Monte Carlo study of Siemens PRIMUS photoneutron production

Simulating the head of a TrueBeam linear particle accelerator and calculating the photoneutron spectrum on the central axis of a 10-MV photon using particle and heavy-ion transport system code

Photon energy is higher than the (γ,n) threshold, allowing it to interact with the nuclei of materials with high z properties and liberate fast neutrons. This represents a potentially harmful source of radiation for humans and the environment. This study validated the Monte Carlo simulation, using the particle and heavy-ion transport code system (PHITS) on a TrueBeam 10-MV linear particle accelerator's head shielding model and then used this PHITS code to simulate a photo-neutron spectrum for the transport of the beam. The results showed that, when comparing the simulated to measured PDD and crosslines, 100% of the γ-indexes were <1 (γ3%/3mm) for both simulations, for both phase-space data source and a mono energy source. Neutron spectra were recorded in all parts of the TrueBeam's head, as well as photon neutron spectra at three points on the beamline.

TOPAS simulation of photoneutrons in radiotherapy: accuracy and speed with variance reduction

Objective. We provide optimal particle split numbers for speeding up TOPAS Monte Carlo simulations of linear accelerator (linac) treatment heads while maintaining accuracy. In addition, we provide a new TOPAS physics module for simulating photoneutron production and transport.Approach.TOPAS simulation of a Siemens Oncor linac was used to determine the optimal number of splits for directional bremsstrahlung splitting as a function of the field size for 6 MV and 18 MV x-ray beams. The linac simulation was validated against published data of lateral dose profiles and percentage depth-dose curves (PDD) for the largest square field (40 cm side). In separate simulations, neutron particle split and the custom TOPAS physics module was used to generate and transport photoneutrons, called 'TsPhotoNeutron'. Verification of accuracy was performed by comparing simulations with published measurements of: (1) neutron yields as a function of beam energy for thick targets of Al, Cu, Ta, W, Pb and concrete; and (2) photoneutron energy spectrum at 40 cm laterally from the isocenter of the Oncor linac from an 18 MV beam with closed jaws and MLC.Main results.The optimal number of splits obtained for directional bremsstrahlung splitting enhanced the computational efficiency by two orders of magnitude. The efficiency decreased with increasing beam energy and field size. Calculated lateral profiles in the central region agreed within 1 mm/2% from measured data, PDD curves within 1 mm/1%. For the TOPAS physics module, at a split number of 146, the efficiency of computing photoneutron yields was enhanced by a factor of 27.6, whereas it improved the accuracy over existing Geant4 physics modules.Significance.This work provides simulation parameters and a new TOPAS physics module to improve the efficiency and accuracy of TOPAS simulations that involve photonuclear processes occurring in high-Zmaterials found in linac components, patient devices, and treatment rooms, as well as to explore new therapeutic modalities such as very-high energy electron therapy.

Internal absorbed dose calculation in body organs due to injection of Rhenium-188 labeled to Mu-9 antibody

The use of radiopharmaceuticals has gained a special place in the diagnosis and treatment of cancers and evaluation of the function of different organs of the body. In this study, the absorbed dose distribution of organs after injection of 188Re-Mu-9 has been investigated using MIRD method and MCNP-4C simulation code. The 188Re-Mu-9 labeled was injected the mouse body and the amount of 188Re-labeled accumulation was evaluated after 1, 4 and 2 4 h. Having a map of the distribution of radiopharmaceutical activity in the animal body, it is possible to convert it into a human model to obtain the internal dose received by 188Re-Mu-9 injection using the MIRD calculation method and the MCNP simulation code. According to the results of the study, the animal/human model can be acceptable method for dose estimation of antibody-based radiopharmaceuticals.

A dosimetric comparison of 3D-CRT, IMRT and IMAT treatment techniques - assessment from radiation protection point of view

Background

The purpose was to assess the impact of irradiation technique type and beam energy on the mixed radiation field around the medical linear accelerator (linac) in terms of radiation quality and related radiation protection quantities.

Materials and methods

Seven radiotherapeutic plans with Alderson-Rando anthropomorphic phantom [different techniques: conventional three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and intensity modulated arc therapy (IMAT), different beams: 6 MV or 18 MV, and their arrangements) were prepared for the case of prostate malignancy. Recombination chambers REM-2 and GW2 were positioned on the treatment couch 100 cm from the beam axis at the height of the isocentre. Recombination chambers REM-2 and GW2 were used for recombination index of radiation quality Q4 determination, measurement of total tissue dose Dt and calculation of gamma and neutron components to Dt. Estimation of Dt and Q4 allowed for the ambient dose equivalent H*(10) calculations for each plan.

Results

For plans prepared with 6 MV beams, Q4 values within the limits of uncertainty were equal to one, which confirms the correctness of the measurement method. For plans implemented with 18 MV beams, the value of Q4 was in the range of 3.7-5.7. Comparison between treatment techniques indicates that the lowest exposure resulting from out-of-field doses comes from 6 MV IMAT (0.7 mSv), whereas the highest one is from 18 MV IMRT (55.1 mSv).

Conclusion

With the recombination chambers technique it was confirmed that the choice of beam energy directly affects the generation of photoneutrons. The treatment plan technique can have a significant impact on the out-of-field dose.

FOIL ACTIVATION TECHNIQUE-A TOOL FOR THE EVALUATION OF PHOTO-NEUTRON DOSE IN RADIOTHERAPY

Treatment of cancer is carried out using photon beams from high-energy medical linear accelerators. Photo-neutrons are also produced as an unwanted by product in the process of dose delivery to the cancer patients during their radiation treatments. In the present study, photo-neutron dose equivalents (both thermal and fast components) per unit delivered gamma-photon dose were measured at different depths, as function of distances from iso-centre in patient plane, field sizes, wedge angles and at LINAC head for a 15-MV medical linear accelerator model Elekta Precise using multi-foil activation technique. The neutron dose equivalents determined for the above-mentioned parameters were found to be lower (<0.05%) in comparison with the therapeutic photon dose delivered and within the prescribed limits recommended by the national regulatory authority.

Measurement of Neutron Dose Equivalent within and Outside of a LINAC Treatment Vault Using a Neutron Survey Meter

This work concerns neutron doses associated with the use of a Siemens Primus M5497 electron accelerator, which is operated in the photon mode at 15 MV. The conditions offer a situation within which a fraction of the bremsstrahlung emission energies exceed the photoneutron threshold. For different field sizes, an investigation has been made of neutron dose equivalent values at various measurement locations, including: (i) At the treatment table, at a source-surface distance of 100 cm; (ii) at the level of the floor directly adjacent to the treatment table; and (iii) in the control room and patient waiting area. The evaluated neutron dose equivalent was found to range from 0.0001 to 8.6 mSv/h, notably with the greatest value at the level of the floor directly adjacent to the treatment couch (8.6 mSv/h) exceeding the greatest value on the treatment table (5.5 mSv/h). Low values ranging from unobservable to between 0.0001 to 0.0002 mSv/h neutron dose were recorded around the control room and patient waiting area. For measurements on the floor, the study showed the dose equivalent to be greatest with the jaws closed. These data, most particularly concerning neutron distribution within the treatment room, are of great importance in making steps towards improving patient safety via the provision of protective measures.

Monte Carlo methods for device simulations in radiation therapy

Monte Carlo (MC) simulations play an important role in radiotherapy, especially as a method to evaluate physical properties that are either impossible or difficult to measure. For example, MC simulations (MCSs) are used to aid in the design of radiotherapy devices or to understand their properties. The aim of this article is to review the MC method for device simulations in radiation therapy. After a brief history of the MC method and popular codes in medical physics, we review applications of the MC method to model treatment heads for neutral and charged particle radiation therapy as well as specific in-room devices for imaging and therapy purposes. We conclude by discussing the impact that MCSs had in this field and the role of MC in future device design.

Neutron contamination in radiotherapy processes: a review study

Using high-energy photon beams is one of the most practical methods in radiotherapy treatment of cases in deep site located tumors. In such treatments, neutron contamination induced through photoneutron interaction of high energy photons (>8 MeV) with high Z materials of LINAC structures is the most crucial issue which should be considered. Generated neutrons will affect shielding calculations and cause extra doses to the patient and the probability of increase induced secondary cancer risks. In this study, different parameters of neutron production in radiotherapy processes will be reviewed.

Photoneutron-induced damage reduction for cardiac implantable electronic devices using neutron-shielding sheets in high-energy X-ray radiotherapy: A phantom study

PURPOSE

To evaluate damage reduction in cardiac implantable electronic devices (CIEDs) caused by photoneutrons in high-energy X-ray radiotherapy using a neutron-shielding sheet (NSS).

METHODS

The NSS consists of a bolus with a thickness of 1 or 2 cm (Bls1 or Bls2) as a moderator and several absorbers (20%, 50%, or 80% B₄C silicone sheet [B₄C20, B₄C50, or B₄C80] or a 40% LiF silicone sheet [LiF40]). First, a linear accelerator (LINAC) with a water-equivalent phantom was modeled in the simulation and measured experimentally. Several NSSs were placed on the phantom, a Eu:LiCaAlF₆ scintillator was placed between the phantom and the NSS, and X-rays were irradiated. The relative counts (Cr = counts when placing the NSS or Bls2) were compared between the experiment and simulation. Second, CIED damage was evaluated in the simulation. The relative damage (Dr = damage when placing or not placing the NSS) was compared among all the NSSs. In addition, the γ-ray and leaking X-ray dose from B₄C was measured using a dosimetric film. After determining the optimal NSS combination, Dr value analysis was performed by changing the length of one side and the thickness.

RESULTS

The Cr values of the simulation and experiment agreed within a 30% percentage difference, except for Bare or LiF40-only. The Dr value was reduced by 43% when Bls2 + B₄C80 was applied. The photon dose was less than 5 cGy/1500 MU. The Dr values were smaller for the smaller lengths of one side of B₄C80 and decreased as the M-layer thickness increased.

CONCLUSIONS

The CIED damage induced by photoneutrons generated by a LINAC was effectively reduced by applying the optimal NSS.

Study of Photoneutron Production for the 18 MV Photon Beam of the Siemens Medical linac by Monte Carlo Simulation

Background:

Considering the importance of photoneutron production in linear accelerators, it is necessary to describe and measure the photoneutrons produced around modern linear accelerators.

Objective:

The aim of the present research is to study photoneutron production for the 18 MV photon beam of a Siemens Primus Plus medical linear accelerator.

Material and Methods:

This study is an experimental study. The main components of the head of Siemens Primus Plus linac were simulated using MCNPX 2.7.0 code. The contribution of different components of the linac in photoneutron production, neutron source strength, neutron source strength and photon and electron spectra were calculated for the flattening filter and flattening filter free cases for the 18 MV photon beam, and was scored for three fields of 5 × 5 cm², 10 × 10 cm² and 20 × 20 cm² in size.

Results:

The results show that the primary collimator has the largest contribution to production of neutrons. Moreover, the photon fluence for the flattening filter free case is 8.62, 6.51 and 4.62 times higher than the flattening filter case for the three fields, respectively. The electron fluences for the flattening filter free case are 4.62, 2.93 and 2.79 times higher than with flattening filter case for the three fields under study, respectively. In addition to these cases, by increasing the field size, the contribution of neutron production related to the jaws is reduced, so that when the field size increases from 5 × 5 cm² to 20 × 20 cm², a 17.93% decrease in photoneutron production was observed.

Conclusion:

In all of the accelerators, the neutron strength also increases with increasing energy. The calculated neutron strength was equal to 0.83×10¹² neutron Gy ⁻¹ at the isocenter.

Different Methods of Measuring Neutron Dose/Fluence Generated During Radiation Therapy with Megavoltage Beams

Medical linear accelerators (linacs) are the most frequently applied radiation therapy machines in the locoregional treatment of cancers by producing either high-energy electron or photon beams. However, with high-energy photons (>8 MeV), interaction of these photons with different high-Z nuclei of materials in components of the linac head unavoidably generates neutrons. On the other hand, the average energy of these generated neutrons has almost the highest radiation-weighting factor. Therefore, the produced neutrons should not be neglected. There are various tools for the measurement of neutron dose/fluence generated in a megavoltage linac, including thermoluminescent dosimeters, solid-state nuclear track detectors, bubble detectors, activation foils, Bonner sphere systems, and ionization chamber pairs. In this review article, each of the above-mentioned dosimetric methods will be described in detail.

Essential considerations for accurate evaluation of photoneutron contamination in Radiotherapy

Nowadays, high-energy X-rays produced by medical linear accelerators (LINACs) are widely used in many Radiation Therapy (RT) centers. High-energy photons (> 8 MeV) produce undesired neutrons in the LINAC head which raise concerns about unwanted neutron dose to the patients and RT personnel. Regarding the significance of radiation protection in RT, it is important to evaluate photoneutron contamination inside the RT room. Unfortunately, neutron dosimeters used for this purpose have limitations that can under the best conditions cause to > 10% uncertainty. In addition to this uncertainty, the present Monte Carlo (MC) study introduces another uncertainty in measurements (nearly up to 20%) when neutron ambient dose equivalent (H_n^*(10)) is measured at the patient table or inside the maze and the change in neutron energy is ignored. This type of uncertainty can even reach 35% if H_n^*(10) is measured by dosimeters covered by a layer of ¹⁰B as converter. So, in these cases, neglecting the change in neutron energy can threaten the credibility of measured data and one should attend to this energy change in order to reduce measurement uncertainty to the possible minimum. This study also discusses the change in neutron spectra and H_n^*(10) at the patient table caused by removing a typical RT room from MC simulations. Under such conditions, neutron mean energy (Ē_n) overestimated by 0.2-0.4 MeV at the patient table. Neutron fluence (φ_n) at the isocenter (IC) was underestimated by 23-54% for different field sizes that caused H_n^*(10) to be miscalculated up to 24%. This finding informs researchers that for accurate evaluation of H_n^*(10) at the patient table, simulating the RT room is an effective parameter in MC studies.

The effect of the flattening filter on photoneutron production at 10 MV in the Varian TrueBeam linear accelerator

PURPOSE

Neutrons are an unavoidable by-product of high-energy radiation therapy treatments that deliver unwanted nontarget dose to patients. Use of flattening-filter-free (FFF) photon beams has been shown to significantly reduce photoneutron production per monitor unit (MU) of dose delivered. The purpose of this investigation was to characterize the photoneutron production of the 10 MV and 10 MV FFF beams of the Varian TrueBeam^TM linear accelerator.

METHODS

Neutron fluence spectra were measured using a Nested Neutron Spectrometer^TM (NNS, Detec Inc., Gatineau, Canada). The ratios of neutron fluence and ambient dose equivalent for the 10 MV FFF beam relative to the 10 MV beam, dubbed FF-ratios (FFF/FF), were used to characterize the difference between the two beams. FF-ratios were compared under the following three conditions (a) per MU, at various locations in the treatment room, (b) per MU, with the linac jaws opened and closed, and (c) per electron striking the bremsstrahlung target, as opposed to per MU, at one location with the jaws closed.

RESULTS

On average, the neutron fluence for the 10 MV FFF beam was 37% lower per MU than the 10 MV beam (FF-ratio = 0.63). The FF-ratio in neutron fluence and ambient dose equivalent did not vary by much between different locations within the treatment room. However, the FF-ratio in neutron ambient dose equivalent was reduced significantly when the linac jaws were opened compared to closed, which implies that the jaws contribute more to the photoneutron spectrum of the 10 MV FFF beam than to the 10 MV beam. Finally, it was found that the 10 MV FFF beam produces more photoneutrons per electron striking the bremsstrahlung target than the 10 MV beam (FF-ratio = 2.56).

CONCLUSIONS

The photoneutron fluence per MU produced by the 10 MV FFF beam is 37% lower than the 10 MV beam of a Varian TrueBeam linac. Accordingly, a reduction in neutron dose received by patients is achieved through use of the unflattened beam, provided that treatment plans for each beam require approximately the same number of MU. It was found to be instructive to compare the photoneutron yield per source electron between the two beams as it helped provide an understanding of the physics underlying photoneutron production in both beams.

MCNP5 evaluation of photoneutron production from the Alexandria University 15 MV Elekta Precise medical LINAC

Photoneutron production, and the dose equivalent, in the head assembly of the 15 MV Elekta Precise medical linac; operating in the faculty of Medicine at Alexandria University were estimated with the MCNP5 code. Photoneutron spectra were calculated in air and inside a water phantom to different depths as a function of the radiation field sizes. The maximum neutron fluence is 3.346×10^-9 n/cm²-e for a 30×30 cm² field size to 2-4 cm-depth in the phantom. The dose equivalent due to fast neutron increases as the field size increases, being a maximum of 0.912 ± 0.05 mSv/Gy at depth between 2 and 4 cm in the water phantom for 40×40 cm² field size. Photoneutron fluence and dose equivalent are larger to 100 cm from the isocenter than to 35 cm from the treatment room wall.

Monte Carlo calculation of photo-neutron dose produced by circular cones at 18 MV photon beams

Aim

The aim of this study is to calculate neutron contamination at the presence of circular cones irradiating by 18 MV photons using Monte Carlo code.

Background

Small photon fields are one of the most useful methods in radiotherapy. One of the techniques for shaping small photon beams is applying circular cones made of lead. Using this method in high energy photon due to neutron contamination is a crucial issue.

Materials and methods

Initially, Varian linac producing 18 MV photons was simulated and after validating the code, various circular cones were also simulated. Then, the number of neutrons, neutron equivalent dose and absorbed dose per Gy of photon dose were calculated along the central axis.

Results

Number of neutrons per Gy of photon dose had their maximum value at depth of 2 cm and these values for 5, 10, 15, 20 and 30 mm circular cones were 9.02, 7.76, 7.61, 6.02 and 5.08 (n cm^-2 Gy^-1), respectively. Neutron equivalent doses per Gy of photon dose had their maximum at the surface of the phantom and these values for mentioned collimators were 1.48, 1.33, 1.31, 1.12 and 1.08 (mSv Gy^-1), respectively. Neutron absorbed doses had their maximum at the surface of the phantom and these values for mentioned collimators sizes were 103.74, 99.71, 95.77, 81.46 and 78.20 (μGy/Gy), respectively.

Conclusions

As the field size gets smaller, number of neutrons, equivalent and absorbed dose per Gy of photon increase. Also, neutron equivalent dose and absorbed dose are maximum at the surface of phantom and then these values will be decreased.

Photoneutron depth dose equivalent distributions in high-energy X-ray medical accelerators by a novel position-sensitive dosimeter

PURPOSE

The purpose of this study was to; (1) investigate employing a novel position-sensitive mega-size polycarbonate (MSPC) dosimeter for photoneutron (PN) depth, profile and dose equivalent distributions studies in a multilayer polyethylene phantom in a Siemens ONCOR accelerator, and (2) develop depth dose equivalent distribution matrix data at different depths and positions of the phantom for patient PN dose equivalent determination and in particular for PN secondary cancer risk estimation.

METHODS

Position-sensitive MSPC dosimeters were successfully exposed at 9 different depths of the phantom in a 10×10cm² X-ray field. The dosimeters were processed in mega-size electrochemical chambers at optimum conditions. Each MSPC dosimeter was placed at a known phantom depth for PN depth dose equivalents and profiles on transverse, longitudinal and diagonal axes and isodose equivalent distribution studies in and out of the X-ray beam.

RESULTS

PN dose equivalent distributions at any depth showed the highest value at the beam central axis and decreases as the distance increases. PN dose equivalent at any position studied in the axes has a maximum value on the phantom surface which decreases as depth increases due to flux reduction by multi-elastic scattering interactions.

CONCLUSIONS

Extensive PN dose equivalent matrix data at different depths and positions in the phantom were determined. The position-sensitive MSPC dosimeters proved to be highly efficient for PN depth, profile and isodose equivalent distribution studies. The extensive data obtained highly assists for determining PN dose equivalent of a patient undergoing high-energy X-ray therapy and for PN secondary cancer risk estimation.

Real-time detection of fast and thermal neutrons in radiotherapy with CMOS sensors

The peripheral dose distribution is a growing concern for the improvement of new external radiation modalities. Secondary particles, especially photo-neutrons produced by the accelerator, irradiate the patient more than tens of centimeters away from the tumor volume. However the out-of-field dose is still not estimated accurately by the treatment planning softwares. This study demonstrates the possibility of using a specially designed CMOS sensor for fast and thermal neutron monitoring in radiotherapy. The 14 microns-thick sensitive layer and the integrated electronic chain of the CMOS are particularly suitable for real-time measurements in γ/n mixed fields. An experimental field size dependency of the fast neutron production rate, supported by Monte Carlo simulations and CR-39 data, has been observed. This dependency points out the potential benefits of a real-time monitoring of fast and thermal neutron during beam intensity modulated radiation therapies.

Experimental evaluation of neutron dose in radiotherapy patients: Which dose?

PURPOSE

The evaluation of peripheral dose has become a relevant issue recently, in particular, the contribution of secondary neutrons. However, after the revision of the Recommendations of the International Commission on Radiological Protection, there has been a lack of experimental procedure for its evaluation. Specifically, the problem comes from the replacement of organ dose equivalent by the organ-equivalent dose, being the latter "immeasurable" by definition. Therefore, dose equivalent has to be still used although it needs the calculation of the radiation quality factor Q, which depends on the unrestricted linear energy transfer, for the specific neutron irradiation conditions. On the other hand, equivalent dose is computed through the radiation weighting factor wR, which can be easily calculated using the continuous function provided by the recommendations. The aim of the paper is to compare the dose equivalent evaluated following the definition, that is, using Q, with the values obtained by replacing the quality factor with wR.

METHODS

Dose equivalents were estimated in selected points inside a phantom. Two types of medical environments were chosen for the irradiations: a photon- and a proton-therapy facility. For the estimation of dose equivalent, a poly-allyl-diglicol-carbonate-based neutron dosimeter was used for neutron fluence measurements and, additionally, Monte Carlo simulations were performed to obtain the energy spectrum of the fluence in each point.

RESULTS

The main contribution to dose equivalent comes from neutrons with energy higher than 0.1 MeV, even when they represent the smallest contribution in fluence. For this range of energy, the radiation quality factor and the radiation weighting factor are approximately equal. Then, dose equivalents evaluated using both factors are compatible, with differences below 12%.

CONCLUSIONS

Quality factor can be replaced by the radiation weighting factor in the evaluation of dose equivalent in radiotherapy environments simplifying the practical procedure.

Monte Carlo study of neutron-ambient dose equivalent to patient in treatment room

This paper presents an analytical method for the calculation of the neutron ambient dose equivalent H* (10) regarding patients, whereby the different concrete types that are used in the surrounding walls of the treatment room are considered. This work has been performed according to a detailed simulation of the Varian 2300C/D linear accelerator head that is operated at 18MV, and silver activation counter as a neutron detector, for which the Monte Carlo MCNPX 2.6 code is used, with and without the treatment room walls. The results show that, when compared to the neutrons that leak from the LINAC, both the scattered and thermal neutrons are the major factors that comprise the out-of field neutron dose. The scattering factors for the limonite-steel, magnetite-steel, and ordinary concretes have been calculated as 0.91±0.09, 1.08±0.10, and 0.371±0.01, respectively, while the corresponding thermal factors are 34.22±3.84, 23.44±1.62, and 52.28±1.99, respectively (both the scattering and thermal factors are for the isocenter region); moreover, the treatment room is composed of magnetite-steel and limonite-steel concretes, so the neutron doses to the patient are 1.79 times and 1.62 times greater than that from an ordinary concrete composition. The results also confirm that the scattering and thermal factors do not depend on the details of the chosen linear accelerator head model. It is anticipated that the results of the present work will be of great interest to the manufacturers of medical linear accelerators.

A novel position-sensitive mega-size dosimeter for photoneutrons in high-energy X-ray medical accelerators

PURPOSE

A novel position-sensitive mega-size polycarbonate (MSPC) dosimeter is introduced. It provides photoneutron (PN) dose equivalent matrix of positions in and out of a beam of a high energy X-ray medical accelerator under a single exposure.

METHODS

A novel position-sensitive MSPC dosimeter was developed and applied. It has an effective etched area of 50×50cm(2), as used in this study, processed in a mega-size electrochemical etching chamber to amplify PN-induced-recoil tracks to a point viewed by the unaided eyes. Using such dosimeters, PN dose equivalents, dose equivalent profiles and isodose equivalent distribution of positions in and out of beams for different X-ray doses and field sizes were determined in a Siemens ONCOR Linac.

RESULTS

The PN dose equivalent at each position versus X-ray dose was linear up to 20Gy studied. As the field size increased, the PN dose equivalent in the beam was also increased but it remained constant at positions out of the beam up to 20cm away from the beam edge. The jaws and MLCs due to material differences and locations relative to the target produce different PN contributions.

CONCLUSIONS

The MSPC dosimeter introduced in this study is a perfect candidate for PN dosimetry with unique characteristics such as simplicity, efficiency, dose equivalent response, large size, flexibility to be bent, resembling the patient's skin, highly position-sensitive with high spatial resolution, highly insensitive to X-rays, continuity in measurements and need to a single dosimeter to obtain PN dose equivalent matrix data under a single X-ray exposure.

Monte Carlo simulation of secondary radiation exposure from high-energy photon therapy using an anthropomorphic phantom

The development of intensity-modulated radiotherapy treatments delivering large amounts of monitor units (MUs) recently raised concern about higher risks for secondary malignancies. In this study, optimised combinations of several variance reduction techniques (VRTs) have been implemented in order to achieve a high precision in Monte Carlo (MC) radiation transport simulations and the calculation of in- and out-of-field photon and neutron dose-equivalent distributions in an anthropomorphic phantom using MCNPX, v.2.7. The computer model included a Varian Clinac 2100C treatment head and a high-resolution head phantom. By means of the applied VRTs, a relative uncertainty for the photon dose-equivalent distribution of <1 % in-field and 15 % in average over the rest of the phantom could be obtained. Neutron dose equivalent, caused by photonuclear reactions in the linear accelerator components at photon energies of approximately >8 MeV, has been calculated. Relative uncertainty, calculated for each voxel, could be kept below 5 % in average over all voxels of the phantom. Thus, a very detailed neutron dose distribution could be obtained. The achieved precision now allows a far better estimation of both photon and especially neutron doses out-of-field, where neutrons can become the predominant component of secondary radiation.

Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group

This report describes the current state of flattening filter‐free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high‐dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out‐of‐field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity‐modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated.

PACS number: 87.53.‐j, 87.53.Bn, 87.53.Ly, 87.55.‐x, 87.55.N‐, 87.56.bc

Assessment of radiation exposure outside the radiotherapeutic room during medical accelerator beam emission with the use of TL detectors (radiation exposure outside a LINAC room)

Photon and neutron soft tissue absorbed doses near the entrance door to the medical LINAC treatment room were measured with the use of thermoluminescent detectors LiF:Mg,Cu,P in the anthropomorphic phantom. Two different therapeutic beams (6 and 15 MV) and four treatment techniques were involved in the present study. This allowed one to investigate the contribution of scattered X rays, secondary neutrons and gamma rays to the radiation field. Photon absorbed dose rates 50 cm away from the LINAC room door during emission of 15-MV X rays varied between 4.1×10(-4) and 5.6×10(-4) Gy h(-1), depending on the gantry position and the irradiation field size, whereas in the case of 6-MV therapeutic irradiation these doses are ∼1.5 times lower. In the case of 15-MV beam emission, a mixed radiation field near the bunker door is observed with the photon radiation as the main component, which includes a 33.1 % contribution of the induced gamma radioactivity and ∼2.1 % contribution of the neutron radiation.

Photoneutron contamination from an 18 MV Saturne medical linear accelerator in the treatment room

Dose escalation with high-energy X rays of medical linear accelerators (linacs) in radiotherapy offers several distinct advantages over the lower energy photons. However, owing to photoneutron reactions, interaction of high-energy photons (>8 MV) with various high-Z nuclei of the materials in the linac head components produces unavoidable neutrons. The aim of this study was to evaluate the photoneutron dose equivalent per unit therapeutic X-ray dose of 18 MV, GE Saturne 20 linac in the treatment room using Monte Carlo (MC) MCNP linac head full simulation as well as thermoluminescence dosemeter measurements. This machine is one of the old linac models manufactured by General Electric Company; however, it is widely used in the developing countries because of low cost and simple maintenance for radiotherapy applications. The results showed a significant photoneutron dose from Saturne 20 linac head components especially at distances near the linac head (<150 cm). Results of this work could be used in several applications, especially designing bunker and entrance door shielding against neutrons produced by photoneutron reactions in GE Saturne 20. However, a detailed cost optimisation for a specific room would require a dedicated calculation.

Neutron measurements with ultra-thin 3D silicon sensors in a radiotherapy treatment room using a Siemens PRIMUS linac

The accurate detection and dosimetry of neutrons in mixed and pulsed radiation fields is a demanding instrumental issue with great interest both for the industrial and medical communities. In recent studies of neutron contamination around medical linacs, there is a growing concern about the secondary cancer risk for radiotherapy patients undergoing treatment in photon modalities at energies greater than 6 MV. In this work we present a promising alternative to standard detectors with an active method to measure neutrons around a medical linac using a novel ultra-thin silicon detector with 3D electrodes adapted for neutron detection. The active volume of this planar device is only 10 µm thick, allowing a high gamma rejection, which is necessary to discriminate the neutron signal in the radiotherapy peripheral radiation field with a high gamma background. Different tests have been performed in a clinical facility using a Siemens PRIMUS linac at 6 and 15 MV. The results show a good thermal neutron detection efficiency around 2% and a high gamma rejection factor.

Neutron dosimetry in organs of an adult human phantom using linacs with multileaf collimator in radiotherapy treatments

PURPOSE

To calculate absorbed doses due to neutrons in 87 organs/tissues for anthropomorphic phantoms, irradiated in position supine (head first into the gantry) with orientations anteroposterior (AP) and right-left (RLAT) with a 18 MV accelerator. Conversion factors from monitor units to μGy per neutron in organs, equivalent doses in organs/tissues, and effective doses, which permit to quantify stochastic risks, are estimated.

METHODS

MAX06 and FAX06 phantoms were modeled with MCNPX and irradiated with a 18 MV Varian Clinac 2100C/D accelerator whose geometry included a multileaf collimator. Two actual fields of a pelvic treatment were simulated using electron-photon-neutron coupled transport. Absorbed doses due to neutrons were estimated from kerma. Equivalent doses were estimated using the radiation weighting factor corresponding to an average incident neutron energy 0.47 MeV. Statistical uncertainties associated to absorbed doses, as calculated by MCNPX, were also obtained.

RESULTS

Largest doses were absorbed in shallowest (with respect to the neutron pathway) organs. In μGyMU(-1), values of 2.66 (for penis) and 2.33 (for testes) were found in MAX06, and 1.68 (for breasts), 1.05 (for lenses of eyes), and 0.94 (for sublingual salivary glands) in FAX06, in AP orientation. In RLAT, the largest doses were found for bone tissues (leg) just at the entrance of the beam in the body (right side in our case). Values, in μGyMU(-1), of 1.09 in upper leg bone right spongiosa, for MAX06, and 0.63 in mandible spongiosa, for FAX06, were found. Except for gonads, liver, and stomach wall, equivalent doses found for FAX06 were, in both orientations, higher than for MAX06. Equivalent doses in AP are higher than in RLAT for all organs/tissues other than brain and liver. Effective doses of 12.6 and 4.1 μSvMU(-1) were found for AP and RLAT, respectively. The organs/tissues with larger relative contributions to the effective dose were testes and breasts, in AP, and breasts and red marrow, in RLAT. Equivalent and effective doses obtained for MAX06/FAX06 were smaller (between 2 and 20 times) than those quoted for the mathematical phantoms ADAM/EVA in ICRP-74.

CONCLUSIONS

The new calculations of conversion coefficients for neutron irradiation in AP and RLAT irradiation geometries show a reduction in the values of effective dose by factors 7 (AP) and 6 (RLAT) with respect to the old data obtained with mathematical phantoms. The existence of tissues or anatomical regions with maximum absorbed doses, such as penis, lens of eyes, fascia (part of connective tissue), etc., organs/tissues that classic mathematical phantoms did not include because they were not considered for the study of stochastic effects, has been revealed. Absorbed doses due to photons, obtained following the same simulation methodology, are larger than those due to neutrons, reaching values 100 times larger as the primary beam is approached. However, for organs far from the treated volume, absorbed photon doses can be up to three times smaller than neutron ones. Calculations using voxel phantoms permitted to know the organ dose conversion coefficients per MU due to secondary neutrons in the complete anatomy of a patient.

Neutron dose equivalent and neutron spectra in tissue for clinical linacs operating at 15, 18 and 20 MV

In this work, the dose equivalent due to photoneutrons and the neutron spectra in tissue was calculated for various linacs (Varian Clinac 2100C, Elekta Inor, Elekta SL25 and Siemens Mevatron KDS) operating at energies between 15 and 20 MV, using the Monte Carlo code MCNPX (v. 2.5). The dose equivalent in an ICRU tissue phantom has been calculated for anteroposterior treatments with a detailed simulation of the geometry of the linac head and the coupled electron-photon-neutron transport. Neutron spectra at the phantom entrance and at 1-cm depth in the phantom, depth distribution of the neutron fluence in the beam axis and dose distributions outside the beam axis at various depths have also been calculated and compared with previously published results. The differences between the neutron production of the various linacs considered has been analysed. Varian linacs show a larger neutron production than the Elekta and Siemens linacs at the same operating energy. The dose equivalent due to neutrons produced by medical linacs operating at energies >15 MeV is relevant and should not be neglected because of the additional doses that patients can receive.

A review on photoneutrons characteristics in radiation therapy with high-energy photon beams

In radiation therapy with high-energy photon beams (E > 10 MeV) neutrons are generated mainly in linacs head thorough (γ,n) interactions of photons with nuclei of high atomic number materials that constitute the linac head and the beam collimation system. These neutrons affect the shielding requirements in radiation therapy rooms and also increase the out-of-field radiation dose of patients undergoing radiation therapy with high-energy photon beams. In the current review, the authors describe the factors influencing the neutron production for different medical linacs based on the performed measurements and Monte Carlo studies in the literature.

The impact of automatic wedge filter on photoneutron and photon spectra of an 18-MV photon beam

The effect of an automatic wedge filter on photon and photoneutron spectra of a medical linac was evaluated using the Monte Carlo method. The head of an Elekta SL75/25 was simulated using the MCNPX Monte Carlo code. The photon and photoneutron spectra for open and wedged beams were calculated at the isocentre with a source to axis distance of 100 cm. For a wedged beam, the neutron fluence was from 3.84 to 7.2 times higher for field sizes from 10 x 10 to 30 x 30 cm(2). The neutron fluence is decreased with field size for open beams and is increased with field size for wedged beams The photon beam spectra became harder and the mean energy was 6 % higher for a wedged beam, which led to a 4 % increase in relative depth dose and a better skin sparing effect. The results here recommend that the higher photoneutron fluence of the wedged beam should be taken into account in patient dosimetry and shielding calculations.