Modeling the extrafocal radiation and monitor chamber backscatter for photon beam dose calculation

Optimization of the Eclipse TPS beam configuration parameters for small field dosimetry using Monte Carlo simulations and experimental measurements

PURPOSE

To evaluate the impact of tuning the beam configurations parameters on the Analytical Anisotropic Algorithm (AAA) and the Acuros XB (AXB) algorithm for small fields using Monte Carlo simulations and measurements.

METHODS

The TrueBeam STx with the high-definition 120 multi-leaf collimator (HD120-MLC) was modeled with Geant4 application for emission tomography (GATE) Monte Carlo platform and validated against measurements. The impact of varying the effective spot size (ESS) and dosimetric leaf gap (DLG) on AAA and AXB calculations was carried out for small MLC-fields ranging from 0.5×0.5 cm2 to 3 × 3 cm2. Beam penumbras, field sizes and output factors calculated by AAA and AXB were compared to GATE calculations and measurements.

RESULTS

The beam penumbra comparisons showed that the best ESS value for AXB was about 1.0 mm in the crossplane direction and 0.5 mm in the inplane direction. By optimizing the ESS values, AXB could provide output factor results almost within 2% of GATE calculations and measurements for fields down to 0.5×0.5 cm2. For AAA, significant output factor differences were observed for all ESS values and tuning the DLG in addition to the ESS optimization resulted in an absorbed dose difference of less than 2.5% for MLC-fields down to 1 × 1 cm2.

CONCLUSION

By optimizing the ESS values, AXB can achieve accurate output factors in the case of small MLC-fields without the need of DLG tuning. Nevertheless, compromises between the output factor, DLG and ESS values were found necessary for AAA calculations. A MLC model improvement would allow to avoid the complexity related to tuning the configuration parameters.

A convolution-superposition fluence model for the Siemens HD120 multi leaf collimator with application to a 3D VMAT dose engine

Purpose. To construct a fast-calculating fluence modelfor the Siemens HD120 multi leaf collimator (MLC) using convolution-superposition techniques, and to develop a 3D VMAT dose engine using this fluence model.  This work offers analternative to time-consuming open-source Monte Carlo simulations for thosedeveloping in-house dose-calculating software for research or clinical needs.Methods. EPID-acquired images of sweeping-window and sweeping-checker field profiles were used to commission transmission, 2 Dinterleaf leakage, and tongue-and-groove maps specific to the HD120 MLC.  These maps, along with a 2D head-scattermodel were incorporated into a convolution-superposition algorithm to provide a fluence model for the HD120 MLC. This fluence model was used to develop a 3D VMAT dose engine, where 3D pre-computed 6MV dose kernels (EGSnrc) and a 3D fluence curvature-correction map were incorporatedto calculate 3D VMAT doses in a 22 cm diameter cylindrical phantom. Four VMAT patient plans witha large range of PTV sizes (36 cc to 604 cc) were chosen to test the fluence model and dose engine.Results. Excellent agreement was observed between the simulated commissioning fields and measured EPID-responses. 2D 2%/2 mm gamma analysis yielded a 98.9% pass rate for 1 cm, 2 cm, and 4 cm sweeping-window fields. 2D 2%/2mm gamma analysis for outer/inner MLC leaves yielded 89.1%/77.0% and 95.2%/91.1% pass rates from 1 cm and 2 cm sweeping-checker fields. Mean 3%/3 mm gamma analysis showed excellent agreement between our dose engine and Eclipse (Acuros) regardless of PTV size: 98.7% pass rate, with 95.1% pass rate in the high-dose volume.  Fluence calculation times were13.6 seconds per dynamic MLC field and 1.4 minutes/arc for 3D VMAT dose on a standard PC. Conclusions. A fast-calculating convolution-superposition fluence model has been commissioned for the Siemens HD120 MLC and incorporatedinto a 3D VMAT dose engine.  This work can be used to facilitate the development of fast in-house dose-calculating software.

Beam modeling and beam model commissioning for Monte Carlo dose calculation-based radiation therapy treatment planning: Report of AAPM Task Group 157

Dose calculation plays an important role in the accuracy of radiotherapy treatment planning and beam delivery. The Monte Carlo (MC) method is capable of achieving the highest accuracy in radiotherapy dose calculation and has been implemented in many commercial systems for radiotherapy treatment planning. The objective of this task group was to assist clinical physicists with the potentially complex task of acceptance testing and commissioning MC-based treatment planning systems (TPS) for photon and electron beam dose calculations. This report provides an overview on the general approach of clinical implementation and testing of MC-based TPS with a specific focus on models of clinical photon and electron beams. Different types of beam models are described including those that utilize MC simulation of the treatment head and those that rely on analytical methods and measurements. The trade-off between accuracy and efficiency in the various source-modeling approaches is discussed together with guidelines for acceptance testing of MC-based TPS from the clinical standpoint. Specific recommendations are given on methods and practical procedures to commission clinical beam models for MC-based TPS.

Modeling scattered radiation from multi-leaf collimators (MLCs) to improve calculation accuracy of in-air output ratio

This study aims to model an extra-focal source for the scattered radiation from multi-leaf collimators (MLCs), namely an MLC scatter source, and to correct in-air output ratio (S_c) calculated using the conventional dual source model (DSM) to achieve better accuracy of point dose calculation. To develop the MLC scatter source, a 6 MV photon beam from a Varian Clinac® iX linear accelerator with millennium 120 MLCs was used. It was assumed that the position for the MLC scatter source was located at the center of the MLC, consisting of line-based and area-based sources to consider the characteristics of the scattered radiation from the MLCs empirically. Based on the measured S_c values for MLC-defined fields, optimal parameters for the line-based and area-based sources were calculated using optimization process. For evaluation of proposed method, measurements were taken for various MLC-defined square and irregular fields. The S_c values calculated using the proposed MLC scatter source and conventional DSM were compared with the measured data. For MLC-defined square fields, the measured S_c values showed better agreement with those calculated using the MLC scatter source (the mean difference was − 0.03%) compared with those calculated using the DSM (the mean difference was 0.18%). For MLC-defined irregular fields, the maximum dose differences between measurements and calculations using the MLC scatter source and DSM were 0.54% and 1.45%, respectively. The developed MLC scatter source could improve the accuracy of S_c calculation for both square and irregular fields defined by MLCs.

Benchmarking of Monte Carlo model of Siemens Oncor® linear accelerator for 18MV photon beam: Determination of initial electron beam parameters

OBJECTIVE

This study aims to benchmark a Monte Carlo (MC) model of the 18 MV photon beam produced by the Siemens Oncor® linac using the BEAMnrc and DOSXYZnrc codes.

METHODS

By matching the percentage depth doses and beam profiles calculated by MC simulations with measurements, the initial electron beam parameters including electron energy, full width at half maximum (spatial FWHM), and mean angular spread were derived for the 10×10 cm2 and 20×20 cm2 field sizes. The MC model of the 18 MV photon beam was then validated against the measurements for different field sizes (5×5, 30×30 and 40×40 cm2) by gamma index analysis.

RESULTS

The optimum values for electron energy, spatial FWHM and mean angular spread were 14.2 MeV, 0.08 cm and 0.8 degree, respectively. The MC simulations yielded the comparable measurement results of these optimum parameters. The gamma passing rates (with acceptance criteria of 1% /1 mm) for percentage depth doses were found to be 100% for all field sizes. For cross-line profiles, the gamma passing rates were 100%, 97%, 95%, 96% and 95% for 5×5, 10×10, 20×20, 30×30 and 40×40 cm2 field sizes, respectively.

CONCLUSIONS

By validation of the MC model of Siemens Oncor® linac using various field sizes, it was found that both dose profiles of small and large field sizes were very sensitive to the changes in spatial FWHM and mean angular spread of the primary electron beam from the bending magnet. Hence, it is recommended that both small and large field sizes of the 18 MV photon beams should be considered in the Monte Carlo linac modeling.

Efficient independent planar dose calculation for FFF IMRT QA with a bivariate Gaussian source model

The aim of this study is to perform a direct comparison of the source model for photon beams with and without flattening filter (FF) and to develop an efficient independent algorithm for planar dose calculation for FF‐free (FFF) intensity‐modulated radiotherapy (IMRT) quality assurance (QA). The source model consisted of a point source modeling the primary photons and extrafocal bivariate Gaussian functions modeling the head scatter, monitor chamber backscatter, and collimator exchange effect. The model parameters were obtained by minimizing the difference between the calculated and measured in‐air output factors (S_c). The fluence of IMRT beams was calculated from the source model using a backprojection and integration method. The off‐axis ratio in FFF beams were modeled with a fourth degree polynomial. An analytical kernel consisting of the sum of three Gaussian functions was used to describe the dose deposition process. A convolution‐based method was used to account for the ionization chamber volume averaging effect when commissioning the algorithm. The algorithm was validated by comparing the calculated planar dose distributions of FFF head‐and‐neck IMRT plans with measurements performed with a 2D diode array. Good agreement between the measured and calculated S_c was achieved for both FF beams (<0.25%) and FFF beams (<0.10%). The relative contribution of the head‐scattered photons reduced by 34.7% for 6 MV and 49.3% for 10 MV due to the removal of the FF. Superior agreement between the calculated and measured dose distribution was also achieved for FFF IMRT. In the gamma comparison with a 2%/2 mm criterion, the average passing rate was 96.2 ± 1.9% for 6 MV FFF and 95.5 ± 2.6% for 10 MV FFF. The efficient independent planar dose calculation algorithm is easy to implement and can be valuable in FFF IMRT QA.

Modification and validation of an analytical source model for external beam radiotherapy Monte Carlo dose calculations

PURPOSE

A dose calculation tool, which combines the accuracy of the dose planning method (DPM) Monte Carlo code and the versatility of a practical analytical multisource model, which was previously reported has been improved and validated for the Varian 6 and 10 MV linear accelerators (linacs). The calculation tool can be used to calculate doses in advanced clinical application studies. One shortcoming of current clinical trials that report dose from patient plans is the lack of a standardized dose calculation methodology. Because commercial treatment planning systems (TPSs) have their own dose calculation algorithms and the clinical trial participant who uses these systems is responsible for commissioning the beam model, variation exists in the reported calculated dose distributions. Today's modern linac is manufactured to tight specifications so that variability within a linac model is quite low. The expectation is that a single dose calculation tool for a specific linac model can be used to accurately recalculate dose from patient plans that have been submitted to the clinical trial community from any institution. The calculation tool would provide for a more meaningful outcome analysis.

METHODS

The analytical source model was described by a primary point source, a secondary extra-focal source, and a contaminant electron source. Off-axis energy softening and fluence effects were also included. The additions of hyperbolic functions have been incorporated into the model to correct for the changes in output and in electron contamination with field size. A multileaf collimator (MLC) model is included to facilitate phantom and patient dose calculations. An offset to the MLC leaf positions was used to correct for the rudimentary assumed primary point source.

RESULTS

Dose calculations of the depth dose and profiles for field sizes 4 × 4 to 40 × 40 cm agree with measurement within 2% of the maximum dose or 2 mm distance to agreement (DTA) for 95% of the data points tested. The model was capable of predicting the depth of the maximum dose within 1 mm. Anthropomorphic phantom benchmark testing of modulated and patterned MLCs treatment plans showed agreement to measurement within 3% in target regions using thermoluminescent dosimeters (TLD). Using radiochromic film normalized to TLD, a gamma criteria of 3% of maximum dose and 2 mm DTA was applied with a pass rate of least 85% in the high dose, high gradient, and low dose regions. Finally, recalculations of patient plans using DPM showed good agreement relative to a commercial TPS when comparing dose volume histograms and 2D dose distributions.

CONCLUSIONS

A unique analytical source model coupled to the dose planning method Monte Carlo dose calculation code has been modified and validated using basic beam data and anthropomorphic phantom measurement. While this tool can be applied in general use for a particular linac model, specifically it was developed to provide a singular methodology to independently assess treatment plan dose distributions from those clinical institutions participating in National Cancer Institute trials.

Automatic commissioning of a GPU-based Monte Carlo radiation dose calculation code for photon radiotherapy

Monte Carlo (MC) simulation is commonly considered as the most accurate method for radiation dose calculations. Commissioning of a beam model in the MC code against a clinical linear accelerator beam is of crucial importance for its clinical implementation. In this paper, we propose an automatic commissioning method for our GPU-based MC dose engine, gDPM. gDPM utilizes a beam model based on a concept of phase-space-let (PSL). A PSL contains a group of particles that are of the same type and close in space and energy. A set of generic PSLs was generated by splitting a reference phase-space file. Each PSL was associated with a weighting factor, and in dose calculations the particle carried a weight corresponding to the PSL where it was from. Dose for each PSL in water was pre-computed, and hence the dose in water for a whole beam under a given set of PSL weighting factors was the weighted sum of the PSL doses. At the commissioning stage, an optimization problem was solved to adjust the PSL weights in order to minimize the difference between the calculated dose and measured one. Symmetry and smoothness regularizations were utilized to uniquely determine the solution. An augmented Lagrangian method was employed to solve the optimization problem. To validate our method, a phase-space file of a Varian TrueBeam 6 MV beam was used to generate the PSLs for 6 MV beams. In a simulation study, we commissioned a Siemens 6 MV beam on which a set of field-dependent phase-space files was available. The dose data of this desired beam for different open fields and a small off-axis open field were obtained by calculating doses using these phase-space files. The 3D γ-index test passing rate within the regions with dose above 10% of dmax dose for those open fields tested was improved averagely from 70.56 to 99.36% for 2%/2 mm criteria and from 32.22 to 89.65% for 1%/1 mm criteria. We also tested our commissioning method on a six-field head-and-neck cancer IMRT plan. The passing rate of the γ-index test within the 10% isodose line of the prescription dose was improved from 92.73 to 99.70% and from 82.16 to 96.73% for 2%/2 mm and 1%/1 mm criteria, respectively. Real clinical data measured from Varian, Siemens, and Elekta linear accelerators were also used to validate our commissioning method and a similar level of accuracy was achieved.

Modulation factors calculated with an EPID-derived MLC fluence model to streamline IMRT/VMAT second checks

This work outlines the development of a robust method of calculating modulation factors used for the independent verification of MUs for IMRT and VMAT treatments, to replace onerous ion chamber measurements. Two‐dimensional fluence maps were calculated for dynamic MLC fields that include MLC interleaf leakage, transmission, and tongue‐and‐groove effects, as characterized from EPID‐acquired images. Monte Carlo‐generated dose kernels were then used to calculate doses for a modulated field and that field with the modulation removed at a depth specific to the calculation point in the patient using in‐house written software, Mod_Calc. The ratio of these two doses was taken to calculate modulation factors. Comparison between Mod_Calc calculation and ion chamber measurement of modulation factors for 121 IMRT fields yielded excellent agreement, where the mean difference between the two was −0.3%±1.2%. This validated use of Mod_Calc clinically. Analysis of 5,271 dynamic fields from clinical use of Mod_Calc gave a mean difference of 0.3%±1.0% between Mod_Calc and Eclipse‐generated factors. In addition, 99.3% and 96.5% fields pass 5% and 2% criteria, respectively, for agreement between these two predictions. The development and use of Mod_Calc at our clinic has considerably streamlined our QA process for IMRT and RapidArc fields, compared to our previous method based on ion chamber measurements. As a result, it has made it feasible to maintain our established and trusted current in‐house method of MU verification, without resorting to commercial software alternatives.

PACS numbers: 87.55.km, 87.55.Qr, 87.55.kd, 87.57.uq

Effects of interportal error on dose distribution in patients undergoing breath-holding intensity-modulated radiotherapy for pancreatic cancer: evaluation of a new treatment planning method

In patients with pancreatic cancer, intensity-modulated radiotherapy (IMRT) under breath holding facilitates concentration of the radiation dose in the tumor, while sparing the neighboring organs at risk and minimizing interplay effects between movement of the multileaf collimator and motion of the internal structures. Although the breath-holding technique provides high interportal reproducibility of target position, dosimetric errors caused by interportal breath-holding positional error have not been reported. Here, we investigated the effects of interportal breath-holding positional errors on IMRT dose distribution by incorporating interportal positional error into the original treatment plan, using random numbers in ten patients treated for pancreatic cancer. We also developed a treatment planning technique that shortens breath-holding time without increasing dosimetric quality assurance workload. The key feature of our proposed method is performance of dose calculation using the same optimized fluence map as the original plan, after dose per fraction in the original plan was cut in half and the number of fractions was doubled. Results confirmed that interportal error had a negligible effect on dose distribution over multiple fractions. Variations in the homogeneity index and the dose delivered to 98%, 2%, and 50% of the volume for the planning target volume, and the dose delivered to 1 cc of the volume for the duodenum and stomach were ±1%, on average, in comparison with the original plan. The new treatment planning method decreased breath-holding time by 33%, and differences in dose-volume metrics between the original and the new treatment plans were within ± 1%. An additional advantage of our proposed method is that interportal errors can be better averaged out; thus, dose distribution in the proposed method may be closer to the planned dose distribution than with the original plans.

GPU-based Monte Carlo radiotherapy dose calculation using phase-space sources

A novel phase-space source implementation has been designed for graphics processing unit (GPU)-based Monte Carlo dose calculation engines. Short of full simulation of the linac head, using a phase-space source is the most accurate method to model a clinical radiation beam in dose calculations. However, in GPU-based Monte Carlo dose calculations where the computation efficiency is very high, the time required to read and process a large phase-space file becomes comparable to the particle transport time. Moreover, due to the parallelized nature of GPU hardware, it is essential to simultaneously transport particles of the same type and similar energies but separated spatially to yield a high efficiency. We present three methods for phase-space implementation that have been integrated into the most recent version of the GPU-based Monte Carlo radiotherapy dose calculation package gDPM v3.0. The first method is to sequentially read particles from a patient-dependent phase-space and sort them on-the-fly based on particle type and energy. The second method supplements this with a simple secondary collimator model and fluence map implementation so that patient-independent phase-space sources can be used. Finally, as the third method (called the phase-space-let, or PSL, method) we introduce a novel source implementation utilizing pre-processed patient-independent phase-spaces that are sorted by particle type, energy and position. Position bins located outside a rectangular region of interest enclosing the treatment field are ignored, substantially decreasing simulation time with little effect on the final dose distribution. The three methods were validated in absolute dose against BEAMnrc/DOSXYZnrc and compared using gamma-index tests (2%/2 mm above the 10% isodose). It was found that the PSL method has the optimal balance between accuracy and efficiency and thus is used as the default method in gDPM v3.0. Using the PSL method, open fields of 4 × 4, 10 × 10 and 30 × 30 cm(2) in water resulted in gamma passing rates of 99.96%, 99.92% and 98.66%, respectively. Relative output factors agreed within 1%. An intensity modulated radiation therapy patient plan using the PSL method resulted in a passing rate of 97%, and was calculated in 50 s (per GPU) compared to 8.4 h (per CPU) for BEAMnrc/DOSXYZnrc.

2D lag and signal nonlinearity correction in an amorphous silicon EPID and their impact on pretreatment dosimetric verification

PURPOSE

This investigation provides measurements of signal lag and nonlinearity separately for the Varian aS500 electronic portal imaging device (EPID), and an algorithm to correct for these effects in 2D; their potential impact on intensity modulated radiation therapy (IMRT) verification is also investigated. The authors quantify lag, as a function of both delivered monitor units (MU) and time, by using a range of MUs delivered at a clinically used rate of 400 MU∕min. Explicit cumulative lag curves are thus determined for a range of MUs and times between the end of irradiation and the end of image acquisition. Signal nonlinearity is also investigated as a function of total MUs delivered. The family of cumulative lag curves and signal nonlinearity are then used to determine their effects on dynamic multileaf collimator (MLC) (IMRT) deliveries, and to correct for theses effects in 2D.

METHODS

Images acquired with an aS500 EPID and Varis Portal-Vision software were used to quantify detector lag and signal-nonlinearity. For the signal lag investigation, Portal-Vision's service monitor was used to acquire EPID images at a rate of 8 frames/s. The images were acquired during irradiation and 66 s thereafter, by inhibiting the M-holdoff-In signal of the Linac for a range of 4.5-198.5 MUs. Relative cumulative lag was calculated by integrating the EPID signal for a time after beam-off, and normalizing this to the integrated EPID signal accumulated during radiation. Signal nonlinearity was studied by acquiring 10 × 10 cm(2) open-field EPID images in "integrated image" mode for a range of 2-500 MUs, and normalized to the 100 MU case. All data were incorporated into in-house written software to create a 2D correction map for these effects, using the field's MLC file and a field-specific calculated 2D "time-map," which keeps track of the time elapsed from the last fluence delivered at each given point in the image to the end of the beam delivery.

RESULTS

Relative cumulative lag curves reveal that the lag alone can deviate the EPID's perceived dose by as large as 6% (1 MU delivery, 60 s postirradiation). For signal nonlinearity relative to 100 MU, EPID signals per MU of 0.84 and 1.01 were observed for 2 and 500 MUs, respectively. Correction maps were applied to a 1 cm sweeping-window 14 × 14 cm(2) field and clinical head-and-neck IMRT field. A mean correction of 1.028 was implemented in the head-and-neck field, which significantly reduced lag-related asymmetries in the EPID images, and restored linearity to the EPID imager's dose response. Corrections made to the sweeping-field showed good agreement with the treatment planning system-predicted field, yielding an average percent difference of 0.05% ± 0.91%, compared to the -1.32% ± 1.02% before corrections, or 1.75% ± 1.04% when only a signal nonlinearity correction is made.

CONCLUSIONS

Lag and signal-nonlinearity have been quantified for an aS500 EPID imager, and an effective 2D correction method has been developed which effectively removes nonlinearity and lag effects. Both of these effects were shown to negatively impact IMRT verifications. Especially fields that involve prolonged irradiation and small overall MUs should be corrected for in 2D.

Validation and automation of the DYNJAWS component module of the BEAMnrc Monte Carlo code

The purpose of this work is to validate and automate the use of DYNJAWS; a new component module (CM) in the BEAMnrc Monte Carlo (MC) user code. The DYNJAWS CM simulates dynamic wedges and can be used in three modes; dynamic, step-and-shoot and static. The step-and-shoot and dynamic modes require an additional input file defining the positions of the jaw that constitutes the dynamic wedge, at regular intervals during its motion. A method for automating the generation of the input file is presented which will allow for the more efficient use of the DYNJAWS CM. Wedged profiles have been measured and simulated for 6 and 10 MV photons at three field sizes (5 cm × 5 cm, 10 cm × 10 cm and 20 cm × 20 cm), four wedge angles (15°, 30°, 45° and 60°), at d (max) and at 10 cm depth. Results of this study show agreement between the measured and the MC profiles to within 3% of absolute dose or 3 mm distance to agreement for all wedge angles at both energies and depths. The gamma analysis suggests that dynamic mode is more accurate than the step-and-shoot mode. The DYNJAWS CM is an important addition to the BEAMnrc code and will enable the MC verification of patient treatments involving dynamic wedges.

Verification of monitor unit calculations for non-IMRT clinical radiotherapy: report of AAPM Task Group 114

The requirement of an independent verification of the monitor units (MU) or time calculated to deliver the prescribed dose to a patient has been a mainstay of radiation oncology quality assurance. The need for and value of such a verification was obvious when calculations were performed by hand using look-up tables, and the verification was achieved by a second person independently repeating the calculation. However, in a modern clinic using CT/MR/PET simulation, computerized 3D treatment planning, heterogeneity corrections, and complex calculation algorithms such as convolution/superposition and Monte Carlo, the purpose of and methodology for the MU verification have come into question. In addition, since the verification is often performed using a simpler geometrical model and calculation algorithm than the primary calculation, exact or almost exact agreement between the two can no longer be expected. Guidelines are needed to help the physicist set clinically reasonable action levels for agreement. This report addresses the following charges of the task group: (1) To re-evaluate the purpose and methods of the "independent second check" for monitor unit calculations for non-IMRT radiation treatment in light of the complexities of modern-day treatment planning. (2) To present recommendations on how to perform verification of monitor unit calculations in a modern clinic. (3) To provide recommendations on establishing action levels for agreement between primary calculations and verification, and to provide guidance in addressing discrepancies outside the action levels. These recommendations are to be used as guidelines only and shall not be interpreted as requirements.

Effect of collimator and couch angle change on breast IMRT dose distributions

Intensity‐modulated tangential photon beams for breast cancer treatment can improve the dose uniformity significantly throughout the whole breast and reduce the dose to the lung and the heart when compared to the conventional technique. Before the first treatment, patient setup may require a change on the collimator angle and/or the couch angle based on the chest wall coverage according to the port films. The objective of this work is to investigate the effects of the collimator and the couch angle change on the dose distribution for breast cancer treatment using intensity‐modulated tangential photon beams, and to determine the clinical acceptable range of the angle change for routine treatment. Ten breast cases treated with intensity‐modulated tangential photon beams were analyzed in this study. Patient‐specific CT data and the radiation therapy planning (RTP) files obtained from our in‐house Monte Carlo based breast IMRT treatment planning system were used for IMRT dose recalculation with collimator or couch angle changes. The isodose distributions and DVHs were compared with the original plans, and the effects of the collimator and couch angle change to breast IMRT dose distributions were evaluated. Our results show that a 4° change in the collimator angle or the couch angle did not affect the dose distribution significantly and it is acceptable in the clinic for patient treatment.

PACS number: 87.10.Rt

Dosimetric impact of motion in free-breathing and gated lung radiotherapy: a 4D Monte Carlo study of intrafraction and interfraction effects

The purpose of this study was to investigate if interfraction and intrafraction motion in free-breathing and gated lung IMRT can lead to systematic dose differences between 3DCT and 4DCT. Dosimetric effects were studied considering the breathing pattern of three patients monitored during the course of their treatment and an in-house developed 4D Monte Carlo framework. Imaging data were taken in free-breathing and in cine mode for both 3D and 4D acquisition. Treatment planning for IMRT delivery was done based on the free-breathing data with the CORVUS (North American Scientific, Chatsworth, CA) planning system. The dose distributions as a function of phase in the breathing cycle were combined using deformable image registration. The study focused on (a) assessing the accuracy of the CORVUS pencil beam algorithm with Monte Carlo dose calculation in the lung, (b) evaluating the dosimetric effect of motion on the individual breathing phases of the respiratory cycle, and (c) assessing intrafraction and interfraction motion effects during free-breathing or gated radiotherapy. The comparison between (a) the planning system and the Monte Carlo system shows that the pencil beam algorithm underestimates the dose in low-density regions, such as lung tissue, and overestimates the dose in high-density regions, such as bone, by 5% or more of the prescribed dose (corresponding to approximately 3-5 Gy for the cases considered). For the patients studied this could have a significant impact on the dose volume histograms for the target structures depending on the margin added to the clinical target volume (CTV) to produce either the planning target (PTV) or internal target volume (ITV). The dose differences between (b) phases in the breathing cycle and the free-breathing case were shown to be negligible for all phases except for the inhale phase, where an underdosage of the tumor by as much as 9.3 Gy relative to the free-breathing was observed. The large difference was due to breathing-induced motion/deformation affecting the soft/lung tissue density and motion of the bone structures (such as the rib cage) in and out of the beam. Intrafraction and interfraction dosimetric differences between (c) free-breathing and gated delivery were found to be small. However, more significant dosimetric differences, of the order of 3%-5%, were observed between the dose calculations based on static CT (3DCT) and the ones based on time-resolved CT (4DCT). These differences are a consequence of the larger contribution of the inhale phase in the 3DCT data than in the 4DCT.

The characterization of unflattened photon beams from a 6 MV linear accelerator

Commissioning data have been measured for an Elekta Precise linear accelerator running at 6 MV without a flattening filter with the aim of studying the effects of flattening filter removal on machine operation and beam characterization. Modern radiotherapy practice now routinely relies on the use of fluence modifying techniques such as IMRT, i.e. the active production of non-flat beams. For these techniques the flattening filter should not be necessary. It is also possible that the increased intensity around the central axis associated with unflattened beams may be useful for conventional treatment planning by acting as a field-in-field or integrated boost technique. For this reason open and wedged field data are presented. Whilst problems exist in running the machine filter free clinically, this paper shows that in many ways the beam is actually more stable, exhibiting almost half the variation in field symmetry for changes in steering and bending currents. Dosimetric benefits are reported here which include a reduction in head scatter by approx. 70%, decreased penumbra (0.5 mm), lower dose outside of the field edge (11%) and a doubling in dose rate (2.3 times for open and 1.9 times for wedged fields). Measurements also show that reduced scatter also reduces leakage radiation by approx. 60%, significantly lowering whole body doses. The greatest benefit of filter-free use is perceived to be for IMRT where increased dose rate combined with reduced head scatter and leakage radiation should lead to improved dose calculation, giving simpler, faster and more accurate dose delivery with reduced dose to normal tissues.

Determination of depth and field size dependence of multileaf collimator transmission in intensity-modulated radiation therapy beams

Intensity‐modulated radiation therapy (IMRT) plans for the treatment of large and complex volumes may contain a relatively large contribution from multileaf collimator (MLC) transmission. In such cases, comprehensive characterization of direct and scatter MLC transmission is important. We designed a set of tests (open beam, closed static MLC, and dynamic MLC gap) to determine dosimetric MLC properties as a function of field size and depth at the central axis.

We developed a generalized model of MLC transmission to account for direct MLC transmission, MLC scatter, beam hardening, and leaf‐end transmission (dosimetric gap). The model is consistent with the beam model used in IMRT optimization. We tested the model for extreme asymmetric fields relevant for large targets and for split IMRT fields. We applied our MLC scatter estimation formula to clinically relevant cases and showed that MLC scatter is contributing an undesired background dose. This contribution is relatively large, especially in low‐dose regions. (For instance, a uniform extra dose may dramatically increase normal‐lung toxicity in thorax treatment.) For complex IMRT of large‐volume targets, we found direct MLC transmission dose to be as high as 30%, and MLC scatter, up to 10% within the target volume for the selected cases. We identified that the dose discrepancies between the IMRT planning system [Eclipse (Varian Medical Systems, Palo Alto, CA)] and ionization chamber measurements (inside and outside of the field) are attributable to an inadequate model of MLC transmission in the planning system (constant‐value model).

In the present study, we measured MLC transmission properties for Varian 6EX (6 MV) and 21EXs (6 and 10 MV) linear accelerators; however, the experimental method and theoretical model are more general.

PACS number: 87.53.‐j

Spatial dependence of MLC transmission in IMRT delivery

In complex intensity-modulated radiation therapy cases, a considerable amount of the total dose may be delivered through closed leaves. In such cases an accurate knowledge of spatial characteristics of multileaf collimator (MLC) transmission is crucial, especially for the treatment of large targets with split fields. Measurements with an ionization chamber, radiographic films (EDR2, EBT) and EPID are taken to characterize all relevant effects related to MLC transmission for various field sizes and depths. Here we present a phenomenological model to describe MLC transmission, whereby the main focus is the off-axis decrease of transmission for symmetric and asymmetric fields as well as on effects due to the tongue and groove design of the leaves, such as interleaf transmission and the tongue and groove effect. Data obtained with the four different methods are presented, and the utility of each measurement method to determine the necessary model parameters is discussed. With the developed model, it is possible to predict the relevant MLC effects at any point in the phantom for arbitrary jaw settings and depths.

Investigation of optimal beam margins for stereotactic radiotherapy of lung-cancer using Monte Carlo dose calculations

This work investigated the selection of beam margins in lung-cancer stereotactic body radiotherapy (SBRT) with 6 MV photon beams. Monte Carlo dose calculations were used to systematically and quantitatively study the dosimetric effects of beam margins for different lung densities (0.1, 0.15, 0.25, 0.35 and 0.5 g cm(-3)), planning target volumes (PTVs) (14.4, 22.1 and 55.3 cm3) and numbers of beam angles (three, six and seven) in lung-cancer SBRT in order to search for optimal beam margins for various clinical situations. First, a large number of treatment plans were generated in a commercial treatment planning system, and then recalculated using Monte Carlo simulations. All the plans were normalized to ensure that 95% of the PTV at least receives the prescription dose and compared quantitatively. Based on these plans, the relationships between the beam margin and quantities such as the lung toxicity (quantified by V20, the percentage volume of the two lungs receiving at least 20 Gy) and the maximum target (PTV) dose were established for different PTVs and lung densities. The impact of the number of beam angles on the relationship between V20 and the beam margin was assessed. Quantitative information about optimal beam margins for lung-cancer SBRT was obtained for clinical applications.

Determination of parameters for a multiple-source model of megavoltage photon beams using optimization methods

Accurate modelling of the radiation output of a medical linear accelerator is important for radiotherapy treatment planning. The major challenge is the adjustment of the model to a specific treatment unit. One approach is to use a multiple-source model containing a set of physical parameters. In this work, the parameters were derived from standard beam data measurements using optimization methods. The source model used includes sub-sources for bremsstrahlung radiation from the target, extra-focal photon radiation and electron contamination. The cost function includes a gamma error measure between measurements and current dose calculations. The procedure was applied to six beam data sets (6 MV to 23 MV) measured with accelerators from three vendors, but the results focus primarily on Varian accelerators. The obtained average gamma error (1%, 1 mm) between dose calculations and measurements used in optimization was smaller than 0.7 for each studied treatment beam and field size, and a minimum of 83% of measurement points passed the gamma < 1 criterion. For experiments made at different SSDs and for asymmetric fields, the average gamma errors were smaller than 1.1. For irregularly shaped MLC apertures, the differences in point doses were smaller than 1.0%. This work demonstrates that the source model parameters can be automatically derived from simple measurements using optimization methods. The developed procedure is applicable to a wide range of accelerators, and has an acceptable accuracy and processing time.

Measurements of in-air output ratios for a linear accelerator with and without the flattening filter

The in-air output ratio (Sc) for photon beams from linear accelerators describes the change of in-air output as a function of the collimator settings. The physical origin of the Sc is mainly due to the change in scattered radiation that can reach the point of measurement as the geometry of the head changes. The flattening filter (FF) and primary collimator are the major sources of scattered radiation. The change in amount of backscattered radiation from the collimator into the beam-monitoring chamber also contributes to the variation of output. In this work, we measured the Sc and backscatter factors (Sb) into the beam-monitoring chamber for a linear accelerator with and without the FF. We measured the Sc with a Farmer-type chamber in a miniphantom at the depth of 10 g/cm2 for 6- and 18-MV x-ray beams from a Varian Clinac 2100EX linear accelerator. The Sb were measured with a universal pulse counter and a diode array with build-in counting hardware and software. The head scatter component (Sh) was then derived from the relationship Sc= Sh x Sb, where Sb was the linear fit of measured results. Significant differences were observed for Sc with and without the FF. Within the range of experimental uncertainty, the Sb was similar with and without the FF. The variations in Sh differed significantly over the range of field sizes of 3 X 3 to 40 X 40 cm2 with and without the FF; for the 6-MV beam, it was 8% vs 3%, and for the 18-MV beam, 7% vs 1%. By analyzing the contributions of backscatter factor and total in-air output ratios with and without the FF, we directly gained insight into the contributions of different components to the total variations in Sc of a linear accelerator. Sc, Sb, and Sh are basic and useful dosimetric quantities for delivery of intensity-modulated radiation therapy using a linear accelerator operating in a mode without the FF.

Monte Carlo study of backscatter in a flattening filter free clinical accelerator

In conventional linear accelerators, the flattening filter provides a uniform lateral dose profile. In intensity modulated radiation therapy applications, however, the flatness of the photon field and hence the presence of a flattening filter, is not necessary. Removing the filter may provide some advantages, such as faster treatments and smaller out-of-field doses to the patients. In clinical accelerators the backscattered radiation dose from the collimators must be taken into account when the dose to the target volume in the patient is being determined. In the case of a conventional machine, this backscatter is known to great precision. In a flattening filter free accelerator, however, the amount of backscatter may be different. In this study we determined the backscatter contribution to the monitor chamber signal in a flattening filter free clinical accelerator (Varian Clinac 21EX) with Monte Carlo simulations. We found that with the exception of very small fields in the 18-MV photon mode, the contribution of backscattered radiation to the monitor signal did not differ from that of conventional machines with a flattening filter. Hence, a flattening filter free clinical accelerator would not necessitate a different backscatter correction.

Evaluation of uncertainty predictions and dose output for model-based dose calculations for megavoltage photon beams

In many radiotherapy clinics an independent verification of the number of monitor units (MU) used to deliver the prescribed dose to the target volume is performed prior to the treatment start. Traditionally this has been done by using methods mainly based on empirical factors which, at least to some extent, try to separate the influence from input parameters such as field size, depth, distance, etc. The growing complexity of modern treatment techniques does however make this approach increasingly difficult, both in terms of practical application and in terms of the reliability of the results. In the present work the performance of a model-based approach, describing the influence from different input parameters through actual modeling of the physical effects, has been investigated in detail. The investigated model is based on two components related to megavoltage photon beams; one describing the exiting energy fluence per delivered MU, and a second component describing the dose deposition through a pencil kernel algorithm solely based on a measured beam quality index. Together with the output calculations, the basis of a method aiming to predict the inherent calculation uncertainties in individual treatment setups has been developed. This has all emerged from the intention of creating a clinical dose/MU verification tool that requires an absolute minimum of commissioned input data. This evaluation was focused on irregular field shapes and performed through comparison with output factors measured at 5, 10, and 20 cm depth in ten multileaf collimated fields on four different linear accelerators with varying multileaf collimator designs. The measurements were performed both in air and in water and the results of the two components of the model were evaluated separately and combined. When compared with the corresponding measurements the resulting deviations in the calculated output factors were in most cases smaller than 1% and in all cases smaller than 1.7%. The distribution describing the calculation errors in the total dose output has a mean value of -0.04% and a standard deviation of 0.47%. In the dose calculations a previously developed correction of the pencil kernel was applied that managed to contract the error distribution considerably. A detailed analysis of the predicted uncertainties versus the observed deviations suggests that the predictions indeed can be used as a basis for creating action levels and tracking dose calculation errors in homogeneous media.

Determination of the initial beam parameters in Monte Carlo linac simulation

For Monte Carlo linac simulations and patient dose calculations, it is important to accurately determine the phase space parameters of the initial electron beam incident on the target. These parameters, such as mean energy and radial intensity distribution, have traditionally been determined by matching the calculated dose distributions with the measured dose distributions through a trial and error process. This process is very time consuming and requires a lot of Monte Carlo simulation experience and computational resources. In this paper, we propose an easy, efficient, and accurate method for the determination of the initial beam parameters. We hypothesize that (1) for one type of linacs, the geometry and material of major components of the treatment head are the same; the only difference is the phase space parameters of the initial electron beam incident on the target, and (2) most linacs belong to a limited number of linac types. For each type of linacs, Monte Carlo treatment planning system (MC-TPS) vendors simulate the treatment head and calculate the three-dimensional (3D) dose distribution in water phantom for a grid of initial beam energies and radii. The simulation results (phase space files and dose distribution files) are then stored in a data library. When a MC-TPS user tries to model their linac which belongs to the same type, a standard set of measured dose data is submitted and compared with the calculated dose distributions to determine the optimal combination of initial beam energy and radius. We have applied this method to the 6 MV beam of a Varian 21EX linac. The linac was simulated using EGSNRC/BEAM code and the dose in water phantom was calculated using EGSNRC/DOSXYZ. We have also studied issues related to the proposed method. Several common cost functions were tested for comparing measured and calculated dose distributions, including chi2, mean absolute error, dose difference at the penumbra edge point, slope of the dose difference of the lateral profile, and the newly proposed Kappaalpha factor (defined as the fraction of the voxels with absolute dose difference less than alpha%). It was found that the use of the slope of the lateral profile difference or the difference of the penumbra edge points may lead to inaccurate determination of the initial beam parameters. We also found that in general the cost function value is very sensitive to the simulation statistical uncertainty, and there is a tradeoff between uncertainty and specificity. Due to the existence of statistical uncertainty in simulated dose distributions, it is practically impossible to determine the best energy/radius combination; we have to accept a group of energy/radius combinations. We have also investigated the minimum required data set for accurate determination of the initial beam parameters. We found that the percent depth dose curves along or only a lateral profile at certain depth for a large field size is not sufficient and the minimum data set should include several lateral profiles at various depths as well as the central axis percent depth dose curve for a large field size.

Measurement of head scatter factors of linear accelerators with columnar miniphantoms

The measurement of linear accelerator head scatter factors or in-air output factors, Sc, with columnar miniphantoms is refined in this work. Columnar miniphantoms are constructed from water equivalent materials: solid water and M3, and materials with higher mass density and atomic number: copper and lead. The change in the value of Sc from a 4-cm X 4-cm to a 40-cm X 40-cm field is different by 22% +/- 3%, 18% +/- 2%, and 10% +/- 3% for 6, 15, and 23 MV x rays, respectively, when measured with water equivalent or lead miniphantoms of 10 gm/cm2 depth. Based on measurements of transmission factors in solid-water miniphantoms of different depths, it is demonstrated that the beam energy spectra decreases in energy with increased field size. These changes in beam energy spectra alter the transmission and scatter of radiation and buildup of the dose in the miniphantom even if the miniphantom is made of water-equivalent material. These changes underlie the alteration in Sc when measured by miniphantoms fabricated from materials of different atomic number. It is shown that miniphantoms designed with a depth just adequate to stop contamination electrons will minimize these distortions due to transmission and scatter of radiation and buildup of dose in the miniphantom. Use of a miniphantom constructed from water-equivalent material with a depth appropriate for the x-ray energy being measured is the preferred method for determining Sc for dosimetry in water.

Modelling of output factors for conformal megavoltage X-ray beams

A method is described for calculating the output from conformally shaped megavoltage X-ray beams. The model has been developed for Varian accelerators but is shown to work for accelerators from another manufacturer. The use of dynamic wedging and both static and dynamic multileaf collimated beams are included in the model. For any linear accelerator, the data required are a set of measured output factors for square beams, an in-air profile and a limited number of readily available parameters defining the geometry of the head of the accelerator. The three components of the output, namely primary, head scatter and phantom scatter are modelled and calculated individually for any point in a beam. An optimization procedure is developed that automatically determines the eight parameters required to model an accelerator in order for these calculations to be performed. The performance of the method is demonstrated for shaped beams using asymmetric and multileaf collimation, both with and without wedging, and for a range of beam energies. The model has been incorporated into a computer program that is used clinically.

Monte Carlo source model for photon beam radiotherapy: photon source characteristics

A major barrier to widespread clinical implementation of Monte Carlo dose calculation is the difficulty in characterizing the radiation source within a generalized source model. This work aims to develop a generalized three-component source model (target, primary collimator, flattening filter) for 6- and 18-MV photon beams that match full phase-space data (PSD). Subsource by subsource comparison of dose distributions, using either source PSD or the source model as input, allows accurate source characterization and has the potential to ease the commissioning procedure, since it is possible to obtain information about which subsource needs to be tuned. This source model is unique in that, compared to previous source models, it retains additional correlations among PS variables, which improves accuracy at nonstandard source-to-surface distances (SSDs). In our study, three-dimensional (3D) dose calculations were performed for SSDs ranging from 50 to 200 cm and for field sizes from 1 x 1 to 30 x 30 cm2 as well as a 10 x 10 cm2 field 5 cm off axis in each direction. The 3D dose distributions, using either full PSD or the source model as input, were compared in terms of dose-difference and distance-to-agreement. With this model, over 99% of the voxels agreed within +/-1% or 1 mm for the target, within 2% or 2 mm for the primary collimator, and within +/-2.5% or 2 mm for the flattening filter in all cases studied. For the dose distributions, 99% of the dose voxels agreed within 1% or 1 mm when the combined source model-including a charged particle source and the full PSD as input-was used. The accurate and general characterization of each photon source and knowledge of the subsource dose distributions should facilitate source model commissioning procedures by allowing scaling the histogram distributions representing the subsources to be tuned.

Photon-beam subsource sensitivity to the initial electron-beam parameters

One limitation to the widespread implementation of Monte Carlo (MC) patient dose-calculation algorithms for radiotherapy is the lack of a general and accurate source model of the accelerator radiation source. Our aim in this work is to investigate the sensitivity of the photon-beam subsource distributions in a MC source model (with target, primary collimator, and flattening filter photon subsources and an electron subsource) for 6- and 18-MV photon beams when the energy and radial distributions of initial electrons striking a linac target change. For this purpose, phase-space data (PSD) was calculated for various mean electron energies striking the target, various normally distributed electron energy spread, and various normally distributed electron radial intensity distributions. All PSD was analyzed in terms of energy, fluence, and energy fluence distributions, which were compared between the different parameter sets. The energy spread was found to have a negligible influence on the subsource distributions. The mean energy and radial intensity significantly changed the target subsource distribution shapes and intensities. For the primary collimator and flattening filter subsources, the distribution shapes of the fluence and energy fluence changed little for different mean electron energies striking the target, however, their relative intensity compared with the target subsource change, which can be accounted for by a scaling factor. This study indicates that adjustments to MC source models can likely be limited to adjusting the target subsource in conjunction with scaling the relative intensity and energy spectrum of the primary collimator, flattening filter, and electron subsources when the energy and radial distributions of the initial electron-beam change.

Dosimetric verification of IMRT treatment planning using Monte Carlo simulations for prostate cancer

The purpose of this work is to investigate the accuracy of dose calculation of a commercial treatment planning system (Corvus, Normos Corp., Sewickley, PA). In this study, 30 prostate intensity-modulated radiotherapy (IMRT) treatment plans from the commercial treatment planning system were recalculated using the Monte Carlo method. Dose-volume histograms and isodose distributions were compared. Other quantities such as minimum dose to the target (D(min)), the dose received by 98% of the target volume (D98), dose at the isocentre (D(iso)), mean target dose (D(mean)) and the maximum critical structure dose (D(max)) were also evaluated based on our clinical criteria. For coplanar plans, the dose differences between Monte Carlo and the commercial treatment planning system with and without heterogeneity correction were not significant. The differences in the isocentre dose between the commercial treatment planning system and Monte Carlo simulations were less than 3% for all coplanar cases. The differences on D98 were less than 2% on average. The differences in the mean dose to the target between the commercial system and Monte Carlo results were within 3%. The differences in the maximum bladder dose were within 3% for most cases. The maximum dose differences for the rectum were less than 4% for all the cases. For non-coplanar plans, the difference in the minimum target dose between the treatment planning system and Monte Carlo calculations was up to 9% if the heterogeneity correction was not applied in Corvus. This was caused by the excessive attenuation of the non-coplanar beams by the femurs. When the heterogeneity correction was applied in Corvus, the differences were reduced significantly. These results suggest that heterogeneity correction should be used in dose calculation for prostate cancer with non-coplanar beam arrangements.

Derivation of the distribution of extrafocal radiation for head scatter factor calculation

Head scatter factors for high energy photon beams from linear accelerators can be modeled using a two-source model consisting of focal and extrafocal radiation. The focal radiation can be approximated as a point source, and the distribution of the extrafocal radiation is a two-dimensional (2D) radial symmetric function. Various methods, including analytical, Monte Carlo, and empirical trial functions, have been used to determine the radial symmetric function of extrafocal radiation distribution. This article describes a method for directly determining the extrafocal radiation distribution without assuming any empirical trial function. The extrafocal radiation distribution is determined with measured head scatter factors for rectangular fields defined by the lower jaw (X) fixed at 40 cm and the upper jaw (Y) varying from 3 to 40 cm. The derivatives of the measured head scatter factors, with respect to the Y jaw position projected in the plane of extrafocal radiation, are proportional to the one-dimensional (1D) projection (also called the line spread function) of the extrafocal radiation distribution. Two methods are used to solve the radial function of extrafocal radiation from the 1D projection. The first method uses a 2D filtered backprojection algorithm, originally developed for parallel beam computed tomography reconstruction, to directly derive the radial dependence of the extrafocal radiation distribution. The method has been applied to 6 and 18 MV photon beams from a Siemens linear accelerator and has been tested by comparing measured and calculated head scatter factors for square and rectangular fields. The second method uses a Fourier transform followed by a Fourier-Bessel transform to solve the problem. The distributions of extrafocal radiation derived from these two methods are virtually identical.

Modelling of electron contamination in clinical photon beams for Monte Carlo dose calculation

The purpose of this work is to model electron contamination in clinical photon beams and to commission the source model using measured data for Monte Carlo treatment planning. In this work, a planar source is used to represent the contaminant electrons at a plane above the upper jaws. The source size depends on the dimensions of the field size at the isocentre. The energy spectra of the contaminant electrons are predetermined using Monte Carlo simulations for photon beams from different clinical accelerators. A 'random creep' method is employed to derive the weight of the electron contamination source by matching Monte Carlo calculated monoenergetic photon and electron percent depth-dose (PDD) curves with measured PDD curves. We have integrated this electron contamination source into a previously developed multiple source model and validated the model for photon beams from Siemens PRIMUS accelerators. The EGS4 based Monte Carlo user code BEAM and MCSIM were used for linac head sinulation and dose calculation. The Monte Carlo calculated dose distributions were compared with measured data. Our results showed good agreement (less than 2% or 2 mm) for 6, 10 and 18 MV photon beams.

Output ratio in air for MLC shaped irregular fields

For accurate monitor unit calculation, it is important to calculate the output ratio in air, Sc, for an irregular field shaped by MLC. We have developed an algorithm to calculate Sc based on an empirical model [Med. Phys. 28, 925-937 (2001)] by projecting each leaf position to the isocenter plane. Thus it does not require the exact knowledge of the head geometry. Comparisons were made for three different types of MLC: those with MLC replacing the inner collimator jaws; those with MLC replacing the outer collimator jaws; and those with MLC as a tertiary attachment. When the MLC leaf positions are substantially different from the secondary collimators (or the rectangular field encompassing the irregular field), one observes an up to 5% difference in the value of head-scatter correction factor, HCF, defined as the ratio of output ratio in air between the MLC shaped irregular field and that of the rectangular field encompassing the irregular field. No collimator exchange effect was observed for rectangular fields shaped by MLC (e.g., 5x30 and 30x5 cm2 diagonal) when the secondary collimators are fixed, unlike that for the rectangular fields shaped by the inner and outer collimator jaws, where it can be 1-2%. For the same MLC shaped irregular field, the value of Sc increases from the Elekta, to the Siemens, to the Varian accelerators, with an up to 4% difference. The calculation agrees with measurement to within 1.2% for points both on and off the central-axis. The fitting parameters used in the algorithm are derived from measurements for square field sizes on the central-axis.

Optimization of combined electron and photon beams for breast cancer

Recently, intensity-modulated radiation therapy and modulated electron radiotherapy have gathered a growing interest for the treatment of breast and head and neck tumours. In this work, we carried out a study to combine electron and photon beams to achieve differential dose distributions for multiple target volumes simultaneously. A Monte Carlo based treatment planning system was investigated, which consists of a set of software tools to perform accurate dose calculation, treatment optimization, leaf sequencing and plan analysis. We compared breast treatment plans generated using this home-grown optimization and dose calculation software for different treatment techniques. Five different planning techniques have been developed for this study based on a standard photon beam whole breast treatment and an electron beam tumour bed cone down. Technique 1 includes two 6 MV tangential wedged photon beams followed by an anterior boost electron field. Technique 2 includes two 6 MV tangential intensity-modulated photon beams and the same boost electron field. Technique 3 optimizes two intensity-modulated photon beams based on a boost electron field. Technique 4 optimizes two intensity-modulated photon beams and the weight of the boost electron field. Technique 5 combines two intensity-modulated photon beams with an intensity-modulated electron field. Our results show that technique 2 can reduce hot spots both in the breast and the tumour bed compared to technique 1 (dose inhomogeneity is reduced from 34% to 28% for the target). Techniques 3, 4 and 5 can deliver a more homogeneous dose distribution to the target (with dose inhomogeneities for the target of 22%, 20% and 9%, respectively). In many cases techniques 3, 4 and 5 can reduce the dose to the lung and heart. It is concluded that combined photon and electron beam therapy may be advantageous for treating breast cancer compared to conventional treatment techniques using tangential wedged photon beams followed by a boost electron field.

Clinical implementation of intensity-modulated tangential beam irradiation for breast cancer

A Monte Carlo based intensity-modulated radiation therapy (IMRT) treatment planning system has been developed and used for breast treatment. An iterative method was used for optimization to generate IMRT plans and a step-and-shoot technique was used for beam delivery. The patient setup and incident beam directions were the same as those for conventional tangential photon treatment. The weights for the opposed beamlets in the two tangential beams were determined first by the doses at the depths of the maximum dose at both sides to minimize hot spots. The intensity of an individual beamlet pair was then optimized based on the dose at the midplane. Fine tuning was made to achieve optimal target dose uniformity and to reduce the dose to the heart when necessary. The final dose calculations were performed using the Monte Carlo method and the plans were verified by phantom measurements. The dose distributions and dose-volume-histograms of IMRT plans were compared with those of conventional plans that were generated using a commercial treatment planning system and recalculated using an in-house Monte Carlo system for the first 25 patients. The dose comparisons showed that the percentage volume receiving more than 95% of the prescription dose (V95) and the percentage volume receiving more than 100% of the prescription dose (V100) for the clinical target volume (CTV) of IMRT plans were about the same as those of conventional plans. The percentage volume receiving more than 105% of the prescription dose (V105) for the CTV was reduced from 23.1% to 7.9% on average. The percentage volume of the lung receiving more than 20 Gy dose (V20 Gy) during the entire treatment was reduced by about 10%. The percentage volume of the heart receiving more than 30 Gy dose (V30 Gy) is reduced from 3.3% to 0.3%. Further studies revealed that a less than 5 degrees change in couch angle and collimator angle at patient setup had no significant effect on the dose coverage of CTV but had significant effect on the dose to the lung and heart. The study on the effect of beam spoiler showed that it increased the dose at the buildup region by 0- 13% that varies with location. The machine output linearity and stability for small monitor unit delivery of Siemens accelerators used for this study was checked and found to be suitable for breast IMRT. The total effect of variations was calculated to be less than 1% for typical breast treatments. The beam delivery time was increased by about 2 min compared with conventional tangential treatments. The whole treatment including patient setup and beam delivery can be completed in a 15 min slot. The IMRT technique has been proven practical for breast treatment clinically. The results showed that tangential IMRT improved the dose homogeneity in the breast and reduced the dose to the lung and heart.

Summary and recommendations of a National Cancer Institute workshop on issues limiting the clinical use of Monte Carlo dose calculation algorithms for megavoltage external beam radiation therapy

Due to the significant interest in Monte Carlo dose calculations for external beam megavoltage radiation therapy from both the research and commercial communities, a workshop was held in October 2001 to assess the status of this computational method with regard to use for clinical treatment planning. The Radiation Research Program of the National Cancer Institute, in conjunction with the Nuclear Data and Analysis Group at the Oak Ridge National Laboratory, gathered a group of experts in clinical radiation therapy treatment planning and Monte Carlo dose calculations, and examined issues involved in clinical implementation of Monte Carlo dose calculation methods in clinical radiotherapy. The workshop examined the current status of Monte Carlo algorithms, the rationale for using Monte Carlo, algorithmic concerns, clinical issues, and verification methodologies. Based on these discussions, the workshop developed recommendations for future NCI-funded research and development efforts. This paper briefly summarizes the issues presented at the workshop and the recommendations developed by the group.