Monte Carlo study of Siemens PRIMUS photoneutron production

Secondary neutron spectra from modern Varian, Siemens, and Elekta linacs with multileaf collimators

Neutrons are a by-product of high-energy x-ray radiation therapy (threshold for [gamma,n] reactions in high-Z material -7 MeV). Neutron production varies depending on photon beam energy as well as on the manufacturer of the accelerator. Neutron production from modern linear accelerators (linacs) has not been extensively compared, particularly in terms of the differences in the strategies that various manufacturers have used to implement multileaf collimators (MLCs) into their linac designs. However, such information is necessary to determine neutron dose equivalents for different linacs and to calculate vault shielding requirements. The purpose of the current study, therefore, was to measure the neutron spectra from the most up-to-date linacs from three manufacturers: Varian 21EX operating at 15, 18, and 20 MV, Siemens ONCOR operating at 15 and 18 MV, and Elekta Precise operating at 15 and 18 MV. Neutron production was measured by means of gold foil activation in Bonner spheres. Based on the measurements, the authors determined neutron spectra and calculated the average energy, total neutron fluence, ambient dose equivalent, and neutron source strength. The shapes of the neutron spectra did not change significantly between accelerators or even as a function of treatment energy. However, the neutron fluence, and therefore the ambient dose equivalent, did vary, increasing with increasing treatment energy. For a given nominal treatment energy, these values were always highest for the Varian linac. The current study thus offers medical physicists extensive information about the neutron production of MLC-equipped linacs currently in operation and provides them information vital for accurate comparison and prediction of neutron dose equivalents and calculation of vault shielding requirements.

Monte Carlo modeling of a 6 and 18 MV Varian Clinac medical accelerator for in-field and out-of-field dose calculations: development and validation

There is a serious and growing concern about the increased risk of radiation-induced second cancers and late tissue injuries associated with radiation treatment. To better understand and to more accurately quantify non-target organ doses due to scatter and leakage radiation from medical accelerators, a detailed Monte Carlo model of the medical linear accelerator is needed. This paper describes the development and validation of a detailed accelerator model of the Varian Clinac operating at 6 and 18 MV beam energies. Over 100 accelerator components have been defined and integrated using the Monte Carlo code MCNPX. A series of in-field and out-of-field dose validation studies were performed. In-field dose distributions calculated using the accelerator models were tuned to match measurement data that are considered the de facto 'gold standard' for the Varian Clinac accelerator provided by the manufacturer. Field sizes of 4 cm x 4 cm, 10 cm x 10 cm, 20 cm x 20 cm and 40 cm x 40 cm were considered. The local difference between calculated and measured dose on the percent depth dose curve was less than 2% for all locations. The local difference between calculated and measured dose on the dose profile curve was less than 2% in the plateau region and less than 2 mm in the penumbra region for all locations. Out-of-field dose profiles were calculated and compared to measurement data for both beam energies for field sizes of 4 cm x 4 cm, 10 cm x 10 cm and 20 cm x 20 cm. For all field sizes considered in this study, the average local difference between calculated and measured dose for the 6 and 18 MV beams was 14 and 16%, respectively. In addition, a method for determining neutron contamination in the 18 MV operating model was validated by comparing calculated in-air neutron fluence with reported calculations and measurements. The average difference between calculated and measured neutron fluence was 20%. As one of the most detailed accelerator models for both in-field and out-of-field dose calculations, the model will be combined with anatomically realistic computational patient phantoms into a computational framework to calculate non-target organ doses to patients from various radiation treatment plans.

Doses to patients from photoneutrons emitted in a medical linear accelerator

This study of doses to patients from emitted photoneutrons in a medical linear accelerator (Varian 2100C) was carried out. Dose calculation was performed using Monte Carlo Geant4 code. The model was used to calculate the neutron fluence, as a function of the neutron energy inside the treatment room to estimate the effective dose to patients. The ambient dose equivalent versus field size for patients is reported in this study. The ambient dose equivalent using 1 x 1 cm(2) field size, at isocentre and X-ray modes of 20, 18, 15 and 10 MV, was found to be 1.85, 1.79, 0.61 and 0.06 mSv Gy(-1), respectively. The mean energies of emitted photoneutrons were 0.48, 0.44, 0.40 and 0.16 MeV at X-ray modes of 20, 18, 15 and 10 MV, respectively. The results of ambient dose equivalent from emitted photoneutrons cannot be ignored and can represent a risk for healthy tissues. This study emphasised that Geant4 Monte Carlo code is an appropriate choice for studying photoneutron production and transport.

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

Recent studies on flattening filter (FF) free beams have shown increased dose rate and less out-of-field dose for unflattened photon beams. On the other hand, changes in contamination electrons and neutron spectra produced through photon (E>10 MV) interactions with linac components have not been completely studied for FF free beams. The objective of this study was to investigate the effect of removing FF on contamination electron and neutron spectra for an 18-MV photon beam using Monte Carlo (MC) method. The 18-MV photon beam of Elekta SL-25 linac was simulated using MCNPX MC code. The photon, electron and neutron spectra at a distance of 100 cm from target and on the central axis of beam were scored for 10 x 10 and 30 x 30 cm(2) fields. Our results showed increase in contamination electron fluence (normalized to photon fluence) up to 1.6 times for FF free beam, which causes more skin dose for patients. Neuron fluence reduction of 54% was observed for unflattened beams. Our study confirmed the previous measurement results, which showed neutron dose reduction for unflattened beams. This feature can lead to less neutron dose for patients treated with unflattened high-energy photon beams.

A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction

It has been long known that patients treated with ionizing radiation carry a risk of developing a second cancer in their lifetimes. Factors contributing to the recently renewed concern about the second cancer include improved cancer survival rate, younger patient population as well as emerging treatment modalities such as intensity-modulated radiation treatment (IMRT) and proton therapy that can potentially elevate secondary exposures to healthy tissues distant from the target volume. In the past 30 years, external-beam treatment technologies have evolved significantly, and a large amount of data exist but appear to be difficult to comprehend and compare. This review article aims to provide readers with an understanding of the principles and methods related to scattered doses in radiation therapy by summarizing a large collection of dosimetry and clinical studies. Basic concepts and terminology are introduced at the beginning. That is followed by a comprehensive review of dosimetry studies for external-beam treatment modalities including classical radiation therapy, 3D-conformal x-ray therapy, intensity-modulated x-ray therapy (IMRT and tomotherapy) and proton therapy. Selected clinical data on second cancer induction among radiotherapy patients are also covered. Problems in past studies and controversial issues are discussed. The needs for future studies are presented at the end.

Measurement of photoneutron dose produced by wedge filters of a high energy linac using polycarbonate films

Radiotherapy represents the most widely spread technique to control and treat cancer. To increase the treatment efficiency, high energy linacs are used. However, applying high energy photon beams leads to a non-negligible dose of neutrons contaminating therapeutic beams. In addition, using conventional linacs necessitates applying wedge filters in some clinical conditions. However, there is not enough information on the effect of these filters on the photoneutrons produced. The aim of this study was to investigate the change of photoneutron dose equivalent due to the use of linac wedge filters. A high energy (18 MV) linear accelerator (Elekta SL 75/25) was studied. Polycarbonate films were used to measure the dose equivalent of photoneutrons. After electrochemical etching of the films, the neutron dose equivalent was calculated using Hp(10) factor, and its variation on the patient plane at 0, 5, 10, 50 and 100 cm from the center of the X-ray beam was determined. By increasing the distance from the center of the X-ray beam towards the periphery, the photoneutron dose equivalent decreased rapidly for the open and wedged fields. Increasing of the field size increased the photoneutron dose equivalent. The use of wedge filter increased the proportion of the neutron dose equivalent. The increase can be accounted for by the selective absorption of the high energy photons by the wedge filter.

Cephalometric assessment of the axial inclination of upper and lower incisors in relation to the third-order angle

BACKGROUND AND AIM

Estimating incisor inclination cephalometrically by reference lines NA and NB puts the orthodontist in the difficult position of relating these axial inclination data to the bracket's third-order prescription which refers to a perpendicular to the occlusal plane. Purpose of the present study was to evaluate the relationship between the cephalometrically-assessed incisor inclination (using the lines NA and NB for reference) and the third-order angle (syn.: torque angle, TA) according to Andrews' description, and moreover to investigate the correlation between incisor inclination data and skeletal-sagittal and skeletal-vertical findings.

MATERIALS AND METHODS

The lateral cephalograms and corresponding dental casts of 67 subjects between 10 and 25 years of age (regardless of skeletal and dental relationships) were considered in the study. All subjects were Caucasian, and none had undergone orthodontic therapy. Upper (U1) and lower (L1) incisor angulations were cephalometrically assessed in reference to the NA and NB lines and compared to third-order angles obtained from dental cast measurements with an incisor inclination-recording appliance. Incisor inclination data from the two measurements were correlated to craniofacial sagittal (angles SNA, SNB, ANB) and vertical (angles NSL-NL, NSL-ML, ML-NL) findings from the radiographs.

RESULTS

The third-order angles in the upper arch measured on the dental casts were a mean of 16.2 degrees (SD = 5.3 degrees) smaller than the axial inclination according to the NA line; the lower incisor third-order data were less than those of the axial inclination according to the NB line by a mean of 27.8 degrees (SD = 4.75 degrees). In this sample, there was a range of 42.7 degrees for the U1TA variable (mean = 5.6 degrees, SD 9.73 degrees) and 47 degrees for U1NA/ degrees variable (mean = 21.71 degrees, SD = 8.67 degrees). The L1TA variable showed a range of 29 degrees (mean = -2.95 degrees, SD = 7.17 degrees), the radiographic L1NB/ degrees range was 23 degrees (mean = 24.91 degrees, SD = 5.8 degrees). We observed a highly significant correlation (r(NA) = 0.84***, r(NB) = 0.76***) between the Andrews' angle and the inclination estimated in reference to the NA and NB lines. No significant correlation between incisor inclination and craniofacial measurements was detected.

CONCLUSIONS

Dental cast measurements seem to be more precise and more valid than lateral radiographs. The method we describe enables clinicians to get a good idea precisely and quickly of how much torque potential remains in the brackets and archwires during treatment. The inclination of the incisors can also be calculated using the regression equations provided, making additional lateral cephalograms unnecessary.