Siemens Primus Research Articles

Image-guided radiotherapy for prostate cancer by CT–linear accelerator combination: Prostate movements and dosimetric considerations

Multiple studies have indicated that the prostate is not stationary and can move as much as 2 cm. Such prostate movements are problematic for intensity-modulated radiotherapy, with its associated tight margins and dose escalation. Because of these intrinsic daily uncertainties, a relative generous "margin" is necessary to avoid marginal misses. Using the CT-linear accelerator combination in the treatment suite (Primatom, Siemens), we found that the daily intrinsic prostate movements can be easily corrected before each radiotherapy session. Dosimetric calculations were performed to evaluate the amount of discrepancy of dose to the target if no correction was done for prostate movement. The Primatom consists of a Siemens Somatom CT scanner and a Siemens Primus linear accelerator installed in the same treatment suite and sharing a common table/couch. The patient is scanned by the CT scanner, which is movable on a pair of horizontal rails. During scanning, the couch does not move. The exact location of the prostate, seminal vesicles, and rectum are identified and localized. These positions are then compared with the planned positions. The daily movement of the prostate and rectum were corrected for and a new isocenter derived. The patient was treated immediately using the new isocenter. Of the 108 patients with primary prostate cancer studied, 540 consecutive daily CT scans were performed during the last part of the cone down treatment. Of the 540 scans, 46% required no isocenter adjustments for the AP-PA direction, 54% required a shift of > or =3 mm, 44% required a shift of >5 mm, and 15% required a shift of >10 mm. In the superoinferior direction, 27% required a shift of >3 mm, 25% required a shift of >5 mm, and 4% required a shift of >10 mm. In the right-left direction, 34% required a shift of >3 mm, 24% required a shift of >5 mm, and 5% required a shift of >10 mm. Dosimetric calculations for a typical case of prostate cancer using intensity-modulated radiotherapy with 5-mm margin coverage from the clinical target volume (prostate gland) was performed. With a posterior shift of 10 mm for the prostate, the dose coverage dropped from 95-107% to 71-100% coverage. We have described a technique that corrects for the daily prostate motion, allowing for extremely precise prostate cancer treatment. This technique has significant implications for dose escalation and for decreasing rectal complications in the treatment of prostate cancer.

A generalized extension to the Hounsell–Wilkinson head scatter model

Hounsell and Wilkinson (1997 Phys. Med. Biol. 42 1737–49) have demonstrated that the concept of a scatter-plane source can accurately describe head scatter in irregularly shaped fields produced by the MLC of an Elekta linear accelerator. In these linacs, the solid jaw is below the MLC set and plays no part on defining the view of the main source of head scatter, the flattening filter. A more complicated situation arises for linear accelerator head designs which incorporate a solid upper jaw pair with the MLC jaws further from the source. Application of the Hounsell and Wilkinson technique to these accelerator designs does not achieve the accuracy in the Elekta application. We present a generalized extension to Hounsell and Wilkinson's model and present results for typical treatment field shapes on a Siemens Primus linear accelerator.

MLC leaf width impact on the clinical dose distribution: a Monte Carlo approach

Purpose The influence of the multileaf collimator (MLC) leaf width on the dose distribution in patients treated with conformal radiotherapy and intensity-modulated radiotherapy has been analyzed. This study was based on the Monte Carlo simulation with the beams generated by a linac with the double-focused MLC. Materials and methods The transmission through the leaves and the exact shape of the penumbra regions are difficult to model by treatment planning system algorithms. An accurate assessment of the dose variations due to the leaf width change can be achieved by means of Monte Carlo simulation. The BEAM/EGS4 code was used at the Hospital of the Virgen Macarena to model a Siemens PRIMUS linac, featuring an MLC with a leaf width projecting 1 cm at the isocenter. Based on this real model, a virtual head was designed while allowing for a variation of the leaf width projection. Both the real linac and the virtual linac, with leaves projecting 0.5 cm, were used to obtain the dose distributions for several treatments. A few disease sites, including the prostate, head and neck, and endometrium, were selected for the design of the conformal and intensity-modulated radiotherapy treatments with a forward planning algorithm sensitive to the different shapes of the volumes of interest. Isodose curves, differential matrix, gamma function, and the dose–volume histograms (DVHs) corresponding to both MLC models were obtained for all cases. The tumor control probability and the normal tissue complication probability were derived for those cases studied featuring the greatest differences between results for both MLCs. Results The impact on the DVHs of changing leaf width projections at the isocenter from 1.0 cm to 0.5 cm was low. Radiobiologic models showed slightly better tumor control probability/normal tissue complication probability values using the virtual MLC with a leaf width projecting 0.5 cm at isocenter in those cases presenting greater differences in the DVHs. Conclusions The impact on the clinical dose distribution due to the MLC leaf width change is low based on the design and conditions used in this study.

Modelling of electron contamination in clinical photon beams for Monte Carlo dose calculation

The purpose of this work is to model electron contamination in clinical photon beams and to commission the source model using measured data for Monte Carlo treatment planning. In this work, a planar source is used to represent the contaminant electrons at a plane above the upper jaws. The source size depends on the dimensions of the field size at the isocentre. The energy spectra of the contaminant electrons are predetermined using Monte Carlo simulations for photon beams from different clinical accelerators. A ‘random creep’ method is employed to derive the weight of the electron contamination source by matching Monte Carlo calculated monoenergetic photon and electron percent depth–dose (PDD) curves with measured PDD curves. We have integrated this electron contamination source into a previously developed multiple source model and validated the model for photon beams from Siemens PRIMUS accelerators. The EGS4 based Monte Carlo user code BEAM and MCSIM were used for linac head simulation and dose calculation. The Monte Carlo calculated dose distributions were compared with measured data. Our results showed good agreement (less than 2% or 2 mm) for 6, 10 and 18 MV photon beams.

Optimal clinical implementation of the siemens virtual wedge

Installation of a modern high-energy Siemens Primus linear accelerator at the Northern Centre for Cancer Treatment (NCCT) provided the opportunity to investigate the optimal clinical implementation of the Siemens virtual wedge filter. Previously published work has concentrated on the production of virtual wedge angles at 15°, 30°, 45°, and 60° as replacements for the Siemens hard wedges of the same nominal angles. However, treatment plan optimization of the dose distribution can be achieved with the Primus, as its control software permits the selection of any virtual wedge angle from 15° to 60° in increments of 1°. The same result can also be produced from a combination of open and 60° wedged fields. Helax-TMS models both of these modes of virtual wedge delivery by the wedge angle and the wedge fraction methods respectively. This paper describes results of timing studies in the planning of optimized patient dose distributions by both methods and in the subsequent treatment delivery procedures. Employment of the wedge fraction method results in the delivery of small numbers of monitor units to the beam's central axis; therefore, wedge profile stability and delivered dose with low numbers of monitor units were also investigated. The wedge fraction was proven to be the most efficient method when the time taken for both planning and treatment delivery were taken into consideration, and is now used exclusively for virtual wedge treatment delivery in Newcastle. It has also been shown that there are no unfavorable dosimetric consequences from its practical implementation.

Scattered radiation from applicators in clinical electron beams

In radiotherapy with high-energy (4–25 MeV) electron beams, scattered radiation from the electron applicator influences the dose distribution in the patient. In most currently available treatment planning systems for radiotherapy this component is not explicitly included and handled only by a slight change of the intensity of the primary beam. The scattered radiation from an applicator changes with the field size and distance from the applicator. The amount of scattered radiation is dependent on the applicator design and on the formation of the electron beam in the treatment head. Electron applicators currently applied in most treatment machines are essentially a set of diaphragms, but still do produce scattered radiation. This paper investigates the present level of scattered dose from electron applicators, and as such provides an extensive set of measured data. The data provided could for instance serve as example input data or benchmark data for advanced treatment planning algorithms which employ a parametrized initial phase space to characterize the clinical electron beam.Central axis depth dose curves of the electron beams have been measured with and without applicators in place, for various applicator sizes and energies, for a Siemens Primus, a Varian 2300 C/D and an Elekta SLi accelerator. Scattered radiation generated by the applicator has been found by subtraction of the central axis depth dose curves, obtained with and without applicator.Scattered radiation from Siemens, Varian and Elekta electron applicators is still significant and cannot be neglected in advanced treatment planning. Scattered radiation at the surface of a water phantom can be as high as 12%. Scattered radiation decreases almost linearly with depth. Scattered radiation from Varian applicators shows clear dependence on beam energy. The Elekta applicators produce less scattered radiation than those of Varian and Siemens, but feature a higher effective angular variance. The scattered radiation decreases somewhat with increasing field size and is spread uniformly over the aperture. Experimental results comply with the results of simulations of the treatment head and electron applicator, using the BEAM Monte Carlo code.

A semiempirical method for the description of off-center ratios at depth from linear accelerators

A semiempirical method for the description of the off-center ratios (OCR) at depth from linear accelerators is presented, which is based on a method originally developed for cobalt-60 60Co units. The OCR profile is obtained as the sum of 2 components: the first describes an OCR similar to that from a 60Co unit, which approximates that resulting from the modification of the original x-ray intensity distribution by the flattening filter; the second takes into account the variable effect of the flattening filter on dose profile for different depths and field sizes, by considering the existence of a block and employing the negative field concept. The above method is formulated in a mathematical expression, where the parameters involved are obtained by fitting to the measured OCRs. Using this method, OCRs for various depths and field sizes, from a Philips SL-20 for the 6 MV x-ray beam and a Siemens Primus 23, for both the 6-MV and 23-MV x-ray beams, were reproduced with good accuracy. Furthermore, OCRs for other fields and depths that were not included in the fitting procedure were calculated using linear interpolation to estimate the values of the parameters. The results indicate that this method can be used to calculate OCR profiles for a wide range of depths and field sizes from a measured set of data and may be used for monitor unit calculations for off-axis points using a standard geometry. It may also be useful as a quality control tool to verify the accuracy of lacking profiles calculated by a treatment planning system.

Reference photon dosimetry data: A preliminary study of in-air off-axis factor, percentage depth dose, and output factor of the Siemens Primus linear accelerator

The dosimetric characteristics for modern computer-controlled linear accelerators with the same make, model, and nominal energy are known to be very similar, as long as the machines are unaltered from the manufacturer's original specifications. In this preliminary study, a quantitative investigation of the similarity in the basic photon dosimetry data from the Siemens Primus linear accelerators at eight different institutions is reported. The output factor, percentage depth dose (PDD), and in-air off-axis factor (OAF) for the 6 and 18 MV photon beams measured or verified by the Radiological Physics Center (RPC) were analyzed. The RPC-measured output factors varied by less than about 2% for each field size. The difference between the maximum and minimum RPC-verified PDD values at each depth was less than about 3%. The difference between the maximum and minimum RPC-measured in-air OAF was no more than 4% at all off-axis distances considered in this study. These results strongly suggest that it is feasible to establish a reference photon dosimetry data set for each make, model, and nominal energy, universally applicable to those machines unaltered from the manufacturers' original specifications, within a clinically acceptable tolerance (e.g., ). PACS number(s): 87.53.–j, 87.66.–a

Behavior of the Siemens Virtual Wedge™ following an interruption to beam delivery

Investigations were made into the beam profile shape and dose delivered by the Siemens Virtual Wedge™ under standard operational conditions compared with those following delivery interruption on two Siemens Primus linear accelerators (Type 7445 and 8067) running different versions of control software (7.2 and 7.0, respectively). The shape of the Virtual Wedge™ profiles was found to be unaffected by beam delivery interruption. An increase in the dose delivered to the central axis was found when delivery was interrupted and subsequently resumed using information recorded in a recall data file on one of the accelerators. This dose increase was attributed to a difference in delivered monitor units recorded in the recall data file compared to those displayed on the linear accelerator control console. PACS number(s): 87.53.–j, 87.52.–g

Suppression of dark current radiation in step-and-shoot intensity modulated radiation therapy by the initial pulse-forming network.

The effect of the initial pulse forming network (IPFN) on the suppression of dark current is investigated for a Siemens Primus accelerator. The dark current produces a spurious radiation, which is referred to as dark current radiation (DCR) in this study. In the step-and-shoot delivery of an intensity modulated radiation therapy (IMRT), the DCR could be of some concern for whole body dose along with leakage radiation through collimator jaws or multileaf collimator. By adjusting the IPFN-to-PFN ratio to >0.8, the DCR can be measured with an ion chamber during the "PAUSE" state of the accelerator in the IMRT mode. For 15 MV x rays, the magnitude of the DCR is approximately equal to 0.7% of the dose at dmax for a 10 x 10 cm2 field. The DCR has a similar central axis depth dose as a 15 MV beam as determined from a water phantom scan. When the IPFN-to-PFN ratio is lowered to <0.8, no DCR is detected. For low energy x rays (6 MV), no DCR is detected regardless of the IPFN-to-PFN ratio. Although the DCR is studied only for the Siemens Primus model accelerator, the same precaution applies to other models of modern accelerators from other vendors. Due to the large number of field segments used in a step-and-shoot IMRT, it is imperative therefore, that dark current evaluation be part of machine commissioning and annual calibration for high-energy photon beams. Should DCR be detected, the medical physicist should work with a service engineer to rectify the problem. In view of DCR and whole body dose, low-energy photon beams are advisable for IMRT.

Monte carlo simulation of surface percent depth dose

This work studied the surface percent depth dose of 6 and 15 MV X-rays, 10×10 cm 2 and 20×20 cm 2 fields by Monte Carlo simulation. The OMEGA/BEAM code, an EGS4 user code developed by the NRCC, was used. The linac, Siemens PRIMUS, was accurately modeled according to the ion chamber and CEA film measurement, and the phase space data generated from this linac were collected to simulate dose distribution in water. The water phantom had radius 30 cm and thickness 10 cm. The percent depth doses at zero depth, PDD surface, for 6 MV X-rays were 13.85±0.11% and 23.21±0.20% for the 10×10 cm 2 and 20×20 cm 2 fields, respectively. For 15 MV X-rays, PDD surface values were 8.83±0.07% and 18.60±0.12% for the 10×10 cm 2 and 20×20 cm 2 fields, respectively.

Monte Carlo simulation of a clinical linear accelerator

The effects of the physical parameters of an electron beam from a Siemens PRIMUS clinical linear accelerator (linac) on the dose distribution in water were investigated by Monte Carlo simulation. The EGS4 user code, OMEGA/BEAM, was used in this study. Various incident electron beams, for example, with different energies, spot sizes and distances from the point source, were simulated using the detailed linac head structure in the 6 MV photon mode. Approximately 10 million particles were collected in the scored plane, which was set under the reticle to form the so-called phase space file. The phase space file served as a source for simulating the dose distribution in water using DOSXYZ. Dose profiles at D max (1.5 cm) and PDD curves were calculated following simulating about 1 billion histories for dose profiles and 500 million histories for percent depth dose (PDD) curves in a 30×30×30 cm 3 water phantom. The simulation results were compared with the data measured by a CEA film and an ion chamber. The results show that the dose profiles are influenced by the energy and the spot size, while PDD curves are primarily influenced by the energy of the incident beam. The effect of the distance from the point source on the dose profile is not significant and is recommended to be set at infinity. We also recommend adjusting the beam energy by using PDD curves and, then, adjusting the spot size by using the dose profile to maintain the consistency of the Monte Carlo results and measured data.

The measurement of photoneutrons in the vicinity of a Siemens Primus linear accelerator

This study involves the measurement of photoneutron contamination emitted from a Siemens Primus medical linear accelerator by using BD–PND bubble detectors. Various bubble detectors were arranged around the linac head with the interval of 1 m and at the same height as the isocenter to measure the dose equivalent distribution in the treatment room. The measurements were performed for 15 MV X-rays with 40×40 cm 2 and 0×0 cm 2 fields and for 15,18, and 21 MeV electrons with 25×25 cm 2 electron cone. Neutron dose equivalent rate at the points of measurement in the treatment room decreased with increasing distance to the isocenter. The maximum neutron dose equivalents were at the isocenter, and the values for 15 MV 40×40 and 0×0 cm 2 were 1843±90 and 169.9±59.9 μSv per Gy X-ray, respectively. The values for 15, 18 and 21 MeV electrons with 25×25 cm 2 cones were 100.0±20.4, 262.7±61.2 and 349.0±29.6 μSv per Gy electron, respectively. The neutron contamination of electrons less than 12 MeV was below the detection limit.

Independent dose calculations for the CORVUS MLC IMRT

Two independent dose calculation methods have been explored to validate MLC-based IMRT plans from the NOMOS CORVUS system. After the plan is generated on the CORVUS planning system, the beam parameters are imported into an independent workstation. The beam parameters consist of intensity maps at each gantry angle. In addition, CT scans of the patient are imported into the independent workstation to obtain the external contour of the patient. The coordinate system is defined relative to the alignment point chosen in the CORVUS plan. The 2 independent calculation methods are based on a pencil beam kernel convolution and a Clarkson-type differential scatter summation, respectively. The pencil beam data for a 1 × 1-cm beam, as formed by the multileaf collimator, were measured for the 6-MV photon beam from a Siemens PRIMUS linear accelerator using film dosimetry. In the pencil beam method, the dose at a point is calculated using the depth and off-axis distance from a given pencil beam, corrected for beam intensity. The scatter summation method used the conversion of measured depth dose data into scatter maximum ratios. In this method, the differential scatter from each pencil beam is corrected for the beam intensity. Isodose distributions were generated using the independent dose calculations and compared to the CORVUS plans. Although isodose distributions from both methods show good agreement with the CORVUS plan, our implementation of the differential scatter summation approach seems more favorable. The 2 independent dose calculation algorithms are described in this paper.

Independent dose calculations for the Peacock system

An independent dose calculation method has been developed to validate intensity-modulated radiation therapy (IMRT) plans from the NOMOS® PEACOCK System. After the plan is generated on the CORVUS planning system, the beam parameters are imported into an independent workstation. The beam parameters consist of intensity maps at each gantry angle and each arc position. In addition, CT scans of the patient are imported into the independent workstation to obtain the external contour of the patient. The coordinate system is defined relative to the alignment point chosen in the CORVUS plan. The independent calculation uses the pencil beam data viz tissue maximum ratio (TMR) and beam profiles for a single 1 × 0.8-cm beamlet formed by the NOMOS® multileaf intensity-modulating collimator (MIMiC) leaf. The pencil beam data were measured for the 6-MV photon beam from Siemens PRIMUS linear accelerator using film dosimetry. The dose at a point is calculated using the depth and off-axis distance from a given pencil beam, corrected for its beam intensity. Isodose distributions are generated using the independent dose calculations and compared to the CORVUS plans. Isodose distributions show good agreement with the CORVUS plans for a number of clinical cases. The independent dose calculation algorithm is described in this paper.

Implementation and verification of Virtual Wedge in a three‐dimensional radiotherapy planning system

Virtual Wedge (VW) is a Siemens treatment modality which generates wedge-shaped dose distributions by moving a collimator jaw from closed to open at a constant speed while varying the dose rate in every 2 mm jaw position. In this work, the implementation and verification of VW in a radiotherapy treatment planning (RTP) system is presented. The VW implementation models the dose delivered by VW using the Siemens monitor units (MU) analytic formalism which determines the number of MU required to generate a wedge-fluence profile at points across the VW beam. For any set of treatment parameters, the VW algorithm generates an "intensity map" that is used to model the modification of fluence emanating from the collimator. The intensity map is calculated as the ratio of MU delivered on an axis point, divided by the monitor units delivered on the central-axis MU(0). The dose calculation is then performed using either the Clarkson or Convolution/ Superposition algorithms. The VW implementation also models the operational constraints for the delivery of VW due to dose rate and jaw speed limits. Dose verifications with measured profiles were performed using both the Clarkson and Convolution/Superposition algorithms for three photon beams; Siemens Primus 6 and 23 MV, and Mevatron MD 15 MV. Agreement within 2% or 2 mm was found between calculated and measured doses, over a large set of test cases, for 15, 30, 45, and 60 degree symmetric and asymmetric VW fields, using the manufacturer's supplied mu and c values for each beam.

Monte Carlo studies for the optimization of hardware used in conformal radiation therapy (in English)

The Monte Carlo system GEANT was applied to characterize and develop devices used in conformal radiation therapy. First, the Siemens Primus accelerator head was modeled. Second, two alternative techniques for intensity modulation were investigated: (1) Two multileaf collimators were modeled with respect to their penumbra and leakage radiation. To reduce the penumbra, an optimized shape of the leaf face was determined. The effectiveness of a new collimator design for leakage reduction was confirmed, showing a decrease in the average leakage from 4.7% to 2.6%. (2) The feasibility of a scanned narrow photon beam was examined for accelerators with an electron energy of about 20 MeV. The simulated photon intensity distributions were verified by comparison with both data and the theoretical prediction. With a thin beryllium bremsstrahlung target and a purging magnet, a photon beamwidth of about 40 mm at 100 cm source‐to‐surface distance can be achieved. The cost of the narrow distribution is a lower yield, which increases the irradiation time. To narrow down the beamwidth, a design for a fixed collimator with parallel holes was developed that yields a lateral resolution of about 1.5 mm at 100 cm source‐to‐surface distance and a penumbra of less than 1 mm. The use of this collimator requires that the scanned incident electron beam is always perpendicular to the target. This approach has the potential to improve both the cost‐effectiveness and the beam characteristics of intensity modulated radiation therapy.

Performance and beam characteristics of the Siemens Primus linear accelerator.

Siemens Primus is a small footprint, klystron driven medical linear accelerator incorporating a compact solid state modulator. A double focused multileaf collimator (MLC) replaces the lower jaw. The first Primus in the world was installed at St. Jude Children's Research Hospital in early 1997 with x-ray energies of 6 and 15 MV and electron energies of 8, 10, 12, 15, 18, and 21 MeV. The 10 cm depth dose for a 100 cm SSD 10 X 10 cm2 beam is 68% and 77% for 6 and 15 MV x rays, respectively. For both x-ray energies, beam flatness is slightly better than the manufacturers specification of 3% and beam symmetry is considerably better than 1%. The double focus design of the MLC produces a sharp penumbra (5-7 mm at 6 MV and 6-8 mm at 15 MV), increasing modestly with beam size. MLC leaf leakage is less than 1.25%. The depths of the 80% depth dose for the six electron energies of 8, 10, 12, 15, 18, and 21 MeV are 2.6, 3.2, 4.0, 4.9, 6.0, and 7.4 cm, respectively. Beam flatness is typically 2%-3% for all electron energies except 21 MeV, where it reaches 4% for a 25 X 25 cm2 cone. Electron beam symmetry is better than 1% for all energies except 21 MeV, where it is equal to 1%. The results are stored electronically and may be retrieved using anonymous ftp from the American Institute of Physics, Physics Auxiliary Publication Service.