Simulation and experimental verification of ambient neutron doses in a pencil beam scanning proton therapy room as a function of treatment plan parameters.

Out-of-field patient doses in proton therapy are dominated by neutrons. Currently, they are not taken into account by treatment planning systems. There is an increasing need to include out-of-field doses in the dose calculation, especially when treating children, pregnant patients, and patients with implants. In response to this demand, this work presents the first steps towards a tool for the prediction of out-of-field neutron doses in pencil beam scanning proton therapy facilities. As a first step, a general Monte Carlo radiation transport model for simulation of out-of-field neutron doses was set up and successfully verified by comparison of simulated and measured ambient neutron dose equivalent and neutron fluence energy spectra around a solid water phantom irradiated with a variation of different treatment plan parameters. Simulations with the verified model enabled a detailed study of the variation of the neutron ambient dose equivalent with field size, range, modulation width, use of a range shifter, and position inside the treatment room. For future work, it is planned to use this verified model to simulate out-of-field neutron doses inside the phantom and to verify the simulation results by comparison with previous in-phantom measurement campaigns. Eventually, these verified simulations will be used to build a library and a corresponding tool to allow assessment of out-of-field neutron doses at pencil beam scanning proton therapy facilities.

Range-shifter effects on the stray field in proton therapy measured with the variance-covariance method.

Measurements in the stray radiation field from a proton therapy pencil beam at energies 70 and 146 MeV were performed using microdosimetric tissue-equivalent proportional counters (TEPCs). The detector volumes were filled with a propane-based tissue-equivalent gas at low pressure simulating a mean chord length of 2 µm in tissue. Investigations were performed with and without a beam range shifter, and with different air gaps between the range shifter and a solid water phantom. The absorbed dose, the dose-mean lineal energy, and the dose equivalent were determined for different detector positions using the variance-covariance method. The influence from beam energy, detector- and range-shifter positions on absorbed dose, LET, and dose equivalent were investigated. Monte Carlo simulations of the fluence, detector response, and absorbed dose contribution from different particles were performed with MCNP 6.2. The simulated dose response for protons, neutrons, and photons were compared with, and showed good agreement with, previously published experimental data. The simulations also showed that the TEPC absorbed dose agrees well with the ambient absorbed dose for neutron energies above 20 MeV. The results illustrate that changes in both dose and LET variations in the stray radiation field can be identified from TEPC measurements using the variance-covariance method. The results are in line with the changes seen in the simulated relative dose contributions from different particles associated with different proton energies and range-shifter settings. It is shown that the proton contribution scattered directly from the range shifter dominates in some situations, and although the LET of the radiation is decreased, the ambient dose equivalent is increased up to a factor of 3.

Dose-mean lineal energy values for electrons by different Monte Carlo codes: Consequences for estimates of radiation quality in photon beams.

BACKGROUND: The microdosimetric quantity lineal energy and its mean values have proven useful for quantifying radiation quality in many situations. The ratio of dose-mean lineal energies is perhaps the simplest quantity for quantifying differences between two radiation qualities. However, published dose-mean lineal energy values from different codes may differ significantly with potential influence on radiation quality estimates. PURPOSE: The purpose was to compare dose-mean lineal energy values from different track-structure data sets for condensed water vapor and liquid water, and to evaluate the influence on radiation quality estimations for some photon sources. METHODS: Published dose-mean lineal energy values for 0.1 keV to 1 MeV electrons in spheres with diameters 2 nm to 1 µm, calculated with water vapor and liquid water track structure codes and proximity functions, were collected, analyzed, and compared. Data for cylinders were converted to spheres using a theoretical transformation published by Kellerer. A new set of dose-mean lineal energy values was calculated to cover the whole range of volumes of interest here using the GEANT4-DNA code. The influence from the differences between codes on radiation quality calculations was estimated using dose-mean lineal energy ratios for the photon sources 125 I, 169 Yb, and 192 Ir relative to 60 Co. RESULTS: The theoretical relation for converting the dose-mean lineal energy between different geometrical volumes, results in differences up to 10% between cylinders and spheres depending on electron energy and target size, in agreement with published simulated results. For spheres with diameter above 100 nm, dose-mean lineal energy values for condensed water vapor and liquid water are with few exceptions within ±10%. Below 100 nm, the difference increases with decreasing diameter reaching a factor of two at 2 nm. The values from water vapor codes are in general larger than from liquid water codes. If the dose-mean lineal energy ratio is based on condensed water vapor instead of liquid water, the ratio differs less than 9% for the nuclides 125 I, 169 Yb, and 192 Ir relative to 60 Co independent of the volume simulated. However, a specific value of the dose-mean lineal energy ratio, is found at a larger target diameter in liquid water than in condensed water vapor. CONCLUSIONS: When ratios of the dose-mean lineal energy are used as a measure of the radiation quality it is important to compare values for geometrically equal target shapes. A practical method of converting values for cylinders of equal diameter and height to spheres was demonstrated. Although dose-mean lineal energy values calculated with water vapor and liquid water codes may differ significantly, the radiation quality, in terms of ratios of dose-mean lineal energy, for the three photon sources 192 Ir, 169 Yb, and 125 I relative to 60 Co, agree within 9%. The same ratio appears at a larger diameter when a liquid water code is used. It is therefore important to use the same code in radiation quality investigations. The present findings may be of special interest in studies related to the relative biological effectiveness (RBE).

Out-of-field doses from secondary radiation produced in proton therapy and the associated risk of radiation-induced cancer from a brain tumor treatment.

PURPOSE: To determine out-of-field doses produced in proton pencil beam scanning (PBS) therapy using Monte Carlo simulations and to estimate the associated risk of radiation-induced second cancer from a brain tumor treatment. METHODS: Simulations of out-of-field absorbed doses were performed with MCNP6 and benchmarked against measurements with tissue-equivalent proportional counters (TEPC) for three irradiation setups: two irradiations of a water phantom using proton energies of 78-147 MeV and 177-223 MeV, and one brain tumor irradiation of a whole-body phantom. Out-of-field absorbed and equivalent doses to organs in a whole-body phantom following a brain tumor treatment were subsequently simulated and used to estimate the risk of radiation-induced cancer. Additionally, the contribution of absorbed dose originating from radiation produced in the nozzle was calculated from simulations. RESULTS: Out-of-field absorbed doses to the TEPC ranged from 0.4 to 135 µGy/Gy. The average deviation between simulations and measurements of the water phantom irradiations was about 17%. The absorbed dose contribution from radiation produced in the nozzle ranged between 0 and 70% of the total dose; the contribution was however small in absolute terms. The absorbed and equivalent doses to the organs ranged between 0.2 and 60 µGy/Gy and 0.5-151 µSv/Gy. The estimated lifetime risk of radiation-induced second cancer was approximately 0.01%. CONCLUSIONS: The agreement of out-of-field absorbed doses between measurements and simulations was good given the sources of uncertainties. Calculations of out-of-field organ doses following a brain tumor treatment indicated that proton PBS therapy of brain tumors is associated with a low risk of radiation-induced cancer.

Comment on 'Monte Carlo calculated microdosimetric spread for cell nucleus-sized targets exposed to brachytherapy (125)I and (192)Ir sources and (60)Co cell irradiation'.

The relative standard deviation, σr,D, of calculated multi-event distributions of specific energy for (60)Co ϒ rays was reported by the authors F Villegas, N Tilly and A Ahnesjö (Phys. Med. Biol. 58 6149-62). The calculations were made with an upgraded version of the Monte Carlo code PENELOPE. When the results were compared to results derived from experiments with the variance method and simulated tissue equivalent volumes in the micrometre range a difference of about 50% was found. Villegas et al suggest wall-effects as the likely explanation for the difference. In this comment we review some publications on wall-effects and conclude that wall-effects are not a likely explanation.