[en] Neutron production is an unwanted result of high-energy radiation therapy and results in secondary exposure of patients and radiation therapists to radiation. Recent studies have shown that delivering therapy using a standard medical accelerator with the flattening filter removed may reduce neutron fluence by nearly 70% over the course of prostate intensity-modulated radiation therapy (IMRT). In the current study, the ¹⁹⁷Au Bonner sphere technique was used to compare the neutron spectrum produced when the filter is present and when it is absent. In addition, the following was calculated: (1) the neutron-shielding parameters of source strength and ambient dose equivalent (H₀) and (2) using the Monte Carlo technique, the sources of neutron production in the accelerator head. It was found that the neutron spectrum was nearly constant, regardless of the presence of the flattening filter; however, the total fluence and ambient dose equivalent over the course of prostate IMRT were more than 70% lower when the filter was removed. Similarly, shielding parameters were lower when the filter was removed. Finally, the primary collimator and jaws accounted for the majority of neutron production, both with and without the flattening filter; however, with the flattening filter removed, the upper jaw accounted for much more neutron production relative to when the filter was present. Ultimately, removal of the flattening filter may offer several clinical advantages, including a reduction in the dose from neutrons to the patient and to radiation personnel

[en] In conventional clinical linear accelerators, the flattening filter scatters and absorbs a large fraction of primary photons. Increasing the beam-on time, which also increases the out-of-field exposure to patients, compensates for the reduction in photon fluence. In recent years, intensity modulated radiation therapy has been introduced, yielding better dose distributions than conventional three-dimensional conformal therapy. The drawback of this method is the further increase in beam-on time. An accelerator with the flattening filter removed, which would increase photon fluence greatly, could deliver considerably higher dose rates. The objective of the present study is to investigate the dosimetric properties of 6 and 18 MV photon beams from an accelerator without a flattening filter. The dosimetric data were generated using the Monte Carlo programs BEAMnrc and DOSXYZnrc. The accelerator model was based on the Varian Clinac 2100 design. We compared depth doses, dose rates, lateral profiles, doses outside collimation, total and collimator scatter factors for an accelerator with and without a flatteneing filter. The study showed that removing the filter increased the dose rate on the central axis by a factor of 2.31 (6 MV) and 5.45 (18 MV) at a given target current. Because the flattening filter is a major source of head scatter photons, its removal from the beam line could reduce the out-of-field dose

[en] 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

[en] Basic dosimetric properties of 6 MV and 18 MV photon beams from a Varian Clinac 21EX accelerator operating without the flattening filter have been measured. These include dose rate data, depth dose dependencies and lateral profiles in a water phantom, total scatter factors and transmission factors of a multileaf collimator. The data are reviewed and compared with measurements for the flattened beams. The unflattened beams have the following: a higher dose rate by factors of 2.3 (6 MV) and 5.5 (18 MV) on the central axis; lower out-of-field dose due to reduced head scatter and softer spectra; less variation of the total scatter factor with field size; and less variation of the shape of lateral dose profiles with depth. The findings suggest that with a flattening filter free accelerator better radiation treatments can be developed, with shorter delivery times and lower doses to normal tissues and organs

[en] Our purpose in this work was to validate a very detailed Monte Carlo model, developed in MCNPX, of a Millennium 120 multileaf collimator integrated into a Varian Clinac 21EX treatment head. The Monte Carlo results were compared with measurements for both the 6-MV and 18-MV photon modes. The following comparisons were performed: depth-dose curves, lateral profiles, multileaf collimator leakage, the tongue-and-grove test, and the round leaf-end test. The good agreement between the Monte Carlo simulations and measurements showed that our model is accurate. Consequently, the benchmarks provided by our study can be used in future Monte Carlo studies

[en] As a proton-therapy beam passes through the field-limiting aperture, some of the protons are scattered off the edges of the collimator. The edge-scattered protons can degrade the dose distribution in a patient or phantom, and these effects are difficult to model with analytical methods such as those available in treatment planning systems. The objective of this work was to quantify the dosimetric impact of edge-scattered protons for a representative variety of clinical treatment beams. The dosimetric impact was assessed using Monte Carlo simulations of proton beams from a contemporary treatment facility. The properties of the proton beams were varied, including the penetration range (6.4-28.5 cm), width of the spread-out Bragg peak (SOBP; 2-16 cm), field size (3 x 3 cm² to 15 x 15 cm²) and air gap, i.e. the distance between the collimator and the phantom (8-48 cm). The simulations revealed that the dosimetric impact of edge-scattered protons increased strongly with increasing range (dose increased by 6-20% with respect to the dose at the center of the spread-out Bragg peak), decreased strongly with increasing field size (dose changed by 2-20%), increased moderately with increasing air gap (dose increased by 2-6%) and increased weakly with increasing SOBP width (dose change <4%). In all cases examined, the effects were largest at shallow depths. We concluded that the dose deposited by edge-scattered protons can distort the dose proximal to the target with varying contributions due to the proton range, treatment field size, collimator position and thickness, and width of the SOBP. Our findings also suggest that accurate predictions of dose per monitor-unit calculations may require taking into account the dose from protons scattered from the edge of the patient-specific collimator, particularly for fields of small lateral size and deep depths

[en] The purpose of this work was to provide an initial validation of a Monte Carlo (MC) model of the passive scattering treatment nozzle at University of Texas M. D. Anderson Cancer Center Proton Therapy Center. The MC model included a detailed definition of each beam-modifying element in the nozzle, and calculations accounted for interactions of the beam with the rotating modulator wheel used to create the spread out Bragg peak. In this work we show comparisons of calculated dose and fluence profiles with measured data from the nozzle for the 250 and 180 MeV beam energies used for patient treatments. Agreement to within 1.5 mm of measured data was observed for all MC calculations. The high level of agreement between the measurements and the MC model for the two beam energies studied provides validation for use of the model in a study of the dosimetric effects of the proton beam size and shape at the nozzle entrance

[en] Density heterogeneities in the path of proton beams are known to cause degradation of the Bragg peak and, thus, widening of its distal fall-off. Inadequate accounting for this effect may lead to unwanted dose delivered to normal tissue distal to the target volume. In low-density regions, such as the thorax, this may lead to large volumes of healthy tissue receiving unnecessary dose. Although it is known that multiple Coulomb scattering within the density heterogeneities is the main cause of Bragg peak degradation, no systematic attempt has been made to quantify the contribution of multiple Coulomb scattering and nuclear scattering. Through a systematic study using a 220 MeV proton beam, we show that nuclear scattering contributes to about 5% of the distal fall-off width and is only slightly dependent on heterogeneity complexity. Furthermore, we also show that the energy spectra of the proton fluence downstream of various heterogeneity volumes are well correlated with the Bragg peak distal fall-off widths. Based on this correlation, a novel method for predicting distal fall-offs is suggested. This method is tested for three clinical setups of a voxelized model of a human head based on computer tomography data. Results are within 3% of the distal fall-off values obtained using Monte Carlo simulations

[en] Proton beam radiotherapy exposes healthy tissue to stray radiation emanating from the treatment unit and secondary radiation produced within the patient. These exposures provide no known benefit and may increase a patient's risk of developing a radiogenic second cancer. The aim of this study was to explore strategies to reduce stray radiation dose to a patient receiving a 76 Gy proton beam treatment for cancer of the prostate. The whole-body effective dose from stray radiation, E, was estimated using detailed Monte Carlo simulations of a passively scattered proton treatment unit and an anthropomorphic phantom. The predicted value of E was 567 mSv, of which 320 mSv was attributed to leakage from the treatment unit; the remainder arose from scattered radiation that originated within the patient. Modest modifications of the treatment unit reduced E by 212 mSv. Surprisingly, E from a modified passive-scattering device was only slightly higher (109 mSv) than from a nozzle with no leakage, e.g., that which may be approached with a spot-scanning technique. These results add to the body of evidence supporting the suitability of passively scattered proton beams for the treatment of prostate cancer, confirm that the effective dose from stray radiation was not excessive, and, importantly, show that it can be substantially reduced by modest enhancements to the treatment unit

[en] In scanned-beam proton therapy, the beam spot properties, such as the lateral and longitudinal size and the minimum achievable range, are influenced by beam optics, scattering media and drift spaces in the treatment unit. Currently available spot scanning systems offer few options for adjusting these properties. We investigated a method for adjusting the lateral and longitudinal spot size that utilizes downstream plastic pre-absorbers located near a water phantom. The spot size adjustment was characterized using Monte Carlo simulations of a modified commercial scanned-beam treatment head. Our results revealed that the pre-absorbers can be used to reduce the lateral full width at half maximum (FWHM) of dose spots in water by up to 14 mm, and to increase the longitudinal extent from about 1 mm to 5 mm at residual ranges of 4 cm and less. A large factor in manipulating the lateral spot sizes is the drift space between the pre-absorber and the water phantom. Increasing the drift space from 0 cm to 15 cm leads to an increase in the lateral FWHM from 2.15 cm to 2.87 cm, at a water-equivalent depth of 1 cm. These findings suggest that this spot adjustment method may improve the quality of spot-scanned proton treatments.