An extendable x-ray multi-leaf collimator (eMLC) is investigated for collimation of electron beams on a linear accelerator. The conventional method of collimation using an electron applicator is impractical for conformal, modulated and mixed beam therapy techniques. An eMLC would allow faster, more complex treatments with potential for reduction in dose to organs-at-risk and critical structures. The add-on eMLC was modelled using the EGSnrc Monte Carlo code and validated against dose measurements at 6-21 MeV with the eMLC mounted on a Siemens Oncor linear accelerator at 71.6 and 81.6 cm source-to-collimator distances. Measurements and simulations at 8.4-18.4 cm airgaps showed agreement of 2%/2 mm. The eMLC dose profiles and percentage depth dose curves were compared with standard electron applicator parameters. The primary differences were a wider penumbra and up to 4.2% reduction in the build-up dose at 0.5 cm depth, with dose normalized on the central axis. At 90 cm source-to-surface distance (SSD)--relevant to isocentric delivery--the applicator and eMLC penumbrae agreed to 0.3 cm. The eMLC leaves, which were 7 cm thick, contributed up to 6.3% scattered electron dose at the depth of maximum dose for a 10 × 10 cm2 field, with the thick leaves effectively eliminating bremsstrahlung leakage. A Monte Carlo calculated wedge shaped dose distribution generated with all six beam energies matched across the maximum available eMLC field width demonstrated a therapeutic (80% of maximum dose) depth range of 2.1-6.8 cm. Field matching was particularly challenging at lower beam energies (6-12 MeV) due to the wider penumbrae and angular distribution of electron scattering. An eMLC isocentric electron breast boost was planned and compared with the conventional applicator fixed SSD plan, showing similar target coverage and dose to critical structures. The mean dose to the target differed by less than 2%. The low bremsstrahlung dose from the 7 cm thick MLC leaves had the added advantage of reducing the mean dose to the whole heart. Isocentric delivery using an extendable eMLC means that treatment room re-entry and repositioning the patient for SSD set-up is unnecessary. Monte Carlo simulation can accurately calculate the fluence below the eMLC and subsequent patient dose distributions. The eMLC generates similar dose distributions to the standard electron applicator but provides a practical method for more complex electron beam delivery.
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[Show abstract][Hide abstract]ABSTRACT: Monte Carlo (MC) simulation can be used for accurate electron beam treatment planning and modeling. Measurement of large electron fields, with the applicator removed and secondary collimator wide open, has been shown to provide accurate simulation parameters, including asymmetry in the measured dose, for the full range of clinical field sizes and patient positions. Recently, disassembly of the treatment head of a linear accelerator has been used to refine the simulation of the electron beam, setting tightly measured constraints on source and geometry parameters used in simulation. The simulation did not explicitly include the known deflection of the electron beam by a fringe magnetic field from the bending magnet, which extended into the treatment head. Instead, the secondary scattering foil and monitor chamber were unrealistically laterally offset to account for the beam deflection. This work is focused on accounting for this fringe magnetic field in treatment head simulation.
The magnetic field below the exit window of a Siemens Oncor linear accelerator was measured with a Tesla-meter from 0 to 12 cm from the exit window and 1-3 cm off-axis. Treatment head simulation was performed with the EGSnrc/BEAMnrc code, modified to incorporate the effect of the magnetic field on charged particle transport. Simulations were used to analyze the sensitivity of dose profiles to various sources of asymmetry in the treatment head. This included the lateral spot offset and beam angle at the exit window, the fringe magnetic field and independent lateral offsets of the secondary scattering foil and electron monitor chamber. Simulation parameters were selected within the limits imposed by measurement uncertainties. Calculated dose distributions were then compared with those measured in water.
The magnetic field was a maximum at the exit window, increasing from 0.006 T at 6 MeV to 0.020 T at 21 MeV and dropping to approximately 5% of the maximum at the secondary scattering foil. It was up to three times higher in the bending plane, away from the electron gun, and symmetric within measurement uncertainty in the transverse plane. Simulations showed the magnetic field resulted in an offset of the electron beam of 0.80 cm (mean) at the machine isocenter for the exit window only configuration. The fringe field resulted in a 3.5%-7.6% symmetry and 0.25-0.35 cm offset of the clinical beam R(max) profiles. With the magnetic field included in simulations, a single (realistic) position of the secondary scattering foil and monitor chamber was selected. Measured and simulated dose profiles showed agreement to an average of 2.5%/0.16 cm (maximum: 3%/0.2 cm), which is a better match than previously achieved without incorporating the magnetic field in the simulation. The undulations from the 3 stepped layers of the secondary scattering foil, evident in the measured profiles of the higher energy beams, are now aligned with those in the simulated beam. The simulated fringe magnetic field had negligible effect on the central axis depth dose curves and cross-plane dose profiles.
The fringe magnetic field is a significant contributor to the electron beam in-plane asymmetry. With the magnetic field included explicitly in the simulation, realistic monitor chamber and secondary scattering foil positions have been achieved, and the calculated fluence and dose distributions are more accurate.
[Show abstract][Hide abstract]ABSTRACT: Despite promising research in modulated electron radiotherapy (MERT), an applicator to produce modulated electron beams and associated treatment planning software is still not commercially available. This work investigated an optimization process in treatment planning for the McGill few leaf electron collimator (FLEC) MERT delivery device. In addition, the possibility of combining MERT with photon fields was examined to investigate mixed beam radiotherapy.
A FLEC direct aperture optimization (DAO) method, in which FLEC apertures and weights were iteratively optimized was created. The authors evaluated the performance of DAO against our previous technique for generating FLEC plans and with commercially available photon beam optimization algorithms using a basic target and organ at risk geometry. The authors applied the DAO technique on a sarcoma treatment to evaluate clinical parameters. Finally, the authors examined the merit of mixing the DAO generated FLEC electron fields with photon fields to improve the dosimetry of the sarcoma treatment.
In relation to the alternative plans, the DAO generated sarcoma MERT plan was competitive in its ability to reduce the dose to OAR but weaker in its ability to highly conform the dose to the target volume. The addition of photon fields improved the quality of the MERT plan in terms of OAR sparing and target conformality.
The DAO approach yielded deliverable FLEC-based MERT plans with a limited number of fields. The approach combined with photon optimization added flexibility, where the mutual benefits of each radiation type was used in unison to improve plan quality.
[Show abstract][Hide abstract]ABSTRACT: A motorized electron multileaf collimator (eMLC) was developed as an add-on device to the Varian linac for delivery of advanced electron beam therapy. It has previously been shown that electron beams collimated by an eMLC have very similar penumbra to those collimated by applicators and cutouts. Thus, manufacturing patient specific cutouts would no longer be necessary, resulting in the reduction of time taken in the cutout fabrication process. Moreover, cutout construction involves handling of toxic materials and exposure to toxic fumes that are usually generated during the process, while the eMLC will be a pollution-free device. However, undulation of the isodose lines is expected due to the finite size of the eMLC. Hence, the provided planned target volume (PTV) shape will not exactly follow the beam's-eye-view of the PTV, but instead will make a stepped approximation to the PTV shape. This may be a problem when the field edge is close to a critical structure. Therefore, in this study the capability of the eMLC to achieve the same clinical outcome as an applicator/cutout combination was investigated based on real patient computed tomographies (CTs). An in-house Monte Carlo based treatment planning system was used for dose calculation using ten patient CTs. For each patient, two plans were generated; one with electron beams collimated using the applicator/cutout combination; and the other plan with beams collimated by the eMLC. Treatment plan quality was compared for each patient based on dose distribution and dose-volume histogram. In order to determine the optimal position of the leaves, the impact of the different leaf positioning strategies was investigated. All plans with both eMLC and cutouts were generated such that 100% of the target volume receives at least 90% of the prescribed dose. Then the percentage difference in dose between both delivery techniques was calculated for all the cases. The difference in the dose received by 10% of the volume of the target was showing a mean percentage difference of 1.57%±1.65, while the difference in the dose received by 99% of the volume was showing a mean percentage difference of 1.08%±0.78. The mean percentage volume of Lung receiving a percentage dose equal to or greater than 20% of the prescribed dose was found to be 8.55%±7.3 and 8.67%±7 for the eMLC and applicator/cutout combination delivery methods respectively. Results have shown that target coverage and critical structure sparing can be effectively achieved by electron beams collimated with the eMLC. Positioning the eMLC leaves in such a way to avoids shielding any part of the projected treatment volume is most conservative and would be the recommended method to define the actual leaf position for the eMLC defined field. More optimal leaf positions can be achieved in shaping the same treatment field through the interplay of different leaf positioning strategies. We concluded that the eMLC represents an effective time saving and pollution-free device that can completely replace patient specific cutouts.
No preview · Article · Jul 2013 · Physics in Medicine and Biology