The neutron therapy facility (DT, 14 MeV) at the radiotherapy department of the university hospital Hamburg-Eppendorf

The neutron therapy facility at the Radiotherapy Department of the University Hospital Hamburg-Eppendorf is described. This unit has been developed for clinical purposes according to the initiative and conception of the radiotherapist by AEG/Fed. Rep. of Germany and RDI/USA since 1969. The installation was completed at the beginning of 1974. Special treatment head and bed systems allow isocentric treatment and arc or multiple port therapy. For routine work operation conditions of 8 to 12 mA total beam current and 500 kV accelerating voltage are used. The neutron output at 12 mA is about 3.5 x 10(12) n/s giving a phantom dose rate of more than 20 rad/min for a field size of 17.8 x 17.8 cm2 at 80 cm source-skin distance. Technical installations for improvement of dose rate and half-life of the target are planned. Results of physical measurements about neutron energy distributions, contributions from neutrons and gamma-rays to the total absorbed dose, build-up effect, axial and lateral dose distributions as well as isodose profiles for different field sizes in a homogeneous phantom are presented. Bewteen February 1976 and November 1977 up to 180 patients have been treated.     

Peripheral dose from uniform dynamic multileaf collimation fields: implications for sliding window intensity-modulated radiotherapy

The increase in the number of monitor units in sliding window intensity-modulated radiotherapy, compared with conventional techniques for the same target dose, may lead to an increase in peripheral dose (PD). PD from a linear accelerator was measured for 6 MV X-ray using 0.6 cm3 ionization chamber inserted at 5 cm depth into a 35 cm x 35 cm x 105 cm plastic water phantom. Measurements were made for field sizes of 6 cm x 6 cm, 10 cm x 10 cm and 14 cm x 14 cm, shaped in both static and dynamic multileaf collimation (DMLC) mode, employing strip fields of fixed width 0.5 cm, 1.0 cm, 1.5 cm, and 2.0 cm, respectively. The effect of collimator rotation and depth of measurement on peripheral dose was investigated for 10 cm x 10 cm field. Dynamic fields require 2 to 14 times the number of monitor units than does a static open field for the same dose at the isocentre, depending on strip field width and field size. Peripheral dose resulting from dynamic fields manifests two distinct regions showing a crest and trough within 30 cm from the field edge and a steady exponential fall beyond 30 cm. All dynamic fields were found to deliver a higher PD compared with the corresponding static open fields, being highest for smallest strip field width and largest field size; also, the percentage increase observed was highest at the largest out-of-field distance. For 6 cm x 6 cm field, dynamic fields with 0.5 cm and 2 cm strip field width deliver PDs 8 and 2 times higher than that of the static open field. The corresponding factors for 14 cm x 14 cm field were 15 and 6, respectively. The factors by which PD for DMLC fields increase, relative to jaws-shaped static fields for out-of-field distance beyond 30 cm, are almost the same as the corresponding increases in the number of monitor units. Reductions of 20% and 40% in PD were observed when the measurements were done at a depth of 10 cm and 15 cm, respectively. When the multileaf collimator executes in-plane (collimator 90 degrees) motion, peripheral dose decreases by as much as a factor of 3 compared with cross-plane data. The knowledge of PD from DMLC field is necessary to estimate the increase in whole-body dose and the likelihood of radiation induced secondary malignancy.     

High energy fast neutrons from the Harwell variable energy cyclotron. I. Physical characteristics.

A high energy fast neutron beam potentially suitable for radiotherapy was built at the Harwell variable energy cyclotron. The beam line is described and results are given of physical measurements on the fast neutron beams produced by 42 MeV deuterons on thick (4 mm) and thin (2 mm) beryllium targets. With 20 muA beam current the entrance dose rate in a phantom 150 cm from the target was about 130 rad min-1 with the thick target and about 60 rad min-1 with the thin target. Therefore, it is possible to use both the thin target and the relatively large target-skin distance of 150 cm to improve depth dose for radiotherapy or radiobiology. With this arrangement the dose rate decreased to 50% at depths in the phantom of 11.3-15.4 cm, depending on the field size. The use of primarily hydrogenous materials for shielding and collimation provided beam edge definition similar to that of 60Co teletherapy units, and off-axis radiation levels of approximately 1% which compare favorably with 14 MeV deuteron-tritium generators. The copper backing of the thin target became highly radioactive and an alterative material may be preferable. Biologic characteristics of the beam are described in a companion paper.     

Commissioning and quality assurance for MLC-based IMRT.

The commissioning and quality assurance (QA) associated with the implementation of linear accelerator multileaf collimator (MLC)-based intensity-modulated radiation therapy (IMRT) at the University of Nebraska Medical Center are described. Our MLC-based IMRT is implemented using the PRIMUS linear accelerator interface through the IMPAC record and verification system to the CORVUS treatment planning system. The "step-and-shoot" technique is used for this MLC-based IMRT. Commissioning process requires the verification of predefined parameters available on the CORVUS and the collection of some machine data. The machine data required are output factor in air and output factor in phantom, and percent depth dose for a number of field sizes. In addition, inplane and crossplane dose profiles of 4 x 4 cm and 20 x 20 cm field sizes and diagonal dose profiles of a large field size have to be measured. Validation of connectivity and dose model includes the use of uniform intensity bar strips, triangular-shaped nonuniform intensity bar strip, and N-shaped target. QA procedure follows the recommendation of the AAPM Task Group No. 40 report. In addition, the leaf position accuracy and reproducibility of the MLC should be checked at regular intervals. The dose validation is implemented through the hybrid plan where the patient beam parameters are applied to a flat phantom. Independent dose calculation method is used to confirm the dose delivery plan and data input to the CORVUS.     

BNCT dose calculation in irregular fields using the sector integration method.

Irregular fields for boron neutron capture therapy (BNCT) have been already proposed to spare normal tissue in the treatment of superficial tumors. This added dependence would require custom measurements and/or to have a secondary calculation system. As a first step, we implemented the sector-integration method for irregular field calculation in a homogeneous medium and on the central beam axis. The dosimetric responses (fast neutron and photon dose and thermal neutron flux), are calculated by sector integrating the measured responses of circular fields over the field boundary. The measurements were carried out at our BNCT facility, the RA-6 reactor (Argentina). The input data were dosimetric responses for circular fields measured at different depths in a water phantom using ionisation and activation techniques. Circular fields were formed by shielding the beam with two plates: borated polyethilene plus lead. As a test, the dosimetric responses of a 7x4 cm(2) rectangular field, were measured and compared to calculations, yielding differences less than 3% in equivalent dose at any depth indicating that the tool is suitable for redundant calculations.     

Dosimetry with phantom for total body irradiation(TBI)

Total body irradiation(TBI) is being used as a method of preparation for bone marrow transplantation(BMT). In TBI, the dose calculation is based on dosimetry using a phantom. We measured the basic dose with a phantom using a 10 MV X-rays. We confirmed the accuracy of the dose calculation performed in our facilities and investigated a method of more accurate dosimetry. We measured the variation in dose according to the size of the phantom and the depth using a tough water phantom, and examined the difference in TMR according to SCD, field size, and size of the phantom. Consequently, the dose has been changed regardless of the size of the phantom at larger than 80 x 30 x 30 cm(3), and it is about 1% larger than 30 x 30 x 30 cm(3). Also TMR has changed according to various conditions, including the size of the phantom, field size, and SCD. Therefore, it was found that dosimetry using the 30 x 30 x 30 cm(3) phantom leads to underestimation in dose calculation, and there is no difference in dose between the field size of 151.5 x 160 cm(2) and 151.5 x 80 cm(2). It is also necessary to consider the effect of the vertical size of the phantom.     

The RBE of the leakage radiation from the Hiletron neutron therapy unit

The RBE of the leakage radiation from the Hiletron 14.7 MeV neutron therapy unit has been measured using three sensitive biological systems in mice, which differ markedly in their radiobiological characteristics. These systems comprise type A spermatogonia and bone marrow stem cells, which are affected insignificantly by dose rate, and pigment abnormalities in hair follicles which are affected markedly by dose rate. For mice irradiated at 10 cm depth in a water phantom, the leakage radiation up to 40 cm from the beam axis was virtually as effective as the primary beam for the latter two biological systems, and for spermatogonia in mice when irradiated in air. At this distance, the total dose rate was about 0.2 cGy (rad) per minute (3% of that in the primary beam), and the gamma-ray component was about 70%. This equal effectiveness of the total dose for all three systems was considered fortuitous, and it implied high RBE values for equal effect with the small neutron component at far distances. Considering published data on RBE versus neutron energy, the evidence suggested either a positive interaction of neutron and gamma-ray components in killing bone marrow stem cells when the neutron component was less than 40% of the total dose, or an increased efficiency of neutrons when delivered at very low dose rates. However the components were additive in killing spermatogonia.     

Dose estimation in postoperative keloid irradiation with special consideration of ovarian dose

For a long time now, surgery followed by irradiation has been the preferred therapy in the treatment of keloids. Radiation can be administered by means of X-rays (energy level less than or equal to 100 KV), electrons (energy level less than or equal to 5 MeV) or 192Ir wires. The choice of one of these methods depends on the availability of suitable facilities within a short period of time (less than 24 hours postoperatively), and the possibility of adapting the irradiation field quickly and easily to the scar. A further criterion is the dose received by underlying organs possibly, especially the ovaries of women of child-bearing age. It consists of primary and secondary (scattered) parts of radiation and was measured in two standard field sizes for the various types of radiation so as to allow a rapid evaluation. Apart from the types of radiation mentioned above, such measurements were also carried out for 125I seeds. With a field size of 20 x 1.5 cm2 and a surface dose of 10 Gy, ovaries at a depth of 10 cm in the central beam will receive a dose of between less than 1 m Gy in electron therapy to around 1 Gy in X-ray therapy (100 KV).     

Characteristics of the new THOR epithermal neutron beam for BNCT.

A characterization of the new Tsing Hua open-pool reactor (THOR) epithermal neutron beam designed for boron neutron capture therapy (BNCT) has been performed. The facility is currently under construction and expected in completion in March 2004. The designed epithermal neutron flux for 1 MW power is 1.7x10(9)n cm(-2)s(-1) in air at the beam exit, accompanied by photon and fast neutron absorbed dose rates of 0.21 and 0.47 mGys(-1), respectively. With (10)B concentrations in normal tissue and tumor of 11.4 and 40 ppm, the calculated advantage depth dose rate to the modified Snyder head phantom is 0.53RBE-Gymin(-1) at the advantage depth of 85 mm, giving an advantage ratio of 4.8. The dose patterns determined by the NCTPlan treatment planning system using the new THOR beam for a patient treated in the Harvard-MIT clinical trial were compared with results of the MITR-II M67 beam. The present study confirms the suitability of the new THOR beam for possible BNCT clinical trials.     

GE PETtrace cyclotron as a neutron source for boron neutron capture therapy.

This paper discusses the use of a General Electric PETtrace cyclotron as a neutron source for boron neutron capture therapy. In particular, the standard PETtrace (18)O target is considered. The resulting dose from the neutrons emitted from the target is evaluated using the Monte Carlo radiation transport code MCNP at different depths in a brain phantom. MCNP-simulated results are presented at 1, 2, 3, 4, 5, 6, 7, and 8 cm depth inside this brain phantom. Results showed that using a PETtrace cyclotron in the current configuration allows treating tumors at a depth of up to 4 cm with reasonable treatment times. Further increase of a beam current should significantly improve the treatment time and allow treating tumors at greater depths.     

Build-up and depth-dose characteristics of different fast neutron beams relevant for radiotherapy.

Build-up and central axis depth-dose curves have been obtained for d(50) + Be and d + T neutron beams. Measurements carried out with the collimator opening covered with a layer of lead showed that for all three neutron beams the entrance dose is approximately 60% of the dose at the maximum. Consequently the skin-sparing properties of these neutron beams will be approximately equal and comparable to those for electron beam therapy. Central axis depth-dose curves have been established for d(50) + Be neutrons at 129 cm SSD, for p(42) + Be neutrons at 125 cm SSD and d + T neurtons and 60Co gamma rays at 80 cm SSD. The 50% dose values in a water phantom are at depths of 12.7 cm, 12.0 cm, 9.7 cm and 12.7 cm respectively, for field sizes of approximately 15 cm x 20 cm. Insertion of a 6 cm thick nylon filter in the p(42)+Be beam increases this value from 12.0 cm to 13.5 cm. The gamma component for the d+T neutron beam is higher than for the cyclotron beams.     

Changes in relative biological effectiveness with depth of the Clatterbridge neutron therapy beam

We have measured the biological equivalence of the Clatterbridge neutron therapy beam [p(62)-Be] and the Hammersmith neutron therapy beam [d(16)-Be] using the mouse intestinal crypt assay. The ratio (NDR) of Clatterbridge neutron (n + gamma) dose relative to Hammersmith neutron dose (n + gamma) was found to be 1.2-1.13 over a dose/fraction range of 1.8-9 Gy at 2 cm deep in a Perspex phantom. It is shown that the effectiveness of the Clatterbridge beam was reduced with penetration into the phantom because of hardening of the beam to a maximum reduction of 11% at 12 cm deep in the phantom. The hardening of the beam with depth of penetration will need to be taken into account by clinicians in assessing the tumour dose and tissue tolerance. Relative biological effectiveness values for the Clatterbridge and Hammersmith neutron beams were also measured. All neutron doses for both Hammersmith and Clatterbridge beams are total doses (n + gamma) which comply with the European protocol for neutron dosimetry and include the gamma-ray component of dose.     

Changes of the cytogenetic effectiveness of the therapeutic ray of fast neutrons in water phantoms

Changes of cytogenetic effectiveness of the therapeutic ray of fast neutrons were studied in water phantom in the Medical-Biological Complex of CyclotronU-120 at the Institute for Nuclear Research of the Academy of Sciences of the Ukrainian SSR. Investigations were done in a culture of lymphocytes of the peripheral human blood by means of metaphase method to find out chromosomal aberrations. The neutrons were generated by firing a thick beryllium target with a 13.6 MeV-deuteron ray in the nuclear reaction 9Be (d,n) 10B. The investigated dose range was 25-220 cGy. The results of the studies demonstrate that the cytogenetic effectiveness of radiation is reduced with increasing depth of the water phantom. The maximum reduction of the effect was seen in a depth up to 6 cm, which is attached to absorption of low-energetic neutron fraction. The obtained results confirm necessity of to filter the therapeutically applicable beam of neutron radiation.     

15MV医用直线加速器光中子蒙特卡罗模拟

目的 研究高能医用直线加速器运行过程中因光核反应所形成的光中子辐射场。方法 利用蒙特卡罗(MC)程序模拟Clinic 2300CD型医用电子加速器15 MV X射线模式下光中子污染,掌握机头内不同位置光中子能谱和不同照射野下等中心处中子周围剂量当量变化,分析光中子在等中心平面内剂量分布和水模体中剂量衰减。结果 准直器关闭时,加速器机头内靶、主准直器、均整器和多叶准直器下表面的光中子平均能量分别为1.08、1.20、0.35、0.30MeV;等中心处中子周围剂量当量随着照射野的增大先增大后减少,在30 cm × 30 cm照射野下达到最大;随着测点在水模体中的深度增加,中子通量先增加后减小,而中子剂量却在逐渐减小;不同照射野下,光中子剂量率在水模体深度20 cm处,基本都接近本底。结论 探究高能医用直线加速器机头光中子谱和剂量分布特点,以及光中子在水模体内剂量沉积规律,能为进一步研究高能医用直线加速器光中子污染对患者产生的附加剂量提供支持。     

Characterization of ultra high energy neutron beam generated by 500 MeV proton beam

An ultra high energy neutron facility was constructed at PARMS, University of Tsukuba, to produce a neutron beam superior to an X-ray beam generated by a modern linac in terms of dose distribution. This has been achieved using the reaction on a thick uranium target struck by 500 MeV proton beam from the booster-synchrotron of High Energy Physics Laboratory. The percentage depth dose of this neutron beam is nearly equivalent to that of X-rays at around 20 MV and the dose rate of 15 cGy per minute. Relative biological effectiveness of this neutron beam has been estimated on the cell killing effect by the use of HMV-I cell line. Resultant survival curve of cells after the neutron irradiation shows the shoulder with n and Dq of 8 and 2.3 Gy, respectively. RBE value at 10(-2) survival level for the present neutron, compared with 137Cs gamma-rays is 1.24. The result suggests that the biological effects of high energy neutrons are not practically large enough whenever the depth dose distribution of neutrons becomes superior to high energy linac X-rays.     

Evaluation of absorbed dose in respiratory-gated radiotherapy using a phantom system that simulates patient respiration

Respiratory-gated (RG) radiotherapy is useful for minimizing the irradiated volume of normal tissues resulting from the shifting of internal structures caused by respiratory movement. In this technique, although improvement in the dose distribution of the target can be expected, the actual absorbed dose distribution is not clearly determined. Therefore, it is important to clarify the absorbed dose at the tumor and at the evaluation points according to the patient's respiration. We have developed a phantom system that simulates patient respiration (TNK Co., Ltd.), to evaluate the absorbed dose and ensure precise RG radiotherapy. Actual patient respiratory signals were obtained using a respiratory synchronization and gating system (AZ-733V, Anzai Medical). The acquired data were then transferred to a phantom system driven by a ball screw to simulate the shifting of internal structures caused by respiratory movement. We measured the absorbed dose using a micro-ionization chamber dosimeter and the dose distribution using the film method for RG irradiation at expiratory phase by using Linac (PRIMUS, Toshiba Medical Systems Corp.) X-rays. When the distance of phantom movement was set to the average patient respiratory movement distance of 1.5 cm, we first compared absorbed dose with RG irradiation with a gating signal of 50% or less, and without RG irradiation. The absorbed dose at the iso-center was improved by 6.0% and 4.4% at a field size of 4x4 cm2, and by 1.3% and 0.7% at a field size of 5x5 cm2 with an X-ray energy of 6 MV and 10 MV, respectively. There was, however, no dose change at a field size of 10x10 cm2 and 15x15 cm2. When the gating signal was reduced to 25% and 10%, absorbed dose was also improved. With regard to the flatness of the dose profile, no changes in dose distribution were observed in the lateral direction, e.g., beam flatness was within 1.4% and 1.6% at field sizes of 5x5 cm2 and 10x10 cm2, respectively, with an X-ray energy of 6 MV. In the cranial-caudal direction, the dose profile was relatively large even if a gating signal of 50% was applied, i.e., 8.1% and 10.4% at field sizes of 5x5 cm2 and 10x10 cm2, respectively. Beam flatness without RG was much worse, i.e., 37.8% and 38.2%, at field sizes of 5x5 cm2 and 10x10 cm2, respectively. In both cases, the dose was insufficient in the expiratory direction. Although RG radiotherapy is quite useful, the margins in the inspiratory and expiratory phases should be considered based on the level of gating signal and field size in order to formulate appropriate radiotherapy planning in terms of the shifting of internal structures. To ensure accurate radiotherapy, the characteristics of the RG irradiation technique and the radiotherapy equipment must be clearly understood when this technique is to be employed in clinical practice.     

A comparison of two methods of in vivo dosimetry for a high energy neutron beam

Two methods of in vivo dosimetry have been compared in a high energy neutron beam. These were activation dosimetry and thermoluminescence dosimetry (TLD). Their suitability was determined by comparison with estimates of total dose, obtained using a tissue equivalent ionization chamber. Measurements were made on the central axis and a profile of a 10 x 10 cm square field and also behind a shielding block in order to simulate conditions of clinical use. The TLD system was found to provide the best estimate of total dose.     

医用加速器射线参数对百分深度剂量影响的蒙特卡罗模拟

目的 通过蒙特卡罗方法模拟瓦里安IX 6 MV直线加速器治疗机头,得到不同射野下的最适电子线能量,研究径向强度分布对百分深度剂量的影响。方法 首先对所研究的每个射野,保持径向强度大小不变,改变电子线能量,将得到的百分深度剂量与测量值进行对比,得到该射野下的最适电子线能量。随后将电子线能量设置为得到的最适值,改变径向强度分布大小,研究其对百分深度剂量的影响。结果 对于4 cm×4 cm、10 cm×10 cm、20 cm×20 cm和30 cm×30 cm的射野,最适能量分别为5.9、6.0、6.3和6.4 MeV;改变径向强度分布对4 cm×4 cm、10 cm×10 cm射野下的百分深度剂量没有影响,对20 cm×20 cm和30 cm×30 cm的射野则有明显影响。结论 适用于不同射野的最佳能量略有不同,径向强度的改变对大野下的深度剂量有较明显影响。为提高模拟精度,电子线能量和径向强度分布的选取需要考虑射野大小的因素。     

Skin dose measurement by using ultra-thin TLDs.

The treatment schedule for radiation therapy is often interrupted because of complicated skin reactions. Quantitative information relating beam parameters and skin reactions will be helpful. Measurements were performed for 6-15 MV photons and 6-21 MeV electrons with ultra thin TLD films (GR-200F, surface area 0.5 x 0.5cm2, nominal thickness 5 mg cm(-2)). The skin doses for various field sizes, ranging from 10 x 10 to 40 x 40 cm2, and various incident angles of beam from 0 degrees to 80 degrees were measured. The ratios of skin dose to maximum dose in phantom for 10 x 10 cm2 are 16.10+/-0.68%, 14.03+/-1.04% and 10.59+/-0.64% for 6, 10 and 15 MV, respectively. Such ratios increase with a larger field size. For electrons the ratios are 72.59+/-1.72%, 78.52+/-2.99%, 78.89+/-2.86%, 86.08+/-2.62%. 87.75+/-1.94% and 86.33+/-3.09% for 6, 9, 12, 15, 18 and 21 MeV, respectively. They also increase with a larger size. The oblique factors also increase with larger incident angle.