Superheated drop detector for determination of neutron dose equivalent to patients undergoing high-energy x-ray and electron radiotherapy

Peripheral Doses Beyond Electron Applicators in Conventional C-Arm Linear Accelerators: A Systematic Literature Review

Background: This review investigates peripheral dose levels in electron beam treatments, comparing different manufacturers including Varian, Elekta, and Siemens. Accurate measurement of peripheral dose is vital for patient safety and precise radiation delivery in radiation therapy. Methods: This review followed PRISMA standards, conducting a comprehensive literature search from 1978 to July 2023. Emphasis was on identifying studies analyzing peripheral doses related to various electron beam energies, beam angle, field sizes, cutouts, and applicator combinations. Three major databases including PubMed, Web of Science, and Scopus were searched. Results: A total of 7 articles were included in this review. Strategies such as bolus materials, personalized cutouts, and optimal treatment procedures have all been developed to reduce peripheral radiation exposure and enhance patient safety. Ongoing research in this field is focused on further minimizing the risks associated with out-of-field radiation by improving dose delivery systems. Conclusion: The literature emphasizes importance of precision in electron beam radiation therapy, highlighting the critical need for managing peripheral doses and optimizing hardware to ensure patient safety. It advocates for the use of advanced tools and protocols to maintain a balance between effective treatment while protecting healthy tissues. Continuous research, careful treatment planning, and effective management of peripheral doses are essential.

Dosimetric study to assess the feasibility of intraoperative radiotherapy with electrons (ELIOT) as partial breast irradiation for patients with cardiac implantable electronic device (CIED)

PURPOSE

To report in-vivo dosimetry in the infraclavicular region, a potential site of a cardiac implantable electronic device (CIED) and to evaluate the absorbed dose from intraoperative radiotherapy with electrons (ELIOT).

METHODS

27 non-cardiopathic breast cancer (BC) patients without CIED received quadrantectomy and ELIOT as partial breast irradiation. Before delivering ELIOT, two catheters, each containing eight thermoluminescent dosimeters (TLDs), were positioned in the infraclavicular region. TLDs internal catheter was located deep in the tumor bed while the external catheter was placed on patient's skin.

RESULTS

Data were available for 24/27 patients. The absorbed doses were referred to the dose of 21 Gy. Values measured by the external catheter were low, although statistically significant higher doses were found close to the applicator (mean values 0.26-0.49 Gy). External TLD doses in proximity of the applicator were lower than those detected by their internal counterparts. Values measured by the internal catheter TLDs varied according to the distance from the applicator while no correlation with tumor site and beam energy was found. The distance from the applicator to deliver < 2 Gy to a CIED was 2 cm, while from 2.5 cm the dose measured in all the patients became negligible.

CONCLUSIONS

This dosimetric study provided data to support the clinical use of ELIOT in BC patients having CIEDs as long as the suggested minimum safe distance of 2.5 cm is taken from the RT field in case of ELIOT single dose of 21 Gy, in the energy range of 6-10 MeV.

Out-of-field doses and neutron dose equivalents for electron beams from modern Varian and Elekta linear accelerators

Out-of-field doses from radiotherapy can cause harmful side effects or eventually lead to secondary cancers. Scattered doses outside the applicator field, neutron source strength values, and neutron dose equivalents have not been broadly investigated for high-energy electron beams. To better understand the extent of these exposures, we measured out-of-field dose characteristics of electron applicators for high-energy electron beams on two Varian 21iXs, a Varian TrueBeam, and an Elekta Versa HD operating at various energy levels. Out-of-field dose profiles and percent depth-dose curves were measured in a Wellhofer water phantom using a Farmer ion chamber. Neutron dose was assessed using a combination of moderator buckets and gold activation foils placed on the treatment couch at various locations in the patient plane on both the Varian 21iX and Elekta Versa HD linear accelerators. Our findings showed that out-of-field electron doses were highest for the highest electron energies. These doses typically decreased with increasing distance from the field edge but showed substantial increases over some distance ranges. The Elekta linear accelerator had higher electron out-of-field doses than the Varian units examined, and the Elekta dose profiles exhibited a second dose peak about 20 to 30 cm from central-axis, which was found to be higher than typical out-of-field doses from photon beams. Electron doses decreased sharply with depth before becoming nearly constant; the dose was found to decrease to a depth of approximately E(MeV)/4 in cm. With respect to neutron dosimetry, Q values and neutron dose equivalents increased with electron beam energy. Neutron contamination from electron beams was found to be much lower than that from photon beams. Even though the neutron dose equivalent for electron beams represented a small portion of neutron doses observed under photon beams, neutron doses from electron beams may need to be considered for special cases.

Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO)

Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

Study on bubble detectors used as personal neutron dosimeters

Neutron bubble detector is so far the only personal neutron dosimeter satisfying the energy response criteria of the International Committee of Radiation Protection 60 (ICRP 60). This paper presents our studies on neutron bubble detectors including the manufacture, the relevant equipments, the basic calibrations and on-site tests for monitoring personal neutron dose. The results of calibrations show that the highest sensitivity so far manufactured by the authors reaches about 4bubbles/μSv, the correlation coefficient of dose response is 0.99, and the in-batch consistency and reproducibility are up to the ISO standards. The results of on-site test show that the in-batch consistency and between-batch consistency are within 15% relative standard uncertainty. The results are directly readable. The detectors are portable, especially suitable for on-site neutron dose monitoring in n-γ mixed radiation fields.

The measurement of photoneutron dose in the vicinity of clinical linear accelerators

In Brazil, the replacement of rather old cobalt and cesium teletherapy machines with high-energy (E > 10 MV) medical linear accelerators (linacs) started in the year 2000, as part of an effort by the Ministry of Health to update radiotherapy installations. Since then, the contamination of undesirable neutrons in the therapeutic beam generated by these high-energy photons has become an issue of concern when considering patient and occupational doses. The walls of the treatment room are shielded to attenuate the primary and secondary X-ray fluence, and this shielding is generally considered adequate also to attenuate neutrons. However, these neutrons are scattered through the treatment room maze and might result in a radiological problem at the door entrance, an area of high occupancy by the workers of a radiotherapy facility. This paper presents and discusses the results of ambient dose equivalent measurements of neutron using bubble detectors. The measurements were made at different points inside the treatment rooms, including the isocentre and the maze. Several radiation oncology centres, which are users of Varian Clinac or Siemens machines, have agreed to allow measurements to be taken at their facilities. The measured values were compared with the results obtained through the semi-empirical Kersey method of neutron dose equivalent calculation at maze entrances, with reported values provided by the manufacturers as well as values published in the literature. It was found that the measured values were below the dose limits adopted by the Brazilian Regulatory Agency (CNEN), requiring no additional shielding in any of the points measured.

Monte Carlo study of Siemens PRIMUS photoneutron production

Neutron production in radiotherapy facilities has been studied from the early days of modern linacs. Detailed studies are now possible using photoneutron capabilities of general-purpose Monte Carlo codes at energies of interest in medical physics. The present work studies the effects of modelling different accelerator head and room geometries on the neutron fluence and spectra predicted via Monte Carlo. The results from the simulation of a 15 MV Siemens PRIMUS linac show an 80% increase in the fluence scored at the isocentre when, besides modelling the components necessary for electron/photon simulations, other massive accelerator head components are included. Neutron fluence dependence on inner treatment room volume is analysed showing that thermal neutrons have a 'gaseous' behaviour and then a 1/V dependence. Neutron fluence maps for three energy ranges, fast (E > 0.1 MeV), epithermal (1 eV < E < 0.1 MeV) and thermal (E < 1 eV), are also presented and the influence of the head components on them is discussed.

A neutron dosemeter for nuclear criticality accidents

A neutron dosemeter which offers instant read-out has been developed for nuclear criticality accidents. The system is based on gels containing emulsions of superheated dichlorodifluoromethane droplets, which vaporise into bubbles upon neutron irradiation. The expansion of these bubbles displaces an equivalent volume of gel into a graduated pipette, providing an immediate measure of the dose. Instant read-out is achieved using an array of transmissive optical sensors which consist of coupled LED emitters and phototransistor receivers. When the gel displaced in the pipette crosses the sensing region of the photomicrosensors, it generates a signal collected on a computer through a dedicated acquisition board. The performance of the device was tested during the 2002 International Accident Dosimetry Intercomparison in Valduc, France. The dosemeter was able to follow the initial dose gradient of a simulated accident, providing accurate values of neutron kerma; however, the emulsion was rapidly depleted of all its drops. A model of the depletion effects was developed and it indicates that an adequate dynamic range of the dose response can be achieved by using emulsions of smaller droplets.

Are neutrons responsible for the dose discrepancies between Monte Carlo calculations and measurements in the build-up region for a high-energy photon beam?

This study presents measured neutron dose using a neutron dosimeter in a water phantom and investigates a hypothesis that neutrons in a high-energy photon beam may be responsible for the reported significant dose discrepancies between Monte Carlo calculations and measurements at the build-up region in large fields. Borated polyethylene slabs were inserted between the accelerator head and the phantom in order to remove neutrons generated in the accelerator head. The thickness of the slab ranged from 2.5 cm to 10 cm. A lead slab of 3 mm thickness was also used in the study. The superheated drop neutron dosimeter was used to measure the depth-dose curve of neutrons in a high-energy photon beam and to verify the effectiveness of the slab to remove these neutrons. Total dose measurements were performed in water using a WELLHOFER WP700 beam scanner with an IC-10 ionization chamber. The Monte Carlo code BEAM was used to simulate an 18 MV photon beam from a Varian Clinac-2100EX accelerator. Both EGS4/DOSXYZ and EGSnrc/DOSRZnrc were used in the dose calculations. Measured neutron dose equivalents as a function of depth per unit total dose in water were presented for 10 x 10 and 40 x 40 cm2 fields. The measured results have shown that a 5-10 cm thick borated polyethylene slab can reduce the neutron dose by a factor of 2 when inserted between the accelerator head and the detector. In all cases the measured neutron dose equivalent was less than 0.5% of the photon dose. In order to study if the ion chamber was highly sensitive to the neutron dose, we have investigated the disagreement between the Monte Carlo calculated and measured central-axis depth-dose curves in the build-up region when different shielding materials were used. The result indicated that the IC-10 chamber was not highly sensitive to the neutron dose. Therefore, neutrons present in a high-energy photon beam were unlikely to be responsible for the reported discrepancies in the build-up region for large fields.

Energy spectra, angular spread, fluence profiles and dose distributions of 6 and 18 MV photon beams: results of monte carlo simulations for a varian 2100EX accelerator

The purpose of this study is to provide detailed characteristics of incident photon beams for different field sizes and beam energies. This information is critical to the future development of accurate treatment planning systems. It also enhances our knowledge of radiotherapy photon beams. The EGS4 Monte Carlo code, BEAM, has been used to simulate 6 and 18 MV photon beams from a Varian Clinac-2100EX accelerator. A simulated realistic beam is stored in a phase space data file, which contains details of each particle's complete history including where it has been and where it has interacted. The phase space files are analysed to obtain energy spectra, angular distribution, fluence profile and mean energy profiles at the phantom surface for particles separated according to their charge and history. The accuracy of a simulated beam is validated by the excellent agreement between the Monte Carlo calculated and measured dose distributions. Measured depth-dose curves are obtained from depth-ionization curves by accounting for newly introduced chamber fluence corrections and the stopping-power ratios for realistic beams. The study presents calculated depth-dose components from different particles as well as calculated surface dose and contribution from different particles to surface dose across the field. It is shown that the increase of surface dose with the increase of the field size is mainly due to the increase of incident contaminant charged particles. At 6 MV, the incident charged particles contribute 7% to 21% of maximum dose at the surface when the field size increases from 10 x 10 to 40 x 40 cm2. At 18 MV, their contributions are up to 11% and 29% of maximum dose at the surface for 10 x 10 cm2 and 40 x 40 cm2 fields respectively. However, the fluence of these incident charged particles is less than 1% of incident photon fluence in all cases.

Depth dose-equivalent and effective energies of photoneutrons generated by 6-18 MV X-ray beams for radiotherapy

Photoneutron production was investigated on Siemens KD 2 and Varian Clinac accelerators operating in the 6-18 MV range. Neutron dose equivalent rates were measured on the surface of a water phantom at the isocenter of the accelerators and also inside the phantom at depths of 1, 5, and 10 cm and off-axis distances of 0, 20, and 50 cm. Superheated drop detectors based on dichlorofluoromethane and etched-track detectors with boronated converters were employed in this study. The energy response of these detectors permits a direct measurement of dose equivalent without prior knowledge of the neutron energy spectra. Dose equivalent rates were assessed using the Q(L) relationship from ICRP publication 60, as well as using earlier data from ICRP publication 21. This permitted both a comparison with previously published data and an assessment of the impact of the recent ICRP recommendations--which were found to increase the dose equivalent levels by about 30%. In addition, the depth corresponding to 50% of maximum dose equivalent, dH50, was determined along the central axis of the beams and at 50 cm off-axis. Monte Carlo neutron transport calculations were performed to determine the depth-dose equivalent distributions in a phantom irradiated with monoenergetic neutrons. Effective energies of the photoneutron spectra were then estimated by comparing our measured dH50 values to those calculated for monoenergetic neutrons. It was found that the effective photoneutron energy is 1.8-2.1 MeV within the 10-18 MV x-ray beams, and it is 0.5-0.8 MeV for photoneutrons transmitted through the accelerator head. Data from this work cover most of the x-ray beam energies in clinical use and permit an assessment of integral dose values as well as specific organ doses to a radiotherapy patient.

A sensitive neutron dosimeter using superheated liquid

The present work relates to a sensitive neutron dosimeter, a device for monitoring neutron dose in some accelerator and reactor sites. This device is capable of measuring a neutron dose as small as 0.1 microSv using superheated liquid as a sensitive liquid. The nucleation was measured by the volumetric method developed in our laboratory. The dose response of superheated drops of four liquids having boiling points of 8.92, -29.79, -40.75 and -45.6 degrees C, irradiated by a 3 Ci Am-Be neutron source has also been presented in this article.

Shielding for neutron scattered dose to the fetus in patients treated with 18 MV x-ray beams

Neutrons are associated with therapeutic high energy x-ray beams as a contaminant that contributes significant unwanted dose to the patient. Measurement of both photon and neutron scattered dose at the position of a fetus from chest irradiation by a large field 18 MV x-ray beam was performed using an ionization chamber and superheated drop detector, respectively. Shielding construction to reduce this scattered dose was investigated using both lead sheet and borated polyethylene slabs. A 7.35 cm lead shield reduced the scattered photon dose by 50% and the scattered neutron dose by 40%. Adding 10 cm of 5% borated polyethylene to this lead shield reduced the scattered neutron dose by a factor of 7.5 from the unshielded value. When the 5% borated polyethylene was replaced by the same thickness of 30% borated polyethylene there was no significant change in the reduction of neutron scatter dose. The most efficient shield studied reduced the neutron scatter dose by a factor of 10. The results indicate that most of the scattered neutrons present at the position of the fetus produced by an 18 MV x-ray beam are of low energy and in the thermal to 0.57 MeV range since lead is almost transparent to neutrons with energies lower than 0.57 MeV. This article constitutes the first report of an effective shield to reduce neutron dose at the fetus when treating a pregnant woman with a high energy x-ray beam.

Comparison of superheated drop detector with phosphorous pentoxide powder for the detection of neutrons in 18 MV x rays

Neutron dose equivalent measurements were performed in and around an 18 MV x-ray beam using superheated drop detectors (SDD) and phosphorous pentoxide (P2O5) powder. The neutron dose equivalent profiles for various field sizes of 10 X 10 cm2, 20 X 20 cm2, and 30 X 30 cm2 were measured. The results measured with the P2O5 were checked for any gross systematic errors by comparing with the published results computed by using Monte Carlo calculations. A comparison was then made between the neutron dose equivalent profiles measured with the P2O5 and the SDD. The results of this comparison show that the neutron dose equivalents measured with the two types of detectors agree with each other for measurements about 20 cm away from the beam edges. However, in and near the beam edges the SDD measurements are upto 50% less than the neutron dose equivalents measured using P2O5 for the 18 MV x-ray beam.

In-phantom dosimetry and spectrometry of photoneutrons from an 18 MV linear accelerator

A combination of three superheated drop detectors with different neutron energy responses was developed to evaluate dose-equivalent and energy distributions of photoneutrons in a phantom irradiated by radiotherapy high-energy x-ray beams. One of the three detectors measures the total neutron dose equivalent and the other two measure the contributions from fast neutrons above 1 and 5.5 MeV, respectively. In order to test the new method, the neutron field produced by the 10 cm X 10 cm x-ray beam of an 18 MV radiotherapy accelerator was studied. Measurements were performed inside a tissue-equivalent liquid phantom, at depths of 1, 5, 10 and 15 cm and at lateral distances of 0, 10, and 20 cm from the central axis. These data were used to calculate the average integral dose to the radiotherapy patient from direct neutrons as well as from neutrons transmitted through the accelerator head. The characteristics of the dosimeters were confirmed by results in excellent agreement with those of prior studies. Track etch detectors were also used and provided an independent verification of the validity of this new technique. Within the primary beam, we measured a neutron entrance dose equivalent of 4.5 mSv per Gy of photons. It was observed that fast neutrons above 1 MeV deliver most of the total neutron dose along the beam axis. Their relative contribution increases with depth, from about 60% at the entrance to over 90% at a depth of 10 cm. Thus, the average energy increases with depth in the phantom as neutron spectra harden.

In vivo neutron dosimetry during high-energy Bremsstrahlung radiotherapy

PURPOSE

A new technique is presented for in vivo measurements of the dose equivalent from photoneutrons produced by high-energy radiotherapy accelerators.

METHODS AND MATERIALS

The dosimeters used for this purpose are vials of superheated halocarbon droplets suspended in a tissue-equivalent gel. Neutron interactions nucleate the formation of bubbles, which can be recorded through the volume of gel they displace from the detector vials into graduated pipettes. These detectors offer inherent photon discrimination, dose-equivalent response to neutrons, passive operation, and small sensitive size. An in vivo vaginal probe was fabricated containing one of these neutron detector vials and a photon-sensitive diode. Measurements were carried out in patients undergoing high-energy x-ray radiotherapy and were also repeated in-phantom, under similar irradiation geometries.

RESULTS AND CONCLUSION

Neutron doses of 0.02 Sv were measured in correspondence to the cervix, 50 cm from the photon beam axis, following a complete treatment course of 46.5 Gy with an upper mantle field of 18-MV x-rays. This fraction of dose from neutrons is measured reliably within an intense photon background, making the technique a valid solution to challenging dosimetry problems such as the determination of fetal exposure in radiotherapy. These measurements can be easily carried out with tissue-equivalent phantoms, as our results indicate an excellent correlation between in vivo and in-phantom dosimetry.

Comparison of measured and calculated peripheral doses in patients undergoing radiation therapy

BACKGROUND AND PURPOSE

Many papers have been published on the measurement for specific treatment machines and/or techniques of the dose to points outside the primary beam, often called the peripheral dose (PD). Most papers concern measurements in phantoms. We report on the results of a comparison of estimates of the PD, based on these phantom measurements, with PDs measured on patients.

MATERIAL AND METHODS

A special holder with thermoluminescent dosimeters was placed against the perineum of patients referred to our institute for radiation therapy. The measured dose was then compared with the dose calculated on the basis of published PD data.

RESULTS

For all measurements together, the calculated values exceeded the measured PDs by about 9%, with a standard deviation of 35%. The correlation varied between specific subgroups but the difference between measurement and calculation did not exceed 50%.

CONCLUSIONS

We conclude that published PD data can be used to accurately predict the peripheral dose in the clinical situation.

A simple and generally applicable method to estimate the peripheral dose in radiation teletherapy with high energy x-rays or gamma radiation

PURPOSE

Many articles have been published on the measurement of the dose to points outside the primary beam, often called the peripheral dose (PD), for instance, to the gonads, for specific treatment machines and/or techniques. We investigated the possibilities for developing a generalized method based on the data from several publications.

METHODS AND MATERIALS

The data from several publications were recalculated for a reference situation, then averaged, and the frequency distributions around the mean were determined. Published data were available for 60Co, 4, 6, 8, and 10 MV, and 18 to 25 MV for a large variety of treatment machines. Furthermore, an analysis of possible corrections for depth dependence, field elongation, irregularly shaped fields, wedges, and shielding blocks was carried out.

RESULTS

The frequency distributions of all published PD values for square fields for photon energies of 4 MV to 25 MV showed a standard deviation of 33%. The PD values of 60Co are significantly different with a standard deviation of 25%. A difference in the leakage radiation between cobalt machines and linear accelerators can possibly explain this difference, especially for large distances, where leakage radiation predominates. Taking the uncertainty of the risk factors into consideration, we conclude that the use of average values is justified. Although statistically not significant, the peripheral dose appears to be dependent on photon energy with a minimum around 6 MV.

CONCLUSIONS

It is possible to estimate the peripheral dose for photon energies of 4 MV to 25 MV with an accuracy of +/- 33%; for 60Co, the accuracy is even better. The variation of the PD between different treatment machines is so small that it is justified to use average PD values, irrespective of the treatment machine.