A generalized extension to the Hounsell–Wilkinson head scatter model

A comparison of phantom scatter from flattened and flattening filter free high-energy photon beams

Flattening filter free (FFF) photon beams have different dosimetric properties from those of flattened beams. The aim of this work was to characterize the collimator scatter (Sc) and total scatter (Scp) from 3 FFF beams of differing quality indices and use the resulting mathematical fits to generate phantom scatter (Sp) data. The similarities and differences between Sp of flattened and FFF beams are described. Sc and Scp data were measured for 3 flattened and 3 FFF high-energy photon beams (Varian 6 and 10MV and Elekta 6MV). These data were fitted to logarithmic power law functions with 4 numerical coefficients. The agreement between our experimentally determined flattened beam Sp and published data was within ± 1.2% for all 3 beams investigated and all field sizes from 4 × 4 to 40 × 40cm(2). For the FFF beams, Sp was only within 1% of the same flattened beam published data for field sizes between 6 × 6 and 14 × 14cm(2). Outside this range, the differences were much greater, reaching - 3.2%, - 4.5%, and - 4.3% for the fields of 40 × 40cm(2) for the Varian 6-MV, Varian 10-MV, and Elekta 6-MV FFF beams, respectively. The FFF beam Sp increased more slowly with increasing field size than that of the published and measured flattened beam of a similar reference field size quality index, i.e., there is less Phantom Scatter than that found with flattened beams for a given field size. This difference can be explained when the fluence profiles of the flattened and FFF beams are considered. The FFF beam has greatly reduced fluence off axis, especially as field size increases, compared with the flattened beam profile; hence, less scatter is generated in the phantom reaching the central axis.

Current status and future perspective of flattening filter free photon beams

PURPOSE

Flattening filters (FFs) have been considered as an integral part of the treatment head of a medical accelerator for more than 50 years. The reasons for the longstanding use are, however, historical ones. Advanced treatment techniques, such as stereotactic radiotherapy or intensity modulated radiotherapy have stimulated the interest in operating linear accelerators in a flattening filter free (FFF) mode. The current manuscript reviews treatment head physics of FFF beams, describes their characteristics and the resulting potential advantages in their medical use, and closes with an outlook.

METHODS

A number of dosimetric benefits have been determined for FFF beams, which range from increased dose rate and dose per pulse to favorable output ratio in-air variation with field size, reduced energy variation across the beam, and reduced leakage and out-of-field dose, respectively. Finally, the softer photon spectrum of unflattened beams has implications on imaging strategies and radiation protection.

RESULTS

The dosimetric characteristics of FFF beams have an effect on treatment delivery, patient comfort, dose calculation accuracy, beam matching, absorbed dose determination, treatment planning, machine specific quality assurance, imaging, and radiation protection. When considering conventional C-arm linacs in a FFF mode, more studies are needed to specify and quantify the clinical advantages, especially with respect to treatment plan quality and quality assurance.

CONCLUSIONS

New treatment units are already on the market that operate without a FF or can be operated in a dedicated clinical FFF mode. Due to the convincing arguments of removing the FF, it is expected that more vendors will offer dedicated treatment units for advanced photon beam therapy in the near future. Several aspects related to standardization, dosimetry, treatment planning, and optimization need to be addressed in more detail in order to facilitate the clinical implementation of unflattened beams.