Combining tissue-phantom ratios to provide a beam-quality specifier for flattening filter free photon beams.

PURPOSE: There are currently several commercially available radiotherapy treatment units without a flattening filter in the beam line. Unflattened photon beams have an energy and lateral fluence distribution that is different from conventional beams and, thus, their attenuation properties differ. As a consequence, for flattening filter free (FFF) beams, the relationship between the beam-quality specifier TPR20,10 and the Spencer-Attix restricted water-to-air mass collision stopping-power ratios, L̄/ρair (water), may have to be refined in order to be used with equivalent accuracy as for beams with a flattening filter. The purpose of this work was twofold. First, to study the relationship between TPR20,10 and L̄/ρair (water) for FFF beams, where the flattening filter has been replaced by a metal plate as in most clinical FFF beams. Second, to investigate the potential of increasing the accuracy in determining L̄/ρair (water) by adding another beam-quality metric, TPR10,5. The relationship between L̄/ρair (water) and %dd(10)x for beams with and without a flattening filter was also included in this study. METHODS: A total of 24 realistic photon beams (10 with and 14 without a flattening filter) from three different treatment units have been used to calculate L̄/ρair (water), TPR20,10, and TPR10,5 using the EGSnrc Monte Carlo package. The relationship between L̄/ρair (water) and the dual beam-quality specifier TPR20,10 and TPR10,5 was described by a simple bilinear equation. The relationship between the photon beam-quality specifier %dd(10)x used in the AAPM's TG-51 dosimetry protocol and L̄/ρair (water) was also investigated for the beams used in this study, by calculating the photon component of the percentage depth dose at 10 cm depth with SSD 100 cm. RESULTS: The calculated L̄/ρair (water) for beams without a flattening filter was 0.3% lower, on average, than for beams with a flattening filter and comparable TPR20,10. Using the relationship in IAEA, TRS-398 resulted in a root mean square deviation (RMSD) of 0.0028 with a maximum deviation of 0.0043 (0.39%) from Monte Carlo calculated values. For all beams in this study, the RMSD between the proposed model and the Monte Carlo calculated values was 0.0006 with a maximum deviation of 0.0013 (0.1%). Using an earlier proposed relationship [Xiong and Rogers, Med. Phys. 35, 2104-2109 (2008)] between %dd(10)x and L̄/ρair (water) gave a RMSD of 0.0018 with a maximum deviation of 0.0029 (0.26%) for all beams in this study (compared to RMSD 0.0015 and a maximum deviation of 0.0048 (0.47%) for the relationship used in AAPM TG-51 published by Almond et al. [Med. Phys. 26, 1847-1870 (1999)]). CONCLUSIONS: Using TPR20,10 as a beam-quality specifier, for the flattening filter free beams used in this study, gave a maximum difference of 0.39% between L̄/ρair (water) predicted using IAEA TRS-398 and Monte Carlo calculations. An additional parameter for determining L̄/ρair (water) has been presented. This parameter is easy to measure; it requires only an additional dose measurement at 5 cm depth with SSD 95 cm, and provides information for accurate determination of the L̄/ρair (water) ratio for beams both with and without a flattening filter at the investigated energies.

Flattening filter free beams in SBRT and IMRT: dosimetric assessment of peripheral doses.

PURPOSE: Recently, there has been a growing interest in operating medical linear accelerators without a flattening filter. Due to reduced scatter, leaf transmission and radiation head leakage a reduction of out-of-field dose is expected for flattening filter free beams. The aim of the present study was to determine the impact of unflattened beams on peripheral dose for advanced treatment techniques with a large number of MUs. MATERIAL AND METHODS: An Elekta Precise linac was modified to provide 6 and 10 MV photon beams without a flattening filter. Basic beam data were collected and implemented into the TPS Oncentra Masterplan (Nucletron). Leakage radiation, which predominantly contributes to peripheral dose at larger distances from the field edge, was measured using a Farmer type ionisation chamber. SBRT (lung) and IMRT (prostate, head&neck) treatment plans were generated for 6 and 10 MV for both flattened and unflattened beams. All treatment plans were delivered to the relevant anatomic region of an anthropomorphic phantom which was extended by a solid water slab phantom. Dosimetric measurements were performed with TLD-700 rods, radiochromic films and a Farmer type ionisation chamber. The detectors were placed within the slab phantom and positioned along the isocentric longitudinal axis. RESULTS: Using unflattened beams results in a reduction of treatment head leakage by 52% for 6 and 65% for 10 MV. Thus, peripheral doses were in general smaller for treatment plans calculated with unflattened beams. At about 20 cm distance from the field edge the dose was on average reduced by 23 and 31% for the 6 and 10 MV SBRT plans. For the IMRT plans (10 MV) the average reduction was 16% for the prostate and 18% for the head&neck case, respectively. For all examined cases, the relative deviation between peripheral doses of flattened and unflattened beams was found to increase with increasing distance from the field. CONCLUSIONS: Removing the flattening filter lead to reduced peripheral doses for advanced treatment techniques. The relative difference between peripheral doses of flattened and unflattened beams was more pronounced when the nominal beam energy was increased. Patients may benefit by decreased exposure of normal tissue to scattered dose outside the field.

A Monte Carlo study of a flattening filter-free linear accelerator verified with measurements.

A Monte Carlo model of an Elekta Precise linear accelerator has been built and verified by measured data for a 6 and 10 MV photon beam running with and without a flattening filter in the beam line. In this study the flattening filter was replaced with a 6 mm thick copper plate, provided by the linac vendor, in order to stabilize the beam. Several studies have shown that removal of the filter improves some properties of the photon beam, which could be beneficial for radiotherapy treatments. The investigated characteristics of this new beam included output, spectra, mean energy, half value layer and the origin of scattered photons. The results showed an increased dose output per initial electron at the central axis of 1.76 and 2.66 for the 6 and 10 MV beams, respectively. The number of scattered photons from the accelerator head was reduced by (31.7 ± 0.03)% (1 SD) for the 6 MV beam and (47.6 ± 0.02)% for the 10 MV beam. The photon energy spectrum of the unflattened beam was softer compared to a conventional beam and did not vary significantly with the off-axis distance, even for the largest field size (0-20 cm off-axis).