Dose measurements compared with Monte Carlo simulations of narrow 6 MV multileaf collimator shaped photon beams.

Small fields where electronic equilibrium is not achieved are becoming increasingly important in clinical practice. These complex situations give rise to problems and inaccuracies in both dosimetry and analytical/empirical dose calculation, and therefore require other than conventional methods. A natural diamond detector and a Markus parallel plate ionization chamber have been selected for clinical dosimetry in 6 MV photon beams. Results of simulations using the Monte Carlo system BEAM/EGS4 to model the beam geometry have been compared with dose measurements. A modification of the existing component module for multileaf collimators (MLCs) allowed the modeling of a linear accelerator SL 25 (Elekta Oncology Systems) equipped with a MLC with curved leaf-ends. A mechanical measurement method with spacer plates and a light-field edge detection technique are described as methods to obtain geometrical data of collimator openings for application in the Monte Carlo system. Generally a good agreement is found between measurements and calculations of depth dose distributions and deviations are typically less than 1%. Calculated lateral dose profiles slightly exceed measured dose distributions near the higher level of the penumbras for a 10x2 cm2 field, but agree well with the measurements for all other cases. The simulations are also able to predict variations of output factors and ratios of output factors as a function of field width and field-offset. The Monte Carlo results demonstrate that qualitative changes in energy spectra are too small to explain these variations and that especially geometrical factors affect the output factors and depth dose curves and profiles.     

The characterization of unflattened photon beams from a 6 MV linear accelerator

Commissioning data have been measured for an Elekta Precise linear accelerator running at 6 MV without a flattening filter with the aim of studying the effects of flattening filter removal on machine operation and beam characterization. Modern radiotherapy practice now routinely relies on the use of fluence modifying techniques such as IMRT, i.e. the active production of non-flat beams. For these techniques the flattening filter should not be necessary. It is also possible that the increased intensity around the central axis associated with unflattened beams may be useful for conventional treatment planning by acting as a field-in-field or integrated boost technique. For this reason open and wedged field data are presented. Whilst problems exist in running the machine filter free clinically, this paper shows that in many ways the beam is actually more stable, exhibiting almost half the variation in field symmetry for changes in steering and bending currents. Dosimetric benefits are reported here which include a reduction in head scatter by approx. 70%, decreased penumbra (0.5 mm), lower dose outside of the field edge (11%) and a doubling in dose rate (2.3 times for open and 1.9 times for wedged fields). Measurements also show that reduced scatter also reduces leakage radiation by approx. 60%, significantly lowering whole body doses. The greatest benefit of filter-free use is perceived to be for IMRT where increased dose rate combined with reduced head scatter and leakage radiation should lead to improved dose calculation, giving simpler, faster and more accurate dose delivery with reduced dose to normal tissues.     

Peripheral dose from a linear accelerator equipped with multileaf collimation

In radiation therapy, knowledge of the peripheral dose is important when anatomical structures with very low dose tolerances might be involved. Two of the major sources of peripheral dose, leakage from the linac head, and scatter from secondary collimators, depend strongly on the configuration of the linac head and therefore might be affected by the presence of a multileaf collimator (MLC). In this study, peripheral dose was measured at two depths and two field sizes for 6 and 18 MV photons from a linac with a MLC. The MLC was configured both with leaves fully retracted and with leaves positioned at the field edges defined by the secondary collimator jaws. Comparative measurements were also made for 6 MV photons from a linac without MLC. Peripheral dose was determined as a percentage of the central axis dose for the same energy, field size, and depth using diode detectors in solid phantom material. The data for the 6 MV without MLC agreed with those for the beam with MLC leaves retracted. For both energies at all depths and distances from the field edge, configuring the MLC leaves at the field edge yielded a reduction in peripheral dose of 6%-50% compared to MLC leaves fully retracted.     

Properties of unflattened photon beams shaped by a multileaf collimator

Several studies have shown that removal of the flattening filter from the treatment head of a clinical accelerator increases the dose rate and changes the lateral profile in radiation therapy with photons. However, the multileaf collimator (MLC) used to shape the field was not taken into consideration in these studies. We therefore investigated the effect of the MLC on flattened and unflattened beams. To do this, we performed measurements on a Varian Clinac 21EX and MCNPX Monte Carlo simulations to analyze the physical properties of the photon beam. We compared lateral profiles, depth dose curves, MLC leakages, and total scatter factors for two energies (6 and 18 MV) of MLC-shaped fields and jaw-shaped fields. Our study showed that flattening filter-free beams shaped by a MLC differ from the jaw-shaped beams. Similar differences were also observed for flattened beams. Although both collimating methods produced identical depth dose curves, the penumbra size and the MLC leakage were reduced in the softer, unflattened beam and the total scatter factors showed a smaller field size dependence.     

Buildup/surface dose and exit dose measurements for a 6-MV linear accelerator

The central axis dose distribution in the buildup region for the Varian Clinac 6/100 6-MV x-ray beam was measured in a polystyrene phantom using a fixed volume (0.5 cm3) parallel-plate ionization chamber (2.4-mm plate separation). Results for the surface dose measurements ranged from approximately 8% of the maximum dose for a 5 X 5 cm field, up to 36% for a 40 X 40 cm field, 100-cm source-skin distance. The effect of a 0.6-cm-thick polycarbonate blocking tray and metal filters on the surface and buildup dose is also reported. In addition, ionization measurements were made to document the dose perturbations caused by the absence of backscattering material at the exit surface of a polystyrene phantom. Exit dose measurements showed a 15% reduction in dose with essentially no scattering material beyond the measurement point. Near full scatter condition could be restored by placing 5-10 mm (depending on field size) of unit density material directly behind the ion chamber's distal surface.     

Leakage of the Siemens 160 MLC multileaf collimator on a dual energy linear accelerator

Multileaf collimators (MLCs) have been in clinical use for many years and meanwhile are commonly used to deliver intensity-modulated radiotherapy (IMRT) beams. For this purpose it is important to know their dosimetric properties precisely, one of them being inter- and intraleaf leakage. The Siemens 160 MLC features a single focus design with flat-sided and tilted leaves instead of tongue-and-groove. The leakage performance of the 160 MLC was investigated on a dual energy linear accelerator Siemens ARTISTE with 6 MV and 18 MV photon energies. While the intraleaf leakage amounted to nearly the same dose for 6 and for 18 MV, a much higher interleaf leakage for 6 MV was measured. It could be reduced by simply rotating the collimator, and also by changing the voltage applied to the beam steering coils. The leakage of the 160 MLC is shown to be sensitive to beam alignment. This is of special interest for dual energy accelerators, as the two focal spots of both energies, neither in position nor in shape, do not necessarily always coincide. As a consequence of that, a higher leakage can be expected for one out of two energies for the 160 MLC.     

Calculation of effective dose from measurements of secondary neutron spectra and scattered photon dose from dynamic MLC IMRT for 6 MV, 15 MV, and 18 MV beam energies

Effective doses were calculated from the delivery of 6 MV, 15 MV, and 18 MV conventional and intensity-modulated radiation therapy (IMRT) prostate treatment plans. ICRP-60 tissue weighting factors were used for the calculations. Photon doses were measured in phantom for all beam energies. Neutron spectra were measured for 15 MV and 18 MV and ICRP-74 quality conversion factors used to calculate ambient dose equivalents. The ambient dose equivalents were corrected for each tissue using neutron depth dose data from the literature. The depth corrected neutron doses were then used as a measure of the neutron component of the ICRP protection quantity, organ equivalent dose. IMRT resulted in an increased photon dose to many organs. However, the IMRT treatments resulted in an overall decrease in effective dose compared to conventional radiotherapy. This decrease correlates to the ability of an intensity-modulated field to minimize dose to critical normal structures in close proximity to the treatment volume. In a comparison of the three beam energies used for the IMRT treatments, 6 MV resulted in the lowest effective dose, while 18 MV resulted in the highest effective dose. This is attributed to the large neutron contribution for 18 MV compared to no neutron contribution for 6 MV.     

Energy spectra, angular spread, fluence profiles and dose distributions of 6 and 18 MV photon beams: results of monte carlo simulations for a varian 2100EX accelerator

The purpose of this study is to provide detailed characteristics of incident photon beams for different field sizes and beam energies. This information is critical to the future development of accurate treatment planning systems. It also enhances our knowledge of radiotherapy photon beams. The EGS4 Monte Carlo code, BEAM, has been used to simulate 6 and 18 MV photon beams from a Varian Clinac-2100EX accelerator. A simulated realistic beam is stored in a phase space data file, which contains details of each particle's complete history including where it has been and where it has interacted. The phase space files are analysed to obtain energy spectra, angular distribution, fluence profile and mean energy profiles at the phantom surface for particles separated according to their charge and history. The accuracy of a simulated beam is validated by the excellent agreement between the Monte Carlo calculated and measured dose distributions. Measured depth-dose curves are obtained from depth-ionization curves by accounting for newly introduced chamber fluence corrections and the stopping-power ratios for realistic beams. The study presents calculated depth-dose components from different particles as well as calculated surface dose and contribution from different particles to surface dose across the field. It is shown that the increase of surface dose with the increase of the field size is mainly due to the increase of incident contaminant charged particles. At 6 MV, the incident charged particles contribute 7% to 21% of maximum dose at the surface when the field size increases from 10 x 10 to 40 x 40 cm2. At 18 MV, their contributions are up to 11% and 29% of maximum dose at the surface for 10 x 10 cm2 and 40 x 40 cm2 fields respectively. However, the fluence of these incident charged particles is less than 1% of incident photon fluence in all cases.     

A model to calculate the induced dose rate around an 18 MV ELEKTA linear accelerator

The dose rate due to activity induced by (gamma, n) reactions around an ELEKTA Precise accelerator running at 18 MV is reported. A model to calculate the induced dose rate for a variety of working practices has been derived and compared to the measured values. From this model, the dose received by the staff using the machine can be estimated. From measured dose rates at the face of the linear accelerator for a 10 x 10 cm2 jaw setting at 18 MV an activation coefficient per MU was derived for each of the major activation products. The relative dose rates at points around the linac head, for different energy and jaw settings, were measured. Dose rates adjacent to the patient support system and portal imager were also measured. A model to calculate the dose rate at these points was derived, and compared to those measured over a typical working week. The model was then used to estimate the maximum dose to therapists for the current working schedule on this machine. Calculated dose rates at the linac face agreed to within +/- 12% of those measured over a week, with a typical dose rate of 4.5 microSv h(-1) 2 min after the beam has stopped. The estimated maximum annual whole body dose for a treatment therapist, with the machine treating at only 18 MV, for 60000 MUs per week was 2.5 mSv. This compares well with value of 2.9 mSv published for a Clinac 21EX. A model has been derived to calculate the dose from the four dominant activation products of an ELEKTA Precise 18 MV linear accelerator. This model is a useful tool to calculate the induced dose rate around the treatment head. The model can be used to estimate the dose to the staff for typical working patterns.     

On the discrepancies between Monte Carlo dose calculations and measurements for the 18 MV varian photon beam

Significant discrepancies between Monte Carlo dose calculations and measurements for the Varian 18 MV photon beam with a large field size (40 x 40 cm2) were reported by different investigators. In this work, we investigated these discrepancies based on a new geometry model ("New Model") of the Varian 21EX linac using the GEPTS Monte Carlo code. Some geometric parameters used in previous investigations (Old Model) were inaccurate, as suggested by Chibani in his AAPM presentation (2004) and later confirmed by the manufacturer. The entrance and exit radii of the primary collimator of the New Model are 2 mm larger than previously thought. In addition to the corrected dimensions of the primary collimator, the New Model includes approximate models for the lead shield and the mirror frame between the monitor chamber and the Y jaws. A detailed analysis of the phase space data shows the effects of these corrections on the beam characteristics. The individual contributions from the linac component to the photon and electron fluences are calculated. The main source of discrepancy between measurements and calculations based on the Old Model is the underestimated electron contamination. The photon and electron fluences at the isocenter are 5.3% and 36% larger in the New Model in comparison with the Old Model. The flattening filter and the lead shield (plus the mirror frame) contribute 48.7% and 13% of the total electron contamination at the isocenter, respectively. For both open and filtered (2 mm Pb) fields, the calculated (New Model) and measured dose distributions are within 1% for depths larger than 1 cm. To solve the residual problem of large differences at shallow depths (8% at 0.25 cm depth), the detailed geometry of an IC-10 ionization chamber was simulated and the dose in the air cavity was calculated for different positions on the central axis including at the surface, where half of the chamber is outside the phantom. The calculated and measured chamber responses are within 3% even at the zero depth.     

Dosimetric aspects of the therapeutic photon beams from a dual-energy linear accelerator

Parameters of the photon beams (6 and 20 MV) from a dual-energy linear accelerator (Mevatron-KD, Siemens Medical Laboratories, CA) are presented. The depth dose characteristics of the photon beams are dmax of 1.8 and 3.8 cm and percentage depth dose of 68% and 80% at 10-cm depth and 100-cm source-surface distance for a field size of 10 X 10 cm2 for 6 and 20 MV, respectively. The 6 and 20 MV beams were found to correspond to nominal accelerating potentials of 4.7 and 17 MV, respectively. The stability of output is within +/- 1% and flatness and symmetry are within +/- 3%. These figures compare favorably with the manufacturer's specifications.     

Optimization of parameters for fitting linear accelerator photon beams using a modified CBEAM model

Measured beam profiles and central-axis depth-dose data for 6- and 25-MV photon beams are used to generate a dose matrix which represents the full beam. A corresponding dose matrix is also calculated using the modified CBEAM model. The calculational model uses the usual set of three parameters to define the intensity at beam edges and the parameter that accounts for collimator transmission. An additional set of three parameters is used for the primary profile factor, expressed as a function of distance from the central axis. An optimization program has been adapted to automatically adjust these parameters to minimize the chi 2 between the measured and calculated data. The average values of the parameters for small (6 X 6 cm2), medium (10 X 10 cm2), and large (20 X 20 cm2) field sizes are found to represent the beam adequately for all field sizes. The calculated and the measured doses at any point agree to within 2% for any field size in the range 4 X 4 to 40 X 40 cm2.     

Comparison of PENELOPE Monte Carlo dose calculations with Fricke dosimeter and ionization chamber measurements in heterogeneous phantoms (18 MeV electron and 12 MV photon beams)

Different measurements of depth-dose curves and dose profiles were performed in heterogeneous phantoms and compared to dose distributions calculated by a Monte Carlo code. These heterogeneous phantoms consisted of lung and/or bone heterogeneities. Irradiations and simulations were carried out for an 18 MeV electron beam and a 12 MV photon beam. Depth-dose curves were measured with Fricke dosimeters and with plane and cylindrical ionization chambers. Dose profiles were measured with a small cylindrical ionization chamber at different depths. The LINAC was modelled using the PENELOPE code and phase space files were used as input data for the calculations of the dose distributions in every simulation. The detectors (Fricke dosimeters and ionization chambers) were not modelled in the geometry. There is generally a good agreement between the measurements and PENELOPE. Some discrepancies exist, near interfaces, between the ionization chamber and PENELOPE due to the attenuation of the lower energy electrons by the wall of the ionization chamber.     

VMC++ versus BEAMnrc: a comparison of simulated linear accelerator heads for photon beams

BEAMnrc, a code for simulating medical linear accelerators based on EGSnrc, has been bench-marked and used extensively in the scientific literature and is therefore often considered to be the gold standard for Monte Carlo simulations for radiotherapy applications. However, its long computation times make it too slow for the clinical routine and often even for research purposes without a large investment in computing resources. VMC++ is a much faster code thanks to the intensive use of variance reduction techniques and a much faster implementation of the condensed history technique for charged particle transport. A research version of this code is also capable of simulating the full head of linear accelerators operated in photon mode (excluding multileaf collimators, hard and dynamic wedges). In this work, a validation of the full head simulation at 6 and 18 MV is performed, simulating with VMC++ and BEAMnrc the addition of one head component at a time and comparing the resulting phase space files. For the comparison, photon and electron fluence, photon energy fluence, mean energy, and photon spectra are considered. The largest absolute differences are found in the energy fluences. For all the simulations of the different head components, a very good agreement (differences in energy fluences between VMC++ and BEAMnrc <1%) is obtained. Only a particular case at 6 MV shows a somewhat larger energy fluence difference of 1.4%. Dosimetrically, these phase space differences imply an agreement between both codes at the <1% level, making VMC++ head module suitable for full head simulations with considerable gain in efficiency and without loss of accuracy.     

Modelling 6 MV photon beams of a stereotactic radiosurgery system for Monte Carlo treatment planning

The goal of this work is to build a multiple source model to represent the 6 MV photon beams from a Cyberknife stereotactic radiosurgery system for Monte Carlo treatment planning dose calculations. To achieve this goal, the 6 MV photon beams have been characterized and modelled using the EGS4/BEAM Monte Carlo system. A dual source model has been used to reconstruct the particle phase space at a plane immediately above the secondary collimator. The proposed model consists of two circular planar sources for the primary photons and the scattered photons, respectively. The dose contribution of the contaminant electrons was found to be in the order of 10(-3) of the total maximum dose and therefore has been omitted in the source model. Various comparisons have been made to verify the dual source model against the full phase space simulated using the EGS4/BEAM system. The agreement in percent depth dose (PDD) curves and dose profiles between the phase space and the source model was generally within 2%/1 mm for various collimators (5 to 60 mm in diameter) at 80 to 100 cm source-to-surface distances (SSD). Excellent agreement (within 1%/1 mm) was also found between the dose distributions in heterogeneous lung and bone geometry calculated using the original phase space and those calculated using the source model. These results demonstrated the accuracy of the dual source model for Monte Carlo treatment planning dose calculations for the Cyberknife system.     

Commissioning 6 MV photon beams of a stereotactic radiosurgery system for Monte Carlo treatment planning

The goal of this work is to implement a beam commissioning procedure to generate a multiple source model using a set of standard measurement data for possible Monte Carlo treatment planning in the clinic for a Cyberknife stereotactic radiosurgery system. The required measurement data include the central axis depth dose curve (PDD), the dose profile at dmax(= 1.5 cm) of 60 mm cone at 80 cm source-to-surface distance (SSD), and the cone output factors for cones of 5 mm to 60 mm at 80 cm source-to-axis distance (SAD). The employed dual source model has the same structure as the one that has been studied in our previous work while most of the parameters of each source are extracted from the measurement data rather than the beam phase space. The energy spectra will be extracted from the central axis PDD, the fluence distributions will be deconvoluted from the dose profile at dmax, and the source distributions will be determined from the measured cone output factors. Monte Carlo dose calculations in various water phantoms have been performed to verify the beam commissioning procedure. The agreement between the measurements and the commissioning results was within 2%/1 mm for the central axis PDDs and the dose profiles at various depths when an IC-3 chamber was used and within 2% for the cone output factors for various collimator sizes of 5 to 60 mm. Largest difference (9.5%) was observed for the 7.5 mm cone when an IC-10 chamber was used. The large differences can be attributed to the volumetric averaging effect of the IC-10 chamber, whose dimension is comparable to the field of the small cones. The overall agreement between the measurements and the commissioning results is clinically acceptable, which implies that our commissioning tool is adequate for clinical applications of Monte Carlo dose calculations for the Cyberknife stereotactic radiosurgery system.     

Dosimetric verification of modulated electron radiotherapy delivered using a photon multileaf collimator for intact breasts

Modulated electron radiotherapy (MERT) may potentially be an effective modality for the treatment of shallow tumors, but dose calculation accuracy and delivery efficiency challenges remain. The purpose of this work is to investigate the dose accuracy of MERT delivery using a photon multileaf collimator (pMLC) on a Siemens Primus accelerator. A Monte Carlo (MC)-based inverse treatment planning system was developed for the 3D treatment planning process. Phase space data of 6, 9, 12 and 15 MeV electron beams were commissioned and used as the input source for MC dose calculations. A treatment plan was performed based on the 3D CT data of a heterogeneous 'breast phantom' that mimics a breast cancer patient, and delivered with 22 segments, each associated with a particular energy and Monitor Unit value. Film and ion chamber dosimetry was carefully performed for the conversion from measurement reading to dose, and the results were employed for plan verification using the heterogeneous breast phantom and a solid water phantom. Dose comparisons between measurements and calculations showed agreement within 2% or 1 mm. We conclude that our in-house MC treatment planning system is capable of performing treatment planning and accurate dose calculations for MERT using the pMLC to deliver radiation therapy to the intact breast.     

用测量的6MV医用电子直线加速器X射线能谱验证放疗剂量的初步研究

本研究工作用实验测量的北京医疗器械研究所生产的6MV电子直线加速器X射线谱作为输入数据，计算加速器水葙测量的基本数据PDD和OAR曲线并和实验测量的相应曲线进行比较。这里的X射线能谱是经过Monte Carlo程序EGS4的模拟计算结果验证过的。从比较的结果看，无论能谱测量、Monte Carlo模拟结果，还是通过PDD和OAR曲线的测量和计算，都证明把衰减法测量的X射线能谱作为对未知头部结构的加速器进行放疗计划验证的技术路线是可行的。     

Properties of the 18-MV photon beam from a dual energy linear accelerator

The beam characteristics of the 18-MV photon beam of a Varian Clinac 1800 are presented. The clinically relevant parameters of central axis depth dose, tissue-phantom ratios, peak-scatter factors, and relative output factors are discussed and compared to 18-MV beam data previously reported. The nominal beam energy was found to be 18.3 +/- 0.8 MV on the central axis. The beam symmetry and uniformity meet the manufacturer's specifications. The inverse-square law is applicable within 1.4% over the clinically useful range of distances and field sizes. An empirical fit equation for the central axis depth dose is presented.     

Build-up and surface dose measurements on phantoms using micro-MOSFET in 6 and 10 MV x-ray beams and comparisons with Monte Carlo calculations

This work is intended to investigate the application and accuracy of micro-MOSFET for superficial dose measurement under clinically used MV x-ray beams. Dose response of micro-MOSFET in the build-up region and on surface under MV x-ray beams were measured and compared to Monte Carlo calculations. First, percentage-depth-doses were measured with micro-MOSFET under 6 and 10 MV beams of normal incidence onto a flat solid water phantom. Micro-MOSFET data were compared with the measurements from a parallel plate ionization chamber and Monte Carlo dose calculation in the build-up region. Then, percentage-depth-doses were measured for oblique beams at 0 degrees-80 degrees onto the flat solid water phantom with micro-MOSFET placed at depths of 2 cm, 1 cm, and 2 mm below the surface. Measurements were compared to Monte Carlo calculations under these settings. Finally, measurements were performed with micro-MOSFET embedded in the first 1 mm layer of bolus placed on a flat phantom and a curved phantom of semi-cylindrical shape. Results were compared to superficial dose calculated from Monte Carlo for a 2 mm thin layer that extends from the surface to a depth of 2 mm. Results were (1) Comparison of measurements with MC calculation in the build-up region showed that micro-MOSFET has a water-equivalence thickness (WET) of 0.87 mm for 6 MV beam and 0.99 mm for 10 MV beam from the flat side, and a WET of 0.72 mm for 6 MV beam and 0.76 mm for 10 MV beam from the epoxy side. (2) For normal beam incidences, percentage depth dose agree within 3%-5% among micro-MOSFET measurements, parallel-plate ionization chamber measurements, and MC calculations. (3) For oblique incidence on the flat phantom with micro-MOSFET placed at depths of 2 cm, 1 cm, and 2 mm, measurements were consistent with MC calculations within a typical uncertainty of 3%-5%. (4) For oblique incidence on the flat phantom and a curved-surface phantom, measurements with micro-MOSFET placed at 1.0 mm agrees with the MC calculation within 6%, including uncertainties of micro-MOSFET measurements of 2%-3% (1 standard deviation), MOSFET angular dependence of 3.0%-3.5%, and 1%-2% systematical error due to phantom setup geometry asymmetry. Micro-MOSFET can be used for skin dose measurements in 6 and 10 MV beams with an estimated accuracy of +/- 6%.