Characterization of electron contamination in megavoltage photon beams

The purpose of the present study is to characterize electron contamination in photon beams in different clinical situations. Variations with field size, beam modifier (tray, shaping block) and source-surface distance (SSD) were studied. Percentage depth dose measurements with and without a purging magnet and replacing the air by helium were performed to identify the two electron sources that are clearly differentiated: air and treatment head. Previous analytical methods were used to fit the measured data, exploring the validity of these models. Electrons generated in the treatment head are more energetic and more important for larger field sizes, shorter SSD, and greater depths. This difference is much more noticeable for the 18 MV beam than for the 6 MV beam. If a tray is used as beam modifier, electron contamination increases, but the energy of these electrons is similar to that of electrons coming from the treatment head. Electron contamination could be fitted to a modified exponential curve. For machine modeling in a treatment planning system, setting SSD at 90 cm for input data could reduce errors for most isocentric treatments, because they will be delivered for SSD ranging from 80 to 100 cm. For very small field sizes, air-generated electrons must be considered independently, because of their different energetic spectrum and dosimetric influence.     

Evaluation of a computed radiography system for megavoltage photon beam dosimetry

Computed radiography (CR) systems have been gaining adoption as digital replacements for film for diagnostic and therapy imaging. As a result, film processors are being removed from service, leaving a void for the medical physicists who use film and processors for two-dimensional mega-voltage beam dosimetry. This is the first report to evaluate the ability of a commercial CR reader and storage phosphor plate system to accurately quantitate absolute dose and dose distributions from a 6 MV photon beam. There are potential advantages and disadvantages of current CR systems compared to film systems. CR systems inherently produce a linear dose-response over several logs of dose. However, the barium in the storage phosphor has a higher atomic number than the silver in film, resulting in significant energy sensitivity. The purpose of this work is to fully characterize the impact of these and other features of this CR system relevant to dosimetry. The tests performed and reported on in this study include uniformity of readout across a uniform field, geometrical accuracy, intra- and interday reproducibility, signal decay with time and with light exposure, dose-to-signal calibration, high dose effects, obliquity effects, perpendicular and parallel calibration results, field size and depth of measurement effects and the use of lead filters to minimize them, and intensity modulated radiation therapy quality assurance test results compared to that for film. Practical techniques are provided to optimize the accuracy of the system as a dosimetric replacement for film.     

On few-view tomographic reconstruction with megavoltage photon beams

Currently portal imaging devices are used to obtain information on patient localization during radiation therapy treatments. Such obtained information is two dimensional in nature, limited to the plane of the captured image. It has been proposed that megavoltage computed tomography images be reconstructed to overcome this limitation. This study explores the feasibility of reconstructing tomographic images from fan-beam projection data acquired with a commercial portal imaging device on a standard radiotherapy linear accelerator. Several CT reconstruction algorithms are examined as to their performance and suitability for applications in radiation therapy verification. The results show that it is possible, using some of the iterative reconstruction techniques, to obtain an image useful for patient localization from only several (< or =10) projection views.     

Surface dose for megavoltage photon beams outside the treatment field

Measurements made on photon beams from four different radiotherapy machines have demonstrated that skin dose several centimeters outside the boundary of a treatment field may be as much as 20% of the central axis maximum dose. This surface dose has been measured for an AECL Theratron 80, Siemens Mevatron VI, Varian Clinac 20, and CGR Sagittaire for distances up to 12 cm outside the field boundary and for depths up to the depth of maximum central axis dose. This dose has also been measured as a function of field size and of source-to-skin distance. For the lower energy photon beams, this radiation is significantly attenuated in the first 2-3 mm of tissue, while for higher energy beams, a buildup phenomenon with a dmax of 2-3 mm is observed. The magnitude of this radiation is approximately linearly dependent upon field dimension for all energies.     

Generation and modelling of megavoltage photon beams for contrast-enhanced radiation therapy

Contrast-enhanced radiation therapy (CERT) is a treatment approach involving the irradiation of tumours containing high atomic number (Z) contrast media, using low-quality x-ray beams. This work describes the experimental generation of x-ray beams using a linear accelerator with low-Z target materials (beryllium and aluminium), in order to produce photon energy spectra appropriate for CERT. Measurements were made to compare the experimental beams to conventional linear accelerator photon beams in terms of per cent depth dose. Monte Carlo simulation was used to model the generation of each beam, and models were validated against experimental measurement. Validated models were used to demonstrate changes in photon spectra as well as to quantify the variation of tumour dose enhancement with iodinated contrast medium concentration in a simulated tumour volume. Finally, the ratio of the linear attenuation coefficient for iodinated contrast medium relative to water was determined experimentally as a function of iodine concentration. Beams created with low-Z targets show significant changes in energy spectra compared to conventional beams. For the 4 MeV/Be beam, for example, 33% of photons have energies below 60 keV. Measurements and calculation show that both the linear attenuation coefficient ratio and dose enhancement factor (DEF) increase most rapidly at concentrations below 46 mg I ml(-1). There is a significant dependence of DEF on electron energy and a lesser dependence on target material. The 4 MeV/Be beam is the most promising in terms of magnitude of DEF - for example, DEF values of 1.16 and 1.29 are obtained for concentrations of 20 mg I ml(-1) and 50 mg I ml(-1), respectively. DEF will increase or decrease, respectively, for shallower or deeper tumours at a rate of approximately 1.1% cm(-1). In summary, we show that significant dose enhancement is possible by altering the linear accelerator target and filtration, but the magnitude is highly dependent on contrast medium concentration.     

Validation of Monte Carlo calculated surface doses for megavoltage photon beams

Recent work has shown that there is significant uncertainty in measuring build-up doses in mega-voltage photon beams especially at high energies. In this present investigation we used a phantom-embedded extrapolation chamber (PEEC) made of Solid Water to validate Monte Carlo (MC)-calculated doses in the dose build-up region for 6 and 18 MV x-ray beams. The study showed that the percentage depth ionizations (PDIs) obtained from measurements are higher than the percentage depth doses (PDDs) obtained with Monte Carlo techniques. To validate the MC-calculated PDDs, the design of the PEEC was incorporated into the simulations. While the MC-calculated and measured PDIs in the dose build-up region agree with one another for the 6 MV beam, a non-negligible difference is observed for the 18 MV x-ray beam. A number of experiments and theoretical studies of various possible effects that could be the source of this discrepancy were performed. The contribution of contaminating neutrons and protons to the build-up dose region in the 18 MV x-ray beam is negligible. Moreover, the MC calculations using the XCOM photon cross-section database and the NIST bremsstrahlung differential cross section do not explain the discrepancy between the MC calculations and measurement in the dose build-up region for the 18 MV. A simple incorporation of triplet production events into the MC dose calculation increases the calculated doses in the build-up region but does not fully account for the discrepancy between measurement and calculations for the 18 MV x-ray beam.     

Evaluation of precalibrated implantable MOSFET radiation dosimeters for megavoltage photon beams

We have studied the response of factory calibrated implantable MOSFET detectors to absorbed doses from 100 to 400 cGy. The average measured dose is quite close to the true delivered dose, with the standard deviation falling between 1.4 and 3.6%. The measured dose tends to be slightly underestimated for smaller doses, while it tends to be slightly overestimated for larger doses. Thus, although the calibration of the detector is most accurate for doses close to the calibration dose of 200 cGy, it may be used over the range of commonly used doses in fractionated radiotherapy.     

A dosimetric intercomparison of megavoltage photon beams in UK radiotherapy centres.

A dosimetry intercomparison has been carried out for all 64 radiotherapy centres in the UK. Doses were measured with an ionization chamber in an epoxy resin water-substitute phantom of relatively simple geometry. Reference-point measurements were made for all MV photon beams. For 61 Co-60 beams, a mean ratio of measured-to-stated dose of 1.002 was observed with a standard deviation of 0.014, whilst for 100 MV x-ray beams, the corresponding figures were 1.003 and 0.015. 97% of beams lay within a +/- 3% deviation. One measurement was instrumental in discovering a large discrepancy. Doses were also investigated in two planned three-field distributions at one beam quality in each centre. One of these was in a homogeneous phantom, whilst the second included a lung-equivalent insert. Doses were measured at the central point and at four other points in the high dose volume. In both situations, the mean ratio of measured-to-calculated doses for all points was 1.008, with standard deviations of 0.027 and 0.035 for the uniform and non-uniform phantoms, respectively. Discrepancies over 5% were followed up. The work must be viewed in the context of other international intercomparisons and is an essential part of wider radiotherapy audit processes.     

Modeling the output ratio in air for megavoltage photon beams.

The output ratio in air, OR, for a high-energy x-ray beam describes how the incident central axis photon fluence varies with collimator setting. For field sizes larger than 3 x 3 cm2, its variation is caused by the scatter of photons in structures in the accelerator head (primarily the flattening filter and the wedge, if one is used) and by the backscatter of radiation into the monitor ionization chamber. The objective of this study was to evaluate the use of an analytical function to parametrize OR for square collimator setting c: OR = (1 + a1.c).[1 + a2.erf(c/lambda)2].H0. For open beams, these parameters can be attributed to explicit physical meanings within the systematical uncertainty of the model: a1 accounts for backscatter into the monitor, a2 is the maximum scatter-to-primary ratio for head-scattered photons, and lambda represents the effective width of the "source" of head-scatter photons. H0 is a constant that sets OR = 1 for c = 10 cm. This formula also fits OR for wedge beams and a Co-60 unit, although the fitting parameters lose their physical interpretations. To calculate the output ratio for a rectangular field, cx x cy, an equivalent square can be used: c = (1 + k).cy x cx/(k.cx + cy), where k is a constant. The study included a number of different accelerators and a cobalt-60 unit. The fits for square fields agreed with measurements with a standard deviation (SD) of less than 0.5%. Using k = lx.(f - ly)/ly.(f - lx), where lx and ly are the source-to-collimator distances and f is the source-to-detector distance, measurements and calculations agreed within a SD of 0.7% for rectangular fields. Sufficient data for the three parameters are presented to suggest constraints that can be used for quality assurance of the measured output ratio in air.     

The forward production of high-energy electrons from megavoltage photon beams

The forward production of high-energy electrons from materials with various atomic numbers from carbon to lead has been measured for megavoltage photon beams from 4- to 25-MV peak bremsstrahlung energy by placing a thin-window parallel-plate ionization chamber directly behind foils of the various materials. The relative forward production of electrons decreases with atomic number for energies less than or equal to 10 MV until about Z = 50, after which it rises. For photon energies greater than or equal to 15 MV, forward production increases with atomic number with a break point at Z approximately 50, beyond which the curve becomes steeper.     

Single-use MOSFET radiation dosimeters for the quality assurance of megavoltage photon beams

We investigated the applicability of single-use MOSFET detectors as quality-assurance devices. Using ten accelerators available at our institution, we performed output measurements in both water and solid phantoms under photon irradiation. The MOSFET detectors performed well within the manufacturer's specifications, with average deviations of 2.1% and 0.7% for the 6 and 18 MV beams, respectively. The strength of the detector's design, including its wireless set-up, factory calibration and direct read-out, makes the system an acceptable independent quality-assurance device for use in verifying machine output within an accuracy of +/-5%. The MOSFET detectors provide a quick check of machine output, which can be efficacious in detecting gross errors in machine calibrations.     

On the effective point of measurement in megavoltage photon beams

This paper presents a numerical investigation of the effective point of measurement of thimble ionization chambers in megavoltage photon beams using Monte Carlo simulations with the EGSNRC system. It is shown that the effective point of measurement for relative photon beam dosimetry depends on every detail of the chamber design, including the cavity length, the mass density of the wall material, and the size of the central electrode, in addition to the cavity radius. Moreover, the effective point of measurement also depends on the beam quality and the field size. The paper therefore argues that the upstream shift of 0.6 times the cavity radius, recommended in current dosimetry protocols, is inadequate for accurate relative photon beam dosimetry, particularly in the build-up region. On the other hand, once the effective point of measurement is selected appropriately, measured depth-ionization curves can be equated to measured depth-dose curves for all depths within +/- 0.5%.     

Tumour dose enhancement using modified megavoltage photon beams and contrast media

This study examines the magnitude of tumour dose enhancement achieved by injection of gadolinium or iodine contrast media (CM) and treatment using modified x-ray photon spectra from linear accelerators. Monte Carlo modelling of the linear accelerator and patient geometry was used to explore the effect of removing the flattening filter for various beam qualities and the resultant effect on dose enhancement. In addition, ionization measurements were conducted to observe dose enhancement within a phantom containing CM. Simulation results indicate that for flattened 6-24 MV photon beams and realistic CM tumour concentrations, the dose enhancement remains below 5%. However, if the flattening filter is removed, dose enhancement is increased significantly. For a 30 mg ml(-1) gadolinium CM tumour concentration, for example, 8.4%, 10.8%, 13.7% and 23.1% dose enhancements are achieved for 18 MV, 6 MV, 4 MV and 2 MV unflattened beams, respectively. In contrast to the phototherapy technique, which uses the orthovoltage beam from a modified CT scanner to achieve dose enhancement, all unflattened spectra preserve the dose build-up at the surface, and thus the skin and bone are spared.     

Determination of parameters for a multiple-source model of megavoltage photon beams using optimization methods

Accurate modelling of the radiation output of a medical linear accelerator is important for radiotherapy treatment planning. The major challenge is the adjustment of the model to a specific treatment unit. One approach is to use a multiple-source model containing a set of physical parameters. In this work, the parameters were derived from standard beam data measurements using optimization methods. The source model used includes sub-sources for bremsstrahlung radiation from the target, extra-focal photon radiation and electron contamination. The cost function includes a gamma error measure between measurements and current dose calculations. The procedure was applied to six beam data sets (6 MV to 23 MV) measured with accelerators from three vendors, but the results focus primarily on Varian accelerators. The obtained average gamma error (1%, 1 mm) between dose calculations and measurements used in optimization was smaller than 0.7 for each studied treatment beam and field size, and a minimum of 83% of measurement points passed the gamma < 1 criterion. For experiments made at different SSDs and for asymmetric fields, the average gamma errors were smaller than 1.1. For irregularly shaped MLC apertures, the differences in point doses were smaller than 1.0%. This work demonstrates that the source model parameters can be automatically derived from simple measurements using optimization methods. The developed procedure is applicable to a wide range of accelerators, and has an acceptable accuracy and processing time.     

Evaluation of uncertainty predictions and dose output for model-based dose calculations for megavoltage photon beams

In many radiotherapy clinics an independent verification of the number of monitor units (MU) used to deliver the prescribed dose to the target volume is performed prior to the treatment start. Traditionally this has been done by using methods mainly based on empirical factors which, at least to some extent, try to separate the influence from input parameters such as field size, depth, distance, etc. The growing complexity of modern treatment techniques does however make this approach increasingly difficult, both in terms of practical application and in terms of the reliability of the results. In the present work the performance of a model-based approach, describing the influence from different input parameters through actual modeling of the physical effects, has been investigated in detail. The investigated model is based on two components related to megavoltage photon beams; one describing the exiting energy fluence per delivered MU, and a second component describing the dose deposition through a pencil kernel algorithm solely based on a measured beam quality index. Together with the output calculations, the basis of a method aiming to predict the inherent calculation uncertainties in individual treatment setups has been developed. This has all emerged from the intention of creating a clinical dose/MU verification tool that requires an absolute minimum of commissioned input data. This evaluation was focused on irregular field shapes and performed through comparison with output factors measured at 5, 10, and 20 cm depth in ten multileaf collimated fields on four different linear accelerators with varying multileaf collimator designs. The measurements were performed both in air and in water and the results of the two components of the model were evaluated separately and combined. When compared with the corresponding measurements the resulting deviations in the calculated output factors were in most cases smaller than 1% and in all cases smaller than 1.7%. The distribution describing the calculation errors in the total dose output has a mean value of -0.04% and a standard deviation of 0.47%. In the dose calculations a previously developed correction of the pencil kernel was applied that managed to contract the error distribution considerably. A detailed analysis of the predicted uncertainties versus the observed deviations suggests that the predictions indeed can be used as a basis for creating action levels and tracking dose calculation errors in homogeneous media.     

An investigation into the presence of secondary electrons in megavoltage photon beams

The presence of secondary electrons in photon beams of 60Co and 4, 8, 10, 15 and 25 MV x-rays has been studied by measuring surface charge using thin window ionisation chambers. Measurements have been made for square fields from 4 X 4 cm2 to 35 X 35 cm2 for locations from the collimator head to a distance of 4 m from the target. In addition, measurements have been made for rectangular fields at 10 MV and 25 MV for fields of equivalent area from 5 X 5 cm2 to 25 X 25 cm2. By eliminating the inverse square effect, the presence of contaminants from the head and the effect of build-up in air are clearly seen and well separated. Comparison between the curves at different energies indicates an increasing effect of contamination from the head with energy and a decreasing effect of electron production in air with increasing energy.     

Water/air mass stopping power ratios for megavoltage photon and electron beams.

Water/air mass stopping power ratios have been calculated for 5, 10, 20 and 30 MeV electron beams and various photon beams from 60Co to 31 MV betatron. The stopping power ratios have been evaluated by applying a modified version of the Spencer-Attix theory to depth-dependent electron flux spectra computed by the Monte Carlo method. Results are presented for three values of the cavity size parameter delta, 0.001, 0.01 and 0.1 MeV, and also for a Bragg-Gray cavity. For the electron beams, the results are compared to Berger's comprehensive computations. In the case of the photon beams, such a rigorous evaluation of the stopping power ratio has not been carried out previously. It is shown that the currently used approximate Bragg-Gray ratios are as much as 2% too low for high energy photon beams, and that there is a difference of about 1% between values for betatron (thin target) and linac (thick target) beams of the same maximum photon energy.     

Backscatter dose perturbation at high atomic number interfaces in megavoltage photon beams

Most computer algorithms used clinically for photon beam treatment planning are unable to predict the effect of electron backscattering on dose distribution from high atomic number materials. It has been observed that there is a significant dose enhancement at such an interface. We define the dose enhancement in terms of backscatter dose factor (BSDF), which depends on the energy of the photon beam, thickness and width of the inhomogeneity, distance from the interface, and the atomic number of the inhomogeneity. For all energies studied, the dose fall-off is initially very rapid and disappears beyond a few millimeters upstream from the interface. Empirically derived equations are presented for dose calculation at the interfaces of various media, including bone and soft tissue, for photon energies in the range of Co-60 gamma rays to 24 MV x rays.