Monte Carlo commissioning of radiotherapy LINAC—Introducing an improved methodology

PurposeMonte Carlo (MC) commissioning of medical linear accelerator (LINAC) is a time-consuming process involving a comparison between measured and simulated cross beam/lateral profiles and percentage depth doses (PDDs) for various field sizes. An agreement between these two data sets is sought by trial and error method while varying the incident electron beam parameters, such as electron beam energy or width, etc. This study aims to improve the efficiency of MC commissioning of a LINAC by assessing the feasibility of using a limited number of simulated PDDs.Materials and methodsUsing EGSnrc codes, a Varian Clinac 2100 unit has been commissioned for 6 MV photon beam, and a methodology has been proposed to identify the incident electron beam parameters in a speedier fashion. Impact of voxel size in 3-dimensions and cost functions used for comparison of the measured and simulated data have been investigated along with the role of interpolation.ResultsA voxel size of 1 × 1×0.5 cm³ has been identified as suitable for accurate and fast commissioning of the LIANC. The optimum number of simulated PDDs (required for further interpolation) has been found to be five.ConclusionThe present study suggests that PDDs alone at times can be insufficient for an unambiguous commissioning process and should be supported by including the lateral beam profiles in the process.     

Monte Carlo determination of a nanoDot OSLD response using quality index for diagnostic kilovoltage X-ray beams

PurposeThis study aims to investigate the energy response of an optically stimulated luminescent dosimeter known as nanoDot for diagnostic kilovoltage X-ray beams via Monte Carlo calculations.MethodsThe nanoDot response is calculated as a function of X-ray beam quality in free air and on a water phantom surface using Monte Carlo simulations. The X-ray fluence spectra are classified using the quality index (QI), which is defined as the ratio of the effective energy to the maximum energy of the photons. The response is calculated for X-ray fluence spectra with QIs of 0.4, 0.5, and 0.6 with tube voltages of 50–137.6 kVp and monoenergetic photon beams. The surface dose estimated using the calculated response is verified by comparing it with that measured using an ionization chamber.ResultsThe nanoDot response in free air for monoenergetic photon beams (QI = 1.0) varies significantly at photon energies below 100 keV and reaches a factor of 3.6 at 25–30 keV. The response differs by up to approximately 6% between QIs of 0.4 and 0.6 for the same half-value layer (HVL). The response at the phantom surface decreases slightly owing to the backscatter effect, and it is almost independent of the field size. The agreement between the surface dose estimated using the nanoDot and that measured using the ionization chamber for assessing X-ray beam qualities is less than 2%.ConclusionsThe nanoDot response is indicated as a function of HVL for the specified QIs, and it enables the direct surface dose measurement.     

Simultaneous production of mixed electron–photon beam in a medical LINAC: A feasibility study

PurposeThe electron or photon beams might be used for treatment of tumors. Each beam has its own advantage and disadvantages. Combo beam can increase the advantages. No investigation has been performed for producing simultaneous mixed electron and photon beam. In current study a device has been added to the Medical Linac to produce a mixed photon–electron beam.MethodsFirstly a Varian 2300CD head was simulated by MCNP Monte Carlo Code. Two sets of perforated lead sheets with 1 and 2 mm thickness and 0.2, 0.3, and 0.5 cm punches then placed at the top of the applicator holder tray. This layer produces bremsstrahlung x-ray upon impinging fraction electrons on it. The remaining fraction of electrons passes through the holes. The simulation was performed for 10 × 10, 6 × 6, and 4 × 4 cm² field size.ResultsFor 10 × 10 cm² field size, among the punched targets, the largest penumbra difference between the depth of 1 and 7 cm was 72%. This difference for photon and electron beams were 31% and 325% respectively. A maximum of 39% photon percentage was produced by 2 mm target with 0.2 cm holes diameter layer. The minimum surface dose value was 4% lesser than pure electron beam. For small fields, unlike the pure electron beam, the PDD, penumbra, and flatness variations were negligible.ConclusionsThe advantages of mixing the electron and photon beam is reduction of pure electron's penumbra dependency with the depth, especially for small fields, also decreasing of dramatic changes of PDD curve with irradiation field size.     

Measurement of the restricted dose mean LET outside the primary beam of a 60Co radiotherapy unit

A recently developed method for the direct measurement of the restricted dose mean LET (cutoff energy = 500 eV) of an unspecified photon or electron radiation field with the high-pressure ionization chamber has been utilized to investigate the variation of this radiobiologically important parameter outside the primary beam of a clinical 60Co unit. A small high-pressure tissue-equivalent ionization chamber was used, and its characteristics and experimental considerations for the present investigation are reported. Measurement of the restricted dose mean LET at the examined points outside the primary 60Co beam showed an increase of 50% with respect to the restricted dose mean LET of the uncollimated 60Co beam. No significant variation was noted with off-central axis distance, field size, wedge filter, or depth below Perspex slabs. Dose rates at the points of measurement outside the primary 60Co beam were 1-5% of the dose rate in the primary beam.     

Characterization of irregular electron beam for boost dose after whole breast irradiation

Irradiating a tumor bed with boost dose after whole breast irradiation helps reducing the probability of local recurrence. However, the success of electron beam treatment with a small area aiming to cover a superficial lesion is a dual challenge as it requires an adequate dosimetry beside a double check for dose coverage with an estimation of various combined uncertainty of tumor location and losing lateral electron equilibrium within small field dimensions.Aim of workthis work aims to measure the electron beam fluence within different field dimensions and the deviation from measurement performed in standard square electron applicator beam flatness and symmetry, then to calculate the average range of the correction factor required to overcome the loss of lateral electron equilibrium.Material and methodthe electron beam used in this work generated from the linear accelerator model ELEKTA Precise and dosimetry system used were a pair of PTW Pin Point ion chambers for electron beam dosimetry at standard conditions and assessment of beam quality at a reference depth of measurement, with an automatic water phantom, then a Roos ion chamber was used for absolute dose measurement, and PTW 2Darray to investigate the beam fluence of four applicators 6, 10, 14 and 20 cm² and 4 rectangular cutouts 6 × 14, 8 × 14, 6 × 17 and 8 × 17 cm², the second part was clinical application which was performed in a precise treatment planning system and examined boost dose after whole breast irradiation.Resultsrevealed that lower energy (6MeV and 8MeV) showed the loss of lateral electron equilibrium and deviation from measurements of a standard applicator more than the high energy (15 MeV) which indicated that the treatment of superficial dose with 6MeV required higher monitor unit to allow for the loss of lateral electron equilibrium and higher margin as well.     

Dosimetry quality control based on percent depth dose rate variation for checking beam quality in radiotherapy

Recently, the quality management inside a radiotherapy department has been crucial to treat cancer efficiently. Thus, many international bodies recommend multiple methods to check in periodically the dosimetry quality beyond the depth of 10 cm as the beam quality index. However, they evade checking out the beam dosimetry quality on both the build-up dose and the electronic equilibrium regions. The objective of this study is to cover the overall variation of the percent depth dose (PDD) by including all sub-regions in the procedure evaluation of the beam quality.In this work, we have studied and examined the dosimetry quality by considering the whole PDD variation. The PDD rate is therefore introduced to determine accurately the quality as an overall notion in external beam radiotherapy according to the field size and photon beam energy. We have presented the reasons and methods to introduce particles contamination, such as electrons and low photon energy in this new approach. The latter enables us to figure the dosimetry quality by extending the International Atomic Energy Agency (IAEA) procedure at any field size less than 25 × 25 cm² under the current conditions without being limited to 10 × 10 cm² on the exponential decay region.     

Experimental determination of the effective point of measurement of cylindrical ionization chambers for high-energy photon and electron beams

Measurements of depth-dose curves in water phantom using a cylindrical ionization chamber require that its effective point of measurement is located at the measuring depth. Recommendations for the position of the effective point of measurement with respect to the central axis valid for high-energy electron and photon beams are given in dosimetry protocols. According to these protocols, the use of a constant shift P_eff is currently recommended. However, this is still based on a very limited set of experimental results. It is therefore expected that an improved knowledge of the exact position of the effective point of measurement will further improve the accuracy of dosimetry. Recent publications have revealed that the position of the effective point of measurement is indeed varying with beam energy, field size and also with chamber geometry. The aim of this study is to investigate whether the shift of P_eff can be taken to be constant and independent from the beam energy. An experimental determination of the effective point of measurement is presented based on a comparison between cylindrical chambers and a plane-parallel chamber using conventional dosimetry equipment. For electron beams, the determination is based on the comparison of halfvalue depth R₅₀ between the cylindrical chamber of interest and a well guarded plane-parallel Roos chamber. For photon beams, the depth of dose maximum, d_max, the depth of 80% dose, d₈₀, and the dose parameter PDD(10) were used. It was again found that the effective point of measurement for both, electron and photon beams Dosimetry, depends on the beam energy. The deviation from a constant value remains very small for photons, whereas significant deviations were found for electrons. It is therefore concluded that use of a single upstream shift value from the centre of the cylindrical chamber as recommended in current dosimetry protocols is adequate for photons, however inadequate for accurate electron beam dosimetry.     

Accuracy checks of physical beam modifier factors algorithm used in computerized treatment planning system for a 15 MV photon beam

In order to optimize the tumour dose by using wedge filters, systematic studies were carried out to investigate the accuracy of the beam modifier algorithm in a computerized treatment planning system (Theraplan plus, version 3.8). The effect of different parameters such as beam hardening and softening coefficients on the wedge factor was also studied. A 15 MV photon beam obtained from a linear accelerator was used throughout the experiments. Normalized wedge factors were determined experimentally as well as with the Theraplan plus system as a function of field size and depth in a water phantom for 15°, 30°, 45°, and 60° wedge filters. The attenuation coefficients, beam hardening coefficient, and beam softening coefficients were also determined experimentally using the 15 MV photon beam for each wedge angle. The measured normalized wedge factor was found to increase with increasing depth and field size for the 15 MV beam. The Theraplan plus calculated normalized wedge factor was found to be in good agreement with the experimental values. This study indicated that ignoring the dependence of the wedge factor on depth and field size will result in underexposure of the tumour.     

Monte carlo model and output factors of elekta infinity™ 6 and 10 MV photon beam

AimThis study aimed to commission the Elekta Infinity™ working in 6 and 10 MV photon beam installed in Concord International Hospital, Singapore, and compare the OFs between MC simulation and measurement using PTW semiflex and microDiamond detector for small field sizes.Material and MethodsThere are two main steps in this study: modelling of Linac 6 and 10 MV photon beam and analysis of the output factors for field size 2 × 2–10 × 10 cm². The EGSnrc/BEAMnrc-DOSXYZnrc code was used to model and characterize the Linac and to calculate the dose distributions in a water phantom. The dose distribution and OFs were compared to the measurement data in the same condition.ResultsThe commissioning process was only conducted for a 10 × 10 cm² field size. The PDD obtained from MC simulation showed a good agreement with the measurement. The local dose difference of PDDs was less than 2% for 6 and 10 MV. The initial electron energy was 5.2 and 9.4 MeV for 6 and 10 MV photon beam, respectively. This Linac model can be used for dose calculation in other situations and different field sizes because this Linac has been commissioned and validated using Monte Carlo simulation. The 10 MV Linac produces higher electron contamination than that of 6 MV.ConclusionsThe Linac model in this study was acceptable. The most important result in this work comes from OFs resulted from MC calculation. This value was more significant than the OFs from measurement using semiflex and microDiamond for all beam energy and field sizes because of the CPE phenomenon.     

Comparison of ITO and ZnO ternary glassy composites in terms of radiation shielding properties by Monte Carlo N-particle transport code and BXCOM

In the present study, radiation shielding properties of two glassy composite materials that are widely used in electronics, photovoltaic applications, and sensor technology, were investigated in the photon energy range from 15 keV to 15 MeV. The materials chosen were (ITO)/V2O5/B2O3 and ZnO/V2O5/B2O3 including various concentrations of B2O3. Radiation interaction was simulated and shielding parameters calculated by means of the MCNP and BXCOM codes. More specifically, buildup factors, effective electron density ($$N_{\text{eff}}$$) and effective atomic number ($$Z_{\text{eff}}$$) were calculated with BXCOM, while mass attenuation coefficients ($$\mu /\rho$$), half-value layer (HVL) and tenth-value layer (TVL) values were calculated with MCNP. The results were compared with those obtained with the WinXCOM code, for validation. Acceptable and preferable results were obtained for both composites as alternative to other glassy shielding materials. The composite including ITO showed better shielding properties than the composite including ZnO. In terms of radiation shielding, both composites turned out to be better than concrete and close to lead.     

Energy and dose dependence of GafChromic EBT3-V3 film across a wide energy range

AimTo determine the energy and dose dependence of GafChromic EBT3-V3 film over an energy range 0.2 mm Al HVL to 6 MV.BackgroundThe decay scheme of a brachytherapy source may be complex and the spectrum of energy can be wide. LiF TLDs are the golden standard recommended for dosimetric measures in brachytherapy, for their energy independence, but TLDs could be not available in some centres. An alternative way to perform dose measurements is to use GafChromic films, but they show energy dependence.Methods and materialsFilms have been irradiated at increasing dose with three different beams: 6 MV beam, TPR20, 10 = (0.684 ± 0.01), HVL = (2.00 ± 0.01)mmAl and HVL = (0.20 ± 0.01)mmAl. Calibration curves were generated using the same dose range (0cGy to 850cGy) for the three energies. Using the 6 MV calibration curve as reference, the film response in terms of net optical density (OD) was evaluated.ResultsThe difference in the calibration curve obtained by irradiating the film with 6 MV and 2 mm Al HVL energy beams is less than 3 %, within the calibration uncertainty, in the dose range 500-850cGy. The OD of EBT3-V3 film is significantly lower at 0.2 mmAl HVL compared to 6 MV, showing differences up to 25 %.ConclusionWithin the range 6 MV-2 mm Al HVL and dose higher than 500cGy, GafChromic EBT3-V3 films are energy independent. In this dose range, films can be calibrated in a simple geometry, using a 6 MV Linac beam, and can be used for brachytherapy sources dose measures. The use of EBT3 films can be extended to reference dosimetry in Ir-192 clinical brachytherapy.     

Relativistic diamagnetic equilibrium of a thin-walled annular electron beam in an external magnetic field

A self-consistent equilibrium state of a thin-walled annular electron beam in an external magnetic field is investigated with allowance for diamagnetic effect and relativistic effects in the beam rotational motion. An equation for the relativistic angular velocities of the beam rotation is derived in the hydrodynamic approximation. The main parameters of the beam equilibrium state are obtained analytically and are calculated numerically. The parameters of a longitudinally homogeneous, relativistic diamagnetic high-density electron beam are determined.     

Establishing the impact of temporary tissue expanders on electron and photon beam dose distributions

PurposeThis study investigates the effects of temporary tissue expanders (TTEs) on the dose distributions in breast cancer radiotherapy treatments under a variety of conditions.MethodsUsing EBT2 radiochromic film, both electron and photon beam dose distribution measurements were made for different phantoms, and beam geometries. This was done to establish a more comprehensive understanding of the implant's perturbation effects under a wider variety of conditions.ResultsThe magnetic disk present in a tissue expander causes a dose reduction of approximately 20% in a photon tangent treatment and 56% in electron boost fields immediately downstream of the implant. The effects of the silicon elastomer are also much more apparent in an electron beam than a photon beam.ConclusionsEvidently, each component of the TTE attenuates the radiation beam to different degrees. This study has demonstrated that the accuracy of photon and electron treatments of post-mastectomy patients is influenced by the presence of a tissue expander for various beam orientations. The impact of TTEs on dose distributions establishes the importance of an accurately modelled high-density implant in the treatment planning system for post-mastectomy patients.     

Monte Carlo simulation and measurement of radiation leakage from applicators used in external electron radiotherapy

External electron radiotherapy is performed using a cone or applicator to collimate the beam. However, because of a trade-off between collimation and scattering/bremsstrahlung X-ray production, applicators generate a small amount of secondary radiation (leakage). We investigate the peripheral dose outside the radiation field of a Varian-type applicator. The dose and fluence outside the radiation field were analyzed in a detailed Monte Carlo simulation. The differences between the calculation results and data measured in a water phantom in an ionization chamber were less than ±1% in regions more than 3 mm below the surface of the phantom and at the depth of dose maximum. The calculated fluence was analyzed inside and outside the radiation field on a plane just above the water phantom surface. Changing the electron energy affected the off-axis fluence distribution outside the radiation field; however, the size of the applicator had little effect on this distribution. For each energy, the distributions outside the radiation field were similar to the dose distribution at shallow depths in the water phantom. The effect of secondary electrons generation by photon transmission through the alloy making up the lowest scraper was largest in the region from the field edge to directly below the cutout and at higher beam energies. The results of the Monte Carlo simulation confirm that the peripheral dose outside the field is significantly affected by radiation scattered or transmitted from the applicator, and the effect increases with the electron energy.     

Antenna Size Dependency of Photoinactivation of Photosystem II in Light-Acclimated Pea Leaves

Utilization of absorbed light energy by photosystem (PS) II for O2 evolution depends on the light-harvesting antenna size, but the role of antenna size in the photoinactivation of PSII seems controversial. To address this controversy, pea (Pisum sativum L.) plants were grown in low (50 [mu]mol m-2 s-1) or high (650 [mu]mol m-2 s-1) light. The doubled functional antenna size of PSII in low light allows each PSII to utilize twice as many photons at given flash light energies for O2 evolution. The application of a target theory to depict the photon dose dependency of PSII photoinactivation measured by repetitive-flash O2 yield and the ratio of variable to maximal chlorophyll fluorescence indicates that photoinactivation of PSII is probably a single-hit process in which repair or photoprotective mechanisms are only slightly involved. Furthermore, the exacerbation of photoinactivation of PSII with greater antenna size under anaerobic conditions strongly indicates that photoinactivation of PSII depends on antenna size.     

Role of the Ridley-Watkins-Hilsum mechanism in the stabilization of surface plasma waves

The stabilization of unstable harmonic oscillations of the surface charge density and electromagnetic field that are excited by a low-density electron beam propagating parallel to the plane boundary of a half-space occupied by gallium arsenide (GaAs) is studied in the hydrodynamic approximation. It is shown that, for gallium arsenide semiconductors (and, generally, for other so-called A^IIIB^V compound semiconductors), these oscillations are stabilized primarily by the Ridley-Watkins-Hilsum mechanism. The equilibrium field amplitudes and equilibrium surface charge densities of both the semiconductor and the beam are obtained for a slightly overcritical level, i.e., for electrons with energies slightly greater than the energy gap between the lower and higher valleys.     

Photon beam energy dependent single-arc volumetric modulated arc optimization

PurposeThe purpose of this work was to present a new single-arc mixed photon (6&18MV) VMAT (SAMP) optimization framework that concurrently optimizes for two photon energies with corresponding partial arc lengths.Methods and materialsOwing to simultaneous optimization of energy dependent intensity maps and corresponding arc locations, the proposed model poses nonlinearity. Unique relaxation constraints based on McCormick approximations were introduced for linearization. Energy dependent intensity maps were then decomposed to generate apertures. Feasibility of the proposed framework was tested on a sample of ten prostate cancer cases with lateral separation ranging from 34 cm (case no.1) to 52 cm (case no.6). The SAMP plans were compared against single energy (6MV) VMAT (SE) plans through dose volume histograms (DVHs) and radiobiological parameters including normal tissue complication probability (NTCP) and equivalent uniform dose (EUD).ResultsThe contribution of higher energy photon beam optimized by the algorithm demonstrated an increase for cases with a lateral separation >40 cm. SAMP–VMAT notably improved bladder and rectum sparing in large size cases. Compared to single energy, SAMP–VMAT plans reduced bladder and rectum NTCP in cases with large lateral separation. With the exception of one case, SAMP–VMAT either improved or maintained femoral heads compared to SE–VMAT. SAMP–VMAT reduced the nontarget tissue integral dose in all ten cases.ConclusionsA single-arc VMAT optimization framework comprising mixed photon energy partial arcs was presented. Overall results underline the feasibility and potential of the proposed approach for improving OAR sparing in large size patients without compromising the target homogeneity and coverage.     

6X Acuros algorithm validation in the presence of inhomogeneities for VMAT treatment planning

AimTo validate the Acuros®XB (AXB) dose calculation algorithm for a 6 MV beam from the Varian TrueBeam treatment units.BackgroundCurrently Anisotropic Analytic Algorithm (AAA) is clinically used on authors’ department but AXB could replace it for VMAT treatments in regions where inhomogeneities and free air are present.Materials and methodsTwo steps are followed in the validation process of a new dose calculation algorithm. The first is to check the accuracy of algorithm for a homogenous phantom and regular fields. Multiple fields of increasing complexity have been acquired using a MapCheck diode array. The accuracy of the algorithm was evaluated using the gamma analysis method. The second is to validate the algorithm in the presence of heterogeneous media. Planar absolute dose was measured with GafChromic®EBT2 film and was compared with the dose calculated by AXB. Gamma analysis was performed between MapCheck measurements and AXB dose calculations, at a range of clinical source-surface distance.ResultsFor SSDs ranging from 80 to 100 cm, the results show a minimum pass rate of 95% between AXB and MapCheck acquisition. For open 6 MV photon beam interacting with a phantom with an air gap, the agreement after the air gap between AXB and GafChromic®EBT2 is less than 1% in the 3 × 3cm² field and less than 2% in the 10 × 10 cm² field.ConclusionsAXB has advanced modelling of lateral electron transport that enables a more accurate dose calculation in heterogeneous regions and, compared with AAA, improves accuracy between different density interfaces. This will be of particular benefit for head/neck treatments.     

Direct and bystander effects induced by scattered radiation generated during penetration of radiation inside a water-phantom

In this study, the dose distribution of photon (6 MV) and electron (22 MeV) radiation in a water-phantom was compared with the frequency of apoptotic and micronucleated cells of two human cell lines (BEAS-2B normal bronchial epithelial cells and A549 lung cancer epithelial cells). Formation of micronuclei and apoptotic-like bodies was evaluated by the cytokinesis-block micronucleus test. Measurements were performed for five different phantom depths (3-20 cm). Irradiated cells were placed in a water-phantom in three variants: directly on the axis in the beam, under shielding (only in photon radiation) and outside the beam field. The results reveal a discrepancy between the distribution of physical dose at different depths of the water-phantom and biological effects. This discrepancy is of special significance in case of cells irradiated at a greater depth or placed outside the field and under shield during the exposure to radiation. The frequency of cytogenetic damage was higher than the expected value based on the physical dose received at different depths. Cells placed outside the beam axis were exposed to scattered radiation at very low doses, so we tested if bystander effects could have had a role in the observed discrepancy between physical radiation dose and biological response. We explored this question by use of a medium-transfer technique in which medium (ICM-irradiation conditioned medium) from irradiated cells was transferred to non-irradiated (bystander) cells. The results indicate that when cells were incubated in ICM transferred from cells irradiated at bigger depths or from cells exposed outside the radiation field, the number of apoptotic and micronucleated cells was similar to that after direct irradiation. This suggests that these damages are caused by factors released by irradiated cells into the medium rather than being induced directly in DNA by X-rays. Evaluation of biological effects of scattered radiation appears useful for clinical practice.     

Solution of a set of Maxwell-Lorentz equations for a ring relativistic electron beam

Nonlinear solutions to a set of Maxwell’s equations and the relativistic equations of electron motion are obtained that describe the equilibrium of a high-power ring relativistic electron beam against the background of immobile ions. By transforming the basic equations, a set of equations for a three-component vortex vector field is derived that describes ring beam configurations for plasma confinement. An example of a numerical calculation of the steady state of a compact beam torus of immobile ions and relativistic electrons is presented.