Surface dosimetry for oblique tangential photon beams: a Monte Carlo simulation study

The effect of beam obliquity on the surface relative dose profiles for the tangential photon beams was studied. The 6 and 15 MV photon beams with 4 x 4 and 10 x 10 cm2 field sizes produced by a Varian 21 EX linear accelerator were used. Phase-space models of the photon beams were created using Monte Carlo simulations based on the EGSnrc code, and were verified using film measurements. The relative dose profiles in the phantom skin, at 2 mm depth from the surface of the half-phantom geometry, or HPG, were calculated for increasing gantry angles from 270 to 280 deg clockwise. Relative dose profiles of a full phantom enclosing the whole tangential beam (full phantom geometry, or FPG) were also calculated using Monte Carlo simulation as a control for comparison. The results showed that, although the relative dose profiles in the phantom skin did not change significantly with an oblique beam using a FPG, the surface relative depth dose was increased for the HPG. In the HPG, with 6 MV photon beams and field size = 10 x 10 cm2, when the beam angle, starting from 270 deg, was increased from 1 to 3 deg, the relative depth doses in the phantom skin were increased from 68% to 79% at 10 cm depth. This increase in dose was slightly larger than the dose from 15 MV photon beams with the same field size and beam angles, where the relative depth doses in phantom skin were increased from 81% to 87% at 10 cm depth. A parameter called the percent depth dose (PDD) ratio, defined as the relative depth dose from the HPG to the relative depth dose from the FPG at a given depth along the phantom skin, was used to evaluate the effect of the phantom-air interface. It is found that the PDD ratio increased significantly when the beam angle was changed from zero to 1-3 degrees. Moreover, the PDD ratio, for a given field size, experienced a greater increase for 6 MV than for 15 MV. For the same photon beam energy, the PDD ratio increased more with a 4 x 4 cm2 field compared to 10 x 10 cm2. The results in this study will be useful for physicists and dosimetrists to predict the surface relative dose variations when using clinical tangential-like photon beams in radiation therapy.     

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.     

Radiation induced currents in parallel plate ionization chambers: measurement and Monte Carlo simulation for megavoltage photon and electron beams

Polarity effects in ionization chambers are caused by a radiation induced current, also known as Compton current, which arises as a charge imbalance due to charge deposition in electrodes of ionization chambers. We used a phantom-embedded extrapolation chamber (PEEC) for measurements of Compton current in megavoltage photon and electron beams. Electron contamination of photon beams and photon contamination of electron beams have a negligible effect on the measured Compton current. To allow for a theoretical understanding of the Compton current produced in the PEEC effect we carried out Monte Carlo calculations with a modified user code, the COMPTON/ EGSnrc. The Monte Carlo calculated COMPTON currents agree well with measured data for both photon and electron beams; the calculated polarity correction factors, on the other hand, do not agree with measurement results. The conclusions reached for the PEEC can be extended to parallel-plate ionization chambers in general.     

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.     

An EGS4 Monte Carlo examination of the response of a PTW-diamond radiation detector in megavoltage electron beams.

The EGS4 Monte Carlo code has been used to investigate the response of a PTW/diamond detector irradiated in both clinical and monoenergetic megavoltage electron beams ranging in energy from 5 to 20 MeV. The sensitive volume of the PTW/diamond detector simulated has a thickness of 0.4 mm and a diameter of 4.4 mm. Irradiation was simulated at various depths in a water phantom. The results show that the PTW/diamond detector has a constant response (within 1.0%) in electron beams if irradiated at depths closed to dmax, and its response is almost independent of irradiation depth or incident electron energy (within 3%). A detailed examination of the average detector dose shows that the sensitive volume of the PTW/diamond detector acts as a Spencer-Attix cavity within 1%. The encapsulation of the bare diamond detector with low-Z epoxy and polystyrene wall material does not affect its response in electron beams. The difference in response between the unencapsulated (TLD) and the encapsulated form of the detector is less than 0.5% for all depths over electron energy range investigated.     

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.     

Monte Carlo and experimental investigations of multileaf collimated electron beams for modulated electron radiation therapy

Modulated electron radiation therapy (MERT) has been proposed as a means of delivering conformal dose to shallow tumors while sparing distal structures and surrounding tissues. Conventional systems for electron beam collimation are labor and time intensive in their construction and are therefore inadequate for use in the sequential delivery of multiple complex fields required by MERT. This study investigates two proposed methods of electron beam collimation: the use of existing photon multileaf collimators (MLC) in a helium atmosphere to reduce in-air electron scatter, and a MLC specifically designed for electron beam collimation. Monte Carlo simulations of a Varian Clinac 2100C were performed using the EGS4/BEAM system and dose calculations performed with the MCDOSE code. Dose penumbras from fields collimated by photon MLCs both with air and with helium at 6, 12, and 20 MeV at a range of SSDs from 70 to 90 cm were examined. Significant improvements were observed for the helium based system. Simulations were also performed on an electron specific MLC located at the level of the last scraper of a 25x25 cm2 applicator. A number of leaf materials, thicknesses, end shapes, and widths were simulated to determine optimal construction parameters. The results demonstrated that tungsten leaves 15 mm thick and 5 mm wide with unfocused ends would provide sufficient collimation for MERT fields. A prototype electron MLC was constructed and comparisons between film measurements and simulation demonstrate the validity of the Monte Carlo model. Further simulations of dose penumbras demonstrate that such an electron MLC would provide improvements over the helium filled photon MLC at all energies, and improvements in the 90-10 penumbra of 12% to 45% at 20 MeV and 6 MeV, respectively. These improvements were also seen in isodose curves when a complex field shape was simulated. It is thus concluded that an MLC specific for electron beam collimation is required for MERT.     

Sensitivity of megavoltage photon beam Monte Carlo simulations to electron beam and other parameters

The BEAM code is used to simulate nine photon beams from three major manufacturers of medical linear accelerators (Varian, Elekta, and Siemens), to derive and evaluate estimates for the parameters of the electron beam incident on the target, and to study the effects of some mechanical parameters like target width, primary collimator opening, flattening filter material and density. The mean energy and the FWHM of the incident electron beam intensity distributions (assumed Gaussian and cylindrically symmetric) are derived by matching calculated percentage depth-dose curves past the depth of maximum dose (within 1% of maximum dose) and off-axis factors (within 2sigma at 1% statistics or less) with measured data from the AAPM RTC TG-46 compilation. The off-axis factors are found to be very sensitive to the mean energy of the electron beam, the FWHM of its intensity distribution, its angle of incidence, the dimensions of the upper opening of the primary collimator, the material of the flattening filter and its density. The off-axis factors are relatively insensitive to the FWHM of the electron beam energy distribution, its divergence and the lateral dimensions of the target. The depth-dose curves are sensitive to the electron beam energy, and to its energy distribution, but they show no sensitivity to the FWHM of the electron beam intensity distribution. The electron beam incident energy can be estimated within 0.2 MeV when matching either the measured off-axis factors or the central-axis depth-dose curves when the calculated uncertainties are about 0.7% at the 1 sigma level. The derived FWHM (+/-0.1 mm) of the electron beam intensity distributions all fall within 1 mm of the manufacturer specifications except in one case where the difference is 1.2 mm.     

Ionization chamber dosimetry of small photon fields: a Monte Carlo study on stopping-power ratios for radiosurgery and IMRT beams

Absolute dosimetry with ionization chambers of the narrow photon fields used in stereotactic techniques and IMRT beamlets is constrained by lack of electron equilibrium in the radiation field. It is questionable that stopping-power ratio in dosimetry protocols, obtained for broad photon beams and quasi-electron equilibrium conditions, can be used in the dosimetry of narrow fields while keeping the uncertainty at the same level as for the broad beams used in accelerator calibrations. Monte Carlo simulations have been performed for two 6 MV clinical accelerators (Elekta SL-18 and Siemens Mevatron Primus), equipped with radiosurgery applicators and MLC. Narrow circular and Z-shaped on-axis and off-axis fields, as well as broad IMRT configured beams, have been simulated together with reference 10 x 10 cm2 beams. Phase-space data have been used to generate 3D dose distributions which have been compared satisfactorily with experimental profiles (ion chamber, diodes and film). Photon and electron spectra at various depths in water have been calculated, followed by Spencer-Attix (delta = 10 keV) stopping-power ratio calculations which have been compared to those used in the IAEA TRS-398 code of practice. For water/air and PMMA/air stopping-power ratios, agreements within 0.1% have been obtained for the 10 x 10 cm2 fields. For radiosurgery applicators and narrow MLC beams, the calculated s(w,air) values agree with the reference within +/-0.3%, well within the estimated standard uncertainty of the reference stopping-power ratios (0.5%). Ionization chamber dosimetry of narrow beams at the photon qualities used in this work (6 MV) can therefore be based on stopping-power ratios data in dosimetry protocols. For a modulated 6 MV broad beam used in clinical IMRT, s(w,air) agrees within 0.1% with the value for 10 x 10 cm2, confirming that at low energies IMRT absolute dosimetry can also be based on data for open reference fields. At higher energies (24 MV) the difference in s(w,air) was up to 1.1%, indicating that the use of protocol data for narrow beams in such cases is less accurate than at low energies, and detailed calculations of the dosimetry parameters involved should be performed if similar accuracy to that of 6 MV is sought.     

Monte Carlo calculation of nine megavoltage photon beam spectra using the BEAM code

A recent paper analyzed the sensitivity to various simulation parameters of the Monte Carlo simulations of nine beams from three major manufacturers of commercial medical linear accelerators, ranging in energy from 4-25 MV. In this work the nine models are used: to calculate photon energy spectra and average energy distributions and compare them to those published by Mohan et al. [Med. Phys. 12, 592-597 (1985)]; to separate the spectra into primary and scatter components from the primary collimator, the flattening filter and the adjustable collimators; and to calculate the contaminant-electron fluence spectra and the electron contribution to the depth-dose curves. Notwithstanding the better precision of the calculated spectra, they are similar to those calculated by Mohan et al. The three photon spectra at 6 MV from the machines of three different manufacturers show differences in their shapes as well as in the efficiency of bremsstrahlung production in the corresponding target and filter combinations. The contribution of direct photons to the photon energy fluence in a 10 x 10 field varies between 92% and 97%, where the primary collimator contributes between 0.6% and 3.4% and the flattening filter contributes between 0.6% and 4.5% to the head-scatter energy fluence. The fluence of the contaminant electrons at 100 cm varies between 5 x 10(-9) and 2.4 x 10(-7) cm(-2) per incident electron on target, and the corresponding spectrum for each beam is relatively invariant inside a 10 x 10 cm2 field. On the surface the dose from electron contamination varies between 5.7% and 11% of maximum dose and, at the depth of maximum dose, between 0.16% and 2.5% of maximum dose. The photon component of the percentage depth-dose at 10 cm depth is compared with the general formula provided by AAPM's task group 51 and confirms the claimed accuracy of 2%.     

Modelling of electron contamination in clinical photon beams for Monte Carlo dose calculation

The purpose of this work is to model electron contamination in clinical photon beams and to commission the source model using measured data for Monte Carlo treatment planning. In this work, a planar source is used to represent the contaminant electrons at a plane above the upper jaws. The source size depends on the dimensions of the field size at the isocentre. The energy spectra of the contaminant electrons are predetermined using Monte Carlo simulations for photon beams from different clinical accelerators. A 'random creep' method is employed to derive the weight of the electron contamination source by matching Monte Carlo calculated monoenergetic photon and electron percent depth-dose (PDD) curves with measured PDD curves. We have integrated this electron contamination source into a previously developed multiple source model and validated the model for photon beams from Siemens PRIMUS accelerators. The EGS4 based Monte Carlo user code BEAM and MCSIM were used for linac head sinulation and dose calculation. The Monte Carlo calculated dose distributions were compared with measured data. Our results showed good agreement (less than 2% or 2 mm) for 6, 10 and 18 MV photon beams.     

Using Monte Carlo methods to commission electron beams: a feasibility study

The purpose of this study was to investigate the feasibility of using Monte Carlo methods to assist in the commissioning of electron beams for a medical linear accelerator. The EGS4/BEAM code system was used to model an installed linear accelerator at this institution. Following an initial tuning of the input parameters, dosimetry data normally measured during the machine commissioning was calculated using the Monte Carlo code. All commissioning data was calculated for 6- and 12-MeV electron beams, and a subset of the commissioning data was calculated for the 20-MeV electron beams. On central axis, calculated percentage depth dose, cross-beam profiles, cone-insert ratios, and air-gap factors were generally within 2% of Dmax or 1 mm of the measured commissioning data; however, calculated open-cone ratios were not within 2%, in most cases. Calculated off-axis dose profiles for small fields were generally within the 2% (1-mm) criteria; however, calculated dose profiles for larger (open cone) fields frequently failed the 2% (1-mm) criteria. The remaining discrepancies between Monte Carlo calculations and measurement could be due to flaws in the Monte Carlo code, inaccuracies in the simulation geometry, the approximation of the initial source configuration, or a combination of the above. Although agreement between Monte Carlo calculated and measured doses was impressive and similar to previously published comparisons, our results did not prove our hypothesis that Monte Carlo calculations can generate electron commissioning data that is accurate within 2% of Dmax or 0.1 cm over the entire range of clinical treatment parameters. Although we believe that this hypothesis can be proved, it remains a challenge for the medical physics community. We intend to pursue this further by developing systematic methods for isolating causes of these differences.     

A Monte Carlo comparison of the response of the PTW-diamond and the TL-diamond detectors in megavoltage photon beams

A detailed Monte Carlo study of the PTW-diamond solid state detector response in megavoltage photon beams (60Co gamma rays to 25 MV x rays) has been performed with the EGS4 Monte Carlo Code. The sensitive volume of the diamond detector is a disk of diameter 4.4 mm and thickness 0.40 mm. The phantom material was water and the irradiation depth was usually 3 cm but additional simulations were performed at six other depths for the 10 and 25 MV x rays. Results show that the PTW-diamond detector response per unit of absorbed dose is constant within 1% for photon beam energies ranging from 60Co gamma rays to 25 MV x rays. Accurate depth dose curves for 10 and 25 MV x-ray beams may be measured with the diamond detector since the response per unit of absorbed dose at different depths in a water phantom is also constant to within 1% for depths ranging from 3 to 25 cm and field sizes ranging from 2.5 cm by 2.5 cm to 10 cm by 10 cm. An examination of the difference between the PTW-diamond detector and the wall-less form of the detector (e.g., TLDs) revealed that there is no significant difference in their response in megavoltage photon beams. This implies that the encapsulation of the diamond dosimeter causes less than a 1.3% change in its response for these megavoltage photon beams. Analysis of the total dose deposited in the sensitive volume of the detector shows that the PTW-diamond detector behaves as an intermediate-sized cavity, not a simple Bragg-Gray cavity, since the dose contribution from photon interactions within the cavity (alpha(c)) to the total cavity dose is 8% for 25 MV x rays and increases to 42% for 60Co gamma rays.     

Intensity modulated radiation therapy using laser-accelerated protons: a Monte Carlo dosimetric study

In this paper we present Monte Carlo studies of intensity modulated radiation therapy using laser-accelerated proton beams. Laser-accelerated protons coming out of a solid high-density target have broad energy and angular spectra leading to dose distributions that cannot be directly used for therapeutic applications. Through the introduction of a spectrometer-like particle selection system that delivers small pencil beams of protons with desired energy spectra it is feasible to use laser-accelerated protons for intensity modulated radiotherapy. The method presented in this paper is a three-dimensional modulation in which the proton energy spectrum and intensity of each individual beamlet are modulated to yield a homogeneous dose in both the longitudinal and lateral directions. As an evaluation of the efficacy of this method, it has been applied to two prostate cases using a variety of beam arrangements. We have performed a comparison study between intensity modulated photon plans and those for laser-accelerated protons. For identical beam arrangements and the same optimization parameters, proton plans exhibit superior coverage of the target and sparing of neighbouring critical structures. Dose-volume histogram analysis of the resulting dose distributions shows up to 50% reduction of dose to the critical structures. As the number of fields is decreased, the proton modality exhibits a better preservation of the optimization requirements on the target and critical structures. It is shown that for a two-beam arrangement (parallel-opposed) it is possible to achieve both superior target coverage with 5% dose inhomogeneity within the target and excellent sparing of surrounding tissue.     

Quantifying effects of lead shielding in electron beams: a Monte Carlo study

Lead shielding in contact with the patient's skin is often encountered in radiotherapy with electron beams. The influence of the lead shielding on dose distributions in the patient cannot fully be assessed using modern treatment planning systems. In this work the problem of quantifying the effect of lead shielding on dose distributions is addressed. Monte Carlo dose calculations were performed in a half-blocked water phantom shielded by lead, using a realistic model for the fluence of an electron linear accelerator. Electron beam energies of 6-20 MeV and lead thicknesses of 1-7 mm are used for 10 x 10 cm2 and 5 x 5 cm2 fields. The perturbation of the particle fluence and dose distributions in water introduced by the lead shielding is quantified. The effect of oblique electron beams on the dose perturbation is shown. A fictitious clinical example, the shielding of an eye in electron beam treatment, is used to demonstrate the usefulness of Monte Carlo based treatment planning algorithms that can incorporate the effects of lead shielding.     

Monte Carlo feasibility study of orthogonal bremsstrahlung beams for improved radiation therapy imaging

The basic characteristics of orthogonal bremsstrahlung beams are studied and the feasibility of improved contrast imaging with such a beam is evaluated. In the context of this work, orthogonal bremsstrahlung beams represent the component of the bremsstrahlung distribution perpendicular to the electron beam impinging on an accelerator target. The BEAMnrc Monte Carlo code was used to study target characteristics, energy spectra and relative fluences of orthogonal beams to optimize target design. The reliability of the simulations was verified by comparing our results with benchmark experiments. Using the results of the Monte Carlo optimization, the targets with various materials and a collimator were designed and built. The primary pencil electron beam from the research port of a Varian Clinac-18 accelerator striking on Al, Pb and C targets was used to create orthogonal beams. For these beams, diagnostic image contrast was tested by placing simple Lucite objects in the path of the beams and comparing image contrast obtained in the orthogonal direction to the one obtained in the forward direction. The simulations for various target materials and various primary electron energies showed that a width of 80% of the continuous-slowing-down approximation range (RCSDA) is sufficient to remove electron contamination in the orthogonal direction. The photon fluence of the orthogonal beam for high Z targets is larger compared to low Z targets, i.e. by a factor of 20 for W compared to Be. For a 6 MeV electron beam, the mean energy for low Z targets is calculated to be 320 keV for Al and 150 keV for Be, and for a high Z target like Pb to be 980 keV. For irradiation times of 1.2 s in an electron mode of the linac, the contrast of diagnostic images created with orthogonal beams from the Al target is superior to that in the forward direction. The image contrast and the beam profile of the bremsstrahlung beams were also studied. Both the Monte Carlo study and experiment showed an improvement of the contrast for lower Z target materials. This study confirms the feasibility, both in terms of intensity and image contrast, of orthogonal bremsstrahlung beams for radiation therapy imaging.     

Dosimetry characteristics of degraded electron beams investigated by Monte Carlo calculations in a setup for intraoperative radiation therapy

Degraded electron beams, as used for intraoperative radiation therapy (IORT) or similar complicated dosimetric situations, have different characteristics compared to conventional electron therapy beams. If international dosimetry protocols are applied in a direct manner to such degraded beams, uncertainties will be introduced in the absorbed dose determination. The Monte Carlo method has been used to verify experimentally determined relative absorbed dose distributions and output factors in an IORT geometry. Monte Carlo generated dose distributions are mostly within +/-2% or +/-2 mm of measured data. The simulated output variation between the IORT cones (relative output factors) are mostly within 2% of measured values. By comparing IORT and conventional electron beam characteristics (e.g. energy spectra, angular distributions and the contributions of different system components to these quantities) limitations and uncertainties of commonly used dosimetric techniques in IORT electron fields are quantified. The intraoperative treatment field contains a larger amount of scattered electrons, which leads to a broader energy spectrum as well as a wider angular distribution of electrons at the phantom surface. The dose from the scattered electrons can contribute up to 40% of the total dose at a depth of dose maximum, compared to approximately 10% for standard beams. A study of the energy spectra at the reference depth reveals that an uncertainty of the order of 1% can be introduced if ionization chamber based dosimetry is used to determine output factors for the investigated IORT system. We recommend that relative absorbed dose distributions and output factors in IORT electron beams and for similar complicated dosimetric situations should be determined with detectors having a small energy and angular dependence (e.g. diamond detectors or p-Si diodes).