Rapid Switching of a C-Series Linear Accelerator Between Conventional and Ultrahigh-Dose-Rate Research Mode With Beamline Modifications and Output Stabilization

PURPOSE

In this study, a C-series linear accelerator was configured to enable rapid and reliable conversion between the production of conventional electron beams and an ultrahigh-dose-rate (UHDR) electron beamline to the treatment room isocenter for FLASH radiation therapy. Efforts to tune the beam resulted in a consistent, stable UHDR beamline.

METHODS AND MATERIALS

The linear accelerator was configured to allow for efficient switching between conventional and modified electron output modes within 2 minutes. Additions to the air system allow for retraction of the x-ray target from the beamline when the 10 MV photon mode is selected. With the carousel set to an empty port, this grants access to the higher current pristine electron beam normally used to produce clinical photon fields. Monitoring signals related to the automatic frequency control system allows for tuning of the waveguide while the machine is in a hold state so a stable beam is produced from the initial pulse. A pulse counting system implemented on an field-programmable gate array-based controller platform controls the delivery to a desired number of pulses. Beam profiles were measured with Gafchromic film. Pulse-by-pulse dosimetry was measured using a custom electrometer designed around the EDGE diode.

RESULTS

This method reliably produces a stable UHDR electron beam. Open-field measurements of the 16-cm full-width, half-maximum gaussian beam saw average dose rates of 432 Gy/s at treatment isocenter. Pulse overshoots were limited and ramp up was eliminated. Over the last year, there have been no recorded incidents that resulted in machine downtime due to the UHDR conversions.

CONCLUSIONS

Stable 10 MeV UHDR beams were generated to produce an average dose rate of 432 Gy/s at the treatment room isocenter. With a reliable pulse-counting beam control system, consistent doses can be delivered for FLASH experiments with the ability to accommodate a wide range of field sizes, source-to-surface distances, and other experimental apparatus that may be relevant for future clinical translation.

CERN-based experiments and Monte-Carlo studies on focused dose delivery with very high energy electron (VHEE) beams for radiotherapy applications

Very High Energy Electron (VHEE) beams are a promising alternative to conventional radiotherapy due to their highly penetrating nature and their applicability as a modality for FLASH (ultra-high dose-rate) radiotherapy. The dose distributions due to VHEE need to be optimised; one option is through the use of quadrupole magnets to focus the beam, reducing the dose to healthy tissue and allowing for targeted dose delivery at conventional or FLASH dose-rates. This paper presents an in depth exploration of the focusing achievable at the current CLEAR (CERN Linear Electron Accelerator for Research) facility, for beam energies >200 MeV. A shorter, more optimal quadrupole setup was also investigated using the TOPAS code in Monte Carlo simulations, with dimensions and beam parameters more appropriate to a clinical situation. This work provides insight into how a focused VHEE radiotherapy beam delivery system might be achieved.

ÖGRO survey on radiotherapy capacity in Austria : Status quo and estimation of future demands

BACKGROUND

A comprehensive evaluation of the current national and regional radiotherapy capacity in Austria with an estimation of demands for 2020 and 2030 was performed by the Austrian Society for Radiation Oncology, Radiobiology and Medical Radiophysics (ÖGRO).

MATERIALS AND METHODS

All Austrian centers provided data on the number of megavoltage (MV) units, treatment series, fractions, percentage of retreatments and complex treatment techniques as well as the daily operating hours for the year 2014. In addition, waiting times until the beginning of radiotherapy were prospectively recorded over the first quarter of 2015. National and international epidemiological prediction data were used to estimate future demands.

RESULTS

For a population of 8.51 million, 43 MV units were at disposal. In 14 radiooncological centers, a total of 19,940 series with a mean number of 464 patients per MV unit/year and a mean fraction number of 20 (range 16-24) per case were recorded. The average re-irradiation ratio was 14%. The survey on waiting times until start of treatment showed provision shortages in 40% of centers with a mean waiting time of 13.6 days (range 0.5-29.3 days) and a mean maximum waiting time of 98.2 days. Of all centers, 21% had no or only a limited ability to deliver complex treatment techniques. Predictions for 2020 and 2030 indicate an increased need in the overall number of MV units to a total of 63 and 71, respectively.

CONCLUSION

This ÖGRO survey revealed major regional differences in radiooncological capacity. Considering epidemiological developments, an aggravation of the situation can be expected shortly. This analysis serves as a basis for improved public regional health care planning.

Shielding Design for Adjacent, Underground Buildings of a Megavoltage Radiotherapy Facility

In a radiotherapy facility, safety in areas next to the treatment room can be of concern when irradiating downward due to oblique x-ray transmission through the floor and/or walls, especially in areas immediately adjacent or underground. Even when there is no basement underneath, a usual conservative solution is to build a thick concrete slab as the base for the treatment room. Of course, this implies deeper soil excavation and higher associated costs. As a convenient alternative, the limiting walls can be buried a certain depth below floor level to shield oblique, downward irradiation. Besides, for space considerations, laminated barriers are usually employed, and some additional shielding to the floor may be required (L-shaped barriers). In this work, the author introduces an analytical method for calculating the required wall penetration below floor level or, alternatively, the additional floor shielding for L-shaped barriers, taking into account in either case the attenuation properties of the earth underneath the vault. Interestingly, the required penetration depth for a given wall barrier (primary or secondary), relative to a reference thickness, is only a function of basic attenuation data. Likewise, for a laminated, lead-concrete barrier, the required dimensions depend on the relative amount of lead used for the wall and on the corresponding attenuation data. The shielding design criteria developed in this work to protect underground nearby sites is conservative in nature, yet it yields optimal shield dimensions for wall footing and for wall-floor shielding, avoiding the need to construct oversized concrete slab floors.

Optimization of Physical Dose Distributions with Hadron Beams: Comparing Photon IMRT with IMPT

Intensity modulated radiotherapy with high enengy photons (IMRT) and with charged particles (IMPT) refer to the most advanced development in conformal radiation therapy. Their general aim is to increase local tumor control rates while keeping the radiation induced complications below desired thresholds. IMRT is currently widely introduced in clinical practice. However, the more complicated IMPT is still under development. Especially, spot-scanning techniques integrated in rotating gantries that can deliver proton or light ion-beams to a radiation target from any direction will be available in the near future.

We describe the basic concepts of intensity modulated particle therapy (IMPT). Starting from the potential advantages of hadron therapy inverse treatment planning strategies are discussed for various dose delivery techniques of IMPT. Of special interest are the techniques of distal edge tracking (DET) and 3D-scanning. After the introduction of these concepts a study of comparative inverse treatment planning is presented. The study aims to identify the potential advantages of achievable physical dose distributions with proton and carbon beams, if different dose delivery techniques are employed. Moreover, a comparison to standard photon IMRT is performed.

The results of the study are summarized as: i) IMRT with photon beams is a strong competitor to intensity modulated radiotherapy with charged particles. The most obvious benefit observed for charged particles is the reduction of medium and low doses in organs at risk. ii) The 3D-scanning technique could not improve the dosimetric results achieved with DET, although 10–15 times more beam spots were employed for 3D-scanning than for DET. However, concerns may arise about the application of DET, if positioning errors of the patient or organ movements have to be accounted for. iii) Replacing protons with carbon ions leads to further improvements of the physical dose distributions. However, the additional degree of improvement due to carbon ions is modest. The main clinical potential of heavy ion beams is probably related to their radiobiological properties.

Experimental assessment of out-of-field dose components in high energy electron beams used in external beam radiotherapy

The purpose of this work was to experimentally investigate the out-of-field dose in a water phantom, with several high energy electron beams used in external beam radiotherapy (RT). The study was carried out for 6, 9, 12, and 18 MeV electron beams, on three different linear accelerators, each equipped with a specific applicator. Measurements were performed in a water phantom, at different depths, for different applicator sizes, and off-axis distances up to 70 cm from beam central axis (CAX). Thermoluminescent powder dosimeters (TLD-700) were used. For given cases, TLD measurements were compared to EBT3 films and parallel-plane ionization chamber measurements. Also, out-of-field doses at 10 cm depth, with and without applicator, were evaluated. With the Siemens applicators, a peak dose appears at about 12-15 cm out of the field edge, at 1 cm depth, for all field sizes and energies. For the Siemens Primus, with a 10 × 10 cm(²) applicator, this peak reaches 2.3%, 1%, 0.9% and 1.3% of the maximum central axis dose (Dmax) for 6, 9, 12 and 18 MeV electron beams, respectively. For the Siemens Oncor, with a 10 × 10 cm(²) applicator, this peak dose reaches 0.8%, 1%, 1.4%, and 1.6% of Dmax for 6, 9, 12, and 14 MeV, respectively, and these values increase with applicator size. For the Varian 2300C/D, the doses at 12.5 cm out of the field edge are 0.3%, 0.6%, 0.5%, and 1.1% of Dmax for 6, 9, 12, and 18 MeV, respectively, and increase with applicator size. No peak dose is evidenced for the Varian applicator for these energies. In summary, the out-of-field dose from electron beams increases with the beam energy and the applicator size, and decreases with the distance from the beam central axis and the depth in water. It also considerably depends on the applicator types. Our results can be of interest for the dose estimations delivered in healthy tissues outside the treatment field for the RT patient, as well as in studies exploring RT long-term effects.

Evaluation of equivalent dose from neutrons and activation products from a 15-MV X-ray LINAC

A high-energy photon beam that is more than 10 MV can produce neutron contamination. Neutrons are generated by the [γ,n] reactions with a high-Z target material. The equivalent neutron dose and gamma dose from activation products have been estimated in a LINAC equipped with a 15-MV photon beam. A Monte Carlo simulation code was employed for neutron and photon dosimetry due to mixed beam. The neutron dose was also experimentally measured using the Optically Stimulated Luminescence (OSL) under various conditions to compare with the simulation. The activation products were measured by gamma spectrometer system. The average neutron energy was calculated to be 0.25 MeV. The equivalent neutron dose at the isocenter obtained from OSL measurement and MC calculation was 5.39 and 3.44 mSv/Gy, respectively. A gamma dose rate of 4.14 µSv/h was observed as a result of activations by neutron inside the treatment machine. The gamma spectrum analysis showed (28)Al, (24)Na, (54)Mn and (60)Co. The results confirm that neutrons and gamma rays are generated, and gamma rays remain inside the treatment room after the termination of X-ray irradiation. The source of neutrons is the product of the [γ,n] reactions in the machine head, whereas gamma rays are produced from the [n,γ] reactions (i.e. neutron activation) with materials inside the treatment room. The most activated nuclide is (28)Al, which has a half life of 2.245 min. In practice, it is recommended that staff should wait for a few minutes (several (28)Al half-lives) before entering the treatment room after the treatment finishes to minimize the dose received.

Medical physics aspects of the synchrotron radiation therapies: Microbeam radiation therapy (MRT) and synchrotron stereotactic radiotherapy (SSRT)

Stereotactic Synchrotron Radiotherapy (SSRT) and Microbeam Radiation Therapy (MRT) are both novel approaches to treat brain tumor and potentially other tumors using synchrotron radiation. Although the techniques differ by their principles, SSRT and MRT share certain common aspects with the possibility of combining their advantages in the future. For MRT, the technique uses highly collimated, quasi-parallel arrays of X-ray microbeams between 50 and 600 keV. Important features of highly brilliant Synchrotron sources are a very small beam divergence and an extremely high dose rate. The minimal beam divergence allows the insertion of so called Multi Slit Collimators (MSC) to produce spatially fractionated beams of typically ∼25-75 micron-wide microplanar beams separated by wider (100-400 microns center-to-center(ctc)) spaces with a very sharp penumbra. Peak entrance doses of several hundreds of Gy are extremely well tolerated by normal tissues and at the same time provide a higher therapeutic index for various tumor models in rodents. The hypothesis of a selective radio-vulnerability of the tumor vasculature versus normal blood vessels by MRT was recently more solidified. SSRT (Synchrotron Stereotactic Radiotherapy) is based on a local drug uptake of high-Z elements in tumors followed by stereotactic irradiation with 80 keV photons to enhance the dose deposition only within the tumor. With SSRT already in its clinical trial stage at the ESRF, most medical physics problems are already solved and the implemented solutions are briefly described, while the medical physics aspects in MRT will be discussed in more detail in this paper.

Automated marker tracking using noisy X-ray images degraded by the treatment beam

This study demonstrates the feasibility of automated marker tracking for the real-time detection of intrafractional target motion using noisy kilovoltage (kV) X-ray images degraded by the megavoltage (MV) treatment beam. The authors previously introduced the in-line imaging geometry, in which the flat-panel detector (FPD) is mounted directly underneath the treatment head of the linear accelerator. They found that the 121 kVp image quality was severely compromised by the 6 MV beam passing through the FPD at the same time. Specific MV-induced artefacts present a considerable challenge for automated marker detection algorithms. For this study, the authors developed a new imaging geometry by re-positioning the FPD and the X-ray tube. This improved the contrast-to-noise-ratio between 40% and 72% at the 1.2 mAs/image exposure setting. The increase in image quality clearly facilitates the quick and stable detection of motion with the aid of a template matching algorithm. The setup was tested with an anthropomorphic lung phantom (including an artificial lung tumour). In the tumour one or three Calypso beacons were embedded to achieve better contrast during MV radiation. For a single beacon, image acquisition and automated marker detection typically took around 76 ± 6 ms. The success rate was found to be highly dependent on imaging dose and gantry angle. To eliminate possible false detections, the authors implemented a training phase prior to treatment beam irradiation and also introduced speed limits for motion between subsequent images.

Radiographic film dosimetry of proton beams for depth-dose constancy check and beam profile measurement

Radiographic film dosimetry suffers from its energy dependence in proton dosimetry. This study sought to develop a method of measuring proton beams by the film and to evaluate film response to proton beams for the constancy check of depth dose (DD). It also evaluated the film for profile measurements. To achieve this goal, from DDs measured by film and ion chamber (IC), calibration factors (ratios of dose measured by IC to film responses) as a function of depth in a phantom were obtained. These factors imply variable slopes (with proton energy and depth) of linear characteristic curves that relate film response to dose. We derived a calibration method that enables utilization of the factors for acquisition of dose from film density measured at later dates by adapting to a potentially altered processor condition. To test this model, the characteristic curve was obtained by using EDR2 film and in-phantom film dosimetry in parallel with a 149.65 MeV proton beam, using the method. An additional validation of the model was performed by concurrent film and IC measurement perpendicular to the beam at various depths. Beam profile measurements by the film were also evaluated at the center of beam modulation. In order to interpret and ascertain the film dosimetry, Monte Carlos simulation of the beam was performed, calculating the proton fluence spectrum along depths and off-axis distances. By multiplying respective stopping powers to the spectrum, doses to film and water were calculated. The ratio of film dose to water dose was evaluated. Results are as follows. The characteristic curve proved the assumed linearity. The measured DD approached that of IC, but near the end of the spread-out Bragg peak (SOBP), a spurious peak was observed due to the mismatch of distal edge between the calibration and measurement films. The width of SOBP and the proximal edge were both reproducible within a maximum of 5mm; the distal edge was reproducible within 1 mm. At 5 cm depth, the dose was reproducible within 10%. These large discrepancies were identified to have been contributed by film processor uncertainty across a layer of film and the misalignment of film edge to the frontal phantom surface. The deviations could drop from 5 to 2 mm in SOBP and from 10% to 4.5% at 5 cm depth in a well-controlled processor condition(i.e., warm up). In addition to the validation of the calibration method done by the DD measurements, the concurrent film and IC measurement independently validated the model by showing the constancy of depth-dependent calibration factors. For profile measurement, the film showed good agreement with ion chamber measurement. In agreement with the experimental findings, computationally obtained ratio of film dose to water dose assisted understanding of the trend of the film response by revealing relatively large and small variances of the response for DD and beam profile measurements, respectively. Conclusions are as follows. For proton beams, radiographic film proved to offer accurate beam profile measurements. The adaptive calibration method proposed in this study was validated. Using the method, film dosimetry could offer reasonably accurate DD constancy checks, when provided with a well-controlled processor condition. Although the processor warming up can promote a uniform processing across a single layer of the film, the processing remains as a challenge.

Comparison of the NMIJ and the ARPANSA standards for absorbed dose to water in high-energy photon beams

The authors report the results of an indirect comparison of the standards of absorbed dose to water in high-energy photon beams from a clinical linac and (60)Co radiation beam performed between the National Metrology Institute of Japan (NMIJ) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). Three ionisation chambers were calibrated by the NMIJ in April and June 2013 and by the ARPANSA in May 2013. The average ratios of the calibration coefficients for the three ionisation chambers obtained by the NMIJ to those obtained by the ARPANSA were 0.9994, 1.0040 and 1.0045 for 6-, 10- and 15-MV (18 MV at the ARPANSA) high-energy photon beams, respectively. The relative standard uncertainty of the value was 7.2 × 10(-3). The ratio for (60)Co radiation was 0.9986(66), which is consistent with the results published in the key comparison of BIPM.RI(I)-K4.

Dose reduction of scattered photons from concrete walls lined with lead: Implications for improvement in design of megavoltage radiation therapy facility mazes

PURPOSE

This study explores the possibility of using lead to cover part of the radiation therapy facility maze walls in order to absorb low energy photons and reduce the total dose at the maze entrance of radiation therapy rooms.

METHODS

Experiments and Monte Carlo simulations were utilized to establish the possibility of using high-Z materials to cover the concrete walls of the maze in order to reduce the dose of the scatteredphotons at the maze entrance. The dose of the backscatteredphotons from a concrete wall was measured for various scattering angles. The dose was also calculated by the FLUKA and EGSnrc Monte Carlo codes. The FLUKA code was also used to simulate an existing radiotherapy room to study the effect of multiple scattering when adding lead to cover the concrete walls of the maze. Monoenergetic photons were used to represent the main components of the x ray spectrum up to 10 MV.

RESULTS

It was observed that when the concrete wall was covered with just 2 mm of lead, the measured dose rate at all backscattering angles was reduced by 20% for photons of energy comparable to Co-60 emissions and 70% for Cs-137 emissions. The simulations with FLUKA and EGS showed that the reduction in the dose was potentially even higher when lead was added. One explanation for the reduction is the increased absorption of backscatteredphotons due to the photoelectric interaction in lead. The results also showed that adding 2 mm lead to the concrete walls and floor of the maze reduced the dose at the maze entrance by up to 90%.

CONCLUSIONS

This novel proposal of covering part or the entire maze walls with a few millimeters of lead would have a direct implication for the design of radiation therapy facilities and would assist in upgrading the design of some mazes, especially those in facilities with limited space where the maze length cannot be extended to sufficiently reduce the dose.

Microbeam radiation therapy: Clinical perspectives

Microbeam radiation therapy (MRT), a novel form of spatially fractionated radiotherapy (RT), uses arrays of synchrotron-generated X-ray microbeams (MB). MRT has been identified as a promising treatment concept that might be applied to patients with malignant central nervous system (CNS) tumours for whom, at the current stage of development, no satisfactory therapy is available yet. Preclinical experimental studies have shown that the CNS of healthy rodents and piglets can tolerate much higher radiation doses delivered by spatially separated MBs than those delivered by a single, uninterrupted, macroscopically wide beam. High-dose, high-precision radiotherapies such as MRT with reduced probabilities of normal tissue complications offer prospects of improved therapeutic ratios, as extensively demonstrated by results of experiments published by many international groups in the last two decades. The significance of developing MRT as a new RT approach cannot be understated. Up to 50% of cancer patients receive conventional RT, and any new treatment that provides better tumour control whilst preserving healthy tissue is likely to significantly improve patient outcomes.

Bremsstrahlung and photoneutron production in a steel shield for 15-22-MeV clinical electron beams

The physical data regarding bremsstrahlung and neutrons produced in a steel shield by high-energy electron beams from a medical linear accelerator were investigated. These data are required to allow the accurate prediction of shielding performance for high-energy electron beams and in the design of radiotherapy facilities. A Monte Carlo code was used to develop Monte Carlo beam models for clinical electron beams and to directly simulate bremsstrahlung and secondary neutron production in a steel shield. The effective dose and dose equivalent of bremsstrahlung X rays and secondary neutrons outside a vault were determined using a realistic radiation source. The accuracy of Monte Carlo simulations was validated experimentally by comparing the measured and calculated physical quantities. In validating the Monte Carlo simulation, the measured and calculated values showed reasonable agreement, indicating that bremsstrahlung and photoneutron production and transport were simulated accurately. The bremsstrahlung X-ray dose was the main component of the total dose outside a vault. The secondary neutron dose was 1-20 % of the bremsstrahlung X-ray dose, but the neutron dose was also at a non-negligible level. The calculated neutron dose outside the vault differed from the McGinley's reported data. These results indicate that McGinley's method overestimates the neutron dose beyond the steel shield. The physical data used here will be useful in the accurate estimation of bremsstrahlung X-ray and neutron doses for high-energy electron beams.

Radial dependence of lineal energy distribution of 290-MeV/u carbon and 500-MeV/u iron ion beams using a wall-less tissue-equivalent proportional counter

Using a wall-less tissue-equivalent proportional counter for a 0.72-μm site in tissue, we measured the radial dependence of the lineal energy distribution, yf(y), of 290-MeV/u carbon ions and 500-MeV/u iron ion beams. The measured yf(y) distributions and the dose-mean of y, [Formula: see text], were compared with calculations performed with the track structure simulation code TRACION and the microdosimetric function of the Particle and Heavy Ion Transport code System (PHITS). The values of the measured [Formula: see text] were consistent with calculated results within an error of 2%, but differences in the shape of yf(y) were observed for iron ion irradiation. This result indicates that further improvement of the calculation model for yf(y) distribution in PHITS is needed for the analytical function that describes energy deposition by delta rays, particularly for primary ions having linear energy transfer in excess of a few hundred keV μm(-1).

Direct megavoltage photon calibration service in Australia

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) maintains the Australian primary standard of absorbed dose. Until recently, the standard was used to calibrate ionisation chambers only in (60)Co gamma rays. These chambers are then used by radiotherapy clinics to determine linac output, using a correction factor (k Q) to take into account the different spectra of (60)Co and the linac. Over the period 2010-2013, ARPANSA adapted the primary standard to work in megavoltage linac beams, and has developed a calibration service at three photon beams (6, 10 and 18 MV) from an Elekta Synergy linac. We describe the details of the new calibration service, the method validation and the use of the new calibration factors with the International Atomic Energy Agency's TRS-398 dosimetry Code of Practice. The expected changes in absorbed dose measurements in the clinic when shifting from (60)Co to the direct calibration are determined. For a Farmer chamber (model 2571), the measured chamber calibration coefficient is expected to be reduced by 0.4, 1.0 and 1.1 % respectively for these three beams when compared to the factor derived from (60)Co. These results are in overall agreement with international absorbed dose standards and calculations by Muir and Rogers in 2010 of k Q factors using Monte Carlo techniques. The reasons for and against moving to the new service are discussed in the light of the requirements of clinical dosimetry.

Specific features of the influence of high-energy electron beams on the luminescent properties of undoped and Nb, Fe-doped Al₂O₃ crystals

The influence of 10 MeV high-current electron beams accelerated by the M-30 microtron on the luminescent properties of the α-Al₂O₃, Al₂O₃:Nb and Al₂O₃:Fe crystals has been studied. The effect of the long-term phosphorescence at room temperature has been found that can be used to monitor electron and gamma accelerator beams.

[Neutron Dosimetry System Using CR-39 for High-energy X-ray Radiation Therapy]

Neutrons are produced during radiation treatment by megavolt X-ray energies. However, it is difficult to measure neutron dose especially just during the irradiation. Therefore, we have developed a system for measuring neutrons with the solid state track detector CR-39, which is free from the influence of the X-ray beams. The energy spectrum of the neutrons was estimated by a Monte Carlo simulation method, and the estimated neutron dose was corrected by the contribution ratio of each energy. Pit formation rates of CR-39 ranged from 2.3 x 10(-3) to 8.2 x 10(-3) for each detector studied. According to the estimated neutron energy spectrum, the energy values for calibration were 144 keV and 515keV, and the contribution ratios were approximately 40:60 for 10 MV photons and 20:70 for photons over 15 MV. Neutron doses measured in the center of a high-energy X-ray field were 0.045 mSv/Gy for a 10 MV linear accelerator and 0.85 mSv/Gy for a 20 MV linear accelerator. We successfully developed the new neutron dose measurement system using the solid track detector, CR-39. This on-time neutron measurement system allows users to measure neutron doses produced in the radiation treatment room more easily.

Experimental evaluations of head scatter factor calculation by use of a Gaussian function

In external beam radiation therapy, it is important to calculate the output of the linear accelerator. The head scatter factor, S h, is one of the important factors for calculation of Monitor Unit, which changes with the size of the irradiation field. In irregular fields shaped by multileaf collimators (MLCs), it is difficult to calculate S h precisely. S h comprises backscatter from the upper and lower secondary collimators and scatter from the flattening filter. We measured the effect of backscatter on a monitor chamber (S b), and we modeled the scatter from a flattening filter using a Gaussian distribution. The modeled parameters used in this method are derived from measurements of square field sizes on the central axis. Furthermore, we divided an MLC irregular field in the shape of fans and integrated the scatter from a flattening filter by a method similar to Clarkson's sector integration. We were able to calculate S h with <1% error in comparison with measurements, even with a field setting with an error of >3% by the conventional method. This method requires no special measuring tools or software.

Angular distributions of absorbed dose of Bremsstrahlung and secondary electrons induced by 18-, 28- and 38-MeV electron beams in thick targets

Angular distributions of absorbed dose of Bremsstrahlung photons and secondary electrons at a wide range of emission angles from 0 to 135°, were experimentally obtained using an ion chamber with a 0.6 cm(3) air volume covered with or without a build-up cap. The Bremsstrahlung photons and electrons were produced by 18-, 28- and 38-MeV electron beams bombarding tungsten, copper, aluminium and carbon targets. The absorbed doses were also calculated from simulated photon and electron energy spectra by multiplying simulated response functions of the ion chambers, simulated with the MCNPX code. Calculated-to-experimental (C/E) dose ratios obtained are from 0.70 to 1.57 for high-Z targets of W and Cu, from 15 to 135° and the C/E range from 0.6 to 1.4 at 0°; however, the values of C/E for low-Z targets of Al and C are from 0.5 to 1.8 from 0 to 135°. Angular distributions at the forward angles decrease with increasing angles; on the other hand, the angular distributions at the backward angles depend on the target species. The dependences of absorbed doses on electron energy and target thickness were compared between the measured and simulated results. The attenuation profiles of absorbed doses of Bremsstrahlung beams at 0, 30 and 135° were also measured.

Evaluations of absorbed dose ratio factor of Al2O3 dosemeter in radiotherapy photon beams using cavity theory

The aim of the work was to evaluate the absorbed dose ratio factor f(md) of an Al(2)O(3) dosemeter to water in photon radiotherapy beams using cavity theory. Burlin theory was used for calculating of this ratio. The effective mass attenuation coefficient β was obtained by comparing Monte Carlo simulations in monoenergetic photon beams. The evaluations of the absorbed dose ratio factor f(md) were studied for Al(2)O(3) dosemeters of different sizes, which were placed at various depths of the water phantom in different radiation field sizes of Mohan's 6, 10 and 15-MV X-rays. Beyond the build-up region, the variation of f(md) increases by 0.25 % as the depth increases from 4 to 10 cm. The maximum variation due to different dosemeter sizes is 8.3 %. The difference in the f(md) due to different radiation field sizes is 1.5 %. The effect of the dosemeter size cannot be neglected. The difference in the f(md) due to the radiation field sizes of different beams would increase as the dosemeter size increases.

Assessment of leakage doses around the treatment heads of different linear accelerators

Out-of-field doses to untargeted organs may have long-term detrimental health effects for patients treated with radiotherapy. It has been observed that equivalent treatments delivered to patients with different accelerators may result in significant differences in the out-of-field dose. In this work, the points of leakage dose are identified about the gantry of several treatment units. The origin of the observed higher doses is investigated. LiF:Mg,Cu,P thermoluminescent dosimetry has been employed to quantify the dose at a several points around the linac head of various linear accelerators (linacs): a Varian 600C, Varian 21-iX, Siemens Primus and Elekta Synergy-II. Comparisons are also made between different energy modes, collimator rotations and field sizes. Significant differences in leaked photon doses were identified when comparing the various linac models. The isocentric-waveguide 600C generally exhibits the lowest leakage directed towards the patient. The Siemens and Elekta models generally produce a greater leakage than the Varian models. The leakage 'hotspots' are evident on the gantry section housing the waveguide on the 21-iX. For all machines, there are significant differences in the x and y directions. Larger field sizes result in a greater leakage at the interface plate. There is a greater leakage around the waveguide when operating in a low-energy mode, but a greater leakage for the high-energy mode at the linac face. Of the vendors investigated, the Varian 600C showed the lowest average leakage dose. The Varian 21-iX showed double the dose of the 600C. The Elekta Synergy-II had on average four times the dose leakage than the 600C, and the Siemens Primus showed an average of five times that of the 600C. All vendors show strong differences in the x and y directions. The results offer the potential for patient-positioning strategies, linac choice and shielding strategies to reduce the leakage dose to patients.