Optimization and experimental characterization of the innovative thermo-brachytherapy seed for prostate cancer treatment

BACKGROUND

Adjuvant administration of hyperthermia (HT) with radiation therapy in the treatment of cancer has been extensively studied in the past five decades. Concurrent use of the two modalities leads to both complementary and synergetic enhancements in tumor management, but presents a practical challenge. Their simultaneous administration using the same implantable thermo-brachytherapy (TB) seed source has been established theoretically through magnetically mediated heat induction with ferromagnetic materials. Careful consideration, however, showed that regular ferromagnetic alloys lack the required conductivity to generate enough power through eddy current to overcome heat dissipation due to blood perfusion at clinically measured rates.

PURPOSE

We characterized the TB implant that combines a sealed radioactive source with a ferrimagnetic ceramic (ferrite) core, serving as a self-regulating HT source when placed in an alternating electromagnetic field. To increase the heat production and uniformity of temperature distribution the empty spacers between radioisotope seeds were replaced by hyperthermia-only (HT-only) seeds.

METHODS

The heat generation due to eddy currents circulating in the seed's thin metal shell, surrounding the core, depends drastically on the core permeability. We identified a soft ferrite material (MnZnFe 2 O 4 $\rm MnZnFe_2O_4$ ) as the best candidate for the core, owing to its high permeability, the HT-range Curie temperature, adjustable through material composition, and a sharp Curie transition, leading to heat self-regulation, with no invasive thermometry required. The core permeability as a function of temperature was calculated based on measured resistor-inductor (RL) circuit parameters and material B-H curves. The thickness of the shell was optimized separately for TB and HT-only seeds, having slightly different dimensions. Heat generation was calculated using the power versus temperature approximation. Finally, the temperature distribution for a realistic prostate LDR brachytherapy plan was modeled with COMSOL Multiphysics for a set of blood perfusion rates found in the literature.

RESULTS

The small size of the investigated ferrite core samples resulted in demagnetization significantly decreasing the relative permeability from its intrinsic value of ∼5000 to about 11 in the range of magnetic field amplitude and frequency values relevant to HT. The power generated by the seed dropped sharply as the shell thickness deviated from the optimal value. The optimized TB and HT-only seeds generated 45 and 267 mW power, respectively, providing a HT source sufficient for >90% volume coverage even for the highest blood perfusion rates. The toxicity of the surrounding normal tissues was minimal due to the rapid temperature fall off within a few millimeters distance from a seed.

CONCLUSIONS

The investigated TB and HT-only seed prototypes were shown to provide sufficient power for the concurrent administration of radiation and HT. In addition to being used as a source for both radiation and heat at the onset of cancer therapy, these implanted seeds would be available for treatment intensification in the setting of salvage brachytherapy for locally radiorecurrent disease, possibly as a sensitizer to systemic therapies or as a modulator of the immune response, without another invasive procedure. Experimentally determined parameters of the ferrite material cores provided in this study establish a mechanistic foundation for future pre-clinical and clinical validation studies.

Electron backscattering for signal enhancement in a thin-film CdTe radiation detector

BACKGROUND

Thin-film cadmium telluride (CdTe) offers high average electron density, direct detection configuration, and excellent radiation hardness, making it an attractive material for radiation detectors. Although a very thin detector provides capabilities to conduct high-resolution measurements in high-energy radiation fields, it is limited by a low signal, often boosted with a front metal converter enhancing X-ray absorption. An extension of this approach can be explored through the investigation of electron backscattering phenomenon, known to be highly dependent on the material atomic number Z. Adding an electron reflector in tandem with the back electrode is proposed to be utilized for the detector signal enhancement.

PURPOSE

We investigated the possibility of augmenting the fluence of electrons traversing CdTe thin film and thus increasing the detected signal pursuing two pathways: (1) adding a high-Z metal layer to the back of the detector surface, and (2) adding a top low-Z material to the detector layer to return its backscattered electrons. Copper (Cu) and lead (Pb) layers of varying thickness were investigated as potential metal back-reflectors, whereas polymethyl methacrylate (PMMA) water phantom material was tested as the top cover in multilayer detector structures.

METHODS

The Monte Carlo (MC) radiation transport package MCNP5 was first used to model a basic multilayer structure of a CdTe-sensitive volume surrounded by PMMA, under a 6-MV photon beam. Addition of Cu or Pb back-reflectors allowed for the analysis of the signal enhancement and associated changes in Compton electrons fluence spectra. Related backscattering coefficients were then calculated using EGSnrc MC user-code for monoenergetic electron sources. Analytical functions were established to represent the best fitting curves to the simulation data. Finally, electron backscattering data was related to signal enhancement in the CdTe sensitive layer based on a semiquantitative approach.

RESULTS

We studied multilayer detector structures, decoupling the effects of PMMA and the back-reflector metals, Cu or Pb, on electron backscattering for electron energy range of up to 500 keV or 1 MeV depending on the choice of metal. Adding a 100-200-µm-thick metal film below the detector sensitive volume increased the fraction of reflected electrons, especially in the low, 100-200 keV, energy range. The thickness dependence of backscattering coefficients from thin films exhibits saturations at values significantly exceeding the electron ranges. That effect was related to the large-angle electron scattering. A detailed simulation of energy deposition revealed that the modified structures using Cu and Pb increased energy deposition by ∼10% and 75%, respectively. We have also established a linear dependence between the energy deposition in the semiconductor layer and the fluence of backscattered electrons in the corresponding multilayer structure. The low-Z top layer in practically implemental thicknesses of tens of micrometers has a positive effect due to partial electron reflection back to the semiconductor layer.

CONCLUSIONS

Signal enhancement in a thin-film CdTe radiation detector could be achieved using electron backscattering from metal reflectors. The methodology explored here warrants further studies to quantify achievable signal enhancement for various thin films and other small sensitive volume detectors.

Evaluation of parameters affecting gamma passing rate in patient-specific QAs for multiple brain lesions IMRS treatments using ray-station treatment planning system

Purpose

Using intensity‐modulated radiosurgery (IMRS) with single isocenter for the treatment of multiple brain lesions has gained acceptance in recent years. One of the challenges of this technique is conducting a patient‐specific quality assurance (QA), involving accurate gamma passing rate (GPR) calculations for small and wide spread‐out targets. We evaluated effects of parameters such as dose grid and energy on GPR using our clinical IMRS plans.

Methods

Ten patients with total of 40 volumetric modulated arc therapy (VMAT) plans were created in Raystation (V.8A) treatment planning system (TPS) for the Varian Edge Linac using 6 and 10 flattening filter‐free (FFF) beams and planned dose grids of 1 mm and 2 mm resulting in four plans with 6–10 targets per patient. All parameters and objectives except dose grid and energy were kept the same in all plans. Next, patient‐specific QAs were measured evaluating GPR with 10% threshold, 3%/3 mm objective, and an acceptance criterion of 95%. Modulation factors (MF) and confidence intervals were calculated. Two modes of measurements, standard density (SD) and high density (HD), were used.

Results

Generally, plans computed with 1 mm dose grid have higher GPRs than those with 2 mm dose grid for both energies used. The GPRs of 6 FFF plans were higher than those of 10 FFF plans. GPR showed no noticeable difference between HD and SD measurements. Negative correlation between MF and GPR was observed. The HD pass rates fall within the confidence interval of SD.

Conclusion

Calculated dose grid should be less than or equal to one‐third of distance to agreement, thus 1 mm planned dose grid is recommended to reduce artifacts in gamma calculation. GPR of SD and HD measurement modes is almost the same, which indicates that SD mode is clinically preferable for performing patient‐specific QAs. According to our results, using 6 FFF beams with 1 mm planned dose grid is more accurate and reliable for dose calculation of IMRS plans.

A novel property of gold nanoparticles: Free radical generation under microwave irradiation

PURPOSE

Gold nanoparticles (GNPs) are known to be effective mediators in microwave hyperthermia. Interaction with an electromagnetic field, large surface to volume ratio, and size quantization of nanoparticles (NPs) can lead to increased cell killing beyond pure heating effects. The purpose of this study is to explore the possibility of free radical generation by GNPs in aqueous media when they are exposed to a microwave field.

METHODS

A number of samples with 500 mM 5,5-dimethyl-1-pyrroline N-oxide (DMPO) in 20 ppm GNP colloidal suspensions were scanned with an electron paramagnetic resonance (EPR)/electron spin resonance spectrometer to generate and detect free radicals. A fixed (9.68 GHz) frequency microwave from the spectrometer has served for both generation and detection of radicals. EPR spectra obtained as first derivatives of intensity with the spectrometer were double integrated to get the free radical signal intensities. Power dependence of radical intensity was studied by applying various levels of microwave power (12.5, 49.7, and 125 mW) while keeping all other scan parameters the same. Free radical signal intensities from initial and final scans, acquired at the same power levels, were compared.

RESULTS

Hydroxyl radical (OH⋅) signal was found to be generated due to the exposure of GNP-DMPO colloidal samples to a microwave field. Intensity of OH⋅ signal thus generated at 12.5 mW microwave power for 2.8 min was close to the intensity of OH⋅ signal obtained from a water-DMPO sample exposed to 1.5 Gy ionizing radiation dose. For repeated scans, higher OH⋅ intensities were observed in the final scan for higher power levels applied between the initial and the final scans. Final intensities were higher also for a shorter time interval between the initial and the final scans.

CONCLUSIONS

Our results observed for the first time demonstrate that GNPs generate OH⋅ radicals in aqueous media when they are exposed to a microwave field. If OH⋅ radicals can be generated close to deoxyribonucleic acid of cells by proper localization of NPs, NP-aided microwave hyperthermia can yield cell killing via both elevated temperature and free radical generation.

Use of novel thermobrachytherapy seeds for realistic prostate seed implant treatments

PURPOSE

A practical means of delivering both therapeutic radiation and hyperthermia to a deep-seated target has been identified in the literature as highly desirable, provided it is capable of generating sufficient temperatures over the defined target volume. The authors present continued development of a dual-modality thermobrachytherapy (TB) seed, investigating its capabilities in delivering prescribed hyperthermia to realistic deep-seated targets.

METHODS

The TB seed is based on the ubiquitous low dose-rate (LDR) brachytherapy permanent implant. Heat is generated by incorporating a ferromagnetic core within the seed and placing the patient in an oscillating external magnetic field, producing eddy currents within the core and hence Joule heating. A strategically selected Curie temperature results in thermal self-regulation. The magnetic and thermal properties of the TB seed were studied experimentally by means of seed prototypes placed in a tissue-mimicking phantom and heated with an industrial induction heater, as well as computationally in the finite element analysis solver COMSOL Multiphysics. Patient-specific seed distributions derived from LDR permanent prostate implants previously conducted at their institution were modeled in COMSOL to evaluate their ability to adequately cover a defined target volume and to overcome the loss of heat due to blood perfusion within tissue. The calculated temperature distributions were analyzed by generating temperature-volume histograms, which were used to quantify coverage and temperature homogeneity for varied blood perfusion rates, seed Curie temperatures, and thermal power production rates. Use of additional hyperthermia-only (HT-only) seeds in unused spots within the implantation needles was investigated, as was an increase in these seeds' core size to increase their power. The impact of the interseed attenuation and scatter (ISA) effect on radiation dose distributions of this seed was also quantified by Monte Carlo studies in the software package Monte Carlo N-Particle Version 5.

RESULTS

Increasing the power production of the seeds, as well as increasing their Curie point, would increase the maximum blood perfusion rate that a given seed distribution could overcome to obtain an acceptable temperature distribution. However, this would also increase the maximum temperatures generated at the seed surfaces. Auxiliary HT-only seeds serve to improve the temperature uniformity within the target, as well as decrease the seed power generation requirements. Both an increase in their core size and an increase in both seed types' Curie temperatures enhance the resulting temperature coverage. The interseed and scatter effect caused by both the TB and HT-only seeds was found to reduce the dose to 90% of the target volume (D90) by a factor of 1.10 ± 0.02.

CONCLUSIONS

A systematic approach of combining LDR prostate brachytherapy with hyperthermia is described, and its ability to provide sufficient and uniform temperature distributions in realistic patient-specific implants evaluated. A combination of TB and HT-only seeds may be used to produce a uniform temperature distribution in a defined target. Various modeled changes to their design, such as optimization of their Curie temperature, improve their ability to overcome the thermal effects of blood perfusion. The enhanced ISA of the TB and HT-only seeds must be taken into account for dose calculations, but is manageable.

Thin-film CdTe detector for microdosimetric study of radiation dose enhancement at gold-tissue interface

Presence of interfaces between high and low atomic number (Z) materials, often encountered in diagnostic imaging and radiation therapy, leads to radiation dose perturbation. It is characterized by a very narrow region of sharp dose enhancement at the interface. A rapid falloff of dose enhancement over a very short distance from the interface makes the experimental dosimetry nontrivial. We use an in-house-built inexpensive thin-film Cadmium Telluride (CdTe) photodetector to study this effect at the gold-tissue interface and verify our experimental results with Monte Carlo (MC) modeling. Three-micron thick thin-film CdTe photodetectors were fabricated in our lab. One-, ten- or one hundred-micron thick gold foils placed in a tissue-equivalent-phantom were irradiated with a clinical Ir-192 high-dose-rate (HDR) source and current measured with a CdTe detector in each case was compared with the current measured for all uniform tissue-equivalent phantom. Percentage signal enhancement (PSE) due to each gold foil was then compared against MC modeled percentage dose enhancement (PDE), obtained from the geometry mimicking the experimental setup. The experimental PSEs due to 1, 10, and 100 μm thick gold foils at the closest measured distance of 12.5μm from the interface were 42.6 ± 10.8 , 137.0 ± 11.9, and 203.0 ± 15.4, respectively. The corresponding MC modeled PDEs were 38.1 ± 1, 164 ± 1, and 249 ± 1, respectively. The experimental and MC modeled values showed a closer agreement at the larger distances from the interface. The dose enhancement in the vicinity of gold-tissue interface was successfully measured using an in-house-built, high-resolution CdTe-based photodetector and validated with MC simulations. A close agreement between experimental and the MC modeled results shows that CdTe detector can be utilized for mapping interface dose distribution encountered in the application of ionizing radiation.

Practical considerations for maximizing heat production in a novel thermobrachytherapy seed prototype

PURPOSE

A combination of hyperthermia and radiation in the treatment of cancer has been proven to provide better tumor control than radiation administered as a monomodality, without an increase in complications or serious toxicities. Moreover, concurrent administration of hyperthermia and radiation displays synergistic enhancement, resulting in greater tumor cell killing than hyperthermia and radiation delivered separately. The authors have designed a new thermobrachytherapy (TB) seed, which serves as a source of both radiation and heat for concurrent brachytherapy and hyperthermia treatments when implanted in solid tumors. This innovative seed, similar in size and geometry to conventional seeds, will have self-regulating thermal properties.

METHODS

The new seed's geometry is based on the standard BEST Model 2301(125)I seed, resulting in very similar dosimetric properties. The TB seed generates heat when placed in an oscillating magnetic field via induction heating of a ferromagnetic Ni-Cu alloy core that replaces the tungsten radiographic marker of the standard Model 2301. The alloy composition is selected to undergo a Curie transition near 50 °C, drastically decreasing power production at higher temperatures and providing for temperature self-regulation. Here, the authors present experimental studies of the magnetic properties of Ni-Cu alloy material, the visibility of TB seeds in radiographic imaging, and the ability of seed prototypes to uniformly heat tissue to a desirable temperature. Moreover, analyses are presented of magnetic shielding and thermal expansion of the TB seed, as well as matching of radiation dose to temperature distributions for a short interseed distance in a given treatment volume.

RESULTS

Annealing the Ni-Cu alloy has a significant effect on its magnetization properties, increasing the sharpness of the Curie transition. The TB seed preserves the radiographic properties of the BEST 2301 seed in both plain x rays and CT images, and a preliminary experiment demonstrates thermal self-regulation and adequate heating of a tissue-mimicking phantom by seed prototypes. The effect of self-shielding of the seed against the external magnetic field is small, and only minor thermal stress is induced in heating of the seeds from room temperature to well above the seed operating temperature. With proper selection of magnetic field parameters, the thermal dose distribution of an arrangement of TB and hyperthermia-only seeds may be made to match with its radiation dose distribution.

CONCLUSIONS

The presented analyses address several practical considerations for manufacturing of the proposed TB seeds and identify critical issues for the prototype implementation. The authors' preliminary experiments demonstrate close agreement with the modeling results, confirming the feasibility of combining sources of heat and radiation into a single thermobrachytherapy seed.

SU-E-T-310: Micro-Dosimetry Study of the Radiation Dose Enhancement at the Gold-Tissue Interface for Nanoparticle-Aided Radiation Therapy

PURPOSE

Gold nanoparticles (AuNP) have been proposed to be utilized for local dose enhancement in radiation therapy. Due to a very sharp spatial fall-off of the effect, the dosimetry associated with such an approach is difficult to implement in a direct measurement. This study is aimed at establishing a micro-dosimetry technique for experimental verification of dose enhancement in the vicinity of gold-tissue interface.

METHODS

The spatial distribution of the dose enhancement near the gold-tissue interface is modeled with Monte Carlo (MC) package MCNP5 in a 1-dimentional approach of a thin gold slab placed in an ICRU-4 component tissue phantom. The model is replicating the experiment, where the dose enhancement due to gold foils having thicknesses of 1, 10, and 100μm and areas of 12.5×25mm² are placed at a short distance from clinical HDR brachytherapy (Ir-192) source. The measurements are carried out with a thin-film CdTe-based photodetector, having thickness <10μm, allowing for high spatial resolution at progressively increasing distances from the foil.

RESULTS

Our MC simulation results indicate that for Ir-192 energy spectrum the dose enhancement region extends over ∼1 mm distance from the foil, changing from several hundred at the interface to just a few percent. The trend in the measured dose enhancement closely follows the results obtained from MC simulations.

CONCLUSIONS

AuNP's have been established as promising candidates for dose enhancement in nanoparticle-aided radiation therapy, particularly, in the energy range relevant to brachytherapy applications. Most researchers study the dose enhancement with MC simulations, or experimental approaches involving biological systems, where achievable dose enhancements are difficult to quantify. Successful development of micro-dosimetry approaches will pave a way for direct assessment of the dose in experiments on biological models, shedding some light on apparent discrepancy between physical dose enhancement and biological effect established in studies of AuNP-aided radiation therapy. No conflict of interest.

SU-E-T-303: Practical Considerations for Maximizing Heat Production in Novel Thermo-Brachytherapy Seed Prototype

PURPOSE

Our recently proposed thermo-brachytherapy seed offers a convenient approach to radiation sensitization with heat in treatment of solid tumors through concurrent administration of hyperthermia and brachytherapy. The seed consists of a titanium capsule, containing radioactive I-125 and a ferromagnetic core, serving as a source of self-regulating hyperthermia when placed in an alternating electromagnetic field. We present an experimental study of the magnetic properties of ferromagnetic Ni-Cu alloy, and develop a protocol for obtaining the material capable of the maximum heat generation. Based on the practically achievable temperature interval we evaluate the effect of thermal expansion on the seed components during the hyperthermia treatment.

METHODS

Alloy samples of Ni1-xCux (0.28= × =0.3) were prepared by arc melting method in argon atmosphere. The ingots were annealed in vacuum at 1000°C for 12 hours. These samples were cut into pieces and used for magnetization measurements with SQUID magnetometer. The thermal expansion along greatest dimension of each component of the purposed seed was estimatedfor temperature increase from 37 to 60 ËšC.

RESULTS

The annealed samples show sharp Curie transition at temperature TC∼50°C, varying with the alloy concentration. However, the un-annealed sample does not show the clear transition, thus indicating a strong influence of thermal treatments on the magnetic properties of the Ni-Cu alloy. The annealing favors atomic diffusion, and leads a sample homogenization, minimizing composition fluctuations and maximizing the heat generation. The effect of the temperature rise on the thermal expansion of each component of the seed was found to be negligible.

CONCLUSIONS

We have established the thermal annealing protocol resulting in the maximum heat generation from the Ni- Cu alloy core. The negligible change in dimensions of the seed components due to heating assures the safety of the implementation of thermo-brachytherapy seed for hyperthermia treatments. This project is supported through NIH grant # 1 R41 CA153681-01A1.

Abstract 5730: Dosimetric properties of a new thermobrachytherapy seed with ferromagnetic core for treatment of solid tumors

Studies of the curative effects of hyperthermia and radiation therapy on treatment of cancer show a strong evidence of a synergistic enhancement when both radiation and hyperthermia modalities are applied simultaneously. Varieties of tissue heating approaches developed up to date still fail to overcome such essential limitations as an inadequate temperature control, temperature non-uniformity, and prolonged time delay between hyperthermia and radiation treatments. We propose a new self-regulating Thermobrachytherapy seed, which serves as a source of both radiation and heat for concurrent administration of brachytherapy and hyperthermia. The proposed seed is based on the BEST Seed Model 2301-I125, where tungsten marker core and the air gap are replaced with a ferromagnetic material. The ferromagnetic core produces heat when subjected to alternating electro-magnetic (EM) field and effectively shuts off after reaching the Curie temperature (TC) of the ferromagnetic material thus realizing the temperature self-regulation. We present the Monte Carlo study of dose rate constant and the other TG-43 radiation characteristic factors for the proposed seed. For the thermal characteristics, we studied a model consisting of 16 seeds placed in the central region of a cylindrical water phantom using a finite-element partial differential equation solver package “COMSOL Multiphysics”. The modeling result shows that temperature of the thermoseed surface rises rapidly and stays constant around TC of the ferromagnetic material. The amount of heat produced by the ferromagnetic core is sufficient to raise the temperature of the surrounding volume to the therapeutic range. The volume of the therapeutic temperature range increases with increase of frequency or magnetic field strength. These studies demonstrate that an optimal isothermal distribution can be achieved on a target volume to match with the radiation isodose distribution for the seed configuration by tuning frequency and intensity of the alternating magnetic field. The proposed combination seed model has a high potential for implementation of concurrent brachytherapy and hyperthermia.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5730. doi:1538-7445.AM2012-5730

Absorption and photoluminescence studies of lightly alloyed CdTe(S) and CdS(Te)

CdTe-rich and CdS-rich alloy films were deposited at temperatures less than 300C using an rf sputtering technique. Transmission-reflection and photoluminescence measurements were conducted to study the near-band edge properties of this ternary system for films of different compositions at room temperature and at 10K. Results were compared to data on defect states introduced in CdTe single crystal by annealing at several different overpressure conditions, including CdS and CdCl2 overpressures. A below-band-gap photoluminescence excitation technique was used to study systematically the effect of different steps in the production of the complete solar cell on band gap states of CdSxTe1−x alloys as well as pure binary constituents.

Physics of CdTe Photovoltaics: from Front to Back

We discuss physical mechanisms underlying the performance and stability of CdTe based thin-film PV. The processes in (i) photovoltaic junction, (ii) back contact, (iii) nonuniformities, (iv) grain boundaries, and (v) light-induced degradation are addressed including their interactions. The physics of thin film PV turns out to be quite different from that of crystalline PV. High surface-volume ratio and lack of crystallinity result in strong interfacial effects, lateral nonuniformities, and shunting-like and adhesion instabilities in thin film structures. This paper is aimed at presenting a ‘big picture'; also, it suggests practical ways of improving thin-film PV.

Design and optimization of large area thin-film CdTe detector for radiation therapy imaging applications

PURPOSE

The authors investigate performance of thin-film cadmium telluride (CdTe) in detecting high-energy (6 MV) x rays. The utilization of this material has become technologically feasible only in recent years due to significant development in large area photovoltaic applications.

METHODS

The CdTe film is combined with a metal plate, facilitating conversion of incoming photons into secondary electrons. The system modeling is based on the Monte Carlo simulations performed to determine the optimized CdTe layer thickness in combination with various converter materials.

RESULTS

The authors establish a range of optimal parameters producing the highest DQE due to energy absorption, as well as signal and noise spatial spreading. The authors also analyze the influence of the patient scatter on image formation for a set of detector configurations. The results of absorbed energy simulation are used in device operation modeling to predict the detector output signal. Finally, the authors verify modeling results experimentally for the lowest considered device thickness.

CONCLUSIONS

The proposed CdTe-based large area thin-film detector has a potential of becoming an efficient low-cost electronic portal imaging device for radiation therapy applications.

Quantitative and analytical comparison of isodose distributions for shaped electron fields from ADAC Pinnacle treatment planning system and Monte Carlo simulations

We assess the accuracy of ADAC Pinnacle(3) commercial treatment planning system (TPS) in computation of isodose distributions for shaped electron fields. The assessment is based on comparison of dose profiles generated by TPS and a Monte Carlo model for different beam energies, applicator sizes, and percentages of field blocking. Dose differences of up to 14% are observed at the depth of maximum dose. These discrepancies, often ignored in clinical evaluations, are attributable to inadequate modeling of scatter from applicators and blocks by TPS.