Out Of Field Dose Research Articles

Beam collimation and filtration optimization for a novel orthovoltage radiotherapy system.

The inaccessibility of clinical linear accelerators in low- and middle-income countries creates a need for low-cost alternatives. Kilovoltage (kV)x-ray tubes have shown promise as a source that could meet this need. However, performing radiotherapy with a kV x-ray tube has numerous difficulties, including high skin dose, rapid dose fall-off, and low dose rates. These limitations create a need for highly effective beam collimation andfiltration. To improve the treatment potential of a novel kV x-ray system by optimizing an iris collimator and beam filtration using Bayesian techniques and Monte Carlo (MC)simulations. The Kilovoltage Optimized AcceLerated Adaptive therapy system's current beam configuration consists of a 225kVp x-ray tube, a 12-leaflet tungsten iris collimator, and a 0.1mm copper filter. A Bayesian optimization was performed for the large and small focal spot sizes of the kV x-ray tube source at 220kVp using TopasOpt, an open-source library for optimization in TOPAS. Collimator thickness, copper filter thickness, source-to-collimator distance (SCD), and source-to-surface distance (SSD) were the variables considered in the optimization. The objective function was designed to maximize the dose rate and the dose at a depth of 5 cm while minimizing the beam penumbra width and the out-of-field dose (OFD), all evaluated in a water phantom. Post-optimization, the optimal beam configuration was simulated and compared to the existingconfiguration. The optimal collimation setup consisted of 2.5mm thick tungsten leaflets for the iris collimator and a 350mm SSD for both focal spot sizes. The optimal copper filtration was 0.22mm for the large focal spot and 0.15mm for the small focal spot, with a SCD of 148.5mm for the large focal spot and 125.8mm for the small focal spot. For the large focal spot, the surface dose rate decreased by 9.4%, while the PDD at 5cm depth ( ) increased by 7.7% compared to the existing iris collimator. Additionally, the surface beam penumbra width was reduced by 31.3%, and no significant changes in the OFD were observed. For the small focal spot, the surface dose rate for the new collimator increased by 3.7% and the increased by 5.3%, with no statistically significant changes in the beam penumbra width orOFD. The optimal beam collimation and filtration for both x-ray tube focal spot sizes of a kV radiotherapy system was determined using Bayesian optimization and MC simulations and resulted in improved dosedistributions.

Prostate radiotherapy may cause fertility issues: a retrospective analysis of testicular dose following modern radiotherapy techniques

BackgroundProstate cancer in younger men is rare but not exceptional. Radiotherapy is a cornerstone of prostate cancer treatment and yet, its impact on fertility is scarcely reported in literature. Given the radiosensitivity of testicular tissue, this study aimed to determine the testicular dose using modern radiotherapy techniques for definitive prostate irradiation.MethodsOne hundred radiotherapy plans were reviewed. Testicles were contoured retrospectively without dosimetric optimization on testicles.ResultsThe median testicular dose was 0.58 Gy: 0.18 Gy in stereotactic plans, 0.62 Gy in Volumetric Modulated Arc Therapy plans and 1.50 Gy in Tomotherapy plans (p < 0.001). Pelvic nodal irradiation increased the median testicular dose to 1.18 Gy versus 0.26 Gy without nodal irradiation (p < 0.001). Weight and BMI were inversely associated with testicular dose (p < 0.005). 65% of patients reached the theoretical dose threshold for transient azoospermia, and 10% received more than 2 Gy, likely causing definitive azoospermia.ConclusionDespite being probably lower than doses from older techniques, the testicular dose delivered with modern prostate radiotherapy is not negligible and is often underestimated because the contribution of daily repositioning imaging is not taken into account and most Treatment Planning Systems underestimate the out of field dose. Radiation oncologists should consider the impact on fertility and gonadal endocrine function, counseling men on sperm preservation if they wish to maintain fertility.Trial registration: retrospectively registered.

Electron streaming dose measurements and calculations on a 1.5 T MR-Linac.

To evaluate the accuracy of different dosimeters and the treatment planning system (TPS) for assessing the skin dose due to the electron streaming effect (ESE) on a 1.5 T magnetic resonance (MR)-linac. Skin dose due to the ESE on an MR-linac (Unity, Elekta) was investigated using a solid water phantom rotated 45° in the x-y plane (IEC61217) and centered at the isocenter. The phantom was irradiated with 1 × 1, 3 × 3, 5 × 5, 10 × 10, and 22 × 22cm2 fields, gantry at 90°. Out-of-field doses (OFDs) deposited by electron streams generated at the entry and exit surface of the angled phantom were measured on the surface of solid water slabs placed±20.0cm from the isocenter along the x-direction. A high-resolution MOSkin™ detector served as a benchmark due to its shallower depth of measurement that matches the International Commission on Radiological Protection (ICRP) recommended depth for skin dose assessment (0.07mm). MOSkin™ doses were compared to EBT3 film, OSLDs, a diamond detector, and the TPS where the experimental setup was modeled using two separate calculation parameters settings: a 0.1cm dose grid with 0.2% statistical uncertainty (0.1cm, 0.2%) and a 0.2cm dose grid with 3.0% statistical uncertainty (0.2cm, 3.0%). OSLD, film, the 0.1cm, 0.2%, and 0.2cm, 3.0% TPS ESE doses, underestimated skin doses measured by the MOSkin™ by as much as -75.3%, -7.0%, -24.7%, and -41.9%, respectively. Film results were most similar to MOSkin™ skin dose measurements. These results show that electron streams can deposit significant doses outside the primary field and that dosimeter choice and TPS calculation settings greatly influence the reported readings. Due to the steep dose gradient of the ESE, EBT3 film remains the choice for accurate skin dose assessment in this challenging environment.

Measuring out-of-field dose to the hippocampus in common radiotherapy indications

BackgroundThe high susceptibility of the hippocampus region to radiation injury is likely the causal factor of neurocognitive dysfunctions after exposure to ionizing radiation. Repetitive exposures with even low doses have been shown to impact adult neurogenesis and induce neuroinflammation. We address the question whether the out-of-field doses during radiotherapy of common tumour entities may pose a risk for the neuronal stem cell compartment in the hippocampus.MethodsThe dose to the hippocampus was determined for a single fraction according to different treatment plans for the selected tumor entities: Point dose measurements were performed in an anthropomorphic Alderson phantom and the out-of-field dose to the hippocampus was measured using thermoluminescence dosimeters.ResultsFor carcinomas in the head and neck region the dose exposure to the hippocampal region for a single fraction ranged from to 37.4 to 154.8 mGy. The hippocampal dose was clearly different for naso-, oro- and hypopharynx, with maximal values for nasopharynx carcinoma. In contrast, hippocampal dose levels for breast and prostate cancer ranged between 2.7 and 4.1 mGy, and therefore significantly exceeded the background irradiation level.ConclusionThe mean dose to hippocampus for treatment of carcinomas in the head and neck region is high enough to reduce neurocognitive functions. In addition, care must be taken regarding the out of field doses. The mean dose is mainly related to scattering effects, as is confirmed by the data from breast or prostate treatments, with a very different geometrical set-up but similar dosimetric results.

Absorbed dose calculation for a realistic CT-derived mouse phantom irradiated with a standard Cs-137 cell irradiator using a Monte Carlo method.

Computed tomography (CT) derived Monte Carlo (MC) phantoms allow dose determination within small animal models that is not feasible with in-vivo dosimetry. The aim of this study was to develop a CT-derived MC phantom generated from a mouse with a xenograft tumour that could then be used to calculate both the dose heterogeneity in the tumour volume and out of field scattered dose for pre-clinical small animal irradiation experiments. A BEAMnrc Monte-Carlo model has been built of our irradiation system that comprises a lead collimator with a 1 cm diameter aperture fitted to a Cs-137 gamma irradiator. The MC model of the irradiation system was validated by comparing the calculated dose results with dosimetric film measurement in a polymethyl methacrylate (PMMA) phantom using a 1D gamma-index analysis. Dose distributions in the MC mouse phantom were calculated and visualized on the CT-image data. Dose volume histograms (DVHs) were generated for the tumour and organs at risk (OARs). The effect of the xenographic tumour volume on the scattered out of field dose was also investigated. The defined gamma index analysis criteria were met, indicating that our MC simulation is a valid model for MC mouse phantom dose calculations. MC dose calculations showed a maximum out of field dose to the mouse of 7% of Dmax. Absorbed dose to the tumour varies in the range 60%-100% of Dmax. DVH analysis demonstrated that tumour received an inhomogeneous dose of 12 Gy-20 Gy (for 20 Gy prescribed dose) while out of field doses to all OARs were minimized (1.29 Gy-1.38 Gy). Variation of the xenographic tumour volume exhibited no significant effect on the out of field scattered dose to OARs. The CT derived MC mouse model presented here is a useful tool for tumour dose verifications as well as investigating the doses to normal tissue (in out of field) for preclinical radiobiological research.

Evaluation of the RadCalc collapsed cone dose calculation algorithm against measured data.

This work describes the experimental validation of the RadCalc (Lifeline software Inc, Tyler) collapsed cone dose calculation algorithm against measured data for a range of scenarios. 6 MV photon beam data were measured in a large water tank on a Varian TrueBeam linear accelerator. These were input into the RadCalc software, in conjunction with head geometry and output calibration information, then used to create a collapsed cone beam model. The model performance was assessed by comparison against measurement, using a selection of homogeneous and inhomogeneous geometries not incorporated into the original beam model. Dose calculations generated using the collapsed cone algorithm are generally in good agreement with measurement. However, the primary collimating of the linac is not accounted for in the RadCalc model and hence dose in the corners of large fields is significantly overestimated. Percentage depth doses were within 0.5% beyond a depth of 2 cm. The dose in the build-up region was underestimated by RadCalc Version 7.1.4.1, with (Distance To Agreement) discrepancies of up to 3 mm which were corrected in Version 7.2.2.0. Beam profiles for homogeneous phantom comparisons were within 2% in the central 80% of the field with out of field dose underestimated by no more than 3%. Dose comparisons in heterogeneous geometries were acceptable and generally within 3.5%. The largest observed differences were found at density interfaces and a result of the RadCalc dose resolution of 2 mm against 1 mm measured. Absolute dose comparisons demonstrated that RadCalc agreed with measurement to within 1.2% under homogeneous media irradiation geometries. For static beam IMRT deliveries agreement was within 2% or 2 mm of measured data, and for complex VMAT deliveries within 3% or 2 mm. The implementation of the (model-based) photon collapsed cone algorithm in RadCalc shows generally good agreement with measured data over a range of simple and complex scenarios considered.

Electron Streaming Effect Associated With the Elekta Unity Anterior Imaging Coil

The presence of the static field in magnetic resonance guided radiation therapy (MRgRT) systems, such as the Elekta Unity MR-Linac (MRL), influences charged particle motion due to the Lorentz force in and around patients. Consequently, for the Unity, changes to out-of-field dose (OFD) relative to conventional linacs occur due to the electron streaming effect (ESE) and spiraling contaminant electrons (SCE). This work investigates OFD associated with irradiation of the anterior MR imaging coil, which is in situ for all treatments on the Unity. Film measurements and Monaco simulations were performed to quantify the magnitude of OFD at the superior and inferior ends of the coil as a function of coil tilt relative to the beam direction. The dependence of OFD on field size and the relative electron density (RED) assigned to the coil and surrounding air are reported. The doses at both coil ends were clinically significant, with nearly 23.0% of the Dmax dose to water being recorded for the largest field (8.0 × 22.0 cm2) and 6.8% for the smallest field (3.0 × 3.0 cm2). Monaco simulations of OFD agreed with film within 5.0%, when appropriate calculation conditions were set. OFD decreases as coil tilt is reduced, and there is no evidence of ESE when the coil is horizontal. Clinically, the potential magnitude of cranio–caudal streaming dose from a tilted coil necessitates the use of appropriate shielding. A clinical case involving coil-induced ESE during treatment of a lesion in the right angle is presented. The planning-based investigation revealed that ESE doses associated with the coil and an immobilization vacuum bag can be clinically significant.

Out-of-field dose and its constituent components for a 1.5 T MR-Linac

This study aims to quantify the relative contributions of phantom scatter, collimator scatter and head leakage to the out-of-field doses (OFDs) of both static fields and clinical intensity-modulated radiation therapy (IMRT) treatments in a 1.5 T MR-Linac. The OFDs of static fields were measured at increasing distances from the field edge in an MR-conditional water phantom. Inline scans at depths of dmax (14 mm), 50 and 100 mm were performed for static fields of 5 × 5, 10 × 10 and 15 × 15 cm2 under three different conditions: full scatter, with phantom scatter prevented, and head leakage only. Crossline scans at isocenter and offset positions were performed in full scatter condition. EBT3 radiochromic films were placed at 100 mm depth of solid water phantom to measure the OFD of clinical IMRT plans. All water tank data were normalized to Dmax of a 10 × 10 cm2 field and the film results were presented as a fraction of the target mean dose. The OFD in the inline direction varied from 3.5% (15 × 15 cm2, 100 mm depth, 50 mm distance) to 0.014% (5 × 5 cm2, dmax, 400 mm distance). For all static fields, the collimator scatter was higher than the phantom scatter and head leakage at a distance of 100–400 mm. Head leakage remained the smallest among the three components, except at long distances (>375 mm) with small field size. Compared to the inline scans, the crossline scans at the isocenter showed higher doses at distances longer than 80 mm. All crossline profiles at longitudinal offset positions showed a cone shape with laterally shifted maxima. The OFD of IMRT deliveries varied with different target size. For prostate stereotactic body radiation therapy (SBRT) treatment, the OFD decreased from 2% to 0.03% at a distance of 50–500 mm. The OFDs have been measured for a 1.5 T MR-Linac. The presented dosimetric data are valuable for radiation safety assessments on patients treated with the MR-Linac, such as evaluating carcinogenic risk and radiation exposure to cardiac implantable electronic devices.

Measurement of out of field doses in brain proton therapy with GATE simulations

Proton therapy as one of the radiotherapy applications, aims to treat the tumor by using the accelerated proton particle. High radiation dose distributions delivered to the tumor tissue, is characterized with Bragg curves, while the radiation in the tissues surrounding the tumor is expected to be as low as possible. In our study, proton treatment of the tumor volume placed in the brain created by GATE software was simulated. The absorbed doses in other organs created by GATE software during treatment were determined using DoseActor and TLEDoseActor algorithms. Nuclear interactions of the accelerated proton with the nucleus of the target atom make the target atom reactive and cause secondary radiation. Similar to the TLEDoseActor algorithm, NTLE algorithm was used to determine the doses caused by neutrons from these secondary radiations. With the algorithms used, out-of-field doses and secondary doses for proton beams at 250 MeV energy were determined. It is important to determine the secondary radiations caused by the interaction of the proton with the tissue and to determine the doses out of the field. These results may be helpful in determining and preventing secondary cancer formation in proton therapy in clinical applications.

Sources of out-of-field dose in MRgRT: an inter-comparison of measured and Monaco treatment planning system doses for the Elekta Unity MR-linac.

With the clinical introduction of MR-linacs, out-of-field dose (OFD) associated with head leakage/scatter (HLS), spiralling contaminant electrons (SCE) and the electron streaming effect (ESE) is of interest. To investigate HLS and SCE, EBT3 film on solid water 5.0cm beyond each edge of a 10.0 × 10.0 cm2 field was used to determine depth-dose for 0T and 1.5T, in the isocentric plane. Additionally, ESE induced by the anterior imaging coil was quantified and the experimental arrangements to measure SCE and ESE were modelled using Monaco. For a clinical treatment of supraclavicular nodal disease, Monaco OFD was compared to in vivo measurements. For 0T, depth-dose was isotropic and surface dose was approximately 4.4% of Dmax. With 1.5T surface doses were approximately 3.8% of Dmax at ± Y (IEC61217), compared to 2.6% and 0.6% of Dmax at - X and X, respectively. For both field strengths, the TPS depth-dose variation was consistent with experimental trends; however, near surface doses calculated at ± Y differed significantly from measurements. For the field sizes investigated, measured coil ESE dose was between 9.0 and 28.0% of Dmax and Monaco coil ESE was less than measured by up to 13.0%. OFD in 0T and 1.5T are comparable at ± Y, inconsistent with previous work. Anterior coil ESE should be mitigated during treatment and for the clinical case investigated, in vivo OFD was within 2σ of TPS calculations. Monaco overestimates near surface SCE and underestimates coil ESE.

Investigation of scattered dose in a mouse phantom model for pre-clinical dosimetry studies

Tissue-equivalent phantoms are suitable tools for radiation dosimetry investigations. The goal of this study was to determine the scattered dose in a simple phantom model of a mouse with a xenographic tumour using experimental dose measurements and Monte-Carlo calculations. We manufactured a cubic polymethyl methacrylate (PMMA) phantom with an extrusion on its side to model both normal tissue and xenograft tumour of a tumour-bearing mouse. The phantom was positioned in a novel add-on collimator, designed by our research group, to enable targeted irradiation of the xenograft tumour with a dose of 20 Gy using a137Cs gamma irradiator. EBT3 GAFchromic film was utilized to measure the dose distribution within the phantom. EGSnrc MC code was used to simulate the irradiation system and to calculate the dose distribution in the phantom for comparison with the film dose measurements. Good agreement was observed between film dose measurements and simulation results based on gamma index analysis. The results demonstrate that the out of field dose (dose to the normal tissue) is of the order 8–9% of the prescribed dose when irradiating the xenographic tumour of the phantom. Our physical phantom is a useful tool to assess the out of field dose when irradiating xenographic tumours.

Beam flatness modulation for a flattening filter free photon beam utilizing a novel direct leaf trajectory optimization model.

Flattening filter free (FFF) linear accelerators produce a fluence distribution that is forward peaked. Various dosimetric benefits, such as increased dose rate, reduced leakage and out of field dose has led to the growth of FFF technology in the clinic. The literature has suggested the idea of vendors offering dedicated FFF units where the flattening filter (FF) is removed completely and manipulating the beam to deliver conventional flat radiotherapy treatments. This work aims to develop an effective way to deliver modulated flat beam treatments, rather than utilizing a physical FF. This novel optimization model is an extension of the direct leaf trajectory optimization (DLTO) previously developed for volumetric modulated radiation therapy (VMAT) and is capable of accounting for all machine and multileaf collimator (MLC) dynamic delivery constraints, using a combination of linear constraints and a convex objective function. Furthermore, the tongue and groove (T&G) effect was also incorporated directly into our model without introducing nonlinearity to the constraints, nor nonconvexity to the objective function. The overall beam flatness, machine deliverability, and treatment time efficiency were assessed. Regular square fields, including field sizes of 10 × 10 cm2 to 40 × 40 cm2 were analyzed, as well as three clinical fields, and three arbitrary contours with "concave" features. Quantitative flatness was measured for all modulated FFF fields, and the results were comparable or better than their open FF counterparts, with the majority having a quantitative flatness of less than 3.0%. The modulated FFF beams, due to the included efficiency constraint, were able to achieve acceptable delivery time compared to their open FF counterpart. The results indicated that the dose uniformity and flatness for the modulated FFF beams optimized with the DLTO model can successfully match the uniformity and flatness of their conventional FF counterparts, and may even provide further benefit by taking advantage of the unique FFF beam characteristics.

Evaluation of Cied Dosimetry Using Oslds for Patients Treated for Lung Cancers Using SBRT

For medically inoperable patients with peripheral lung cancers, SBRT is the standard of care according to ASTRO guidelines. The presence of a cardiovascular implantable electronic device (CIED) complicates the planning of SBRT treatments, as excess radiation dose and neutron production could produce an undesirable malfunction in the CIED. Current recommendations based on AAPM TG34 limit the treatment beam energy to ≤ 10MV to minimize neutron dose and limit dose to the CIED to < 2 Gy. At the author’s institution, dosimetric contribution from scatter and leakage are calculated to estimate CIED dose. The scatter dose is determined from the treatment planning system (TPS) based on work from Howell et al. (2010), which scales TPS dose dependent on field edge to CIED distance. Leakage dose is determined by the total number of MU per fraction, and the number of fractions in the treatment. The purpose of this work was to evaluate CIED dosimetry using OSLDs in an anthropomorphic phantom for patients treated with lung SBRT. An anthropomorphic ATOM® phantom developed by CIRS was CT-simulated. Contours were drawn for the PTV, lungs, heart, esophagus, chest wall, skin, spinal cord, and CIED. Two lung SBRT plans were generated using an IMRT static gantry and a VMAT approach (AAA algorithm, 6 MV photons, and 1 mm grid). The IMRT plan included 11 fields and the VMAT plan used four full arcs, with both plans optimized to minimize entrance dose to the CIED. The plans were delivered using a medical linear accelerator on the phantom with OSLDs placed 1 cm below the surface, which was created using bolus. Five OSLDs were placed in an array and were marked using BBs. A singular OSLD was placed inside the CIED contour, and four additional OSLDs were placed 0.5 cm from the CIED in the lateral and superior/inferior directions. Comparisons between the TPS dose, estimated CIED dose, and the OSLD measurement were performed. For both IMRT and VMAT plans, the TPS-calculated dose to out of field CIEDs is underestimated when compared with the measured dose (Table 1). The difference between the TPS-calculated and measured doses were consistently 10 cGy for both plans, an increase of 225%. This discrepancy may be due to the excess dose from the CBCT that was used for phantom alignment. Implementing scatter factors determined the CIED dose to be 14.6 cGy and 37.9 cGy for the IMRT and VMAT plans, respectively. This overestimated the measured CIED dose of 13.4 cGy and 20.8 cGy. Preliminary results showed that the TPS-calculated dose underestimates the out of field dose to a CIED by 10 cGy compared to OSLD measurements. Future work will investigate the effects of the CBCT dose on the CIED dose.Abstract 3808; Table 1OSLDLocationIMRT EclipseIMRT OSLDDifferenceVMAT EclipseVMAT OSLDDifference[cGy][cGy][cGy][cGy][cGy][cGy]1Left6.715.18.412.027.115.12Inferior4.215.311.126.135.79.63CIED6.613.46.89.020.811.84Superior8.718.49.712.125.012.95Right6.817.710.94.89.64.8Average:9.4Average:10.8 Open table in a new tab

An Assessment of Dosimetric Characteristics of Inline 2.5 Mega Voltage Unflattened Imaging X-Ray Beam.

Purpose:The aim of this work is to study the dosimetric parameters of newly introduced 2.5 MV imaging x-ray beam used as inline imaging to do setup verification of the patient undergoing radiation therapy. As this x-ray beam is in megavoltage range but comprises of a lower energy spectrum. It is essential to study the pros and cons of 2.5 MV imaging x-ray beam for clinical use.Methods:The mean energy was calculated using the NIST XCOM table through MAC. Profile analysis was done using RFA to understand the percentage depth dose, degree of unflatteness, symmetry, penumbra and out of field dose. Dose to skin for the 2.5 MV x-ray beam was analysed for field sizes 10x10 cm2, 20x20 cm2, 30x30 cm2. Leakage measurements for treatment head and at the patient plane were done using IEC 819/98 protocol. Finally, the spatial resolution and contrast were analyzed with and without patient scatter medium. Results:The MAC at 15 cm off-axis was found to be lower than that at the CAX. Similarly, there was a decrease in mean energy from 0.47 MV to 0.37 MV at 15 cm off-axis. The reduction of mean energy towards off-axis is lower than the other high energy MV x-ray beams. The tuned absolute dose of 1 cGy/MU is consistent and within < ±1 %. The relative output factors were found to be in correlation with Co-60. The beam quality of 2.5 MV x-ray beam was found to be 0.4771. The profile parameters like the degree of unflatness of the 2.5 x-ray beam were studied at 85 %, 90 %, 95 % lateral distances, and the penumbra at different depth and field sizes are higher than the 6 MV treatment beam. In addition, out of field dose also drastically increases to a maximum of up to 30 % laterally at 5cm at deeper depths. The skin dose increases from 48.51 % to 88.15 % from 6 MV to 2.5 MV x-ray beam for the field size 10x10 cm2. Also, the skin dose increases from 88.15 % to 91.78 % from the field size 10x10 cm2 to 30x30 cm2. Although the measured leakage radiation for 2.5 MV x-ray beam at the patient plane and other than patient planes are with the tolerance limit, an increase in exposure towards gantry side compared to other areas around treatment head and the patient plane may lead to more skin dose to head and chest while imaging pelvis region. The MLC transmission of 2.5 MV x-ray beam such as inter, intra and edge effect are 0.40 %, 0.37 % and 11% respectively. The spatial resolution of 2.0, 1.25 and 0.9 LP/mm was observed for KV, 2.5MV, and 6 MV x-ray beams. The spatial resolution and contrast of 2.5 MV x-ray beam are superior to 6 MV x-ray beam and inferior to KV x-rays. Conclusions:The 2.5 MV x-ray imaging beam is analysed in view of beam characteristics and radiation safety to understand the above-studied concepts while using this imaging beam in a clinical situation. In future, if 2.5MV x-ray beam is used for treatment purpose with increased dose rate, the above-studied notions can be incorporated prior to implementation.

Feasibility study of using flattening-filter-free photon beams to deliver conventional flat beams

Various dosimetric benefits such as increased dose rate, and reduced leakage and out of field dose have led to the growth of flattening-filter-free (FFF) technology in the clinic. In this study, we concentrate on investigating the feasibility of using FFF beams to deliver conventional flat beams, since completely getting rid of the flattening-filter module from the gantry head can not only simplify the gantry design but also decrease the workload on machine maintenance and quality assurance. Two intensity modulated radiotherapy techniques, step-and-shoot (S&S) and sliding window (SW), were used to generate flat beam profiles for 6 regular-shaped beams and 3 clinical beams while operating in FFF mode. The inverse plans were generated based on uniform dose optimization. Degree of flatness, MU efficiency, and beam delivery time for both methods were assessed. S&S technique is able to achieve a degree of flatness less than 2.5% for most field configurations. While SW technique was able to generate relatively flat beams for field sizes less than 18 × 18 cm2. For all field configurations, S&S beams resulted in a longer delivery time compared to reference flat beams and SW beams. For field sizes less than 18 × 18 cm2, SW modulated FFF beams resulted in a faster delivery time compared to reference flat beams. The ability to deliver conventional flat beams is not absent when operating in FFF mode. Utilizing beam modulation, FFF mode can achieve reasonable flat profiles and comparable efficiency to conventional flat beams. The ability to deliver most clinical treatments from the same treatment unit will allow for less quality assurance as well as maintenance, and completely eliminate the need for the flattening filter on modern linacs.

Out of field dose during Gamma Knife treatment: a paediatric case study

An 11-year-old girl with an arteriovenous malformation (AVM) was referred for Gamma Knife treatment. As this would be the first paediatric treatment in Australia, additional investigations were undertaken into out of field dose to assure the best possible long term outcome for the patient. A phantom was constructed from water equivalent materials to simulate the patient. A target volume was defined to emulate the size and location of the AVM visible in diagnostic images. An ionisation chamber and EBT3 Gafchromic film were used to record absorbed dose at strategic points both on the surface and at depth within the phantom. On the day of treatment, EBT3 Gafchromic film was used to conduct in vivo dosimetry. The pre-treatment phantom measurements matched the planning system for the cranial section (the only modelled section) and no measurable dose above background was detected in the extracranial sites. In vivo measurements of the lenses returned doses of up to 2 cGy for imaging and 8 cGy for treatment which was also consistent with the planned dose. Dose to the thyroid, chest and abdomen was not measurable above background.

Comparative dose levels between CT-scanner and slot-scanning device (EOS system) in pregnant women pelvimetry

PurposeTo estimate fetal absorbed doses for pregnant women pelvimetry, a comparative study between EOS imaging system and low-dose spiral CT-scanner was carried out. For this purpose three different studies were investigated: in vivo, in vitro and Monte Carlo calculations. MethodsIn vivo dosimetry was performed, using OSL NanoDot dosimeters, to determine the dose to the skin of twenty pregnant women. In vitro studies were established by using a cubic phantom of water, in order to estimate the out of field doses. In the latter study, OSLDs were placed at depths corresponding to the lowest, average and highest position of the uterus. Monte Carlo calculations of effective doses to high radio-sensitive organs were established, using PCXMC and CTExpo software suites for EOS imaging system and CT-scanner, respectively. ResultsThe EOS imaging system reduces radiation exposure 4 to 8 times compared to the CT-scanner. The entrance skin doses were 74% (p-values <0.01) higher with the CT-scanner than with the EOS system. In the out of field region, the measured doses of the EOS system were reduced by 80% (p-values <0.02).Monte Carlo calculations confirmed that effective doses to organs are less accentuated for EOS than for CT pelvimetry. ConclusionsThe EOS system is less irradiating than the CT exam. The out-of-field dose which is significant, is lower in the EOS than in the CT-scanner and could be reduced even further by optimizing the time used for image acquisition.

SU‐F‐SPS‐05: Experimental Validation of Peripheral Dose Distribution of Electron Beams for Eclipse Electron Monte Carlo Algorithm

Purpose:In this study, the two available calculation algorithms of the Varian Eclipse treatment planning system(TPS), the electron Monte Carlo(eMC) and General Gaussian Pencil Beam(GGPB) algorithms were used to compare measured and calculated peripheral dose distribution of electron beams.Methods:Peripheral dose measurements were carried out for 6, 9, 12, 15, 18 and 22 MeV electron beams of Varian Triology machine using parallel plate ionization chamber and EBT3 films in the slab phantom. Measurements were performed for 6×6, 10×10 and 25×25cm2 cone sizes at dmax of each energy up to 20cm beyond the field edges. Using the same film batch, the net OD to dose calibration curve was obtained for each energy. Films were scanned 48 hours after irradiation using an Epson 1000XL flatbed scanner. Dose distribution measured using parallel plate ionization chamber and EBT3 film and calculated by eMC and GGPB algorithms were compared. The measured and calculated data were then compared to find which algorithm calculates peripheral dose distribution more accurately.Results:The agreement between measurement and eMC was better than GGPB. The TPS underestimated the out of field doses. The difference between measured and calculated doses increase with the cone size. The largest deviation between calculated and parallel plate ionization chamber measured dose is less than 4.93% for eMC, but it can increase up to 7.51% for GGPB. For film measurement, the minimum gamma analysis passing rates between measured and calculated dose distributions were 98.2% and 92.7% for eMC and GGPB respectively for all field sizes and energies.Conclusion:Our results show that the Monte Carlo algorithm for electron planning in Eclipse is more accurate than previous algorithms for peripheral dose distributions. It must be emphasized that the use of GGPB for planning large field treatments with 6 MeV could lead to inaccuracies of clinical significance.

SU‐F‐T‐511: Feasibility Study of Using Flattening‐Filter‐Free Photon Beams to Deliver Conventional Flat Beam

Purpose:Various dosimetric benefits such as increased dose rate, and reduced leakage and out of field dose has led to the growth of FFF technology in the clinic. In this study, we concentrate on investigating the feasibility of using flattening‐filter‐free (FFF) beams to deliver conventional flat beams (CFB), since completely getting rid of the flattening‐filter module from the gantry head can not only simplify the gantry design but also decrease the workload on machine maintain and quality assurance.Methods:The sliding window based IMRT technique was utilized to generate the CFB from the FFF beam for various beam configurations on the Elekta Versa HD. The flat beam reproducibility and MU efficiency were compared for each beam configuration among FFF planning, delivery and CFB planning.Results:Compared to the CFB plan, the 3%3mm passing rates of the FFF beams from both measurement and plan are 100% and 95%(or better) for 15×15 cm2 or smaller field size and for any field size greater than 15×15 cm2at 10 cm depth, respectively. The largest discrepancy is about 5% and typically appears at the field shoulder area. The MU increase average was 80% for FFF compared to CFB, however has a minimal impact on treatment delivery time.Conclusion:The ability to deliver conventional flat treatments is not absent when operating in FFF mode. With proper TPS manipulation and beam modulation, FFF mode can achieve reasonable flat profiles and comparable dose coverage as CFB does for various conventional treatment techniques, such as four field box, or long spine treatment techniques. The ability to deliver most clinical treatments from the same treatment unit, will allow for less quality assurance as well as maintenance, and completely eliminate the need for the flattening filter on modern linacs.

SU‐E‐T‐216: Comparison of Volumetrically Modulated Arc Therapy Treatment Using Flattening Filter Free Beams Vs. Flattened Beams for Partial Brain Irradiation

Purpose:Flattening Filter Free (FFF) beams offer the potential for higher dose rates, short treatment time, and lower out of field dose. Therefore, the aim of this study was to investigate the dosimetric effects and out of field dose of Volumetric Modulated Arc Therapy (VMAT) plans using FFF vs Flattening Filtering (FF) beams for partial brain irradiation.Methods:Ten brain patients treated with a 6FF beam from a Truebeam STX were analyzed retrospectively for this study. These plans (46Gy at 2 Gy per fraction) were re‐optimized for 6FFF beams using the same dose constraints as the original plans. PTV coverage, PTV Dmax, total MUs, and mean dose to organs‐at‐risk (OAR) were evaluated. In addition, the out‐of‐field dose for 6FF and 6FFF plans for one patient was measured on an anthropomorphic phantom. TLDs were placed inside (central axis) and outside (surface) the phantom at distances ranging from 0.5 cm to 17 cm from the field edge. Paired T‐test was used for statistical analysis.Results:PTV coverage and PTV Dmax were comparable for the FF and FFF plans with 95.9% versus 95.6% and 111.2% versus 111.9%, respectively. Mean dose to the OARs were 3.7% less for FFF than FF plans (p&lt;0.0001). Total MUs were, on average, 12.5% greater for FFF than FF plans with 481±55 MU (FFF) versus 429±50 MU (FF), p=0.0003. On average, the measured out of field dose was 24% less for FFF compared to FF, p&lt;0.0001. A similar beam‐on time was observed for the FFF and FF treatment.Conclusion:It is beneficial to use 6FFF beams for regular fractionated brain VMAT treatments. VMAT treatment plans using FFF beams can achieve comparable PTV coverage but with more OAR sparing. The out of field dose is significant less with mean reduction of 24%.