Varian Linear Accelerator Research Articles

Investigation of the beam quality and dose rate dependence of PAKAG polymer gel dosimeter in optical readout technique

This study aims to evaluate the optical response dependence of the PAKAG polymer gel dosimeter on photon energy and dose rate. The produced gel dosimeters were irradiated using a Varian CL 21EX medical linear accelerator with delivered doses of 0, 2, 4, 6, 8, and 10 Gy. To examine the response dependence on the delivered dose rate, dose rates of 50, 100, 200, and 350 cGy min−1 were investigated. Additionally, two incident beam qualities of 6 and 18 MV were examined to study the response dependence on the incident beam energy. The irradiated polymer gel dosimeters were readout using a UV–vis spectrophotometer in the 300 to 800 nm scan range. The results reveal that a wide variation in dose rate (50–350 cGy.min−1) influences the absorbance-dose response and the sensitivity of PAKAG gel. However, smaller variations did not show a significant effect on the response. Furthermore, the response changed insignificantly with beam quality for investigated energies. It was concluded that the optical reading response of the PAKAG polymer gel dosimeter is satisfactorily independent of external parameters, including dose rate and incident beam quality.

93 RT Cyber Resilience: Feasibility of a Mobile Aria Offline Cart (MARIO Cart) for Varian Linear Accelerators

93 RT Cyber Resilience: Feasibility of a Mobile Aria Offline Cart (MARIO Cart) for Varian Linear Accelerators

Beam profile characteristics of a Varian linear accelerator across different photon energy levels

Radiotherapy employs variety of energy radiation to destroy cancer cells. A linear accelerator(also called LINAC) is the machine used to delivered external beam radiation therapy.In order to confirm the treatment planning systems that deliver the best radiation to the tumors while sparing the surrounding normal tissues, extensive measurements of dosimetric parameters are part of the commissioning procedure of a LINAC for clinical usage. This work aimed to compare and assess photon beam profiles with respect to penumbra width, symmetry, and beam flatness. Beam profile measurements were performed for this study atTMSS Cancer Center, Bogura, Bangladesh, using a linear accelerator (Varian VitalBeam SN: 5199) with 6MV,10MV and 15MV photon energies for a set of field sizes (4 × 4, 10 × 10 and 20 × 20 cm2) and various reference depths keeping the same environmental conditions. A 3D water phantom, CC13 ionization chamber (SN:18635)as a reference chamber, CC04 ionization field chamber (SN:18616) as a and IBA myQA Accept software version 1.6 were used to measure the profiles of photon energies 6 MV, 10 MV 15 MV respectively. Utilizing the Eclipse (Version: 16.1) external treatment planning system, the profile calculation was carried out. According to the manufacturer's and IEC specifications, the photon beam profile data from the current investigation are compatible, and all of the tolerances fall within the ranges of clinically acceptable tolerance.

Clinical applicability of Linac-integrated CBCT based NIPAM 3D dosimetry: a dual-institutional investigation

Objective. To develop and benchmark a novel 3D dose verification technique consisting of polymer gel dosimetry (PGD) with cone-beam-CT (CBCT) readout through a two-institution study. The technique has potential for wide and robust applicability through reliance on CBCT readout. Approach. Three treatment plans (3-field, TG119-C-shape spine, 4-target SRS) were created by two independent institutions (Institutions A and B). A Varian Truebeam linear accelerator was used to deliver the plans to NIPAM polymer gel dosimeters produced at both institutions using an identical approach. For readout, a slow CBCT scan mode was used to acquire pre- and post-irradiation images of the gel (1 mm slice thickness). Independent gel analysis tools were used to process the PGD images (A: VistaAce software, B: in-house MATLAB code). Comparing planned and measured doses, the analysis involved a combination of 1D line profiles, 2D contour plots, and 3D global gamma maps (criteria ranging between 2%1 mm and 5%2 mm, with a 10% dose threshold). Main results. For all gamma criteria tested, the 3D gamma pass rates were all above 90% for 3-field and 88% for the SRS plan. For the C-shape spine plan, we benchmarked our 2% 2 mm result against previously published work using film analysis (93.4%). For 2%2 mm, 99.4% (Institution A data), and 89.7% (Institution B data) were obtained based on VistaAce software analysis, 83.7% (Institution A data), and 82.9% (Institution B data) based on MATLAB. Significance. The benchmark data demonstrate that when two institutions follow the same rigorous procedures gamma passing rates up to 99%, for 2%2 mm criteria can be achieved for substantively different treatment plans. The use of different software and calibration techniques may have contributed to the variation in the 3D gamma results. By sharing the data across institutions, we observe the gamma passing rate is more consistent within each pipeline, indicating the need for standardized analysis methods.

Patient-specific quality assurance in SBRT treatments using 3D polymer gel dosimetry

In stereotactic body radiation therapy (SBRT), patient-specific quality assurance (PSQA) is required due to the complex dose distributions delivered. In this context, polymer gels are considered reliable as a three-dimensional dosimeter. This work used polymer MAGIC-gel sealed in 2 mm thin-wall glass spheres to assess the three-dimensional (3D) dose distribution imparted to patients and compared the results with that provided by the treatment planning system. Four SBRT treatments targeting vertebral, ilium, pelvic lymph node and lung regions were selected for this study. A computed tomography (CT) scan of each glass sphere was obtained, and the patient treatment plan was superimposed on the glass sphere CT image. Thereafter, the spheres were irradiated under similar conditions to the patient using a Varian TrueBeam linear accelerator. A high-spatial resolution optical CT scanner was used to read the glass sphere containing the gel. Planned and delivered 3D dose distributions were compared quantitatively through 3D gamma passing rates at several selected acceptance criteria and qualitatively through the evaluation of dose-profiles, isodose-curves, and dose-volume histograms. We observed that the overall 3D gamma passing rate exceeded 90% at acceptance criteria of 2% dose difference and 2 mm distance-to-agreement for a dose threshold of 20%. The results of this study suggest that the polymer MAGIC-gel sealed in thin-wall glass spheres in conjunction with the optical CT readout method is a suitable PSQA system for SBRT treatments.

New optically stimulated luminescence dosimetry film optimized for energy dependence guided by Monte Carlo simulations

Optically stimulated luminescence (OSL) film dosimeters, based on BaFBr:Eu2+ phosphor material, have major dosimetric advantages such as dose linearity, high spatial resolution, film re-usability, and immediate film readout. However, they exhibit an energy-dependent over-response at low photon energies because they are not made of tissue-equivalent materials. In this work, the OSL energy-dependent response was optimized by lowering the phosphor grain size and seeking an optimal choice of phosphor concentration and film thickness to achieve sufficient signal sensitivity. This optimization process combines measurement-based assessments of energy response in narrow x-ray beams with various energy response calculation methods applied to different film metrics. Theoretical approaches and MC dose simulations were used for homogeneous phosphor distributions and for isolated phosphor grains of different dimensions, where the dose in the phosphor grain was calculated. In total 8 OSL films were manufactured with different BaFBr:Eu2+ median particle diameters (D50): 3.2 μm, 1.5 μm and 230 nm and different phosphor concentrations (1.6%, 5.3% and 21.3 %) and thicknesses (from 5.2 to 49 μm). Films were irradiated in narrow x-ray spectra (N60, N80, N-150 and N-300) and the signal intensity relative to the nominal dose-to-water value was normalized to Co-60. Finally, we experimentally tested the response of several films in Varian 6MV TrueBeam STx linear accelerator using the following settings: 10 × 10 cm2 field, 0deggantry angle, 90 cm SSD, 10 cm depth. The x-ray irradiation experiment reported a reduced energy response for the smallest grain size with an inverse correlation between response and grain size. The N-60 irradiation showed a 43% reduction in the energy over-response when going from 3 μm to 230 nm grain size for the 5% phosphor concentration. Energy response calculation using a homogeneous dispersion of the phosphor underestimated the experimental response and was not able to obtain the experimental correlation between grain size and energy response. Isolated grain size modeling combined with MC dose simulations allowed to establish a good agreement with experimental data, and enabled steering the production of optimized OSL-films. The clinical 6 MV beam test confirmed a reduction in energy dependence, which is visible in small-grain films where a decrease in out-of-field over-response was observed.

Single isocenter versus dual isocenter treatment using flattening filter-free and jaw-tracking volumetrically modulated arc therapy for boot-shaped lung cancer: Evaluation of dosimetric and feasibility.

To determine whether a dual-isocenter volumetrically modulated arc therapy (VMAT) technique results in lower normal pulmonary dosage compared to a traditional single isocenter technique for boot-shaped lung cancer. A cohort of 15 patients with advanced peripheral or central lung cancer who had metastases in the mediastinum and supraclavicular lymph nodes was randomly selected for this retrospective study. VMAT plans were generated for each patient using two different beam alignment techniques with the 6-MV flattening filter-free (FFF) photon beam: single-isocenter jaw-tracking VMAT based on the Varian TrueBeam linear accelerator (S-TV), and dual-isocenter VMAT based on both TrueBeam (D-TV) and Halcyon linear accelerator (D-HV). For all 45 treatment plans, planning target volume (PTV) dose coverage, conformity/homogeneity index (CI/HI), mean heart dose (MHD), mean lung dose (MLD) and the total lung tissue receiving 5, 20, 30Gy (V5, V20, V30) were evaluated. The monitor units (MUs), delivery time, and plan quality assurance (QA) results were recorded. The quality of the objectives of the three plans was comparable to each other. In comparison with S-TV, D-TV and D-HV improved the CI and HI of the PTV (p<0.05). The MLD was 13.84±1.44Gy (mean±SD) for D-TV, 14.22±1.30Gy and 14.16±1.42Gy for S-TV and D-HV, respectively. Lungs-V5Gy was 50.78±6.24%, 52.00±7.32% and 53.36±8.48%, Lungs-V20Gy was 23.72±2.27%, 26.18±2.86% and 24.96±3.09%, Lungs-V30Gy was 15.69±1.76%, 17.20±1.72% and 16.52±2.07%. Compared to S-TV, D-TV provided statistically significant better protection for the total lung, with the exception of the lungs-V5. All plans passed QA according the gamma criteria of 3%/3mm. Taking into account the dosimetric results and published clinical data on radiation-induced pulmonary injury, dual-isocenter jaw-tracking VMAT may be the optimal choice for treating boot-shaped lung cancer.

A comparative study of photon beam percentage depth dose of a recently installed varian vitalbeam linear accelerator at TMSS cancer center, Bangladesh

A comparative study of photon beam percentage depth dose of a recently installed varian vitalbeam linear accelerator at TMSS cancer center, Bangladesh

A Study on Workload of a Medical Linear Accelerator at a High Throughput Cancer Treatment Centre in Sri Lanka

Radiotherapy bunker design depends on several factors, and among them, workload is one of the important factors. Workload is calculated from the radiation dose delivered at the isocenter. Due to the introduction of new radiotherapy treatment modalities and an increasing number of new cancer patients, there is a higher possibility to increase the workload. Therefore, this study aims to assess the workload of Varian linear accelerator vault at Apeksha Hospital, Maharagama. Data were collected from 1st of August 2020 to 30th November 2020. Dose delivered at isocenter from the 3D-CRT procedures with 6 MV and 15 MV photon energy, the IMRT procedures with 6 MV photon energy and the quality assurance (QA) procedures were collected from ARIA patient management system and transferred into Excel spread sheet for data analysis. The calculated weekly workload was 2326 Gy/week with a 43% contribution from the IMRT procedures with 6 MV, 39% contribution from the 3D-CDT procedures with 6 MV, 16% contribution from the 3D-CDT procedures with 15 MV and 2% contribution from physics workload (QA procedures). The evaluated workload is higher than the NCRP recommended workload of 1000 Gy/week. This study recommends for at least a one-year survey for more accuracy on workload assessment, and also to evaluate the use factor since most of the advanced radiotherapy treatment techniques use high number of monitor units which will increase the leakage radiation.

Prediction Analysis of Dose Verification Based on Plan Complexity Metrics during Radiotherapy

Plan validation in radiotherapy includes pre-treatment and in-treatment validation. It is feasible to leverage plan complexity to optimize validation processes, because some research reports that the consistency between planning and measurement or execution decreases as plan complexity increases. Therefore, starting from the plan complexity, this study comprehensively and systematically explores these factors affecting whether the plan verification is passed or not and the strength of their correlations, so as to establish a regression model and optimize the verification process. The IMRT and model-based validation information were retrospectively collected for patients who received tumor radiotherapy at our institution from January 2020 to May 2022. The seventy-eight metrics characterizing the plan complexity were calculated and checked for each plan by an in-house developed computing platform. The comparisons of plan verification results under different tumor species and different verification methods were carried out, and the plan complexity metrics was also compared. Subsequently, Spearman correlation analysis between plan complexity and plan validation under different tumor species, different verification methods and different evaluation indexes was analyzed to provide the basis for regression analysis. One thousand two hundred twenty-six patients were enrolled in the study. The plans in Eclipse TPS were performed by Varian Edge and iX linear accelerators and their verification were executed by EPID, Delat4, and ArcCheck. The gamma index under evaluation index of 3%/3mm, 3%/2mm, 2%/2mm, 1%/1mm were respectively 97.4% (7.1%), 94.8% (10.9%), 86.1% (20.1%), 50.7% (22.6%). The γ and DD of EPID and Detla4 decreased with the increase of TH, and the change of DD was the most significant, while the DTA of Detla4 did not change significantly with TH, and the passing rate of DTA and γ in thoracic and abdominal was the highest in ArcCheck group. Contrast and Variance were the most different between tumor types. The pelvic MIs and MIa were larger than those planned for the other three sites. Except for head and neck CLS and MD, other metrics did not vary significantly among tumor species. The correlation between the metrics characterizing the static characteristics of leaves was more significant for head and neck tumors; the correlation between metrics characterizing the flux complexity were significantly different in pelvic. There was a correlation between plan complexity and γ indicators, and the overall strength was ArcCheck > EPID > Delta4 for head and neck, Delta4 > EPID and ArcCheck for thorax-abdomen, Delta4 and EPID > ArcCheck for pelvic, Delta4 > ArcCheck > EPID for arms and legs. There was a correlation between different plan complexity metrics. Based on this study, it is feasible to predict the verification results based on these complexity metrics, but the regression models were respectively established according to tumor types and validation methods.

Characterization of a 0.8 mm3 Medscint plastic scintillator detector system for small field dosimetry

Objective. Plastic scintillator detectors (PSDs) have demonstrated ability to meet requirements of small field dosimetry. Medscint developed a 1 mm long, 1 mm diameter cylindrical PSD with effective volume of 0.8 mm3. Clinically relevant, small field dosimetric properties of this detector, combined with a novel scintillation dosimetry system—HYPERSCINT RP-200, and HYPERDOSE analysis software were evaluated in this study. Approach. This novel scintillator-based dosimetry system was characterized with 6 MV-WFF and 10 MV-FFF x-ray beams delivered by Varian TrueBeamTM linear accelerator. The detector was characterized for leakage, short-term repeatability, dose response linearity, angular response, dose rate response, and field size dependence for radiation field sizes of 0.25 × 0.25 to 10 × 10 cm2. Measured detector specific output ratios were compared with microDiamond output factors to determine small field output correction factors, Main results. The dosimetry system showed excellent short-term repeatability with standard deviation of only 0.04 ± 0.01%. It demonstrated good dose linearity with variations less than 1.0% for 14.4 cGy and above. The dosimetry system was found to be independent of dose rate and angle of irradiation, with deviations for both below 0.5%. Leakage was found to be comparable to background readings. For 6 MV-WFF energy beams, detector specific output ratios for field sizes down to 1 × 1 cm2 agreed with output factors measured with PTW TN60019 microDiamond, thus, equates to unity for these field sizes. For 10 MV-FFF energy beams, detector specific output ratios for field sizes down to 2 × 2 cm2 agreed with PTW TN60019 microDiamond output factors, thus, equates to unity for these field sizes. for field sizes down to 0.5 × 0.5 cm2 were determined to be within 6% of unity for both 6 MV-WFF and 10 MV-FFF energy beams. Significance. The HYPERSCINT RP-200 dosimetry system coupled with a 0.8 mm3 PSD showed excellent dosimetric properties and was found to be clinically relevant for relative dosimetry down to field sizes of 0.5 × 0.5 cm2 and potentially smaller.

Monitor unit verification for Varian TrueBeam VMAT plans using Monte Carlo calculations and phase space data.

To use the open-source Monte Carlo (MC) software calculations for TPS monitor unit verification of VMAT plans, delivered with the Varian TrueBeam linear accelerator, and compare the results with a commercial software product, following the guidelines set in AAPM Task Group 219. The TrueBeam is modeled in EGSnrc using the Varian-provided phase-space files. Thirteen VMAT TrueBeam treatment plans representing various anatomical regions were evaluated, comprising 37 treatment arcs. VMAT plans simulations were performed on a computing cluster, using 107 -109 particle histories per arc. Point dose differences at five reference points per arc were compared between Eclipse, MC, and the commercial software, MUCheck. MC simulation with 5×107 histories per arc offered good agreement with Eclipse and a reasonable average calculation time of 9-18 min per full plan. The average absolute difference was 3.0%, with only 22% of all points exceeding the 5% action limit. In contrast, the MUCheck average absolute difference was 8.4%, with 60% of points exceeding the 5% dose difference. Lung plans were particularly problematic for MUCheck, with an average absolute difference of approximately 16%. Our EGSnrc-based MC framework can be used for the MU verification of VMAT plans calculated for the Varian TrueBeam; furthermore, our phase space approach can be adapted to other treatment devices by using appropriate phase space files. The use of 5×107 histories consistently satisfied the 5% action limit across all plan types for the majority of points, performing significantly better than a commercial MU verification system, MUCheck. As faster processors and cloud computing facilities become even more widely available, this approach can be readily implemented in clinical settings.

Towards clinical use of Varian Clinac iX linear accelerator in a low resource radiotherapy facility: evaluation of commissioning data

Towards clinical use of Varian Clinac iX linear accelerator in a low resource radiotherapy facility: evaluation of commissioning data

Analysis of different protocols using an Exradin A12 cylindrical chamber for electron beam reference dosimetry

The Technical Report Series 398 (TRS-398), Electron Dosimetry Working Party (EWDP), and Task Group 51 (TG 51) are the most important protocols for reference dosimetry. In the case of electron beam reference dosimetry, these protocols recommend using parallel-plate ionization chambers for beams with R50 values below specific thresholds. However, recent papers suggested using cylindrical chambers for reference dosimetry of all electron beam energies. Here we compared different protocols using a cylindrical chamber with the recommendations of using a parallel-plate chamber and the TRS-398 formalism for the dosimetry of several electron beam energies. We employed electron beams with nominal energies of 4, 6, 9, 12, and 15 MeV of a Varian 2100C linear accelerator, an Exradin A12, and an Exradin P11 chamber for the analysis. The results showed differences below 3% when comparing the cylindrical chamber and alternative protocols with the parallel-plate chamber and the TRS-398 formalism for electron beams reference dosimetry. These results can bring confidence in using a cylindrical chamber for reference electron beam dosimetry, which can make the electron beam dosimetry procedure simpler and faster.

Evaluation of 3D-printed bolus for radiotherapy using megavoltage X-ray beams

A radiotherapy bolus is a tissue-equivalent material placed on the skin to adjust the surface dose of megavoltage X-ray beams used for treatment. In this study, the dosimetric properties of two 3D-printed filament materials, polylactic acid (PLA) and thermoplastic polyether urethane (TPU), used as radiotherapy boluses, were investigated. The dosimetric properties of PLA and TPU were compared with those of several conventional bolus materials and RMI457 Solid Water. Percentage depth-dose (PDD) measurements in the build-up region were performed for all materials using 6 and 10 MV photon treatment beams on Varian linear accelerators. The results showed that the differences in the PDDs of the 3D-printed materials from the RMI457 Solid Water were within 3%, whereas those of the dental wax and SuperFlab gel materials were within 5%. This indicates that PLA and TPU 3D-printed materials are suitable radiotherapy bolus materials.

Assessment of image quality of two cone-beam computed tomography of the Varian Linear accelerators: Comparison with spiral CT simulator

Assessment of image quality of two cone-beam computed tomography of the Varian Linear accelerators: Comparison with spiral CT simulator

The effects of different photon beam energies in stereotactic radiosurgery with cones.

Stereotactic radiosurgery (SRS) relies on small fields to ablate lesions. Currently, linac based treatment is delivered via circular cones using a 6 MV beam. There is interest in both lower energy photon beams, which can offer steeper dose fall off as well as higher energy photon beams, which have higher dose rates, thus reducing radiation delivery times. Of interest in this study is the 2.5 MV beam developed for imaging applications and both the 6 and 10 MV flattening-filter-free (FFF) beams, which can achieve dose rates up to 2400 cGy/min. This study aims to assess the benefit and feasibility among different energy beams ranging from 2.5 to 10 MV beams by evaluating the dosimetric effects of each beam and comparing the dose to organs-at-risk (OARs) for two separate patient plans. One based on a typical real patient tremor utilizing a 4mm cone and the other a typical brain metastasis delivered with a 10mm cone. The Monte Carlo codes BEAMnrc/DOSXYZnrc were used to generate beams of 2.5 MV, 6 MV-FFF, 6 MV-SRS, 6 MV, 10 MV-FFF, and 10 MV from a Varian TrueBeam except 6 MV-SRS, which is taken from a Varian TX model linear accelerator. Each beam's energy spectrum, mean energy, %dd curve, and dose profile were obtained by analyzing the simulated beams. Calculated patient dose distributions were compared among six different energy beam configurations based on a realistic treatment plan for thalamotomy and a conventional brain metastasis plan. Dose to OARs were evaluated using dose-volume histograms for the same target dose coverage. The mean energies of photons within the primary beam projected area were insensitive to cone sizes and the values of percentage depth-dose curves (%dd) at d=5cm and SSD=95cm for a 4mm (10mm) cone ranges from 62.6 (64.4) to 82.2 (85.7) for beam energy ranging from 2.5 to 10 MV beams, respectively. Doses to OARs were evaluated among these beams based on real treatment plans delivering 15000 and 2200cGy to the target with a 4 and 10mm cone, respectively. The maximum doses to the brainstem, which is 10mm away from the isocenter, was found to be 434 (300), 632 (352), 691 (362), 733 (375), 822 (403), and 975 (441)cGy for 2.5 MV, 6 MV-FFF, 6 MV-SRS, 6 MV, 10 MV-FFF, and 10 MV beams delivering 15000 (2200) cGy target dose, respectively. Using the 6 MV-SRS as reference, changes of the maximum dose (691 cGy) to the brain stem are -37%, -9%, +6%, +19%, and 41% for 2.5 MV, 6 MV-FFF, 6 MV, 10 MV-FFF, and 10 MV beams, respectively, based on the thalamotomy plan, where the "-" or "+" signs indicate the percentage decrease or increase. Changes of the maximum dose (362 cGy) to brain stem, based on the brain metastasis plan are much less for respective beam energies. The sum of 21 arcs beam-on time was 39 min on our 6 MV-SRS beam with 1000 cGy/min for thalamotomy. The beam-on time can be reduced to 16 min with 10 MV-FFF.

Dosimetric evaluation in brachytherapy and teletherapy for prostate cancer using Monte Carlo simulation and anatomically realistic virtual anthropomorphic phantom

The benefits that radiotherapy provides to the patient are unquestionable. However, there is growing concern about the increased risk of radiation-induced secondary cancer and the late damage to organs and tissues associated with the treatment. In this sense, the main objective of this study was to determine the radiation doses in the organs and tissues of the prostate cancer patient for two radiotherapy options, using the Monte Carlo code MCNP×2.7.0. The patient was represented by the ICRP 110 reference virtual anthropomorphic phantom and underwent brachytherapy with a192Ir source, Nucletron Microselectron V2 model, and alternatively, conventional 3D-CRT radiotherapy with an 18 MV X-ray beam from a Varian 2100c medical linear accelerator with 4-field planning (anteroposterior, 0°; posteroanterior, 180°; left lateral, 90°; and right lateral, 270°). A set of conversion factors (CF) for equivalent and effective dose were determined. The obtained results showed that in the more distant organs related to the prostate, such as the lung, brain, and salivary glands, the contribution of scattered radiation decreases, especially when brachytherapy is used. Comparing the two treatment modalities, the CF for effective dose per therapeutic dose was 42% lower when 192Ir was chosen as the main form of treatment. The CF values for photon equivalent doses calculated in 3D-CRT 4-fields are among one and two orders of magnitude higher than 192Ir therapy. These differences are even higher when the neutron equivalent dose in 3D-CRT is considered. In this way, the tools and methodology presented significantly improve the previously used to accurately estimate the equivalent doses in organs and tissues, which is the best quantity to assess the risk of inducing secondary cancer of healthy organs and tissues of patients undergoing treatment with radiotherapy.

Comparison of 116 Radiosurgery Treatment Plans for Multi-Leaf and Cone Collimator on a Varian Edge Linac: Are Cones Superior in the Daily Routine?

Delivering focused radiation doses via linear accelerators is a crucial component of stereotactic radiosurgery (SRS) for brain metastases. The Varian Edge linear accelerator provides highly conformal radiation therapy through a high-definition multi-leaf collimator (HD120 MLC) and conical collimator (CC). HD120 MLC adapts to the shape of the target volume using movable tungsten leaves, while CC has a block of conical shape (cones). CC in SRS treatments of small brain metastases is preferred due to its mechanical stability and steeper dose fall-off, potentially sparing organs at risk (OARs) and the brain better than HD120 MLC. This study aims to determine if CC offers significant advantages over HD120 MLC for SRS treatments. For 116 metastatic lesions, CC and HD120 MLC treatment plans were created in Varian Eclipse TPS and compared based on various dose parameters, robustness tests, and QA measurements. The results indicate that CC provides no significant advantages over HD120 MLC, except for slight, clinically insignificant benefits in brain sparing and dose fall-off for the smallest lesions. HD120 MLC outperforms CC in almost every aspect, making it a better choice for irradiating brain metastases with 0.1 cm3 or higher volumes.

Measurement of neutron yield for a medical linear accelerator below 10 MV.

The recent trend toward 10MV for volumetric radiotherapy treatment such as volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), and stereotactic ablative body radiotherapy (SABR) introduces photoneutron production, with implications for non-therapeutic patient dose and additional shielding requirements for treatment room design. The sharply nonlinear drop-off in photoneutron production below 10MV to negligible at 6MV has scarcely been characterized quantitatively, yet can elucidate important practical insights. To measure photoneutron yields in a medical linac at 8MV, which may strike a reasonable balance between usefully increased beam penetration and dose rate as compared to 6MV while reducing photoneutron production which is present at 10MV. A Varian iX linear accelerator undergoing decommissioning at our clinic was made to operate over a range of photon energies between 6 and 15MV by calibrating the bending magnet and adjusting other beam generation parameters. Neutron dose within the treatment room was measured using an Anderson-Braun type detector over a continuum of intermediate energies. The photoneutron production for energies below 10MV was measured, adding to data that is otherwise scarce in the literature. Our results are consistent with previously published results for neutron yield. We found that the photoneutron production at 8MV was about 1/10 of the value at 10MV, and about 10 times higher than detector background at 6MV. Photoneutron production drops off below 10MV, but is still present at 8MV. An 8MV beam is more penetrating than a 6MV beam, and may offer a suitable tradeoff for modern radiotherapy techniques such as VMAT, SRS, and SABR. Further studies are needed to better understand the impact on treatment plan quality between 8 and 10MV beams considering the benefits to facility requirements and non-therapeutic patient dose.