Backscatter towards the monitor ion chamber in high-energy photon and electron beams: charge integration versus Monte Carlo simulation

In some linear accelerators, the charge collected by the monitor ion chamber is partly caused by backscattered particles from accelerator components downstream from the chamber. This influences the output of the accelerator and also has to be taken into account when output factors are derived from Monte Carlo simulations. In this work, the contribution of backscattered particles to the monitor ion chamber response of a Varian 2100C linac was determined for photon beams (6, 10 MV) and for electron beams (6, 12, 20 MeV). The experimental procedure consisted of charge integration from the target in a photon beam or from the monitor ion chamber in electron beams. The Monte Carlo code EGS4/BEAM was used to study the contribution of backscattered particles to the dose deposited in the monitor ion chamber. Both measurements and simulations showed a linear increase in backscatter fraction with decreasing field size for photon and electron beams. For 6 MV and 10 MV photon beams, a 2-3% increase in backscatter was obtained for a 0.5 x 0.5 cm2 field compared to a 40 x 40 cm2 field. The results for the 6 MV beam were slightly higher than for the 10 MV beam. For electron beams (6, 12, 20 MeV), an increase of similar magnitude was obtained from measurements and simulations for 6 MeV electrons. For higher energy electron beams a smaller increase in backscatter fraction was found. The problem is of less importance for electron beams since large variations of field size for a single electron energy usually do not occur.     

Neutron dosimetry in high energy X-ray beams of medical accelerators.

High energy X-ray beams from medical accelerators are used in cancer therapy. In such beams, neutrons are also produced due to photon-neutron interactions in the target material, collimator and beam flattening filter. The feasibility of employing fast-neutron-induced recoil particle tracks in polycarbonate foils developed by the electrochemical etching (ECE) method for the dosimetry of such neutrons was investigated. The experiments were carried out in, and out of, the beam of a Varian Clinac-18, an Allis-Chalmers 25 MeV betatron and a Brown Boveri 45 MeV betatron. Neutron dose equivalents were found both as a function of the photon dose and of the distance away from the centre of the beam. The neutron dose equivalent was found to be 0.6 and 1.3% of the X-ray dose at the centre position of the beam for a TSD = 100 cm and a 10 x 10 cm2 field for the 25 and 45 MeV betatrons respectively. Although the dosemeter showed adequate sensitivity to neutrons in the beam of the betatrons, it showed insensitivity to neutrons in the beam of the Clinac-18 which has a softer spectrum than the neutron energy threshold of the dosemeter. It can be concluded that this dosimetry method provides a new approach with a number of advantages compared to some other existing techniques for such measurements above the energy threshold of the dosemeter.     

Dose distributions in a human head phantom for neutron capture therapy using moderated neutrons from the 2.5 meV proton-7Li reaction or from fission of 235U.

The feasibility of neutron capture therapy (NCT) using an accelerator-based neutron source of the 7Li(p,n) reaction produced by 2.5 MeV protons was investigated by comparing the neutron beam tailored by both the Hiroshima University radiological research accelerator (HIRRAC) and the heavy water neutron irradiation facility in the Kyoto University reactor (KUR-HWNIF) from the viewpoint of the contamination dose ratios of the fast neutrons and the gamma rays. These contamination ratios to the boron dose were estimated in a water phantom of 20 cm diameter and 20 cm length to simulate a human head, with experiments by the same techniques for NCT in KUR-HWNIF and/or the simulation calculations by the Monte Carlo N-particle transport code system version 4B (MCNP-4B). It was found that the 7Li(p,n) neutrons produced by 2.5 MeV protons combined with 20, 25 or 30 cm thick D20 moderators of 20 cm diameter could make irradiation fields for NCT with depth-dose characteristics similar to those from the epithermal neutron beam at the KUR-HWNIF.     

Commissioning of a medical accelerator photon beam Monte Carlo simulation using wide-field profiles

A method for commissioning an EGSnrc Monte Carlo simulation of medical linac photon beams through wide-field lateral profiles at moderate depth in a water phantom is presented. Although depth-dose profiles are commonly used for nominal energy determination, our study shows that they are quite insensitive to energy changes below 0.3 MeV (0.6 MeV) for a 6 MV (15 MV) photon beam. Also, the depth-dose profile dependence on beam radius adds an additional uncertainty in their use for tuning nominal energy. Simulated 40 cm x 40 cm lateral profiles at 5 cm depth in a water phantom show greater sensitivity to both nominal energy and radius. Beam parameters could be determined by comparing only these curves with measured data.     

Fast neutron absorbed dose distributions in the energy range 0.5-80 meV--a Monte Carlo study

Neutron pencil-beam absorbed dose distributions in phantoms of bone, ICRU soft tissue, muscle, adipose and the tissue substitutes water, A-150 (plastic) and PMMA (acrylic) have been calculated using the Monte Carlo code FLUKA in the energy range 0.5 to 80 MeV. For neutrons of energies < or = 20 MeV, the results were compared to those obtained using the Monte Carlo code MCNP4B. Broad-beam depth doses and lateral dose distributions were derived. Broad-beam dose distributions in various materials were compared using two kinds of scaling factor: a depth-scaling factor and a dose-scaling factor. Build-up factors due to scattered neutrons and photons were derived and the appropriate choice of phantom material for determining dose distributions in soft tissue examined. Water was found to be a good substitute for soft tissue even at neutron energies as high as 80 MeV. The relative absorbed doses due to photons ranged from 2% to 15% for neutron energies 10-80 MeV depending on phantom material and depth. For neutron energies below 10 MeV the depth dose distributions derived with MCNP4B and FLUKA differed significantly, the difference being probably due to the use of multigroup transport of low energy (< 19.6 MeV) neutrons in FLUKA. Agreement improved with increasing neutron energies up to 20 MeV. At energies > 20 MeV, MCNP4B fails to describe dose build-up at the phantom interface and penumbra at the edge of the beam because it does not transport secondary charged particles. The penumbra width, defined as the distance between the 80% and 20% iso-dose levels at 5 cm depth and for a 10 x 10 cm2 field, was between 0.9 mm and 7.2 mm for neutron energies 10-80 MeV.     

Shielding for neutron scattered dose to the fetus in patients treated with 18 MV x-ray beams

Neutrons are associated with therapeutic high energy x-ray beams as a contaminant that contributes significant unwanted dose to the patient. Measurement of both photon and neutron scattered dose at the position of a fetus from chest irradiation by a large field 18 MV x-ray beam was performed using an ionization chamber and superheated drop detector, respectively. Shielding construction to reduce this scattered dose was investigated using both lead sheet and borated polyethylene slabs. A 7.35 cm lead shield reduced the scattered photon dose by 50% and the scattered neutron dose by 40%. Adding 10 cm of 5% borated polyethylene to this lead shield reduced the scattered neutron dose by a factor of 7.5 from the unshielded value. When the 5% borated polyethylene was replaced by the same thickness of 30% borated polyethylene there was no significant change in the reduction of neutron scatter dose. The most efficient shield studied reduced the neutron scatter dose by a factor of 10. The results indicate that most of the scattered neutrons present at the position of the fetus produced by an 18 MV x-ray beam are of low energy and in the thermal to 0.57 MeV range since lead is almost transparent to neutrons with energies lower than 0.57 MeV. This article constitutes the first report of an effective shield to reduce neutron dose at the fetus when treating a pregnant woman with a high energy x-ray beam.     

Are neutrons responsible for the dose discrepancies between Monte Carlo calculations and measurements in the build-up region for a high-energy photon beam?

This study presents measured neutron dose using a neutron dosimeter in a water phantom and investigates a hypothesis that neutrons in a high-energy photon beam may be responsible for the reported significant dose discrepancies between Monte Carlo calculations and measurements at the build-up region in large fields. Borated polyethylene slabs were inserted between the accelerator head and the phantom in order to remove neutrons generated in the accelerator head. The thickness of the slab ranged from 2.5 cm to 10 cm. A lead slab of 3 mm thickness was also used in the study. The superheated drop neutron dosimeter was used to measure the depth-dose curve of neutrons in a high-energy photon beam and to verify the effectiveness of the slab to remove these neutrons. Total dose measurements were performed in water using a WELLHOFER WP700 beam scanner with an IC-10 ionization chamber. The Monte Carlo code BEAM was used to simulate an 18 MV photon beam from a Varian Clinac-2100EX accelerator. Both EGS4/DOSXYZ and EGSnrc/DOSRZnrc were used in the dose calculations. Measured neutron dose equivalents as a function of depth per unit total dose in water were presented for 10 x 10 and 40 x 40 cm2 fields. The measured results have shown that a 5-10 cm thick borated polyethylene slab can reduce the neutron dose by a factor of 2 when inserted between the accelerator head and the detector. In all cases the measured neutron dose equivalent was less than 0.5% of the photon dose. In order to study if the ion chamber was highly sensitive to the neutron dose, we have investigated the disagreement between the Monte Carlo calculated and measured central-axis depth-dose curves in the build-up region when different shielding materials were used. The result indicated that the IC-10 chamber was not highly sensitive to the neutron dose. Therefore, neutrons present in a high-energy photon beam were unlikely to be responsible for the reported discrepancies in the build-up region for large fields.     

Neutron beams from protons on beryllium

Measurements of dose rate and penetration in water have been made for neutron beams produced by 30--75 MeV protons on beryllium. The effects of Polythene filters added on the target side of the collimator have also been studied. A neutron beam comparable with a photon beam from a 4--8 MeV linear accelerator can be produced with p/Be neutrons plus 5 cm Polythene filtrations, with protons in the range 50--75 MeV. This is a more economical method than use of the d/Be reaction.     

Improvement of a p(65)+Be neutron beam for therapy at Cyclone, Louvain-la-Neuve

The variable energy cyclotron of the Catholic University of Louvain is used to produce intense neutron beams for neutron therapy purposes. As a first step, neutrons were produced by bombarding a Be target with 50 MeV deuterons; at present they are produced by 65 MeV protons. This paper describes the improvements to the target system. A new (17 mm) Be target together with the old (10 mm) Be target are inserted in a movable support which allows the production of neutrons either by 65 MeV protons or by 50 MeV deuterons. Both targets can be removed for proton beam therapy. The dosimetric characteristics of the p(65)+Be and d(50)+Be neutron beams are compared: dose rate, gamma-contribution, depth dose and room activation.     

Electron beam treatment verification using measured and Monte Carlo predicted portal images

Electron beam treatments may benefit from techniques to verify patient positioning and dose delivery. This is particularly so for complex techniques such as mixed photon and electron beam radiotherapy and electron beam modulated therapy. This study demonstrates that it is possible to use the bremsstrahlung photons in an electron beam from a dual scattering foil linear accelerator to obtain portal images of electron beam treatments. The possibility of using Monte Carlo (MC) simulations to predict the electron beam treatment portal images was explored. The MC code EGSnrc was used to model a Varian CL21EX linear accelerator (linac) and to characterize the bremsstrahlung photon production in the linac head. It was found that the main sources of photons in the electron beam are the scattering foils, the applicator and the beam-shaping cut-out. Images were acquired using the Varian CL21EX linac and the Varian aS500 electronic portal imager (EPI); four electron energies (6, 9, 12, 16 MeV), and different applicator and cut-out sizes were used. It was possible to acquire images with as little as 10.7 MU per image. The contrast, the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), the resolution and an estimate of the modulated transfer function (MTF) of the electron beam portal images were computed using a quality assurance (QA) phantom and were found to be comparable to those of a 6 MV photon beam. Images were also acquired using a Rando anthropomorphic phantom. MC simulations were used to model the aS500 EPID and to obtain predicted portal images of the QA and Rando phantom. The contrast in simulated and measured portal images agrees within +/-5% for both the QA and the Rando phantom. The measured and simulated images allow for a verification of the phantom positioning by making sure that the structure edges are well aligned. This study suggests that the Varian aS500 portal imager can be used to obtain patient portal images of electron beams in the scattering foil linacs.     

Monitor unit calculation on the beam axis of open and wedged asymmetric high-energy photon beams

An ESTRO booklet and a report of the Netherlands Commission on Radiation Dosimetry have been published recently describing empirical methods for monitor unit (MU) calculations in symmetrical high-energy photon beams. Both documents support the same basic ideas; firstly the separation of head scatter and volume scatter components and secondly the determination of head scatter quantities in a mini-phantom. Based on these ideas the methods previously described for MU calculations in symmetrical beams are extended to asymmetrical open and wedged beams in isocentric treatment conditions. All required dosimetric parameters (normalized head scatter factors, phantom scatter correction factors, wedge factors, off-axis ratios, quality index, and depth dose parameters) are determined as a function of beam axis position in order to study their off-axis dependence. Measurements are performed for 6 MV and 18 MV photon beams provided by two different dual-energy linear accelerators, a GE Saturne 42 and a Varian 2100 CD linac.     

A Monte Carlo model for out-of-field dose calculation from high-energy photon therapy

As cancer therapy becomes more efficacious and patients survive longer, the potential for late effects increases, including effects induced by radiation dose delivered away from the treatment site. This out-of-field radiation is of particular concern with high-energy radiotherapy, as neutrons are produced in the accelerator head. We recently developed an accurate Monte Carlo model of a Varian 2100 accelerator using MCNPX for calculating the dose away from the treatment field resulting from low-energy therapy. In this study, we expanded and validated our Monte Carlo model for high-energy (18 MV) photon therapy, including both photons and neutrons. Simulated out-of-field photon doses were compared with measurements made with thermoluminescent dosimeters in an acrylic phantom up to 55 cm from the central axis. Simulated neutron fluences and energy spectra were compared with measurements using moderated gold foil activation in moderators and data from the literature. The average local difference between the calculated and measured photon dose was 17%, including doses as low as 0.01% of the central axis dose. The out-of-field photon dose varied substantially with field size and distance from the edge of the field but varied little with depth in the phantom, except at depths shallower than 3 cm, where the dose sharply increased. On average, the difference between the simulated and measured neutron fluences was 19% and good agreement was observed with the neutron spectra. The neutron dose equivalent varied little with field size or distance from the central axis but decreased with depth in the phantom. Neutrons were the dominant component of the out-of-field dose equivalent for shallow depths and large distances from the edge of the treatment field. This Monte Carlo model is useful to both physicists and clinicians when evaluating out-of-field doses and associated potential risks.     

Neutrons from fragmentation of light nuclei in tissue-like media: a study with the GEANT4 toolkit

We study energy deposition by light nuclei in tissue-like media taking into account nuclear fragmentation reactions, in particular, production of secondary neutrons. The calculations are carried out within a Monte Carlo model for heavy-ion therapy (MCHIT) based on the GEANT4 toolkit. Experimental data on depth-dose distributions for 135-400 A MeV (12)C and (18)O beams are described very well without any adjustment of the model parameters. This gives confidence in successful use of the GEANT4 toolkit for MC simulations of cancer therapy with beams of light nuclei. The energy deposition due to secondary neutrons produced by (12)C and (20)Ne beams in a (40-50 cm)(3) water phantom is estimated to be 1-2% of the total dose, that is only slightly above the neutron contribution (approximately 1%) induced by a 200 MeV proton beam.     

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.     

Shielding design for a laser-accelerated proton therapy system

In this paper, we present the shielding analysis to determine the necessary neutron and photon shielding for a laser-accelerated proton therapy system. 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. A special particle selection and collimation device is needed to generate desired proton beams for energy- and intensity-modulated proton therapy. A great number of unwanted protons and even more electrons as a side-product of laser acceleration have to be stopped by collimation devices and shielding walls, posing a challenge in radiation shielding. Parameters of primary particles resulting from the laser-target interaction have been investigated by particle-in-cell simulations, which predicted energy spectra with 300 MeV maximum energy for protons and 270 MeV for electrons at a laser intensity of 2 x 10(21) W cm(-2). Monte Carlo simulations using FLUKA have been performed to design the collimators and shielding walls inside the treatment gantry, which consist of stainless steel, tungsten, polyethylene and lead. A composite primary collimator was designed to effectively reduce high-energy neutron production since their highly penetrating nature makes shielding very difficult. The necessary shielding for the treatment gantry was carefully studied to meet the criteria of head leakage <0.1% of therapeutic absorbed dose. A layer of polyethylene enclosing the whole particle selection and collimation device was used to shield neutrons and an outer layer of lead was used to reduce photon dose from neutron capture and electron bremsstrahlung. It is shown that the two-layer shielding design with 10-12 cm thick polyethylene and 4 cm thick lead can effectively absorb the unwanted particles to meet the shielding requirements.     

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

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

Monte Carlo simulations of dose near a nonradioactive gold seed

The relative doses and hot/cold spot positions around a non-radioactive gold seed, irradiated by a 6 or 18 MV photon beam in water, were calculated using Monte Carlo simulation. Phase space files of 6 and 18 MV photon beams with a field size of 1 x 1 cm2 were generated by a Varian 21 EX linear accelerator using the EGSnrc and BEAMnrc code. The seed (1.2 x 1.2 x 3.2 mm3) was positioned at the isocenter in a water phantom (20 x 20 x 20 cm2) with source-to-axis distance = 100 cm. For the single beam geometry, the relative doses (normalized to the dose at 5 mm distance above the isocenter) at the upstream seed surface were calculated to be 1.64 and 1.56 for the 6 and 18 MV beams respectively when the central beam axis (CAX) is parallel to the width of the seed. These doses were slightly higher than those (1.58 and 1.52 for 6 and 18 MV beams respectively) calculated when the CAX is perpendicular to the width of the seed. Compared to the relative dose profiles with the same beam geometry without the seed in the water phantom, the presence of the seed affects the dose distribution at about 3 mm distance beyond both the upstream and downstream seed surface. For a pair of opposing beams with equal and unequal beam weight, the hot and cold spots of both opposing beams were mixed. For a 360 degree photon arc around the longitudinal axis of the seed, the relative dose profile along the width of the seed was similar to that of the opposing beam pair, except the former geometry has a larger dose gradient near the seed surface. In this study, selected results from our simulation were compared to previous measurements using film dosimetry.     

Characterizing a pulse-resolved dosimetry system for complex radiotherapy beams using organic scintillators

A fast-readout dosimetry system based on fibre-coupled organic scintillators has been developed for the purpose of conducting point measurements of absorbed dose in radiotherapy beams involving high spatial and temporal dose gradients. The system measures the dose for each linac radiation pulse with millimetre spatial resolution. To demonstrate the applicability of the system in complex radiotherapy fields, output factors and per cent depth dose measurements were performed in solid water for a 6 MV photon beam and compared with Monte Carlo simulated doses for square fields down to 0.6 cm × 0.6 cm size. No significant differences between measurements and simulations were observed. The temporal resolution of the system was demonstrated by measuring dose per pulse, beam start-up transients and the quality factor for 6 MV. The precision of dose per pulse measurements was within 2.7% (1 SD) for a 10 cm × 10 cm field at 10 cm depth. The dose per pulse behaviour compared well with linac target current measurements and accumulated dose measurements, and the system was able to resolve transient dose delivery differences between two Varian linac builds. The system therefore shows promise for reference dosimetry and quality assurance of complex radiotherapy treatments.