dose response of BaFBrl: Eu2+ storage phosphor plates exposed to megavoltage photon beams

The BaFBrI:Eu2+ storage phosphor plate (SPP) is a reusable radiation image detector, widely used in diagnostic computed radiography, x-ray crystallography and radioactive tracer studies. When exposed to ionizing radiation, the SPP stores a latent image until it is scanned with a red reading laser which causes blue photostimulated luminescent (PSL) photons to be emitted. The mechanism of formation of the latent image is still poorly understood, especially for megavoltage photon beams. In order to gain insight into this mechanism and aid applications to high-energy beam dosimetry, the authors have directly determined the SPP generation efficiency, W, the energy required to produce one quantum of emitted PSL when it is irradiated by 60Co and 6 MV photon beams. This was done in four steps: 1. The SPP, in a water-equivalent plastic (WEP) phantom, was exposed to a 60Co or 6 MV beam, which had been calibrated to give a known absorbed dose to water in a water phantom at the position of the sensitive layer of the SPP. 2. Monte Carlo simulations were used to calculate the ratio of the dose to the sensitive layer in the WEP phantom to the dose to water at the same position in a water phantom. 3. A bleaching experiment was used to determine the number of photons emitted by a plate given a known dose. 4. The generation efficiency was calculated from the number of photons and the dose. This method is much more direct than previous calculations for kilovoltage x-ray beams based on quantum noise analysis. W was found, within experimental uncertainty, to be 190 eV for 60Co and 160 eV for 6 MV, independent of dose. The values for kilovoltage x-ray beams determined previously agree, within their large uncertainty, with these values for megavoltage beams.     

Scattered radiation from dental metallic crowns in head and neck radiotherapy

We aimed to estimate the scattered radiation from dental metallic crowns during head and neck radiotherapy by irradiating a jaw phantom with external photon beams. The phantom was composed of a dental metallic plate and hydroxyapatite embedded in polymethyl methacrylate. We used radiochromic film measurement and Monte Carlo simulation to calculate the radiation dose and dose distribution inside the phantom. To estimate dose variations in scattered radiation under different clinical situations, we altered the incident energy, field size, plate thickness, plate depth and plate material. The simulation results indicated that the dose at the incident side of the metallic dental plate was approximately 140% of that without the plate. The differences between dose distributions calculated with the radiation treatment-planning system (TPS) algorithms and the data simulation, except around the dental metallic plate, were 3% for a 4 MV photon beam. Therefore, we should carefully consider the dose distribution around dental metallic crowns determined by a TPS.     

A diamond detector in the dosimetry of high-energy electron and photon beams.

A diamond detector type 60003 (PTW Freiburg) was examined for the purpose of dosimetry with 4-20 MeV electron beams and 4-25 MV photon beams. Results were compared with those obtained by using a Markus chamber for electron beams and an ionization chamber for photon beams. Dose distributions were measured in a water phantom with the detector connected to a Unidos electrometer (PTW Freiburg). After a pre-irradiation of about 5 Gy the diamond detector shows a stability in response which is better than that of an ionization chamber. The current of the diamond detector was measured under variation of photon beam dose rate between 0.1 and 7 Gy min(-1). Different FSDs were chosen. Furthermore the pulse repetition frequency and the depth of the detector were changed. The electron beam dose rate was varied between 0.23 and 4.6 Gy min(-1) by changing the pulse-repetition frequency. The response shows no energy dependence within the covered photon-beam energy range. Between 4 MeV and 18 MeV electron beam energy it shows only a small energy dependence of about 2%, as expected from theory. For smaller electron energies the response increases significantly and an influence of the contact material used for the diamond detector can be surmised. A slight sublinearity of the current and dose rate was found. Detector current and dose rate are related by the expression i alpha Ddelta, where i is the detector current, D is the dose rate and delta is a correction factor of approximately 0.963. Depth-dose curves of photon beams, measured with the diamond detector, show a slight overestimation compared with measurements with the ionization chamber. This overestimation is compensated for by the above correction term. The superior spatial resolution of the diamond detector leads to minor deviations between depth-dose curves of electron beams measured with a Markus chamber and a diamond detector.     

Calculational methods for estimating skin dose from electrons in Co-60 gamma-ray beams

Several methods have been employed to calculate the relative contribution to skin dose due to scattered electrons in Co-60 gamma-ray beams. Either the Klein-Nishina differential scattering probability is employed to determine the number and initial energy of electrons scattered into the direction of a detector, or a Gaussian approximation is used to specify the surface distribution of initial pencil electron beams created by parallel or diverging photon fields. Results of these calculations are compared with experimental data. In addition, that fraction of relative surface dose resulting from photon interactions in air alone is estimated and compared with data extrapolated from measurements at large source-surface distance (SSD). The contribution to surface dose from electrons generated in air is 50% or more of the total skin dose for SSDs greater than 80 cm.     

A scintillating gas detector for 2D dose measurements in clinical carbon beams

A two-dimensional position sensitive dosimetry system based on a scintillating gas detector has been developed for pre-treatment verification of dose distributions in hadron therapy. The dosimetry system consists of a chamber filled with an Ar/CF(4) scintillating gas mixture, inside which two cascaded gas electron multipliers (GEMs) are mounted. A GEM is a thin kapton foil with copper cladding structured with a regular pattern of sub-mm holes. The primary electrons, created in the detector's sensitive volume by the incoming beam, drift in an electric field towards the GEMs and undergo gas multiplication in the GEM holes. During this process, photons are emitted by the excited Ar/CF(4) gas molecules and detected by a mirror-lens-CCD camera system. Since the amount of emitted light is proportional to the dose deposited in the sensitive volume of the detector by the incoming beam, the intensity distribution of the measured light spot is proportional to the 2D hadron dose distribution. For a measurement of a 3D dose distribution, the scintillating gas detector is mounted at the beam exit side of a water-bellows phantom, whose thickness can be varied in steps. In this work, the energy dependence of the output signal of the scintillating gas detector has been verified in a 250 MeV/u clinical (12)C ion beam by means of a depth-dose curve measurement. The underestimation of the measured signal at the Bragg peak depth is only 9% with respect to an air-filled ionization chamber. This is much smaller than the underestimation found for a scintillating Gd(2)O(2)S:Tb ('Lanex') screen under the same measurement conditions (43%). Consequently, the scintillating gas detector is a promising device for verifying dose distributions in high LET beams, for example to check hadron therapy treatment plans which comprise beams with different energies.     

A Monte Carlo study of a flattening filter-free linear accelerator verified with measurements

A Monte Carlo model of an Elekta Precise linear accelerator has been built and verified by measured data for a 6 and 10 MV photon beam running with and without a flattening filter in the beam line. In this study the flattening filter was replaced with a 6 mm thick copper plate, provided by the linac vendor, in order to stabilize the beam. Several studies have shown that removal of the filter improves some properties of the photon beam, which could be beneficial for radiotherapy treatments. The investigated characteristics of this new beam included output, spectra, mean energy, half value layer and the origin of scattered photons. The results showed an increased dose output per initial electron at the central axis of 1.76 and 2.66 for the 6 and 10 MV beams, respectively. The number of scattered photons from the accelerator head was reduced by (31.7 ± 0.03)% (1 SD) for the 6 MV beam and (47.6 ± 0.02)% for the 10 MV beam. The photon energy spectrum of the unflattened beam was softer compared to a conventional beam and did not vary significantly with the off-axis distance, even for the largest field size (0-20 cm off-axis).     

Shielding for neutron scattered dose to the fetus in patients treated with 18 MV x-ray beams

Neutrons are associated with therapeutic high energy x-ray beams as a contaminant that contributes significant unwanted dose to the patient. Measurement of both photon and neutron scattered dose at the position of a fetus from chest irradiation by a large field 18 MV x-ray beam was performed using an ionization chamber and superheated drop detector, respectively. Shielding construction to reduce this scattered dose was investigated using both lead sheet and borated polyethylene slabs. A 7.35 cm lead shield reduced the scattered photon dose by 50% and the scattered neutron dose by 40%. Adding 10 cm of 5% borated polyethylene to this lead shield reduced the scattered neutron dose by a factor of 7.5 from the unshielded value. When the 5% borated polyethylene was replaced by the same thickness of 30% borated polyethylene there was no significant change in the reduction of neutron scatter dose. The most efficient shield studied reduced the neutron scatter dose by a factor of 10. The results indicate that most of the scattered neutrons present at the position of the fetus produced by an 18 MV x-ray beam are of low energy and in the thermal to 0.57 MeV range since lead is almost transparent to neutrons with energies lower than 0.57 MeV. This article constitutes the first report of an effective shield to reduce neutron dose at the fetus when treating a pregnant woman with a high energy x-ray beam.     

Optimum momentum transfer arguments for x-ray forward scatter imaging

In our research program we have shown through modeling, related numerical calculations, and experimental measurements that there exists a potential use of scattered radiation for medical x-ray imaging. Each incident photon of wavelength lambda which scatters at a small angle theta with respect to its initial direction of travel has a change in momentum characterized by the photon momentum transfer argument x = lambda(-1) sin(theta/2). In this work, we show that in order to maximize the signal-to-noise ratio (SNR) obtained with scattered x rays, one must detect photons with specific x values. Using a photon counting detector to distinguish 2-cm-thick polymethyl methacrylate and nylon targets situated within a 15-cm-diam spherical water phantom with an 80 kV beam yields experimentally SNR/square root(K(air)c) = 12.8 +/- 0.2 (mJ/kg)(-1/2) when using the photons between x = 0.5 and 0.7 nm(-1). Here K(air)c is the air collision kerma and the average momentum transfer argument, x, is calculated by weighting x by the incident photon fluence distribution. The model predicts a value of SNR/square root(K(air)c) = 12.9 (mJ/kg)(-1/2). If we choose to form the signal with the range in x extended to be from 0.5 to 1.0 nm(-1) then, despite the detection of more scattered photons, experimentally SNR/square root(K(air)c) decreases by 38% to 7.9 +/- 0.3 (mJ/kg)(-1/2). The model predicts a value of 9.46 (mJ/kg)(-1/2). Results for energy integrating detectors are in general similar to those for photon counters, but there exist cases where a significant decrease in SNR can occur. For example, for measurements in air with the two plastics at theta = 3 degrees the SNR for an energy integrator was found to be 52% that of a photon counter. Numerical calculations predict that the effects of spectral blur can be significant when a narrow angular range is used for detection. Preliminary numerical predictions for breast tissues suggest a potential use of x-ray scatter in the field of mammography.     

Unwanted photon and neutron radiation resulting from collimated photon beams interacting with the body of radiotherapy patients

Monte Carlo calculations have been made to determine the energies delivered by photons and neutrons to the human body irradiated by collimated photon beams. The beams were monoenergetic and ranged from 100 keV to 40 MeV. The energy deposition in the body was sorted into two regions: inside and outside the irradiated volume. Most of the results obtained were for a beam size of 100 cm2 although some calculations were also made to 600 cm2 beams. The effect of beam size on energy deposition in the two regions was investigated for 60Co gamma rays. Graphs are presented which give the integral doses delivered by neutrons and photons to the two regions for therapy beams of various energies. These graphs can be used to calculate the integral doses which are delivered inside and outside the treatment volume for photon spectra from most medical accelerators. Calculations of energy deposition were also made for the spectra from two particular accelerators. These were done using Monte Carlo as well as by simply "folding" the spectra into the results for monoenergetic photons. The results obtained by both methods were in good agreement and indicated that the integral doses deposited outside the treatment volume by neutrons are more than two orders of magnitude smaller than those deposited by scattered photons.     

Assessing the effect of electron density in photon dose calculations

Photon dose calculation algorithms (such as the pencil beam and collapsed cone, CC) model the attenuation of a primary photon beam in media other than water, by using pathlength scaling based on the relative mass density of the media to water. In this study, we assess if differences in the electron density between the water and media, with different atomic composition, can influence the accuracy of conventional photon dose calculations algorithms. A comparison is performed between an electron-density scaling method and the standard mass-density scaling method for (i) tissues present in the human body (such as bone, muscle, etc.), and for (ii) water-equivalent plastics, used in radiotherapy dosimetry and quality assurance. We demonstrate that the important material property that should be taken into account by photon dose algorithms is the electron density, and not the mass density. The mass-density scaling method is shown to overestimate, relative to electrondensity predictions, the primary photon fluence for tissues in the human body and water-equivalent plastics, where 6%-7% and 10% differences were observed respectively for bone and air. However, in the case of patients, differences are expected to be smaller due to the large complexity of a treatment plan and of the patient anatomy and atomic composition and of the smaller thickness of bone/air that incident photon beams of a treatment plan may have to traverse. Differences have also been observed for conventional dose algorithms, such as CC, where an overestimate of the lung dose occurs, when irradiating lung tumors. The incorrect lung dose can be attributed to the.incorrect modeling of the photon beam attenuation through the rib cage (thickness of 2-3 cm in bone upstream of the lung tumor) and through the lung and the oversimplified modeling of electron transport in convolution algorithms. In the present study, the overestimation of the primary photon fluence, using the mass-density scaling method, was shown to be a consequence of the differences in the hydrogen content between the various media studied and water. On the other hand, the electron-density scaling method was shown to predict primary photon fluence in media other than water to within 1%-2% for all the materials studied and for energies up to 5 MeV. For energies above 5 MeV, the accuracy of the electron-density scaling method was shown to depend on the photon energy, where for materials with a high content of calcium (such as bone, cortical bone) or for primary photon energies above 10 MeV, the pair-production process could no longer be neglected. The electron-density scaling method was extended to account for pair-production attenuation of the primary photons. Therefore the scaling of the dose distributions in media other than water became dependent on the photon energy. The extended electron-scaling method was shown to estimate the photon range to within 1% for all materials studied and for energies from 100 keV to 20 MeV, allowing it to be used to scale dose distributions to media other than water and generated by clinical radiotherapy photon beams with accelerator energies from 4 to 20 MV.     

Monte Carlo study of si diode response in electron beams

Silicon semiconductor diodes measure almost the same depth-dose distributions in both photon and electron beams as those measured by ion chambers. A recent study in ion chamber dosimetry has suggested that the wall correction factor for a parallel-plate ion chamber in electron beams changes with depth by as much as 6%. To investigate diode detector response with respect to depth, a silicon diode model is constructed and the water/silicon dose ratio at various depths in electron beams is calculated using EGSnrc. The results indicate that, for this particular diode model, the diode response per unit water dose (or water/diode dose ratio) in both 6 and 18 MeV electron beams is flat within 2% versus depth, from near the phantom surface to the depth of R50 (with calculation uncertainty <0.3%). This suggests that there must be some other correction factors for ion chambers that counter-balance the large wall correction factor at depth in electron beams. In addition, the beam quality and field-size dependence of the diode model are also calculated. The results show that the water/diode dose ratio remains constant within 2% over the electron energy range from 6 to 18 MeV. The water/diode dose ratio does not depend on field size as long as the incident electron beam is broad and the electron energy is high. However, for a very small beam size (1 X 1 cm(2)) and low electron energy (6 MeV), the water/diode dose ratio may decrease by more than 2% compared to that of a broad beam.     

Monte Carlo simulation of diagnostic x-ray scatter

A Monte Carlo method was developed and implemented to simulate x-ray photon transport. Simulations consisted of a pencil beam of monoenergetic photons with energies from 50 to 110 keV incident on water and aluminum slabs. The dependence of scatter fraction and multiple scattering on x-ray energy, scatterer thickness, and material is reported in both number and energy fluence. The average energy of scattered photons reaching the detector plane is also reported. Comparisons are made to previous x-ray scatter computations.     

Commissioning stereotactic radiosurgery beams using both experimental and theoretical methods

The purpose of this investigation is to study the feasibility of using an alternative method to commission stereotactic radiosurgery beams shaped by micro multi-leaf collimators by using Monte Carlo simulations to obtain beam characteristics of small photon beams, such as incident beam particle fluence and energy distributions, scatter ratios, depth-dose curves and dose profiles where measurements are impossible or difficult. Ionization chambers and diode detectors with different sensitive volumes were used in the measurements in a water phantom and the Monte Carlo codes BEAMnrc/DOSXYZnrc were used in the simulation. The Monte Carlo calculated data were benchmarked against measured data for photon beams with energies of 6 MV and 10 MV produced from a Varian Trilogy accelerator. The measured scatter ratios and cross-beam dose profiles for very small fields are shown to be not only dependent on the size of the sensitive volume of the detector used but also on the type of detectors. It is known that the response of some detectors changes at small field sizes. Excellent agreement was seen between scatter ratios measured with a small ion chamber and those calculated from Monte Carlo simulations. The values of scatter ratios, for field sizes from 6 x 6 mm2 to 98 x 98 mm2, range from 0.67 to 1.0 and from 0.59 to 1.0 for 6 and 10 MV, respectively. The Monte Carlo calculations predicted that the incident beam particle fluence is strongly affected by the X-Y-jaw openings, especially for small fields due to the finite size of the radiation source. Our measurement confirmed this prediction. This study demonstrates that Monte Carlo calculations not only provide accurate dose distributions for small fields where measurements are difficult but also provide additional beam characteristics that cannot be obtained from experimental methods. Detailed beam characteristics such as incident photon fluence distribution, energy spectra, including composition of primary and scattered photons, can be independently used in dose calculation models and to improve the accuracy of measurements with detectors with an energy-dependent response. Furthermore, when there are discrepancies between results measured with different detectors, the Monte Carlo calculated values can indicate the most correct result. The data set presented in this study can be used as a reference in commissioning stereotactic radiosurgery beams shaped by a BrainLAB m3 on a Varian 2100EX or 600C accelerator.     

Generation of photon energy deposition kernels using the EGS Monte Carlo code

The EGS Monte Carlo code was used to generate photon energy deposition kernels which describe the energy deposited by charged particles set in motion by primary, first scattered, second scattered, multiple scattered and bremsstrahlung plus annihilation photons. These were calculated for a water medium irradiated with monoenergetic photons with energies in the range 0.1-50 MeV. In addition to the primary energy deposition kernels, primary charged particle transport was further characterised by computing the effective centre of the voxels, and the effective penetration depth, effective radius and effective lateral distance travelled by these particles. The dose per unit collision kerma for parallel monoenergetic primary photons beta' was calculated. Additional applications of the energy deposition kernels are discussed.     

Evaluation of the performance of VIPAR polymer gels using a variety of x-ray and electron beams

The aim of this investigation was the evaluation of the usefulness of N-vinyl pyrrolidone argon (VIPAR) polymer gel dosimetry for relative dose measurements using the majority of types and energies of radiation beams used in clinical practice. For this reason, VIPAR polymer gels were irradiated with the following beams: 6 and 23 MV photons (maximum dose: 15 Gy) and 6, 9, 12, 15, 18 and 21 MeV electrons (90% dose: 15 Gy). Using 6 MV x-rays, a linear gel dose response was verified for doses up to 20 Gy. Assuming linearity of response for the rest of the photon and electron beams used in this study, percentage depth dose measurements were derived. For all beams used and the range of relative doses studied, a satisfying agreement was observed between percentage depth dose measurements performed using the VIPAR gel-MRI method and an ion chamber, validating the assumption that a linear gel dose response holds for all photon and electron beams studied. VIPAR gels, therefore, can be used for relative dose distribution measurements using photons or electrons of any typical energy used in external radiotherapy applications. It is also demonstrated that two-dimensional dose distribution measurements through an irradiated (9 MeV electrons, 3 cm x 3 cm cone) VIPAR gel volume can be easily obtained.     

Analysis of spectral blur effects in x-ray scatter imaging.

Previous analysis in our research program investigating the potential use of scattered photons for medical x-ray imaging has been for monoenergetic beams. In practice, polyenergetic beams are almost always used due to their higher photon fluence rate. The effects of beam polychromaticity on x-ray scatter imaging are determined with the aid of our semianalytic model that images a target object against a background material of the same dimensions when both are situated within a water phantom. Our analysis involves four different photon beams with constant incident energy fluence: (1) a monoenergetic beam with photon energy E0, (2) a dual peak beam with two separate monoenergetic peaks of energies E1 and E2, (3) a clinical x-ray beam, and (4) a rectangular beam with uniform energy fluence between energies Emin and Emax. A comparison between the polyenergetic spectra is accomplished by matching the centroids and standard deviations of the dual peak and rectangular spectra to those of the clinical x-ray spectrum. For the task of imaging liver versus fat structures 1 cm thick in a 25-cm-diam spherical water phantom with the scattered photons between 2 degrees and 12 degrees, the predicted signal-to-noise ratio (SNR) obtained with a 100 kV beam is 87.5% of the SNR acquired with the optimum monoenergetic beam (SNRopt). The SNR for the corresponding dual peak beam is 84.4% of SNRopt and for the rectangular beam is 86.3%. Our analysis shows that monoenergetic x-ray beams are not necessary for x-ray scatter imaging.