Methods for radiation dose distribution analysis and treatment planning in boron neutron capture therapy

Gold Nanoparticles Permit In Situ Absorbed Dose Evaluation in Boron Neutron Capture Therapy for Malignant Tumors

Boron neutron capture therapy (BNCT) is an anticancer modality realized through ¹⁰B accumulation in tumor cells, neutron irradiation of the tumor, and decay of boron atoms with the release of alpha-particles and lithium nuclei that damage tumor cell DNA. As high-LET particle release takes place inside tumor cells absorbed dose calculations are difficult, since no essential extracellular energy is emitted. We placed gold nanoparticles inside tumor cells saturated with boron to more accurately measure the absorbed dose. T98G cells accumulated ~50 nm gold nanoparticles (AuNPs, 50 µg gold/mL) and boron-phenylalanine (BPA, 10, 20, 40 µg boron-10/mL), and were irradiated with a neutron flux of 3 × 10⁸ cm⁻²s⁻¹. Gamma-rays (411 keV) emitted by AuNPs in the cells were measured by a spectrometer and the absorbed dose was calculated using the formula D = (k × N × n)/m, where D was the absorbed dose (GyE), k—depth-related irradiation coefficient, N—number of activated gold atoms, n—boron concentration (ppm), and m—the mass of gold (g). Cell survival curves were fit to the linear-quadratic (LQ) model. We found no influence from the presence of the AuNPs on BNCT efficiency. Our approach will lead to further development of combined boron and high-Z element-containing compounds, and to further adaptation of isotope scanning for BNCT dosimetry.

Photon fluence and dose estimation in computed tomography using a discrete ordinates Boltzmann solver

In this study, cone-beam single projection and axial CT scans are modeled with a software package—DOCTORS, which solves the linear Boltzmann equation using the discrete ordinates method. Phantoms include a uniform 35 cm diameter water cylinder and a non-uniform abdomen phantom. Series simulations were performed with different simulation parameters, including the number of quadrature angles, the order of Legendre polynomial expansions, and coarse and fine mesh grid. Monte Carlo simulations were also performed to benchmark DOCTORS simulations. A quantitative comparison was made between the simulation results obtained using DOCTORS and Monte Carlo methods. The deterministic simulation was in good agreement with the Monte Carlo simulation on dose estimation, with a root-mean-square-deviation difference of around 2.87%. It was found that the contribution of uncollided photon fluence directly from the source dominates the local absorbed dose in the diagnostic X-ray energy range. The uncollided photon fluence can be calculated accurately using a ‘ray-tracing’ algorithm. The accuracy of collided photon fluence estimation is largely affected by the pre-calculated multigroup cross-sections. The primary benefit of DOCTORS lies in its rapid computation speed. Using DOCTORS, parallel computing with GPU enables the cone-beam CT dose estimation nearly in real-time.

Prompt gamma ray imaging for verification of proton boron fusion therapy: A Monte Carlo study

PURPOSE

The purpose of this study was to verify acquisition feasibility of a single photon emission computed tomography image using prompt gamma rays for proton boron fusion therapy (PBFT) and to confirm an enhanced therapeutic effect of PBFT by comparison with conventional proton therapy without use of boron.

METHODS

Monte Carlo simulation was performed to acquire reconstructed image during PBFT. We acquired percentage depth dose (PDD) of the proton beams in a water phantom, energy spectrum of the prompt gamma rays, and tomographic images, including the boron uptake region (BUR; target). The prompt gamma ray image was reconstructed using maximum likelihood expectation maximisation (MLEM) with 64 projection raw data. To verify the reconstructed image, both an image profile and contrast analysis according to the iteration number were conducted. In addition, the physical distance between two BURs in the region of interest of each BUR was measured.

RESULTS

The PDD of the proton beam from the water phantom including the BURs shows more efficient than that of conventional proton therapy on tumour region. A 719keV prompt gamma ray peak was clearly observed in the prompt gamma ray energy spectrum. The prompt gamma ray image was reconstructed successfully using 64 projections. Different image profiles including two BURs were acquired from the reconstructed image according to the iteration number.

CONCLUSION

We confirmed successful acquisition of a prompt gamma ray image during PBFT. In addition, the quantitative image analysis results showed relatively good performance for further study.

Fast Neutron Beams for Boron Neutron Capture Therapy?

In view of Boron Neutron Capture Enhanced Fast Neutron Therapy (BNCEFNT) of brain tumours, the spatial distributions of thermal flux and fast neutron plus photon dose were measured in a hydrogenous cylinder phantom under conditions varying with respect to neutron energy, field size, and irradiation technique. The behaviour of the ratio thermal fluence per unit total dose leads to the conclusion that an appreciable dose contribution from the BNC reaction can be expected only with low energies and large fields. Beams from small apertures (< 6 x 6 cm2) produce only marginal BNC dose contributions, and might gain therapeutic relevance only in combination with a very effective tumour-seeking Boron-10 carrier.

The use of positron emission tomography to develop boron neutron capture therapy treatment plans for metastatic malignant melanoma

Centers in Japan and the United States are extending boron neutron capture therapy (BNCT) to the treatment of malignant melanoma (MM). Positron emission tomography (PET) has been used to image glioblastoma multiforme with 18F-boronophenylalanine (18F-BPA) for the purpose of generating 10B distribution maps. These distribution maps can be used to improve the BNCT treatment planning. 18F-BPA was given to a patient with widely metastatic MM involving the thorax and brain. 18F-BPA PET scans of the chest and the head were obtained and compared to the computed tomograms (CT) and magnetic resonance (MR) images. The lung metastases seen on the chest CT images and intracranial metastases seen on CT and MR images were correlated with the PET images. The PET images clearly identified a brain lesion that was difficult to identify on MR and CT images. The 18F-BPA lung and peri-oral mucous gland activity was intense indicating a relatively high concentration of BPA. The intensity seen in the peri-oral mucous glands is consistent with the experiences in the BNCT clinical trials. These results have implications in the use of BNCT outside of the cranium. The PET images allow the generation of treatment plans that are consistent with the clinical findings. PET imaging with 18F-BPA can be used to identify potential tumors that may be amenable to BNCT and to improve treatment plans prior to BNCT.

A Monte Carlo tutorial and the application for radiotherapy treatment planning

Monte Carlo-based treatment planning algorithms are advancing rapidly and will certainly be implemented as part of conventional treatment planning systems in the near future. This paper was designed as a basic tutorial for using the Monte Carlo method as applied to radiotherapy treatment planning. The tutorial addresses the basic transport differences between photon and electron transport as well as the sampling distributions. The implementation of a virtual linac source model and the conversion from the Monte Carlo source modeling reference plane into the treatment reference plane is discussed. The implementation of a thresholding algorithm for converting CT electron density to patient specific materials is also presented. A 6-field prostate boost treatment is used to compare a conventional treatment planning algorithm (pencil beam model) with a Monte Carlo simulation algorithm. The agreement between the 2 calculation methods is good based upon the qualitative comparison of the isodose distribution and the dose-volume histograms for the prostate and the rectum. The effects of statistical uncertainty on the Monte Carlo calculation are also presented.

Improved treatment planning for boron neutron capture therapy for glioblastoma multiforme using fluorine-18 labeled boronophenylalanine and positron emission tomography

Boron neutron capture therapy (BNCT) is a cancer brachytherapy based upon the thermal neutron reaction: 10B(n,alpha)7Li. The efficacy of the treatment depends primarily upon two conditions being met: (a) the preferential concentration of a boronated compound in the neoplasm and (b) an adequate fluence of thermal neutrons delivered to the neoplasm. The boronated amino acid, para-boronophenylalanine (BPA), is the agent widely used in clinical trials to deliver 10B to the malignancy. Positron emission tomography (PET) can be used to generate in vivo boron distribution maps by labeling BPA with the positron emitting nuclide fluorine-18. The incorporation of the PET-derived boron distribution maps into current treatment planning protocols is shown to provide improved treatment plans. Using previously established protocols, six patients with glioblastoma had 18BPA PET scans. The PET distribution maps obtained were used in the conventional BNCT treatment codes. The isodose curves derived from the PET data are shown to differ both qualitatively and quantitatively from the conventional isodose curves that were derived from calculations based upon the assumption of uniform uptake of the pharmaceutical in tumor and normal brain regions. The clinical course of each of the patients who eventually received BNCT (five of the six patients) was compared using both sets of isodose calculations. The isodose contours based upon PET derived distribution data appear to be more consistent with the patients' clinical course.

Treatment planning and dosimetry for the Harvard-MIT Phase I clinical trial of cranial neutron capture therapy

PURPOSE

A Phase I trial of cranial neutron capture therapy (NCT) was conducted at Harvard-MIT. The trial was designed to determine maximum tolerated NCT radiation dose to normal brain.

METHODS AND MATERIALS

Twenty-two patients with brain tumors were treated by infusion of boronophenylalanine-fructose (BPA-f) followed by exposure to epithermal neutrons. The study began with a prescribed biologically weighted dose of 8.8 RBE (relative biologic effectiveness) Gy, escalated in compounding 10% increments, and ended at 14.2 RBE Gy. BPA-f was infused at a dose 250-350 mg/kg body weight. Treatments were planned using MacNCTPlan and MCNP 4B. Irradiations were delivered as one, two, or three fields in one or two fractions.

RESULTS

Peak biologically weighted normal tissue dose ranged from 8.7 to 16.4 RBE Gy. The average dose to brain ranged from 2.7 to 7.4 RBE Gy. Average tumor dose was estimated to range from 14.5 to 43.9 RBE Gy, with a mean of 25.7 RBE Gy.

CONCLUSIONS

We have demonstrated that BPA-f-mediated NCT can be precisely planned and delivered in a carefully controlled manner. Subsequent clinical trials of boron neutron capture therapy at Harvard and MIT will be initiated with a new high-intensity, high-quality epithermal neutron beam.

An investigation on the use of removal-diffusion theory for BNCT treatment planning: a method for determining proper removal-diffusion parameters

This paper outlines a method for determining proper removal-diffusion parameters to be used in removal-diffusion theory calculations for the purpose of BNCT treatment planning. Additionally, this paper demonstrates that, given the proper choice of removal-diffusion parameters, removal-diffusion theory may provide an accurate calculation technique for determining absorbed dose distributions for the purpose of BNCT treatment planning. For a four-group, one-dimensional calculation in water, this method was used to determine values for the neutron scattering cross sections, neutron removal cross sections, neutron diffusion coefficients, and extrapolation distances. These values were then used in a one-dimensional DIF3D calculation. The results of the DIF3D calculation showed a maximum deviation of 2.5% from a MCNP calculation performed for the same geometry.

The effects of boron neutron capture therapy on liver tumors and normal hepatocytes in mice

To explore the feasibility of employing boron neutron capture therapy (BNCT) to treat liver tumors, the effects of BNCT were investigated by using liver tumor models and normal hepatocytes in mice. Liver tumor models in C3H mice were developed by intrasplenic injection of SCCVII tumor cells. After borocaptate sodium (BSH) and boronophenylalanine (BPA) administration, (10)B concentrations were measured in tumors and liver and the liver was irradiated with thermal neutrons. The effects of BNCT on the tumor and normal hepatocytes were studied by using colony formation assay and micronucleus assay, respectively. To compare the effects of BSH-BNCT and BPA-BNCT, the compound biological effectiveness (CBE) factor was determined. The CBE factors for BSH on the tumor were 4.22 and 2.29 using D(10) and D(0) as endpoints, respectively. Those for BPA were 9.94 and 5.64. In the case of hepatocytes, the CBE factors for BSH and BPA were 0.94 and 4.25, respectively. Tumor-to-liver ratios of boron concentration following BSH and BPA administration were 0.3 and 2.8, respectively. Considering the accumulation ratios of (10)B, the therapeutic gain factors for BSH and BPA were 0.7 - 1.3 and 3.8 - 6.6, respectively. Therefore, it may be feasible to treat liver tumors with BPA-BNCT.

Dosimetric modeling of the microselectron high-dose rate 192Ir source by the multigroup discrete ordinates method

The DANTSYS multigroup discrete ordinates computer code is applied to quantitatively estimate the absorbed dose rate distributions in the vicinity of a microSelectron 192Ir high-dose-rate (HDR) source in two-dimensional cylindrical R-Z geometry. The source is modeled in a cylindrical water phantom of diameter 20 cm and height 20 cm. The results are also used for evaluation of the Task Group 43 (TG-43) dosimetric quantities. The DANTSYS accuracy is estimated by direct comparisons with corresponding Monte Carlo results. Our 210-group photon cross section library developed previously, together with angular quadratures consisting of 36 (S16) to 210 (S40) directions and associated weights per octant, are used in the DANTSYS simulations. Strong ray effects are observed but are significantly mitigated through the use of DANTSYS's stochastic ray-tracing first collision source algorithm. The DANTSYS simulations closely approximate Monte Carlo estimates of both direct dose calculations and TG-43 dosimetric quantities. The discrepancies with S20 angular quadrature (55 directions and weights per octant) or higher are shown to be less than +/- 5% (about 2.5 standard deviations of Monte Carlo calculations) everywhere except for limited regions along the Z axis of rotational symmetry, where technical limitations in the DANTSYS first collision source implementation makes adequate suppression of ray effects difficult to achieve. The efficiency of DANTSYS simulations is compared with that of the EGS4 Monte Carlo code. It is demonstrated that even with the 210-group cross section library, DANTSYS achieves two-fold efficiency gains using the the S20 quadrature set. The potential of discrete ordinates method for further efficiency improvements is also discussed.

Tolerance of the normal canine brain to epithermal neutron irradiation in the presence of p-boronophenylalanine

Twelve normal dogs underwent brain irradiation in a mixed-radiation, mainly epithermal neutron field at the Brookhaven Medical Research Reactor following intravenous infusion of 950 mg of 10B-enriched BPA/kg as its fructose complex. The 5 x 10 cm irradiation aperture was centered over the left hemisphere. For a subgroup of dogs reported previously, we now present more detailed analyses including dose-volume relationships, longer follow-ups, MRIs, and histopathological observations. Peak doses (delivered to 1 cm3 of brain at the depth of maximum thermal neutron flux) ranged from 7.6 Gy (photon-equivalent dose: 11.8 Gy-Eq) to 11.6 Gy (17.5 Gy-Eq). The average dose to the brain ranged from 3.0 Gy (4.5 Gy-Eq) to 8.1 Gy (11.9 Gy-Eq) and to the left hemisphere, 6.6 Gy (10.1 Gy-Eq) to 10.0 Gy (15.0 Gy-Eq). Maximum tolerated 'threshold' doses were 6.7 Gy (9.8 Gy-Eq) to the whole brain and 8.2 Gy (12.3 Gy-Eq) to one hemisphere. The threshold peak brain dose was 9.5 Gy (14.3 Gy-Eq). At doses below threshold, some dogs developed subclinical MRI changes. Above threshold, all dogs developed dose-dependent MRI changes, neurological deficits, and focal brain necrosis.

On the optimal energy of epithermal neutron beams for BNCT

The optimal neutron energy for the treatment of deep-seated tumours using boron neutron capture therapy is studied by analysing various figures of merit. In particular, analysis of the therapeutic gain as a function of the neutron energy indicates that, with the currently available 10B carriers, the most useful neutrons for the treatment of deep-seated tumours, in particular glioblastoma multiforme, are those with an energy of a few keV. Based on the results of the simulations, a method is presented which allows us to evaluate the quality of epithermal neutron beams of known energy spectrum, thus allowing us to compare different neutron-producing reactions and beam-shaping assembly configurations used for accelerator-based neutron sources.

Boron self-shielding effects on dose delivery of neutron capture therapy using epithermal beam and boronophenylalanine

Previous dosimetry studies for boron neutron capture therapy have often neglected the thermal neutron self-shielding effects caused by the 10B accumulation in the brain and the tumor. The neglect of thermal neutron flux depression, therefore, results in an overestimation of the actual dose delivery. The relevant errors are expected to be more pronounced when boronophenylalanine is used in conjunction with an epithermal neutron beam. In this paper, the boron self-shielding effects are calculated in terms of the thermal neutron flux depression across the brain and the dose delivered to the tumors. The degree of boron self-shielding is indicated by the difference between the thermal neutron fluxes calculated with and without considering a 10B concentration as part of the head phantom composition. The boron self-shielding effect is found to increase with increasing 10B concentrations and penetration depths from the skin. The calculated differences for 10B concentrations of 7.5-30 ppm are 2.3%-8.3% at 2.3 cm depth (depth of the maximum brain dose) and 4.6%-17% at 7.3 cm depth (the center of the brain). The additional self-shielding effects by the 10B concentration in a bulky tumor are investigated for a 3-cm-diam spherical tumor located either near the surface (3.3 cm depth) or at the center of the brain (7.3 cm depth) along the beam centerline. For 45 ppm of 10B in the tumor and 15 ppm of 10B in the brain, the dose delivered to the tumors is approximately 10% lower at 3.3 cm depth and 20% lower at the center of the brain, compared to the dose neglecting the boron self-shielding in transport calculations.

Designing accelerator-based epithermal neutron beams for boron neutron capture therapy

The 7Li(p,n)7Be reaction has been investigated as an accelerator-driven neutron source for proton energies between 2.1 and 2.6 MeV. Epithermal neutron beams shaped by three moderator materials, Al/AlF3, 7LiF, and D2O, have been analyzed and their usefulness for boron neutron capture therapy (BNCT) treatments evaluated. Radiation transport through the moderator assembly has been simulated with the Monte Carlo N-particle code (MCNP). Fluence and dose distributions in a head phantom were calculated using BNCT treatment planning software. Depth-dose distributions and treatment times were studied as a function of proton beam energy and moderator thickness. It was found that an accelerator-based neutron source with Al/AlF3 or 7LiF as moderator material can produce depth-dose distributions superior to those calculated for a previously published neutron beam design for the Brookhaven Medical Research Reactor, achieving up to approximately 50% higher doses near the midline of the brain. For a single beam treatment, a proton beam current of 20 mA, and a 7LiF moderator, the treatment time was estimated to be about 40 min. The tumor dose deposited at a depth of 8 cm was calculated to be about 21 Gy-Eq.

A fast and accurate treatment planning method for boron neutron capture therapy

BACKGROUND AND PURPOSE

The aim of this study was to test the applicability of conventional semi-empirical algorithms for the treatment planning of boron neutron capture therapy (BNCT).

MATERIALS AND METHODS

Beam data of a clinical epithermal BNCT beam obtained in a large cuboid water phantom were introduced into a commercial treatment planning system (TPS). For the calculation of thermal neutron fluence distributions, the Gaussian pencil beam model of the electron beam treatment planning algorithm was used. A simple photon beam algorithm was used for the calculation of the gamma-ray and fast neutron dose distribution. The calculated dose and fluence distributions in the central plane of an anthropomorphic head phantom were compared with measurements for various field sizes. The calculation time was less than 1 min.

RESULTS

At the normalization point in the head phantom, the absolute dose and fluence values agreed within the measurement uncertainty of approximately 2-3% (1 SD) with those at the same depth in a cuboid phantom of approximately the same size. Excellent agreement of within 2-3% (1 SD) was obtained between measured and calculated relative fluence and dose values on the central beam axis and at most off-axis positions in the head phantom. At positions near the phantom boundaries, generally in low dose regions, local differences of approximately 30% were observed.

CONCLUSIONS

A fast and accurate treatment planning method has been developed for BNCT. This is the first treatment planning method that may allow the same interactive optimization procedures for BNCT as applied clinically for conventional radiotherapy.

Computational dosimetry and treatment planning for boron neutron capture therapy

The technology for computational dosimetry and treatment planning for Boron Neutron Capture Therapy (BNCT) has advanced significantly over the past few years. Because of the more complex nature of the problem, the computational methods that work well for treatment planning in photon radiotherapy are not applicable to BNCT. The necessary methods have, however, been developed and have been successfully employed both for research applications as well as human trials, although further improvements in speed are needed for routine clinical applications. Computational geometry for BNCT applications can be constructed directly from tomographic medical imagery and computed radiation dose distributions can be readily displayed in formats that are familiar to the radiotherapy community.

Boron neutron capture therapy for glioblastoma multiforme using p-boronophenylalanine and epithermal neutrons: trial design and early clinical results

A Phase I/II clinical trial of boron neutron capture therapy (BNCT) for glioblastoma multiforme is underway using the amino acid analog p-boronophenylalanine (BPA) and the epithermal neutron beam at the Brook-haven Medical Research Reactor. Biodistribution studies were carried out in 18 patients at the time of craniotomy using an i.v. infusion of BPA, solubilized as a fructose complex (BPA-F). There were no toxic effects related to the BPA-F administration at doses of 130, 170, 210, or 250 mg BPA/kg body weight. The tumor/ blood, brain/blood and scalp/blood boron concentration ratios were approximately 3.5:1, 1:1 and 1.5:1, respectively. Ten patients have received BNCT following 2-hr infusions of 250 mg BPA/kg body weight. The average boron concentration in the blood during the irradiation was 13.0 +/- 1.5 micrograms 10B/g. The prescribed maximum dose to normal brain (1 cm3 volume) was 10.5 photon-equivalent Gy (Gy-Eq). Estimated maximum and minimum doses (mean +/- sd, n = 10) to the tumor volume were 52.6 +/- 4.9 Gy-Eq (range: 64.4-47.6) and 25.2 +/- 4.2 Gy-Eq (range: 32.3-20.0), respectively). The estimated minimum dose to the target volume (tumor +2 cm margin) was 12.3 +/- 2.7 Gy-Eq (range: 16.2-7.8). There were no adverse effects on normal brain. The scalp showed mild erythema, followed by epilation in the 8 cm diameter field. Four patients developed recurrent tumor, apparently in the lower dose (deeper) regions of the target volume, at post-BNCT intervals of 7,5,3.5 and 3 months, respectively. The remaining patients have had less than 4 months of post-BNCT follow-up. BNCT, at this starting dose level, appears safe. Plans are underway to begin the dose escalation phase of this protocol.

Monte Carlo-based treatment planning for boron neutron capture therapy using custom designed models automatically generated from CT data

PURPOSE

A Monte Carlo-based treatment planning code for boron neutron capture therapy (BNCT), called NCTPLAN, has been developed in support of the New England Medical Center-Massachusetts Institute of Technology program in BNCT. This code has been used to plan BNCT irradiations in an ongoing peripheral melanoma BNCT protocol. The concept and design of the code is described and illustrative applications are presented.

METHODS AND MATERIALS

NCTPLAN uses thin-slice Computed Tomography (CT) image data to automatically create a heterogeneous multimaterial model of the relevant body part, which is then used as input to a Monte Carlo simulation code, MCNP, to derive distributions within the model. Results are displayed as isocontours superimposed on precisely corresponding CT images of the body part. Currently the computational slowness of the dose calculations precludes efficient treatment planning per se, but does provide the radiation oncologist with a preview of the doses that will be delivered to tumors and to various normal tissues, and permits neutron irradiation times in Megawatt-minutes (MW-min) to be calculated for specific dose prescriptions. The validation of the NCTPLAN results by experimental mixed-field dosimetry is presented. A typical application involving a cranial parallel-opposed epithermal neutron beam irradiation of a human subject with a glioblastoma multiforme is illustrated showing relative biological effectiveness-isodose (RBE) distributions in normal CNS structures and in brain tumors. Parametric curves for the MITR-II M67 epithermal neutron beam, showing the gain factors (gain factor = minimum tumor dose/maximum normal brain dose) for various combinations of boron concentrations in tumor and in normal brain, are presented.

RESULTS

The NCTPLAN code provides good computational agreement with experimental measurements for all dose components along the neutron beam central axis in a head phantom. For the M67 epithermal beam the gain factor for 1, boronophenylalanine for a small midline brain tumor under typical distribution assumptions is 1.4-1.8 x . Implementation of the code under clinical conditions is demonstrated.

CONCLUSION

The NCTPLAN code has been shown to be well suited to treatment-planning applications in BNCT. Comparison of computationally derived dose distributions in a phantom compared with experimental measurements demonstrates good agreement. Automatic superposition of isodose contours with corresponding CT image data provides the ability to evaluate BNCT doses to tumor and to normal structures. Calculation of gain factors suggests that for the M67 epithermal neutron beam, more advantage is gained from increasing boron concentrations in tumor than from increasing the boron tumor-to-normal brain ratio.

Monte Carlo calculations of epithermal boron neutron capture therapy with heavy water

Much work over the past decade has centred upon the development of epithermal neutron beams for boron neutron capture therapy (BNCT) in an effort to increase thermal-neutron flux penetration and dose homogeneity throughout the brain. While heavy water has been used extensively to improve neutron penetration associated with thermal neutron beams, the effects of heavy water with epithermal neutron beams remain largely unexplored. Applying the Monte Carlo code MCNP to a heterogenous ellipsoidal skull/brain model, the effects of heavy-water replacement are studied for the JRC/ECN Petten HFR epithermal neutron beam. Thermal neutron flux and induced gamma depth dose distributions are calculated for 20% D2O replacement in comparison to standard brain and skull materials. Results are presented for both unilateral and bilateral irradiation. With bilateral irradiation, thermal-neutron flux homogeneity is substantially increased with 20% D2O replacement, thus improving the potential to give lethal doses to boron-10-loaded, disseminated cancer cells whilst avoiding local 'hot spots' to healthy tissue. Additionally, the induced gamma dose is reduced by up to 30%, substantially lowering the background dose to healthy tissue. With bilateral irradiation, 20% D2O replacement increases the therapeutic ratio from 2.25 to 2.75 for over 4 cm depth centred at the midline of the brain. These calculations use documented tumour and blood 10B concentrations for boronophenylalanine (BPA) in humans and recently documented neutron relative biological effectiveness (RBE) values.

An expression for the RBE of neutrons as a function of neutron energy

The goal of this paper is to develop a relationship between a neutron RBE and neutron energy, En, which can be used to design neutron sources for BNCT. In an earlier calculation of a neutron RBE as a function of En, we approximated the contribution to a total neutron RBE, RBEt (En), arising from 14N(n,p)14C reactions. In this paper, we recalculate RBEt (En), accounting more exactly for the contribution to RBEt (En) from 14N(n,p)14C reactions.