Characteristics of photon beams from Philips SL25 linear accelerators

Verification of field match lines in whole breast radiation therapy using Cherenkov imaging

PURPOSE

In mono-isocentric radiation therapy treatment plans designed to treat the whole breast and supraclavicular lymph nodes, the fields meet at isocenter, forming the match line. Insufficient coverage at the match line can lead to recurrence, and overlap over weeks of treatment can lead to increased risk of healthy tissue toxicity. Cherenkov imaging was used to assess the accuracy of delivery at the match line and identify potential incidents during patient treatments.

METHODS AND MATERIALS

A controlled calibration was constructed from the deconvolved Cherenkov images from the delivery of a modified patient treatment plan to an anthropomorphic phantom with introduced separation and overlap. The trend from this calibration was then used to evaluate the field match line for accuracy and inter-fraction consistency for two patients.

RESULTS

The intersection point between matching field profiles was directly correlated to the distance (gap/overlap) between the fields (anthropomorphic phantom R² = 0.994 "breath hold" and R² = 0.990 "free breathing"). The profile intersection points from two patients' imaging sessions yielded an average of +1.40 mm offset (overlap) and -1.32 mm offset (gap), thereby introducing roughly a 25.0% over-dose and a -23.6% under-dose (R² = 0.994).

CONCLUSIONS

This study shows that field match regions can be detected and quantified by taking deconvolved Cherenkov images and using their product image to create steep intensity gradients, causing match lines to stand out. These regions can then be quantitatively translated into a dose consequence. This approach offers a high sensitivity detection method which can quantify match line variability and errors in vivo.

Reference dosimetry data and modeling challenges for Elekta accelerators based on IROC-Houston site visit data

PURPOSE

Reference dosimetry data can provide an independent second check of acquired values when commissioning or validating a treatment planning system (TPS). The Imaging and Radiation Oncology Core at Houston (IROC-Houston) has measured numerous linear accelerators throughout its existence. The results of those measurements are given here, comparing accelerators and the agreement of measurement versus institutional TPS calculations.

METHODS

Data from IROC-Houston on-site reviews from 2000 through 2014 were analyzed for all Elekta accelerators, approximately 50. For each, consistent point dose measurements were conducted for several basic parameters in a water phantom, including percentage depth dose, output factors, small-field output factors, off-axis factors, and wedge factors. The results were compared by accelerator type independently for 6, 10, 15, and 18 MV. Distributions of the measurements for each parameter are given, providing the mean and standard deviation. Each accelerator's measurements were also compared to its corresponding TPS calculation from the institution to determine the level of agreement, as well as determining which dosimetric parameters were most often in error.

RESULTS

Accelerators were grouped by head type and reference dosimetric values were compiled. No class of linac had better overall agreement with its TPS, but percentage depth dose and output factors commonly agreed well, while small-field output factors, off-axis factors, and wedge factors often disagreed substantially from their TPS calculations.

CONCLUSION

Reference data has been collected and analyzed for numerous Elekta linacs, which provide an independent way for a physicist to double-check their own measurements to prevent gross treatment errors. In addition, treatment planning parameters more often in error have been highlighted, providing practical caution for physicists commissioning treatment planning systems for Elekta linacs.

Decoupling initial electron beam parameters for Monte Carlo photon beam modelling by removing beam-modifying filters from the beam path

A new method is presented to decouple the parameters of the incident e(-) beam hitting the target of the linear accelerator, which consists essentially in optimizing the agreement between measurements and calculations when the difference filter, which is an additional filter inserted in the linac head to obtain uniform lateral dose-profile curves for the high energy photon beam, and flattening filter are removed from the beam path. This leads to lateral dose-profile curves, which depend only on the mean energy of the incident electron beam, since the effect of the radial intensity distribution of the incident e- beam is negligible when both filters are absent. The location of the primary collimator and the thickness and density of the target are not considered as adjustable parameters, since a satisfactory working Monte Carlo model is obtained for the low energy photon beam (6 MV) of the linac using the same target and primary collimator. This method was applied to conclude that the mean energy of the incident e- beam for the high energy photon beam (18 MV) of our Elekta SLi Plus linac is equal to 14.9 MeV. After optimizing the mean energy, the modelling of the filters, in accordance with the information provided by the manufacturer, can be verified by positioning only one filter in the linac head while the other is removed. It is also demonstrated that the parameter setting for Bremsstrahlung angular sampling in BEAMnrc ('Simple' using the leading term of the Koch and Motz equation or 'KM' using the full equation) leads to different dose-profile curves for the same incident electron energy for the studied 18 MV beam. It is therefore important to perform the calculations in 'KM' mode. Note that both filters are not physically removed from the linac head. All filters remain present in the linac head and are only rotated out of the beam. This makes the described method applicable for practical usage since no recommissioning process is required.

Comparison of characteristics of photon and electron beams generated by Philips/Elekta and Varian linear accelerators

Commissioning data of the common energy of 6 MV photon beams are analyzed for seven Philips/ Elekta linacs of five different models: SL 75/5, SL 15, SL 25, SLi Precise, and SLi. The observed beam quality %dd(10)x of 67.7% +/- 0.3 agrees with the manufacturer's specification of 67.5% +/- 2% but with a much smaller variation, suggesting the possibility of a more accurate beam quality guideline for acceptance commissioning of these linac models. Field size factors are less uniform, especially for the biggest field size of 40 x 40 cm2, but all agree within 1.1% between the five models. These 6 MV photon beams are also shown to be 0.4 MV harder than the Varian 2100C model. For commissioning electron beams generated by the Philips/Elekta models SL 15, SLi Precise and SLi, guidelines can be found from this work for the following parameters: actual field size at 100 SSD (up to +/- 0.6%) (different from manufacturer specified values at 95 SSD), and virtual source distance (up to +/- 0.7%). Significant differences are seen for R50 (up to 3.7 mm), sigma-theta-x, effective source distance, and cone size factor. However, except for R50 where Varian 2100C datasets are not available for comparison, the differences between the different Philips/Elekta models are comparable to those between the same Varian 2100C model linacs measured by us and Watts.

Monte Carlo calculation of nine megavoltage photon beam spectra using the BEAM code

A recent paper analyzed the sensitivity to various simulation parameters of the Monte Carlo simulations of nine beams from three major manufacturers of commercial medical linear accelerators, ranging in energy from 4-25 MV. In this work the nine models are used: to calculate photon energy spectra and average energy distributions and compare them to those published by Mohan et al. [Med. Phys. 12, 592-597 (1985)]; to separate the spectra into primary and scatter components from the primary collimator, the flattening filter and the adjustable collimators; and to calculate the contaminant-electron fluence spectra and the electron contribution to the depth-dose curves. Notwithstanding the better precision of the calculated spectra, they are similar to those calculated by Mohan et al. The three photon spectra at 6 MV from the machines of three different manufacturers show differences in their shapes as well as in the efficiency of bremsstrahlung production in the corresponding target and filter combinations. The contribution of direct photons to the photon energy fluence in a 10 x 10 field varies between 92% and 97%, where the primary collimator contributes between 0.6% and 3.4% and the flattening filter contributes between 0.6% and 4.5% to the head-scatter energy fluence. The fluence of the contaminant electrons at 100 cm varies between 5 x 10(-9) and 2.4 x 10(-7) cm(-2) per incident electron on target, and the corresponding spectrum for each beam is relatively invariant inside a 10 x 10 cm2 field. On the surface the dose from electron contamination varies between 5.7% and 11% of maximum dose and, at the depth of maximum dose, between 0.16% and 2.5% of maximum dose. The photon component of the percentage depth-dose at 10 cm depth is compared with the general formula provided by AAPM's task group 51 and confirms the claimed accuracy of 2%.

Sensitivity of megavoltage photon beam Monte Carlo simulations to electron beam and other parameters

The BEAM code is used to simulate nine photon beams from three major manufacturers of medical linear accelerators (Varian, Elekta, and Siemens), to derive and evaluate estimates for the parameters of the electron beam incident on the target, and to study the effects of some mechanical parameters like target width, primary collimator opening, flattening filter material and density. The mean energy and the FWHM of the incident electron beam intensity distributions (assumed Gaussian and cylindrically symmetric) are derived by matching calculated percentage depth-dose curves past the depth of maximum dose (within 1% of maximum dose) and off-axis factors (within 2sigma at 1% statistics or less) with measured data from the AAPM RTC TG-46 compilation. The off-axis factors are found to be very sensitive to the mean energy of the electron beam, the FWHM of its intensity distribution, its angle of incidence, the dimensions of the upper opening of the primary collimator, the material of the flattening filter and its density. The off-axis factors are relatively insensitive to the FWHM of the electron beam energy distribution, its divergence and the lateral dimensions of the target. The depth-dose curves are sensitive to the electron beam energy, and to its energy distribution, but they show no sensitivity to the FWHM of the electron beam intensity distribution. The electron beam incident energy can be estimated within 0.2 MeV when matching either the measured off-axis factors or the central-axis depth-dose curves when the calculated uncertainties are about 0.7% at the 1 sigma level. The derived FWHM (+/-0.1 mm) of the electron beam intensity distributions all fall within 1 mm of the manufacturer specifications except in one case where the difference is 1.2 mm.

Determining clinical photon beam spectra from measured depth dose with the Cimmino algorithm

A method to determine the spectrum of a clinical photon beam from measured depth-dose data is described. At shallow depths, where the range of Compton-generated electrons increases rapidly with photon energy, the depth dose provides the information to discriminate the spectral contributions. To minimize the influence of contaminating electrons, small (6 x 6 cm2) fields were used. The measured depth dose is represented as a linear combination of basis functions, namely the depth doses of monoenergetic photon beams derived by Monte Carlo simulations. The weights of the basis functions were obtained with the Cimmino feasibility algorithm, which examines in each iteration the discrepancy between predicted and measured depth dose. For 6 and 15 MV photon beams of a clinical accelerator, the depth dose obtained from the derived spectral weights was within about 1% of the measured depth dose at all depths. Because the problem is ill conditioned, solutions for the spectrum can fluctuate with energy. Physically realistic smooth spectra for these photon beams appeared when a small margin (about +/- 1%) was attributed to the measured depth dose. The maximum energy of both derived spectra agreed with the measured energy of the electrons striking the target to within 1 MeV. The use of a feasibility method on minimally relaxed constraints provides realistic spectra quickly and interactively.

Monitor unit calculation on the beam axis of open and wedged asymmetric high-energy photon beams

An ESTRO booklet and a report of the Netherlands Commission on Radiation Dosimetry have been published recently describing empirical methods for monitor unit (MU) calculations in symmetrical high-energy photon beams. Both documents support the same basic ideas; firstly the separation of head scatter and volume scatter components and secondly the determination of head scatter quantities in a mini-phantom. Based on these ideas the methods previously described for MU calculations in symmetrical beams are extended to asymmetrical open and wedged beams in isocentric treatment conditions. All required dosimetric parameters (normalized head scatter factors, phantom scatter correction factors, wedge factors, off-axis ratios, quality index, and depth dose parameters) are determined as a function of beam axis position in order to study their off-axis dependence. Measurements are performed for 6 MV and 18 MV photon beams provided by two different dual-energy linear accelerators, a GE Saturne 42 and a Varian 2100 CD linac.

Linear accelerator output variations and their consequences for megavoltage imaging

An experimental study of radiation output intensity fluctuations of a Philips SL25 linear accelerator is presented. Measurements are obtained using an electronic portal imaging device, and the consequences of the measured fluctuations for various different applications of megavoltage imaging including portal imaging, transit dosimetry and megavoltage computed tomography (MVCT) are discussed with examples. Fluctuations in output of +/- 0.7% (1 SD) are seen on every radiation pulse after photon noise and uncertainties caused by the detection system have been accounted for. Large fluctuations are also seen during the initial beam stabilization period (15%), during normal accelerator operation after the beam has been on for more than 1 min (4.5%) and during are therapy as a repeatable function of gantry angle (9%). Such output intensity fluctuations are shown to produce image artifacts in portal imaging devices with scanned detector readout and can also produce systematic errors in detector calibration that would lead to uncertainty in transit dose calculations. The propagation of these intensity fluctuations through MVCT image reconstruction is shown to produce ring artifacts in the reconstructed image. Sample portal and MVCT images are presented. All observed fluctuations in accelerator output are well within the manufacturer's specifications and do not affect the total dose delivered during normal treatment. Finally, megavoltage imaging is shown to be a powerful tool for accelerator quality assurance and treatment verification.

Measurements of basic parameters in wedged high-energy photon beams using a mini-phantom

Basic dosimetric quantities necessary to specify wedged beans (beam quality, wedge factors, output ratios) are obtained by measurements performed in a narrow coaxial mini-phantom for 6, 18 and 15 MV photon beams. To express beam quality, an attenuation coefficient mu is derived from measurements in a mini-phantom at 20 and 10 cm depth. Wedge factors and output ratios are measured as a function of field size at 10 cm water-equivalent depth. In open beams one observes beam softening with increasing distance from the collimator axis for all energies. With an inserted wedge a beam hardening is observed at 6 MV. This beam hardening decreases at 18 MV while at 25 MV a slight beam softening is detected. Larger variations of output ratios with field sizes are observed with a wedge than without a wedge. An equivalent square formula for head-scatter factors can be used with a good accuracy for rectangular wedged fields. For irregular wedged fields a method is proposed to calculate the product of the output ratio and the wedge factor. Measurements and calculations agree within 1% for all irregular wedged fields checked.

Dosimetric analysis and clinical implementation of 6 MV X-ray radiosurgery beam

The dosimetric data on tissue maximum ratios (TMR), output factors, off axis ratios and beam profiles are presented for small circular fields of diameters ranging from 12.5 to 40 mm for 6 MV radiosurgery beam. It is noticed that dmax increases as the collimator field size increases. Comparison of our data with the published TMR and output factors of similar small circular fields shows that our values are higher than those data. Similarities in trend are noticed with the published isodose volumes for 1-5 and 10 arcs. Not much variation is seen beyond two arcs for 80% isodose volumes for all the field sizes. The variation is small in 20% isodose volumes beyond three arcs. Variations are noticed in 5% isodose volumes for 12.5 mm diameter collimated beam. Our experience has been exclusively with malignant neoplasms. An ideal target volume is covered by 80% isodose volume with 3-4 arcs and a single isocenter. Sixteen patients have been treated to date at our institution, including one patient with brain metastases, two patients with meningiomas, one patient with lymphoma and 12 patients with astrocytomas. The majority of tumors have been treated with single isocenter but some as large as 7 cm have been treated safely with two isocenters.

Flatness characteristics for diagonal scans from Varian and Siemens linear accelerators

The advent of 3D treatment planning systems whose algorithms utilize diagonal scan data to perform dose calculations has made the collection of diagonal profile data essential. Manufacturers' specifications (MS) on beam flatness and symmetry apply to both the radial and transverse axes of all square field sizes from 10 X 10 cm2 to the largest field available. Beam profile measurements were obtained for both diagonal axes over a range of field sizes and depths for two units, a Varian 2100C and a Siemens KD. In this note the International Electrotechnical Commission (IEC) flatness definition was used to characterize the diagonal flatness of each beam.

Dosimetric properties of megavoltage grid therapy

PURPOSE

Grid therapy is a technique used to deliver a high dose of radiation (15-20 Gy) in a single fraction to many small volumes within a large treatment field. This treatment modality is used for the palliative treatment of large, deeply seated tumors, which have either been treated to tolerance with conventional radiation, or, due to massive tumor bulk, would most likely not benefit from a conventional course of radiation therapy. As the dose distribution from megavoltage grid therapy differs significantly from that of conventional radiation therapy (i.e., many large dose gradients exist within the tumor volume), we have measured various dosimetric properties inherent in this unique treatment modality.

METHODS AND MATERIALS

The grid is a 16 x 16 array of 1-cm diameter holes in a 7-cm thick piece of custom blocking material. The ratio of shielded to open surface area is 1:1. Depth dose, valley-to-peak ratios, and output factors for this square array grid were measured in a water phantom for several field sizes, as well as for a 1-cm diameter narrow beam using 6 MV and 25 MV photon beams.

RESULTS

The depth dose curves for the grid fields lie between those for an open portal and a narrow beam. For the 6-MV beam at dmax, the ratios of the doses delivered to the center of the shielded regions to that under the center of the holes, expressed as valley-to-peak ratios, range from 15 to 40%. At 10 cm, the ratios increase to between 25 and 45%. At 25 MV at both dmax and 10 cm, the valley-to-peak ratios are between 40 and 60%. The output factors, 0.89 for 6 MV and 0.77 for 25 MV, do not depend on field size.

CONCLUSION

Megavoltage grid therapy is a unique treatment modality where the dose is delivered differentially to a large volume in one fraction. Characterization of the dosimetric properties has allowed clinical implementation of the grid.

Physical characteristics of photon and electron beams from a dual energy linear accelerator

Clinically pertinent data of the photon beams of nominal energy 6 MV and 18 MV from a dual photon energy linear accelerator are measured using a radiation field analyser with semiconductor diodes and ionisation chambers. Percentage depth dose values are compared with available data from other linacs and BJR-17. Measurements made in the buildup region using a parallel plate chamber show a marked increase in the surface dose and dmax shifts by 3 mm and 14 mm for 6 MV and 18 MV photons, respectively as the field size is increased from 4 x 4 cm2 to the maximum. Variations of wedge angles with energy and field size are also determined up to wedge widths of 15 cm for all the four available wedge angles. Isodose plots of both the energies are plotted using semiconductor diodes in a RFA-3 system. Output factors, wedge transmission factors, and shielding tray factors were also measured in clear polystyrene phantom for both the photon energies at the depths of maximum ionisation. Beam characteristics of the electron beams of energies 6, 9, 12, 16, and 20 MeV produced by the Clinac-1800 have also been studied. The characteristics include percentage depth dose, isodose distribution, depth of maximum dose, surface dose, photon contamination, uniformity index, and penumbra. Most of the measurements were carried out using semiconductor detectors, whereas small volume ionization chambers and a plane-parallel chamber were kept as standards for comparison. Isodose distributions were drawn from the film densitometry method. Range-energy parameters are obtained from the observed depth dose data. These parameters vary from machine to machine and must be ascertained for individual units. The parameters differ to a considerable extent from their theoretically predicted values but generally follow the trend, experimentally observed by others, for similar types of units.

High energy photon beam percent depth dose curves

The percent depth dose of 8 MV and 18 MV photon beams were measured for various field sizes. The percent depth dose curves exhibited crossed over at selective depth in phantom. Hence, the percent depth dose increases at shallower depth, is independent at crossed over depth, and decreases at deeper depth with decreasing field size. This peculiar phenomenon, which cannot be explained using the primary and scattered radiation concept, should be noted.