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Study of the neutron beam line shield design for JSNS.

The JSNS, a spallation neutron source of J-PARC (JAERI-KEK Joint Project of the High Intensity Proton Accelerator) has 23 neutron beam lines. In the present study, a database was formulated for an optimum shielding design using the MCNP-X code. The calculations involved two steps. In the first step, the neutron distributions were created in the typical neutron beam line with a model that included the spallation neutron source target. The neutron currents evaluated flowed from the duct into the duct wall which was the boundary source for the bulk shield surrounding the beam line. In the second step, bulk-shield calculations were performed for the various shielding materials (iron, concrete, heavy concrete and so on) used and their composites up to thicknesses of 3 m. The results were compared with each other. Composite material shields of iron and such hydrogeneous materials as polyethylene or concrete were more effective. A typical design was prepared for a beam line within 25 m distance from a moderator, as a sample.

Computer Simulation↗

Shielding design of a treatment room for an accelerator-based epithermal neutron irradiation facility for BNCT.

Protecting the facility personnel and the general public from radiation exposure is a primary safety concern of an accelerator-based epithermal neutron irradiation facility. This work makes an attempt at answering the questions "How much?" and "What kind?" of shielding will meet the occupational limits of such a facility. Shielding effectiveness is compared for ordinary and barytes concretes in combination with and without borated polyethylene. A calculational model was developed of a treatment room , patient "scatterer," and the epithermal neutron beam. The Monte Carlo code, MCNP, was used to compute the total effective dose equivalent rates at specific points of interest outside of the treatment room. A conservative occupational effective dose rate limit of 0.01 mSv h-1 was the guideline for this study. Conservative Monte Carlo calculations show that constructing the treatment room walls with 1.5 m of ordinary concrete, 1.2 m of barytes concrete, 1.0 m of ordinary concrete preceded by 10 cm of 5% boron-polyethylene, or 0.8 m of barytes concrete preceded by 10 cm of 5% boron-polyethylene will adequately protect facility personnel.

Boron Neutron Capture Therapy↗

Wedge factor dependence on depth and field size for various beam energies using symmetric and half-collimated asymmetric jaw settings.

The depth- and field-size dependence of the in-phantom wedge factor have been determined for a Cobalt-60 (Co-60) teletherapy unit and four medical linear accelerators with 4-, 6-, 10-, and 18-MV x-ray beams containing 15 degrees-60 degrees (nominal) lead, brass, and steel wedge filters. Measurements were made with ionization chambers in solid water or water with a source-skin distance of 80 or 100 cm. Field sizes varied from 4 x 4 cm up to a maximum allowable size for each wedge filter. Measurements were performed for symmetric and half-collimated asymmetric fields at depth of maximum dose, 5- and 10-cm depths. For half-collimated fields, wedge factor reference points were located at a fixed off-axis distance from the collimator's rotational axis. These systematic measurements on wedges indicate that the wedge factor dependence on depth and field size is a function of beam energy as well as the design of the treatment head and wedge filters. Significance of the results reported herein are discussed for the most commonly used treatment depths and field sizes with various beam energies and wedge filters.

Cobalt Radioisotopes↗

X-ray surface dose measurements using TLD extrapolation.

Surface dose measurements in therapeutic x-ray beams are of importance in determining the dose to the skin of patients undergoing radiotherapy. Measurements were performed in the 6-MV beam of a medical linear accelerator with LiF thermoluminescence dosimeters (TLD) using a solid water phantom. TLD chips (surface area 3.17 x 3.17 cm2) of three different thicknesses (0.230, 0.099, and 0.038 g/cm2) were used to extrapolate dose readings to an infinitesimally thin layer of LiF. This surface dose was measured for field sizes ranging from 1 x 1 cm2 to 40 x 40 cm2. The surface dose relative to maximum dose was found to be 10.0% for a field size of 5 x 5 cm2, 16.3% for 10 x 10 cm2, and 26.9% for 20 x 20 cm2. Using a 6-mm Perspex block tray in the beam increased the surface dose in these fields to 10.7%, 17.7%, and 34.2% respectively. Due to the small size of the TLD chips, TLD extrapolation is applicable also for intracavity and exit dose determinations. The technique used for in vivo dosimetry could provide clinicians information about the build up of dose up to 1-mm depth in addition to an extrapolated surface dose measurement.

Electrons↗

Megavoltage imaging with low Z targets: implementation and characterization of an investigational system.

The poor quality of stereotactic radiotherapy portal images is a limiting factor in precise image registration. To alleviate this problem, a low atomic number (Z) target was implemented on our Siemens MXE linear accelerator. This investigational system was used to assess the performance of various target materials by filming an aluminum contrast object. Beryllium, carbon and conventional target materials were studied. The bremsstrahlung spectra of these materials were simulated using Monte Carlo techniques. These spectra were used to calculate the dependence of narrow beam contrast on phantom thickness for verification of the data measured from film. A Monte Carlo simulation of the beryllium spectrum in a wide beam geometry was used to evaluate the effect of phantom-to-film distance on contrast. Although the same degree of contrast improvement with distance was not realized in practice, the improvement in image quality rivaled that achieved using a scatter reduction grid. A comparison of conventional localization images of the head and neck of an anthropomorphic phantom with images produced with a beryllium or carbon target and a mammography film and screen system supports earlier suggestions that the technique is clinically useful.

Biophysical Phenomena↗

Image-guided radiosurgery in the treatment of spinal metastases.

OBJECT: The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. METHODS: Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of framebased skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. CONCLUSIONS: These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

Aged↗

Dose distribution considerations of medium energy electron beams at extended source-to-surface distance.

PURPOSE: To determine the effects of extended source-to-surface distance (SSD) on dose distributions for a range of medium energy electron beams and cone sizes. METHODS AND MATERIALS: The depth-dose curves and isodose distributions of 6 MeV, 10 MeV, and 14 MeV electron beams from a dual photon and multielectron energies linear accelerator were studied. To examine the influence of cone size, the smallest and the largest cone sizes available were used. Measurements were carried out in a water phantom with the water surface set at three different SSDs from 101 to 116 cm. RESULTS: In the region between the phantom surface and the depth of maximum dose, the depth-dose decreases as the SSD increases for all electron beam energies. The effects of extended SSD in the region beyond the depth of maximum dose are unobservable and, hence, considered minimal. Extended SSD effects are apparent for higher electron beam energy with small cone size causing the depth of maximum dose and the rapid dose fall-off region to shift deeper into the phantom. However, the change in the depth-dose curve is small. On the other hand, the rapid dose fall-off region is essentially unaltered when the large cone is used. The penumbra enlarges and electron beam flatness deteriorates with increasing SSD.

Electrons↗

Wide dynamic dose range of VIPAR polymer gel dosimetry.

In this work the extent of the linear dose response and the dynamic dose range of N-vinylpyrrolidone-argon based (VIPAR) polymer gels were investigated. VIPAR gels were irradiated using a 6 MV linear accelerator up to 60 Gy and a Nucletron microSelectron 192Ir HDR brachytherapy source to much higher doses to cover a dose range of two orders of magnitude. They were then MR scanned at 1.5 T to obtain T2-maps. VIPAR gel measurements obtained from the two irradiation regimes were calibrated against ion chamber measurements and dose calculations derived using the AAPM TG-43 protocol respectively. A satisfying agreement between the calibration results derived using the 6 MV x-rays and the 192Ir source was found for doses up to 60 Gy, implying that the response of the VIPAR gels is independent of photon energy and dose rate. A linear R2 dose response up to approximately 40 Gy and a dynamic dose range up to at least approximately 250 Gy were observed. VIPAR gel dose measurements derived using the monoexponentially fitted brachytherapy calibration data were found to be quite accurate.

Algorithms↗

Properties of unflattened photon beams shaped by a multileaf collimator.

Several studies have shown that removal of the flattening filter from the treatment head of a clinical accelerator increases the dose rate and changes the lateral profile in radiation therapy with photons. However, the multileaf collimator (MLC) used to shape the field was not taken into consideration in these studies. We therefore investigated the effect of the MLC on flattened and unflattened beams. To do this, we performed measurements on a Varian Clinac 21EX and MCNPX Monte Carlo simulations to analyze the physical properties of the photon beam. We compared lateral profiles, depth dose curves, MLC leakages, and total scatter factors for two energies (6 and 18 MV) of MLC-shaped fields and jaw-shaped fields. Our study showed that flattening filter-free beams shaped by a MLC differ from the jaw-shaped beams. Similar differences were also observed for flattened beams. Although both collimating methods produced identical depth dose curves, the penumbra size and the MLC leakage were reduced in the softer, unflattened beam and the total scatter factors showed a smaller field size dependence.

Computer Simulation↗

Effects of changes in stopping-power ratios with field size on electron beam relative output factors.

Stopping-power ratios are a function of field size and vary with accelerators. To investigate how these variations affect relative output factor measurements made using ion chambers for electron beams, especially for small fields, (L/rho)air(water) is calculated using the Monte Carlo technique for different field sizes, beam energies, and accelerators and is compared to the data in TG-21 or TG-25, which are for mono-energetic broad beams. For very small field sizes defined by cutouts, if the change in (L/rho)air(water) with dmax is ignored (i.e., TG-25 is not carefully followed), there is an overestimate of relative output factors by up to 3%. Ignoring the field-size effect on stopping-power ratio adds an additional overestimate of up to one-half percent, and using mono-energetic stopping-power ratio data instead of realistic beam data gives another error, but in the opposite direction, of up to 0.7%. Due to the cancellation of these latter two errors, following TG-25 with (L/rho)air(water) data for broad mono-energetic beams will give the correct answer for the ROF measurement within 0.4% compared to using (L/rho)air(water) data for which the field-size effect is considered for realistic electron beams.

Biophysical Phenomena↗

Three dimensional image correlation of CT, MR, and PET studies in radiotherapy treatment planning of brain tumors.

A treatment planning system for stereotactic convergent beam irradiation of deeply localized brain tumors is reported. The treatment technique consists of several moving field irradiations in noncoplanar planes at a linear accelerator facility. Using collimated narrow beams, a high concentration of dose within small volumes with a dose gradient of 10-15%/mm was obtained. The dose calculation was based on geometrical information of multiplanar CT or magnetic resonance (MR) imaging data. The patient's head was fixed in a stereotactic localization system, which is usable at CT, MR, and positron emission tomography (PET) installations. Special computer programs for correction of the geometrical MR distortions allowed a precise correlation of the different imaging modalities. The therapist can use combinations of CT, MR, and PET data for defining target volume. For instance, the superior soft tissue contrast of MR coupled with the metabolic features of PET may be a useful addition in the radiation treatment planning process. Furthermore, other features such as calculated dose distribution to critical structures can also be transferred from one set of imaging data to another and can be displayed as three-dimensional shaded structures.

Brain↗

Measured electron energy and angular distributions from clinical accelerators.

Electron energy spectra and angular distributions, including angular spreads, were measured using magnetic spectrometer techniques, at isocenter, for two clinical linear accelerators: one scanning beam machine, which achieves field flatness by scanning a pencil beam over the desired field at the patient plane, and one scattering foil machine, which disperses the electrons through a graded-thickness scattering foil. All measurements were made at isocenter (in the patient plane), in air, 1 m from the nominal accelerator source. The energy measurements were confined to electrons traveling along the central axis; any widely scattered electrons were effectively neglected. The energy spectra of the scanning beam machine are all of nearly Gaussian shape and energy full-width-at-half-maximum intensity (FWHM) of about 5% of the peak mean energy (denoted (E0)*). The energy spectra of the scattering foil machine have a variety of forms as a function of energy, including even spectra with double peaks, and spectra which changed with time. The FWHM values ranged from 9%-22% of (E0)*. The angular spread measurements, at isocenter, yielded sigma theta (x) x (E0)* approximately 295 mrad-MeV for the scanning beam machine, and 346 mrad-MeV for the scattering foil machine, where sigma theta x denotes the standard deviation of the plane-projected angular distribution. These angular spreads are 30%-40% smaller than angular spreads reported by others on a very similar machine using the penumbra method. Possible causes of this discrepancy are discussed.

Electrons↗

Linear accelerator and Greitz-Bergstrom's head fixation system in radiosurgery of single cerebral metastases. A report of 86 cases.

Between 1984 and 1991 86 patients with single cerebral metastases underwent linear accelerator radiosurgery using the atraumatic and reproducible Greitz-Bergström head-fixation device. Routine one-month follow-up documented disappearance of the tumour in 16 patients, with resolution of the oedema and ventricular shift. Shrinkage of the metastasis occurred in 51 patients. In 9 patients the tumour remained stable, in 7 there was progression of tumour size. Among the patients showing shrinkage of the tumour or unchanged tumour volume, repeated radiosurgery resulted in disappearance of the metastasis in 5 and further shrinkage in 28. In 14 patients routine stereotactic CT follow-up study led to the detection of a new metastasis, again treated with excellent results. Local recurrence occurred in 2 patients and radiation necrosis in the target area in 5 patients. Radiosurgery thus proves to be an appropriate alternative to surgery. The versatility of our non-invasive and painless method permits CT staging (which we consider essential) without hospitalization of the patient.

Adult↗

Scanned intensity modulations for 50 MV photons.

Optimization of the dose distributions by individual beam compensation is a useful tool in conformal radiation therapy. Intensity modulation by electromagnetic scanning of a narrow elementary beam allows fast dose delivery and causes little change in beam quality compared with other methods, especially for high energies such as 50 MV. Intensity modulated beams from the MM50 accelerator were measured and compared with calculations based on Monte Carlo simulations. Good agreement between measurements and calculations were found, typically within 1% for central dose profiles. The steepest wedge angle that was produced with the scanning beam technique was of 45 degrees or 3.5% cm(-1) for a 20 cm x 20 cm field, slightly varying with depth. The elementary 50 MV photon 'pencil beam' for a full range, high-z bremsstrahlung target, is a wide dose distribution at 10 cm depth in water which limits the modulation gradient and hence the complexity of the modulation by the scanning of a photon pencil beam only. Scanned wedge beam distributions were modelled in the treatment planning system and a pelvic treatment with three fields was used to illustrate a clinical application. The resulting dose volume data were compared for different radiation qualities but with similar beam portals. 'Energy modulation' by field matching with lower photon energies was performed to sharpen the penumbra towards organs at risk.

Electromagnetic Fields↗

Dynamic stereotactic radiosurgery using a linear accelerator.

We describe a system for stereotactic radiosurgery with a linear accelerator. This technique allows treatment of small (less than 40 mm diameter) intracranial lesions, including vascular malformations, and primary and metastatic tumors that are deep within the brain or in areas not amenable to open surgery. A beam of ionizing radiation (1800 to 2500 cGy) is focused on the center of the lesion, which is determined by stereotactic localization. "Dynamic rotation" of the linac gantry and table continuously about this predetermined point ensures that only the lesion receives the full radiation dose, while the normal structures in the head receive minimal amounts of radiation. The system combines, for the first time in one place, elements of radiosurgical technique developed at various centers. Testing for accuracy compares favorably with results at other centers using linac-based systems as well as comparing favorably with the gamma knife.

Brain Neoplasms↗

An empirical formula for calculating the output factors of electron beams from a therac 20 linear accelerator.

A polynomial formula, deduced from the data published by Mills et al. [Med. Phys. 12, 473 (1985)], in predicting the relative electron beam output factors, is presented in this report. This formula contains four parameters. By choosing four measured output factors, from four field sizes normalized at the field size of (10,10), the values of these parameters can be determined. A comparison of the factors predicted with this formula and the values measured by Mills et al. shows that the differences between the field sizes of (4,4) to (30,30) are 0.5% or less in 31 out of 35 field sizes. All the 35 field sizes are within 1% for an electron beam of 20 MeV. With 6-MeV electron beams, the differences are 0.5% or less in 26 out of 35 field sizes, and 1% or less in 31 out of 35 field sizes. Those having differences greater than 1% have either a small field size (5 cm) or a large field size (20 cm). Considering that this formula requires only four accurately measured relative output factors, one can predict the factors of any field within an acceptable accuracy. The calculation is easy with a scientific hand calculator. This formula provides major improvement over the other methods which require many measurements to be taken in order to interpolate with acceptable accuracy.

Humans↗

Characteristics of a spoiled 6-MV beam from a dual-energy linear accelerator.

A beam spoiler for a 6-MV x-ray beam was designed and spoiled beam dosimetry performed. The spoiled beam quality was similar to that of the unspoiled beam. The percentage depth doses at 5 mm were at least 90% for all field sizes except 4 x 4 cm, while the surface dose at 0 mm varied from 22.5% for a 4 x 4-cm field to 85.8% for a 22 x 22-cm field. The spoiled beam showed degraded beam flatness for small field size at superficial depths; the beam flatness at 6 mm for a 4 x 4-cm field was +/- 9.0%. The beam flatness improved as the field size increased, e.g., at same depth, the beam flatness was +/- 2.5% for a 22 x 22-cm field. The penumbra width (90%-10%) of the spoiled beam was greater than that of the unspoiled beam for all field sizes and at all depths; e.g., at 0-mm depth, for a 22 x 22-cm field, the penumbra width was 3.8 cm for the unspoiled beam and 7.2 cm for the spoiled beam. Beyond dmax the difference in the penumbra widths between the spoiled and unspoiled beam was about 3-4 mm for all field sizes and at all depths. The peripheral dose was larger for the spoiled beam.

Humans↗

Preliminary results of concomitant radiotherapy and chemotherapy in advanced cervical carcinoma.

Ten patients with advanced and previously untreated squamous cell carcinoma of the cervix were treated with a synchronous course of radiotherapy (RT) and chemotherapy (CT). RT consisted of 3600 to 4500 cGy external pelvic treatments on a 6-MeV linear accelerator followed by two intracavitary applications administering a total of 4000 mg hr of radium equivalent cesium. CT consisted of a course of mitomycin C (10 mg/m2 iv bolus) and 5-fluorouracil (5FU; 1000 mg/m2/24 hr for 96 hr) during the second week of external RT and another course of cis-platinum (CDDP; 75 mg/m2, 1-6 hr infusion) and 5FU (1000 mg/m2/24 hr for 96 hr) during the first intracavitary cesium application. Toxicity was acceptable and complete clinical response was obtained in all patients at the end of the regimen. Nine patients are alive (eight without disease) 6 to 37 months following initiation of treatment (median 20 months). One patient has developed lumbar spine bone metastases and another died of local and pulmonary disease at 28 months. This combination of 5FU/mitomycin C/CDDP and RT appears to be a practical, well-tolerated, and highly effective regimen for advanced cervical carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗