[Calculation of Experimental Penumbral Width of X-ray Dose Distributions Using Multiple Detectors].

INTRODUCTION: X-ray penumbral width depends on the size of the detector in the off-axis ratio of medical linear accelerators. The use of detectors with appropriate sizes according to the irradiation field is recommended. However, when measuring dose distributions, the shape of the off-axis ratio differs depending on detectors even if the dose distribution remains unchanged. This study aims to calculate the penumbral width using multiple detectors and obtain the independent penumbral width according to irradiation size. MATERIALS AND METHODS: Using the X-ray output from a medical linear accelerator, off-axis ratios in water were measured using nine types of detectors. Penumbral width was calculated from each measured off-axis ratio by linear approximation and determining the intercept for analysis. The experimental irradiation fields were square areas (1×1 cm2 to 10×10 cm2). Penumbral widths were obtained from three types of detectors with different sensitive region widths of at least 1.2 mm. RESULTS: The values estimated from the nine detectors were 2.51-4.07 and 2.93-4.70 mm for 6 and 10 MV X-rays, respectively. The penumbral width and variation due to detector size increased with the irradiation field. The results estimated from the three selected detectors varied within ±0.5 mm compared with those from the nine detectors and were generally consistent. The reliability of the results was evaluated by comparing with the results from past studies and Monte Carlo simulations. CONCLUSION: Calculation of the penumbral width can be done regardless of size for various detectors. Thus, dose distributions can be compared for the linear accelerator at different facilities.

[Effect of Differences in Insert Materials of Cutout Block on Dose Distribution in Electron Radiotherapy: Comparison between Measurements and Monte Carlo Simulation].

INTRODUCTION: In electron beam radiotherapy, an irradiation field is created with a cutout block using a low melting point lead alloy. The block can be replaced with a lead plate as a shield. Dose distribution is expected to be affected by differences in the material and thickness of the shield. Thus, this study aimed to investigate the cause of differences in dose distribution by reproducing the electron beam irradiation condition via Monte Carlo simulation, comparing dose distribution when each shield is used and analyzing energy fluence distribution. MATERIALS AND METHODS: Radiation interaction in the treatment device manufactured by Varian was assessed using the general-purpose simulation code, and the dose distribution in the water was calculated. Electron energy fluence and incident angle of the electron fluence incident on the water surface were analyzed, and the effect of the difference in the shield was investigated in the irradiation field limited to 3 cm or less. RESULTS: Regarding dose distribution, the deviation in the buildup area became larger when the lead plate was made thinner. A difference of 1.6-6.8% was observed on an average when comparing the buildup region of depth dose distributions except for 1×1 cm2 field. In electron energy fluence, the lower the lead thickness, the higher the low energy component, which affected the buildup region. The effect was greater as the electron beam energy increased. CONCLUSION: It was possible to evaluate the difference in scattered radiation between the low melting point lead alloy and the lead plate by MC simulation. Based on the study findings, the effect of scattered electrons generated from the block was strong as a factor.

Effect of computed tomography value error on dose calculation in adaptive radiotherapy with Elekta X-ray volume imaging cone beam computed tomography.

PURPOSE: We evaluated the effect of changing the scan mode of the Elekta X-ray volume imaging cone beam computed tomography (CBCT) on the accuracy of dose calculation, which may be affected by computed tomography (CT) value errors in three dimensions. METHODS: We used the electron density phantom and measured the CT values in three dimensions. CT values were compared with planning computed tomography (pCT) values for various materials. The evaluated scan modes were for head and neck (S-scan), chest (M-scan), and pelvis (L-scan) with various collimators and filter systems. To evaluate the effects of the CT value error of the CBCT on dose error, Monte Carlo calculations of dosimetry were performed using pCT and CBCT images. RESULTS: The L-scan had a CT value error of approximately 800 HU at the isocenter compared with the pCT. Furthermore, inhomogeneity in the longitudinal CT value profile was observed in the bone material. The dose error for ±100 HU difference in CT values for the S-scan and M-scan was within ±2%. The center of the L-scan had a CT error of approximately 800 HU and a dose error of approximately 6%. The dose error of the L-scan occurred in the beam path in the case of both single field and two parallel opposed fields, and the maximum error occurred at the center of the phantom in the case of both the 4-field box and single-arc techniques. CONCLUSIONS: We demonstrated the three-dimensional CT value characteristics of the CBCT by evaluating the CT value error obtained under various imaging conditions. It was found that the L-scan is considerably affected by not having a unique bowtie filter, and the S-scan without the bowtie filter causes CT value errors in the longitudinal direction. Moreover, the CBCT dose errors for the 4-field box and single-arc irradiation techniques converge to the isocenter.

[Quantitative Evaluation of Coincidence between Quantified Light Field Width and X-ray Field Width as Mechanical Quality Assurance].

AIM: The aim of this work was to evaluate the coincidence between light and X-ray field width in air. BACKGROUND: Light fields are often used for confirmation of irradiation position to superficial tumors and final confirmation of the patient's irradiation position. To guarantee collation by the light field, the light and X-ray fields must coincide. Currently, the light field width is determined mainly by visual evaluation using manual methods, such as use of graph paper and rulers. The light field width is difficult to visually recognize a definite position at the edge of the light field. MATERIALS AND METHODS: We quantified the width of light fields emitted from a linear accelerator using a light probe detector and compared the results with those of X-ray fields. In-air measurements were conducted at the same position in the light field with the light probe detector and X-ray field using an ionization chamber installed in an emptied three-dimensional water phantom. RESULTS: The radiation field in air was approximately 2 mm larger than the light field, and we found some influence of transmission and scattered rays on the penumbra region. Before and after exchanging crosshair sheets, the fields also exhibited differences in uniformity. CONCLUSIONS: The proposed method quantifies the light field using a photodetector and can be used to compare the light field with the X-ray field, conforming a useful tool for evaluating the accuracy of treatment devices in an objective and systematic manner.

[Dose Distribution Combinations of Different Electron Beam Energy for Treatment Region Expansion in High-energy Electron Beam Radiation Therapy: A Feasibility Study].

INTRODUCTION: External electron beams have excellent distributions in treatment for superficial tumors while suppressing influence deeper normal tissue. However, the skin surface cannot be given a sufficient dose due to the build-up effect. In this study, we have investigated the combination of electron beams to expand the treatment region by keeping the dose gradient beyond dmax. MATERIALS AND METHODS: The percentage depth doses of different electron beams were superimposed on a spreadsheet to determine the combinations of electron beams so that the treatment range was maximized. Based on the obtained weight for electron beams, dose distributions were calculated using a treatment planning system and examined for potential clinical application. RESULTS: With the combination of 4 MeV and 9 MeV electron beams, the 90% treatment range in the depth direction increased by 8.0 mm, and with 4 MeV and 12 MeV beams, it increased by 4.0 mm, with the same maximum dose depth and halfdose depth of the absorbed dose. The dose calculations were performed using the treatment planning system yielded similar results with a matching degree of ±1.5%. CONCLUSIONS: Although the influences of low monitor unit values and daily output differences remain to be considered, the results suggest that the proposed approach can be clinically applied to expand treatment regions easily.

Influence of Acquisition Mode of Cone-beam Computed Tomography on Accuracy of Image Registration for Image-guided Radiotherapy.

Half scan can acquire images at the 200° rotation in image-guided radiation treatment using cone-beam CT and is useful to evaluate the influence of the half-scan-imaging start angle and imaging direction on image registration accuracy. The half-scan-imaging start angle is changed from 180° to 340° in the clockwise direction and from 180° to 20° in the counter clockwise direction to calculate the registration error. As a result, registration errors between -0.37 mm and 0.27 mm in the left and right directions occur because of the difference in the imaging start angle and approximately 0.3° in the gantry rotation direction because of the difference in the imaging direction. Because half scan does not have data for 360° rotation, depending on the subject structure, inconsistency of opposing data can lower reconstruction accuracy and cause a verification error. In addition, in image acquisition during rotation, the slower the shutter speed is, the more the actual gantry angle and angle information of the image are apart, which is considered the cause of rotation errors. Although these errors are very minute, it is thought that there is no influence on the treatment effect, but these errors are considered an evaluation item indispensable for ensuring the accuracy of high-precision radiation treatment. In addition, these errors need to be considered for ensuring the quality of high-precision radiation treatment.

Beam Characterization of 10-MV Photon Beam from Medical Linear Accelerator without Flattening Filter.

AIM: This work investigated the dosimetric properties of a 10-MV photon beam emitted from a medical linear accelerator (linac) with no flattening filter (FF). The aim of this study is to analyze the radiation fluence and energy emitted from the flattening filter free (FFF) linac using Monte Carlo (MC) simulations. MATERIALS AND METHODS: The FFF linac was created by removing the FF from a linac in clinical use. Measurements of the depth dose (DD) and the off-axis profile were performed using a three-dimensional water phantom with an ionization chamber. A MC simulation for a 10-MV photon beam from this FFF linac was performed using the BEAMnrc code. RESULTS: The off-axis profiles for the FFF linac exhibited a chevron-like distribution, and the dose outside the irradiation field was found to be lower for the FFF linac than for a linac with an FF (FF linac). The DD curves for the FFF linac included many contaminant electrons in the build-up region. CONCLUSION: Therefore, for clinical use, a metal filter is additionally required to reduce the effects of the electron contamination. The mean energy of the FFF linac was found to be lower than that of the FF linac owing to the absence of beam hardening caused by the FF.

Microdosimetric calculation of penumbra for biological dose in wobbled carbon-ion beams with Monte Carlo Method.

In carbon-ion radiotherapy, it is important to evaluate the biological dose because the relative biological effectiveness values vary greatly in a patient's body. The microdosimetric kinetic model (MKM) is a method of estimating the biological effect of radiation by use of microdosimetry. The lateral biological dose distributions were estimated with a modified MKM, in which we considered the overkilling effect in the high linear-energy-transfer region. In this study, we used the Monte Carlo calculation of the Geant4 code to simulate a horizontal port at the Heavy Ion Medical Accelerator in Chiba of the National Institute of Radiological Sciences. The lateral biological dose distributions calculated by Geant4 were almost flat as the lateral absorbed dose in the flattened area. However, in the penumbra region, the lateral biological dose distributions were sharper than the lateral absorbed dose distributions. Furthermore, the differences between the lateral absorbed dose and biological dose distributions were dependent on the depth for each multi-leaf collimator opening size. We expect that the lateral biological dose distribution presented here will enable high-precision calculations for a treatment-planning system.

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.

Evaluating the output stability of LINAC with a reference detector using 3D water phantom.

We report the discovery of abnormal fluctuations in the output obtained when measuring a water phantom and adjustments that reduce these outliers. Using a newly developed three-dimensional scanning water phantom system, we obtained the depth dose and off-axis dose ratio required for the beam data of a medical linear accelerator (LINAC). The field and reference detectors were set such that the measured values could be viewed in real time. We confirmed the scanning data using the field detector and the change in the output using the reference detector while measuring by using the water phantom. Prior to output adjustment of the LINAC, we observed output abnormalities as high as 18.4%. With optimization of accelerator conditions, the average of the output fluctuation width was reduced to less than +/-0.5%. Through real-time graphing of reference detector measurements during measurement of field detector, we were able to rapidly identify abnormal fluctuations. Although beam data collected during radiation treatment planning are corrected for output fluctuations, it is possible that sudden abnormal fluctuations actually occur in the output. Therefore, the equipment should be tested for output fluctuations at least once a year. Even after minimization of fluctuations, we recommend determining the potential dose administered to the human body taking into account the width of the output fluctuation.

[Dosimetric perturbation due to scattered rays released by a gold marker used for tumor tracking in external radiotherapy].

Image-guided radiation therapy using a gold marker-based tumor tracking technique provides precise patient setup and monitoring. However, the marker consists of high-Z material, and the resulting scattered rays tend to have adverse effects on the dose distribution of radiotherapy. The purpose of this study was to evaluate the dosimetric perturbation due to the use of a gold marker for radiotherapy in the lungs. The relative dose distributions were compared with film measurement, Monte Carlo simulation, and XiO calculation with the multi grid superposition algorithm using two types of virtual lung phantoms, which were composed of tough water phantoms, tough lung phantoms, cork boards, and a 2.0-mm-diameter gold ball. No dose increase and decrease in the vicinity of the gold ball was seen in the XiO calculations, although it was seen in the film measurements and the Monte Carlo simulation. The dose perturbation due to a gold marker cannot be evaluated using XiO calculation with the superposition algorithm when the tumor is near a gold marker (especially within 0.5 cm). To rule out the presence of such dose perturbations due to a gold marker, the distance between the gold marker and the tumor must therefore be greater than 0.5 cm.

Dose distribution near thin titanium plate for skull fixation irradiated by a 4-MV photon beam.

To investigate the effects of scattered radiation when a thin titanium plate (thickness, 0.05 cm) used for skull fixation in cerebral nerve surgery is irradiated by a 4-MV photon beam. We investigated the dose distribution of radiation inside a phantom that simulates a human head fitted with a thin titanium plate used for post-surgery skull fixation and compared the distribution data measured using detectors, obtained by Monte Carlo (MC) simulations, and calculated using a radiation treatment planning system (TPS). Simulations were shown to accurately represent measured values. The effects of scattered radiation produced by high-Z materials such as titanium are not sufficiently considered currently in TPS dose calculations. Our comparisons show that the dose distribution is affected by scattered radiation around a thin high-Z material. The depth dose is measured and calculated along the central beam axis inside a water phantom with thin titanium plates at various depths. The maximum relative differences between simulation and TPS results on the entrance and exit sides of the plate were 23.1% and - 12.7%, respectively. However, the depth doses do not change in regions deeper than the plate in water. Although titanium is a high-Z material, if the titanium plate used for skull fixation in cerebral nerve surgery is thin, there is a slight change in the dose distribution in regions away from the plate. In addition, we investigated the effects of variation of photon energies, sizes of radiation field and thickness of the plate. When the target to be irradiated is far from the thin titanium plate, the dose differs little from what it would be in the absence of a plate, though the dose escalation existed in front of the metal plate.

Evaluation of Linearity for the Radiophotoluminescence Glass Dosimeter Based on Monochromatic X-rays.

Although low energy X-rays have been utilized for mammography, their safety in medical use is a matter of concern. Characteristics of the radiophotoluminescence glass dosimeter, GD-403, consisting of a glass element and filters, were investigated with respect to monochromatic X-rays obtained from a synchrotron radiation for personal monitoring of low energy photons. We focused on low energy X-rays ranging from 8 to 20 keV to study the linearity of the GD-403 response between photon fluence and dose equivalent. The GD-403 was placed on a tough water phantom and irradiated using an 11-15 mm x 0.1-7 mm beam for modulation of the photon fluence. The tough water phantom could be moved through a distance of 110-150 mm with a stepping motor. For the dose equivalent at 1cm depth (H1), 3mm (H3) and 70 &mgr;m (H70), the GD-403 showed sufficient linearities against the photon fluences in the energy regions of 8 to 20 keV, 13 to 20 keV and 13 to 20 keV, respectively. However, H3 and H70 did not provide sufficient linearities in the energy region of 8 to 12 keV. Moreover, we compared the result in this experiment with the value calculated from the absorbed dose of air using the mass absorption coefficient for the X-ray energy ranging from 10 to 20 keV.