M. Romero-Expósito

Measurement of stray radiation within a scanning proton therapy facility: EURADOS WG9 intercomparison exercise of active dosimetry systems

PURPOSE To characterize stray radiation around the target volume in scanning proton therapy and study the performance of active neutron monitors. METHODS Working Group 9 of the European Radiation Dosimetry Group (EURADOS WG9-Radiation protection in medicine) carried out a large measurement campaign at the Trento Centro di Protonterapia (Trento, Italy) in order to determine the neutron spectra near the patient using two extended-range Bonner sphere spectrometry (BSS) systems. In addition, the work focused on acknowledging the performance of different commercial active dosimetry systems when measuring neutron ambient dose equivalents, H(∗)(10), at several positions inside (8 positions) and outside (3 positions) the treatment room. Detectors included three TEPCs--tissue equivalent proportional counters (Hawk type from Far West Technology, Inc.) and six rem-counters (WENDI-II, LB 6411, RadEye™ NL, a regular and an extended-range NM2B). Meanwhile, the photon component of stray radiation was deduced from the low-lineal energy transfer part of TEPC spectra or measured using a Thermo Scientific™ FH-40G survey meter. Experiments involved a water tank phantom (60 × 30 × 30 cm(3)) representing the patient that was uniformly irradiated using a 3 mm spot diameter proton pencil beam with 10 cm modulation width, 19.95 cm distal beam range, and 10 × 10 cm(2) field size. RESULTS Neutron spectrometry around the target volume showed two main components at the thermal and fast energy ranges. The study also revealed the large dependence of the energy distribution of neutrons, and consequently of out-of-field doses, on the primary beam direction (directional emission of intranuclear cascade neutrons) and energy (spectral composition of secondary neutrons). In addition, neutron mapping within the facility was conducted and showed the highest H(∗)(10) value of ∼ 51 μSv Gy(-1); this was measured at 1.15 m along the beam axis. H(∗)(10) values significantly decreased with distance and angular position with respect to beam axis falling below 2 nSv Gy(-1) at the entrance of the maze, at the door outside the room and below detection limit in the gantry control room, and at an adjacent room (<0.1 nSv Gy(-1)). Finally, the agreement on H(∗)(10) values between all detectors showed a direct dependence on neutron spectra at the measurement position. While conventional rem-counters (LB 6411, RadEye™ NL, NM2-458) underestimated the H(∗)(10) by up to a factor of 4, Hawk TEPCs and the WENDI-II range-extended detector were found to have good performance (within 20%) even at the highest neutron fluence and energy range. Meanwhile, secondary photon dose equivalents were found to be up to five times lower than neutrons; remaining nonetheless of concern to the patient. CONCLUSIONS Extended-range BSS, TEPCs, and the WENDI-II enable accurate measurements of stray neutrons while other rem-counters are not appropriate considering the high-energy range of neutrons involved in proton therapy.

A comprehensive spectrometry study of a stray neutron radiation field in scanning proton therapy.

The purpose of this study is to characterize the stray neutron radiation field in scanning proton therapy considering a pediatric anthropomorphic phantom and a clinically-relevant beam condition. Using two extended-range Bonner sphere spectrometry systems (ERBSS), Working Group 9 of the European Radiation Dosimetry Group measured neutron spectra at ten different positions around a pediatric anthropomorphic phantom irradiated for a brain tumor with a scanning proton beam. This study compares the different systems and unfolding codes as well as neutron spectra measured in similar conditions around a water tank phantom. The ten spectra measured with two ERBSS systems show a generally similar thermal component regardless of the position around the phantom while high energy neutrons (above 20 MeV) were only registered at positions near the beam axis (at 0°, 329° and 355°). Neutron spectra, fluence and ambient dose equivalent, H (*)(10), values of both systems were in good agreement (<15%) while the unfolding code proved to have a limited effect. The highest H (*)(10) value of 2.7 μSv Gy(-1) was measured at 329° to the beam axis and 1.63 m from the isocenter where high-energy neutrons (E  ⩾  20 MeV) contribute with about 53%. The neutron mapping within the gantry room showed that H (*)(10) values significantly decreased with distance and angular position with respect to the beam axis dropping to 0.52 μSv Gy(-1) at 90° and 3.35 m. Spectra at angles of 45° and 135° with respect to the beam axis measured here with an anthropomorphic phantom showed a similar peak structure at the thermal, fast and high energy range as in the previous water-tank experiments. Meanwhile, at 90°, small differences at the high-energy range were observed. Using ERBSS systems, neutron spectra mapping was performed to characterize the exposure of scanning proton therapy patients. The ten measured spectra provide precise information about the exposure of healthy organs to thermal, epithermal, evaporation and intra-nuclear cascade neutrons. This comprehensive spectrometry analysis can also help in understanding the tremendous literature data based rem-counters while also being of great value for general neutron shielding and radiation safety studies.

Analytical model for photon peripheral dose estimation in radiotherapy treatments

This work aims to generate a simple analytical model that allows estimation of peripheral photon equivalent dose to organs of individual patients, valid for any isocentric technique. Photon radiation scattered in the LINAC head has been simulated as a virtual source of radiation emitting isotropically so that, before reaching a point inside the patient, it decreases with the square law and with attenuation due to air and tissue. Leakage has been simulated as a constant background dose along the patient. Firstly, a dose-to-points basic model was proposed and parameterized by fitting it to absorbed doses measured with TLD-700 in a humanoid phantom. Secondly, this model was generalized to any other situation involving intensity-modulated beams of any size and shape. Validation of this general model, usable beyond 10 cm from the field edge, was carried out by comparing estimation with TLD-100 doses for VMAT and IMRT treatments as well as with experimental data and models existing in the bibliography. Finally, an equivalent dose-to-organs model has been proposed by rescaling individual anatomical dimensions onto a mathematical phantom in order to make an estimation of organ length for dose calculation. The parameterized extended model, accounting for intensity-modulated beams of any shape, predicts measurements with a maximum relative uncertainty of ±25%. This general model, easy to apply in a clinical routine thanks to the ready availability of input parameters, has been proposed and validated for estimation of photon equivalent doses to peripheral organs. Finally, as a first step, it has been implemented into a piece of software termed PERIPHOCAL (PERIpheral PHOton CALculation), which is easily transferred to a commercial treatment planning system (TPS).

Dose distribution of secondary radiation in a water phantom for a proton pencil beam - EURADOS WG9 inter-comparison exercise

Systematic 3D mapping of out-of-field doses induced by a therapeutic proton pencil scanning beam in a 300  ×  300  ×  600 mm3 water phantom was performed using a set of thermoluminescence detectors (TLDs): MTS-7 (7LiF:Mg,Ti), MTS-6 (6LiF:Mg,Ti), MTS-N (natLiF:Mg,Ti) and TLD-700 (7LiF:Mg,Ti), radiophotoluminescent (RPL) detectors GD-352M and GD-302M, and polyallyldiglycol carbonate (PADC)-based (C12H18O7) track-etched detectors. Neutron and gamma-ray doses, as well as linear energy transfer distributions, were experimentally determined at 200 points within the phantom. In parallel, the Geant4 Monte Carlo code was applied to calculate neutron and gamma radiation spectra at the position of each detector. For the cubic proton target volume of 100  ×  100  ×  100 mm3 (spread out Bragg peak with a modulation of 100 mm) the scattered photon doses along the main axis of the phantom perpendicular to the primary beam were approximately 0.5 mGy Gy-1 at a distance of 100 mm and 0.02 mGy Gy-1 at 300 mm from the center of the target. For the neutrons, the corresponding values of dose equivalent were found to be ~0.7 and ~0.06 mSv Gy-1, respectively. The measured neutron doses were comparable with the out-of-field neutron doses from a similar experiment with 20 MV x-rays, whereas photon doses for the scanning proton beam were up to three orders of magnitude lower.

Uncomplicated and Cancer-Free Control Probability (UCFCP): A new integral approach to treatment plan optimization in photon radiation therapy

PURPOSE Biological treatment plan evaluation does not currently consider second cancer induction from peripheral doses associated to photon radiotherapy. The aim is to propose a methodology to characterize the therapeutic window by means of an integral radiobiological approach, which considers not only Tumour Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) but also Secondary Cancer Probability (SCP). METHODS Uncomplicated and Cancer-Free Control Probability (UCFCP) function has been proposed assuming a statistically uncorrelated response for tumour and normal tissues. The Poissons and Lymans models were chosen for TCP and NTCP calculations, respectively. SCP was modelled as the summation of risks associated to photon and neutron irradiation of radiosensitive organs. For the medium (>4Gy) and low dose regions, mechanistic and linear secondary cancer risks models were used, respectively. Two conformal and intensity-modulated prostate plans at 15MV (same prescription dose) were selected to illustrate the UCFCP features. RESULTS UCFCP exhibits a bell-shaped behaviour with its maximum inside the therapeutic window. SCP values were not different for the plans analysed (∼2.4%) and agreed with published epidemiological results. Therefore, main differences in UCFCP came from differences in rectal NTCP (18% vs 9% for 3D-CRT and IMRT, respectively). According to UCFCP values, the evaluated IMRT plan ranked first. CONCLUSIONS The level of SCP was found to be similar to that of NTCP complications which reinforces the importance of considering second cancer risks as part of the possible late sequelae due to treatment. Previous concerns about the effect of peripheral radiation, especially neutrons, in the induction of secondary cancers can be evaluated by quantifying the UCFCP.

SU‐E‐T‐365: Estimation of Neutron Ambient Dose Equivalents for Radioprotection Exposed Workers in Radiotherapy Facilities Based On Characterization Patient Risk Estimation

Purpose: Previous measurements with Bonner spheres1 showed that normalized neutron spectra are equal for the majority of the existing linacs 2. This information, in addition to thermal neutron fluences obtained in the characterization procedure33, would allow to estimate neutron doses accidentally received by exposed workers, without the need of an extra experimental measurement. Methods: Monte Carlo (MC) simulations demonstrated that the thermal neutron fluence distribution inside the bunker is quite uniform, as a consequence of multiple scatter in the walls⁴. Although inverse square law is approximately valid for the fast component, a more precise calculation could be obtained with a generic fast fluence distribution map around the linac, from MC simulations⁴. Thus, measurements of thermal neutron fluences performed during the characterization procedure3, together with a generic unitary spectra2, would allow to estimate the total neutron fluences and H*(10) at any point⁵. As an example, we compared estimations with Bonner sphere measurements1, for two points in five facilities: 3 Siemens (15–23 MV), Elekta (15 MV) and Varian (15 MV). Results: Thermal neutron fluences obtained from characterization, are within (0.2–1.6×10⁶) cm−2•Gy−1 for the five studied facilities. This implies ambient equivalent doses ranging from (0.27–2.01) mSv/Gy 50 cm far from the isocenter and (0.03–0.26) mSv/Gy at detector location with an average deviation of ±12.1% respect to Bonner measurements. Conclusion: The good results obtained demonstrate that neutron fluence and H*(10) can be estimated based on: (a) characterization procedure established for patient risk estimation in each facility, (b) generic unitary neutron spectrum and (c) generic MC map distribution of the fast component. [1] Radiat. Meas (2010) 45: 1391 – 1397; [2] Phys. Med. Biol (2012) 5 7:6167–6191; [3] Med. Phys (2015) 42:276 - 281. [4] IFMBE (2012) 39: 1245–1248. [5] ICRU Report 57 (1998)

SU-E-T-249: Neutron Model Upgrade for Radiotherapy Patients Monitoring Using a New Online Detector

PURPOSE The purpose of this work is to improve the existing methodology to estimate neutron equivalent dose in organs during radiotherapy treatments, based on a Static Random Access Memory neutron detector (SRAMnd) [1]. This is possible thanks to the introduction of a new digital detector with improved characteristics, which is able to measure online the neutron fluence rate in the presence of an intense photon background [2]. Its reduced size, allows the direct estimation of doses in specific points inside an anthropomorphic phantom (NORMA) without using passive detectors as TLD or CR-39. This versatility will allow not only to improve the existing models (generic abdomen and H&N [1]) but to generate more specific ones for any technique. METHODS The new Thermal Neutron Rate Detector (TNRD), based on a diode device sensitized to thermal neutrons, have been inserted in 16 points of the phantom. These points are distributed to infer doses to specific organs. Simultaneous measurements of these devices and a reference one, located in front of the gantry, have been performed for the mentioned generic treatments, in order to improve the existing model. RESULTS These new devices have shown more precise since they agree better with Monte Carlo simulations. The comparison of the thermal neutron fluence, measured with TNRD, and the existing models, converted from events to fluence, shows an average improvement of (3.90±3.37) % for H&N and (12.61±9.43) % for abdomen, normalized to the maximum value. CONCLUSION This work indicates the potential of these new devices for more precise neutron equivalent dose estimation in organs, as a consequence of radiotherapy treatments. The simplicity of the process makes possible to establish more specific models that will provide a better dose estimation. References[1] Phys Med Biol 2012; 57:6167-6191.[2] A new active thermal neutron detector. Radiat. Prot. Dosim. (in press).

WE‐D‐17A‐05: Measurement of Stray Radiation Within An Active Scanning Proton Therapy Facility: EURADOS WG9 Intercomparison Exercise of Active Dosimetry Systems

PURPOSE Intercomparison of active dosemeters in the measurement of stray radiation at the Trento active-scanning proton therapy facility. METHODS EURADOS WG9 carried out a large intercomparison exercise to test different dosemeters while measuring secondary neutrons within a 230 MeV scanned proton therapy facility. Detectors included two Bonner Sphere Spectrometers (BSS), three tissue equivalent proportional counters (TEPCHawk) and six rem-counters (Wendi II, Berthold, RadEye, a regular and an extended-range Anderson & Braun NM2B counters). Measurements of neutron ambient dose equivalents, H*(10), were done at several positions inside (8 positions) and outside (3 positions) the treatment room while irradiating a water tank phantom with a 10 × 10 × 10 cc field. RESULTS A generally good agreement on H*(10) values was observed for the tested detectors. At distance of 2.25 m and angles 45°, 90° and 180° with respect to the beam axis, BSS and proportional counters agreed within 30%. Higher differences (up to 60%) were observed at the closest and farthest distances, i.e. at positions where detectors sensitivity, energy, fluence and angular response are highly dependent on neutron spectra (flux and energy). The highest neutron H*(10) value, ∼60 microSv/Gy, was measured at 1.15 m along the beam axis. H*(10) decreased significantly with the distance from the isocenter dropping to 1.1 microSv/Gy at 4.25 m and 90° from beam axis, ∼2 nanoSv/Gy at the entrance of the maze, 0.2 nanoSv/Gy at the door outside the room and below detection limit in the gantry control room and at an adjacent room. These values remain considerately lower than those of passively scattered proton beams. BSS and Hawk unfolded spectra provide valuable inputs when studying the response of each detector. CONCLUSION TEPCs and BSS enable accurate measurements of stray neutrons while other rem-meters also give satisfactory results but require further improvements to reduce uncertainties.