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

Comparison and estimation of photoneutron dose produce between 10 MV flattened and unflattened beam in Elekta Versa HD™ medical linac

BACKGROUND

In a high-energy medical linear accelerator (linac), if the interaction of photon energy is higher than the neutron binding energy of high atomic material, it emits a neutron field through photonuclear (γ, n) reaction.

AIM

The current study, evaluates the photoneutron dose equivalent (PNDE) produced between the 10 MV flattened and unflattened beams as a function of field sizes in the Elekta Versa HD™ linac.

MATERIALS AND METHODS

The PNDE produced from Versa linac was recorded along the patient plane using the bubble detector personal neutron dosimeter and from the measured PNDE values, the theoretical PNDE values were simulated for various field sizes using nonlinear least-squares curve-fitting as a function of a polynomial. The percentage of deviation (PoD) and Chi-square (χ2) tests were performed between the measured and simulated PNDE values to study the reliability and validity.

RESULTS

The results show that the mean PoD between the measured and simulated PNDE values for respective positions of a field size of FF beam was found to be -1.99% for 0.3×0.3, -4.39% for 5×5, -3.868% for 10×10, 0.590% for 15×15, 9.18% for 20×20, -4.133% for 25×25, and 0.467% for 30×30 cm2. Similarly, the mean PoD between the measured and simulated PNDE values for flattening filter-free (FFF) beam was found to be 1.36% for 0.3×0.3, -1.39% for 5×5, -5.38% for 10×10, 4.41% for 15×15, 3.84% for 20×20, 5.69% for 25×25, and -1.75% for 30×30 cm2. The maximum deviation between the measured and simulated PNDE values lies within the range ± 5%.

CONCLUSIONS

From the study, it is observed that the FFF beam produces lesser neutron contamination than the FF beam.

Measurement of neutron yield for a medical linear accelerator below 10 MV

BACKGROUND

The recent trend toward 10 MV for volumetric radiotherapy treatment such as volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), and stereotactic ablative body radiotherapy (SABR) introduces photoneutron production, with implications for non-therapeutic patient dose and additional shielding requirements for treatment room design. The sharply nonlinear drop-off in photoneutron production below 10 MV to negligible at 6 MV has scarcely been characterized quantitatively, yet can elucidate important practical insights.

PURPOSE

To measure photoneutron yields in a medical linac at 8 MV, which may strike a reasonable balance between usefully increased beam penetration and dose rate as compared to 6 MV while reducing photoneutron production which is present at 10 MV.

METHODS

A Varian iX linear accelerator undergoing decommissioning at our clinic was made to operate over a range of photon energies between 6 and 15 MV by calibrating the bending magnet and adjusting other beam generation parameters. Neutron dose within the treatment room was measured using an Anderson-Braun type detector over a continuum of intermediate energies.

RESULTS

The photoneutron production for energies below 10 MV was measured, adding to data that is otherwise scarce in the literature. Our results are consistent with previously published results for neutron yield. We found that the photoneutron production at 8 MV was about 1/10 of the value at 10 MV, and about 10 times higher than detector background at 6 MV.

CONCLUSIONS

Photoneutron production drops off below 10 MV, but is still present at 8 MV. An 8 MV beam is more penetrating than a 6 MV beam, and may offer a suitable tradeoff for modern radiotherapy techniques such as VMAT, SRS, and SABR. Further studies are needed to better understand the impact on treatment plan quality between 8 and 10 MV beams considering the benefits to facility requirements and non-therapeutic patient dose.

Breakthrough whole body energy-specific and tissue-specific photoneutron dosimetry by novel miniature neutron dosimeter/spectrometer

Breakthrough whole body energy-specific photoneutron (PN) dosimetry was made in/out-of-field in polyethylene phantom organ surface/depths remote from isocenter of 10 × 10 cm2 field prostate cancer therapy in 18 MV X-rays Varian Clinac 2100C medical linear accelerator for PN tissue-specific second primary cancer (PN-SPC) risk estimation. A novel miniature neutron dosimeter/spectrometer with polycarbonate/10B/cadmium inserts was invented and applied. Each dosimeter determines seven tissue-specific dose equivalent (mSv)/Gy X-ray dose at each measurement point providing seven major energy-specific responses for beam thermal, albedo thermal, total thermal, total epithermal, total fast, sum of totals (thermal + epithermal) and sum of totals (thermal + epithermal + fast) PNs dose equivalents. The neutron dosimeter is simple, efficient, and unique with high spatial resolution and provides matrix of energy-specific PN dose equivalent (mSv)/Gy X-ray dose on surface and organ depths for tissue-specific PN-SPC risk estimation. The dosimeter also performs like a "miniature neutron spectrometer" and is unique for other applications in health physics in particular individual neutron dosimetry, medical physics, space flights, science and technology.

Comparison of fast-neutron contamination of different models of Siemens medical linacs with CR-39 film

Background

Nowadays, radiotherapy has an important role in the treatment of cancer. The use of medical linacs in radiotherapy can have risks for patients. When radiotherapy is performed with photons with energies higher than 8 MeV, due to the photonuclear reaction of photons with various components in the head of the accelerator, the neutron is produced. This imposes an unwanted neutron dose to the patient. The purpose of this study is evaluation and comparison of fast-neutron contamination with increasing of field size and depth for Siemens Primus (15 MV), Siemens Primus Plus (18 MV), and Siemens Artiste (15 MV) linacs.

Materials and Methods

Neutron dosimetry was carried out with CR-39 films, as a fast-neutron dosimeter, using chemical etching technique. Measurements were performed in depths of 0.5, 2, 3, and 4 cm and source-to-surface distance of 100 cm. Field sizes were 10 cm × 10 cm and 30 cm × 30 cm.

Results

The results of measurements showed that, with increasing depth, equivalent dose is reduced. In addition, fast-neutron equivalent dose decreases with increasing the field size.

Conclusion

Siemens Primus Plus had the highest neutron contamination in comparison with the two other linacs. Deeper tissues receive less fast-neutron doses. In radiation therapy with high-energy photon beams, neutron dose delivered to the patients should be taking into account.

Photoneutron spectrometry by novel multi-directional spherical neutron spectrometry system

Neutron spectrometry in science and technology applications in general and accurate exotic photoneutron (PN) dosimetry of cancer patients undergoing high-dose high-energy X-rays therapy in medical accelerators in particular is of vital need. In this study, a novel passive multi-directional multi-detector neutron spectrometry system was developed and home-made using 6 polycarbonate/10B detectors on 6 sides of polyethylene (PE) cubes used bare and also embedded at center of PE spheres of 8 different diameters. The system provided well-resolved unfolded directional PN spectra showing thermal and fast PN peaks of 6 sides and mean spectrum in 5 field sizes at isocenter and other locations in 18 MV Siemens ONCOR medical linear accelerator bunker. The neutron spectrometry system developed has unique characteristics such as being simple, efficient, low cost, practical, and insensitive to low-LET radiation with well-resolved directional and mean spectra easily applicable in medicine, health, environment, science and technology in developing and developed laboratories.

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

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

Neutron track length estimator for GATE Monte Carlo dose calculation in radiotherapy

The out-of-field dose in radiation therapy is a growing concern in regards to the late side-effects and secondary cancer induction. In high-energy x-ray therapy, the secondary neutrons generated through photonuclear reactions in the accelerator are part of this secondary dose. The neutron dose is currently not estimated by the treatment planning system while it appears to be preponderant for distances greater than 50 cm from the isocenter. Monte Carlo simulation has become the gold standard for accurately calculating the neutron dose under specific treatment conditions but the method is also known for having a slow statistical convergence, which makes it difficult to be used on a clinical basis. The neutron track length estimator, a neutron variance reduction technique inspired by the track length estimator method has thus been developped for the first time in the Monte Carlo code GATE to allow a fast computation of the neutron dose in radiotherapy. The details of its implementation, as well as the comparison of its performances against the analog MC method, are presented here. A gain of time from 15 to 400 can be obtained by our method, with a mean difference in the dose calculation of about 1% in comparison with the analog MC method.

Advanced readout methods for superheated emulsion detectors

Superheated emulsions develop visible vapor bubbles when exposed to ionizing radiation. They consist in droplets of a metastable liquid, emulsified in an inert matrix. The formation of a bubble cavity is accompanied by sound waves. Evaporated bubbles also exhibit a lower refractive index, compared to the inert gel matrix. These two physical phenomena have been exploited to count the number of evaporated bubbles and thus measure the interacting radiation flux. Systems based on piezoelectric transducers have been traditionally used to acquire the acoustic (pressure) signals generated by bubble evaporation. Such systems can operate at ambient noise levels exceeding 100 dB; however, they are affected by a significant dead time (>10 ms). An optical readout technique relying on the scattering of light by neutron-induced bubbles has been recently improved in order to minimize measurement dead time and ambient noise sensitivity. Beams of infra-red light from light-emitting diode (LED) sources cross the active area of the detector and are deflected by evaporated bubbles. The scattered light correlates with bubble density. Planar photodiodes are affixed along the detector length in optimized positions, allowing the detection of scattered light from the bubbles and minimizing the detection of direct light from the LEDs. A low-noise signal-conditioning stage has been designed and realized to amplify the current induced in the photodiodes by scattered light and to subtract the background signal due to intrinsic scattering within the detector matrix. The proposed amplification architecture maximizes the measurement signal-to-noise ratio, yielding a readout uncertainty of 6% (±1 SD), with 1000 evaporated bubbles in a detector active volume of 150 ml (6 cm detector diameter). In this work, we prove that the intensity of scattered light also relates to the bubble size, which can be controlled by applying an external pressure to the detector emulsion. This effect can be exploited during the readout procedure to minimize shadowing effects between bubbles, which become severe when the latter are several thousands. The detector we used in this work is based on superheated C-318 (octafluorocyclobutane), emulsified in 100 μm ± 10% (1 SD) diameter drops in an inert matrix of approximately 150 ml. The detector was operated at room temperature and ambient pressure.

Photoneutron Dose Estimation in GRID Therapy Using an Anthropomorphic Phantom: A Monte Carlo Study

Background:

In the past, GRID therapy was used as a treatment modality for the treatment of bulky and deeply seated tumors with orthovoltage beams. Now and with the introduction of megavoltage beams to radiotherapy, some of the radiotherapy institutes use GRID therapy with megavoltage photons for the palliative treatment of bulky tumors. Since GRID can be a barrier for weakening the photoneutrons produced in the head of medical linear accelerators (LINAC), as well as a secondary source for producing photoneutrons, therefore, in terms of radiation protection, it is important to evaluate the GRID effect on photoneutron dose to the patients.

Methods:

In this study, using the Monte Carlo code MCNPX, a full model of a LINAC was simulated and verified. The neutron source strength of the LINAC (Q), the distributions of flux (φ), and ambient dose equivalent (H*[10]) of neutrons were calculated on the treatment table in both cases of with/without the GRID. Finally, absorbed dose and dose equivalent of neutrons in some of the tissues/organs of MIRD phantom were computed with/without the GRID.

Results:

Our results indicate that the GRID increases the production of the photoneutrons in the LINAC head only by 0.3%. The calculations in the MIRD phantom show that neutron dose in the organs/tissues covered by the GRID is on average by 48% lower than conventional radiotherapy. In addition, in the uncovered organs (by the GRID), this amount is reduced to 25%.

Conclusion:

Based on the findings of this study, in GRID therapy technique compared to conventional radiotherapy, the neutron dose in the tissues/organs of the body is dramatically reduced. Therefore, there will be no concern about the GRID effect on the increase of unwanted neutron dose, and consequently the risk of secondary cancer.

EFFECTS OF FIELD SIZE AND DEPTH ON PHOTONEUTRON DOSE EQUIVALENT DISTRIBUTIONS IN AN 18 MV X-RAY MEDICAL ACCELERATOR

Photoneutron (PN) dosimetry studies in high-energy X-ray medical accelerators are of high clinical and scientific interest in particular to protect patients undergoing radiotherapy. In this context, fast, epithermal and thermal PN dose equivalent distributions in different field sizes and depths in air and in a multilayer polyethylene phantom were studied. Polycarbonate track dosemeters in contact with a 10B convertor (with or without cadmium cover) when electrochemically etched were applied. PN dose equivalents in air and on the surface of the phantom are linear functions of field size. PN depth dose equivalents versus depth in air at the central axis are almost constant. Fast, epithermal and thermal PN dose equivalent responses versus depth in phantom peak respectively at 0.0, ~3.0 and ~3.0 cm while that of the sum PN dose equivalent value (3.32 ± 0.19 mSv·Gy-1) peaks at ~1 cm. These values confirm those of some studies but contract some others.

Fast, epithermal and thermal photoneutron dosimetry in air and in tissue equivalent phantom for a high-energy X-ray medical accelerator

Photoneutron (PN) dosimetry in fast, epithermal and thermal energy ranges originated from the beam and albedo neutrons in high-energy X-ray medical accelerators is highly important from scientific, technical, radiation protection and medical physics points of view. Detailed dose equivalents in the fast, epithermal and thermal PN energy ranges in air up to 2m as well as at 35 positions from the central axis of 12 cross sections of the phantom at different depths were determined in 18MV X-ray beams of a Siemens ONCOR accelerator. A novel dosimetry method based on polycarbonate track dosimeters (PCTD)/¹⁰B (with/without cadmium cover) was used to determine and separate different PN dose equivalents in air and in a multilayer polyethylene phantom. Dose equivalent distributions of PNs, as originated from the main beam and/or albedo PNs, on cross-plane, in-plane and diagonal axes in 10cm×10cm fields are reported. PN dose equivalent distributions on the 3 axes have their maxima at the isocenter. Epithermal and thermal PN depth dose equivalent distributions in the phantom for different positions studied peak at ∼3cm depth. The neutron dosimeters used for the first time in such studies are highly effective for separating dose equivalents of PNs in the studied energy ranges (beam and/or albedo). The PN dose equivalent data matrix made available in this paper is highly essential for detailed patient dosimetry in general and for estimating secondary cancer risks in particular.

MCNP6 model of the University of Washington clinical neutron therapy system (CNTS)

A MCNP6 dosimetry model is presented for the Clinical Neutron Therapy System (CNTS) at the University of Washington. In the CNTS, fast neutrons are generated by a 50.5 MeV proton beam incident on a 10.5 mm thick Be target. The production, scattering and absorption of neutrons, photons, and other particles are explicitly tracked throughout the key components of the CNTS, including the target, primary collimator, flattening filter, monitor unit ionization chamber, and multi-leaf collimator. Simulations of the open field tissue maximum ratio (TMR), percentage depth dose profiles, and lateral dose profiles in a 40 cm × 40 cm × 40 cm water phantom are in good agreement with ionization chamber measurements. For a nominal 10 × 10 field, the measured and calculated TMR values for depths of 1.5 cm, 5 cm, 10 cm, and 20 cm (compared to the dose at 1.7 cm) are within 0.22%, 2.23%, 4.30%, and 6.27%, respectively. For the three field sizes studied, 2.8 cm × 2.8 cm, 10.4 cm × 10.3 cm, and 28.8 cm × 28.8 cm, a gamma test comparing the measured and simulated percent depth dose curves have pass rates of 96.4%, 100.0%, and 78.6% (depth from 1.5 to 15 cm), respectively, using a 3% or 3 mm agreement criterion. At a representative depth of 10 cm, simulated lateral dose profiles have in-field (⩾ 10% of central axis dose) pass rates of 89.7% (2.8 cm × 2.8 cm), 89.6% (10.4 cm × 10.3 cm), and 100.0% (28.8 cm × 28.8 cm) using a 3% and 3 mm criterion. The MCNP6 model of the CNTS meets the minimum requirements for use as a quality assurance tool for treatment planning and provides useful insights and information to aid in the advancement of fast neutron therapy.

Peripheral photon and neutron doses from prostate cancer external beam irradiation

Peripheral photon and neutron doses from external beam radiotherapy (EBRT) are associated with increased risk of carcinogenesis in the out-of-field organs; thus, dose estimations of secondary radiation are imperative. Peripheral photon and neutron doses from EBRT of prostate carcinoma were measured in Rando phantom. (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P glass-rod thermoluminescence dosemeters (TLDs) were inserted in slices of a Rando phantom followed by exposure to 80 Gy with 18-MV photon four-field 3D-CRT technique. The TLDs were calibrated using 6- and 18-MV X-ray beam. Neutron dose equivalents measured with CR-39 etch-track detectors were used to derive readout-to-neutron dose conversion factor for (6)LiF:Mg,Cu,P TLDs. Average neutron dose equivalents per 1 Gy of isocentre dose were 3.8±0.9 mSv Gy(-1) for thyroid and 7.0±5.4 mSv Gy(-1) for colon. For photons, the average dose equivalents per 1 Gy of isocentre dose were 0.2±0.1 mSv Gy(-1) for thyroid and 8.1±9.7 mSv Gy(-1) for colon. Paired (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P TLDs can be used to measure photon and neutron doses simultaneously. Organs in close proximity to target received larger doses from photons than those from neutrons whereas distally located organs received higher neutron versus photon dose.

Monte Carlo characterizations mapping of the (γ,n) and (n,γ) photonuclear reactions in the high energy X-ray radiation therapy

AIM

The aim of this work was to map the characteristics of (n,γ) and (γ,n) reactions in a high energy photon radiation therapy.

BACKGROUND

Photoneutrons produced in the high energy X-Ray radiation therapy may damage patients and staff. It is due to high RBE of the produced neutrons according to their energy and isotropic emission. Characterization of the photoneutrons can help us in appropriate shielding.

MATERIALS AND METHODS

This study focused on the photoneutron and capture gamma ray phenomena. Characteristics such as dose value, fluence and spectra of both the neutrons and the by produced prompt gamma ray were described.

RESULTS AND DISCUSSION

Neutron and prompt gamma spectra in different points showed the neutrons to be thermalized when increasing the distance from the linac. Energy of the neutrons changed from about 0.6 MeV at the isocentre to around 10(-08) MeV at the outer door position. Although the neutrons were found as fast neutrons, their spectra showed they were thermal neutrons at the outer door position. Additionally, it was seen that the energy of the gamma rays is higher than the scattered X-ray energy. The energy of gamma rays was seen to be up to 10 MeV while the linac photons had energy lower than 1 MeV. Neutron source strength obtained in this work was in good agreement with the published data, which may be a confirmation of our simulation accuracy.

CONCLUSION

The study showed that the Monte Carlo simulation can be applied in the radiotherapy and industrial radiation works as a useful and precise estimator. We also concluded that the dose from the prompt gamma ray at the outer door location is higher than the scattered radiation from the linac and should be considered in the shielding.

The use of enriched 6Li and 7Li Lif:Mg,Cu,P glass-rod thermoluminescent dosemeters for linear accelerator out-of-field radiation dose measurements

(6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P glass-rod thermoluminescent dosemeters (TLDs) were used for measurements of out-of-field photon and neutron doses produced by Varian iX linear accelerator. Both TLDs were calibrated using 18-MV X-ray beam to investigate their dose-response sensitivity and linearity. CR-39 etch-track detectors (Luxel+, Landauer) were employed to provide neutron dose data to calibrate (6)LiF:Mg,Cu,P TLDs at various distances from the isocentre. With cadmium filters employed, slow neutrons (<0.5 eV) were distinguished from fast neutrons. The average in-air photon dose equivalents per monitor unit (MU) ranged from 1.5±0.4 to 215.5±94.6 μSv at 100 and 15 cm from the isocentre, respectively. Based on the cross-calibration factors obtained with CR-39 etch-track detectors, the average in-air fast neutron dose equivalents per MU range from 10.6±3.8 to 59.1±49.9 μSv at 100 and 15 cm from the isocentre, respectively. Contribution of thermal neutrons to total neutron dose equivalent was small: 3.1±7.2 μSv per MU at 15 cm from the isocentre.

Ambient neutron dose equivalent outside concrete vault rooms for 15 and 18 MV radiotherapy accelerators

In this work, the ambient dose equivalent, H*(10), due to neutrons outside three bunkers that house a 15- and a 18-MV Varian Clinac 2100C/D and a 15-MV Elekta Inor clinical linacs, has been calculated. The Monte Carlo code MCNPX (v. 2.5) has been used to simulate the neutron production and transport. The complete geometries including linacs and full installations have been built up according to the specifications of the manufacturers and the planes provided by the corresponding medical physical services of the hospitals where the three linacs operate. Two of these installations, those lodging the Varian linacs, have an entrance door to the bunker while the other one does not, although it has a maze with two bends. Various treatment orientations were simulated in order to establish plausible annual equivalent doses. Specifically anterior-posterior, posterior-anterior, left lateral, right lateral orientations and an additional one with the gantry rotated 30° have been studied. Significant dose rates have been found only behind the walls and the door of the bunker, near the entrance and the console, with a maximum of 12 µSv h(-1). Dose rates per year have been calculated assuming a conservative workload for the three facilities. The higher dose rates in the corresponding control areas were 799 µSv y(-1), in the case of the facility which operates the 15-MV Clinac, 159 µSv y(-1), for that with the 15-MV Elekta, and 21 µSv y(-1) for the facility housing the 18-MV Varian. A comparison with measurements performed in similar installations has been carried out and a reasonable agreement has been found. The results obtained indicate that the neutron contamination does not increase the doses above the legal limits and does not produce a significant enhancement of the dose equivalent calculated. When doses are below the detection limits provided by the measuring devices available today, MCNPX simulation provides an useful method to evaluate neutron dose equivalents based on a detailed description of linac, patient and bunker.

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

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

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.

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

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

Monte Carlo estimation of photoneutrons contamination from high-energy X-ray medical accelerators in treatment room and maze: a simplified model

Despite all advantages associated with high-energy radiotherapy to improve therapeutic gain, the production of photoneutron via interaction of high-energy photons with high atomic number (Z) materials increases undesired dose to the patient and staff. Owing to the limitation and complication of experimental neutron dosimetry in mixed beam environment, including photon and neutron, the Monte Carlo (MC) simulation is a gold standard method for calculation of photoneutron contaminations. On the other hand, the complexity of treatment head makes the MC simulation more difficult and time-consuming. In this study, the possibility of using a simplified MC model for the simulation of treatment head has been investigated using MCNP4C general purpose MC code. As a part of comparative assessment strategy, the fluence, average energy and dose equivalent of photoneutrons were estimated and compared with other studies for several fields and energies at different points in treatment room and maze. The mean energy of photoneutrons was 0.17, 0.19 and 0.2 MeV at the patient plan for 10, 15 and 18 MeV, respectively. The calculated values differed, respectively, by a factor of 1.4, 0.7 and 0.61 compared with the reported measured data for 10, 15 and 18 MeV. Our simulation results in the maze showed that the neutron dose equivalent is attenuated by a factor of 10 for every 4.6 m of maze length while the related factor from Kersey analytical method is 5 m. The neutron dose equivalent was 4.1 mSv Gy(-1) at the isocentre and decreased to 0.79 mSv Gy(-1) at a distance of 100 cm away from the isocentre for 40 x 40 cm(2). There is good agreement between the data calculated using simplified model in this study and measurements. Considering the reported high uncertainties (up to 50%) in experimental neutron dosimetry, it can be concluded that the simplified model can be used as a useful tool for estimation of photoneutron contamination associated with high-energy photon radiotherapy.

Doses to patients from photoneutrons emitted in a medical linear accelerator

This study of doses to patients from emitted photoneutrons in a medical linear accelerator (Varian 2100C) was carried out. Dose calculation was performed using Monte Carlo Geant4 code. The model was used to calculate the neutron fluence, as a function of the neutron energy inside the treatment room to estimate the effective dose to patients. The ambient dose equivalent versus field size for patients is reported in this study. The ambient dose equivalent using 1 x 1 cm(2) field size, at isocentre and X-ray modes of 20, 18, 15 and 10 MV, was found to be 1.85, 1.79, 0.61 and 0.06 mSv Gy(-1), respectively. The mean energies of emitted photoneutrons were 0.48, 0.44, 0.40 and 0.16 MeV at X-ray modes of 20, 18, 15 and 10 MV, respectively. The results of ambient dose equivalent from emitted photoneutrons cannot be ignored and can represent a risk for healthy tissues. This study emphasised that Geant4 Monte Carlo code is an appropriate choice for studying photoneutron production and transport.

A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction

It has been long known that patients treated with ionizing radiation carry a risk of developing a second cancer in their lifetimes. Factors contributing to the recently renewed concern about the second cancer include improved cancer survival rate, younger patient population as well as emerging treatment modalities such as intensity-modulated radiation treatment (IMRT) and proton therapy that can potentially elevate secondary exposures to healthy tissues distant from the target volume. In the past 30 years, external-beam treatment technologies have evolved significantly, and a large amount of data exist but appear to be difficult to comprehend and compare. This review article aims to provide readers with an understanding of the principles and methods related to scattered doses in radiation therapy by summarizing a large collection of dosimetry and clinical studies. Basic concepts and terminology are introduced at the beginning. That is followed by a comprehensive review of dosimetry studies for external-beam treatment modalities including classical radiation therapy, 3D-conformal x-ray therapy, intensity-modulated x-ray therapy (IMRT and tomotherapy) and proton therapy. Selected clinical data on second cancer induction among radiotherapy patients are also covered. Problems in past studies and controversial issues are discussed. The needs for future studies are presented at the end.

Measurement of photoneutron dose produced by wedge filters of a high energy linac using polycarbonate films

Radiotherapy represents the most widely spread technique to control and treat cancer. To increase the treatment efficiency, high energy linacs are used. However, applying high energy photon beams leads to a non-negligible dose of neutrons contaminating therapeutic beams. In addition, using conventional linacs necessitates applying wedge filters in some clinical conditions. However, there is not enough information on the effect of these filters on the photoneutrons produced. The aim of this study was to investigate the change of photoneutron dose equivalent due to the use of linac wedge filters. A high energy (18 MV) linear accelerator (Elekta SL 75/25) was studied. Polycarbonate films were used to measure the dose equivalent of photoneutrons. After electrochemical etching of the films, the neutron dose equivalent was calculated using Hp(10) factor, and its variation on the patient plane at 0, 5, 10, 50 and 100 cm from the center of the X-ray beam was determined. By increasing the distance from the center of the X-ray beam towards the periphery, the photoneutron dose equivalent decreased rapidly for the open and wedged fields. Increasing of the field size increased the photoneutron dose equivalent. The use of wedge filter increased the proportion of the neutron dose equivalent. The increase can be accounted for by the selective absorption of the high energy photons by the wedge filter.

Investigation of photoneutron dose equivalent from high-energy photons in radiotherapy

Spatial distribution of photoneutron dose equivalent during radiotherapy at different beam size, depth, and distance from a 15 MV linear accelerator was investigated with bubble detectors in a water phantom. The photoneutron dose equivalent was mainly from fast neutrons, and decreased with distance at a fixed field and with depth. Besides, photoneutron dose equivalent was slightly affected by beam size due to the variation of tungsten area exposed in the beam direction and photoneutrons occurred at the jaws. Fast photoneutron dose equivalent of shallow critical organs was represented still considerably outside the beam size.

Status of radiation detection with superheated emulsions

The introduction of new approaches for neutron detection and measurements is very rare. A similar breakthrough occurred in 1979 when Robert Apfel redefined the bubble chamber concept with his invention of the superheated drop detector. Twenty-five years after the introduction of these devices, the field of radiation detection with superheated liquids is thriving. A large variety of halocarbons are employed in the formulation of detectors, and this permits a broad range of applications. These are literally pushing the superheated emulsions to their ultimate limits and they require refinements in our understanding of the detector physics. This paper reviews the physics of superheated emulsions, the related instrumentation and their applications in radiation measurements.

Dosimetric issues in radiation protection of radiotherapy patients

As life expectancy increases, thanks to improving general medical practices, cancer treatments for the ageing population become evermore necessary. Radiation therapy is increasingly a treatment of choice, promoted by continuing improvements in dose delivery technologies. Some techniques, collectively referred to as intensity-modulated radiation therapy, are encountering widespread acceptance and implementation, promoted by reports of superior tumour control and reduced toxicity. However, these new techniques pose new challenges in terms of radiation protection of patients, as they cause a more extensive low-dose exposure of normal tissues compared with conventional radiation therapy. The related dosimetric challenges and the methods available to tackle them are reviewed in this paper, which also emphasises the need for standard radiation protection dosimetry procedures so that information may be consistently gathered for a comparative evaluation of the different treatment modalities.

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 study of neutron spectra from medical linear accelerators

Medical accelerators with photon energies over 10 MeV generate an undesired fast neutron contamination in the therapeutic beam. In this work, the Monte Carlo code MCNP was used to simulate the transport of these photoneutrons across the head of various medical accelerators of high energy. The average and most probable neutron energies were obtained from these spectra, before and after crossing the accelerator shielding. The degradation of these spectra, when they cross concrete barriers with thickness which vary between 25 and 100 cm, was also studied.

Dosimetry ofin situactivated dysprosium microspheres

This paper presents the results of a study aimed at investigating the dosimetry of stable dysprosium microspheres activated, in situ, by a linac generated photon beam. In phantom measurements of the neutron flux within an 18 MV photon beam were performed using CR-39 detectors and gold activation. The results were used in conjunction with a Monte Carlo computer simulation to investigate the dose distribution resulting from the activation of dysprosium (Dy) microspheres using an 18 MV photon beam. Different depths, lesion volumes and volume concentrations of microspheres are investigated. The linac lower collimator jaws are assumed completely closed to shield the tumour volume from the photon dose. Using a single AP field with 0 x 0 cm2 field size (closed jaws), a photon dose rate of 600 MU min(-1) and 80 cm SSD for 10 min, an average dose exceeding 1 Gy can be delivered to spherical lesions of 0.5 cm and higher diameter. The variation of the average dose with the size of the lesion reaches saturation for tumour volumes exceeding 1 cm in diameter. This report shows that the photon beam of a high-energy linac can be used to activate Dy microspheres in situ and, as a result, deliver a significant dose of beta radiation. Non-radioactive Dy microspheres do not have the toxicity and imaging problems associated with commercially available yttrium-90 based products.

Monte Carlo modelling of external radiotherapy photon beams

An essential requirement for successful radiation therapy is that the discrepancies between dose distributions calculated at the treatment planning stage and those delivered to the patient are minimized. An important component in the treatment planning process is the accurate calculation of dose distributions. The most accurate way to do this is by Monte Carlo calculation of particle transport, first in the geometry of the external or internal source followed by tracking the transport and energy deposition in the tissues of interest. Additionally, Monte Carlo simulations allow one to investigate the influence of source components on beams of a particular type and their contaminant particles. Since the mid 1990s, there has been an enormous increase in Monte Carlo studies dealing specifically with the subject of the present review, i.e., external photon beam Monte Carlo calculations, aided by the advent of new codes and fast computers. The foundations for this work were laid from the late 1970s until the early 1990s. In this paper we will review the progress made in this field over the last 25 years. The review will be focused mainly on Monte Carlo modelling of linear accelerator treatment heads but sections will also be devoted to kilovoltage x-ray units and 60Co teletherapy sources.

Photonuclear dose calculations for high-energy photon beams from Siemens and Varian linacs

The dose from photon-induced nuclear particles (neutrons, protons, and alpha particles) generated by high-energy photon beams from medical linacs is investigated. Monte Carlo calculations using the MCNPX code are performed for three different photon beams from two different machines: Siemens 18 MV, Varian 15 MV, and Varian 18 MV. The linac head components are simulated in detail. The dose distributions from photons, neutrons, protons, and alpha particles are calculated in a tissue-equivalent phantom. Neutrons are generated in both the linac head and the phantom. This study includes (a) field size effects, (b) off-axis dose profiles, (c) neutron contribution from the linac head, (d) dose contribution from capture gamma rays, (e) phantom heterogeneity effects, and (f) effects of primary electron energy shift. Results are presented in terms of absolute dose distributions and also in terms of DER (dose equivalent ratio). The DER is the maximum dose from the particle (neutron, proton, or alpha) divided by the maximum photon dose, multiplied by the particle quality factor and the modulation scaling factor. The total DER including neutrons, protons, and alphas is about 0.66 cSv/Gy for the Siemens 18 MV beam (10 cm x 10 cm). The neutron DER decreases with decreasing field size while the proton (or alpha) DER does not vary significantly except for the 1 cm x 1 cm field. Both Varian beams (15 and 18 MV) produce more neutrons, protons, and alphas particles than the Siemens 18 MV beam. This is mainly due to their higher primary electron energies: 15 and 18.3 MeV, respectively, vs 14 MeV for the Siemens 18 MV beam. For all beams, neutrons contribute more than 75% of the total DER, except for the 1 cm x 1 cm field (approximately 50%). The total DER is 1.52 and 2.86 cSv/Gy for the 15 and 18 MV Varian beams (10 cm x 10 cm), respectively. Media with relatively high-Z elements like bone may increase the dose from heavy charged particles by a factor 4. The total DER is sensitive to primary electron energy shift. A Siemens 18 MV beam with 15 MeV (instead of 14 MeV) primary electrons would increase by 40% the neutron DER and by 210% the proton + alpha DER. Comparisons with measurements (neutron yields from different materials and neutron dose equivalent) are also presented. Using the NCRP risk assessment method, we found that the dose equivalent from leakage neutrons (at 50-cm off-axis distance) represent 1.1, 1.1, and 2.0% likelihood of fatal secondary cancer for a 70 Gy treatment delivered by the Siemens 18 MV, Varian 15 MV, and Varian 18 MV beams, respectively.

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.

Vascular in situ activation radiation therapy insitustent dosimetry

PURPOSE

To investigate the radiation dosimetry of a stable stent following activation by a linac photon beam.

METHODS AND MATERIALS

A computer simulation is used in conjunction with neutron measurements to study the dosimetry of a stent activated by a linac photon beam. Two models are investigated. A gamma emitter, Model G108, with no half-life and 1.43 MeV average energy, and a beta emitter, Model D108, with 2.33 h half-life and 0.45 MeV average energy.

RESULTS

Model D108 delivers a dose exceeding 1 Gy to the artery wall when exposed to an 18-MV photon beam. Model G108 requires a 25-MV photon beam to deliver a similar dose under the same conditions of irradiation.

CONCLUSION

The very short to no half-life of InSituStent emissions makes the fractionation of the dose delivery possible. In addition, an InSituStent coated with an immunosuppressant drug may give patients the potential benefit of a combined radiation and drug treatments.

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.

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.