18-MV X-ray Beam Research Articles

Spectrometry of leakage photoneutrons of 18 MV medical accelerator head by Sohrabi passive multi-directional spherical neutron spectrometry system

PurposeSpectrometry of leakage photoneutrons (PN) of a Siemens ONCOR medical linear accelerator head by applying recently invented Sohrabi passive multi-directional multi-detector neutron spherical spectrometry system; measurements of scientific interest and of importance for meeting the regulatory and safety standards. MethodsThe neutron spectrometry system applied consists of 6 polycarbonate/10B detectors mounted on 6 sides of a polyethylene cube used as bare and also embedded at center of 8 PE spheres of different diameters. Multi-directional and mean PN spectra at isocenter as well as at the left and right sides of head at 100 cm distance from the X-ray target on its plane of 10x10 cm2 18-MV X-ray beams were determined applying Multisphere Neutron Spectrometry Unfolding Code (MNSU + ). ResultsThe well-resolved unfolded directional leakage PN spectra obtained at the 3 positions showed a thermal PN peak of lower intensityfollowed by a tail of epithermal PNs before reaching a fast PN higher peak.“ The mean PN energy are 0.47 ± 0.03 MeV and 0.48 ± 0.02 MeV respectively for the left and right sides of the head and 0.48 ± 0.02 MeV at the isocenter. ConclusionsDue to importance of leakage PN spectra of an accelerator head being of scientific interest and for meeting regulatory and safety standards, well-resolved leakage PN spectra of 3 locations of the medical accelerator head were determined using Sohrabi passive multi-directional neutron spectrometry system. It is a novel learning that the mean PN spectra and mean PN energy of the 3 locations are quite similar within statistical variations.

Fast, epithermal and thermal photoneutron dosimetry in air and in tissue equivalent phantom for a high-energy X-ray medical accelerator

Photoneutron (PN) dosimetry in fast, epithermal and thermal energy ranges originated from the beam and albedo neutrons in high-energy X-ray medical accelerators is highly important from scientific, technical, radiation protection and medical physics points of view. Detailed dose equivalents in the fast, epithermal and thermal PN energy ranges in air up to 2m as well as at 35 positions from the central axis of 12 cross sections of the phantom at different depths were determined in 18MV X-ray beams of a Siemens ONCOR accelerator. A novel dosimetry method based on polycarbonate track dosimeters (PCTD)/10B (with/without cadmium cover) was used to determine and separate different PN dose equivalents in air and in a multilayer polyethylene phantom. Dose equivalent distributions of PNs, as originated from the main beam and/or albedo PNs, on cross-plane, in-plane and diagonal axes in 10cm×10cm fields are reported. PN dose equivalent distributions on the 3 axes have their maxima at the isocenter. Epithermal and thermal PN depth dose equivalent distributions in the phantom for different positions studied peak at ∼3cm depth. The neutron dosimeters used for the first time in such studies are highly effective for separating dose equivalents of PNs in the studied energy ranges (beam and/or albedo). The PN dose equivalent data matrix made available in this paper is highly essential for detailed patient dosimetry in general and for estimating secondary cancer risks in particular.

Peripheral photon and neutron doses from prostate cancer external beam irradiation.

Peripheral photon and neutron doses from external beam radiotherapy (EBRT) are associated with increased risk of carcinogenesis in the out-of-field organs; thus, dose estimations of secondary radiation are imperative. Peripheral photon and neutron doses from EBRT of prostate carcinoma were measured in Rando phantom. (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P glass-rod thermoluminescence dosemeters (TLDs) were inserted in slices of a Rando phantom followed by exposure to 80 Gy with 18-MV photon four-field 3D-CRT technique. The TLDs were calibrated using 6- and 18-MV X-ray beam. Neutron dose equivalents measured with CR-39 etch-track detectors were used to derive readout-to-neutron dose conversion factor for (6)LiF:Mg,Cu,P TLDs. Average neutron dose equivalents per 1 Gy of isocentre dose were 3.8±0.9 mSv Gy(-1) for thyroid and 7.0±5.4 mSv Gy(-1) for colon. For photons, the average dose equivalents per 1 Gy of isocentre dose were 0.2±0.1 mSv Gy(-1) for thyroid and 8.1±9.7 mSv Gy(-1) for colon. Paired (6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P TLDs can be used to measure photon and neutron doses simultaneously. Organs in close proximity to target received larger doses from photons than those from neutrons whereas distally located organs received higher neutron versus photon dose.

The use of enriched 6Li and 7Li Lif:Mg,Cu,P glass-rod thermoluminescent dosemeters for linearaccelerator out-of-field radiation dose measurements

(6)LiF:Mg,Cu,P and (7)LiF:Mg,Cu,P glass-rod thermoluminescent dosemeters (TLDs) were used for measurements of out-of-field photon and neutron doses produced by Varian iX linear accelerator. Both TLDs were calibrated using 18-MV X-ray beam to investigate their dose-response sensitivity and linearity. CR-39 etch-track detectors (Luxel+, Landauer) were employed to provide neutron dose data to calibrate (6)LiF:Mg,Cu,P TLDs at various distances from the isocentre. With cadmium filters employed, slow neutrons (<0.5 eV) were distinguished from fast neutrons. The average in-air photon dose equivalents per monitor unit (MU) ranged from 1.5±0.4 to 215.5±94.6 μSv at 100 and 15 cm from the isocentre, respectively. Based on the cross-calibration factors obtained with CR-39 etch-track detectors, the average in-air fast neutron dose equivalents per MU range from 10.6±3.8 to 59.1±49.9 μSv at 100 and 15 cm from the isocentre, respectively. Contribution of thermal neutrons to total neutron dose equivalent was small: 3.1±7.2 μSv per MU at 15 cm from the isocentre.

Measurements of in‐air output ratios for a linear accelerator with and without the flattening filter

The in-air output ratio (Sc) for photon beams from linear accelerators describes the change of in-air output as a function of the collimator settings. The physical origin of the Sc is mainly due to the change in scattered radiation that can reach the point of measurement as the geometry of the head changes. The flattening filter (FF) and primary collimator are the major sources of scattered radiation. The change in amount of backscattered radiation from the collimator into the beam-monitoring chamber also contributes to the variation of output. In this work, we measured the Sc and backscatter factors (Sb) into the beam-monitoring chamber for a linear accelerator with and without the FF. We measured the Sc with a Farmer-type chamber in a miniphantom at the depth of 10 g/cm2 for 6- and 18-MV x-ray beams from a Varian Clinac 2100EX linear accelerator. The Sb were measured with a universal pulse counter and a diode array with build-in counting hardware and software. The head scatter component (Sh) was then derived from the relationship Sc= Sh x Sb, where Sb was the linear fit of measured results. Significant differences were observed for Sc with and without the FF. Within the range of experimental uncertainty, the Sb was similar with and without the FF. The variations in Sh differed significantly over the range of field sizes of 3 X 3 to 40 X 40 cm2 with and without the FF; for the 6-MV beam, it was 8% vs 3%, and for the 18-MV beam, 7% vs 1%. By analyzing the contributions of backscatter factor and total in-air output ratios with and without the FF, we directly gained insight into the contributions of different components to the total variations in Sc of a linear accelerator. Sc, Sb, and Sh are basic and useful dosimetric quantities for delivery of intensity-modulated radiation therapy using a linear accelerator operating in a mode without the FF.

WE-D-224C-04: Investigation of MLC Effects On Secondary Neutron Spectra for Varian, Siemens, and Elekta

Purpose: To compare the secondary neutron spectra in accelerators with different multileaf collimator (MLC) configurations. The addition of MLC, have lead to design modifications in modern linear accelerators; Elekta has replaced upper collimating jaws with MLC, Siemens has replaced lower jaws with MLC, Varian added tertiary level MLC. Method and Materials: Measurements were made of the neutron fluence and energy spectra for several modern accelerators. The detector consisted of 197 Au activation foils, which were placed on the surface of the holder and inserted into Bonner Spheres. An HPGe detector was used to measure counts under the 411keV photopeak for each foil. Data were unfolded with the MXD_FC33 code with a response matrix specifically calculated for this measurement system using MCNP5. In this investigation, neutron spectra, fluence per MU, and ambient dose equivalent are reported for 18MV x-ray beams generated by Varian 21EX, Siemens Oncor, and Elekta Precise accelerators. The impact of the jaw and MLC configuration were further studied for the Varian 21EX by taking measurements following the complete removal of the MLC. Results: Jaws and MLC closed: similar spectra for the Siemens and Elekta but the Varian spectrum has a lower energy distribution. Varian X and Y jaws closed: With MLC in place, less neutrons are detected and spectrum shifts to lower energies (compared to MLC removed). MLC attenuates neutrons created higher in treatment head. Varian X and Y jaws retracted: With MLC in place more neutrons are detected and the spectra shifts to lower energies (compared to MLC removed). The MLC attenuate neutrons created higher in treatment head but MLC become the primary source of contamination neutrons when jaws retracted. Conclusion: Secondary neutron spectra are different in accelerators with different MLC configurations. This difference translates to a difference in ambient dose equivalent to patients receiving high-energy radiation therapy.

Enhanced dynamic wedge and independent monitor unit verification

Some serious radiation accidents have occurred around the world during the delivery of radiotherapy treatment. The regrettable incident in Panama clearly indicated the need for independent monitor unit (MU) verification. Indeed the International Atomic Energy Agency (IAEA), after investigating the incident, made specific recommendations for radiotherapy centres which included an independent monitor unit check for all treatments. Independent monitor unit verification is practiced in many radiotherapy centres in developed countries around the world. It is mandatory in USA but not yet in Australia. This paper describes development of an independent MU program, concentrating on the implementation of the Enhanced Dynamic Wedge (EDW) component. The difficult case of non centre of field (COF) calculation points under the EDW was studied in some detail. Results of a survey of Australasian centres regarding the use of independent MU check systems is also presented. The system was developed with reference to MU calculations made by Pinnacle 3D Radiotherapy Treatment Planning (RTP) system (ADAC - Philips) for 4MV, 6MV and 18MV X-ray beams used at the Newcastle Mater Misericordiae Hospital (NMMH) in the clinical environment. A small systematic error was detected in the equation used for the EDW calculations. Results indicate that COF equations may be used in the non COF situation with similar accuracy to that achieved with profile corrected methods. Further collaborative work with other centres is planned to extend these findings.

Variations in skin dose using 6MV or 18MV x-ray beams

This research aimed to quantitatively evaluate the differences in percentage dose of maximum for 6MV and 18MV x-ray beams within the first 1 cm of interactions. Thus provide quantitative information regarding the basal, dermal and subcutaneous dose differences achievable with these two types of high-energy x-ray beams. Percentage dose of maximum build up curves are measured for most clinical field sizes using 6MV and 18MV x-ray beams. Calculations are performed to produce quantitative results highlighting the percentage dose of maximum differences delivered to various depths within the skin and subcutaneous tissue region by these two beams. Results have shown that basal cell layer doses are not significantly different for 6MV and 18MV x-ray beams. At depths beyond the surface and basal cell layer there is a measurable and significant difference in delivered dose. This variation increases to 20% of maximum and 22% of maximum at 1 mm and 1 cm depths respectively. The percentage variations are larger for smaller field sizes where the photon in phantom component of the delivered dose is the most significant contributor to dose. By producing graphs or tables of % dose differences in the build up region we can provide quantitative information to the oncologist for consideration (if skin and subcutaneous tissue doses are of importance) during the beam energy selection process for treatment.

Buildup region and depth of dose maximum of megavoltage x‐ray beams

The depth of dose maximum, dmax, of megavoltage x-ray beams was studied as a function of beam energy and field size for 6-, 10-, and 18-MV x-ray beams and field sizes ranging from 1 x 1 to 30 x 30 cm2. For a given beam energy, dmax increases rapidly with increasing field size at small fields, reaches a maximum around 5 x 5 cm2 and then gradually decreases with increasing field size for large fields. Monte Carlo simulations combined with measurements verified that the effect observed at small field sizes is caused by in-phantom scatter, while at large fields the effect is due to scatter contamination of the primary beam from the linac head. A comparison between the dmax behavior of flattened beams to that of unflattened beams indicates that the dmax decrease at large fields for flattened beams is caused mainly by contamination electrons which are produced in the flattening filter and further scattered by collimator jaws and air.

Doses to radiation sensitive organs and structures located outside the radiotherapeutic target volume for four treatment situations

This study documents dosage to radiation sensitive organs/structures located outside the radiotherapeutic target volume for four treatment situations: (a) head and neck, (b) brain (pituitary and temporal lobe), (c) breast and (d) pelvis. Clinically relevant treatment fields were simulated on a tissue-equivalent anthropomorphic phantom and subsequently irradiated with Cobalt-60 gamma rays, 6- and 18-MV x-ray beams. Thermoluminescent dosimeters and diodes were used to measure absorbed dose. The head and neck treatment resulted in significant doses of radiation to the lens and thyroid gland. The total treatment lens dose (300–400 cGy) could be cataractogegic while measured thyroid doses (1000–8000 cGy) have the potential of causing chemical hypothyroidism, thyroid neoplasms, Graves' disease and hyperparathyroidism. Total treatment retinal (400–700cGy) and pituitary (460–1000 cGy) doses are below that considered capable of producing chronic disease. The pituitary treatment studied consisted of various size parallel opposed lateral and vertex fields (4 × 4 through 8 × 8 cm). The lens dose (40–200 cGy) with all field sizes is below those of clinical concern. Parotid doses (130–1200 cGy) and thyroid doses (350–600 cGy) are in a range where temporary xerostomia (parotid) and thyroid neoplasia development are a reasonable possibility. The retinal dose (4000 cGy) from the largest field size (8 × 8 cm 2) is in the range where retinopathy has been reported. The left temporal lobe treatment also used parallel opposed lateral and vertex fields (7 × 7 and 10 × 10 cm). Doses to the pituitary gland (5200–6200 cGy), both parotids (200–6900 cGy), left lens (200–300 cGy) and left retina (1700–4500 cGy) are capable of causing significant future clinical problems. Right-sided structures received insignificant doses. Secondary malignancies could result from the measured total treatment thyroid doses (670–980 cGy). Analysis of three breast/chest wall and regional nodal irradiation techniques demonstrated a 25–50% decrease in secondary lung dose with use of independent collimation compared to use of custom alloy blocking material. However, it is unlikely that a reduction in secondary dose of this magnitude would reduce the risk of treatment sequellae. In four-field “box” pelvic irradiation, secondary testes dose may result in temporary (clamshell shield) or permanent azoospermia, but is unlikely to impair androgen production.

Wedge factor dependence on depth and field size for various beam energies using symmetric and half-collimated asymmetric jaw settings.

The depth- and field-size dependence of the in-phantom wedge factor have been determined for a Cobalt-60 (Co-60) teletherapy unit and four medical linear accelerators with 4-, 6-, 10-, and 18-MV x-ray beams containing 15 degrees-60 degrees (nominal) lead, brass, and steel wedge filters. Measurements were made with ionization chambers in solid water or water with a source-skin distance of 80 or 100 cm. Field sizes varied from 4 x 4 cm up to a maximum allowable size for each wedge filter. Measurements were performed for symmetric and half-collimated asymmetric fields at depth of maximum dose, 5- and 10-cm depths. For half-collimated fields, wedge factor reference points were located at a fixed off-axis distance from the collimator's rotational axis. These systematic measurements on wedges indicate that the wedge factor dependence on depth and field size is a function of beam energy as well as the design of the treatment head and wedge filters. Significance of the results reported herein are discussed for the most commonly used treatment depths and field sizes with various beam energies and wedge filters.

Stimulated positron emission analysis techniques for the quantitative assessment of fluorine in bone

The use of nuclear photoactivation in conjunction with positron emission analysis techniques to quantify the spatial distribution of elements in bone is considered. A realistic model of bone composition and a simplified model of bremsstrahlung spectral intensity have been used to calculate the activation yields obtainable with medical linear accelerators. The results of activation experiments performed using a linac-produced 18-MV X-ray beam have been compared with the predictions of this model to assess the feasibility of obtaining the relative amounts of the different elements from the analysis of the time dependence of the decay. It is concluded that photonuclear activation in conjunction with positron emission analysis techniques has the potential for noninvasively determining the elemental composition of bone. Because this process will also have the unique signature used in positron emission tomography (PET), it provides an approach to imaging the distribution of elements within bones. >

Effects of finite angular steps and extent of profile data on the calculation of rotational x-ray dose distributions.

Computer algorithms for rotational therapy beams, in most cases, perform dose calculations by summing stored fixed beam data at finite angular steps. Such an algorithm, based on the Bentley beam model, was evaluated by comparing calculations with measured data for an 18-MV x-ray beam. Measurements were made in a specially constructed cylindrical water phantom of 15-cm radius using a 0.1-cm3 ionization chamber for an arc of 180 degrees and for a field size of 7.2 X 7.2 cm2 at 100-cm source-axis distance. This study revealed that the Bentley beam model, with fixed beams summed every 10 degrees, predicts the dose in the treatment volume, centered about the isocenter, with an accuracy of approximately 2%. However, dose at depths between the phantom surface and the treatment volume could be underestimated by as much as 10% (3% of isocenter). This was shown to be partially due to the truncated tails of the off-axis profiles in the Bentley model, which extend only 8 mm outside the edge of the radiation field, and the large angular increment of integration (10 degrees). Using beam profiles extending to 4 cm outside the edge of the radiation field and angular steps of 5 degrees or less for summation of fixed beams reduced errors to less than 5%. Therefore, extended beam profiles and smaller angular steps for summing fixed beams are recommended for photon rotation calculation when increased accuracy is required.

A semianalytical method for the design of a linac x-ray beam flattening filter.

The purpose of this study was to design an improved flattening filter for a Therac 20 medical linear accelerator. Profiles of the 18-MV x-ray beam produced by this accelerator measured along the diagonal of a 40 X 40 cm field at a depth of 5 cm were measured, and it was found that there were regions near the corners of the field where the dose was 109% of the central axis dose. An iterative algorithm for designing flattening filters was developed which required, as input, precise measurements of the following data: the unflattened primary beam profile, the fraction of the beam due to contamination radiation arising from interactions of primary photons with the flattening filter and the collimator assemblies, and the attenuation of the primary photons in water and lead as a function of angle from the central axis of the beam. A new flattening filter was designed and profiles of the beam were measured at a number of depths. These measurements showed that the beam was flattened to within +/- 1% out to 24 cm along the diagonal of a 40 X 40 cm field at a depth of 5 cm.

Phosphorus activation neutron dosimetry and its application to an 18‐MV radiotherapy accelerator

Neutron fluxes and dose rates in and near the 18-MV x-ray beam of a Therac-20 accelerator were determined with measured activities from the nuclear reactions 31P(n, rho)31Si (fast neutrons) and 31P(n, gamma)32P (thermal neutrons), published cross sections, and neutron energy spectra from Monte Carlo calculations. Measurements were made in the patient plane in air and at a 10-cm depth in a tissue-similar phantom, and in a plane containing the x-ray target. Orthophosphoric acid solution was identified as a suitable and convenient phosphorus dosimeter material. In the 31P activation method, fluxes and dose rates are determined as the product of measured saturation activity per 31P atom and a conversion factor, which depends on the shape of the assumed neutron spectrum. For fast neutrons, which deliver most of the dose, the accuracy error in the saturation activity determinations was shown to be approximately less than 25%. An inconsistency resulting from neglect of the accelerator's adjustable collimator in the Monte Carlo calculations was demonstrated between the measured saturation activities and the theoretical neutron spectra. The maximum neutron dose equivalent rate observed was 5.9 mSv/Gy of x-ray absorbed dose at the accelerator calibration point. Surface dose equivalent rates of the present study are less than those of fluxmeter and remmeter studies at sites outside Therac-20 treatment fields by as much as factors of 2.4 and 2.8, respectively. The phantom study showed that at 18 MV internally produced neutrons have a negligible effect on the neutron field within the patient.