Monte Carlo simulation of a planar shoulder model

Although variability of anthropometric measures within a population is a well established phenomenon, most biomechanical models are based on average parameter values. For example, optimisation models for predicting muscle forces from net joint reaction moments typically use average muscle moment arms. However, understanding the distribution of musculoskeletal morbidity within a population requires information about the variation of tissue loads within the population. This study investigated the use of Monte Carlo simulation techniques to predict the statistical distribution of deltoid and rotator cuff muscle forces during static arm elevation. Muscle moment arms were modelled either as independent random variables or jointly distributed random variables. Moment arm data was collected on 22 cadaver specimens. The results demonstrated the use of Monte Carlo techniques to describe the statistical distribution of muscle forces. Although assuming statistically independent moment arms did affect the statistical distribution shape, that assumption did not affect the median predicted forces. The standard deviations of muscle forces predicted using Monte Carlo techniques were similar to the standard deviation of muscle force predictions using the whole sample of specimens. It is concluded that Monte Carlo simulation techniques are a useful tool to analyse the interindividual variability of rotator cuff muscle forces.     

Dosimetric verification of a Monte Carlo electron beam model for an add-on eMLC

Dosimetric verification of a new Monte Carlo beam model for multi-leaf collimated electrons was performed using experimental data from an add-on electron multi-leaf collimator (eMLC) prototype. The measurements were compared against calculations using an electron phase space sampled from a parameterized electron beam model and the voxel Monte Carlo++ (VMC++) code for in-phantom energy deposition. Verification of the calculations was performed in a water phantom with the developed eMLC attached to a Varian 2100 C/D radiotherapy accelerator with nominal energies 6 MeV, 9 MeV, 12 MeV, 16 MeV and 20 MeV. The eMLC prototype consisting of 2 cm thick and 5 mm wide steel leaves is fixed under the 20 x 20 cm(2) electron applicator with a source-to-leaf distance 97.2 cm. The eMLC prototype has non-motorized leaves with straight leaf edges and a maximum field size of 20 x 20 cm(2) at SSD 100 cm. The beam model is a coupled multi-source model with parameters derived from detailed beam characterization measurements and a kernel model for the indirect leaf-scattered electrons. Typical calculation times with a 2% mean statistical uncertainty was under 5 min. In extensive set of in-water measurements 88% of the voxels were within 2% /2 mm acceptance criterion. Although at SSD 100 cm the dose near the phantom surface is slightly pronounced due to the short collimator-to-surface distance, the new beam model was suitable for dose calculation of the add-on type eMLC.     

Inverse Monte Carlo method in a multilayered tissue model for diffuse reflectance spectroscopy

Model based data analysis of diffuse reflectance spectroscopy data enables the estimation of optical and structural tissue parameters. The aim of this study was to present an inverse Monte Carlo method based on spectra from two source-detector distances (0.4 and 1.2 mm), using a multilayered tissue model. The tissue model variables include geometrical properties, light scattering properties, tissue chromophores such as melanin and hemoglobin, oxygen saturation and average vessel diameter. The method utilizes a small set of presimulated Monte Carlo data for combinations of different levels of epidermal thickness and tissue scattering. The path length distributions in the different layers are stored and the effect of the other parameters is added in the post-processing. The accuracy of the method was evaluated using Monte Carlo simulations of tissue-like models containing discrete blood vessels, evaluating blood tissue fraction and oxygenation. It was also compared to a homogeneous model. The multilayer model performed better than the homogeneous model and all tissue parameters significantly improved spectral fitting. Recorded in vivo spectra were fitted well at both distances, which we previously found was not possible with a homogeneous model. No absolute intensity calibration is needed and the algorithm is fast enough for real-time processing.     

An image-based rat model for Monte Carlo organ dose calculations

An anatomically realistic rat model was developed from color images of successive cryosections of a mature Sprague-Dawley rat. Images were obtained, by digital scanning, of 9475 slices with thickness of 0.02 mm. A total of 13 major organs and tissues were selected, and models of these organs and tissues constructed from the images were used for calculations of absorbed dose from external photon sources. A detailed set of conversion coefficients from kerma free-in-air to organ absorbed dose have been calculated for external monoenergetic photon beams with energies ranging from 10 keV to 10 MeV under five idealized irradiation conditions (left lateral, right lateral, dorsal-ventral, ventral-dorsal, and isotropic) using the Monte Carlo code MCNPX. Dose results are presented in form of tables as supplemental data for practical use and comparison. The influence of anatomical characteristics, including organ volume, shape, location, and orientation, on dose distributions were evaluated. It would also be possible to make internal dose assessments using the computational rat model.     

A Monte Carlo model of the Varian IGRT couch top for RapidArc QA

The objectives of this study are to evaluate the effect of couch attenuation on quality assurance (QA) results and to present a couch top model for Monte Carlo (MC) dose calculation for RapidArc treatments. The IGRT couch top is modelled in Eclipse as a thin skin of higher density material with a homogeneous fill of foam of lower density and attenuation. The IGRT couch structure consists of two longitudinal sections referred to as thick and thin. The Hounsfield Unit (HU) characterization of the couch structure was determined using a cylindrical phantom by comparing ion chamber measurements with the dose predicted by the treatment planning system (TPS). The optimal set of HU for the inside of the couch and the surface shell was found to be respectively -960 and -700 HU in agreement with Vanetti et al (2009 Phys. Med. Biol. 54 N157-66). For each plan, the final dose calculation was performed with the thin, thick and without the couch top. Dose differences up to 2.6% were observed with TPS calculated doses not including the couch and up to 3.4% with MC not including the couch and were found to be treatment specific. A MC couch top model was created based on the TPS geometrical model. The carbon fibre couch top skin was modelled using carbon graphite; the density was adjusted until good agreement with experimental data was observed, while the density of the foam inside was kept constant. The accuracy of the couch top model was evaluated by comparison with ion chamber measurements and TPS calculated dose combined with a 3D gamma analysis. Similar to the TPS case, a single graphite density can be used for both the thin and thick MC couch top models. Results showed good agreement with ion chamber measurements (within 1.2%) and with TPS (within 1%). For each plan, over 95% of the points passed the 3D gamma test.     

Magnetic fields with photon beams: Monte Carlo calculations for a model magnetic field

Strong transverse magnetic fields can produce very large dose enhancements and reductions in localized regions of a patient under irradiation by a photon beam. We have suggested a model magnetic field which can be expected to produce such large dose enhancements and reductions, and we have carried out EGS4 Monte Carlo calculations to examine this effect for a 6x6 cm2 photon beam of energy 15, 30, or 45 MV penetrating a water phantom. Our model magnetic field has a nominal (center) strength B0 ranging between 1 and 5 T, and a maximum strength within the geometric beam which is 2.2xB0. For all three beam energies, there is significant dose enhancement for B0 = 2 T which increases greatly for B0 = 3 T, but stronger magnetic fields increase the enhancement further only for the 45-MV beam. Correspondingly, there is major reduction in the dose just distal to this region of large dose enhancement, resulting from secondary electrons and positrons originating upstream which are depositing energy in the dose-enhancement region rather than continuing further into the patient. The dose peak region is fairly narrow (in depth), but the magnetic field can be shifted along the longitudinal axis to produce a flat peak region of medium width (approximately 2 cm) or of large width (approximately 4 cm), with rapid dose dropoffs on either side. For the 30-MV beam with B0 = 3 T, we found a dose enhancement of 55% for the narrow-width configuration, 32% for the medium-width configuration, and 23% for the large-width configuration; for the 45-MV beam with B0 = 3 T, the enhancements were quite similar, but for the 15-MV beam they were considerably less. For all of these 30-MV configurations, the dose reductions were approximately 30%, and they were approximately 40% for the 45-MV configurations.     

A Monte Carlo model for calculating out-of-field dose from a varian 6 MV beam

Dose to the patient outside of the treatment field is important when evaluating the outcome of radiotherapy treatments. However, determining out-of-field doses for any particular treatment plan currently requires either time-consuming measurements or calculated estimations that may be highly uncertain. A Monte Carlo model may allow these doses to be determined quickly, accurately, and with a great degree of flexibility. MCNPX was used to create a Monte Carlo model of a Varian Clinac 2100 accelerator head operated at 6 MV. Simulations of the dose out-of-field were made and measurements were taken with thermoluminescent dosimeters in an acrylic phantom and with an ion chamber in a water tank to validate the Monte Carlo model. Although local differences between the out-of-field doses calculated by the model and those measured did exceed 50% at some points far from the treatment field, the average local difference was only 16%. This included a range of doses as low as 0.01% of the central axis dose, and at distances in excess of 50 cm from the central axis of the treatment field. The out-of-field dose was found to vary with field size and distance from the central axis, but was almost independent of the depth in the phantom except where the dose increased substantially at depths less than dmax. The relationship between dose and kerma was also investigated, and kerma was found to be a good estimate of dose (within 3% on average) except near the surface and in the field penumbra. Our Monte Carlo model was found to well represent typical Varian 2100 accelerators operated at 6 MV.     

A virtual photon energy fluence model for Monte Carlo dose calculation

The presented virtual energy fluence (VEF) model of the patient-independent part of the medical linear accelerator heads, consists of two Gaussian-shaped photon sources and one uniform electron source. The planar photon sources are located close to the bremsstrahlung target (primary source) and to the flattening filter (secondary source), respectively. The electron contamination source is located in the plane defining the lower end of the filter. The standard deviations or widths and the relative weights of each source are free parameters. Five other parameters correct for fluence variations, i.e., the horn or central depression effect. If these parameters and the field widths in the X and Y directions are given, the corresponding energy fluence distribution can be calculated analytically and compared to measured dose distributions in air. This provides a method of fitting the free parameters using the measurements for various square and rectangular fields and a fixed number of monitor units. The next step in generating the whole set of base data is to calculate monoenergetic central axis depth dose distributions in water which are used to derive the energy spectrum by deconvolving the measured depth dose curves. This spectrum is also corrected to take the off-axis softening into account. The VEF model is implemented together with geometry modules for the patient specific part of the treatment head (jaws, multileaf collimator) into the XVMC dose calculation engine. The implementation into other Monte Carlo codes is possible based on the information in this paper. Experiments are performed to verify the model by comparing measured and calculated dose distributions and output factors in water. It is demonstrated that open photon beams of linear accelerators from two different vendors are accurately simulated using the VEF model. The commissioning procedure of the VEF model is clinically feasible because it is based on standard measurements in air and water. It is also useful for IMRT applications because a full Monte Carlo simulation of the treatment head would be too time-consuming for many small fields.     

A virtual source model for Monte Carlo modeling of arbitrary intensity distributions

A photon virtual source model was developed for simulating arbitrary, external beam, intensity distributions using the Monte Carlo method. The source model consists of a photon fluence grid composed of a matrix of square elements, located 25-cm downstream from the linear accelerator target. Each particle originating from the fluence map is characterized by the seven phase space parameters, position (x, y, z), direction (u, v, w), and energy. The map was reconstructed from fluence and energy spectra acquired by modeling components of the linear accelerator treatment head using the Monte Carlo code MCNP4B. The effect of contaminant electrons is accounted for by the use of a sub-source derived from a phase-space simulation of a 25-MV linac treatment head using the code BEAM. The BEAM sub-source was incorporated into the MCNP4B phase-space model and is sampled using a field-size dependent sampling ratio. A Gaussian blurring kernel is convolved with the photon fluence map to account for the finite focal spot size and scattering effects from structures such as the flattening filter and MLC leaves. Depth dose and profile source calculations for 6-MV and 25-MV photon beams, for 5 x 5 cm2, 10 x 10 cm2, and 15 x 15 cm2 field sizes, are in good agreement with measurement and are well within acceptability criteria suggested by the AAPM Task Group Report No. 53. Irregular field calculations compared with film measurement and with a 3-D pencil beam algorithm show that the source model is capable of accurately simulating arbitrary MLC fields.     

A Monte Carlo model for the absorption and flux distributions of light in tissue

A Monte Carlo computer model has been developed to study the propagation of light in tissues. Light attenuation is assumed to result from absorption and isotropic scattering. The model has been used to predict the distribution of absorbed dose in homogeneous tissues of different absorption/scattering ratios, for illumination both by external light beams and via implanted optical fibers. The photon flux into optical fibers placed in the tissue as detectors has also been investigated. The results are interpreted in relation to the use of visible light irradiation for photo radiation therapy.     

Development of a 30-week-pregnant female tomographic model from computed tomography (CT) images for Monte Carlo organ dose calculations

Assessment of radiation dose and risk to a pregnant woman and her fetus is an important task in radiation protection. Although tomographic models for male and female patients of different ages have been developed using medical images, such models for pregnant women had not been developed to date. This paper reports the construction of a partial-body model of a pregnant woman from a set of computed tomography (CT) images. The patient was 30 weeks into pregnancy, and the CT scan covered the portion of the body from above liver to below pubic symphysis in 70 slices. The thickness for each slice is 7 mm, and the image resolution is 512x512 pixels in a 48 cm x 48 cm field; thus, the voxel size is 6.15 mm3. The images were segmented to identify 34 major internal organs and tissues considered sensitive to radiation. Even though the masses are noticeably different from other models, the three-dimensional visualization verified the segmentation and its suitability for Monte Carlo calculations. The model has been implemented into a Monte Carlo code, EGS4-VLSI (very large segmented images), for the calculations of radiation dose to a pregnant woman. The specific absorbed fraction (SAF) results for internal photons were compared with those from a stylized model. Small and large differences were found, and the differences can be explained by mass differences and by the relative geometry differences between the source and the target organs. The research provides the radiation dosimetry community with the first voxelized tomographic model of a pregnant woman, opening the door to future dosimetry studies.     

Monte Carlo simulation of a dynamic MLC based on a multiple source model.

Detailed knowledge of the characteristics of the radiation field shaped by a multileaf collimator (MLC) is essential in intensity modulated radiotherapy (IMRT). A previously developed multiple source model (MSM) for a 6 MV beam was extended to a 15 MV beam and supplemented with an accurate model of an 80-leaf dynamic MLC. Using the supplemented MSM and the MC code GEANT, lateral dose distributions were calculated in a water phantom and a portal water phantom. A field which is normally used for the validation of the step and shoot technique and a field from a realistic IMRT treatment plan delivered with dynamic MLC are investigated. To assess possible spectral changes caused by the modulation of beam intensity by an MLC, the energy spectra in five portal planes were calculated for moving slits of different widths. The extension of the MSM to 15 MV was validated by analysing energy fluences, depth doses and dose profiles. In addition, the MC-calculated primary energy spectrum was verified with an energy spectrum which was reconstructed from transmission measurements. MC-calculated dose profiles using the MSM for the step and shoot case and for the dynamic MLC case are in very good agreement with the measured data from film dosimetry. The investigation of a 13 cm wide field shows an increase in mean photon energy of up to 16% for the 0.25 cm slit compared to the open beam for 6 MV and of up to 6% for 15 MV, respectively. In conclusion, the MSM supplemented with the dynamic MLC has proven to be a powerful tool for investigational and benchmarking purposes or even for dose calculations in IMRT.     

ORANGE: a Monte Carlo dose engine for radiotherapy

This study presents data for the verification of ORANGE, a fast MCNP-based dose engine for radiotherapy treatment planning. In order to verify the new algorithm, it has been benchmarked against DOSXYZ and against measurements. For the benchmarking, first calculations have been done using the ICCR-XIII benchmark. Next, calculations have been done with DOSXYZ and ORANGE in five different phantoms (one homogeneous, two with bone equivalent inserts and two with lung equivalent inserts). The calculations have been done with two mono-energetic photon beams (2 MeV and 6 MeV) and two mono-energetic electron beams (10 MeV and 20 MeV). Comparison of the calculated data (from DOSXYZ and ORANGE) against measurements was possible for a realistic 10 MV photon beam and a realistic 15 MeV electron beam in a homogeneous phantom only. For the comparison of the calculated dose distributions and dose distributions against measurements, the concept of the confidence limit (CL) has been used. This concept reduces the difference between two data sets to a single number, which gives the deviation for 90% of the dose distributions. Using this concept, it was found that ORANGE was always within the statistical bandwidth with DOSXYZ and the measurements. The ICCR-XIII benchmark showed that ORANGE is seven times faster than DOSXYZ, a result comparable with other accelerated Monte Carlo dose systems when no variance reduction is used. As shown for XVMC, using variance reduction techniques has the potential for further acceleration. Using modern computer hardware, this brings the total calculation time for a dose distribution with 1.5% (statistical) accuracy within the clinical range (less then 10 min). This means that ORANGE can be a candidate for a dose engine in radiotherapy treatment planning.     

Sensitivity of large-field electron beams to variations in a Monte Carlo accelerator model

Adjustments made to Monte Carlo models during the commissioning of the simulation should be physically realistic and correspond to actual machine characteristics. Large electron fields, with the jaws fully open and the applicator removed, are sensitive to important source and geometry parameters and may provide the most accurate beam models, including those collimated by an applicator. We report on the results of a comprehensive Monte Carlo sensitivity study documenting the response of these large fields to changes in the configuration of a Siemens Primus linear accelerator. The study was performed for 6, 9 12, 15, 18 and 21 MeV configurations, and included variations of thickness, position and lateral alignment of all treatment head components. Variations of electron beam characteristics were also included in the study. Results were classified by their impact on central-axis depth dose distributions, including the bremsstrahlung tail, and on beam profiles near D(max) and in the bremsstrahlung region. Low-energy results show an increased sensitivity to electron beam properties. High-energy bremsstrahlung profiles are shown to be useful in determining misalignments between the beam axis and mechanical isocentre. For all energies, the alignment of the secondary scattering foil and monitor chamber are shown to be critical for correctly modelling beam asymmetries. The results suggest a methodology for commissioning of electron beams using Monte Carlo treatment head simulation.     

A Monte Carlo model for out-of-field dose calculation from high-energy photon therapy

As cancer therapy becomes more efficacious and patients survive longer, the potential for late effects increases, including effects induced by radiation dose delivered away from the treatment site. This out-of-field radiation is of particular concern with high-energy radiotherapy, as neutrons are produced in the accelerator head. We recently developed an accurate Monte Carlo model of a Varian 2100 accelerator using MCNPX for calculating the dose away from the treatment field resulting from low-energy therapy. In this study, we expanded and validated our Monte Carlo model for high-energy (18 MV) photon therapy, including both photons and neutrons. Simulated out-of-field photon doses were compared with measurements made with thermoluminescent dosimeters in an acrylic phantom up to 55 cm from the central axis. Simulated neutron fluences and energy spectra were compared with measurements using moderated gold foil activation in moderators and data from the literature. The average local difference between the calculated and measured photon dose was 17%, including doses as low as 0.01% of the central axis dose. The out-of-field photon dose varied substantially with field size and distance from the edge of the field but varied little with depth in the phantom, except at depths shallower than 3 cm, where the dose sharply increased. On average, the difference between the simulated and measured neutron fluences was 19% and good agreement was observed with the neutron spectra. The neutron dose equivalent varied little with field size or distance from the central axis but decreased with depth in the phantom. Neutrons were the dominant component of the out-of-field dose equivalent for shallow depths and large distances from the edge of the treatment field. This Monte Carlo model is useful to both physicists and clinicians when evaluating out-of-field doses and associated potential risks.     

Monte Carlo source model for photon beam radiotherapy: photon source characteristics

A major barrier to widespread clinical implementation of Monte Carlo dose calculation is the difficulty in characterizing the radiation source within a generalized source model. This work aims to develop a generalized three-component source model (target, primary collimator, flattening filter) for 6- and 18-MV photon beams that match full phase-space data (PSD). Subsource by subsource comparison of dose distributions, using either source PSD or the source model as input, allows accurate source characterization and has the potential to ease the commissioning procedure, since it is possible to obtain information about which subsource needs to be tuned. This source model is unique in that, compared to previous source models, it retains additional correlations among PS variables, which improves accuracy at nonstandard source-to-surface distances (SSDs). In our study, three-dimensional (3D) dose calculations were performed for SSDs ranging from 50 to 200 cm and for field sizes from 1 x 1 to 30 x 30 cm2 as well as a 10 x 10 cm2 field 5 cm off axis in each direction. The 3D dose distributions, using either full PSD or the source model as input, were compared in terms of dose-difference and distance-to-agreement. With this model, over 99% of the voxels agreed within +/-1% or 1 mm for the target, within 2% or 2 mm for the primary collimator, and within +/-2.5% or 2 mm for the flattening filter in all cases studied. For the dose distributions, 99% of the dose voxels agreed within 1% or 1 mm when the combined source model-including a charged particle source and the full PSD as input-was used. The accurate and general characterization of each photon source and knowledge of the subsource dose distributions should facilitate source model commissioning procedures by allowing scaling the histogram distributions representing the subsources to be tuned.