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ABSTRACT: Although treatment planning systems are generally thought to have poor accuracy for out-of-field dose calculations, little work has been done to quantify this dose calculation inaccuracy for modern treatment techniques, such as intensity-modulated radiation therapy (IMRT), or to understand the sources of this inaccuracy. The aim of this work is to evaluate the accuracy of out-of-field dose calculations by a commercial treatment planning system (TPS), Pinnacle3 v.9.0, for IMRT treatment plans. Three IMRT plans were delivered to anthropomorphic phantoms, and out-of-field doses were measured using thermoluminescent detectors (TLDs). The TLD-measured dose was then compared to the TPS-calculated dose to quantify the accuracy of TPS calculations at various distances from the field edge and out-of-field anatomical locations of interest (i.e., radiosensitive organs). The individual components of out-of-field dose (patient scatter, collimator scatter, and head leakage) were also calculated in Pinnacle and compared to Monte Carlo simulations for a 10 × 10 cm2 field. Our results show that the treatment planning system generally underestimated the out-of-field dose and that this underestimation worsened (accuracy decreased) for increasing distances from the field edge. For the three IMRT treatment plans investigated, the TPS underestimated the dose by an average of 50%. Our results also showed that collimator scatter was underestimated by the TPS near the treatment field, while all components of out-of-field dose were severely underestimated at greater distances from the field edge. This study highlights the limitations of commercial treatment planning systems in calculating out-of-field dose and provides data about the level of accuracy, or rather inaccuracy, that can be expected for modern IMRT treatments. Based on our results, use of the TPS-reported dose could lead to an underestimation of secondary cancer induction risk, as well as poor clinical decision-making for pregnant patients or patients with implantable cardiac pacemakers and defibrillators.
Journal of Applied Clinical Medical Physics 01/2013; 14(2):4139. · 1.29 Impact Factor
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ABSTRACT: To determine the impact of treatment planning algorithm on the accuracy of heterogeneous dose calculations in the Radiological Physics Center (RPC) thorax phantom.
We retrospectively analyzed the results of 304 irradiations of the RPC thorax phantom at 221 different institutions as part of credentialing for Radiation Therapy Oncology Group clinical trials; the irradiations were all done using 6-MV beams. Treatment plans included those for intensity-modulated radiation therapy (IMRT) as well as 3-dimensional conformal therapy (3D-CRT). Heterogeneous plans were developed using Monte Carlo (MC), convolution/superposition (CS), and the anisotropic analytic algorithm (AAA), as well as pencil beam (PB) algorithms. For each plan and delivery, the absolute dose measured in the center of a lung target was compared to the calculated dose, as was the planar dose in 3 orthogonal planes. The difference between measured and calculated dose was examined as a function of planning algorithm as well as use of IMRT.
PB algorithms overestimated the dose delivered to the center of the target by 4.9% on average. Surprisingly, CS algorithms and AAA also showed a systematic overestimation of the dose to the center of the target, by 3.7% on average. In contrast, the MC algorithm dose calculations agreed with measurement within 0.6% on average. There was no difference observed between IMRT and 3D CRT calculation accuracy.
Unexpectedly, advanced treatment planning systems (those using CS and AAA algorithms) overestimated the dose that was delivered to the lung target. This issue requires attention in terms of heterogeneity calculations and potentially in terms of clinical practice.
International journal of radiation oncology, biology, physics 01/2013; 85(1):e95-e100. · 4.59 Impact Factor
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ABSTRACT: Optically stimulated luminescent dosimeters (OSLDs) are becoming increasingly popular for measuring an absorbed dose in clinical radiotherapy. OSLDs have known energy dependence, and this is accounted for by either calibrating the OSLD with a specific nominal energy, or using a standard energy correction factor to account for differences between the experimental beam photon energy and the photon energy used to establish the OSLD's sensitivity (e.g., (60)Co). This work is typically done under reference conditions (e.g., at d(max)). The impact of variations in photon spectra on the OSLD response is typically ignored for measurement positions that are different than the reference position. We determined that it is generally necessary to apply an additional non-reference energy correction factor to OSLD measurements made at locations that do not correspond to the reference position, particularly for OSLD measurements made out-of-field, where the photon spectra are softer. We determined this energy correction factor for a range of 6 MV photon spectra using two independent methods: Burlin cavity theory and measurements. The non-reference energy correction factor was found to range from 0.97 to 1.00 for in-field measurement locations and from 0.69 to 0.95 for out-of-field measurement locations. The use of a non-reference energy correction factor can improve the accuracy of OSLDs, especially when used out-of-field.
Physics in Medicine and Biology 04/2012; 57(9):2505-15. · 2.83 Impact Factor
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ABSTRACT: Optically stimulated luminescent detectors (OSLDs) have a number of advantages in radiation dosimetry making them excellent dosimeters for quality assurance and patient dose verification. Although the dosimeters have been investigated in several modalities, relatively little work has been done in examining the dosimeters for use in clinical proton beams. This study examined a number of characteristics of the response of the dosimeters in the spread-out Bragg peak (SOBP) region of clinical proton beams.
Optically stimulated luminescence (OSL) dosimeters from Landauer, Inc., specifically the nanoDot dosimeter, were investigated. These dosimeters were placed in a special phantom with a recess to fit the dosimeters without an air gap. Beams with nominal energies of 160, 200, and 250 MeV were used in the passively-scattered proton beam at the MD Anderson Cancer Center Proton Therapy Center. Dosimetric properties including linearity, field size dependence, energy dependence, residual signal as a function of cumulative dose, and postirradiation fading were investigated by taking measurements at the center of SOBPs.
The dosimeters showed 1% supralinearity at 200 cGy and 5% supralinearity at 1000 cGy. No noticeable field size dependence of the detector was found for field sizes from 2 × 2 cm(2) to 18 × 18 cm(2). Residual signal as a function of cumulative dose showed a small increase for measurements up to 1000 cGy. Readout signal depletion of the dosimeters after consecutive readings showed a slightly larger depletion in protons for doses up to 500 cGy but not by a clinically significant amount. Within the center of various SOBP widths and proton energies the variation in response was less than 2%. An average beam quality factor of 1.089 with experimental standard deviation of 0.007 was determined and applied to the data such that the results were within 1.2% of ion chamber data.
The nanoDot OSL dosimeter characteristics were studied in the SOBP region of clinical proton beams. To achieve accurate dosimetric readings, corrections to the dosimeter response were applied. Corrections tended to be minimal or broadly consistent. The nanoDot OSLD was found to be an acceptable dosimeter for measurement in the SOBP region for a range of clinical proton beams.
Medical Physics 04/2012; 39(4):1854-63. · 2.83 Impact Factor
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ABSTRACT: For radiotherapy of the head and neck, 5-point mask immobilization is used to stabilize the shoulders. Still, the daily position of the shoulders during treatment may be different from the position in the treatment plan despite correct isocenter setup. The purpose of this study was to determine the interfractional displacement of the shoulders relative to isocenter over the course of treatment and the associated dosimetric effect of this displacement.
The extent of shoulder displacements relative to isocenter was assessed for 10 patients in 5-point thermoplastic masks using image registration and daily CT-on-rails scans. Dosimetric effects on IMRT and VMAT plans were evaluated in Pinnacle based on simulation CTs modified to represent shoulder shifts between 3 and 15 mm in the superior-inferior, anterior-posterior, and right-left directions. The impact of clinically observed shoulder shifts on the low-neck dose distributions was examined.
Shoulder motion was 2-5 mm in each direction on average but reached 20 mm. Superior shifts resulted in coverage loss, whereas inferior shifts increased the dose to the brachial plexus. These findings were generally consistent for both IMRT and VMAT plans. Over a course of observed shifts, the dose to 99% of the CTV decreased by up to 101 cGy, and the brachial plexus dose increased by up to 72 cGy.
he position of the shoulder affects target coverage and critical structure dose, and may therefore be a concern during the setup of head and neck patients, particularly those with low neck primary disease.
Radiation Oncology 02/2012; 7:19. · 2.32 Impact Factor
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ABSTRACT: Ion recombination is approximately corrected for in the Task Group 51 protocol by Pion, which is calculated by a two-voltage measurement. This measurement approach may be a poor estimate of the true recombination, particularly if Pion is large (greater than 1.05). Concern exists that Pion in high-dose-per-pulse beams, such as flattening filter free (FFF) beams, may be unacceptably high, rendering the two-voltage measurement technique inappropriate. Therefore, Pion was measured for flattened beams of 6, 10, 15, and 18 MV and for FFF beams of 6 and 10 MV. The values for the FFF beams were verified with 1/V versus 1/Q curves (Jaffé plots). Pion was also measured for electron beams of 6, 12, 16, 18, and 20 MeV on a traditional accelerator, as well as on the high-dose-rate Varian TrueBeam accelerator. The measurements were made at a range of depths and with PTW, NEL, and Exradin Farmer-type chambers. Consistent with the increased dose per pulse, Pion was higher for FFF beams than for flattening filter beams. However, for all beams, measurement locations, and chambers examined, Pion never exceeded 1.018. Additionally, Pion was always within 0.3% of the recombination calculated from the Jaffé plots. We conclude that ion recombination can be adequately accounted for in high-dose-rate FFF beams using Pion determined with the standard two-voltage technique.
Journal of Applied Clinical Medical Physics 01/2012; 13(6):3803. · 1.29 Impact Factor
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ABSTRACT: The skin dose associated with radiotherapy may be of interest for clinical evaluation or investigating the risk of late effects. However, skin dose is not intuitive and is difficult to measure. Our objectives were to develop and evaluate a general estimation technique for skin dose based on treatment parameters. The literature on skin dose was supplemented with measurements and Monte Carlo simulations. Using all available data, a general dosimetry system was developed (in the form of a series of equations) to estimate skin dose based on treatment parameters including field size, the presence of a block tray, and obliquity of the treatment field. For out-of-field locations, the distance from the field edge was also considered. This dosimetry system was then compared to TLD measurements made on the surface of a phantom. As compared to measurements, the general dosimetry system was able to predict skin dose within, on average, 21% of the local dose (4% of the Dmax dose). Skin dose for patients receiving radiotherapy can be estimated with reason-able accuracy using a set of general rules and equations.
Journal of Applied Clinical Medical Physics 01/2012; 13(3):3734. · 1.29 Impact Factor
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ABSTRACT: Delivery of accurate intensity-modulated radiation therapy (IMRT) or stereotactic radiotherapy depends on a multitude of steps in the treatment delivery process. These steps range from imaging of the patient to dose calculation to machine delivery of the treatment plan. Within the treatment planning system's (TPS) dose calculation algorithm, various unique small field dosimetry parameters are essential, such as multileaf collimator modeling and field size dependence of the output. One of the largest challenges in this process is determining accurate small field size output factors. The Radiological Physics Center (RPC), as part of its mission to ensure that institutions deliver comparable and consistent radiation doses to their patients, conducts on-site dosimetry review visits to institutions. As a part of the on-site audit, the RPC measures the small field size output factors as might be used in IMRT treatments, and compares the resulting field size dependent output factors to values calculated by the institution's treatment planning system (TPS). The RPC has gathered multiple small field size output factor datasets for X-ray energies ranging from 6 to 18 MV from Varian, Siemens and Elekta linear accelerators. These datasets were measured at 10 cm depth and ranged from 10 × 10 cm2 to 2 × 2 cm2. The field sizes were defined by the MLC and for the Varian machines the secondary jaws were maintained at a 10 × 10 cm2. The RPC measurements were made with a micro-ion chamber whose volume was small enough to gather a full ionization reading even for the 2 × 2 cm2 field size. The RPC measured output factors are tabulated and are reproducible with standard deviations (SD) ranging from 0.1% to 2.4%, while the institutions' calculated values had a much larger SD range, ranging up to 7.9%. The absolute average percent differences were greater for the 2 × 2 cm2 than for the other field sizes. The RPC's measured small field output factors provide institutions with a standard dataset against which to compare their TPS calculated values. Any discrepancies noted between the standard dataset and calculated values should be investigated with careful measurements and with attention to the specific beam model.
Journal of Applied Clinical Medical Physics 01/2012; 13(5):3962. · 1.29 Impact Factor
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Medical Physics 12/2011; 38(12):6789. · 2.83 Impact Factor
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ABSTRACT: The clinical impact of the Varian Exact Couch on dose, volume coverage to targets and critical structures, and tumor control probability (TCP) has not been described. Thus, we examined their effects on IMRT and arc therapy. Five clinical prostate patients were planned with both 6 MV eight-field IMRT and 6 MV two-arc RapidArc techniques using the Eclipse treatment planning system. These plans neglected treatment couch attenuation, as is a common clinical practice. Dose distributions were then recalculated in Eclipse with the inclusion of the Varian Exact Couch (imaging couch top) and the rails in varying configurations. The changes in dose and coverage were evaluated using the dose-volume histograms from each plan iteration. We used a TCP model to calculate losses in tumor control resulting from not accounting for the couch top and rails. We also verified dose measurements in a phantom. Failure to account for the treatment couch and rails resulted in clinically unacceptable dose and volume coverage losses to the targets for both IMRT and RapidArc. The couch caused average prescription dose losses (relative to plans that ignored the couch) to the prostate of 4.2% and 2.0% for IMRT with the rails out and in, respectively, and 3.2% and 2.9% for RapidArc with the rails out and in, respectively. On average, the percentage of the target covered by the prescribed dose dropped to 35% and 84% for IMRT (rails out and in, respectively) and to 18% and 17% for RapidArc (rails out and in, respectively). The TCP was also reduced by as much as 10.5% (6.3% on average). Dose and volume coverage losses for IMRT plans were primarily due to the rails, while the imaging couch top contributed most to losses for RapidArc. Both the couch top and rails contribute to dose and coverage losses that can render plans clinically unacceptable. A follow-up study we performed found that the less attenuating unipanel mesh couch top available with the Varian Exact couch does not cause a clinically impactful loss of dose or coverage for IMRT but still causes an unacceptable loss for RapidArc. Therefore, both the imaging or mesh couch top and the rails should be accounted for in arc therapy. The imaging couch top should be accounted for in IMRT treatment planning or the mesh top can be used, which would not need to be accounted for, and the rails should be moved to avoid the beams during treatment.
Physics in Medicine and Biology 11/2011; 56(23):7435-47. · 2.83 Impact Factor
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ABSTRACT: Purpose: Optically stimulated luminescent detectors (OSLDs) are quickly gaining popularity as passive dosimeters, with applications in medicine for linac output calibration verification, brachytherapy source verification, treatment plan quality assurance, and clinical dose measurements. With such wide applications, these dosimeters must be characterized for numerous factors affecting their response. The most abundant commercial OSLD is the InLight/OSL system from Landauer, Inc. The purpose of this study was to examine the angular dependence of the nanoDot dosimeter, which is part of the InLight system.
Relative dosimeter response data were taken at several angles in 6 and 18 MV photon beams, as well as a clinical proton beam. These measurements were done within a phantom at a depth beyond the build-up region. To verify the observed angular dependence, additional measurements were conducted as well as Monte Carlo simulations in MCNPX.
When irradiated with the incident photon beams parallel to the plane of the dosimeter, the nanoDot response was 4% lower at 6 MV and 3% lower at 18 MV than the response when irradiated with the incident beam normal to the plane of the dosimeter. Monte Carlo simulations at 6 MV showed similar results to the experimental values. Examination of the results in Monte Carlo suggests the cause as partial volume irradiation. In a clinical proton beam, no angular dependence was found.
A nontrivial angular response of this OSLD was observed in photon beams. This factor may need to be accounted for when evaluating doses from photon beams incident from a variety of directions.
Medical Physics 07/2011; 38(7):3955-62. · 2.83 Impact Factor
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ABSTRACT: Measurement of the absorbed dose from radiotherapy beams is an essential component of providing safe and reproducible treatment. For an energy-dependent dosimeter such as thermoluminescent dosimeters (TLDs), it is generally assumed that the energy spectrum is constant throughout the treatment field and is unperturbed by field size, depth, field modulation, or heterogeneities. However, this does not reflect reality and introduces error into clinical dose measurements. The purpose of this study was to evaluate the variability in the energy spectrum of a Varian 6 MV beam and to evaluate the impact of these variations in photon energy spectra on the response of a common energy-dependent dosimeter, TLD.
Using Monte Carlo methods, we calculated variations in the photon energy spectra of a 6 MV beam as a result of variations of treatment parameters, including field size, measurement location, the presence of heterogeneities, and field modulation. The impact of these spectral variations on the response of the TLD is largely based on increased photoelectric effect in the dosimeter, and this impact was calculated using Burlin cavity theory. Measurements of the energy response were also made to determine the additional energy response due to all intrinsic and secondary effects.
For most in-field measurements, regardless of treatment parameter, the dosimeter response was not significantly affected by the spectral variations (<1% effect). For measurement points outside of the treatment field, where the spectrum is softer, the TLD over-responded by up to 12% due to an increased probability of photoelectric effect in the TLD material as well as inherent ionization density effects that play a role at low photon energies.
It is generally acceptable to ignore the impact of variations in the photon spectrum on the measured dose for locations within the treatment field. However, outside the treatment field, the spectra are much softer, and a correction factor is generally appropriate. The results of this work have determined values for this factor, which range from 0.88 to 0.99 depending on the specific irradiation conditions.
Medical Physics 05/2011; 38(5):2619-28. · 2.83 Impact Factor
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ABSTRACT: Improvements in cancer survival have made the long-term risks from treatments more important, including the risk of developing a second cancer after radiotherapy. We aimed to estimate the proportion of second cancers attributable to radiotherapy in adults with data from the US Surveillance, Epidemiology and End Results (SEER) cancer registries.
We used nine of the SEER registries to systematically analyse 15 cancer sites that are routinely treated with radiotherapy (oral and pharynx, salivary gland, rectum, anus, larynx, lung, soft tissue, female breast, cervix, endometrial, prostate, testes, eye and orbit, brain and CNS, and thyroid). The cohort we studied was composed of patients aged 20 years or older who were diagnosed with a first primary invasive solid cancer reported in the SEER registries between Jan 1, 1973, and Dec 31, 2002. Relative risks (RRs) for second cancer in patients treated with radiotherapy versus patients not treated with radiotherapy were estimated with Poisson regression adjusted for age, stage, and other potential confounders.
647,672 cancer patients who were 5-year survivors were followed up for a mean 12 years (SD 4.5, range 5-34); 60,271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded 1, and varied from 1.08 (95% CI 0.79-1.46) after cancers of the eye and orbit to 1.43 (1.13-1.84) after cancer of the testes. In general, the RR was highest for organs that typically received greater than 5 Gy, decreased with increasing age at diagnosis, and increased with time since diagnosis. We estimated a total of 3266 (2862-3670) excess second solid cancers that could be related to radiotherapy, that is 8% (7-9) of the total in all radiotherapy patients (≥1 year survivors) and five excess cancers per 1000 patients treated with radiotherapy by 15 years after diagnosis.
A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics.
US National Cancer Institute.
The lancet oncology 03/2011; 12(4):353-60. · 14.47 Impact Factor
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ABSTRACT: After a new in-vault CT-on-rails system repeatedly malfunctioned following use of a high-energy radiotherapy beam, we investigated the presence and impact of neutron radiation on this electronic system, as well as neutron shielding options.
We first determined the CT scanner's failure rate as a function of the number of 18 MV monitor units (MUs) delivered. We then re-examined the failure rate with both 2.7-cm-thick and 7.6-cm-thick borated polyethylene (BPE) covering the linac head for neutron shielding. To further examine shielding options, as well as to explore which neutrons were relevant to the scanner failure, Monte Carlo simulations were used to calculate the neutron fluence and spectrum in the bore of the CT scanner. Simulations included BPE covering the CT scanner itself as well as covering the linac head.
We found that the CT scanner had a 57% chance of failure after the delivery of 200 MUs. While the addition of neutron shielding to the accelerator head reduced this risk of failure, the benefit was minimal and even 7.6 cm of BPE was still associated with a 29% chance of failure after the delivery of 200 MU. This shielding benefit was achieved regardless of whether the linac head or CT scanner was shielded. Additionally, it was determined that fast neutrons were primarily responsible for the electronic failures.
As illustrated by the CT-on-rails system in the current study, physicists should be aware that electronic systems may be highly sensitive to neutron radiation. Medical physicists should therefore monitor electronic systems that have not been evaluated for potential neutron sensitivity. This is particularly relevant as electronics are increasingly common in the therapy vault and newer electronic systems may exhibit increased sensitivity.
Medical Physics 01/2011; 38(1):34-9. · 2.83 Impact Factor
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ABSTRACT: An important but little examined aspect of radiation dosimetry studies involving organs outside the treatment field is how to assess dose to organs that are partially within a treatment field; this question is particularly important for studies intended to measure total absorbed dose in order to predict the risk of radiogenic late effects, such as second cancers. The purpose of this investigation was therefore to establish a method to categorize organs as in-field, out-of-field or partially in-field that would be applicable to both conventional and modern radiotherapy techniques. In this study, we defined guidelines to categorize the organs based on isodose inclusion criteria, developed methods to assess doses to partially in-field organs, and then tested the methods by applying them to a case of intensity-modulated radiotherapy for hepatocellular carcinoma based on actual patient data. For partially in-field organs, we recommend performing a sensitivity test to determine whether potential inaccuracies in low-dose regions of the DVH (from the treatment planning system) have a substantial effect on the mean organ dose, i.e. >5%. In such cases, we suggest supplementing calculated DVH data with measured dosimetric data using a volume-weighting technique to determine the mean dose.
Physics in Medicine and Biology 11/2010; 55(23):7009-23. · 2.83 Impact Factor
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ABSTRACT: Mantle field irradiation has historically been the standard radiation treatment for Hodgkin lymphoma. It involves treating large regions of the chest and neck with high doses of radiation (up to 30 Gy). Previous epidemiological studies on the incidence of second malignancies following radiation therapy for Hodgkin lymphoma have revealed an increased incidence of second tumors in various organs, including lung, breast, thyroid and digestive tract. Multiple other studies, including the Surveillance, Epidemiology and End Results, indicated an increased incidence in digestive tract including stomach cancers following mantle field radiotherapy. Assessment of stomach dose is challenging because the stomach is outside the treatment field but very near the treatment border where there are steep dose gradients. In addition, the stomach can vary greatly in size and position. We sought to evaluate the dosimetric impact of the size and variable position of the stomach relative to the field border for a typical Hodgkin lymphoma mantle field irradiation. The mean stomach dose was measured using thermoluminescent dosimetry for nine variations in stomach size and position. The mean doses to the nine stomach variations ranged from 0.43 to 0.83 Gy when 30 Gy was delivered to the treatment isocenter. Statistical analyses indicated that there were no significant differences in the mean stomach dose when the stomach was symmetrically expanded up to 3 cm or shifted laterally (medial, anterior or posterior shifts) by up to 3 cm. There was, however, a significant (P > 0.01) difference in the mean dose when the stomach was shifted superiorly or inferiorly by ≥2.5 cm.
Physics in Medicine and Biology 11/2010; 55(23):7025-36. · 2.83 Impact Factor
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ABSTRACT: The aim of this paper is to determine the effect of removing the flattening filter from a linear accelerator on the out-of-field photon dose. A Monte Carlo model was used to simulate 6 MV and 18 MV photon beams from a Varian 2100 accelerator with the flattening filter in place and with it removed. The out-of-field photon doses and composition (head leakage, patient scatter and collimator scatter) were calculated from square open fields in a water tank as a function of distance from central axis, field size and depth. The out-of-field doses resulting from intensity-modulated radiation therapy to the prostate at 6 MV were also calculated, with and without the flattening filter, to sensitive organs in an anthropomorphic Rando phantom. Removal of the flattening filter reduced the out-of-field dose near the treatment field (<3 cm from the field edge) because of decreased collimator scatter. It increased the out-of-field dose at intermediate distances from the field edge (3-15 cm) because of increased patient scatter. At greater distances, the out-of-field dose was decreased because of reduced head leakage. For the clinical treatment examined, the out-of-field dose was generally reduced following removal of the flattening filter, particularly at large distances from the treatment field. Removal of the flattening filter may be advantageous by reducing the out-of-field dose to the patient. This could contribute to reducing the long-term risk of secondary malignancies. In general, however, the out-of-field dose depends on treatment and patient parameters, and a reduction may not always be achievable.
Physics in Medicine and Biology 03/2010; 55(8):2155-66. · 2.83 Impact Factor
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ABSTRACT: We conducted a metrological evaluation of the dosimetric impact due to the polysulfone cap used with the Fletcher-Williamson (FW) colpostat for 192Ir high-dose rate and pulsed-dose rate intracavitary brachytherapy using Monte Carlo simulations. Polysulfone caps with diameter of 30 mm, 25 mm, 20 mm, and 16 mm (mini-ovoid) were simulated and the absorbed dose rate in the surrounding water was calculated and compared to the dose rate for a bare 192Ir source in water. The dose perturbation depended on the cap diameter, distance away from the cap surface, and angular position around the cap. The largest dose rate reductions were found to be in the direction of the tumor bed where the cap is thickest. The range of perturbation over all depths and cap diameters was +2.8% (dose enhancement) to -6.8% (dose reduction). The FW colpostat cap's material composition should be modified to reduce this dosimetric effect or brachytherapy treatment planning dose algorithms should be improved to account for this perturbation.
Journal of Applied Clinical Medical Physics 01/2010; 11(1):3146. · 1.29 Impact Factor
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ABSTRACT: Calibration of the response functions of a gold (Au)-indium (In) dual foil Bonner sphere extended (BSE) system was described. The response of the In and Au foil of the system was calculated using MCNPX code with different activation cross-sectional libraries: (ACTL and ENDF VI for gold and ACTL and 532DOS2 for In). To verify and correct the calculated response functions the Bonner sphere set (BSS) was irradiated using (252)Cf and (241)AmBe sources of known neutron strengths for neutrons ranging from thermal to 20 MeV, and was irradiated at the 800-MeV neutron beam of the Los Alamos Neutron Science Center. The neutron spectrum of the 800 MeV beam was determined using time-of-flight (TOF) technique. We observed that the uncertainty of activation cross section in the resonance region can result in great uncertainty in the MCNPX-calculated response functions of activation foil-based BSS. The MCNPX-calculated response functions must be corrected using neutron sources of known spectrum and strength.
Radiation Protection Dosimetry 12/2009; 139(4):565-73. · 0.82 Impact Factor
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ABSTRACT: Neutrons are a by-product of high-energy x-ray radiation therapy (threshold for [gamma,n] reactions in high-Z material -7 MeV). Neutron production varies depending on photon beam energy as well as on the manufacturer of the accelerator. Neutron production from modern linear accelerators (linacs) has not been extensively compared, particularly in terms of the differences in the strategies that various manufacturers have used to implement multileaf collimators (MLCs) into their linac designs. However, such information is necessary to determine neutron dose equivalents for different linacs and to calculate vault shielding requirements. The purpose of the current study, therefore, was to measure the neutron spectra from the most up-to-date linacs from three manufacturers: Varian 21EX operating at 15, 18, and 20 MV, Siemens ONCOR operating at 15 and 18 MV, and Elekta Precise operating at 15 and 18 MV. Neutron production was measured by means of gold foil activation in Bonner spheres. Based on the measurements, the authors determined neutron spectra and calculated the average energy, total neutron fluence, ambient dose equivalent, and neutron source strength. The shapes of the neutron spectra did not change significantly between accelerators or even as a function of treatment energy. However, the neutron fluence, and therefore the ambient dose equivalent, did vary, increasing with increasing treatment energy. For a given nominal treatment energy, these values were always highest for the Varian linac. The current study thus offers medical physicists extensive information about the neutron production of MLC-equipped linacs currently in operation and provides them information vital for accurate comparison and prediction of neutron dose equivalents and calculation of vault shielding requirements.
Medical Physics 09/2009; 36(9):4027-38. · 2.83 Impact Factor
