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PubMedDate not supplied

Neutrons from high-energy x-ray medical accelerators: an estimate of risk to the radiotherapy patient.

The problem of neutrons produced by many of the high-energy x-ray therapy machines (10 MV and above) is reviewed, and the possible risk their presence poses to radiotherapy patients is estimated. A review of the regulatory background containing a summary of the recommendations of the U.S. Council of State Governments (USCSG), and of the International Electro-Technical Commission (IEC), as well as an indication that recommendations will be forthcoming from the National Council on Radiation Protection (NCRP) and the International Commission of Radiological Protection (ICRP) is presented. The neutrons in question are produced by high-energy photons (x rays) incident on the various materials of the target, flattening filter, collimators, and other essential components of the equipment. The neutron yield (per treatment dose) increases rapidly as the megavoltage is increased from 10 to 20 MV, but remains approximately constant above this. Measurements and calculations of the quantity, quality, and spatial distribution of these neutrons and their concomitant dose are summarized. Values of the neutron dose are presented as entrance dose, midline dose (10-cm depth), and integral dose, both within and outside of the treatment volume. These values are much less than the unavoidable photon doses which are largely responsible for treatment side effects. For typical equipment, the average neutron integral dose from accelerator-produced neutrons is about 4-7 g cGy (per treatment cGy), depending on the treatment plan. This translates into an average dose of neutrons [averaged over the body of a typical 70-kg (154 lb) patient] of 0.06-0.10 cGy for a treatment of 1000 cGy. Using these neutron doses and the best available neutron risk coefficients, it is estimated that 50 X 10(-6) fatal malignancies per year due to the neutrons may follow a typical treatment course of 5000 rads of 25-MV x rays. This is only about 1/60th of the average incidence of malignancies for the general population. Thus, the cancer risk to the radiotherapy patient from accelerator-produced neutrons poses an additional risk to the patient that is negligible in comparison.

Abnormalities, Radiation-Induced↗
PubMedDate not supplied

Measurement of beam current and evaluation of scatter production in an 18-MeV accelerator.

Measurements of dose rate in a 10-MV x-ray beam may indicate considerable variation with collimator setting. This variation is observed even when the peak scatter factor is fixed by holding the field size at the phantom surface constant. The resulting output factor variation may be due to radiation backscattered from the collimators into the monitor chamber. Measurements of charge deposited in the accelerator target were compared with ionization readings for several field sizes. Evaluation of the data indicates that radiation backscattered into the monitor chamber contributes only a small amount to the output factor.

Humans↗
PubMed1987

Linear accelerator radiosurgery of arteriovenous malformations.

Forty-five patients affected by cerebral arteriovenous malformations not suitable to open surgery have been treated by a radiosurgical technique employing a linear accelerator. One-year follow-up angiography is available for 10 cases. Therapeutic effect of focalized irradiation is presented.

Adolescent↗
PubMed1998

Evaluation of risk from space radiation with high-energy heavy ion beams.

The most challenging radiation in space consists of fully ionized atomic elements with high energy for which only the few lowest energy ions can be stopped in shielding materials. The health risk from exposure to these ions and their secondary radiations generated in shield materials is poorly understood since there are few human data and a systematic study in relevant animal model systems has not been made. The accuracy of risk prediction is described as the major limiting factor in the management of space radiation risk. The expected impact of systematic studies is examined using the limited available biological data and models. Given the limitations of current predictions, models must be developed that are able to incorporate the required fundamental scientific data into accurate risk estimates. The important radiation components that can be provided for laboratory testing are identified. The use of ground-based accelerator beams to simulate space radiation is explained and quantitative scientific constraints on such facilities are derived. Three facilities, one each in the United States, in Germany and in Japan, currently have the partial capability to satisfy these constraints. A facility has been proposed using the Brookhaven National Laboratory Booster Synchrotron in the United States; in conjuction with other on-site accelerators, it will be able to provide the full range of heavy ion beams and energies required.

Aerospace Medicine↗
PubMed1990

An energy monitor for electron accelerators.

A monitor useful for checks of the energy selector scale of medical electron accelerators was developed and tested. It consists of a linear array of flat ionization chambers sandwiched between absorber plates of low-Z material. The first chamber at the electron beam entrance may be used to produce a reference signal Sr, if not another suitable reference signal is taken. The following chambers are electrically connected and deliver the measuring signal Sm. A clinical dosimeter can be used for recording current or charge. The energy-dependent electron range parameters Rp, R50 and R80 in water vary as linear functions of the ratio Sm/Sr. The best linear fit was obtained for the half value layer R50. Three types of the energy monitor are described, and experimental results obtained with a linear accelerator and a betatron between 5 and 25 MeV are reported. Uncertainties for checks of R50 with a calibrated energy monitor were not larger than 1 to 2 mm. Theoretical considerations by a computer model support these results.

Electrons↗
PubMed2004

Contamination by metallic elements released from joint prostheses.

When a metallic implant is in contact with human tissues, the organism reacts and a corrosion process starts. Consequently, we might observe liberation of metallic debris and wear. Our purpose is to measure the contamination and the migration of these metallic elements in the surrounding tissues of the implant. Two types of samples have been studied. First type is sample taken on post-mortem tissues around prostheses to study contamination gradients. Second type is sample taken on pathologic joints on periprosthetic capsular tissues in surgical conditions. These allow estimating contamination degree. The experiments were made on a Van de Graaff accelerator located at CERI (Centre d'Etude et de Recherche par Irradiation, Orléans, France). We measure elemental concentrations resulting from the contamination of the surface of each sample. Results are analysed in function of the pathology and the type of implants. According to the pathology and the location of the sampling, these measurements show a very heterogeneous contamination by metallic elements under particles and/or ionic species which can migrate through soft tissues by various mechanisms.

Arthroplasty↗
PubMed2001

Incorporating dynamic collimator motion in Monte Carlo simulations: an application in modelling a dynamic wedge.

In radiation therapy, new treatment modalities employing dynamic collimation and intensity modulation increase the complexity of dose calculation because a new dimension, time, has to be incorporated into the traditional three-dimensional problem. In this work, we investigated two classes of sampling technique to incorporate dynamic collimator motion in Monte Carlo simulation. The methods were initially evaluated for modelling enhanced dynamic wedges (EDWs) from Varian accelerators (Varian Medical Systems, Palo Alto, USA). In the position-probability-sampling or PPS method, a cumulative probability distribution function (CPDF) was computed for the collimator position, which could then be sampled during simulations. In the static-component-simulation or SCS method, a dynamic field is approximated by multiple static fields in a step-shoot fashion. The weights of the particles or the number of particles simulated for each component field are computed from the probability distribution function (PDF) of the collimator position. The CPDF and PDF were computed from the segmented treatment tables (STTs) for the EDWs. An output correction factor had to be applied in this calculation to account for the backscattered radiation affecting monitor chamber readings. Comparison of the phase-space data from the PPS method (with the step-shoot motion) with those from the SCS method showed excellent agreement. The accuracy of the PPS method was further verified from the agreement between the measured and calculated dose distributions. Compared to the SCS method, the PPS method is more automated and efficient from an operational point of view. The principle of the PPS method can be extended to simulate other dynamic motions, and in particular, intensity-modulated beams using multileaf collimators.

Biophysical Phenomena↗
PubMed2006

Reconstruction of electron spectra from depth doses with adaptive regularization.

Electron spectral reconstruction of medical accelerators from measured depth doses is a practical method for providing the input initial phase space distribution at the patient surface that is required by Monte Carlo treatment planning systems. The posed inverse problem of spectral reconstruction is ill conditioned and this may lead to nonphysical oscillations in the reconstructed spectra. Use of a variational method of solution with a regularization technique removes the oscillations but tends to smooth the sharp (deltalike) energy peak that is a common feature in electron spectra generated by medical accelerators. Because the sharp peak contains a large percentage of the electrons in the spectrum, an accurate estimate of the peak width, height and position is critical to the success of the technique for spectrum reconstruction with regularization. We propose use of an adaptive regularization term as a special form of the general Tichonov regularization function. The variational method with the adaptive regularization term is applied to reconstruct electron spectra for the 6, 9, and 18 MeV electron beams of a Varian Clinac 2100C accelerator and proves to be a very simple, effective and accurate approach. Results using this variational method with adaptive regularization almost perfectly reconstruct electron spectra from depth dose distributions.

Electrons↗
PubMedDate not supplied

Determination of the photon spectrum of a clinical accelerator.

An experiment to determine the peak of the energy spectrum of the photon beam from a Toshiba LMR-15 medical linear accelerator is described. It is found that the flattening filters removed much of the bremsstrahlung spectrum below approximately 1 MeV, resulting in a photon spectrum which peaks around 1.2 MeV.

Particle Accelerators↗
PubMed1991

Absorbed dose to technicians due to induced activity in linear accelerators for radiation therapy.

Absorbed dose to the trunk and to the hands of technicians working with accelerators for radiotherapy have been measured with TL dosimeters for seven different accelerators. The contribution from induced activity in the accelerator and from radiation transmitted through the walls of the treatment room have been estimated separately. The total annual absorbed dose to the trunk and to the hands have been estimated to be 2 mGy, of which the induced activity contributes one-third (0.7 mGy). The exposure of the technicians was found to be dominated by radiation penetrating the walls of the treatment room. For one accelerator the absorbed dose rate in the treatment room was measured continuously between 0.5 min and 48 h after end of treatment. Immediately after irradiation with high-energy photons the radiation is dominated by 28Al and 62Cu T1/2 = 2.3 and 9.7 min respectively) and later by radionuclides with longer half-lives, 187W and 57Ni (T1/2 = 24 and 36 h respectively). Due to these radionuclides the radioactivity in the accelerator will build up and the technicians will therefore be irradiated every time they enter the treatment room and not only directly after a treatment with high-energy photons.

Electrons↗
PubMed1994

Total-body irradiation on an isocentric linear accelerator: a radiation output compensation technique.

A treatment technique for total-body irradiation (TBI) is proposed that combines arc therapy with dynamic output control to achieve high-grade dose uniformity. The patient lies on a low couch and receives exposure in the prone and supine positions from a modulated arcing beam. The technique has been validated using a personal computer to control the linear accelerator and we demonstrate that only minor alterations to current dynamic therapy systems would be required. We have examined the practical application of this treatment with emphasis on methods of conformal therapy where an optimized dose distribution is prepared from a matrix of caliper measurements taken from the patient. This technique provides a means for regular TBI treatment on a computer-controlled linear accelerator that is easy to set up, requires short exposure times and is comfortable for the patient.

Equipment Failure Analysis↗
PubMed1998

Monte Carlo calculations of electron beam output factors for a medical linear accelerator.

The purpose of this study was to investigate the application of the Monte Carlo technique to the calculation and analysis of output factors for electron beams used in radiotherapy. The code EGS4/BEAM was used to obtain phase-space files for 6, 12 and 20 MeV clinical electron beams from a scattering-foil linac (Varian Clinac 2100C) for a clinically representative range of applicator and square or rectangular insert combinations. The source-to-surface distance used was 100 cm. The field sizes ranged from 1 x 1 cm2 to 20 x 20 cm2. These phase-space files were analysed to study the intrinsic beam characteristics and used as source input for relative dose and output factor computations in homogeneous water phantoms using the code EGS4/DOSXYZ. The calculated relative central-axis depth-dose and transverse dose profiles at various depths of clinical interest agreed with the corresponding measured dose profiles to within 2% of the maximum dose. Calculated output factors for the fields studied agreed with measured output factors to about 2%. This demonstrated that for the Varian Clinac 2100C linear accelerator, electron beam dose calculations in homogeneous water phantoms can be performed accurately at the 2% level using Monte Carlo simulations.

Computer Simulation↗
PubMed2002

Comparison of beam characteristics in intensity modulated radiation therapy (IMRT) and those under normal treatment condition.

In the step-and-shoot delivery of an IMRT plan with a Siemens Primus accelerator, radiation is turned off by desynchronizing the injector while the field parameters are being changed. When the machine is ready again a trigger pulse is sent to the injector to start the beam instantaneously. The objective of this study is to investigate the beam characteristics of the machine operating in the IMRT mode and to study the effect of the Initial Pulse Forming Network (IPEN) on the dark current. The central axis (CAX) output for a 10 x 10 cm2 field over the range 1-100 MU was measured with an ion chamber in a polystyrene phantom for both 6 and 15 MV x rays. Beam profiles were also measured over the range of 2-40 MU with the machine operating in the IMRT mode and compared with those in the normal mode. By adjusting the IPFN value, dark current radiation (DCR) was measured using ion chamber measurements. For both the normal and IMRT modes, dose versus MU is nonlinear in the range 1-5 MUs. Above 5 MU, dose varies linearly with MU for both 6 and 15 MV x rays. For stability of dose profiles, the 2 MU-IM group exhibit 20% variation from one subfield to another. The variation is about 5% for the 8 MU-IM group and <5% for 10 MU and higher. The results are similar in the normal treatment mode. With the IPFN at >80% of the PFN value, a spurious radiation associated with dark current at approximately 0.7% of the dose at isocenter for a 10 x 10 cm2 field is detected during the "PAUSE" state of the accelerator for 15 MV x rays. When the IPFN is lowered to <80% of the PFN value, no DCR is detected. For 6 MV x rays, no measurable DCR was detected regardless of the IPFN setting.

Humans↗
PubMed1991

[Radiotherapy of glioblastoma: is shortening of the treatment time justifiable?].

Survival of glioblastoma patients can be double by postoperative radiation but nevertheless rarely exceeds one year. It is therefore desirable to minimize treatment time and hospitalisation. Aim of our study is to investigate the feasibility of a reduction of treatment time by accelerated fractionation. Out of 110 patients treated for glioblastoma from 1975 to 1988 in our institution postoperative radiation was performed in 79 patients using three different fractionation schedules: 60 Gy in six weeks, single fractions 2 Gy (n = 38), 35 Gy in two weeks, single fractions 3.5 Gy (n = 27), 45.5 Gy in 2.5 weeks, single fractions 3.5 Gy (n = 14). No statistically significant differences in both the mean overall and disease free survival were evaluated between the three groups. The larger fraction size was well tolerated and no relevant increase of early or late adverse reactions occurred. As the duration of treatment can be reduced from six to two weeks, this accelerated fractionation schedule seems to be a reasonable alternative to conventional fractionation.

Adult↗
PubMed1985

The effects of ionizing radiation on eight cardiac pacemakers and the influence of electromagnetic interference from two linear accelerators.

Eight cardiac pacemakers were irradiated in a cobalt-60 beam. Two out of six demand-type pacemakers showed an alarming decrease in pulse repetition frequency when irradiated to dose levels that are used in radiotherapy (less than 100 Gy). Two modern programmable pacemakers showed a failure at a dose of 97 and 147 Gy, respectively. The dose levels at which these failures occurred were low enough to recommend that cardiac pacemakers should always be kept outside the radiation beam. The signals induced by electromagnetic interference (EMI) from two linear accelerators were measured using a simulation model of a pacemaker. In the laboratory, 22 modern-type pacemakers were tested with these signals to determine the sensitivity for the electromagnetic fields in the treatment rooms. It was observed that an inhibition of one pacemaker pulse was to be expected on one of the two linear accelerators when switching the machine on and off. No permanent effects were found. These findings resulted in the recommendation in our department not to use this treatment machine for radiation therapy of pacemaker-bearing patients.

Electromagnetic Phenomena↗
PubMed1998

The effect of track structure on the induction of chromosomal aberrations in murine cells.

PURPOSE: To measure chromosome aberrations in C3H 10T1/2 mouse fibroblasts using FISH painting at the first mitosis following exposure to 30 keV/microm hydrogen or neon ions. MATERIALS AND METHODS: Cells in plateau-phase were irradiated with 0.86 MeV protons at the TTT-3 Tandem accelerator in Naples (Italy), or with 400 MeV/n Ne ions at the HIMAC accelerator in Chiba (Japan). Colcemid-blocked cells were harvested at the first mitosis following exposure, and chromosome spreads were hybridized in situ with a fluorescein-labelled composite mouse DNA probe specific for chromosomes 2 and 8. RESULTS: Protons were more efficient than neon ions at the same LET in the induction of chromosome interchanges and breaks. Yields of complex exchanges were similar for both particles at the same dose, but protons produced mostly insertions, while with Ne exposure non-reciprocal exchanges were the most frequent complex-type exchange. CONCLUSIONS: Charged particles with the same LET produce different yields of chromosome aberrations, and some observed differences can be explained based on the available track-structure models.

Animals↗
PubMed1995

Minimization of target positioning error in accelerator-based radiosurgery.

The stereotactic radiosurgery system used at the Mallinckrodt Institute of Radiology is patterned after that developed at the Joint Center for Radiation Therapy (Brigham & Women's Hospital, Boston, MA) and uses the Brown-Roberts-Wells computed tomography (CT) stereotactic system. The patient's head is attached to a stand that rotates with the treatment couch. The irradiation is conducted using a set of converging arcs of irradiation. Because of mechanical limitations, no accelerator or treatment couch is capable of placing the center of the radiation beam at precisely the same point for all gantry and couch angles and a compromise must be made when locating the nominal isocenter. The stand settings are checked by placing a radiopaque QA sphere at the desired target location. The QA sphere is imaged using a series of eight films exposed at a set of couch and gantry angles that encompass the treatment angles. The distances between the QA sphere image and the center of the radiation field indicate if the correct coordinates were set on the stand and if the radiation beam converges to a sufficiently small region (< 0.1-cm diameter) for treatment. A mathematical procedure has been developed to use the film-measured position errors to determine a stand offset that will minimize the distance between the accelerator isocenter and the target. The technique is capable of reducing the average placement error, as measured by imaging the QA sphere, to 0.035 cm with a maximum deviation of 0.07 cm.

Humans↗