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A model to calculate the induced dose rate around an 18 MV ELEKTA linear accelerator.

The dose rate due to activity induced by (gamma, n) reactions around an ELEKTA Precise accelerator running at 18 MV is reported. A model to calculate the induced dose rate for a variety of working practices has been derived and compared to the measured values. From this model, the dose received by the staff using the machine can be estimated. From measured dose rates at the face of the linear accelerator for a 10 x 10 cm2 jaw setting at 18 MV an activation coefficient per MU was derived for each of the major activation products. The relative dose rates at points around the linac head, for different energy and jaw settings, were measured. Dose rates adjacent to the patient support system and portal imager were also measured. A model to calculate the dose rate at these points was derived, and compared to those measured over a typical working week. The model was then used to estimate the maximum dose to therapists for the current working schedule on this machine. Calculated dose rates at the linac face agreed to within +/- 12% of those measured over a week, with a typical dose rate of 4.5 microSv h(-1) 2 min after the beam has stopped. The estimated maximum annual whole body dose for a treatment therapist, with the machine treating at only 18 MV, for 60000 MUs per week was 2.5 mSv. This compares well with value of 2.9 mSv published for a Clinac 21EX. A model has been derived to calculate the dose from the four dominant activation products of an ELEKTA Precise 18 MV linear accelerator. This model is a useful tool to calculate the induced dose rate around the treatment head. The model can be used to estimate the dose to the staff for typical working patterns.

Computer Simulation↗

Compatibility of Varian 2100C gated operations with enhanced dynamic wedge and IMRT dose delivery.

An enhanced dynamic wedge (EDW) is one of the latest technical innovations frequently used in the radiotherapy department. Its usage is enthusiastically supported by radiation therapists. Intensity modulated radiotherapy (IMRT) is the other, which has become popular within the past several years. Its usage is not as straightforward as the EDW. However, its ability to further increase dose conformity to the target and to spare the surrounding normal tissues has been evidenced. Both of these treatment modalities demand sophisticated software, which controls precision motion and speed of jaws or multileaf collimators as well as dose rate. This paper deals with the question of how accurately the EDW profiles and IMRT dose distributions be maintained when the additional constraint of linear accelerator gating is invoked. For this, square pulses mimicking breathing were used in gated and nongated modes for film dosimetry and ion chamber measurements using the Varian 2100C linear accelerator. The results show no observable difference between gated and nongated EDW profiles and IMRT dose distribution regardless of the machine repetition rate. Also studied in this paper are the "fuzzy" dose distributions caused by realistic finite gate window settings.

Humans↗

Dosimetric aspects of the therapeutic photon beams from a dual-energy linear accelerator.

Parameters of the photon beams (6 and 20 MV) from a dual-energy linear accelerator (Mevatron-KD, Siemens Medical Laboratories, CA) are presented. The depth dose characteristics of the photon beams are dmax of 1.8 and 3.8 cm and percentage depth dose of 68% and 80% at 10-cm depth and 100-cm source-surface distance for a field size of 10 X 10 cm2 for 6 and 20 MV, respectively. The 6 and 20 MV beams were found to correspond to nominal accelerating potentials of 4.7 and 17 MV, respectively. The stability of output is within +/- 1% and flatness and symmetry are within +/- 3%. These figures compare favorably with the manufacturer's specifications.

Humans↗

Neutron beams from protons on beryllium.

Measurements of dose rate and penetration in water have been made for neutron beams produced by 30--75 MeV protons on beryllium. The effects of Polythene filters added on the target side of the collimator have also been studied. A neutron beam comparable with a photon beam from a 4--8 MeV linear accelerator can be produced with p/Be neutrons plus 5 cm Polythene filtrations, with protons in the range 50--75 MeV. This is a more economical method than use of the d/Be reaction.

Beryllium↗

The effect of collimator backscatter radiation on photon output of linear accelerators.

The field-size dependence of the photon output of linear accelerators in air has been attributed in part to changes in the amount of radiation backscattered from the collimator jaws into the dose monitor chamber. This possible effect was investigated for a variety of accelerators with energies from 4 to 15 MV by measuring the monitor unit rate (MU/min) for different collimator openings. This measurement was made without dose rate feedback control, i.e., with constant electron beam current in the accelerator. The monitor unit rate was independent of collimator setting for all machines tested. Hence, it is concluded that backscattered radiation from the collimator jaws into the dose monitor chamber does not contribute to the variation of output with field size.

Particle Accelerators↗

Radiosurgery with unflattened 6-MV photon beams.

One of the major drawbacks to doing stereotactic radiosurgery with a linear accelerator is the long time required to deliver the target dose. Single fractions of 25 Gy delivered at the isocenter and at depth in the skull may require beam times in excess of 15 min for a typical linear accelerator with a maximum dose rate of 250 cGy/min in tissue. In an effort to decrease the treatment time for this technique, the flattening filter has been removed from an AECL Therac-6 linear accelerator and the characteristics of the resulting beam have been measured. Flatness is acceptable for the field sizes used with this technique and the dose rate is increased by a factor of 2.75.

Brain Diseases↗

Correlated histogram representation of Monte Carlo derived medical accelerator photon-output phase space.

We present a method for condensing the photon energy and angular distributions obtained from Monte Carlo simulations of medical accelerators. This method represents the output as a series of correlated histograms and as such is well-suited for inclusion as the photon-source package for Monte Carlo codes used to determine the dose distributions in photon teletherapy. The method accounts for the isocenter-plane variations of the photon energy spectral distributions with increasing distance from the beam central axis for radiation produced in the bremsstrahlung target as well as for radiation scattered by the various treatment machine components within the accelerator head. Comparison of the isocenter energy fluence computed by this algorithm with that of the underlying full-physics Monte Carlo photon phase space indicates that energy fluence errors are less than 1% of the maximum energy fluence for a range of open-field sizes. Comparison of jaw-edge penumbrae shows that the angular distributions of the photons are accurately reproduced. The Monte Carlo sampling efficiency (the fraction of generated photons which clear the collimator jaws) of the algorithm is approximately 83% for an open 10x10 field, rising to approximately 96% for an open 40x40 field. Data file sizes for a typical medical accelerator, at a given energy, are approximately 150 kB, compared to the 1 GB size of the underlying full-physics phase space file.

Computer Simulation↗

Psychiatric aspects of radiotherapy.

The authors evaluated 200 cancer patients, half of whom received betatron therapy and half linear accelerator therapy. The incidence and severity of anxiety and depression were high in both groups; as radiotherapy continued these symptoms tended to decrease in intensity among the patients treated with the linear accelerator and to increase among the betatron patients. Patients who denied knowledge of their diagnosis were initially less depressed and remained less depressed than those who knew or suspected that they had cancer.

Anxiety↗

Economics of electron beam accelerators.

Capital and operating costs for high-energy and high-power 10-MeV electron linear accelerators are presented in this article. These are compared with those for gamma-irradiation sterilization using cobalt 60. Medical sterilization processing costs for electron-beam and gamma-irradiation methods are derived as a function of plant utilization and capacity.

Costs and Cost Analysis↗

[Optimization of verification photographs in thoracic wall irradiations (so-called tangential field technique) in breast carcinoma. A short technical-methodical report].

When irradiating under high voltage condition, verification photographs prove to be difficult to take if the Gantry position is not aligned to 0 degree respectively 180 degrees, since the patient is being irradiated diagonally. Under these conditions it is extremely difficult to align the X-ray-cartridge vertically to the central beam of the therapeutic radiation. This results in, amongst others, misprojections, so that definite dimensions of portrayed organ structures become practical impossible to determine. This paper presented describes how we have solved these problems on our high voltage units (tele-gamma cobalt unit and linear-accelerator). By using simple accessories, determination of dimensions of organ structures, as shown on the verification photographs, are made possible. We illustrate our method by using the so-called tangential fields technique when irradiating mamma carcinoma.

Breast Neoplasms↗

[Accelerated irradiation of bone metastases].

In a prospective study, accelerated irradiation was performed over 60 portals in 34 tumor patients with peripheral bone metastases. During a period of three days, three daily fractions of 3 Gy each were applied with intervals of four hours, resulting in a total dose of 27 Gy. Using this fractionation schedule introduced by Ammon, a reduction of metastasis-associated pain was achieved in 90% of cases (54/60). The onset of pain reduction was observed earlier than seen with conventional fractionation schedules (five fractions of 2 Gy each per week, total dose 40 Gy). With regard to objective treatment effects, no significant difference was found between accelerated irradiation and conventional fractionation, the rate of remineralization being 43% (26/60), and the rate of stabilization of formerly progressive bone destructions being 55% (33/60). Accelerated irradiation was tolerated well usually. Marked acute side reactions occurred in only one case with metastatic involvement of joint and reaction of synovia. The major advantage of accelerated irradiation is the shortening of the total treatment period and the consequent reduction of treatment stress in patients with advanced cancer.

Adult↗

[Evaluation of the efficiency of the shaping of brehmstrahlung beams on electron accelerators].

Proceeding from analysis of the influence of parameters of the target-filter system on radiation-physical characteristics of braking radiation, some recommendations were issued for assessment of the efficacy of the forming systems of medical accelerators of electrons. A new criterion--a coefficient of the forming system efficacy--was introduced, characterizing a beam formation tract with relation to a whole set of radiotherapeutic problems.

Absorption↗

Measurements of neutron effective doses and attenuation lengths for shielding materials at the heavy-ion medical accelerator in Chiba.

The effective doses and attenuation lengths for concrete and iron were measured for the design of heavy ion facilities. Neutrons were produced through the reaction of copper, carbon, and lead bombarded by carbon ions at 230 and 400 MeV.A, neon ions at 400 and 600 MeV.A, and silicon ions at 600 and 800 MeV.A. The detectors used were a Linus and a Andersson-Braun-type rem counter and a detector based on the activation of a plastic scintillator. Representative effective dose rates (in units of 10(-8) microSv h(-1) pps(-1) at 1 m from the incident target surface, where pps means particles per second) and the attenuation lengths (in units of m) were 9.4 x 10(4), 0.46 for carbon ions at 230 MeV.A; 8.9 x 10(5), 0.48 for carbon ions at 400 MeV.A; 9.3 x 10(5), 0.48 for neon ions at 400 MeV.A; 3.8 x 10(6), 0.50 for neon ions at 600 MeV.A; 3.9 x 10(6), 0.50 for silicon ions at 600 MeV.A; and 1.1 x 10(7), 0.51 for silicon ions at 800 MeV.A. The attenuation provided by an iron plate approximately 20 cm thick (nearly equal to the attenuation length) corresponded to that of a 50-cm block of concrete in the present energy range. Miscellaneous results, such as the angular distributions of the neutron effective dose, narrow beam attenuation experiments, decay of gamma-ray doses after the bombardment of targets, doses around an irradiation room, order effects in the multi-layer (concrete and iron) shielding, the doses from different targets, the doses measured with a scintillator activation detector, the gamma-ray doses out of walls and the ratio of the response between the Andersson-Braun-type and the Linus rem counters are also reported.

Construction Materials↗

Compounds of 6Li and natural Li for EPR dosimetry in photon/neutron mixed radiation fields.

Formates and dithionates of 6Li, enriched and 7Li in natural composition of Li offer a possibility to measure the absorbed dose from photons and thermal neutrons in a mixed radiation field for instance at a boron neutron capture therapy (BNCT) facility. Tests with formates and dithionates of enriched 6Li and lithium compounds with natural composition have been performed at the BNCT facility at Studsvik, Sweden. Irradiations have been performed at 3 cm depth in a Perspex phantom in a fluence rate of thermal neutrons 1.8 x 10(9) n cm(-2) s(-1). The compounds were also irradiated in a pure X-ray field from a 4MV linear accelerator at 5 cm depth in a phantom with accurately determined absorbed doses. The signal intensity and shape was investigated within 3 h after the irradiation. A single line spectrum attributed to the CO2- radical was observed after irradiation of lithium formate. An increase in line width occurring after neutron irradiation in comparison with photon irradiation of the 6Li sample was attributed to dipolar broadening between CO2- radicals trapped in the tracks of the alpha particles. A spectrum due to the SO3- radical anion was observed after irradiation of lithium dithionate. The signal amplitude increased using the 6Li in place of the Li with natural composition of isotopes, in studies with low energy X-ray irradiation. Due to the decreased line width, caused by the difference in g(N) and I between the isotopes, the sensitivity with 6Li dithionate may be enhanced by an order of magnitude compared to alanine dosimetry. After comprehensive examination of the different combinations of compounds with different amounts of 6Li and 7Li regarding dosimetry, radiation chemistry and EPR properties these dosimeter material might be used for dose determinations at BNCT treatments and for biomedical experiments. Interesting properties of the radical formation might be visible due to the large difference in ionization density of neutrons compared to photons.

Alanine↗

Comparison of build-up dose between Elekta and Varian linear accelerators for high-energy photon beams using radiochromic film and clinical implications for IMRT head and neck treatments.

Skin toxicity has been reported for IMRT of head and neck cancer. The purpose of this study was to investigate the dose in the build-up region delivered by a 6 MV treatment plan for which important skin toxicity was observed. We also investigated if the different designs of the treatment head of an Elekta and a Varian linear accelerator, especially the lower position of the Varian multi-leaf collimator, give rise to different build-up doses. For regular square open beams, the build-up dose along the central beam axis is higher for the Varian machine than for the Elekta machine, both for 6 MV and 18 MV. At the Elekta machine at 18 MV, the superficial dose of a diamond shaped 10 x 10 cm2 field is 3.6% lower than the superficial dose of a regular 10 x 10 cm2 field. This effect is not seen at 6 MV. At the Varian machine, the superficial dose of the diamond shaped field is respectively 3.5 and 14.2% higher than the superficial dose of the regular 10 x 10 cm2 field for 6 MV and 18 MV. Despite the differences measured in build-up dose for single beams between the Elekta and the Varian linear accelerator, there were no measurable differences in superficial dose when a typical IMRT dose plan of 6 MV for a head and neck tumour is executed at the two machines.

Head and Neck Neoplasms↗

A measuring system with a recombination chamber for neutron dosimetry around medical accelerators.

A measuring system for dosimetry of neutrons generated around medical electron accelerators is proposed. The system consists of an in-phantom tissue-equivalent recombination chamber and associated electronics for automated control and data acquisition. A second ionization chamber serves as a monitor of photon radiation. Two quantities are determined by the recombination chamber--the total absorbed dose and the recombination index of radiation quality. The ambient dose equivalent, H*(10), or neutron absorbed dose in an appropriate phantom, can be then derived from the measured values. Tests of the system showed that a 0.5% dose contribution of neutrons to the absorbed dose of photons could be detected and estimated under laboratory conditions. Preliminary tests at the 15 MV Varian Clinac 2300C/D medical accelerator confirmed that the measuring system could be used under clinical conditions. The H*(10) of the mixed radiation was determined with an accuracy of approximately 10%.

Body Burden↗

Measurements of radionuclides induced in the accelerator structure of the KEK-PS.

Radionuclides induced in accelerator structures were measured during each long shut-down by using a pure Ge detector and a portable multichannel pulse height analyzer. Variation in the nuclide composition for various points in the accelerator tunnel was investigated. The decay of the exposure rate was calculated using the measured nuclide composition. Radionuclide measurements of the vacuum chamber removed from the accelerator were also performed. The relation between the variation of the residual exposure rate and that of the nuclide composition was examined and it was found that the proportion of 48V, 54Mn and 56Co corresponds to variation in the beam loss pattern.

Particle Accelerators↗

Room scattered neutrons.

A method of evaluating the photoneutron fluence in the maze of accelerator facilities due to room scattered neutrons is presented. Measurements were made to demonstrate that the room scattered fluence is reduced by a factor of 2pi in going from the treatment room to the inner maze entrance.

Gamma Rays↗