J. Roselló

Routine IMRT verification by means of an automated Monte Carlo simulation system

PURPOSE A tool to simulate complete intensity-modulated radiation therapy (IMRT) treatments with the Monte Carlo (MC) method has been developed. This application is based on a distribution model to employ as short processing times as possible for an operative verification. MATERIALS AND METHODS The Clinical Primus-Siemens Linac beam was simulated with MC, using the EGS4 OMEGA-BEAM code package. An additional home-made program prepares the appropriate parameters for the code, using as input the file sent from the planning system to the linac. These parameters are adapted to the simulation code, making physical and clinical subdivisions of the global simulation of the treatment. Each resultant partition is ordered to a client personal computer in a cluster with 47 machines under a Linux environment. The verification procedure starts delivering the treatment on a plastic phantom containing an ionization chamber. If differences are less than 2%, films are inserted at selected planes in the phantom and the treatment is delivered again to evaluate the relative doses. When matching between treatment planning system (TPS), film, and MC is acceptable, a new evaluation of the patient is then performed between TPS and MC. Three different cases are shown to prove the applicability of the verification model. RESULTS Acceptable agreement between the three methods used was obtained. The results are presented using different analysis tools. The actual time employed to simulate the total treatment in each case was no more than 5 h, depending on the number of segments. CONCLUSIONS The MC model presented is fully automated, and results can be achieved within the operative time limits. The procedure is a reliable tool to verify any IMRT treatment.

Estimation of neutron-equivalent dose in organs of patients undergoing radiotherapy by the use of a novel online digital detector

Neutron peripheral contamination in patients undergoing high-energy photon radiotherapy is considered as a risk factor for secondary cancer induction. Organ-specific neutron-equivalent dose estimation is therefore essential for a reasonable assessment of these associated risks. This work aimed to develop a method to estimate neutron-equivalent doses in multiple organs of radiotherapy patients. The method involved the convolution, at 16 reference points in an anthropomorphic phantom, of the normalized Monte Carlo neutron fluence energy spectra with the kerma and energy-dependent radiation weighting factor. This was then scaled with the total neutron fluence measured with passive detectors, at the same reference points, in order to obtain the equivalent doses in organs. The latter were correlated with the readings of a neutron digital detector located inside the treatment room during phantom irradiation. This digital detector, designed and developed by our group, integrates the thermal neutron fluence. The correlation model, applied to the digital detector readings during patient irradiation, enables the online estimation of neutron-equivalent doses in organs. The model takes into account the specific irradiation site, the field parameters (energy, field size, angle incidence, etc) and the installation (linac and bunker geometry). This method, which is suitable for routine clinical use, will help to systematically generate the dosimetric data essential for the improvement of current risk-estimation models.

Microionization chamber for reference dosimetry in IMRT verification: clinical implications on OAR dosimetric errors

Intensity modulated radiotherapy (IMRT) has become a treatment of choice in many oncological institutions. Small fields or beamlets with sizes of 1 to 5 cm2 are now routinely used in IMRT delivery. Therefore small ionization chambers (IC) with sensitive volumes 0.1 cm3 are generally used for dose verification of an IMRT treatment. The measurement conditions during verification may be quite different from reference conditions normally encountered in clinical beam calibration, so dosimetry of these narrow photon beams pertains to the so-called non-reference conditions for beam calibration. This work aims at estimating the error made when measuring the organ at risks (OAR) absolute dose by a micro ion chamber (microIC) in a typical IMRT treatment. The dose error comes from the assumption that the dosimetric parameters determining the absolute dose are the same as for the reference conditions. We have selected two clinical cases, treated by IMRT, for our dose error evaluations. Detailed geometrical simulation of the microIC and the dose verification set-up was performed. The Monte Carlo (MC) simulation allows us to calculate the dose measured by the chamber as a dose averaged over the air cavity within the ion-chamber active volume (D(air)). The absorbed dose to water (D(water)) is derived as the dose deposited inside the same volume, in the same geometrical position, filled and surrounded by water in the absence of the ion chamber. Therefore, the D(water)/D(air) dose ratio is the MC estimator of the total correction factor needed to convert the absorbed dose in air into the absorbed dose in water. The dose ratio was calculated for the microIC located at the isocentre within the OARs for both clinical cases. The clinical impact of the calculated dose error was found to be negligible for the studied IMRT treatments.

A liquid-filled ionization chamber for high precision relative dosimetry

Radiosurgery and intensity modulated radiation therapy (IMRT) treatments are based on the delivery of narrow and/or irregularly shaped megavoltage photon beams. This kind of beams present both lack of charged particle equilibrium and steep dose gradients. Quality assurance (QA) measurements involved in these techniques must therefore be carried out with a dosimeter featuring high small volume. In order to obtain a good signal to noise ratio, a relatively dense material is needed as active medium. Non-polar organic liquids were proposed as active mediums with both good tissue equivalence and showing high signal to noise ratio. In this work, a liquid-filled ionization chamber is presented. Some results acquired with this detector in relative dosimetry are studied and compared with results obtained with unshielded diode. Medium-term stability measurements were also carried out and its results are shown. The liquid-filled ionization chamber presented here shows its ability to perform profile measurements and penumbrae determination with excellent accuracy. The chamber features a proper signal stability over the period studied.

On line neutron dose evaluation in patients under radiotherapy

Current improvements in radiotherapy require methods to evaluate their costs and benefits. A possible counterpart of the benefit is the creation of a secondary, radiation induced cancer. A new procedure is presented to assess the peripheral dose delivered to the patients due to photo-neutrons by means of a new on line digital detector. The events in the monitor have been correlated with the neutron dose by Monte Carlo simulations and experimental measurements using CR39 and TLD. This digital detector was employed at 6 different linacs, with energies ranging from 6 to 23 MV, obtaining the doses received in each organ of the patient. Additionally, the ambient dose equivalent was determined finding values from 0 to 470 mSv for complete treatments.

Verification of intensity modulated profiles using a pixel segmented liquid-filled linear array

A liquid isooctane (C8H18) filled ionization chamber linear array developed for radiotherapy quality assurance, consisting of 128 pixels (each of them with a 1.7 mm pitch), has been used to acquire profiles of several intensity modulated fields. The results were compared with film measurements using the gamma test. The comparisons show a very good matching, even in high gradient dose regions. The volume-averaging effect of the pixels is negligible and the spatial resolution is enough to verify these regions. However, some mismatches between the detectors have been found in regions where low-energy scattered photons significantly contribute to the total dose. These differences are not very important (in fact, the measurements of both detectors are in agreement using the gamma test with tolerances of 3% and 3 mm in most of those regions), and may be associated with the film energy dependence. In addition, the linear array repeatability (0.27% one standard deviation) is much better than the film one ( approximately 3%). The good repeatability, small pixel size and high spatial resolution make the detector ideal for the real time profile verification of high gradient beam profiles like those present in intensity modulated radiation therapy and radiosurgery.

Computational methods for treatment verification: the Full Monte Carlo contribution

The aim of Radiophysics is, within the frame of Radiotherapy, the precise knowledge of the dose distribution inside the human body due to the energy delivery coming from a radiation beam, either from a particle accelerator or from a radioactive source. The planning systems are mainly devoted to this purpose. These pieces of software, which run usually on powerful computers, simulate the process by means of experimental data and specially suited algorithms. Although the precision of these systems, some uncertainties still remain mainly regarding scattering effects and inhomogeneities. This is so because the calculations are not made generally in true 3D and on the other hand, inhomogeneities are not accounted for in detail. In standard Radiotherapy these uncertainties are may be small, but in the case of special techniques or situations, the accurate knowledge of the dose becomes more critical[1,2,3,4,5,6].

Neutron spectrometry and determination of neutron ambient doses in radiotherapy treatments under different exposure conditions

A project has been set up to study the effect on a radiotherapy patient of the neutrons produced around the LINAC accelerator head by photonuclear reactions induced by the gamma radiation above ~8 MeV. These neutrons may reach directly the patient, or they may interact with the surrounding materials until they become thermalised, scattering all over the treatment room and affecting the patient as well, contributing to the peripherical dose. Spectrometry was performed with a set of Bonner spheres at 50 cm from the isocenter and at the place where a digital device for measuring neutrons will be located the treatment room. Exposures have taken place in six linac accelerators with different energies (from 6 to 23 MV). A summary of the spectrometry results and of the neutron doses received by the patient is presented.

Neutron Contamination in Medical Linear Accelerators Operating at Electron Mode

Nowadays, neutron contamination in high energy photon beams normally used in radiotherapy treatments is an issue of interest from the radioprotection point of view. However, neutron production when using electron beams to treat superficial tumors has usually been ignored. The aim of this paper was to study such contamination and its effect on patients. In order to do that, experimental measurements in a radiotherapy environment were carried out using a digital device sensitive to thermal neutrons. Besides, Monte Carlo simulations were performed to estimate the difference in number of particles between photon and electron operational modes, required to deposit the same dose at a certain depth. Results show that neutron production is lower for electron beams than photon ones but not as low as previously expected.

Monte carlo clinical dosimetry

Abstract The choice of the most appropriate strategy for radiotherapy treatment is mainly based on the use of a planning system. With the introduction of new techniques (conformal and/or small fields, asymmetrical and non coplanar beams, true 3D calculation, IMRT) the trustworthiness of the algorithms used is questioned. An alternative verification procedure has become increasingly more necessary to warranty treatment delivery. The reliability of the Monte Carlo method is generally acknowledged. However, its clinical use has not been practical due to the high CPU time required. During the last few years our objective has decreased CPU time by means of a new process distribution technique. This reduction has made it feasible, not only to apply physical dosimetry under special conditions, but also to use it in numerous clinical cases employing photon and electron conformal fields, in radiosurgery, and IMRT. The procedure carried out is presented. Furthermore, conventional Treatment Planning System calculations are compared with the Monte Carlo simulations.