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Purpose To develop an analytical model for bremsstrahlung production in a thick x-ray target (i.e., the x-ray tube anode) that takes into account the intrinsic bremsstrahlung angular distribution. Methods X-ray spectrum models developed from theoretical principles have traditionally treated the angular distribution of the bremsstrahlung production as spherically uniform. This assumption stems from the rationale that electrons promptly attain a diffuse directional distribution in an x-ray target due to multiple scattering, thereby effectively masking the intrinsic bremsstrahlung angular distribution. In this work, a model that explicitly accounts for the angular distribution of the bremsstrahlung production is presented. The model combines Monte Carlo-calculated depth, energy, and angular distributions of electrons penetrating the x-ray target, and incorporates theoretical results for the differential bremsstrahlung cross section. The effects of using different simplified model assumptions for the electron penetration and the intrinsic bremsstrahlung angular distribution are analyzed for tungsten and molybdenum targets in the energy range 20-300 keV. Results Typical assumptions of previous models are shown to introduce errors in calculated spectra. Particularly, it is shown that predictions of fluence and air kerma free-in-air can be overestimated by 15-30% (2-3% in aluminum half-value layer thickness) for clinically relevant beam qualities. The present model is able to reproduce comprehensive Monte Carlo calculations of the bremsstrahlung production generally to within 1%. Conclusions The bremsstrahlung model developed in this work is an improvement over previous models in that the main features of the electron penetration and the resulting bremsstrahlung are considered in detail. The model can be used for more accurate predictions of the energy and angular distribution of x rays emitted from an x-ray tube.

PURPOSE The purpose of this study was to investigate the feasibility of using fused deposition modeling (FDM) three-dimensional (3D) printer to generate radiation compensators for high-resolution (~1 mm) intensity-modulated radiation therapy (IMRT) for small animal radiation treatment. We propose a novel method incorporating 3D-printed compensator molds filled with NaI powder. METHODS The inverse planning module of the computational environment for radiotherapy research (CERR) software was adapted to simulate the XRAD-225Cx irradiator, both geometry and kV beam quality (the latter using a phase space file provided for XRAD-225Cx). A nine-field IMRT treatment was created for a scaled-down version of the imaging and radiation oncology core (IROC) Head and Neck IMRT credentialing test, recreated on a 2.2-cm-diameter cylindrical phantom. Optimized fluence maps comprising nine fields and a total of 2564 beamlets were calculated at resolution of 1.25 × 1.25 mm2 . A hollow compensator mold was created (using in-house software and algorithm) for each field using 3D printing with polylactic acid (PLA) filaments. The molds were then packed with sodium iodide powder (NaI, measured density ρNaI = 2.062 g/cm3 ). The mounted compensator mold thickness was limited to 13.8 mm due to clearance issues with couch collision. At treatment delivery, each compensator was manually mounted to a customized block tray attached to the reference 40 × 40 mm2 collimator. Compensator reproducibility among three repeated 3D-printed molds was measured with Radiochromic EBT2 film. The two-dimensional (2D) dose distributions of the nine fields were compared to calculated 2D doses from CERR using gamma comparisons with distance-to-agreement criteria of 0.5-0.25 mm and dose difference criteria of 3-5%. RESULTS Good reproducibility of 3D-printed compensator manufacture was observed with mean error of ±0.024 Gy and relative dose error of ±4.2% within the modulated part of the beam. Within the limit of 13.8 mm compensator height, a maximum radiation blocking efficiency of 91.5% was achieved. Per field, about 45.5 g of NaI powder was used. Gamma analysis on each of the nine delivered IMRT fields using radiochromic films resulted in eight of nine treatment fields with >90% pass rate with 5%/0.5 mm tolerances. However, low gamma passing rate of 49-66% (3%/0.25 mm to 5%/0.5 mm) was noted in one field, attributed to fabrication errors resulting in over-filling the mold. The nine-field treatment plan was delivered in under 30 min with no mechanical or collisional issues. CONCLUSIONS We show the feasibility of high spatial resolution IMRT treatment on a small animal irradiator utilizing 3D-printed compensator shells packed with NaI powder. Using the PLA mold with NaI powder was attractive due to the ease of 3D printing a PLA mold at high geometric resolution and the well-balanced attenuation properties of NaI powders that prevented the mold from becoming too bulky. IMRT fields with 1.25-mm resolution are capable with significant fluence modulation with relative dose accuracy of ±4.2%.

Purpose Measurement of the modulation transfer function (MTF) is performed by evaluating the response of an imaging system to a predefined input. To obtain accurate results when using an edge phantom, the detector input signal must resemble an ideal step function. The MTF of megavoltage (MV) imagers used in radiotherapy has been measured with highly absorbing edge phantoms fabricated from thick metal blocks. This study investigates the influence of the edge phantom design on the accuracy of the resulting MTF. Methods The MTF of an electronic portal imaging device (EPID) was measured at 6 MV beam quality with four edge phantoms made of lead with 1.3, 3.3, 5.0, and 10.0 cm thickness. Monte Carlo simulations were carried out for these and a selection of tungsten phantoms to determine the photon fluence at the imaging plane and quantify the systematic error in the MTF introduced by the edge phantom design. Results The measured MTF depends on the design of the edge phantom. The detector input signal of a thin phantom is affected by secondary radiation from the phantom itself, causing an overestimation of the MTF. The amount of secondary radiation can be reduced by increasing the phantom thickness or introducing an air gap between the phantom and the detector. Both methods introduce geometric unsharpness, which can result in an underestimation of the true MTF. Edge phantoms made from 4.0 cm thick tungsten or 5.0 cm thick lead induce comparatively small systematic errors of below 3% or 5%, respectively. Conclusions When MTF measurements are conducted at MV energies, even a highly absorbing edge phantom will introduce a systematic error of several percent. Direct comparison of MTFs obtained with different edge phantoms should therefore be treated with caution.

Purpose To provide a method for optimizing the multileaf collimator angle trajectory in volumetric modulated arc therapy (VMAT) in order to make VMAT delivery and planning more efficient. Methods Static fluence maps are optimized at a 10-degree spacing around the patient. Sliding window delivery time of each of these fields is computed for a large set of possible collimator orientations. An optimal trajectory, which selects a collimator angle for each field and assures that the collimator angles do not differ excessively between adjacent fields, is computed by solving a network flow model of a shortest path problem. Results For four clinical cases (two brains, an anal, and a spine), we demonstrate time reductions from 6% to 32% (average: 24%) for the optimal static angle vs the worst static angle. Further reductions from 3% to 17% (average 9%) are achievable when dynamic collimator trajectories are allowed. Conclusions Dynamic collimator trajectories, which can be computed with an efficient linear programming formulation, can improve the efficiency of VMAT delivery.

PURPOSE We have been investigating two-dimensional (2D) antiscatter grids (2D ASGs) to reduce scatter fluence and improve image quality in cone beam computed tomography (CBCT). In this work, two different aspects of 2D ASGs, their scatter rejection and correction capability, were investigated in CBCT experiments. To correct residual scatter transmitted through the 2D ASG, it was used as a scatter measurement device with a novel method: grid-based scatter sampling. METHODS Three focused 2D ASG prototypes with grid ratios of 8, 12, and 16 were developed for linac-mounted offset detector CBCT geometry. In the first phase, 2D ASGs were used as a scatter rejection device, and the effect of grid ratio on CT number accuracy and contrast-to-noise ratio (CNR) evaluated in CBCT images. In the second phase, a grid-based scatter sampling method which exploits the signal modulation characteristics of the 2D ASG's septal shadows to measure and correct residual scatter transmitted through the grid was implemented. To evaluate CT number accuracy, the percent change in CT numbers was measured by changing the phantom from head to pelvis size and configuration. RESULTS When 2D ASG was used as a scatter rejection device, CT number accuracy increased and the CT number variation due to change in phantom dimensions was reduced from 23% to 2-6%. A grid ratio of 16 yielded the lowest CT number variation. All three 2D ASGs yielded improvement in CNR, up to a factor of two in pelvis-sized phantoms. When 2D ASG prototypes were used for both scatter rejection and correction, CT number variations were reduced further, to 1.3-2.6%. In comparisons with a clinical CBCT system and a high-performance radiographic ASG, 2D ASG provided higher CT number accuracy under the same imaging conditions. CONCLUSIONS When 2D ASG is used solely as a scatter rejection device, substantial improvement in CT number accuracy can be achieved by increasing the grid ratio. Two-dimensional ASGs also provided significant CNR improvement even at lower grid ratios. Two-dimensional ASGs used in conjunction with the grid-based scatter sampling method provided further improvement in CT number accuracy, irrespective of the grid ratio, while preserving 2D ASGs' capacity to improve CNR. The combined effect of scatter rejection and residual scatter correction by 2D ASG may accelerate implementation of new techniques in CBCT that require high quantitative accuracy, such as radiotherapy dose calculation and dual energy CBCT.

PURPOSE: To investigate the dosimetric robustness of dynamically collimated proton therapy (DCPT) treatment plans delivered using a dynamic collimation system (DCS) with respect to random uncertainties in beam spot and collimator position as well as systematic offsets in the DCS mounting alignment. This work also demonstrates a technique that can increase plan robustness while preserving target conformity. METHODS: Variability in beam spot and collimator positioning can result in changes to a beamlet’s dose distribution and incident fluence. The robustness of the DCPT treatment plans was evaluated for three intracranial treatment sites by modeling treatment variability as normally distributed random variables with standard deviations reflecting a clinical system. The simulated treatment plans were then recalculated and compared against their nominal, idealized dose distribution among several trials. It was hypothesized that a plan’s robustness to these delivery variables could be reduced by restricting a trimmer’s placement toward a beamlet’s central axis during collimation. RESULTS: By introducing a minimum trimmer offset of 1.5 mm, the variation of the planning target volume (PTV) D(95%) coverage was reduced to within 2% of the prescribed dose. The treatment plans with trimmers that were placed within 0.5 mm of a collimated beamlet’s central axis resulted in the greatest healthy tissue sparing but deviations as high as 11.4% to the PTV D(95%) were observed. The nominal conformity of these treatment plans utilizing the 1.5 mm trimmer offset was also well maintained. For each treatment plan studied, the 90% conformity index remained within 6.25% of the conformity index achieved without a minimum trimmer offset, and the D(50%) of surrounding healthy tissue increased by no more than 3.1 Gy relative to a plan without a trimmer offset. CONCLUSIONS: While DCPT can offer a significant reduction in healthy tissue irradiation, the results from this work indicate that special care must be taken to ensure proper PTV coverage amid uncertainties associated with this new treatment modality. A simple approach utilizing a minimum trimmer offset was able to preserve the majority of the target conformity and healthy tissue sparing the DCS technology affords while minimizing the uncertainties in this treatment approach.

Purpose The flattening filter (FF) has traditionally been used to flatten beams or create uniform fields in conformal and intensity-modulated radiation therapy (IMRT) but reduces the dose rate. Many studies have confirmed improvement in delivery efficiency by removing the FF, also known as flattening filter free (FFF), especially for small field stereotactic body radiation therapy (SBRT); but it is unclear if large treatment fields still favor the FFF beam. We propose a novel, unified approach to quantify delivery efficiency of the FFF and flattened beams. Methods We modeled the FF effect by inverse conical filters and systematically studied delivery efficiency (beam-on time, BOT) by varying the filter thickness, including the FF and FFF mode. We formulated the BOT of different beams for any arbitrary fluence map in linear programming to solve the optimal inverse conical filter that minimizes the BOT. One-dimensional optimal filters of minimum BOT were also derived in closed form for conical fluence to gain insight for arbitrary clinical fluence maps. We evaluated the BOT of the FFF beam and flattened beam for conformal treatment fields of various dimensions ranging from 5 cm × 5 cm to 25 cm × 25 cm. We also analyzed the BOT for 698 clinical IMRT prostate fluence maps of field size 10 cm × 10 cm, 17 head-and-neck fluence maps of field size 15 cm × 15 cm, and additional realistic test data from 90° rotation and up to 40 cm × 40 cm enlargement of these clinical fluence maps, which were all initially generated with flattened beams. Results The FFF beam minimized the BOT for A field size less than 20 cm in single leaf pair cases and for conformal fields of dimension less than 20 cm × 20 cm. The FFF beam also minimized the BOT for all tested prostate and head-and-neck cases. The median BOT ratios of the FFF beam to the flattened beam were 0.56 and 0.61 for prostate and head-and-neck cases, respectively. The FFF beam minimized the BOT for field size up to 30 cm × 30 cm and had similar BOTs to those of the flattened beam for field size greater than 30 cm × 30 cm in those clinically realistic test data. Conclusion The filter modeling and BOT calculation enable us to quantify delivery efficiency of the FFF beam and flattened beam in a unified approach. The FFF beam minimized the BOT both theoretically and in simulations for all clinically relevant field sizes and fluence maps in IMRT. The results for conformal fields imply that the FFF beam requires less BOT than the flattened beam for volumetric modulated arc therapy (VMAT) treatments. The delivery efficiency consideration favors the FFF beam in intensity-modulated treatments and may eventually lead to removal of the FF in all future linear accelerator head designs.

Purpose Neutrons are an unavoidable by-product of high-energy radiation therapy treatments that deliver unwanted nontarget dose to patients. Use of flattening-filter-free (FFF) photon beams has been shown to significantly reduce photoneutron production per monitor unit (MU) of dose delivered. The purpose of this investigation was to characterize the photoneutron production of the 10 MV and 10 MV FFF beams of the Varian TrueBeamTM linear accelerator. Methods Neutron fluence spectra were measured using a Nested Neutron SpectrometerTM (NNS, Detec Inc., Gatineau, Canada). The ratios of neutron fluence and ambient dose equivalent for the 10 MV FFF beam relative to the 10 MV beam, dubbed FF-ratios (FFF/FF), were used to characterize the difference between the two beams. FF-ratios were compared under the following three conditions (a) per MU, at various locations in the treatment room, (b) per MU, with the linac jaws opened and closed, and (c) per electron striking the bremsstrahlung target, as opposed to per MU, at one location with the jaws closed. Results On average, the neutron fluence for the 10 MV FFF beam was 37% lower per MU than the 10 MV beam (FF-ratio = 0.63). The FF-ratio in neutron fluence and ambient dose equivalent did not vary by much between different locations within the treatment room. However, the FF-ratio in neutron ambient dose equivalent was reduced significantly when the linac jaws were opened compared to closed, which implies that the jaws contribute more to the photoneutron spectrum of the 10 MV FFF beam than to the 10 MV beam. Finally, it was found that the 10 MV FFF beam produces more photoneutrons per electron striking the bremsstrahlung target than the 10 MV beam (FF-ratio = 2.56). Conclusions The photoneutron fluence per MU produced by the 10 MV FFF beam is 37% lower than the 10 MV beam of a Varian TrueBeam linac. Accordingly, a reduction in neutron dose received by patients is achieved through use of the unflattened beam, provided that treatment plans for each beam require approximately the same number of MU. It was found to be instructive to compare the photoneutron yield per source electron between the two beams as it helped provide an understanding of the physics underlying photoneutron production in both beams.

PURPOSE Plastic phantoms are commonly used in daily routine for dosimetric tasks in radiation therapy. Although water is the reference medium according to the dosimetric protocols, measurements with nonwater phantoms are easier to be performed. To succeed absorbed dose determination, certain scaling factors have to be applied to the acquired measurements. Taking into account the increased availability of three-dimensional (3D) printing, we attempted to obtain scaling factors for polylactic acid (PLA), a commonly used thermoplastic material for 3D printing. METHODS Measurements were performed with a custom-made phantom from PLA material, which was designed and constructed using 3D printing technology. Depth and fluence scaling factors were obtained within the range of 6 to 20 MeV. Moreover, Monte Carlo simulations were performed to verify the measured results. RESULTS Experimental and Monte Carlo (MC) values showed a good agreement, especially in lower energies. Mean value of depth scaling factor (cpl ) over the whole range of energies was 0.946, while mean fluence scaling factor (hpl ) was found to be 1.050. For energies below 10 MeV, the corresponding mean values for cpl and hpl were 0.946 and 1.054, respectively. CONCLUSIONS PLA phantoms could be constructed and used for electron beam nonreference measurements, reproducing even more complex geometries, from simple quality assurance devices to geometrically complicated anthropomorphic phantoms.

Purpose Photodynamic therapy (PDT) is used after surgical resection to treat the microscopic disease for malignant pleural mesothelioma and to increase survival rates. As accurate light delivery is imperative to PDT efficacy, the deformation of the pleural volume during the surgery is studied on its impact on the delivered light fluence. In this study, a three-dimensional finite element-based (3D FEM) deformable image registration is proposed to directly match the volume of lung to the volume of pleural cavity obtained during PDT to have accurate representation of the light fluence accumulated in the lung, heart and liver (organs-at-risk) during treatment. Methods A wand, comprised of a modified endotrachial tube filled with Intralipid and an optical fiber inside the tube, is used to deliver the treatment light. The position of the treatment is tracked using an optical tracking system with an attachment comprised of nine reflective passive markers that are seen by an infrared camera-based navigation system. This information is used to obtain the surface contours of the plural cavity and the cumulative light fluence on every point of the cavity surface that is being treated. The lung, heart, and liver geometry are also reconstructed from a series of computed tomography (CT) scans of the organs acquired in the same patient before and after the surgery. The contours obtained with the optical tracking system and CTs are imported into COMSOL Multiphysics, where the 3D FEM-based deformable image registration is obtained. The delivered fluence values are assigned to the respective positions (x, y, and z) on the optical tracking contour. The optical tracking contour is considered as the reference, and the CT contours are used as the target, which will be deformed. The data from three patients formed the basis for this study. Results The physical correspondence between the CT and optical tracking geometries, taken at different times, from different imaging devices was established using the 3D FEM-based image deformable registration. The volume of lung was matched to the volume of pleural cavity and the distribution of light fluence on the surface of the heart, liver and deformed lung volumes was obtained. Conclusion The method used is appropriate for analyzing problems over complicated domains, such as when the domain changes (as in a solid-state reaction with a moving boundary), when the desired precision varies over the entire domain, or when the solution lacks smoothness. Implementing this method in real-time for clinical applications and in situ monitoring of the under- or over- exposed regions to light during PDT can significantly improve the treatment for mesothelioma.

To introduce the heterogeneous multiscale (HetMS) model for Monte Carlo simulations of gold nanoparticle dose-enhanced radiation therapy (GNPT), a model characterized by its varying levels of detail on different length scales within a single phantom; to apply the HetMS model in two different scenarios relevant for GNPT and to compare computed results with others published. The HetMS model is implemented in EGSnrc; the code is tested via comparisons with published data from independent gold nanoparticle (GNP) simulations. Two distinct scenarios for the HetMS model are considered: (1) monoenergetic photon beams incident on a large cylinder; (2) isotropic point source at the center of a large sphere with GNPs diffusing from the center. Dose enhancement factors (DEFs) are compared for different source energies, depths, gold concentrations, GNP sizes, and modeling assumptions. Simulation efficiencies are investigated. The HetMS MC simulations account for the competing effects of photon fluence perturbation coupled with enhanced local energy deposition. DEFs are most sensitive to these effects for lower source energies, varying with distance from the source; DEFs below unity can occur at energies relevant for brachytherapy. Compared to discrete modeling of GNPs throughout the gold-containing volume, efficiencies are enhanced by up to a factor of 122 with the HetMS approach. For the spherical phantom, DEFs vary with time for diffusion, radionuclide, and radius. By combining geometric models of varying complexity on different length scales within a single simulation, the HetMS model can effectively account for both macroscopic and microscopic effects. Efficiency gains with the HetMS approach enable diverse calculations which would otherwise be prohibitively long. The HetMS model may be extended to diverse scenarios relevant for GNPT, providing further avenues for research and development., Comment: 23 pages, 6 figures, 2 tables

Purpose: To find an efficient method to configure the proton fluence for a commercial proton pencil beam scanning (PBS) treatment planning system (TPS). Methods: An in-water dose kernel was developed to mimic the dose kernel of the pencil beam convolution superposition algorithm, which is part of the commercial proton beam therapy planning software, eclipse™ (Varian Medical Systems, Palo Alto, CA). The field size factor (FSF) was calculated based on the spot profile reconstructed by the in-house dose kernel. The workflow of using FSFs to find the desirable proton fluence is presented. The in-house derived spot profile and FSF were validated by a direct comparison with those calculated by the eclipse TPS. The validation included 420 comparisons of the FSFs from 14 proton energies, various field sizes from 2 to 20 cm and various depths from 20% to 80% of proton range. Results: The relative in-water lateral profiles between the in-house calculation and the eclipse TPS agree very well even at the level of 10−4. The FSFs between the in-house calculation and the eclipse TPS also agree well. The maximum deviation is within 0.5%, and the standard deviation is less than 0.1%. Conclusions: The authors’ method significantly reduced the time to find the desirable proton fluences of the clinical energies. The method is extensively validated and can be applied to any proton centers using PBS and the eclipse TPS.

Purpose: To quantify and explain the backscatter dose effects for clinically relevant high atomic number materials being irradiated in the presence of a 1.5 T transverse magnetic field. Methods: Interface effects were investigated using Monte Carlo simulation techniques. We used gpumcd (v5.1) and geant4 (v10.1) for this purpose. gpumcd is a commercial software written for the Elekta AB, MRI linac. Dose was scored using gpumcd in cubic voxels of side 1 and 0.5 mm, in two different virtual phantoms of dimensions 20 × 20 × 20 cm and 5 × 5 × 13.3 cm, respectively. A photon beam was generated from a point 143.5 cm away from the isocenter with energy distribution sampled from a histogram representing the true Elekta, MRI linac photon spectrum. A slab of variable thickness and position containing either bone, aluminum, titanium, stainless steel, or one of the two different dental filling materials was inserted as an inhomogeneity in the 20 × 20 × 20 cm phantom. The 5 × 5 × 13.3 cm phantom was used as a clinical test case in order to explain the dose perturbation effects for a head and neck cancer patient. The back scatter dose factor (BSDF) was defined as the ratio of the doses at a given depth with and without the presence of the inhomogeneity. Backscattered electron fluence was calculated at the inhomogeneity interface using geant4. A 1.5 T magnetic field was applied perpendicular to the direction of the beam in both phantoms, identical to the geometry in the Elekta MRI linac. Results: With the application of a 1.5 T magnetic field, all the BSDF’s were reduced by 12%–47%, compared to the no magnetic field case. The corresponding backscattered electron fluence at the interface was also reduced by 45%–64%. The reduction in the BSDF at the interface, due to the application of the magnetic field, is manifested in a different manner for each material. In the case of bone, the dose drops at the interface contrary to the expected increase when no magnetic field is applied. In the case of aluminum, the dose at the interface is the same with and without the presence of the aluminum. For all of the other materials the dose increases at the interface. Conclusions: The reduction in dose at the interface, in the presence of the magnetic field, is directly related to the reduction in backscattered electron fluence. This reduction occurs due to two different reasons. First, the electron spectrum hitting the interface is changed when the magnetic field is turned on, which results in changes in the electron scattering probability. Second, some electrons that have curved trajectories due to the presence of the magnetic field are absorbed by the higher density side of the interface and no longer contribute to the backscattered electron fluence.

Purpose: A semiempirical model for x-ray production in tungsten thick-targets was evaluated using a new characterization of electron fluence. Methods: Electron fluence is modeled taking into account both the energy and angular distributions, each of them adjusted to Monte Carlo simulated data. Distances were scaled by the CSDA range to reduce the energy dependence. Bremsstrahlung production was found by integrating the cross section with the fluence in a 1D penetration model. Characteristic radiation was added using a semiempirical law whose validity was checked. The results were compared the experimental results of Bhat et al., with the SpekCalc numerical tool, and with mcnpx simulation results from the work of Hernandez and Boone. Results: The model described shows better agreement with the experimental results than the SpekCalc predictions in the sense of area between the spectra. A general improvement of the predictions of half-value layers is also found. The results are also in good agreement with the simulation results in the 50–640 keV energy range. Conclusions: A complete model for x-ray production in thick bremsstrahlung targets has been developed, improving the results of previous works and extending the energy range covered to the 50–640 keV interval.

Purpose: The highest photon fluence rate that a computed tomography (CT) detector must be able to measure is an important parameter. The authors calculate the maximum transmitted fluence rate in a commercial CT scanner as a function of patient size for standard head, chest, and abdomen protocols. Methods: The authors scanned an anthropomorphic phantom (Kyoto Kagaku PBU-60) with the reference CT protocols provided by AAPM on a GE LightSpeed VCT scanner and noted the tube current applied with the tube current modulation (TCM) system. By rescaling this tube current using published measurements on the tube current modulation of a GE scanner [N. Keat, “CT scanner automatic exposure control systems,” MHRA Evaluation Report 05016, ImPACT, London, UK, 2005], the authors could estimate the tube current that these protocols would have resulted in for other patient sizes. An ECG gated chest protocol was also simulated. Using measured dose rate profiles along the bowtie filters, the authors simulated imaging of anonymized patient images with a range of sizes on a GE VCT scanner and calculated the maximum transmitted fluence rate. In addition, the 99th and the 95th percentiles of the transmitted fluence rate distribution behind the patient are calculated and the effect of omitting projection lines passing just below the skin line is investigated. Results: The highest transmitted fluence rates on the detector for the AAPM reference protocols with centered patients are found for head images and for intermediate-sized chest images, both with a maximum of 3.4 ⋅ 108 mm−2 s−1, at 949 mm distance from the source. Miscentering the head by 50 mm downward increases the maximum transmitted fluence rate to 5.7 ⋅ 108 mm−2 s−1. The ECG gated chest protocol gives fluence rates up to 2.3 ⋅ 108 − 3.6 ⋅ 108 mm−2 s−1 depending on miscentering. Conclusions: The fluence rate on a CT detector reaches 3 ⋅ 108 − 6 ⋅ 108 mm−2 s−1 in standard imaging protocols, with the highest rates occurring for ECG gated chest and miscentered head scans. These results will be useful to developers of CT detectors, in particular photon counting detectors.

Purpose: Multileaf collimator (MLC) tracking can be used for motion management. However, on account of mechanical constraints, it is a crucial challenge for conventional MLCs (3–4 cm/s in leaf speed) to track fast targets, especially moving in 2D in the beam's eye view (BEV). Our group has recently developed a “high-speed” MLC (HS-MLC) prototype with a maximum leaf speed of 40 cm/s, which makes it possible to track the vast majority of moving targets without violation of mechanical constraints. The major innovation of the HS-MLC design is that it employs linear motors instead of rotary motors to drive leaves. This paper mainly aims to evaluate the performance of the HS-MLC in real-time intensity-modulated radiation therapy delivery to targets moving in 2D in the BEV. Methods: A 2D real-time tracking algorithm was proposed first based on a previous superimposing leaf sequencing method. Then, simulations were performed to evaluate the delivery performance including fluence accuracy, efficiency, delivery time, and number of monitor units under various settings of limiting coefficient and dose rate for four clinical fluence maps and two target speeds. The comparisons between the HS-MLC with a “medium-speed” MLC (MS-MLC, 10 cm/s) and a “low-speed” MLC (LS-MLC, 5 cm/s) were also made. For validation, experiments were carried out on the HS-MLC prototype in the lab environment. A camera-based measurement system was set up to detect actual leaf trajectories. Results: Simulation results indicate that a limiting coefficient of 0.5 and a dose rate of 400 MU/min are “optimal” in the sense of getting best compromise between delivery time and number of monitor units. Under the optimal parameters, the HS-MLC achieved 100% in efficiency, 18.1 s in delivery time, and 121.2 MU in number of monitor units on average for the “fast” target speed, compared to 94%, 20.6 s, and 129.9 MU with the MS-MLC, and to 53%, 40.2 s, and 141.1 MU with the LS-MLC. The benefits of increased leaf speed were demonstrated. The experimental results agreed with the simulation ones, which further confirmed the efficacy of the HS-MLC. Conclusions: The HS-MLC is superior to conventional MLCs when used for tracking, benefiting from its high leaf speed. These results indicate that the novel HS-MLC is feasible for high-accuracy and high-efficiency motion management. It also offers guidance for future MLC design.

Purpose The dose conversion factor plays an important role in the dosimetry by enabling the absorbed dose in the sensitive volume of a detector to be converted into the absorbed dose in the surrounding medium (in most cases water). The purpose of this paper is to demonstrate that a specific fluence-based approach for the decomposition of the dose conversion factor is in particular useful for the interpretation of the influences of detector properties on measurements under nonreference conditions. Methods Data for the dose conversion factor and secondary fluence spectra were obtained by the Monte Carlo method. The calculation of the secondary charged particle fluence (electrons and positrons) in the sensitive detector volume was imbedded into the code for the calculation of absorbed dose in the detector. The decomposition method into subfactors is based on the use of these fluence data applied to a stepwise transition from the dose at the point of measurement next to a pure water detector and finally to the fully simulated detector geometry. Each subfactor is obtained as a ratio, at which the stopping power only is different in the numerator and the denominator or at which the fluence only is different in the numerator and the denominator. This method was applied at photon dose profiles obtained in water at different radiation qualities and with various detectors of cylindrical type. Results The resulting subfactors can be well identified as a stopping power ratio and as perturbation factors each reflecting particular detector properties. Two of them (f1 and f4 ) are equivalent with perturbation factors which have already been introduced by other authors previously. These are the volume perturbation factor and the extracameral perturbation factor. Subfactor f2 denoted as medium perturbation factor was found to resemble the density perturbation factor. Results obtained for the volume perturbation factor applied to dose profiles measured with cylindrical detectors confirm that the volume effect can be well described by a convolution of the true profile in water with a Gaussian kernel. It was found that the sigma parameter depends on the cylinder radius only and amounts almost exactly to half of its value. The medium perturbation factor strongly depends on the density of the detector medium. For an air-filled detector, the influence of the air again can be described by a Gauss convolution, however, with a less good agreement. For detectors with a density of the cavity medium larger than that of water, for instance, for a diamond detector, it was found that there is a tendency of compensation between the volume averaging effect and the medium effect. Conclusion The fluence-based decomposition of the dose conversion factor leads to a fluence-based formulation of perturbation factors, referred to as volume, medium, and extracameral perturbation factor. These factors offer useful explanations for the behavior of detectors in nonreference conditions. An example was given for cylindrical detectors at dose profile measurements.

Purpose: In the authors’ proton therapy system, the patient-specific aperture can be attached to the nozzle of spot scanning beams to shape an irradiation field and reduce lateral fall-off. The authors herein verified this system for clinical application. Methods: The authors prepared four types of patient-specific aperture systems equipped with an energy absorber to irradiate shallow regions less than 4 g/cm2. The aperture was made of 3-cm-thick brass and the maximum water equivalent penetration to be used with this system was estimated to be 15 g/cm2. The authors measured in-air lateral profiles at the isocenter plane and integral depth doses with the energy absorber. All input data were obtained by the Monte Carlo calculation, and its parameters were tuned to reproduce measurements. The fluence of single spots in water was modeled as a triple Gaussian function and the dose distribution was calculated using a fluence dose model. The authors compared in-air and in-water lateral profiles and depth doses between calculations and measurements for various apertures of square, half, and U-shaped fields. The absolute doses and dose distributions with the aperture were then validated by patient-specific quality assurance. Measured data were obtained by various chambers and a 2D ion chamber detector array. Results: The patient-specific aperture reduced the penumbra from 30% to 70%, for example, from 34.0 to 23.6 mm and 18.8 to 5.6 mm. The calculated field width for square-shaped apertures agreed with measurements within 1 mm. Regarding patient-specific aperture plans, calculated and measured doses agreed within −0.06% ± 0.63% (mean ± SD) and 97.1% points passed the 2%-dose/2 mm-distance criteria of the γ-index on average. Conclusions: The patient-specific aperture system improved dose distributions, particularly in shallow-region plans.

Purpose: This study describes the implementation of a directional source biasing (DSB) scheme for efficiently simulating Cobalt-60 treatment heads using the BEAMnrc Monte Carlo code. Previous simulation of Co-60 beams with BEAMnrc was impractical because of the time required to track photons not directed into the treatment field and to simulate secondary charged particles. Methods: In DSB, efficiency is increased by splitting each photon emitted by the Co-60 source a user-defined number of times. Only those split primary photons directed into a user-defined splitting field (encompassing the treatment field) are sampled, yielding many low-weight photons directed into the field. Efficiency can be further increased by taking advantage of radial symmetry at the top of the treatment head to reduce the number of split primary photons tracked in this portion. There is also an option to generate contaminant electrons in DSB. Results: The DSB scheme in BEAMnrc increases the photon fluence calculation efficiency in a 10 × 10 cm2 Co-60 beam by a factor of 1800 with a concurrent increase in contaminant electron fluence calculation efficiency by a factor of 1200. Implementation of DSB in beampp, a C++ code for accelerator simulations based on EGSnrc and the C++ class library, egspp, increases photon fluence efficiency by a factor of 2800 and contaminant electron fluence efficiency by a factor of 1600. Optimum splitting numbers are in the range of 20 000–40 000. For dose calculations in a water phantom (0.5 × 0.5 × 0.5 cm3 voxels) this translates into a factor of ∼400 increase in dose calculation efficiency (all doses > 0.5 × D max). An example calculation of the ratio of dose to water to dose to chamber (the basis of the beam quality correction factor) to within 0.2% in a realistic chamber using a full simulation of a Co-60 treatment head as a source indicates the practicality of Co-60 simulations with DSB. Conclusions: The efficiency improvement resulting from DSB makes Monte Carlo commissioning of Co-60 beams and calculation of beam quality correction factors feasible.

Purpose: To investigate why dose-rate constants for 125I and 103Pd seeds computed using the spectroscopic technique, Λspec, differ from those computed with standard Monte Carlo (MC) techniques. A potential cause of these discrepancies is the spectroscopic technique’s use of approximations of the true fluence distribution leaving the source, φ full. In particular, the fluence distribution used in the spectroscopic technique, φ spec, approximates the spatial, angular, and energy distributions of φ full. This work quantified the extent to which each of these approximations affects the accuracy of Λspec. Additionally, this study investigated how the simplified water-only model used in the spectroscopic technique impacts the accuracy of Λspec. Methods: Dose-rate constants as described in the AAPM TG-43U1 report, Λfull, were computed with MC simulations using the full source geometry for each of 14 different 125I and 6 different 103Pd source models. In addition, the spectrum emitted along the perpendicular bisector of each source was simulated in vacuum using the full source model and used to compute Λspec. Λspec was compared to Λfull to verify the discrepancy reported by Rodriguez and Rogers. Using MC simulations, a phase space of the fluence leaving the encapsulation of each full source model was created. The spatial and angular distributions of φ full were extracted from the phase spaces and were qualitatively compared to those used by φ spec. Additionally, each phase space was modified to reflect one of the approximated distributions (spatial, angular, or energy) used by φ spec. The dose-rate constant resulting from using approximated distribution i, Λapprox,i , was computed using the modified phase space and compared to Λfull. For each source, this process was repeated for each approximation in order to determine which approximations used in the spectroscopic technique affect the accuracy of Λspec. Results: For all sources studied, the angular and spatial distributions of φ full were more complex than the distributions used in φ spec. Differences between Λspec and Λfull ranged from −0.6% to +6.4%, confirming the discrepancies found by Rodriguez and Rogers. The largest contribution to the discrepancy was the assumption of isotropic emission in φ spec, which caused differences in Λ of up to +5.3% relative to Λfull. Use of the approximated spatial and energy distributions caused smaller average discrepancies in Λ of −0.4% and +0.1%, respectively. The water-only model introduced an average discrepancy in Λ of −0.4%. Conclusions: The approximations used in φ spec caused discrepancies between Λapprox,i and Λfull of up to 7.8%. With the exception of the energy distribution, the approximations used in φ spec contributed to this discrepancy for all source models studied. To improve the accuracy of Λspec, the spatial and angular distributions of φ full could be measured, with the measurements replacing the approximated distributions. The methodology used in this work could be used to determine the resolution that such measurements would require by computing the dose-rate constants from phase spaces modified to reflect φ full binned at different spatial and angular resolutions.

Purpose: Fluence field modulated CT (FFMCT) and volume of interest (VOI) CT imaging applications require adjustment of the profile of the x-ray fluence incident on a patient as a function of view angle. Since current FFMCT prototypes can theoretically take on an infinite number of configurations, measuring a calibration data set for all possible positions would not be feasible. The present work details a methodology for calculating an atlas of configurations that will span all likely body regions, patient sizes, patient positioning, and imaging modes. The hypothesis is that there exists a finite number of unique modulator configurations that effectively span the infinite number of possible fluence profiles with minimal loss in performance. Methods: CT images of a head, shoulder, thorax, abdominal, wrist, and leg anatomical slices were dilated and contracted to model small, medium, and large sized patients. Additionally, the images were positioned from iso-center by three different amounts. The modulator configurations required to compensate for each image were computed assuming a FFMCT prototype, digital beam attenuator, (DBA), was set to equalize the detector exposure. Each atlas configuration should be different from the other atlas configurations. The degree of difference was quantified using the sum of the absolute differences in filter thickness between configurations. Using this metric, a set of unique wedge configurations for which no two configurations have a metric value smaller than some threshold can be constructed. Differences in the total number of incident photons between the unconstrained filters and the atlas were studied as a function of the number of atlas positions for each anatomical site and size/off-centering combination. Results: By varying the threshold used in creating the atlas, it was found that roughly 322 atlas positions provided an incident number of photons within 20% of using 19 440 unique filters (the number of atlas entries ranged from 7213 to 1). Additionally, for VOI applications implemented with a single VOI region, the number of required filter configurations was expressed in a simple closed form solution. Conclusions: The methodology proposed in this work will enable DBA-FFMCT and DBA-VOI imaging in the clinic without the need for patient specific air-scans to be performed. In addition, the methodology proposed here is directly applicable to other modulator designs such as piecewise linear, TomoTherapy multi leaf collimators, 2D fluid arrays, and inverse geometry CT.

Purpose The purpose of this study was to quantify the relative neutron damage induced in CIEDs from clinical 18 MV photon beams for varying field sizes, depths, and off axis distances. Methods and Materials Damage was assessed using silicon damage response functions and ICRP neutron dose conversion factors in MCNPX. Particular attention was devoted to the modelling of the Varian 2100C/D linear accelerator to ensure accurate contamination neutron spectra. Neutron dose, fluence and relative damage to CIEDs was calculated. Results CIED damage from neutrons is related to the neutron dose rather than the neutron fluence. As field size increases, the region of high damage probability extends to a greater distance beyond the edge of the field than with smaller fields. At a distance greater than 50 cm or from the central axis or a depth deeper than 10 cm, the probability of damage is less than 10% of the central axis damage probability for all field sizes. Conclusions Clinically, increasing the depth or the distance from the central axis to the CIED will reduce the probability of damage from neutrons. Care must be taken when treating large fields as the overall probability of damage increase as does the distance the higher probability of damage extends beyond the field edge.

Kilovoltage (kV) daily image‐guidedradiotherapy(IGRT) procedures accumulate radiationdose within the patient that is currently not routinely incorporated in the treatment plan. As part of the process of developing a patient‐specific kV dose computation tool, the kV x‐ray source must be characterized. We propose a simple, clinically feasible experimental characterization method using in‐air dose measurements along the transverse axis. We determine half‐value layer (HVL) along the transverse axis, from which we derive the HVL‐specific mass‐absorption coefficient, which is used to determine beam fluence. These values are interpolated over the entire field. The spectrum at each interpolation point in the field is found from HVL and accelerating potential (kVp) using third‐party software Spektr. We use this method to characterize the spatially varying fluence and spectra of a Varian® On‐Board Imaging®source for energies 80, 100 and 125 kVp. This characterization is used to compute dose within a heterogeneous phantom, using our previously validated in‐house dose computation software, which we compare with relative dose measurements. We show that for a 10×10 cm2field size using no added filtration, the agreement for all three energies is within 2% for the central depth‐dose profile and within 2.6% for the transverse profiles. This clinically feasible experimental characterization method for kV imagingsources represents a crucial step in the development of a patient‐specific dose computation tool.

Purpose: This study performed a dosimetry intercomparison for synchrotron‐produced monochromatic x‐ray beams. Ion chamber depth‐dose measurements in a polymethylmethacrylate (PMMA) phantom were compared with the product of MCNP5 Monte Carlo calculations of dose per fluence and measured incident fluence at 25 and 35 keV. The ion chamber measurements are being used to calibrate dose output for cell irradiations designed to investigate photoactivated Auger electron therapy at the LSU Center for Advanced Microstructures and Devices (CAMD) synchrotron facility. Methods: Monochromatic beams of 25 and 35 keV were generated on the tomography beamline at CAMD. A cylindrical, air‐equivalent ion chamber was used to measure the ionization created in a 10×10×10‐cm3 PMMA phantom at depths of 0.6 – 7.7 cm. AAPM TG‐61 protocol was applied to convert measured ionization into dose. MCNP5 simulations of the irradiation geometry were performed to determine the dose deposition per photon fluence in the phantom. Photon fluence was determined using a NaI detector to make scattering measurements of the beam from a polyethylene target at angles 15 – 60 degrees. Differential Compton and Rayleigh scattering cross sections were used to derive the incident fluence. Results: At 35 keV dose measurements for equal exposures determined using the MCNP5‐fluence results underestimated those of the ion chamber by 1.8 – 4.8% for PMMA depths from 0.6 – 7.7 cm, respectively. At 25 keV there was an overestimate of 6.6 – 1.9%. Conclusions: These results show that TG‐61 ion chamberdosimetry, used to calibrate the dose output for the cell irradiations, is accurate within approximately 7% for beam energies 25–35 keV. This research was supported by contract W81XWH‐10‐1‐0005 awarded by The U.S. Army Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702‐5014. This report does not necessarily reflect the position or policy of the Government, and no official endorsement should be inferred.

Purpose: PARETO (Pareto‐Aware Radiotherapy Evolutionary Treatment Optimization) is a novel multiobjective treatment planning system that performs beam orientation and fluence optimization simultaneously using an advanced evolutionary algorithm. In order to reduce the number of parameters involved in this enormous search space, we present several methods for modeling the beam fluence. The parameterizations are compared using innovative tools that evaluate fluence complexity, solution quality, and run efficiency. Methods: A PARETO run is performed using the basic weight (BW), linear gradient (LG), cosine transform (CT), beam group (BG), and isodose‐projection (IP) methods for applying fluence modulation over the projection of the Planning Target Volume in the beam's‐eye‐view plane. The solutions of each run are non‐dominated with respect to other trial solutions encountered during the run. However, to compare the solution quality of independent runs, each run competes against every other run in a round robin fashion. Score is assigned based on the fraction of solutions that survive when a tournament selection operator is applied to the solutions of the two competitors. To compare fluence complexity, a modulation index, fractal dimension, and image gradient entropy are calculated for the fluence maps of each optimal plan. Results: We have found that the LG method results in superior solution quality for a spine phantom, lung patient, and cauda equina patient. The BG method produces solutions with the highest degree of fluence complexity. Most methods result in comparable run times. Conclusion: The LG method produces superior solution quality using a moderate degree of fluence modulation.

Purpose: To calibrate an algorithm for digitally reconstructed radiographs(DRRs) such that synthetic projections cast through an object in a fan‐beam CT (FBCT) optimally match cone‐beam CT projections of the same object. Methods: Our DRR algorithm models the transmission of primary photons through an object with a ray‐tracing algorithm that samples the CT at small steps along each source‐detector pixel path. Sampled CT values are converted to linear attenuation coefficients (LACs), scaled by the step‐size, and added to a running sum for each detector pixel. We made attenuation measurements of materials of known CT number to calibrate a CT to LAC conversion function for our FBCT and CBCT systems. DRRs are post‐ processed to reproduce the tube output, source fluence distribution, and detector response of the CBCT system. In addition, they are modified to account for scatter, beam hardening, and detector veiling glare. Finally, we determined CBCT geometry parameters using a specially designed phantom. Results: We analyzed the quality of our DRR algorithm by directly comparing synthetic DRRs cast through the FBCT of a Catphan® phantom with actual CBCT projections of the phantom. Line plots comparing the intensity profiles of the DRRs and CBCT projections show that uncorrected DRRs do not align perfectly with the projections. However, when scatter, beam hardening, and veiling glare are modeled there is much closer agreement. Simulations with different geometry phantom shapes and sizes recommend a cylindrical phantom 150 mm in diameter. Computational times under one second per DRR are achieved using a GPU for a simulated 1024×768 pixel detector with a 512×512×281 mm CT volume and 0.5 mm ray step‐size. Conclusions: Our DRR algorithm is able to closely reproduce actual CBCT projections taken through a test object. It is optimized specifically for the FBCT and CBCT systems in our department. Funded in part by NCI grants R01CA123299 and P01CA116602. The authors report no conflicts of interest.

Amorphous silicon (a‐Si) electronic portal imaging devices(EPIDs) have been heavily investigated as treatment verification tools, with a particular focus on intensity modulated radiation therapy(IMRT). This verification could be accomplished through a comparison of measured portal images to predicted images. A general fluence determination for portal doseimage prediction would be a great asset in order to model the complex modulation of IMRT. A physically‐based parameter fluence model was developed by matching multi‐leaf collimator defined predicted images to measured image profiles. The fluence model was composed of a focal Gaussian and extrafocal Gaussian‐like source (Pearson VII). Specific aspects of the MLCs and secondary collimators were also modeled (eg. jaw and MLC transmission factors, MLC rounded leaf tips, tongue and groove effect, interleaf leakage, MLC offsets). The resulting calculated fluence was then convolved with Monte Carlo generated EPID‐specific dose kernels to convert incident fluence to dosedelivered to the EPID. Measured EPID data was obtained with an a‐Si EPID for various MLC‐defined fields (1×1 to 20×20 cm2) over a range of source‐to‐imager distances. These measured profiles were used to determine the fluence model parameters and the resulting model was tested on prostate and oropharyngeal IMRT fields. The model predicted the open‐field profiles within 2%, 2mm, while the predicted IMRT fields were generally within 3%, 3mm for at least 96% of the pixels. This model demonstrates the necessary accuracy needed for IMRT portal doseimage prediction in complex clinical examples (

International audience; PURPOSE:Spatially fractionated radiotherapy is a strategy to overcome the main limitation of radiotherapy, i.e., the restrained normal tissue tolerances. A well-known example is Grid Therapy, which is currently performed at some hospitals using megavoltage photon beams delivered by Linacs. Grid Therapy has been successfully used in the management of bulky abdominal tumors with low toxicity. The aim of this work was to evaluate whether an improvement in therapeutic index in Grid Therapy can be obtained by implementing it in a flattening filter-free (FFF) Linac. The rationale behind is that the removal of the flattening filter shifts the beam energy spectrum towards lower energies and increase the photon fluence. Lower energies result in a reduction of lateral scattering and thus, to higher peak-to-valley dose ratios (PVDR) in normal tissues. In addition, the gain in fluence might allow using smaller beams leading a more efficient exploitation of dose-volume effects, and consequently, a better normal tissue sparing.METHODS:Monte Carlo simulations were used to evaluate realistic dose distributions considering a 6 MV FFF photon beam from a standard medical Linac and a cerrobend mechanical collimator in different configurations: grid sizes of 0.3 × 0.3 cm2 , 0.5 × 0.5 cm2 , and 1 × 1 cm2 and a corresponding center-to-center (ctc) distance of 0.6, 1, and 2 cm, respectively (total field size of 10 × 10 cm2 ). As figure of merit, peak doses in depth, PVDR, output factors (OF), and penumbra values were assessed.RESULTS:Dose at the entrance is slightly higher than in conventional Grid Therapy. However, it is compensated by the large PVDR obtained at the entrance, reaching a maximum of 35 for a grid size of 1 × 1 cm2 . Indeed, this grid size leads to very high PVDR values at all depths (≥ 10), which are much higher than in standard Grid Therapy. This may be beneficial for normal tissues but detrimental for tumor control, where a lower PVDR might be requested. In that case, higher valley doses in the tumor could be achieved by using an interlaced approach and/or adapting the ctc distance. The smallest grid size (0.3 × 0.3 cm2 ) leads to low PVDR at all depths, comparable to standard Grid Therapy. However, the use of very thin beams might increase the normal tissue tolerances with respect to the grid size commonly used (1 × 1 cm2 ). The gain in fluence provided by FFF implies that the important OF reduction (0.6) will not increase treatment time. Finally, the intermediate configuration (0.5 × 0.5 cm2 ) provides high PVDR in the first 5 cm, and comparable PVDR to previous Grid Therapy works at depth. Therefore, this configuration might allow increasing the normal tissue tolerances with respect to Grid Therapy thanks to the higher PVDR and thinner beams, while a similar tumor control could be expected.CONCLUSIONS:The implementation of Grid Therapy in an FFF photon beam from medical Linac might lead to an improvement of the therapeutic index. Among the cases evaluated, a grid size of 0.5 × 0.5 cm2 (1-cm-ctc) is the most advantageous configuration from the physics point of view. Radiobiological experiments are needed to fully explore this new avenue and to confirm our results.

Purpose The purpose of this study was to investigate and characterize the performance of a Multi Leaf Collimator (MLC) designed for Cobalt-60 based MR-guided radiation therapy system in a 0.35 T magnetic field. Methods The MLC design and unique assembly features in the ViewRay MRIdian system were first reviewed. The RF cage shielding of MLC motor and cables were evaluated using ACR phantoms with real-time imaging and quantified by signal-to-noise ratio. The dosimetric characterizations, including the leaf transmission, leaf penumbra, tongue-and-groove effect, were investigated using radiosensitive films. The output factor of MLC-defined fields was measured with ionization chambers for both symmetric fields from 2.1 × 2.1 cm2 to 27.3 × 27.3 cm2 and asymmetric fields from 10.5 × 10.5 cm2 to 10.5 × 2.0 cm2. Multi leaf collimator (MLC) positional accuracy was assessed by delivering either a picket fence (PF) style pattern on radiochromic films with wire-jig phantom or double and triple-rectangular patterns on ArcCheck-MR (Sun Nuclear, Melbourne, FL, USA) with gamma analysis as the pass/fail indicator. Leaf speed tests were performed to assess the capability of full range leaf travel within manufacture's specifications. Multi leaf collimator plan delivery reproducibility was tested by repeatedly delivering both open fields and fields with irregular shaped segments over 1-month period. Results Comparable SNRs within 4% were observed for MLC moving and stationary plans on vendor-reconstructed images, and the direct k-space reconstructed images showed that the three SNRs are within 1%. The maximum leaf transmission for all three MLCs was less than 0.35% and the average leakage was 0.153 ± 0.006%, 0.151 ± 0.008%, and 0.159 ± 0.015% for head 1, 2, and 3, respectively. Both the leaf edge and leaf end penumbra showed comparable values within 0.05 cm, and the measured values are within 0.1 cm with TPS values. The leaf edge TG effect indicated 10% underdose and the leaf end TG showed a shifted dose distribution with 0.3 cm offset. The leaf positioning test showed a 0.2 cm accuracy in the PF style test, and a gamma passing rate above 96% was observed with a 3%/2 mm criteria when comparing the measured double/triple-rectangular pattern fluence with TPS calculated fluence. The average leaf speed when executing the test plan fell in a range from 1.86 to 1.95 cm/s. The measured and TPS calculated output factors were within 2% for squared fields and within 3% for rectangular fields. The reproducibility test showed the deviation of output factors were well within 2% for square fields and the gamma passing rate within 1.5% for fields with irregular segments. The Monte Carlo predicted output factors were within 2% compared to TPS values. 15 out of the 16 IMRT plans have gamma passing rate more than 98% compared to the TPS fluence with an average passing rate of 99.1 ± 0.6%. Conclusion The MRIdian MLC has a good RF noise shielding design, low radiation leakage, good positioning accuracy, comparable TG effect, and can be modeled by an independent Monte Carlo calculation platform.

PURPOSE Correction factors for the relative dosimetry of narrow megavoltage photon beams have recently been determined in several publications. These corrections are required because of the several small-field effects generally thought to be caused by the lack of lateral charged particle equilibrium (LCPE) in narrow beams. Correction factors for relative dosimetry are ultimately necessary to account for the fluence perturbation caused by the detector. For most small field detectors the perturbation depends on field size, resulting in large correction factors when the field size is decreased. In this work, electron and photon fluence differential in energy will be calculated within the radiation sensitive volume of a number of small field detectors for 6 MV linear accelerator beams. The calculated electron spectra will be used to determine electron fluence perturbation as a function of field size and its implication on small field dosimetry analyzed. METHODS Fluence spectra were calculated with the user code PenEasy, based on the PENELOPE Monte Carlo system. The detectors simulated were one liquid ionization chamber, two air ionization chambers, one diamond detector, and six silicon diodes, all manufactured either by PTW or IBA. The spectra were calculated for broad (10 cm × 10 cm) and narrow (0.5 cm × 0.5 cm) photon beams in order to investigate the field size influence on the fluence spectra and its resulting perturbation. The photon fluence spectra were used to analyze the impact of absorption and generation of photons. These will have a direct influence on the electrons generated in the detector radiation sensitive volume. The electron fluence spectra were used to quantify the perturbation effects and their relation to output correction factors. RESULTS The photon fluence spectra obtained for all detectors were similar to the spectrum in water except for the shielded silicon diodes. The photon fluence in the latter group was strongly influenced, mostly in the low-energy region, by photoabsorption in the high-Z shielding material. For the ionization chambers and the diamond detector, the electron fluence spectra were found to be similar to that in water, for both field sizes. In contrast, electron spectra in the silicon diodes were much higher than that in water for both field sizes. The estimated perturbations of the fluence spectra for the silicon diodes were 11-21% for the large fields and 14-27% for the small fields. These perturbations are related to the atomic number, density and mean excitation energy (I-value) of silicon, as well as to the influence of the "extracameral"' components surrounding the detector sensitive volume. For most detectors the fluence perturbation was also found to increase when the field size was decreased, in consistency with the increased small-field effects observed for the smallest field sizes. CONCLUSIONS The present work improves the understanding of small-field effects by relating output correction factors to spectral fluence perturbations in small field detectors. It is shown that the main reasons for the well-known small-field effects in silicon diodes are the high-Z and density of the "extracameral" detector components and the high I-value of silicon relative to that of water and diamond. Compared to these parameters, the density and atomic number of the radiation sensitive volume material play a less significant role.

Ion chamber dosimetry is being used to calibrate dose for cell irradiations designed to investigate photoactivated Auger electron therapy at the Louisiana State University CAMD synchrotron facility. This study performed a dosimetry intercomparison for synchrotron-produced monochromatic x-ray beams at 25 and 35 keV. Ion chamber depth-dose measurements in a PMMA phantom were compared with the product of MCNP5 Monte Carlo calculations of dose per fluence and measured incident fluence. Monochromatic beams of 25 and 35 keV were generated on the tomography beamline at CAMD. A cylindrical, air-equivalent ion chamber was used to measure the ionization created in a 10x10x10-cm3 PMMA phantom for depths from 0.6 to 7.7 cm. The American Association of Physicists in Medicine TG-61 protocol was applied to convert measured ionization into dose. Photon fluence was determined using a NaI detector to make scattering measurements of the beam from a thin polyethylene target at angles 30 degrees to 60 degrees. Differential Compton and Rayleigh scattering cross sections obtained from xraylib, an ANSI C library for x-ray-matter interactions, were applied to derive the incident fluence. MCNP5 simulations of the irradiation geometry provided the dose deposition per photon fluence as a function of depth in the phantom. At 25 keV the fluence-normalized MCNP5 dose overestimated the ion-chamber measured dose by an average of 7.2+/-3.0% to 2.1+/-3.0% for PMMA depths from 0.6 to 7.7 cm, respectively. At 35 keV the fluence-normalized MCNP5 dose underestimated the ion-chamber measured dose by an average of 1.0+/-3.4% to 2.5+/-3.4%, respectively. These results showed that TG-61 ion chamber dosimetry, used to calibrate dose output for cell irradiations, agreed with fluence-normalized MCNP5 calculations to within approximately 7% and 3% at 25 and 35 keV, respectively.

Purpose: To develop a method for inverse volumetric-modulated arc therapy (VMAT) planning that combines multicriteria optimization (MCO) with direct machine parameter optimization. The ultimate goa ...

Purpose: Prior image constrained compressed sensing (PICCS) is an image reconstruction framework that takes advantage of a prior image to improve the image quality of CT reconstructions. An interesting question that remains to be investigated is whether or not the introduction of a statistical model of the photon detection in the PICCS reconstruction framework can improve the performance of the algorithm when dealing with high noise projection datasets. The goal of the research presented in this paper is to characterize the noise properties of images reconstructed using PICCS with and without statistical modeling. This paper investigates these properties in the clinical context of time-resolved contrast-enhanced CT. Methods: Both numerical phantom studies and an Institutional Review Board approved human subject study were used in this research. The conventional filtered backprojection (FBP), and PICCS with and without the statistical model were applied to each dataset. The prior image used in PICCS was generated by averaging over FBP reconstructions from different time frames of the time-resolved CT exam, thus reducing the noise level. Numerical studies were used to evaluate if the noise characteristics are altered for varying levels of noise, as well as for different object shapes. The dataset acquired in vivo was used to verify that the conclusions reached from numerical studies translate adequately to a clinical case. The results were analyzed using a variety of qualitative and quantitative metrics such as the universal image quality index, spatial maps of the noise standard deviations, the noise uniformity, the noise power spectrum, and the model-observer detectability. Results: The noise characteristics of PICCS were shown to depend on the noise level contained in the data, the level of eccentricity of the object, and whether or not the statistical model was applied. Most differences in the characteristics were observed in the regime of low incident x-ray fluence. No substantial difference was observed between PICCS with and without statistics in the high fluence domain. Objects with a semi-major axis ratio below 0.85 were more accurately reconstructed with lower noise using the statistical implementation. Above that range, for mostly circular objects, the PICCS implementation without the statistical model yielded more accurate images and a lower noise level. At all levels of eccentricity, the noise spatial distribution was more uniform and the model-observer detectability was greater for PICCS with the statistical model. The human subject study was consistent with the results obtained using numerical simulations. Conclusions: For mildly eccentric objects in the low noise regime, PICCS without the noise model yielded equal or better noise level and image quality than the statistical formulation. However, in a vast majority of cases, images reconstructed using statistical PICCS have a noise power spectrum that facilitated the detection of model lesions. The inclusion of a statistical model in the PICCS framework does not always result in improved noise characteristics.

Purpose: This study aims to develop an EPID-guided 4D patient dosereconstruction framework and to investigate its feasibility for lungSBRT treatment validation. Methods: Both the beam apertures and tumor movements were detected based on the continuously acquired EPIDimages during the treatment. Instead of directly using the transit photon fluence measured by the EPID, this method reconstructed the entrance fluence with the measured beam apertures and the delivered MUs. The entrance fluence distributions were sorted into their corresponding phases based on the detected tumor motion pattern and then accumulated for each phase. Together with the in-room 4DCT taken before every treatment to consider the interfractional-motion, the entrance fluence was then used for the patient dose calculation. Deformable registration was performed to sum up the phase doses for final treatment assessment. The feasibility of using the transit EPIDimages for entrance fluence reconstruction was evaluated against EPID in-air measurements. The accuracy of 3D- and 4D-dose reconstruction was validated by experiments with a motor-driven cylindrical diode array for six clinical-SBRT plans. Results: The average difference between the measured and reconstructed fluence maps was within 0.16%. The reconstructed 3D-dose showed a less than 1.4% difference for the CAX-dose and at least a 98.3% gamma-passing-rate (2%/2 mm) for the peripheral dose. Distorted dose distributions were observed in the measurement with the moving phantom. The comparison between the measured and the reconstructed 4D-dose without considering temporal information failed the gamma-evaluation for most cases. In contrast, when temporal information was considered, the dose distortion phenomena were successfully represented in the reconstructeddose (97.6%–99.7% gamma-passing rate). Conclusions: The proposed method considered uncertainties of the beam delivery system, the interfractional- and intrafractional-motion, and the interplay effect. The experimental validation demonstrates that this method is practical and accurate for online or offline SBRT patient dose verification.

Purpose: This paper presents new spectral measurements of a tungsten-target digital breast tomosynthesis (DBT) system, including spectra of 43–49 kVp. Methods: Raw x-ray spectra of 20–49 kVp were directly measured from the tube port of a Selenia Dimensions DBT system using a CdTe based spectrometer. Two configurations of collimation were employed: one with two tungsten pinholes of 25 μ m and 200 μ m diameters, and the other with a single pinhole of 25 μ m diameter, for acquiring spectra from the focal spot and from the focal spot as well as its vicinity. Stripping correction was applied to the measured spectra to compensate distortions due to escape events. The measured spectra were compared with the existing mammographicspectra of the TASMIP model in terms of photon fluence per exposure, spectral components, and half-value layer (HVL). HVLs were calculated from the spectra with a numerical filtration of 0.7 mm aluminum and were compared against actual measurements on the DBT system using W/Al (target-filter) combination, without paddle in the beam. Results: The spectra from the double-pinhole configuration, in which the acceptance aperture pointed right at the focal spot, were harder than the single-pinhole spectra which include both primary and off-focus radiation. HVL calculated from the single-pinhole setup agreed with the measured HVL within 0.04 mm aluminum, while the HVL values from the double-pinhole setup were larger than the single-pinhole HVL by at most 0.1 mm aluminum. The spectra from single-pinhole setup agreed well with the TASMIP mammographicspectra, and are more relevant for clinical purpose. Conclusions: The spectra data would be useful for future research on DBT system with tungsten targets.

Purpose: Several works have recently focused on flattening-filter-free (FFF) beams of linear accelerators of various companies (in particular, Varian and Elekta), but no overview as yet exists for the flattening-filter free 7XU beam (Siemens Artiste). Methods: Dosimetric properties of the 7XU beam were measured in May and September 2011. We present depth dose curves and beam profiles, output factors, and MLC transmission and assess the stability of the measurements. The 7XU beam was commissioned in the Pinnacle³ treatment planning system (TPS), and modeling results including the spectrum are presented. Results: The percent depth dose curve of the 7XU beam is similar to the flat 6X beam line, with a slightly smaller surfacedose. The beam profiles show the characteristic shape of flattening-filter free beams, with deviations between measurements of generally less than 1%. The output factors of the 7XU beam decrease more slowly than for the 6X beam. The MLC transmission is comparable but slightly less for the 7XU beam. The 7XU beam can be adequately modeled by the Pinnacle³ TPS, with successful dosimetric verification. The spectrum of the 7XU beam has lower photon fluence up to approximately 2.5 MeV and higher fluence beyond, with a slightly higher mean energy. Conclusions: The 7XU beam has been commissioned for clinical use after successful modeling, stability checks, and dosimetric verification.

Purpose: Selecting the appropriate imaging technique in computed tomography(CT) inherently involves balancing the tradeoff between image quality and imagingdose. Modulation of the x-ray fluence field, laterally across the beam, and independently for each projection, may potentially meet user-prescribed, regional image quality objectives, while reducing radiation to the patient. The proposed approach, called fluence field modulated CT (FFMCT), parallels the approach commonly used in intensity-modulated radiation therapy(IMRT), except “image quality plans” replace the “dose plans” of IMRT. This work studies the potential noise and dose benefits of FFMCT via objective driven optimization of fluence fields. Methods: Experiments were carried out in simulation. Image quality plans were defined by specifying signal-to-noise ratio(SNR) criteria for regions of interest (ROIs) in simulated cylindrical and oblong water phantoms, and an anthropomorphic phantom with bone, air, and water equivalent regions. X-ray fluence field patterns were generated using a simulated annealingoptimization method that attempts to achieve the spatially-dependent prescribed SNR criteria in the phantoms while limiting dose (to the volume or subvolumes). The resulting SNR and dose distributions were analyzed and compared to results using a bowtie filtered fluence field. Results: Compared to using a fixed bowtie filtered fluence, FFMCT achieved superior agreement with the target image quality objectives, and resulted in integral dose reductions ranging from 39 to 52%. Prioritizing dose constraints for specific regions of interest resulted in a preferential reduction of dose to those regions with some tradeoff in SNR, particularly where the target low dose regions overlapped with regions where high SNR was prescribed. The method appeared fairly robust under increased complexity and heterogeneity of the object structure. Conclusions: These results support that FFMCT has the potential to meet prescribed image quality objectives, while decreasing radiation exposure to the patient. Tradeoffs between SNR and dose may not be eliminated, but might be more efficiently managed using FFMCT.

clinical electron beams. In order to determine the necessary shift to account for the nonwater equivalence of the entrance window, the chamber is shifted in steps z around the depth of measurement. The optimal shift z is determined from a comparison of the spectral fluence within the chamber and the bare cavity. The wall perturbation correction is calculated as the ratio between doses for the complete chamber and a wall-less air cavity. Results: The high energy part of the fluence spectra within the chamber strongly varies even with small chamber shifts, allowing the determination of z within micrometers. For the NACP-02 chamber a shift z = �0.058 cm results. This value is independent of the energy of the primary electrons as well as of the depth within the phantom and it is in good agreement with the value recommended in the German dosimetry protocol. Applying this shift, the calculated wall perturbation correction as a function of depth is varying less than 1% from zero up to the half value depth R50 for electron energies in the range of 6–21 MeV. The remaining depth dependence can mainly be attributed to the scatter properties of the entrance window. When neglecting the nonwater equivalence of the entrance window, the variation of p wall with depth is up to 10% and more, especially for low electron energies. Conclusions: The variation of the wall perturbation correction for the NACP-02 chamber in clinical electron beams strongly depends on the positioning of the chamber. Applying a shift z = �0.058 cm toward the focus ensures that the primary electron spectrum within the chamber bears the largest resemblance to the fluence of a wall-less cavity. Hence, the influence of the chamber walls on the perturbation correction can be separated out and the residual variation of pwall with depth is minimized. © 2011 American Association of Physicists in Medicine. DOI: 10.1118/1.3544660

Purpose: To investigate the feasibility of utilizing tumor tracks from electronic portal imaging device (EPID) images taken during treatment to verify the delivered dose. Methods: The proposed method is based on a computation of the delivered fluence by utilizing the planned fluence and the tumor motion track for each field. A phantom study was designed to assess the feasibility of the method. The CIRS dynamic thorax phantom was utilized with a realistic soft resin tumor, modeled after a real patient tumor. The dose calculated with the proposed method was compared to direct measurements taken with 15 metal oxide semiconductor field effect transistors (MOSFETs) inserted in small fissures made in the tumor model. The phantom was irradiated with the tumor static and moved with different range of motions and setup errors. EPID images were recorded throughout all deliveries and the tumor model was tracked post-treatment with in-house developed software. The planned fluence for each field was convolved with the tumor motion tracks to obtain the delivered fluence. Utilizing the delivered fluence from each field, the delivered dose was calculated. The estimated delivered dose was compared to the dose directly measured with the MOSFETs. The feasibility of the proposed method was alsomore » demonstrated on a real lung cancer patient, treated with stereotactic body radiotherapy. Results: The calculation of delivered dose with the delivered fluence method was in good agreement with the MOSFET measurements, with average differences ranging from 0.8% to 8.3% depending on the proximity of a dose gradient. For the patient treatment, the planned and delivered dose volume histograms were compared and verified the overall good coverage of the target volume. Conclusions: The delivered fluence method was applied successfully on phantom and clinical data and its accuracy was evaluated. Verifying each treatment fraction may enable correction strategies that can be applied during the course of treatment to ensure the desired dose coverage.« less

Purpose: The equivalent field size (EFS) method is widely used to estimate dose of nonstandard fields, such as elongated or arbitrary shaped fields, for both central axis and off axis points. However, its application is limited to fluence maps with uniform intensity. In this work, we propose a generalized EFS (GEFS) for nonuniform fluence maps and present a formula for GEFS-based dose calculation. Methods: A parallel-beam dose table (PDT) consisting of central axis dose of circular fields of various diameters at various depths is used to define scatter contributions, based on which we calculate GEFS of any given fluence map. Such obtained GEFS, together with the radiological depth and PDT, is used to determine the dose at the point of interest. We tested GEFS-based dose calculation on a water phantom for both uniform and nonuniform fluence maps and compared the results with those by the collapsed cone convolution/superposition (CCCS) method. Results: For all test cases, the gamma index is less than 1 based on the 3%/1 mm criteria for more than 96% of the calculated points. Larger discrepancies mainly occur along the field edges in the buildup region. Conclusions: A generalized equivalent field size for nonuniform fluence maps was proposed and its application in calculating dose at any point was presented and verified through comparison with the CCCS method.

Purpose: An approach known as goldnanoparticle-aidedradiation therapy (GNRT) is a recent development in radiation therapy which seeks to make a tumor more susceptible to radiation damage by modifying its photon interaction properties with an infusion of goldnanoparticles (GNPs). The purpose of this study was to quantify the energy deposition due to secondary electrons from GNPs on a nanometer scale and to calculate the corresponding microscopic dose enhancement factor around GNPs. Methods: The Monte Carlo code EGSnrc was modified to obtain the spectra of secondary electrons from atoms of gold approximating GNPs and molecules of water under photon irradiation of a tumor loaded with GNPs. Six different photon sources were used: I 125 , P 103 d , Y 169 b , I 192 r , 50 kVp, and 6 MV x rays. Treating the scored electron spectra as point sources within an infinite medium of water, the event-by-event Monte Carlo code NOREC was used to quantify the radial dose distribution, giving rise to gold/water electron dose point kernels and corresponding microscopic dose enhancement factors. These kernels were applied to a test case based on a scanning electron microscope image of a GNP distribution in tissue, enabling the determination of the microscopic dose enhancement at each dose point. Results: For the lower energy sources I 125 , P 103 d , Y 169 b , and 50 kVp, the secondary electron fluence within a GNP-loaded tumor was increased by as much as two orders of magnitude, leading to two orders of magnitude increase in electron energy deposition over radial distances up to 10 μ m . For the test case considered, the dose was enhanced by factors ranging from 2 to 20 within 5 μ m of GNPs, and by 5% as far away as 30 μ m . Conclusions: This study demonstrates a remarkable microscopic dose enhancement due to GNPs and low energy photon sources. By quantifying the microscopic dose enhancement factor for a given photon source as a function of distance from GNPs, it also enables the selection of either a passive or an active tumor targeting strategy using GNPs which will maximize the radiobiological benefit from GNRT.

Purpose: In the TG-21 dosimetry protocol, for cylindrical chambers in electron beams the replacement correction factor P repl (or the product p dis p cav in the IAEA’s notation), was conceptually separated into two components: the gradient correction ( P gr ) accounting for the effective point of measurement and the fluence correction ( P fl ) dealing with the change in the electron fluence spectrum. At the depth of maximum dose ( d max ) , P gr is taken as 1. There are experimental data available at d max for the values of P fl (or P repl ). In the TG-51 dosimetry protocol, the calibration is at the reference depth d ref = 0.6 R 50 − 0.1 ( cm ) where P gr is required for cylindrical chambers and P fl is unknown and so the measured values at d max are used with the corresponding mean electron energy at d ref . Monte Carlo simulations are employed in this study to investigate the replacement correction factors for cylindrical chambers in electron beams. Methods: Using previously established Monte Carlo calculation methods, the values of P repl and P fl are calculated with high statistical precision ( 0.1 % ) for cylindrical cavities of a variety of diameters and lengths in a water phantom irradiated by various electron beams. The values of P gr as defined in the TG-51 dosimetry protocol are also calculated. Results: The calculated values of the fluence correction factors P fl are in good agreement with the measured values when the wall correction factors are taken into account for the plane-parallel chambers used in the measurements. An empirical formula for P fl for cylindrical chambers at d ref in electron beams is derived as a function of the chamber radius and the beam quality specifier R 50 . Conclusions: The mean electron energy at depth is a good beam quality specifier for P fl . Thus TG-51’s adoption of P fl at d max with the same mean electron energy for use at d ref is proven to be accurate. The values of P gr for a Farmer-type chamber as defined in the TG-51 dosimetry protocol may be wrong by 0.3% for high-energy electron beams and by more than 1% for low-energy electron beams.

EGSnrc calculations of ion chamber response and Spencer-Attix (SA) restricted stopping-power ratios are used to test the assumptions of the SA cavity theory and to assess the accuracy of this theory as it applies to the air kerma formalism for 60Co beams. Consistent with previous reports, the EGSnrc calculations show that the SA cavity theory, as it is normally applied, requires a correction for the perturbation of the charged particle fluence (K(fl)) by the presence of the cavity. The need for K(fl) corrections arises from the fact that the standard prescription for choosing the low-energy threshold delta in the SA restricted stopping-power ratio consistently underestimates the values of delta needed if no perturbation to the fluence is assumed. The use of fluence corrections can be avoided by appropriately choosing delta, but it is not clear how delta can be calculated from first principles. Values of delta required to avoid K(fl) corrections were found to be consistently higher than delta values obtained using the conventional approach and are also observed to be dependent on the composition of the wall in addition to the cavity size. Values of K(fl) have been calculated for many of the graphite-walled ion chambers used by the national metrology institutes around the world and found to be within 0.04% of unity in all cases, with an uncertainty of about 0.02%.

Recently, the authors proposed an analytical scheme to estimate the first order x-ray scatter by approximating the Klein-Nishina formula so that the first order scatter fluence is expressed as a function of the primary photon fluence on the detector. In this work, the authors apply the scheme to experimentally obtained 6 MV cone beam CT projections in which the primary photon fluence is the unknown of interest. With the assumption that the higher-order scatter fluence is either constant or proportional to the first order scatter fluence, an iterative approach is proposed to estimate both primary and scatter fluences from projections by utilizing their relationship. The iterative approach is evaluated by comparisons with experimentally measured scatter-primary ratios of a Catphan phantom and with Monte Carlo simulations of virtual phantoms. The convergence of the iterations is fast and the accuracy of scatter correction is high. For a sufficiently long cylindrical water phantom with 10 cm of radius, the relative error of estimated primary photon fluence was within ±2% and ±4% when the phantom was projected with 6 MV and 120 kVp x-ray imaging systems, respectively. In addition, the iterative approach for scatter estimation is applied to 6 MV x-ray projections of a QUASAR and anthropomorphic phantoms (head and pelvis). The scatter correction is demonstrated to significantly improve the accuracy of the reconstructed linear attenuation coefficient and the contrast of the projections and reconstructed volumetric images generated with a linac 6 MV beam.

The purpose of this study is to calculate correction factors for plastic water (PW) and plastic water diagnostic-therapy (PWDT) phantoms in clinical photon and electron beamdosimetry using the EGSnrc Monte Carlo code system. A water-to-plastic ionization conversion factor k p l for PW and PWDT was computed for several commonly used Farmer-type ionization chambers with different wall materials in the range of 4–18 MV photonbeams. For electron beams, a depth-scaling factor c p l and a chamber-dependent fluence correction factor h p l for both phantoms were also calculated in combination with NACP-02 and Roos plane-parallel ionization chambers in the range of 4–18 MeV. The h p l values for the plane-parallel chambers were evaluated from the electron fluence correction factor ϕ p l w and wall correction factors P wall , w and P wall , p l for a combination of water or plastic materials. The calculated k p l and h p l values were verified by comparison with the measured values. A set of k p l values computed for the Farmer-type chambers was equal to unity within 0.5% for PW and PWDT in photonbeams. The k p l values also agreed within their combined uncertainty with the measured data. For electron beams, the c p l values computed for PW and PWDT were from 0.998 to 1.000 and from 0.992 to 0.997, respectively, in the range of 4–18 MeV. The ϕ p l w values for PW and PWDT were from 0.998 to 1.001 and from 1.004 to 1.001, respectively, at a reference depth in the range of 4–18 MeV. The difference in P wall between water and plastic materials for the plane-parallel chambers was 0.8% at a maximum. Finally, h p l values evaluated for plastic materials were equal to unity within 0.6% for NACP-02 and Roos chambers. The h p l values also agreed within their combined uncertainty with the measured data. The absorbed dose to water from ionization chamber measurements in PW and PWDT plastic materials corresponds to that in water within 1%. Both phantoms can thus be used as a substitute for water for photon and electron dosimetry.

This study evaluated the dosimetry of electron backscatter when Solid Water is used to substitute water as phantom in electron radiotherapy. Monte Carlo simulation (EGSnrc-based code) was employed to predict electron energy spectra and depth doses for the 0.5 and 1 cm of Solid Water and water slabs above 3 mm of lead (Pb) layers using electron beams with energies of 4 and 6 MeV. For comparison, Monte Carlo simulations were repeated with Pb layers taken out from the phantoms using the same experimental configuration. Analyses on electron energy spectra for the 4 and 6 MeV electron beams showed that deviations of electron energy distributions between the Solid Water and water phantom were more significant in the high-energy range (i.e., close to the maximal electron energy) than the lower range corresponding to the electron backscatter. These deviations of electron energy spectra varied with depth and were mainly due to the electron fluence or beam attenuation. Dosimetry results from Monte Carlo simulations showed that the Solid Water phantom had lower depth dose compared to water with the same experimental setup. For the 4 MeV electron beams with 0.5 cm of Solid Water, depth doses were 1.8%-3.9% and 2.3%-4.4% lower than thosemore » in water, with and without the Pb layer underneath, respectively. Thicker Solid Water of 1 cm resulted in different decreases in depth doses of 1.8%-4.6% (with Pb) and 2.3%-4.4% (without Pb) compared to water. For higher nominal electron beam energy of 6 MeV with 0.5 cm of Solid Water, depth doses decreased 1.7%-2.9% (with Pb) and 1.6%-2.1% (without Pb) compared to water. These decreases in depth doses changed to 1.7%-3.7% (with Pb) and 1.7%-3% (without Pb) when the thickness of Solid Water was increased to 1 cm. The dosimetry data in this study are useful in determining the correction factor when using Solid Water to substitute water for the electron backscatter measurement in electron radiotherapy.« less