Dosimetric properties of photon beams from a flattening filter free clinical accelerator

Basic dosimetric properties of 6 MV and 18 MV photon beams from a Varian Clinac 21EX accelerator operating without the flattening filter have been measured. These include dose rate data, depth dose dependencies and lateral profiles in a water phantom, total scatter factors and transmission factors of a multileaf collimator. The data are reviewed and compared with measurements for the flattened beams. The unflattened beams have the following: a higher dose rate by factors of 2.3 (6 MV) and 5.5 (18 MV) on the central axis; lower out-of-field dose due to reduced head scatter and softer spectra; less variation of the total scatter factor with field size; and less variation of the shape of lateral dose profiles with depth. The findings suggest that with a flattening filter free accelerator better radiation treatments can be developed, with shorter delivery times and lower doses to normal tissues and organs.     

The nth root percent depth dose method for calculating monitor units for irregularly shaped electron fields

This study outlines an improved method for calculating dose per monitor unit values for irregularly shaped electron fields using the nth root percent depth dose method. This method calculates the percent depth dose and output factors for an irregularly shaped electron field directly from the measured electron beam percent depth dose curves and output factors for circular fields. The percent depth dose curves and output factors for circular fields are normalized and measured at a fixed depth of maximum dose for a reference field, respectively. When compared with the sector integral lateral buildup ratio method, the percent depth dose data calculated using the nth root method accounts more accurately for the change in lateral scatter with decreasing field size. Therefore, it provides more accurate values of dose per monitor unit at different depths for all type of field shapes and beam energies. For beam energies in the range of 6-21 MeV, the differences between measured and calculated dose per monitor unit values, at different depths, were found to be within +/- 1.0% when the nth root percent depth dose method was used for calculation and 12.6% when the sector integral lateral buildup ratio method was used. The nth root percent depth dose method was tested and compared with the sector integral lateral buildup ratio method for ten clinically used irregularly shaped inserts (cutouts). For small irregularly shaped fields, a maximum difference of 2% was found between calculated dose per monitor unit values and measurements when the nth root percent depth dose method was used; this difference changed to 7% when comparisons were made between measurements and calculations based on the sector integral lateral buildup ration method. For large irregular fields this difference was found to be within 1.5% and 3.5%, respectively.     

Characteristics of an MM 22 medical microtron 6-MV photon beam

Instrument AB Scanditronix offers a 6-MV therapeutic photon beam as an option with the 22-MeV medical microtron (MM 22). The method of acceleration, target assembly, and use of two flattening filters produce beams having several characteristics (e.g., field flatness, penetration, and intensity) that are superior to many 6-MV Linac beams. Characteristics of the microtron's 6-MV photon beams including quality, surface dose, depth of maximum dose, peak dose rates, peak scatter factors, central axis percentage depth doses, tissue maximum ratios, and beam profiles are described.     

Characteristics of an 18 MV photon beam from a Therac 20 Medical Linear Accelerator

The 18 MV photon beam characteristics of a Therac 20 Medical Linear Accelerator manufactured by Atomic Energy of Canada Ltd, are presented. Tissue phantom ratios (TRP's) and percent depth dose data are given; for a 10 x 10 cm field, the percent depth dose at a depth of 10 cm is 78.5 (SSD 100 cm). The relative dose factors (RDF'S) are given and are analyzed to elucidate the relative contributions from phantom scatter, collimator scatter, and backscatter from the top of the collimators into the monitor chambers. The effect of field size and depth on the penumbra is described. Crossplots of the beam at a depth of 5 cm indicate that the flattening filter could be improved; there are hot spots of 108% near the corners of 40 x 40 fields.     

The influence of phantom size on output, peak scatter factor, and percentage depth dose in large-field photon irradiation

Machine outputs, peak scatter factors, and central axis percentage depth dose distributions were measured for various phantom sizes in large radiation fields produced at extended distances by cobalt, 6-MV, and 10-MV photon beams. The results can be applied to practical total body irradiation procedures which usually involve treatment volumes smaller than the actual field sizes in order to provide a uniform total body exposure to radiation. Our study addresses the question of the appropriate phantom dimension to be used in the calibration of photon beams employed in total body irradiations. The measurements show that the machine outputs are only slightly dependent on phantom size; the percentage depth dose distributions, however, are strongly dependent on the phantom size, suggesting that machine data for total body irradiations should be measured in phantoms whose dimensions approximate the patient during the total body irradiation. Peak scatter factors measured in large-field/small-phantom configurations link up well with the published small-field/large-phantom data. The finite patient thickness lowers the dose to points close to the beam exit surface by a few percent, when compared to dose measured at the same depths in infinitely thick phantoms. The surface doses in large radiation fields are essentially independent of phantom cross sections and range from 40% for the 10-MV beam, to 65% for the 6-MV beam and 80% for the cobalt beam.     

半导体和电离室探头在直线加速器数据测量中的比较与分析

目的：比较分析半导体探头和电离室探头在三维水箱测量中的差异，为能够提高数据测量精度从而实现治疗计划系统建立准确的计算模型提供依据：方法：在加速器8MV光子线下，使用0．13cm^3的指形电离室和半导体探头在三维水箱中分别测量照射野1cm×lcm，2cm×2cm，3cm×3cm，4cm×4cm，5cm×5cm，6cm×6cm，8cm×8cm，10cm×l0cm的总散射因子、百分深度剂量曲线、离轴比曲线，对测量结果进行比较和分析；结果：对于总散射因子，在较大照射野测量时结果一致，在小野测量时存在差异，1cm×lcm照射野的两者测量结果偏差15．32％；对于百分深度曲线，在建成区差异最大，各照射野的在水面处的测量结果均偏差10％以上：对于离轴比曲线，在半影区存在显著差异．半导体探头在最大剂量点深度测量的射野大小均小明显小于电离室测量的结果。结论：总散射因子，小照射野测量时建议使用半导体探头或者较小体积的电离室；百分深度剂量曲线，建议使用电离室探头；离轴比曲线，使用半导体探头可测量到较好的射野半影区。     

Monte Carlo study of photon fields from a flattening filter-free clinical accelerator

In conventional clinical linear accelerators, the flattening filter scatters and absorbs a large fraction of primary photons. Increasing the beam-on time, which also increases the out-of-field exposure to patients, compensates for the reduction in photon fluence. In recent years, intensity modulated radiation therapy has been introduced, yielding better dose distributions than conventional three-dimensional conformal therapy. The drawback of this method is the further increase in beam-on time. An accelerator with the flattening filter removed, which would increase photon fluence greatly, could deliver considerably higher dose rates. The objective of the present study is to investigate the dosimetric properties of 6 and 18 MV photon beams from an accelerator without a flattening filter. The dosimetric data were generated using the Monte Carlo programs BEAMnrc and DOSXYZnrc. The accelerator model was based on the Varian Clinac 2100 design. We compared depth doses, dose rates, lateral profiles, doses outside collimation, total and collimator scatter factors for an accelerator with and without a flatteneing filter. The study showed that removing the filter increased the dose rate on the central axis by a factor of 2.31 (6 MV) and 5.45 (18 MV) at a given target current. Because the flattening filter is a major source of head scatter photons, its removal from the beam line could reduce the out-of-field dose.     

A Monte Carlo study of radiation transport through multileaf collimators.

Due to the significant increase in the number of monitor units used to deliver a dynamic IMRT treatment, the total MLC leakage (transmission plus scatter) can exceed 10% of the maximum in-field dose. To avoid dosimetric errors, this leakage must be accurately accounted for in the dose calculation and conversion of optimized intensity patterns to MLC trajectories used for treatment delivery. In this study, we characterized the leaf end transmission and leakage radiation for Varian 80- and 120-leaf MLCs using Monte Carlo simulations. The complex geometry of the MLC, including the rounded leaf end, leaf edges (tongue-and-groove and offset notch), mounting slots, and holes was modeled using MCNP4b. Studies were undertaken to determine the leakage as a function of field size, components of the leakage, electron contamination, beam hardening and leaf tip effects. The leakage radiation with the MLC configured to fully block the field was determined. Dose for 6 and 18 MV beams was calculated at 5 cm depth in a water phantom located at 95 cm SSD, and normalized to the dose for an open field. Dose components were scored separately for radiation transmitted through and scattered from the MLC. For the 80-leaf MLC at 6 MV, the average leakage dose is 1.6%, 1.7%, 1.8%, and 1.9% for 5 x 5, 10 x 10, 15 x 15, and 20 x 20cm2 fields, respectively. For the 120-leaf MLC at 6 MV, the average leakage dose is 1.6%, 1.6%, 1.7%, and 1.9% for the same field sizes. Measured leakage values for the 120-leaf MLC agreed with calculated values to within 0.1% of the open field dose. The increased leakage with field size is attributed to MLC scattered radiation. The fractional electron contamination for a blocked MLC field is greater than that for an open field. The MLC attenuation significantly affects the photon spectrum, resulting in an increase in percent depth dose at 6 MV, however, little effect is observed at 18 MV. Both phantom scatter and the finite source size contribute to the leaf tip profile observed in phantom. The results of this paper can be applied to fluence-to-trajectory and trajectory-to-fluence calculations for IMRT.     

An analysis of equivalent fields for electron beam central-axis dose calculations.

The concepts of the equivalent square or circular field have long been used in dose calculations for photon beams. These concepts allow data measured for square or circular fields to be extended to calculate, for example, the percentage depth doses or output factors of rectangular or irregular fields. It has been pointed out in the past that an electron beam equivalent field dimension varies with depth and, thus, will have questionable utility. As the equivalent square and circle have proven to be useful in photon beam dose calculations, the work described in this paper has sought to analyze conditions under which equivalent fields may be useful for electron beam dose calculations. Equivalent square field dimensions and circular field radii are derived using the Fermi-Eyges theory and are compared to a number of approximate equivalent fields that have been applied to electron dose calculations. Calculations are also compared with measurements presented in the literature. It is shown that the accuracy of an electron dose calculation using these approximate equivalent fields diminishes with a decreasing degree of lateral scatter equilibrium at the central axis and only becomes accurate once equilibrium is established. As the central-axis dose under this latter condition is in any event independent of field shape or size, the equivalent field approach becomes unnecessary. Because of this and other restrictions discussed, it is concluded that the equivalent fields analyzed here should not be used for electron beam dose calculations.     

Measurements of dose distributions in small beams of 6 MV x-rays

Dose distributions produced by small circular beams of 6 MV x-rays have been measured using ionisation chambers of small active volume. Specific quantities measured include tissue maximum ratios (TMR), total scatter correction factors (St), collimator scatter correction factors (Sc) and off-axis ratios (OAR). Field sizes ranged from 12.5 to 30 mm diameter, and were defined by machined auxiliary collimators with the movable jaws set for a 4 cm x 4 cm field size. Due to the lack of complete lateral electronic equilibrium for these small fields, the accuracy of the measurements was also investigated. This was accomplished by studying dose response as a function of detector size. Uncertainties of 2.5% were observed for the central axis dose in the 12.5 mm field when measuring with an ionisation chamber with a diameter of 3.5 mm. The total scatter correction factor exhibits a strong field size dependence for fields below 20 mm diameter, while the collimator scatter correction factor is constant and is defined by the setting of the movable jaws. Off-axis ratio measurements show larger dose gradients at the beam edges than those achieved with conventional collimator systems. Corrected profiles measured with an ionisation chamber are compared with measurements made with photographic film and LiF thermoluminescent dosemeters.     

On empirical methods to determine scatter factors for irregular MLC shaped beams

Multileaf collimators (MLCs) are in clinical use for more than a decade and are a well accepted tool in radiotherapy. For almost each MLC design different empirical or semianalytical methods have been presented for calculating output ratios in air for irregularly shaped beams. However, until now no clear recommendations have been given on how to handle irregular fields shaped by multileaf collimators for independent monitor unit (MU) verification. The present article compares different empirical methods, which have been proposed for independent MU verification, to determine (1) output ratios in air (Sc) and (2) phantom scatter factors (Sp) for irregular MLC shaped fields. Ten dedicated field shapes were applied to five different types of MLCs (Elekta, Siemens, Varian, Scanditronix, General Electric). All calculations based on empirical relations were compared with measurements and with calculations performed by a treatment planning system with a fluence based algorithm. For most irregular MLC shaped beams output ratios in air could be adequately modeled with an accuracy of about 1%-1.5% applying a method based on the open field aperture defined by the leaf and jaw setting combined with the equivalent square formula suggested by Vadash and Bj?rngard [P. Vadash and B. E. Bj?rngard, Med. Phys. 20, 733-734 (1993)]. The accuracy of this approach strongly depends on the inherent head scatter characteristics of the accelerator in use and on the irregular field under consideration. Deviations of up to 3% were obtained for fields where leaves obscure central parts of the flattening filter. Simple equivalent square methods for Sp calculations in irregular fields did not provide acceptable results (deviations mostly >3%). Sp values derived from Clarkson integration, based on published tables of phantom scatter correction factors, showed the same accuracy level as calculations performed using a pencil beam algorithm of a treatment planning system (in a homogeneous media). The separation of head scatter and phantom scatter contributions is strongly recommended for irregular MLC shaped beams as both contributions have different factors of influence. With rather simple methods Sc and Sp can be determined for independent MU calculation with an accuracy better than 1.5% for most clinical situations encountered in conformal radiotherapy.     

Monte Carlo calculations of scatter to primary ratios for normalisation of primary and scatter dose

The separation of total absorbed dose into primary and scatter components is a commonly used technique in photon dose calculations. The primary dose component can be characterised by a measured narrow beam attenuation coefficient and a single normalisation value which establishes the relative proportion of the primary to the total dose at some reference depth and field size. The determination of this normalisation value from measured data requires an extrapolation of measured values for finite field sizes to obtain a zero field size value. We have used Monte Carlo simulations to score primary and scatter dose for photon beams of 4, 6, 10, 15 and 24 MV and report values of the scatter to primary ratio at the depth of dose maximum for the circular equivalent of a 10 cm x 10 cm field. These values have an uncertainty of less than 1% and can be used in lieu of extrapolation of measured data to establish the relative magnitude of the primary dose for a wide range of photon beam energies.     

Dose uncertainties in photon pencil kernel calculations at off-axis positions

The purpose of this study was to investigate the specific problems associated with photon dose calculations in points located at a distance from the central beam axis. These problems are related to laterally inhomogeneous energy fluence distributions and spectral variations causing a lateral shift in the beam quality, commonly referred to as off-axis softening (OAS). We have examined how the dose calculation accuracy is affected when enabling and disabling explicit modeling of these two effects. The calculations were performed using a pencil kernel dose calculation algorithm that facilitates modeling of OAS through laterally varying kernel properties. Together with a multi-source model that provides the lateral energy fluence distribution this generates the total dose output, i.e., the dose per monitor unit, at an arbitrary point of interest. The dose calculation accuracy was evaluated through comparisons with 264 measured output factors acquired at 5, 10, and 20 cm depth in four different megavoltage photon beams. The measurements were performed up to 18 cm from the central beam axis, inside square fields of varying size and position. The results show that calculations including explicit modeling of OAS were considerably more accurate, up to 4%, than those ignoring the lateral beam quality shift. The deviations caused by simplified head scatter modeling were smaller, but near the field edges additional errors close to 1% occurred. When enabling full physics modeling in the dose calculations the deviations display a mean value of -0.1%, a standard deviation of 0.7%, and a maximum deviation of -2.2%. Finally, the results were analyzed in order to quantify and model the inherent uncertainties that are present when leaving the central beam axis. The off-axis uncertainty component showed to increase with both off-axis distance and depth, reaching 1% (1 standard deviation) at 20 cm depth.     

Analytical calculation of central-axis dosimetric data for a dedicated 6-MV radiosurgery linear accelerator

Narrow beams are extensively used in stereotactic radiosurgery. The accuracy of treatment planning dose calculation depends largely on how well the dosimetric data are measured during the machine commissioning. Narrow beams are characterized by the lack of lateral electronic equilibrium. The lateral electronic disequilibrium in the radiation field and detector's finite size are likely to compromise the accuracy in dose measurements in these beams. This may have a profound impact on outcome in patients who undergo stereotactic radiosurgery. To confirm the measured commissioning data for a dedicated 6-MV linear accelerator-based radiosurgery system, we developed an analytical model to calculate the narrow photon beam central-axis dose. This model is an extension of a previously reported method of Nizin and Mooij for the calculation of the absorbed dose under lateral electronic disequilibrium conditions at depth of dmax or greater. The scatter factor and tissue-maximum ratio were calculated for narrow beams using the parametrized model and compared to carefully measured results for the same beams. For narrow beam radii ranging from 0.2 to 1.5 cm, the differences between the analytical and measured scatter factors were no greater than 1.4%. In addition, the differences between the analytical and measured tissue-maximum ratios were within 3.3% for regions greater than the maximum dose depth. The estimated error of this analytical calculation was less than 2%, which is sufficient to validate measurement results.     

A modified method of calculating the lateral build-up ratio for small electron fields

This note outlines an improved method of calculating dose per monitor unit values for small electron fields using Khan's lateral build-up ratio (LBR). This modified method obtains the LBR directly from the ratio of measured, surface normalized, electron beam percentage depth dose curves. The LBR calculated using this modified method more accurately accounts for the change in lateral scatter with decreasing field size. The LBR is used along with Khan's dose per monitor unit formula to calculate dose per monitor unit values for a set of small fields. These calculated dose per monitor unit values are compared to measured values to within 3.5% for all circular fields and electron energies examined. The modified method was further tested using a small triangular field. A maximum difference of 4.8% was found.     

Computer dosimetry for flattened and wedged fast-neutron beams.

Beam flattening by the use of polyethylene filters has been developed for the 50-MeV d in equilibrium Be fast-neutron therapy beam at the Texas A&M Variable-Energy Cyclotron (TAMVEC) as a result of the need for a more uniform dose distribution at depth within the patient. A computer algorithm has been developed that allows the use of a modified decrement line method to calculate dose distributions; standards decrement line methods do not apply because of off-axis peaking. The dose distributions for measured flattened beams are transformed into distributions that are physically equivalent to an unflattened distribution. In the transformed space, standard decrement line theory yields a distribution for any field size which, by applying the inverse transformation, generates the flattened dose distribution, including the off-axis peaking. A semiempirical model has been constructed that allows the calculation of dose distributions for wedged beams from open-beam data.     

A new approach in dose measurement and error analysis for narrow photon beams (beamlets) shaped by different multileaf collimators using a small detector

Dose measurement for narrow stereotactic beams and intensity modulation radiotherapy beamlets is difficult and error-prone due to the lack of lateral electron equilibrium. A small detector position error and finite sensitive volume as well as the nonfocus collimation could result in considerable (> 10%) measurement errors. A new method is introduced here to measure the dose and error components so that the accuracy and precision of the dose measurement can be improved. Based on superposition principle, we can create exactly the small field of interest by subtraction of a reference open field (O-field) and two strip fields (S-fields) from the sum of four quadrant fields (Q-fields). The position effect on the dose measurement is determined by the standard deviation of the four Q-field readings. The collimator leaf-edge effect (LEE) is quantified by the difference between the readings of the two S-fields using a detector that has very small sensitive volume. The detector-volume effect can be analytically estimated from the integrals of the dose distributions of the two S-fields over the detector volume. Using a pinpoint ion chamber (PTW N31006) and a stereotactic silicon diode detector (Scanditronix, DEB050), we have measured scatter factors (SF) and tissue-maximum ratios for 6-MV x-ray fields with sizes of 3 x 3 and 6 x 6 mm2 shaped by a BrainLAB micromultileaf collimator (microMLC) (M3), 4.4 x 4.4 and 8.8 x 8.8 mm2 shaped by a 3DLine double-focus MLC, and 5 x 5 and 10 x 10 mm2 by a Varian Millennium MLC. Our experimental results demonstrate that the large errors are often caused by a small setup error or measuring point displacement from the central ray of the beam. The LEE is almost independent of the depth but closely related to the field size and the type of MLC. The volume effect becomes significant when the detector diameter is comparable to the half size of the small fields. Application of the new method using different detectors had achieved less than 8.3% total experiment error for all of the small fields of interest except for the SF of the 3 x 3 mm2 field from the pinpoint ion chamber that has 15% volume effect. Importantly, the new method using a solid water phantom is clinically convenient and highly reproducible.     

Internal scatter, the unavoidable major component of the peripheral dose in photon-beam radiotherapy

In clinical photon beams, the dose outside the geometrical field limits is produced by photons originating from (i) head leakage, (ii) scattering at the beam collimators and the flattening filter (head scatter) and (iii) scattering from the directly irradiated region of the patient or phantom (internal scatter). While the first two components can be modified, e.g. by reinforcement of shielding components or by re-modeling the filter system, internal scatter remains an unavoidable contributor to the peripheral dose. Its relative magnitude compared to the other components, its numerical variation with beam energy, field size and off-axis distance as well as its spectral distribution are evaluated in this study. We applied a detailed Monte Carlo (MC) model of our 6/15 MV Siemens Primus linear accelerator beam head, provided with ideal head leakage shielding conditions (multi-leaf collimator without gaps) to assess the head scatter contribution. Experimental values obtained under real shielding conditions were used to evaluate the head leakage contribution. It was found that the MC-computed internal scatter doses agree with the results of our previous measurements, that internal scatter is the major contributor to the peripheral dose in the near periphery while head leakage prevails in the far periphery, and that the lateral decline of the internal scatter dose can be represented by the sum of two exponentials, with an asymptotic tenth value of 18 to 19 cm. Internal scatter peripheral doses from various elementary beams are additive, so that their sum increases approximately in proportion with field size. The ratio between normalized internal scatter doses at 6 and 15 MV is approximately 2:1. The energy fluence spectra of the internal scatter component at all points of interest outside the field have peaks near 500 keV. The fact that the energy-shifted internal scatter constitutes the major contributor to the dose in the near periphery has a general bearing for dosimetry, i.e. for energy-dependent detector responses and dose conversion factors, for the relative biological effectiveness and for second primary malignancy risk estimates in the peripheral region.     

An investigation of accelerator head scatter and output factor in air

Our purpose in this study was to investigate whether the Monte Carlo simulation can accurately predict output factors in air. Secondary goals were to study the head scatter components and investigate the collimator exchange effect. The Monte Carlo code, BEAMnrc, was used in the study. Photon beams of 6 and 18 MV were from a Varian Clinac 2100EX accelerator and the measurements were performed using an ionization chamber in a mini-phantom. The Monte Carlo calculated in air output factors was within 1% of measured values. The simulation provided information of the origin and the magnitude of the collimator exchange effect. It was shown that the collimator backscatter to the beam monitor chamber played a significant role in the beam output factors. However the magnitude of the scattered dose contributions from the collimator at the isocenter is negligible. The maximum scattered dose contribution from the collimators was about 0.15% and 0.4% of the total dose at the isocenter for a 6 and 18 MV beam, respectively. The scattered dose contributions from the flattening filter at the isocenter were about 0.9-3% and 0.2-6% of the total dose for field sizes of 4x4 cm2-40x40 cm2 for the 6 and 18 MV beam, respectively. The study suggests that measurements of head scatter factors be done at large depth well beyond the depth of electron contamination. The insight information may have some implications for developing generalized empirical models to calculate the head scatter.