Dosimetric characteristics of unflattened 6 MV photon beams of a clinical linear accelerator: a Monte Carlo study.

The purpose of this study is to evaluate the dosimetric properties of a flattening filter free 6 MV photon beam. The 6 MV photon beam of a Varian Clinac 21 EX linac was modeled using the MCNP4C Monte Carlo (MC) code. Dosimetric features including central axis absorbed doses, beam profiles and photon energy spectra were calculated for flattened and unflattened 6 MV photon beams. A substantial increase in the dose rate was seen for the unflattened beam, which was decreased with field size and depth. The penumbra width was decreased less than 0.2 mm (about 5%) and a 25% decrease in out-of-field dose was observed for the unflattened beam. The photon energy spectra were softer for the unflattened beam and the mean energies of spectra were higher for smaller field size. Our study showed that increase in the dose rate and lower out-of-field dose could be considered as practical advantages for unflattened 6 MV beams.     

Monte Carlo study on a flattening filter-free 18-MV photon beam of a medical linear accelerator

PURPOSE: Several studies on the dosimetric properties of unflattened photon beams have shown some advantages for radiotherapy. In this study, the effect of removing the flattening filter from an 18-MV photon beam was investigated using the Monte Carlo method. MATERIALS AND METHODS: The 18-MV photon beam of an Elekta SL25 linear accelerator was simulated using the MCNP4C Monte Carlo (MC) code. Beam dosimetric features, including central axis absorbed doses, beam profiles, and photon energy spectra, were calculated for flattened and unflattened 18-MV photon beams. RESULTS: A 4.24-fold increase in the dose rate was seen for the unflattened beam with a field size of 10 x 10 cm(2). A decrease in the out-of-field dose up to 30% was seen for the unflattened beam. For the unflattened beam, photon energy spectra were softer, and the mean energies of the spectra were higher for a smaller field size. CONCLUSION: Our study showed that the increase in dose rate and lower out-of-field dose can be possible advantages for an unflattened 18-MV beam.     

A Monte Carlo study on neutron and electron contamination of an unflattened 18-MV photon beam

Recent studies on flattening filter (FF) free beams have shown increased dose rate and less out-of-field dose for unflattened photon beams. On the other hand, changes in contamination electrons and neutron spectra produced through photon (E>10 MV) interactions with linac components have not been completely studied for FF free beams. The objective of this study was to investigate the effect of removing FF on contamination electron and neutron spectra for an 18-MV photon beam using Monte Carlo (MC) method. The 18-MV photon beam of Elekta SL-25 linac was simulated using MCNPX MC code. The photon, electron and neutron spectra at a distance of 100 cm from target and on the central axis of beam were scored for 10×10 and 30×30 cm² fields. Our results showed increase in contamination electron fluence (normalized to photon fluence) up to 1.6 times for FF free beam, which causes more skin dose for patients. Neuron fluence reduction of 54% was observed for unflattened beams. Our study confirmed the previous measurement results, which showed neutron dose reduction for unflattened beams. This feature can lead to less neutron dose for patients treated with unflattened high-energy photon beams.     

Treatment planning and delivery of IMRT using 6 and 18 MV photon beams without flattening filter

In light of the increasing use of intensity modulated radiation therapy (IMRT) in modern radiotherapy practice, the use of a flattening filter may no longer be necessary. Commissioning data have been measured for a Varian 23EX linear accelerator with 6 and 18 MV photon energies without a flattening filter. Measurements collected for the commissioning of the linac included percent depth dose curves and profiles for field sizes ranging from 2×2 to 40×40 cm² as defined by the jaws and multileaf collimator. Machine total scatter factors were measured and calculated. Measurements were used to model the unflattened beams with the Pinnacle³ treatment planning system. IMRT plans for prostate, lung, brain and head and neck cancer cases were generated using the flattening filter and flattening filter-free beams. From our results, no difference in the quality of the treatment plans between the flat and unflattened photon beams was noted. There was however a significant decrease in the number of monitor units required for unflattened beam treatment plans due to the increase in linac output—approximately two times and four times higher for the 6 and 18 MV, respectively.     

Dose attenuation effect of hip prostheses in a 9-MV photon beam: commercial treatment planning system versus Monte Carlo calculations

Purpose The purpose of this study was to investigate the dosimetric effect of various hip prostheses on pelvis lateral fields treated by a 9-MV photon beam using Monte Carlo (MC) and effective path-length (EPL) methods. Material and methods The head of the Neptun 10 pc linac was simulated using the MCNP4C MC code. The accuracy of the MC model was evaluated using measured dosimetric features including depth dose values and dose profiles in a water phantom. The Alfard treatment planning system (TPS) was used for EPL calculations. A virtual water phantom with dimensions of 30 × 30 × 30 cm³ and a cube with dimensions of 4 × 4 × 4 cm³ made of various metals centered in 12 cm depth was used for MC and EPL calculations. Various materials including titanium, Co-Cr-Mo, and steel alloys were used as hip prostheses. Results Our results showed significant attenuation in absorbed dose for points after and inside the prostheses. Attenuations of 32%, 54% and 55% were seen for titanium, Co-Cr-Mo, and steel alloys, respectively, at a distance of 5 cm from the prosthesis. Considerable dose increase (up to 18%) was found at the water–prosthesis interface due to back-scattered electrons using the MC method. The results of EPL calculations for the titanium implant were comparable to the MC calculations. This method, however, was not able to predict the interface effect or calculate accurately the absorbed dose in the presence of the Co-Cr-Mo and steel prostheses. Conclusion The dose perturbation effect of hip prostheses is significant and cannot be predicted accurately by the EPL method for Co-Cr-Mo or steel prostheses. The use of MC-based TPS is recommended for treatments requiring fields passing through hip prostheses.     

Comparison of 4 MV photon surface dose among Varian, Siemens, and Elekta linear accelerators for tangential breast treatment: a phantom study

Purpose We have compared the differences in a 4-MV photon surface dose among Varian, Siemens, and Elekta linear accelerators (linacs) with wedges for tangential breast treatment. Materials and methods The wedge factor and the surface dose were measured using a solid water phantom and an ion chamber for each linear accelerator with various field sizes and wedge angles. A tangential treatment plan was applied to an elliptical hollow cylinder water phantom with a radiochromic film placed thereon. A dose was delivered to a simulated target in the phantom, and the resulting dose distribution was analyzed using a film scanner. Results Varian's wedges resulted in the highest wedge factors, ranging from 0.37 to 0.75 depending on the wedge angles. Varian's wedges led to the highest normalized skin doses, ranging between 0.40 and 0.73 depending on the wedge angles and field sizes. In the cylinder phantom test with two tangential beams, the Varian linac provided a nearly 20% higher maximum dose than the Siemens and Elekta linacs. Conclusion The Varian linac resulted in the highest surface doses, and the Elekta linac led to the lowest for nearly all the measurement conditions we employed, including open beams.     

Depth dose characteristics of photon beams released from a scanning-type racetrack microtron

The MM50 is a racetrack microtron that can emit photon beams or electron beams up to 50 MeV. The MM22 using the scanning beam method and the MM22 using a flattening filter method both to flatten the emission field and a water phantom with particular function measurable of PDD etc. in an accelerator using the scanning beam method to make up the PDD curve of photon beams from the linear accelerator. The Clinac21EX was thus employed. The maximum depth of beam flux was shallow, the gradient of the flux decrement large, the surface dose large, and the estimated nominal energy low to the same nominal energy. From these findings, it can be said that thorough comprehension of the characteristics of beam flux properties for these units is necessary when photon beams are to be used.     

Mechanical accuracy of a stereotactic irradiation system using a micro multi-leaf collimator

Mechanical accuracy of a stereotactic irradiation system using a micro multi-leaf collimator (mMLC), Elekta DMLC, has been evaluated. Measurements were made to obtain transmission, leakage, penumbra, and positioning accuracy of the DMLC leaf for a 6 MV photon beam. Mechanical accuracy and long term stability of a linac isocenter was also evaluated. The resulting transmission, along a line perpendicular to the leaf movement, was 0.31±0.01%, and the leakage from the closed opposing leaf pairs was 0.39±0.01%. The measured penumbra, at a depth incurring maximum dose, was 2.37±0.16 mm toward the leaf end and 2.14±0.18 mm toward the leaf side for various field sizes. The leaf gap width error, of 0.10±0.08 mm, was obtained by analyzing picket fence test results. The maximum leaf positioning error, of 0.14±0.06 mm, was obtained by analyzing the log file for a various gantry angles during an arc delivery. The isocenter accuracy was within a radius of 1 mm, without any recalibration for two years. In conclusion, our stereotactic irradiation system using DMLC was capable of providing accurate stereotactic treatment.     

Monte Carlo calculation of Varian 2300C/D Linac photon beam characteristics: a comparison between MCNP4C, GEANT3 and measurements.

Different codes are used for Monte Carlo (MC) calculations in radiation therapy. In this research, MCNP4C and GEANT3 codes have been compared in calculations of dosimetric characteristics of Varian Clinac 2300C/D. The parameters of influence in the differences seen in dosimetric features were discussed. This study emphasizes that both MCNP4C and GEANT3 MC can be used in radiation therapy computations and their differences in photon spectra calculations have a negligible effect on percentage depth dose computations in radiation therapy.     

High dose rate and flattening filter free irradiation can be safely implemented in clinical practice

Purpose: We hypothesize that flattening filter free (FFF) high dose rate irradiation will decrease cell survival in normal and cancer cells with more pronounced effects in DNA repair deficient cells. Additionally, we hypothesize that removal of the flattening filter will result in an enhanced relative biological effectiveness independent of the dose rate.

Materials and methods: Clonogenic survival was assessed after exposure to dose rates of 4 or 24 Gy/min (FFF 10 megavolt [MV] photon beam) using a Varian TrueBeam accelerator. Additionally, cells were exposed to 4 Gy/min with or without flattening filter. Relative biological effectiveness estimations were performed comparing the different beam photon spectra.

Results: Cell survival in tumor and normal cell lines was not influenced by high dose rate irradiation. The intrinsic radiation sensitivity of DNA repair deficient cells was not affected by high dose rate compared to normal dose rate. Furthermore, the relative biological effectiveness was not significantly different from unity in any of the cell lines for both FFF and conventional flattened beam exposures.

Conclusions: High dose rate irradiation did not affect long-term survival and DNA repair for cell lines of different tissues. This suggests that high dose rate does not influence treatment outcome or treatment toxicity and could be safely implemented in clinical routine.     

Evaluation of dose delivery based on a comparison of dosimetry calculations using open beam and wedged beam depth dose data

The purpose of this study is to evaluate the magnitude of the error in dose delivery caused by the use of open beam depth dose data in dosimetry calculations for wedged photon beams. Isodose pians were calculated for treatments given in a 3-field isocentric prostate or rectal setup using an open AP beam with two lateral wedged beams. The dose distributions were first calculated using open beam depth dose data for all three fields. Next, the open beam data was used only for the AP field and true wedged beam depth dose data was substituted for the two lateral wedged fields. The magnitude of the depth dose variations for wedged vs open beams depends on the nominal beam energy, the wedge angle, and the depth of measurement. Consequently, isodose distributions calculated for wedged fields were found to be different when true wedged beam depth dose data was used instead of open beam data as is commonly done. Monitor unit calculations using a field size specific wedge factor show that dose delivery errors up to 4% can result from the use of open beam depth dose data in wedged beam dose distribution calculations for a 6-MV photon beam. Accurate treatment planning for wedged fields requires the use of wedged beam depth dose data specific to each wedge. Simply using open beam depth dose data in dose calculations for wedged beams will result in dose delivery errors, the magnitude of which depends on the combination of wedge angle, field size, and nominal beam energy.     

Monte Carlo simulation of a clinical linear accelerator

The effects of the physical parameters of an electron beam from a Siemens PRIMUS clinical linear accelerator (linac) on the dose distribution in water were investigated by Monte Carlo simulation. The EGS4 user code, OMEGA/BEAM, was used in this study. Various incident electron beams, for example, with different energies, spot sizes and distances from the point source, were simulated using the detailed linac head structure in the 6 MV photon mode. Approximately 10 million particles were collected in the scored plane, which was set under the reticle to form the so-called phase space file. The phase space file served as a source for simulating the dose distribution in water using DOSXYZ. Dose profiles at D_max (1.5 cm) and PDD curves were calculated following simulating about 1 billion histories for dose profiles and 500 million histories for percent depth dose (PDD) curves in a 30×30×30 cm³ water phantom. The simulation results were compared with the data measured by a CEA film and an ion chamber. The results show that the dose profiles are influenced by the energy and the spot size, while PDD curves are primarily influenced by the energy of the incident beam. The effect of the distance from the point source on the dose profile is not significant and is recommended to be set at infinity. We also recommend adjusting the beam energy by using PDD curves and, then, adjusting the spot size by using the dose profile to maintain the consistency of the Monte Carlo results and measured data.     

Effect of wedge filter and field size on photoneutron dose equivalent for an 18 MV photon beam of a medical linear accelerator

Photoneutrons produced during radiation therapy with high energy photons is the main source of unwanted out-of-field received doses of patients. To analyze the neutron dose equivalent (NDE) for wedged beams and its variation with field size, Monte Carlo (MC) modeling of an 18 MV photon beam was performed using MCNPX MC code. The results revealed that the NDE is on average 6.5 times higher for wedged beams. For open beams, the NDE decreased with increasing field size especially for field sizes >20×20 cm². While, for wedged beams, the NDE increased with field size. It was suggested that the increase of NDE for wedged beams should be taken into account in radiation-induced secondary cancer risk estimations and radiation protection calculations.     

Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode,optically stimulated luminescent dosimeters,and LiF thermoluminescent dosimeters

The purpose of this work was to determine the relative sensitivity of skin QED diodes, optically stimulated luminescent dosimeters (OSLDs) (microStar? DOT, Landauer), and LiF thermoluminescent dosimeters (TLDs) as a function of distance from a photon beam field edge when applied to measure dose at out-of-field points. These detectors have been used to estimate radiation dose to patients' implantable cardioverter-defibrillators (ICDs) located outside the treatment field. The ICDs have a thin outer case made of 0.4- to 0.6-mm-thick titanium (～2.4-mm tissue equivalent). A 5-mm bolus, being the equivalent depth of the devices under the patient's skin, was placed over the ICDs. Response per unit absorbed dose-to-water was measured for each of the dosimeters with and without bolus on the beam central axis (CAX) and at a distance up to 20 cm from the CAX. Doses were measured with an ionization chamber at various depths for 6- and 15-MV x-rays on a Varian Clinac-iX linear accelerator. Relative sensitivity of the detectors was determined as the ratio of the sensitivity at each off-axis distance to that at the CAX. The detector sensitivity as a function of the distance from the field edge changed by ± 3% (1–11%) for LiF TLD-700, decreased by 10% (5–21%) for OSLD, and increased by 16% (11–19%) for the skin QED diode (Sun Nuclear Corp.) at the equivalent depth of 5 mm for 6- or 15-MV photon energies. Our results showed that the use of bolus with proper thickness (i.e., ～d_max of the photon energy) on the top of the ICD would reduce the scattered dose to a lower level. Dosimeters should be calibrated out-of-field and preferably with bolus equal in thickness to the depth of interest. This can be readily performed in clinic.     

Determination of head scatter factors released from a scanning-type therapeutic accelerator

The MM50 is a racetrack microtron capable of taking out photon beams and electron beams with energies of up to 50 MeV. It flattens the beam by the beam-scanning method, while the microtron MM22 utilizes a flattening filter. The head-scatter factors (hereafter called S(h)), which are important for evaluating the output of the photon beam of the MM50 and MM22, were measured using a mini-phantom and build-up cap. S(h) measured with the build-up cap showed the influence of contaminated electrons, whereas S(h) measured with the mini-phantom showed less influence, even for 50 MV photon beams. Compared with the MM22, the MM50 showed less change in S(h) according to field size and energy. The reason for this seemed to be that the MM50 has a smaller extra-focal region than other accelerators equipped with flattening filters and, therefore, can essentially be considered a point source by using the beam-scanning method without a flattening filter. This study demonstrated that photons scattered by the flattening filter used for beam flattening in typical medical accelerators mainly contribute to S(h).     

Physical-dosimetric characterization of a multi-leaf collimator system for clinical implementation in conformational radiotherapy

INTRODUCTION: In the present paper we discuss the main dosimetric characteristics of the multileaf collimator (MLC) installed on the Elekta SLi Precise accelerators. To evaluate the effectiveness of the MLC in conformal radiotherapy, beam transmission through leaves and/or diaphragms, leakage between the leaves, central axis depth dose, surface dose, effective penumbra, scalopping effect and field size factors were measured. MATERIALS AND METHODS: The MLC installed on the dual energy (4 and 6 MV) linear accelerator Elekta SLi Precise consists of 40 opposed pairs of 75 mm thick tungsten leaves, set in two raws mounted in place of the upper collimator. Each leaf has a nominal projected width of 10 mm. The maximum field size attainable is 40 x 40 cm2 at 100 cm SAD. Beam transmission through leaves and/or diaphragms and field size factors were measured in RW3 phantom with a ionization chamber, leakage between the leaves and effective penumbra were instead evaluated with radiographic films (X-Omat-V) and a laser scanning photodensitometer. Percentage depth doses were measured in an automatic water phantom. RESULTS: For both energies, approximately 1% of the incident radiation on the multileaf collimator is transmitted through the backup collimator, while the transmission through the different combinations of leaves and collimators is between 0.03 and 0.14%. These values show a good agreement with literature data and are in general lower than the peak values specified by the manufacturer. The peak value of the leakage between the leaves was about 2% for both energies, without significative variation with gantry or collimator angle or distance from the axis. MLC shaped fields show a skin dose less (about 3%) than the one of cerrobend block shaped fields, because of the electronic contamination due to the plexiglass tray of the cerrobend blocks; in both cases, the depth doses are similar, as are flatness and symmetry of irradiation fields. The effective penumbra increases with field dimension, depth and leaves positioning, with a mean value of about 9 mm for both energies. The different beam configurations do not significantly affect the values of the field size factors. CONCLUSIONS: The dosimetric characteristics and the case of use of the Elekta multileaf collimator make its application to conformal radiotherapy convenient and reliable, able to improve the accuracy and the effectiveness of radiation therapy and to develop new kinds of treatments. However, because of the complexity of the MLC, its implementation in radiotherapic practice requires careful dosimetric characterization to evaluate those parameters (transmission, penumbra and output factors) that play a fundamental role in the accuracy of the treatment.     

The effect of titanium stabilization rods on spinal cord radiation dose.

The purpose of this study was to investigate the dosimetric effect of a titanium-rod spinal stabilization system on surrounding tissue, especially the spinal cord. Ion chamber dosimetry was performed for 6- and 18-MV photon beams in a water phantom containing a titanium-rod spinal stabilization system. Isodose curves were obtained in the phantom with and without rods. To assess the ability of a treatment planning system to reproduce the effects of the stabilization system on the radiation dose delivered to surrounding tissue, dose distributions were calculated after appropriate modifications were made in the computed tomography number-to-density conversion table to account for the increased density of the titanium rods. The resultant heterogeneity-corrected plans were compared with uncorrected plans. At a 7-cm depth in the water phantom, corresponding to the depth of the spinal cord, the beam was attenuated by 4% under the rods alone and by 13% rods under the rods with screws for the 6-MV photon beam as compared with curves generated in the absence of rods. The beam was attenuated by 3% and 11%, respectively, for the 18-MV beam. Using anteroposterior (18-MV) and posteroanterior (6-MV) photon beams, with and without heterogeneity correction for the rods, the corrected isodose plan showed an approximately 2% beam attenuation 4 cm anterior to the rods as compared with the uncorrected plan. No significant difference in the spinal cord dose was observed between the 2 plans, however. The titanium-rod spinal stabilization system tested in this study caused a decrease in the dose delivered distal to the rods but did not significantly affect the dose delivered to the spinal cord.     

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。     

Comparison of experimental 3D dose curves in a heterogeneous phantom with results obtained by MCNP5 simulation and those extracted from a commercial treatment planning system

Commercial planning systems used in radiotherapy treatments use determinist correlations to evaluate dose distribution around regions of interest. Estimated dose with this type of planners can be problematic, especially when analyzing heterogeneous zones. The present work is focused in quantifying the dose distribution in a heterogeneous medium irradiated by a 6 MeV photon beam emitted by an Elekta Precise Radiotherapy Unit head. Dose mapping inside the heterogeneous water phantom has been simulated with the photon and electron transport with Monte Carlo computer code MCNP5 and also, using a commercial treatment planning software in the same irradiation conditions. The calculated results were compared with experimental relative dose curves. This comparison shows that inside the heterogeneity region, the commercial algorithms are not able to predict the variation of dose in the heterogeneous zones with the same precision as MCNP5.