Electron beam modeling and commissioning for Monte Carlo treatment planning

Validation of Monte Carlo-based calculations for megavolt electron beams for IORT and FLASH-IORT

In Intra-Operative Radiation Therapy (IORT) the tumour site is surgically exposed and normal tissue located around the tumour may be avoided. Electron applicators would require large surgical incisions; therefore, the preferred mechanism for beam collimation is the IORT cone system. FLASH radiotherapy (FLASH-RT) involves the treatment of tumours at ultra-high dose rates and the IORT cone system can also be used. This study validates the Monte Carlo-based calculations for these small electron beams to accurately determine the dose characteristics of each possible cone-energy combination as well as custom-built alloy cutouts attached to the end of the IORT cone. This will contribute to accurate dose distribution and output factor calculations that are essential to all radiation therapy treatments. A Monte Carlo (MC) model was modelled for electron beams produced by a Siemens Primus LINAC and the IORT cones. The accelerator was built with the component modules available in the BEAMnrc code. The phase-space file generated by the BEAM simulation was used as the source input for the subsequent DOSXYZnrc simulations. Percentage Depth Dose (PDD) data and profiles were extracted from the dose distributions obtained with the DOSXYZnrc simulations. These beam characteristics were compared with measured data for 6, 12, and 18 MeV electron beams for the IORT open cones of diameters 19, 45, and 64 mm and irregularly shaped cutouts. The MC simulations could replicate electron beams within a criterion of 3%/3 mm. Applicator factors were within 0.7%, and cone factors showed good agreement, except for the 9 mm cone size.

Based on the successful comparisons between measurement and MC-calculated dose distributions, output factors for the open cones and for small irregularly shaped IORT beams, it may be concluded that the Monte Carlo based dose calculation could replicate electron beams used for IORT and FLASH-IORT.

DeepBeam: a machine learning framework for tuning the primary electron beam of the PRIMO Monte Carlo software

Background

Any Monte Carlo simulation of dose delivery using medical accelerator-generated megavolt photon beams begins by simulating electrons of the primary electron beam interacting with a target. Because the electron beam characteristics of any single accelerator are unique and generally unknown, an appropriate model of an electron beam must be assumed before MC simulations can be run. The purpose of the present study is to develop a flexible framework with suitable regression models for estimating parameters of the model of primary electron beam in simulators of medical linear accelerators using real reference dose profiles measured in a water phantom.

Methods

All simulations were run using PRIMO MC simulator. Two regression models for estimating the parameters of the simulated primary electron beam, both based on machine learning, were developed. The first model applies Principal Component Analysis to measured dose profiles in order to extract principal features of the shapes of the these profiles. The PCA-obtained features are then used by Support Vector Regressors to estimate the parameters of the model of the electron beam. The second model, based on deep learning, consists of a set of encoders processing measured dose profiles, followed by a sequence of fully connected layers acting together, which solve the regression problem of estimating values of the electron beam parameters directly from the measured dose profiles. Results of the regression are then used to reconstruct the dose profiles based on the PCA model. Agreement between the measured and reconstructed profiles can be further improved by an optimization procedure resulting in the final estimates of the parameters of the model of the primary electron beam. These final estimates are then used to determine dose profiles in MC simulations.

Results

Analysed were a set of actually measured (real) dose profiles of 6 MV beams from a real Varian 2300 C/D accelerator, a set of simulated training profiles, and a separate set of simulated testing profiles, both generated for a range of parameters of the primary electron beam of the Varian 2300 C/D PRIMO simulator. Application of the two-stage procedure based on regression followed by reconstruction-based minimization of the difference between measured (real) and reconstructed profiles resulted in achieving consistent estimates of electron beam parameters and in a very good agreement between the measured and simulated photon beam profiles.

Conclusions

The proposed framework is a readily applicable and customizable tool which may be applied in tuning virtual primary electron beams of Monte Carlo simulators of linear accelerators. The codes, training and test data, together with readout procedures, are freely available at the site: https://github.com/taborzbislaw/DeepBeam.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13014-021-01847-w.

Validation of a Monte Carlo model for multi leaf collimator based electron delivery

PURPOSE

To develop and validate a Monte Carlo model of the Varian TrueBeam to study electron collimation using the existing photon multi-leaf collimators (pMLC), instead of conventional electron applicators and apertures.

MATERIALS AND METHODS

A complete Monte Carlo model of the Varian TrueBeam was developed using Tool for particle simulation (TOPAS) (version 3.1.p3). Vendor-supplied information was used to model the treatment head components and the source parameters. A phase space plane was setup above the collimating jaws and captured particles were reused until a statistical uncertainty of 1% was achieved in the central axis. Electron energies 6, 9, 12, 16, and 20 MeV with a jaw-defined field of 20 × 20 cm² at iso-center, pMLC-defined fields of 6.8 × 6.8 cm² and 11.4 × 11.4 cm² at 80 cm source-to-surface distance (SSD) and an applicator-defined field of 10 × 10 cm² at iso-center were evaluated. All the measurements except the applicator-defined fields were measured using an ionization chamber in a water tank using 80 cm SSD. The dose difference, distance-to-agreement and gamma index were used to evaluate the agreement between the Monte Carlo calculations and measurements. Contributions of electron scattering off pMLC leaves and inter-leaf leakage on dose profiles were evaluated and compared with Monte Carlo calculations. Electron transport through a heterogeneous phantom was simulated and the resulting dose distributions were compared with film measurements. The validated Monte Carlo model was used to simulate several clinically motivated cases to demonstrate the benefit of pMLC-based electron delivery compared to applicator-based electron delivery.

RESULTS

Calculated and measured percentage depth-dose (PDD) curves agree within 2% after normalization. The agreement between normalized percentage depth dose curves were evaluated using one-dimensional gamma analysis with a local tolerance of 2%/1 mm and the %points passing gamma criteria was 100% for all energies. For jaw-defined fields, calculated profiles agree with measurements with pass rates of >97% for 2%/2 mm gamma criteria. Calculated FWHM and penumbra width agree with measurements within 0.4 cm. For fields with tertiary collimation using an pMLC or applicator, the average gamma pass rate of compared profiles was 98% with 2%/2 mm gamma criteria. The profiles measured to evaluate the pMLC leaf scattering agreed with Monte Carlo calculations with an average gamma pass rate of 96.5% with 3%/2 mm gamma criteria. Measured dose profiles below the heterogenous phantom agreed well with calculated profiles and matched within 2.5% for most points. The calculated clinically applicable cases using TOPAS MC and Eclipse TPS for single enface electron beam, electron-photon mixed beam and a matched electron-electron beam exhibited a reasonable agreement in PDDs, profiles and dose volume histograms.

CONCLUSION

We present a validation of a Monte Carlo model of Varian TrueBeam for pMLC-based electron delivery. Monte Carlo calculations agreed with measurements satisfying gamma criterion of 1%/1 mm for depth dose curves and 2%/1 mm for dose profiles. The simulation of clinically applicable cases demonstrated the clinical utility of pMLC-based electrons and the use of MC simulations for development of advanced radiation therapy techniques.

Modeling the head of PRIMUS linear accelerator for electron-mode at 10 MeV for different applicators

OBJECTIVE

This study is to validate the utilization of Monte Carlo (MC) simulation to model the head of Primus linear accelerator, thereafter, using it to estimate the energy fluence distribution (EFD), the percentage depth dose (PDD), and beam profiles.

MATERIALS AND METHODS

The BEAMNRC code that is based on the EGSNRC code has been used for modeling the linear accelerator head for 10 MeV electron beam with different applicator sizes (10 × 10, 15 × 15, and 20 × 20 cm2 ). The phase space was acquired from BEAMNRC at the end of each applicator and then used as an input file to DOSXYZNRC and BEAMDP to calculate the EFD, PDD, and beam profiles.

RESULTS

There were a good consistency between the outcomes of the MC simulation and measured PDD and off-axis dose profiles that performed in a water phantom for all applicators. The PDD for the applicators proved to be favorable as a direct comparison of R100 , R90 , R80 , and R50 yielded results of < 2 mm, while it was 6 mm in R100 for the applicator 15 × 15 cm2 . The discrepancies in the surface doses (<3%) showed a quick decline in the build-up region and differences reached 0% within the first 2.4 mm. For the beam profiles comparison, the differences ranged from 2% (2 mm) to 3% (6 mm) for all applicators.

CONCLUSION

Our examination demonstrated that the MC simulation by BEAMNRC code was accurate in modeling the Primus linear accelerator head.

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.

Monte-Carlo simulation of the Siemens Artiste linear accelerator flat 6 MV and flattening-filter-free 7 MV beam line

The aim of our work is to provide the up-to-now missing information on the Siemens Artiste FFF 7 MV beam line using a Monte-Carlo model fit to the realistic dosimetric measurements at the linear accelerator in clinical use at our department. The main Siemens Artiste 6MV and FFF 7MV beams were simulated using the Geant4 toolkit. The simulations were compared with the measurements with an ionization chamber in a water phantom to verify the validation of simulation and tuning the primary electron parameters. Hereafter, other parameters such as surface dose, spectrum, electron contamination, symmetry, flatness/unflatness, slope, and characteristic off-axis changes were discussed for both Flat and FFF mode. The mean electron energy for the FFF beam was 8.8 MeV and 7.5 MeV for Flat 6 MV, the spread energy and spot size of the selected Gaussian distribution source were 0.4 MeV and 1mm, respectively. The dose rate of the FFF beam was 2.8 (2.96) times higher than for the flattened beam for a field size of 10×10 (20×20) cm2. The electron contamination has significant contribution to the surface dose especially for the flattened beam. The penumbra, surface dose and the mean energy of photons decrease by removing the flattening filter. Finally, the results show that off-axis changes have no strong effect on the mean energy of FFF beams, while this effect was more considerable for the flattened beam.

Monte Carlo Investigation of Photon Beam Characteristics and its Variation with Incident Electron Beam Parameters for Indigenous Medical Linear Accelerator

Purpose

A Monte Carlo model of a 6 MV medical linear accelerator (linac) unit built indigenously was developed using the BEAMnrc user code of the EGSnrc code system. The model was benchmarked against the measurements. Monte Carlo simulations were carried out for different incident electron beam parameters in the study.

Materials and Methods

Simulation of indigenously developed linac unit has been carried out using the Monte Carlo based BEAMnrc user-code of the EGSnrc code system. Using the model, percentage depth dose (PDD), and lateral dose profiles were studied using the DOSXYZnrc user code. To identify appropriate electron parameters, three different distributions of electron beam intensity were investigated. For each case, the kinetic energy of the incident electron was varied from 6 to 6.5 MeV (0.1 MeV increment). The calculated dose data were compared against the measurements using the PTW, Germany make RFA dosimetric system (water tank MP3-M and 0.125 cm³ ion chamber).

Results

The best fit of incident electron beam parameter was found for the combination of beam energy of 6.2 MeV and circular Gaussian distributed source in X and Y with FWHM of 1.0 mm. PDD and beam profiles (along both X and Y directions) were calculated for the field sizes from 5 cm × 5 cm to 25 cm × 25 cm. The dose difference between the calculated and measured PDD and profile values were under 1%, except for the penumbra region where the maximum deviation was found to be around 2%.

Conclusions

A Monte Carlo model of indigenous linac (6 MV) has been developed and benchmarked against the measured data.

Validation of Varian TrueBeam electron phase-spaces for Monte Carlo simulation of MLC-shaped fields

PURPOSE

This work evaluates Varian's electron phase-space sources for Monte Carlo simulation of the TrueBeam for modulated electron radiation therapy (MERT) and combined, modulated photon and electron radiation therapy (MPERT) where fields are shaped by the photon multileaf collimator (MLC) and delivered at 70 cm SSD.

METHODS

Monte Carlo simulations performed with EGSnrc-based BEAMnrc/DOSXYZnrc and penelope-based PRIMO are compared against diode measurements for 5 × 5, 10 × 10, and 20 × 20 cm(2) MLC-shaped fields delivered with 6, 12, and 20 MeV electrons at 70 cm SSD (jaws set to 40 × 40 cm(2)). Depth dose curves and profiles are examined. In addition, EGSnrc-based simulations of relative output as a function of MLC-field size and jaw-position are compared against ion chamber measurements for MLC-shaped fields between 3 × 3 and 25 × 25 cm(2) and jaw positions that range from the MLC-field size to 40 × 40 cm(2).

RESULTS

Percent depth dose curves generated by BEAMnrc/DOSXYZnrc and PRIMO agree with measurement within 2%, 2 mm except for PRIMO's 12 MeV, 20 × 20 cm(2) field where 90% of dose points agree within 2%, 2 mm. Without the distance to agreement, differences between measurement and simulation are as large as 7.3%. Characterization of simulated dose parameters such as FWHM, penumbra width and depths of 90%, 80%, 50%, and 20% dose agree within 2 mm of measurement for all fields except for the FWHM of the 6 MeV, 20 × 20 cm(2) field which falls within 2 mm distance to agreement. Differences between simulation and measurement exist in the profile shoulders and penumbra tails, in particular for 10 × 10 and 20 × 20 cm(2) fields of 20 MeV electrons, where both sets of simulated data fall short of measurement by as much as 3.5%. BEAMnrc/DOSXYZnrc simulated outputs agree with measurement within 2.3% except for 6 MeV MLC-shaped fields. Discrepancies here are as great as 5.5%.

CONCLUSIONS

TrueBeam electron phase-spaces available from Varian have been implemented in two distinct Monte Carlo simulation packages to produce dose distributions and outputs that largely reflect measurement. Differences exist in the profile shoulders and penumbra tails for the 20 MeV phase-space off-axis and in the outputs for the 6 MeV phase-space.

Adapted Prescription Dose for Monte Carlo Algorithm in Lung SBRT: Clinical Outcome on 205 Patients

Purpose

SBRT is the standard of care for inoperable patients with early-stage lung cancer without lymph node involvement. Excellent local control rates have been reported in a large number of series. However, prescription doses and calculation algorithms vary to a great extent between studies, even if most teams prescribe to the D95 of the PTV. Type A algorithms are known to produce dosimetric discrepancies in heterogeneous tissues such as lungs. This study was performed to present a Monte Carlo (MC) prescription dose for NSCLC adapted to lesion size and location and compare the clinical outcomes of two cohorts of patients treated with a standard prescription dose calculated by a type A algorithm or the proposed MC protocol.

Patients and Methods

Patients were treated from January 2011 to April 2013 with a type B algorithm (MC) prescription with 54 Gy in three fractions for peripheral lesions with a diameter under 30 mm, 60 Gy in 3 fractions for lesions with a diameter over 30 mm, and 55 Gy in five fractions for central lesions. Clinical outcome was compared to a series of 121 patients treated with a type A algorithm (TA) with three fractions of 20 Gy for peripheral lesions and 60 Gy in five fractions for central lesions prescribed to the PTV D95 until January 2011. All treatment plans were recalculated with both algorithms for this study. Spearman’s rank correlation coefficient was calculated for GTV and PTV. Local control, overall survival and toxicity were compared between the two groups.

Results

205 patients with 214 lesions were included in the study. Among these, 93 lesions were treated with MC and 121 were treated with TA. Overall survival rates were 86% and 94% at one and two years, respectively. Local control rates were 79% and 93% at one and two years respectively. There was no significant difference between the two groups for overall survival (p = 0.785) or local control (p = 0.934). Fifty-six patients (27%) developed grade I lung fibrosis without clinical consequences. GTV size was a prognostic factor for overall survival (HR = 1.026, IC95% [1.01–1.041], p<0.001) and total dose was a prognostic factor for local control (HR = 0.924, IC95% [0.870–0.982], p = 0.011). D50 of the GTV calculated with MC correlated poorly with the D95 of the PTV calculated with TA (r = 0.116) for lesions with a diameter of 20 mm or less. For lesions larger than 20 mm, spearman correlation was higher (r = 0.618), but still insufficient.

Conclusion

No difference in local control or overall survival was found between patients treated with a type A or a type B algorithm in our cohort. A size and location adapted GTV-based prescription method could be used with a type B algorithm. External validation of these results is warranted.

A virtual source model for Monte Carlo simulation of helical tomotherapy

The purpose of this study was to present a Monte Carlo (MC) simulation method based on a virtual source, jaw, and MLC model to calculate dose in patient for helical tomotherapy without the need of calculating phase‐space files (PSFs). Current studies on the tomotherapy MC simulation adopt a full MC model, which includes extensive modeling of radiation source, primary and secondary jaws, and multileaf collimator (MLC). In the full MC model, PSFs need to be created at different scoring planes to facilitate the patient dose calculations. In the present work, the virtual source model (VSM) we established was based on the gold standard beam data of a tomotherapy unit, which can be exported from the treatment planning station (TPS). The TPS‐generated sinograms were extracted from the archived patient XML (eXtensible Markup Language) files. The fluence map for the MC sampling was created by incorporating the percentage leaf open time (LOT) with leaf filter, jaw penumbra, and leaf latency contained from sinogram files. The VSM was validated for various geometry setups and clinical situations involving heterogeneous media and delivery quality assurance (DQA) cases. An agreement of <1% was obtained between the measured and simulated results for percent depth doses (PDDs) and open beam profiles for all three jaw settings in the VSM commissioning. The accuracy of the VSM leaf filter model was verified in comparing the measured and simulated results for a Picket Fence pattern. An agreement of <2% was achieved between the presented VSM and a published full MC model for heterogeneous phantoms. For complex clinical head and neck (HN) cases, the VSM‐based MC simulation of DQA plans agreed with the film measurement with 98% of planar dose pixels passing on the 2%/2 mm gamma criteria. For patient treatment plans, results showed comparable dose‐volume histograms (DVHs) for planning target volumes (PTVs) and organs at risk (OARs). Deviations observed in this study were consistent with literature. The VSM‐based MC simulation approach can be feasibly built from the gold standard beam model of a tomotherapy unit. The accuracy of the VSM was validated against measurements in homogeneous media, as well as published full MC model in heterogeneous media.

PACS numbers: 87.53.‐j, 87.55.K‐

Use of IAEA's phase-space files for the implementation of a clinical accelerator virtual source model

In the present work, phase-space data files (phsp) provided by the International Atomic Energy Agency (IAEA) for different accelerators were used in order to develop a Virtual Source Model (VSM) for clinical photon beams. Spectral energy distributions extracted from supplied phsp files were used to define the radiation pattern of a virtual extended source in a hybrid model which is completed with a virtual diaphragm used to simulate both electron contamination and the shape of the penumbra region. This simple virtual model was used as the radiation source for dosimetry calculations in a water phantom. The proposed model proved easy to build and test, and good agreement with clinical accelerators dosimetry measurements were obtained for different field sizes. Our results suggest this simple method could be useful for treatment planning systems (TPS) verification purposes.

A source model for modulated electron radiation therapy using dynamic jaw movements

PURPOSE

The development of fast and accurate source models (SMs) might be of crucial importance for the future clinical implementation of modulated electron radiation therapy (MERT). In this study, a SM is presented for reconstructing phase-space information of modulated electron beams using a few-leaf electron collimator (FLEC) and the photon jaws.

METHODS

During a FLEC-based delivery, two collimation devices (jaws and FLEC) modulate the electron beam characteristics dynamically. The SM separates the beam into a primary and a scattered component. The primary component is derived by a fast Monte Carlo (MC) transport calculation in air using the EGSnrc/BEAMnrc code. The scattered beam is modeled analytically. The accelerator was decomposed into its individual leaf components and the scattered beam was characterized at various levels of the accelerator. Scattered particles are assigned an energy and position by sampling pre-calculated probability distributions. The direction is estimated by geometrical arguments. Particles were assumed to emerge from tunable virtual sources on the side of each collimator leaf. A leaf-hit algorithm was developed to dynamically reject particles that are incident on any collimating leaf. Electron transport in air between the two collimation levels was calculated based on a MC-modified version of the Fermi-Eyges scattering theory. Correlations between direction and position were observed and taken into account at the final collimation level.

RESULTS

To validate the model, reconstructed phase-space data were compared with the full accelerator MC phase-space data. The model accurately reproduced the beam characteristics and preserved important correlations. Depth and profile dose distributions in water were derived for square, rectangular, and off-axis field sizes and for a range of clinical energies. Discrepancies in the dose distributions and dose output were within 3% in all cases.

CONCLUSIONS

Fast and accurate SMs open the possibility for fast treatment planning in MERT, based on an inverse optimization MC treatment planning scheme.

Monte Carlo simulation of electron modes of a Siemens Primus linac (8, 12 and 14 MeV)

Background

Electron mode is used for treatment of superficial tumours in linac-based radiotherapy.

Purpose

The aim of present study is simulation of 8, 12 and 14 MeV electrons from a Siemens Primus linac using MCNPX Monte Carlo (MC) code and verification of the results based on comparison of the results with the measured data.

Materials and methods

Electron mode for 8, 12 and 14 MeV electron energies of a Siemens Primus linac was simulated using MCNPX MC code. Percent depth dose (PDD) data for 10 × 10, 15 × 15 and 25 × 25 cm2 applicators obtained from MC simulations were compared with the corresponding measured data.

Results

Gamma index values were less than unity in most of points for all the above-mentioned energies and applicators. However, for 25 × 25 cm2 applicator in 8 MeV energy, 10 × 10 cm2 applicator and 15 × 15 cm2 applicator in 14 MeV energy, there were four data points with gamma indices higher than unity. However among these data points, there are a number of cases with relatively large value of gamma index, these cases are positioned on the bremsstrahlung tail of the PDD curve which is not normally used in treatment planning.

Conclusion

There was good agreement between the results of MC simulations developed in this study and the measured values. The obtained simulation programmes can be used in dosimetry of electron mode of Siemens Primus linac in the cases in which it is not easily feasible to perform experimental in-phantom measurements.

Multiple-source models for electron beams of a medical linear accelerator using BEAMDP computer code

AIM

The aim of this work was to develop multiple-source models for electron beams of the NEPTUN 10PC medical linear accelerator using the BEAMDP computer code.

BACKGROUND

One of the most accurate techniques of radiotherapy dose calculation is the Monte Carlo (MC) simulation of radiation transport, which requires detailed information of the beam in the form of a phase-space file. The computing time required to simulate the beam data and obtain phase-space files from a clinical accelerator is significant. Calculation of dose distributions using multiple-source models is an alternative method to phase-space data as direct input to the dose calculation system.

MATERIALS AND METHODS

Monte Carlo simulation of accelerator head was done in which a record was kept of the particle phase-space regarding the details of the particle history. Multiple-source models were built from the phase-space files of Monte Carlo simulations. These simplified beam models were used to generate Monte Carlo dose calculations and to compare those calculations with phase-space data for electron beams.

RESULTS

Comparison of the measured and calculated dose distributions using the phase-space files and multiple-source models for three electron beam energies showed that the measured and calculated values match well each other throughout the curves.

CONCLUSION

It was found that dose distributions calculated using both the multiple-source models and the phase-space data agree within 1.3%, demonstrating that the models can be used for dosimetry research purposes and dose calculations in radiotherapy.

Delivery of modulated electron beams with conventional photon multi-leaf collimators

Electron beam radiotherapy is an accepted method to treat shallow tumors. However, modulation of electrons to customize dose distributions has not readily been achieved. Studies of bolus and tertiary collimation systems have been met with limitations. We pursue the use of photon multi-leaf collimators (MLC) for modulated electron radiotherapy (MERT) to achieve customized distributions for potential clinical use. As commercial planning systems do not support the use of MLC with electrons, planning was conducted using Monte Carlo calculations. Segmented and dynamic modulated delivery of multiple electron segments was configured, calculated and delivered for validation. Delivery of electrons with segmented or dynamic leaf motion was conducted. A phantom possessing an idealized stepped target was planned and optimized with subsequent validation by measurements. Finally, clinical treatment plans were conducted for post-mastectomy and cutaneous lymphoma of the scalp using forward optimization techniques. Comparison of calculations and measurements was successful with agreement of +/-2%/2 mm for the energies, segment sizes, depths tested for delivered segments for the dynamic and segmented delivery. Clinical treatment plans performed provided optimal dose coverage of the target while sparing distal organs at risk. Execution of plans using an anthropomorphic phantom to ensure safe and efficient delivery was conducted. Our study validates that MERT is not only possible using the photon MLC, but the efficient and safe delivery inherent with the dynamic delivery provides an ideal technique for shallow tumor treatment.

Validation of calculations for electrons modulated with conventional photon multileaf collimators

Treating shallow tumors with a homogeneous dose while simultaneously minimizing the dose to distal critical organs remains a challenge in radiotherapy. One promising approach is modulated electron radiotherapy (MERT). Due to the scattering properties of electron beams, the commercially provided secondary and tertiary photon collimation systems are not conducive for electron beam delivery when standard source-to-surface distances are used. Also, commercial treatment planning systems may not accurately model electron-beam dose distributions when collimated without the standard applicators. However, by using the photon multileaf collimators (MLCs) to create segments to modulate electron beams, the quality of superficial tumor dose distributions may improve substantially. The purpose of this study is to develop and evaluate calculations for the narrow segments needed to modulate megavoltage electron beams using photon beam multileaf collimators. Modulated electron radiotherapy (MERT) will be performed with a conventional linear accelerator equipped with a 120 leaf MLC for 6-20 MeV electron beam energies. To provide a sharp penumbra, segments were delivered with short SSDs (70-85 cm). Segment widths (SW) ranging from 1 to 10 cm were configured for delivery and planning, using BEAMnrc Monte Carlo (MC) code, and the DOSXYZnrc MC dose calculations. Calculations were performed with voxel size of 0.2 x 0.2 x 0.1 cm3. Dosimetry validation was performed using radiographic film and micro- or parallel-plate chambers. Calculated and measured data were compared using technical computing software. Beam sharpness (penumbra) degraded with decreasing incident beam energy and field size (FS), and increasing SSD. A 70 cm SSD was found to be optimal. The PDD decreased significantly with decreasing FS. The comparisons demonstrated excellent agreement for calculations and measurements within 3%, 1 mm. This study shows that accurate calculations for MERT as delivered with existing photon MLC are feasible and allows the opportunity to take advantage of the dynamic leaf motion capabilities and control systems, to provide conformal dose distributions.

A virtual photon source model of an Elekta linear accelerator with integrated mini MLC for Monte Carlo based IMRT dose calculation

A dedicated, efficient Monte Carlo (MC) accelerator head model for intensity modulated stereotactic radiosurgery treatment planning is needed to afford a highly accurate simulation of tiny IMRT fields. A virtual source model (VSM) of a mini multi-leaf collimator (MLC) (the Elekta Beam Modulator (EBM)) is presented, allowing efficient generation of particles even for small fields. The VSM of the EBM is based on a previously published virtual photon energy fluence model (VEF) (Fippel et al 2003 Med. Phys. 30 301) commissioned with large field measurements in air and in water. The original commissioning procedure of the VEF, based on large field measurements only, leads to inaccuracies for small fields. In order to improve the VSM, it was necessary to change the VEF model by developing (1) a method to determine the primary photon source diameter, relevant for output factor calculations, (2) a model of the influence of the flattening filter on the secondary photon spectrum and (3) a more realistic primary photon spectrum. The VSM model is used to generate the source phase space data above the mini-MLC. Later the particles are transmitted through the mini-MLC by a passive filter function which significantly speeds up the time of generation of the phase space data after the mini-MLC, used for calculation of the dose distribution in the patient. The improved VSM model was commissioned for 6 and 15 MV beams. The results of MC simulation are in very good agreement with measurements. Less than 2% of local difference between the MC simulation and the diamond detector measurement of the output factors in water was achieved. The X, Y and Z profiles measured in water with an ion chamber (V = 0.125 cm(3)) and a diamond detector were used to validate the models. An overall agreement of 2%/2 mm for high dose regions and 3%/2 mm in low dose regions between measurement and MC simulation for field sizes from 0.8 x 0.8 cm(2) to 16 x 21 cm(2) was achieved. An IMRT plan film verification was performed for two cases: 6 MV head&neck and 15 MV prostate. The simulation is in agreement with film measurements within 2%/2 mm in the high dose regions (> or = 0.1 Gy = 5% D(max)) and 5%/2 mm in low dose regions (<0.1 Gy).

A beam source model for scanned proton beams

A beam source model, i.e. a model for the initial phase space of the beam, for scanned proton beams has been developed. The beam source model is based on parameterized particle sources with characteristics found by fitting towards measured data per individual beam line. A specific aim for this beam source model is to make it applicable to the majority of the various proton beam systems currently available or under development, with the overall purpose to drive dose calculations in proton beam treatment planning. The proton beam phase space is characterized by an energy spectrum, radial and angular distributions and deflections for the non-modulated elementary pencil beam. The beam propagation through the scanning magnets is modelled by applying experimentally determined focal points for each scanning dimension. The radial and angular distribution parameters are deduced from measured two-dimensional fluence distributions of the elementary beam in air. The energy spectrum is extracted from a depth dose distribution for a fixed broad beam scan pattern measured in water. The impact of a multi-slab range shifter for energy modulation is calculated with an own Monte Carlo code taking multiple scattering, energy loss and straggling, non-elastic and elastic nuclear interactions in the slab assembly into account. Measurements for characterization and verification have been performed with the scanning proton beam system at The Svedberg Laboratory in Uppsala. Both in-air fluence patterns and dose points located in a water phantom were used. For verification, dose-in-water was calculated with the Monte Carlo code GEANT 3.21 instead of using a clinical dose engine with approximations of its own. For a set of four individual pencil beams, both with the full energy and range shifted, 96.5% (99.8%) of the tested dose points satisfied the 1%/1 mm (2%/2 mm) gamma criterion.

A modified simulated annealing algorithm for parameter determination for a hybrid virtual model

In this work we present an algorithm based on the simulated annealing (SA) method for electron beam spectrum reconstruction from central axis PDD data. We use a simulated beam in order to assess the accuracy of the method, and compare it with others usually employed. We found that our modified SA algorithm produced excellent reconstructed PDDs and beam profiles and improved reconstructed spectra. We also tested our method for the simultaneous determination of an electron energy spectrum and the position of a trimmer from central axis PDD data, and found this to be sufficient for the determination of the physical parameters of this hybrid model.

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.

Development and commissioning of a Monte Carlo photon beam model for Varian Clinac 2100EX linear accelerator

Monte Carlo modeling of a linear accelerator is the first and most important step in Monte Carlo dose calculations in radiotherapy. We developed a photon beam model for Varian 2100EX for dose calculation purposes using MCNP4C Monte Carlo code. Results of our modeling were in close agreement with our measurements. The effect of beam width on percentage depth doses and beam profiles was studied. Our results showed that electron beam width could be tuned using large field beam profile at the depth of maximum dose.

A Monte Carlo multiple source model applied to radiosurgery narrow photon beams

Monte Carlo (MC) methods are nowadays often used in the field of radiotherapy. Through successive steps, radiation fields are simulated, producing source Phase Space Data (PSD) that enable a dose calculation with good accuracy. Narrow photon beams used in radiosurgery can also be simulated by MC codes. However, the poor efficiency in simulating these narrow photon beams produces PSD whose quality prevents calculating dose with the required accuracy. To overcome this difficulty, a multiple source model was developed that enhances the quality of the reconstructed PSD, reducing also the time and storage capacities. This multiple source model was based on the full MC simulation, performed with the MC code MCNP4C, of the Siemens Mevatron KD2 (6 MV mode) linear accelerator head and additional collimators. The full simulation allowed the characterization of the particles coming from the accelerator head and from the additional collimators that shape the narrow photon beams used in radiosurgery treatments. Eight relevant photon virtual sources were identified from the full characterization analysis. Spatial and energy distributions were stored in histograms for the virtual sources representing the accelerator head components and the additional collimators. The photon directions were calculated for virtual sources representing the accelerator head components whereas, for the virtual sources representing the additional collimators, they were recorded into histograms. All these histograms were included in the MC code, DPM code and using a sampling procedure that reconstructed the PSDs, dose distributions were calculated in a water phantom divided in 20000 voxels of 1 x 1 x 5 mm3. The model accurately calculates dose distributions in the water phantom for all the additional collimators; for depth dose curves, associated errors at 2sigma were lower than 2.5% until a depth of 202.5 mm for all the additional collimators and for profiles at various depths, deviations between measured and calculated values were less than 2.5% or 1 mm.

Monitor unit calculation for Monte Carlo treatment planning

In this work, we investigate a formalism for monitor unit (MU) calculation in Monte Carlo based treatment planning. By relating MU to dose measured under reference calibration conditions (central axis, depth of dose maximum in water, 10 cm x 10 cm field defined at 100 cm source-to-surface distance) our formalism determines the MU required for a treatment plan based on the prescription dose and Monte Carlo calculated dose distribution. Detailed descriptions and formulae are given for various clinical situations including conventional treatments and advanced techniques such as intensity-modulated radiotherapy (IMRT) and modulated electron radiotherapy (MERT). Analysis is made of the effects of source modelling, beam modifier simulation and patient dose calculation accuracy, all of which are important factors for absolute dose calculations using Monte Carlo simulations. We have tested the formalism through phantom measurements and the predicted MU values were consistent with measured values to within 2%. The formalism has been used for MU calculation and plan comparison for advanced treatment techniques such as MERT, extracranial stereotactic IMRT, MRI-based treatment planning and intensity-modulated laser-proton therapy studies. It is also used for absolute dose calculations using Monte Carlo simulations for treatment verification, which has become part of our comprehensive IMRT quality assurance programme.

Radiation characteristics of helical tomotherapy

Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-board imaging capability (MVCT) and therefore differs from conventional treatment units. Different design goals resulted in some distinctive radiation field characteristics. The most significant differences in the design are the lack of flattening filter, increased shielding of the collimators, treatment and imaging operation modes and narrow fan beam delivery. Radiation characteristics of the helical tomotherapy system, sensitivity studies of various incident electron beam parameters and radiation safety analyses are presented here. It was determined that the photon beam energy spectrum of helical tomotherapy is similar to that of more conventional radiation treatment units. The two operational modes of the system result in different nominal energies of the incident electron beam with approximately 6 MeV and 3.5 MeV in the treatment and imaging modes, respectively. The off-axis mean energy dependence is much lower than in conventional radiotherapy units with less than 5% variation across the field, which is the consequence of the absent flattening filter. For the same reason the transverse profile exhibits the characteristic conical shape resulting in a 2-fold increase of the beam intensity in the center. The radiation leakage outside the field was found to be negligible at less than 0.05% because of the increased shielding of the collimators. At this level the in-field scattering is a dominant source of the radiation outside the field and thus a narrow field treatment does not result in the increased leakage. The sensitivity studies showed increased sensitivity on the incident electron position because of the narrow fan beam delivery and high sensitivity on the incident electron energy, as common to other treatment systems. All in all, it was determined that helical tomotherapy is a system with some unique radiation characteristics, which have been to a large extent optimized for intensity modulated delivery.

Monte Carlo Commissioning of Low Energy Electron Radiotherapy Beams using NXEGS Software

This work is a report on the commissioning of low energy electron beams of a medical linear accelerator for Monte Carlo dose calculation using NXEGS software (NXEGS version 1.0.10.0, NX Medical Software, LLC). A unique feature of NXEGS is automated commissioning, a process whereby a combination of analytic and Monte Carlo methods generates beam models from dosimetric data collected in a water phantom. This study uses NXEGS to commission 6, 9, and 12 MeV electron beams of a Varian Clinac 2100C using three applicators with standard inserts. Central axis depth-dose, primary axis and diagonal beam profiles, and output factors are the measurements necessary for commissioning of the code. We present a comparison of measured dose distributions with the distributions generated by NXEGS, using confidence limits on seven measures of error. We find that confidence limits are typically less than 3% or 3 mm, but increase with increasing source to surface distance (SSD) and depth at or beyond R(50). We also investigate the dependence of NXEGS' performance on the size and composition of data used to commission the program, finding a weak dependence on number of dose profiles in the data set, but finding also that commissioning data need be measured at only two SSDs.

Three-dimensional electron dose calculation using an improved hybrid pencil beam model

An improved hybrid-pencil beam model (HPBM) for electron-beam three-dimensional dose calculation has been studied. The model is based on the fact that away from the edges of a large field, the electron distribution function exactly equals that for an infinitely wide electron beam. In the present model, we use the bipartition model to calculate the longitudinal part of the pencil-beam distribution function, and Fermi-Eyges multiple-scattering theory to calculate its transverse part. In order to describe the electron beam characteristics accurately, we introduce a new parameter, which is extracted from measured profile data near the surface of a water phantom, to correct the transverse distribution determined by the Fermi-Eyges theory. Furthermore, we introduce an effective energy spectrum to describe the effect on the collimated electron beam of the accelerator head. The dose distributions calculated with the improved HPBM were compared with the experimental data, and the agreement was within 1% in most of cases. This preliminary study has demonstrated the potential for use of the model in the clinical therapy.

A Monte Carlo tutorial and the application for radiotherapy treatment planning

Monte Carlo-based treatment planning algorithms are advancing rapidly and will certainly be implemented as part of conventional treatment planning systems in the near future. This paper was designed as a basic tutorial for using the Monte Carlo method as applied to radiotherapy treatment planning. The tutorial addresses the basic transport differences between photon and electron transport as well as the sampling distributions. The implementation of a virtual linac source model and the conversion from the Monte Carlo source modeling reference plane into the treatment reference plane is discussed. The implementation of a thresholding algorithm for converting CT electron density to patient specific materials is also presented. A 6-field prostate boost treatment is used to compare a conventional treatment planning algorithm (pencil beam model) with a Monte Carlo simulation algorithm. The agreement between the 2 calculation methods is good based upon the qualitative comparison of the isodose distribution and the dose-volume histograms for the prostate and the rectum. The effects of statistical uncertainty on the Monte Carlo calculation are also presented.

A Monte Carlo dose calculation tool for radiotherapy treatment planning

A Monte Carlo user code, MCDOSE, has been developed for radiotherapy treatment planning (RTP) dose calculations. MCDOSE is designed as a dose calculation module suitable for adaptation to host RTP systems. MCDOSE can be used for both conventional photon/electron beam calculation and intensity modulated radiotherapy (IMRT) treatment planning. MCDOSE uses a multiple-source model to reconstruct the treatment beam phase space. Based on Monte Carlo simulated or measured beam data acquired during commissioning, source-model parameters are adjusted through an automated procedure. Beam modifiers such as jaws, physical and dynamic wedges, compensators, blocks, electron cut-outs and bolus are simulated by MCDOSE together with a 3D rectilinear patient geometry model built from CT data. Dose distributions calculated using MCDOSE agreed well with those calculated by the EGS4/DOSXYZ code using different beam set-ups and beam modifiers. Heterogeneity correction factors for layered-lung or layered-bone phantoms as calculated by both codes were consistent with measured data to within 1%. The effect of energy cut-offs for particle transport was investigated. Variance reduction techniques were implemented in MCDOSE to achieve a speedup factor of 10-30 compared to DOSXYZ.

Monte Carlo based treatment planning for modulated electron beam radiation therapy

A Monte Carlo based treatment planning system for modulated electron radiation therapy (MERT) is presented. This new variation of intensity modulated radiation therapy (IMRT) utilizes an electron multileaf collimator (eMLC) to deliver non-uniform intensity maps at several electron energies. In this way, conformal dose distributions are delivered to irregular targets located a few centimetres below the surface while sparing deeper-lying normal anatomy. Planning for MERT begins with Monte Carlo generation of electron beamlets. Electrons are transported with proper in-air scattering and the dose is tallied in the phantom for each beamlet. An optimized beamlet plan may be calculated using inverse-planning methods. Step-and-shoot leaf sequences are generated for the intensity maps and dose distributions recalculated using Monte Carlo simulations. Here, scatter and leakage from the leaves are properly accounted for by transporting electrons through the eMLC geometry. The weights for the segments of the plan are re-optimized with the leaf positions fixed and bremsstrahlung leakage and electron scatter doses included. This optimization gives the final optimized plan. It is shown that a significant portion of the calculation time is spent transporting particles in the leaves. However, this is necessary since optimizing segment weights based on a model in which leaf transport is ignored results in an improperly optimized plan with overdosing of target and critical structures. A method of rapidly calculating the bremsstrahlung contribution is presented and shown to be an efficient solution to this problem. A homogeneous model target and a 2D breast plan are presented. The potential use of this tool in clinical planning is discussed.

Monte Carlo calculation of output factors for circular, rectangular, and square fields of electron accelerators (6-20 MeV)

Monte Carlo (MC) techniques can be used to build a simulation model of an electron accelerator to calculate output factors for electron fields. This can be useful during commissioning of electron beams from a linac and in clinical practice where irregular fields are also encountered. The Monte Carlo code BEAM/EGS4 was used to model electron beams (6-20 MeV) from a Varian 2100C linear accelerator. After optimization of the Monte Carlo simulation model, agreement within 1% to 2% was obtained between calculated and measured (with a Si diode) lateral and depth dose distributions or within 1 mm in the penumbral regions. Output factors for square, rectangular, and circular fields were measured using two different plane-parallel ion chambers (Markus and NACP) and compared to MC simulations. The agreement was usually within 1% to 2%. This study was not primarily concerned with minimizing the simulation time required to obtain output factors but some considerations with respect to this are presented. It would be particularly useful if the MC model could also be used to calculate output factors for other, similar linacs. To see if this was possible, the primary electron energies in the MC model were retuned to model a recently commissioned similar linac. Good agreement between calculated and measured output factors was obtained for most field sizes for this second accelerator.

Derivation of electron and photon energy spectra from electron beam central axis depth dose curves

A method for deriving the electron and photon energy spectra from electron beam central axis percentage depth dose (PDD) curves has been investigated. The PDD curves of 6, 12 and 20 MeV electron beams obtained from the Monte Carlo full phase space simulations of the Varian linear accelerator treatment head have been used to test the method. We have employed a 'random creep' algorithm to determine the energy spectra of electrons and photons in a clinical electron beam. The fitted electron and photon energy spectra have been compared with the corresponding spectra obtained from the Monte Carlo full phase space simulations. Our fitted energy spectra are in good agreement with the Monte Carlo simulated spectra in terms of peak location, peak width, amplitude and smoothness of the spectrum. In addition, the derived depth dose curves of head-generated photons agree well in both shape and amplitude with those calculated using the full phase space data. The central axis depth dose curves and dose profiles at various depths have been compared using an automated electron beam commissioning procedure. The comparison has demonstrated that our method is capable of deriving the energy spectra for the Varian accelerator electron beams investigated. We have implemented this method in the electron beam commissioning procedure for Monte Carlo electron beam dose calculations.

Monte Carlo simulation of electron beams from an accelerator head using PENELOPE

The Monte Carlo code PENELOPE has been used to simulate electron beams from a Siemens Mevatron KDS linac with nominal energies of 6, 12 and 18 MeV. Owing to its accuracy, which stems from that of the underlying physical interaction models, PENELOPE is suitable for simulating problems of interest to the medical physics community. It includes a geometry package that allows the definition of complex quadric geometries, such as those of irradiation instruments, in a straightforward manner. Dose distributions in water simulated with PENELOPE agree well with experimental measurements using a silicon detector and a monitoring ionization chamber. Insertion of a lead slab in the incident beam at the surface of the water phantom produces sharp variations in the dose distributions, which are correctly reproduced by the simulation code. Results from PENELOPE are also compared with those of equivalent simulations with the EGS4-based user codes BEAM and DOSXYZ. Angular and energy distributions of electrons and photons in the phase-space plane (at the downstream end of the applicator) obtained from both simulation codes are similar, although significant differences do appear in some cases. These differences, however, are shown to have a negligible effect on the calculated dose distributions. Various practical aspects of the simulations, such as the calculation of statistical uncertainties and the effect of the 'latent' variance in the phase-space file, are discussed in detail.

Validation of a Monte Carlo dose calculation tool for radiotherapy treatment planning

A new EGS4/PRESTA Monte Carlo user code, MCDOSE, has been developed as a routine dose calculation tool for radiotherapy treatment planning. It is suitable for both conventional and intensity modulated radiation therapy. Two important features of MCDOSE are the inclusion of beam modifiers in the patient simulation and the implementation of several variance reduction techniques. Before this tool can be used reliably for clinical dose calculation, it must be properly validated. The validation for beam modifiers has been performed by comparing the dose distributions calculated by MCDOSE and the well-benchmarked EGS4 user codes BEAM and DOSXYZ. Various beam modifiers were simulated. Good agreement in the dose distributions was observed. The differences in electron cutout factors between the results of MCDOSE and measurements were within 2%. The accuracy of MCDOSE with various variance reduction techniques was tested by comparing the dose distributions in different inhomogeneous phantoms with those calculated by DOSXYZ without variance reduction. The agreement was within 1.0%. Our results demonstrate that MCDOSE is accurate and efficient for routine dose calculation in radiotherapy treatment planning, with or without beam modifiers.

Monte Carlo characterization of clinical electron beams in transverse magnetic fields

Monte Carlo simulations were employed to study the characteristics of the electron beams of a clinical linear accelerator in the presence of 1.5 and 3.0 T transverse magnetic fields and to assess the possibility of using magnetic fields in conjunction with modulated electron radiation therapy (MERT). The starting depth of the magnetic field was varied over several centimetres. It was found that peak doses of as much as 2.7 times the surface dose could be achieved with a 1.5 T magnetic field. The magnetic field was shown to reduce the 80% and 20% dose drop-off distance by 50% to 80%. The distance between the 80% dose levels of the pseudo-Bragg peak induced by the magnetic field was found to be extremely narrow, generally less than 1 cm. However, by modulating the energy and intensity of the electron fields while simultaneously moving the magnetic field, a homogeneous dose distribution with low surface dose and a sharp dose fall-off was generated. Heterogeneities are shown to change the effective range of the electron beams, but not eliminate the advantages of a sharp depth dose drop-off or high peak-to-surface dose ratio. This suggests the applicability of MERT with magnetic fields in heterogeneous media. The results of this study demonstrate the ability to use magnetic fields in MERT to produce highly desirable dose distributions.