Surface and buildup dose characteristics for 6, 10, and 18 MV photons from an Elekta Precise linear accelerator

Fitting Monte Carlo simulation results with an empirical model of megavoltage x-ray beams for rapid depth dose calculations in water

Objective. The purpose of this study was to assess a method of accelerating Monte Carlo simulations for modeling depth dose distributions from megavoltage x-ray beams by fitting them to an empirically-derived function.Approach. Using Geant4, multiple simulations of a typical medical linear accelerator beam in water and in water with an air cavity were conducted with varying numbers of initial electrons. The resulting percent depth dose curves were compared to published data from actual linear accelerator measurements. Two methods were employed to reduce computation time for this modeling process. First, an empirical function derived from measurements at a particular linear accelerator energy, source-to-surface distance, and field size was used to directly fit the simulated data. Second, a linear regression was performed to predict the empirical function's parameters for simulations with more initial electrons.Main results. Fitting simulated depth dose curves with the empirical function yielded significant improvements in either accuracy or computation time, corresponding to the two methods described. When compared to published measurements, the maximum error for the largest simulation was 5.58%, which was reduced to 2.01% with the best fit of the function. Fitting the empirical function around the air cavity heterogeneity resulted in errors less than 2.5% at the interfaces. The linear regression prediction modestly improved the same simulation with a maximum error of 4.22%, while reducing the required computation time from 66.53 h to 43.75 h.Significance. This study demonstrates the effective use of empirical functions to expedite Monte Carlo simulations for a range of applications from radiation protection to food sterilization. These results are particularly impactful in radiation therapy treatment planning, where time and accuracy are especially valuable. Employing these methods may improve patient outcomes by ensuring that dose delivery more accurately matches the prescription or by shortening the preparation time before treatment in Monte Carlo-based treatment planning systems.

Dermatofibrosarcoma protuberans of the upper eyelid treated with surface mould high-dose-rate brachytherapy

Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell tumor, comprising less than 0.1% of all malignant neoplasms. The trunk is the most commonly affected area, followed by the extremities and the head and neck. Of the latter cases, involvement of the periorbital area has been infrequently reported. Surgery is the cornerstone of treatment but is associated with a high rate of recurrence if margins remain close or positive. This rate has been shown to be considerably decreased by the use of adjuvant radiotherapy. However, most reported cases utilize external beam radiation therapy (EBRT ) in the treatment of DFSP, including those with primary periorbital locations. We report a case of a 40-year-old male, presenting with a small nodule on the right upper eyelid, diagnosed as DFSP with positive margins post-surgery and treated with adjuvant customized surface mould high-dose-rate (HDR) brachytherapy in a low-resource setting.

Surface dose and build-up region depth dose measurements in non-standard beams of Cyberknife and tomotherapy systems

The purpose of this study was to measure the surface dose and build-up region depth dose characteristics of 6 MV photon beams in Cyberknife and helical tomotherapy (HT) systems for non-standard small fields using parallel plate chambers (Roos and Markus), Gafchromic EBT3 films, and nanoDot optically stimulated luminescence dosimeters (OSLDs), as well as to investigate the effect of oblique incidence on the surface dose of the beam. All measurements were conducted in a virtual water phantom under machine-specific reference conditions. The Roos and OSLDs overestimated the surface dose when compared with the Markus chamber and EBT3 films by 20%. We applied water equivalent thickness (WET) correction to account for the intrinsic build-up thickness of the detectors from their effective point of measurement (EPOM). With WET correction, a reasonably close surface dose estimate was obtained for all detectors, within 1.9% agreement for the 60 mm collimator of Cyberknife and 3.1% agreement for the HT system, with a 5 × 10 cm² field size. The surface dose increased from the normally incident Cyberknife and HT fields with increasing angle of incidence. The surface dose increased to twice its value at normal incidence for highly oblique angles of incidence above 55°. For the tested fields, a reasonable surface dose estimate could be measured with the detectors if the correction for intrinsic buildup thickness was applied. Nevertheless, the use of Roos chambers with large dimensions and nanoDot OSLDs is not recommended for estimating the surface dose for small fields.

Applications and benefits of using gradient percentage depth dose instead of percentage depth dose for electron and photon beams in radiotherapy

Introduction: The aim of this study is to analyze the gradient of percentage depth dose for photon and electron beams of LINACs and to simplify the data set.

Materials and Methods: Dosimetry measurements were performed in accordance with Technical Reports Series No. 398 IAEA.

Results and discussion: The gradient of percentage depth dose was calculated and compared with the available published data.

Conclusion: Instead of percentage depth dose for increasing and decreasing parts, the findings suggest using only two numbers for specific gradient of dose, separately. In this way, they can replace the whole set of the percentage depth dose (PDD).

Surface dose and acute skin reactions in external beam breast radiotherapy

The biologically relevant depth for acute skin reactions in radiotherapy is 70 µm. The dose at this depth is difficult to measure or calculate and can be quite different than the dose at a depth of as little as 1 mm. For breast radiotherapy with medial and lateral tangential beams, the skin dose depends on both the contribution from the entrance beam and the exit beam. The skin dose has been estimated in a breast model hemi-ellipse accounting for field size, beam energy, obliquity, lack of backscatter, fractionation, size and shape of the hemi-ellipse. The dose has been held constant along the axis of symmetry of the hemi-ellipse by introducing modulation as in clinical IMRT practice. Dose distributions have been computed as a function of the polar angle from the center of the hemi-ellipse. The exit dose always dominates the entrance dose for all realistic parameters. As a result, the surface dose is higher for 18 MV than 6 MV over the entire surface for all reasonable sizes and shapes of the hemi-ellipse. The results of these calculations suggest that substituting an 18 MV beam for a 6 MV beam to achieve greater skin sparing may have just the opposite effect. The ratio of the surface dose to the mid-depth dose ranges from about 35% at polar angle 0^o to up to 70% at polar angle 80^o. The dose rises sharply at angles above 30^o. The surface dose rises moderately at all angles as the size of the hemi-ellipse increases. The effect of shape is somewhat complex: as the breast becomes flatter, doses at intermediate angles increase, but doses at small and large angles decrease. The biologically effective dose for erythema and moist desquamation is about 2 to 3 Gy higher at all polar angles for conventional fractionation (2.00 Gy × 25 fractions) than for hypofractionation (2.66 Gy × 16).

Beam and tissue factors affecting Cherenkov image intensity for quantitative entrance and exit dosimetry on human tissue

This study's goal was to determine how Cherenkov radiation emission observed in radiotherapy is affected by predictable factors expected in patient imaging. Factors such as tissue optical properties, radiation beam properties, thickness of tissues, entrance/exit geometry, curved surface effects, curvature and imaging angles were investigated through Monte Carlo simulations. The largest physical cause of variation of the correlation ratio between of Cherenkov emission and dose was the entrance/exit geometry (˜50%). The largest human tissue effect was from different optical properties (˜45%). Beyond these, clinical beam energy varies the correlation ratio significantly (˜20% for X-ray beams), followed by curved surfaces (˜15% for X-ray beams and ˜8% for electron beams), and finally, the effect of field size (˜5% for X-ray beams). Other investigated factors which caused variations less than 5% were tissue thicknesses and source to surface distance. The effect of non-Lambertian emission was negligible for imaging angles smaller than 60 degrees. The spectrum of Cherenkov emission tends to blue-shift along the curved surface. A simple normalization approach based on the reflectance image was experimentally validated by imaging a range of tissue phantoms, as a first order correction for different tissue optical properties.

A Patient-Specific Polylactic Acid Bolus Made by a 3D Printer for Breast Cancer Radiation Therapy

Purpose

The aim of this study was to assess the feasibility and advantages of a patient-specific breast bolus made using a 3D printer technique.

Methods

We used the anthropomorphic female phantom with breast attachments, which volumes are 200, 300, 400, 500 and 650 cc. We simulated the treatment for a right breast patient using parallel opposed tangential fields. Treatment plans were used to investigate the effect of unwanted air gaps under bolus on the dose distribution of the whole breast. The commercial Super-Flex bolus and 3D-printed polylactic acid (PLA) bolus were applied to investigate the skin dose of the breast with the MOSFET measurement. Two boluses of 3 and 5 mm thicknesses were selected.

Results

There was a good agreement between the dose distribution for a virtual bolus generated by the TPS and PLA bolus. The difference in dose distribution between the virtual bolus and Super-Flex bolus was significant within the bolus and breast due to unwanted air gaps. The average differences between calculated and measured doses in a 200 and 300 cc with PLA bolus were not significant, which were -0.7% and -0.6% for 3mm, and -1.1% and -1.1% for 5 mm, respectively. With the Super-Flex bolus, however, significant dose differences were observed (-5.1% and -3.2% for 3mm, and -6.3% and -4.2% for 5 mm).

Conclusion

The 3D-printed solid bolus can reduce the uncertainty of the daily setup and help to overcome the dose discrepancy by unwanted air gaps in the breast cancer radiation therapy.

Surface dose variations in 6 and 10 MV flattened and flattening filter-free (FFF) photon beams

As the use of linear accelerators operating in flattening filter-free (FFF) modes becomes more widespread, it is important to have an understanding of the surface doses delivered to patients with these beams. Flattening filter removal alters the beam quality and relative contributions of low-energy X-rays and contamination electrons in the beam. Having dosimetric data to describe the surface dose and buildup regions under a range of conditions for FFF beams is important if clinical decisions are to be made. An Elekta Synergy linac with standard MLCi head has been commissioned to run at 6 MV and 10 MV running with the flattening filter in or out. In this linac the 6 MV FFF beam has been energy-matched to the clinical beam on the central axis (D10). The 10 MV beam energy has not been adjusted. The flattening filter in both cases is replaced by a thin (2 mm) stainless steel plate. A thin window parallel plate chamber has been used to measure a comprehensive set of surface dose data in these beams for variations in field size and SSD, and for the presence of attenuators (wedge, shadow tray, and treatment couch). Surface doses are generally higher in FFF beams for small field sizes and lower for large field sizes with a crossover at 10 × 10 cm2 at 6 MV and 25 × 25 cm2 at 10 MV. This trend is also seen in the presence of the wedge, shadow tray, and treatment couch. Only small differences (< 0.5%) are seen between the beams on varying SSD. At both 6 and 10 MV the filter-free beams show far less variation with field size than conventional beams. By removing the flattening filter, a source of contamination electrons is exchanged for a source of low-energy photons (as these are no longer attenuated). In practice these two components almost balance out. No significant effects on surface dose are expected by the introduction of FFF delivery.

A simple and fast physics-based analytical method to calculate therapeutic and stray doses from external beam, megavoltage x-ray therapy

State-of-the-art radiotherapy treatment planning systems provide reliable estimates of the therapeutic radiation but are known to underestimate or neglect the stray radiation exposures. Most commonly, stray radiation exposures are reconstructed using empirical formulas or lookup tables. The purpose of this study was to develop the basic physics of a model capable of calculating the total absorbed dose both inside and outside of the therapeutic radiation beam for external beam photon therapy. The model was developed using measurements of total absorbed dose in a water-box phantom from a 6 MV medical linear accelerator to calculate dose profiles in both the in-plane and cross-plane direction for a variety of square field sizes and depths in water. The water-box phantom facilitated development of the basic physical aspects of the model. RMS discrepancies between measured and calculated total absorbed dose values in water were less than 9.3% for all fields studied. Computation times for 10 million dose points within a homogeneous phantom were approximately 4 min. These results suggest that the basic physics of the model are sufficiently simple, fast, and accurate to serve as a foundation for a variety of clinical and research applications, some of which may require that the model be extended or simplified based on the needs of the user. A potentially important advantage of a physics-based approach is that the model is more readily adaptable to a wide variety of treatment units and treatment techniques than with empirical models.

Dosimetric effects of immobilization devices on SABR for lung cancer using VMAT technique

The purpose of this study was to investigate the dosimetric effects of immobilization devices on the dose distributions of stereotactic ablative radiotherapy (SABR) for lung cancer using volumetric‐modulated arc therapy (VMAT) technique. A total of 30 patients who underwent SABR for lung cancer were selected retrospectively. Every patient was immobilized using Body Pro‐Lok with a vacuum bag customized for each patient body shape. Structure sets were generated to include the patient body inside the body structure with and without the immobilization device. Dose distributions, with and without the immobilization device, were calculated using identical VMAT plans for each patient. Correlations between the change in dose‐volumetric parameters and the MU fraction of photon beams penetrating through the immobilization device were analyzed with Pearson correlation coefficients (r). The maximum change in D95%,D100%, and the minimum, maximum and mean dose to the planning target volume (PTV) due to the immobilization device were 5%, 7%, 4%, 5%, and 5%, respectively. The maximum changes in the maximum dose to the spinal cord, esophagus, heart, and trachea were 1.3 Gy, 0.9 Gy, 1 Gy, and 1.7 Gy, respectively. Strong correlations were observed between the changes in PTV D95%, the minimum, the maximum, and the mean dose to the PTV, the maximum dose to the esophagus and heart, and the MU fractions, showing values of r higher than 0.7. The decrease in dose to the target volume was considerable for lung SABR using VMAT technique, especially when MU fraction was large.

PACS number: 87.55.‐x

Superficial dosimetry imaging of Čerenkov emission in electron beam radiotherapy of phantoms

Čerenkov emission is generated from ionizing radiation in tissue above 264 keV energy. This study presents the first examination of this optical emission as a surrogate for the absorbed superficial dose. Čerenkov emission was imaged from the surface of flat tissue phantoms irradiated with electrons, using a range of field sizes from 6 cm × 6 cm to 20 cm × 20 cm, incident angles from 0° to 50°, and energies from 6 to 18 MeV. The Čerenkov images were compared with the estimated superficial dose in phantoms from direct diode measurements, as well as calculations by Monte Carlo and the treatment planning system. Intensity images showed outstanding linear agreement (R(2) = 0.97) with reference data of the known dose for energies from 6 to 18 MeV. When orthogonal delivery was carried out, the in-plane and cross-plane dose distribution comparisons indicated very little difference (± 2-4% differences) between the different methods of estimation as compared to Čerenkov light imaging. For an incident angle 50°, the Čerenkov images and Monte Carlo simulation show excellent agreement with the diode data, but the treatment planning system had a larger error (OPT = ± 1~2%, diode = ± 2~3%, TPS = ± 6-8% differences) as would be expected. The sampling depth of superficial dosimetry based on Čerenkov radiation has been simulated in a layered skin model, showing the potential of sampling depth tuning by spectral filtering. Taken together, these measurements and simulations indicate that Čerenkov emission imaging might provide a valuable method of superficial dosimetry imaging from incident radiotherapy beams of electrons.

An investigation of the depth dose in the build-up region, and surface dose for a 6-MV therapeutic photon beam: Monte Carlo simulation and measurements

The percentage depth dose in the build-up region and the surface dose for the 6-MV photon beam from a Varian Clinac 23EX medical linear accelerator was investigated for square field sizes of 5 × 5, 10 × 10, 15 × 15 and 20 × 20 cm(2)using the EGS4nrc Monte Carlo (MC) simulation package. The depth dose was found to change rapidly in the build-up region, and the percentage surface dose increased proportionally with the field size from approximately 10% to 30%. The measurements were also taken using four common detectors: TLD chips, PFD dosimeter, parallel-plate and cylindrical ionization chamber, and compared with MC simulated data, which served as the gold standard in our study. The surface doses obtained from each detector were derived from the extrapolation of the measured depth doses near the surface and were all found to be higher than that of the MC simulation. The lowest and highest over-responses in the surface dose measurement were found with the TLD chip and the CC13 cylindrical ionization chamber, respectively. Increasing the field size increased the percentage surface dose almost linearly in the various dosimeters and also in the MC simulation. Interestingly, the use of the CC13 ionization chamber eliminates the high gradient feature of the depth dose near the surface. The correction factors for the measured surface dose from each dosimeter for square field sizes of between 5 × 5 and 20 × 20 cm(2)are introduced.

Skin dose estimation for various beam modifiers and source-to-surface distances for 6MV photons

The purpose of this study was to learn the skin dose estimation for various beam modifiers at various source-to-surface distances (SSDs) for a 6 MV photon. Surface and buildup region doses were measured with an acrylic slab phantom and Markus 0.055 cc parallel plate (PP) ionization chamber. Measurements were carried out for open fields, motorized wedge fields, acrylic block tray fields ranging from 3 × 3 cm² to 30 × 30 cm². Twenty-five percent of the field was blocked with a cerrobend block and a Multileaf collimator (MLC). The effect of the blocks on the skin dose was measured for a 20 × 20 cm² field size, at 80 cm, 100 cm and 120 cm SSD. During the use of isocentric treatments, whereby the tumor is positioned at 100 cm from the source, depending on the depth of the tumor and size of the patient, the SSD can vary from 80 cm to 100 cm. To achieve a larger field size, the SSD can also be extended up to 120 cm at times. The skin dose increased as field size increased. The skin dose for the open 10 ×10 cm² field was 15.5%, 14.8% and 15.5% at 80 cm, 100 cm and 120 cm SSDs, respectively. The skin dose due to a motorized 60° wedge for the 10 × 10 cm² field was 9.9%, 9.5%, and 9.5% at 80 cm, 100 cm and 120 cm SSDs. The skin dose due to acrylic block tray, of thickness 1.0 cm for a 10 × 10 cm² field was 27.0%, 17.2% and 16.1% at 80, 100 and 120 cm SSD respectively. Due to the use of an acrylic block tray, the surface dose was increased for all field sizes at the above three SSDs and the percentage skin dose was more dominant at the lower SSD and larger field size. The skin dose for a 30 × 30 cm² field size at 80 cm SSD was 38.3% and it was 70.4% for the open and acrylic block tray fields, respectively. The skin doses for motorized wedge fields were lower than for open fields. The effect of SSDs on the surface dose for motorized 60° wedge fields was not significant for a small field size (difference was less than 1% up to a 15 × 15 cm² field size), but for a larger field (field size more than 15 × 15 cm²), the difference in a percentage skin dose was significant. The skin dose for the open field was more than that for the MLC blocked field and lower than that for the acrylic blocked tray field. The block was 25% of the 20 × 20 cm² open field. Skin doses were increased as the SSD decreased and were dominant for larger field sizes. The surface dose was weakly dependent on the MLC block.

Surface dose and build-up region measurements with wedge filters for 6 and 18 MV photon beams

PURPOSE

High-energy photons are most commonly used in radiotherapy to treat cancer. Wedge filters are required to obtain homogeneous dose distribution in the patient. Different wedge filter types create different surface doses. In this study, the effect of the virtual and physical wedge filters on the surface and build-up region doses was examined for 6- and 18-MV high-energy photon beams.

MATERIALS AND METHODS

The measurements were made in a water equivalent phantom in the build-up region at a 100-cm source-to-surface distance for various field sizes using virtual and physical wedge filters having different angles. A parallel-plate ion chamber was used to measure the percent depth doses.

RESULTS

The percentage dose at the surface increased as the field size increased for open, virtual, and physical wedged beams. For open, physical, and virtual wedged beams, the surface doses were found to be 15.4%, 9.9%, and 15.9% with 6-MV photons and 10.6%, 8.8%, 11.9% with 18-MV photons, respectively, at 10 x 10 cm(2) field size.

CONCLUSION

Build-up doses of virtual wedged beams were similar to those of open beams. Surface and buildup doses of physical wedged beams were lower than those of open and virtual wedged beams.

Comparison of 4 MV photon surface dose among Varian, Siemens, and Elekta linear accelerators for tangential breast treatment: a phantom study

PURPOSE

We have compared the differences in a 4-MV photon surface dose among Varian, Siemens, and Elekta linear accelerators (linacs) with wedges for tangential breast treatment.

MATERIALS AND METHODS

The wedge factor and the surface dose were measured using a solid water phantom and an ion chamber for each linear accelerator with various field sizes and wedge angles. A tangential treatment plan was applied to an elliptical hollow cylinder water phantom with a radiochromic film placed thereon. A dose was delivered to a simulated target in the phantom, and the resulting dose distribution was analyzed using a film scanner.

RESULTS

Varian's wedges resulted in the highest wedge factors, ranging from 0.37 to 0.75 depending on the wedge angles. Varian's wedges led to the highest normalized skin doses, ranging between 0.40 and 0.73 depending on the wedge angles and field sizes. In the cylinder phantom test with two tangential beams, the Varian linac provided a nearly 20% higher maximum dose than the Siemens and Elekta linacs.

CONCLUSION

The Varian linac resulted in the highest surface doses, and the Elekta linac led to the lowest for nearly all the measurement conditions we employed, including open beams.