Ron S. Sloboda

Dose calculation for photon‐emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO

PURPOSE Recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO) on dose calculations for high-energy (average energy higher than 50 keV) photon-emitting brachytherapy sources are presented, including the physical characteristics of specific (192)Ir, (137)Cs, and (60)Co source models. METHODS This report has been prepared by the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group. This report includes considerations in the application of the TG-43U1 formalism to high-energy photon-emitting sources with particular attention to phantom size effects, interpolation accuracy dependence on dose calculation grid size, and dosimetry parameter dependence on source active length. RESULTS Consensus datasets for commercially available high-energy photon sources are provided, along with recommended methods for evaluating these datasets. Recommendations on dosimetry characterization methods, mainly using experimental procedures and Monte Carlo, are established and discussed. Also included are methodological recommendations on detector choice, detector energy response characterization and phantom materials, and measurement specification methodology. Uncertainty analyses are discussed and recommendations for high-energy sources without consensus datasets are given. CONCLUSIONS Recommended consensus datasets for high-energy sources have been derived for sources that were commercially available as of January 2010. Data are presented according to the AAPM TG-43U1 formalism, with modified interpolation and extrapolation techniques of the AAPM TG-43U1S1 report for the 2D anisotropy function and radial dose function.

Consequences of the spectral response of an a‐Si EPID and implications for dosimetric calibration

One of the attractive features of amorphous silicon electronic portal imaging devices (a-Si EPIDs) as dosimetric tools is that for open fields they are known to exhibit a generally linear relation between pixel value and incident energy fluence as measured by an ion chamber. It has also been established that a-Si EPIDs incorporating high atomic number phosphors such as Gd2O2S:Tb exhibit a disproportionately large response to low-energy (<1 MeV) photons. The present work examines the consequences of this hypersensitivity in a commercially available EPID, the Varian aS500, with respect to energy fluence calibration in a 6 MV radiotherapy beam. EPIDs may be deployed in situations where the spectrum of the incident beam is modified by passing through a compensator or through a patient or phantom. By examining the specific case of a beam hardened by passage through compensator material, we show that the discrepancy between open and attenuated beam calibration curves can be as high as 8%. A Monte Carlo study using a comprehensive model of the aS500 shows that this difference can be explained by spectral changes, and further suggests that it can be reduced by the addition of an external copper plate. We consider configurations with the plate placed directly on top of the EPID cassette and 15 cm above the cassette, supported by Styrofoam. In order to reduce the maximum discrepancy to <4%, it was found that a copper thickness of approximately 0.7 cm was required in the elevated configuration. Improvement was minimal with the copper in the contact configuration. Adding 0.7 cm of copper in the elevated configuration reduced the contrast-to-noise ratio by 19% and the modulation transfer for a given spatial frequency by 30%.

Comprehensive Monte Carlo calculation of the point spread function for a commercial a-Si EPID

Images produced by commercial amorphous silicon electronic portal imaging devices (a-Si EPIDs) are subject to multiple blurring processes. Implementation of these devices for fluence measurement requires that the blur be removed from the images. A standard deconvolution operation can be performed to accomplish this assuming the blur kernel is spatially invariant and accurately known. This study determines a comprehensive blur kernel for the Varian aS500 EPID. Monte Carlo techniques are used to derive a dose kernel and an optical kernel, which are then combined to yield an overall blur kernel for both 6 and 15 MV photon beams. Experimental measurement of the line spread function (LSF) is used to verify kernel shape. Kernel performance is gauged by comparing EPID image profiles with in-air dose profiles measured using a diamond detector (approximating fluence) both before and after the EPID images have been deconvolved. Quantitative comparisons are performed using the chi metric, an extension of the well-known y metric, using acceptance criteria of 0.0784 cm (1 pixel width) distance-to-agreement (deltad) and 2% of the relative central axis fluence (deltaD). Without incorporating any free parameters, acceptance was increased from 49.0% of pixels in a cross-plane profile for a 6 MV 10 x 10 cm2 open field to 92.0%. For a 10 x 10 cm2 physically wedged field, acceptance increased from 40.3% to 73.9%. The effect of the optical kernel was found to be negligible for these chi acceptance parameters, however for (deltaD= 1%, deltad = 0.0784 cm) we observed an improvement from 66.1% (without) to 78.6% (with) of chi scores <1 (from 20.6% before deconvolution). It is demonstrated that an empirical kernel having a triple exponential form or a semiempirical kernel based on a simplified model of the detector stack can match the performance of the comprehensive kernel.

Optimization of brachytherapy dose distributions by simulated annealing

An algorithm based on the method of simulated annealing is presented for optimizing brachy-therapy dose distributions. The algorithm accommodates either static configurations of multiple sources or single stepping sources, hence in principle can be used to optimize both low- and high-dose rate treatments delivered with remote afterloading equipment. Required inputs include the specification of target dose rates and dose rate limits, expressed in absolute or relative terms, at operator selected points near the treatment site. The influence of the dose rate limits can be adjusted continuously through the use of one or more penalty factors. The algorithm generates a set of integer weights, one for each available source position, which are interpreted in terms of configuration occupancy numbers for static source arrangements and relative dwell times for stepping sources. Application is made to several variations of a hypothetical low-dose rate vaginal vault planning problem involving one rectal and six applicator calculation points. The algorithms performance for different source strengths, annealing schedules, target dose rates, dose rate limits, and values of a single penalty factor lambda was examined. With a simple annealing schedule and value of lambda = 25, the algorithm found solutions of high quality for all problem variants. The CPU time required for optimization on a Vax 11/750 computer ranged from 2 min for a single configuration to 25 min for a solution consisting of four configurations. These results support the use of simulated annealing for clinical planning of low dose rate vaginal treatments, and encourage investigation of other applications in brachytherapy.

Analytical representation of head scatter factors for shaped photon beams using a two‐component x‐ray source model

An analytic representation proposed for the relative intensity distribution of the extra-focal source in a two-component x-ray source model serves as the basis for calculation. From this representation, a closed-form expression for head scatter factors defined on the central beam axis is derived by integrating over the area of the extra-focal source plane visible from the measurement point. The resulting expression is applicable to photon beams from different Varian accelerators and different photon energies, and includes effects arising from beam shaping with cerrobend blocks or multileaf collimators (MLCs). For 6- and 15-MV photon beams from Varian 600 C and 2300 CD accelerators (Varian Oncology Systems, Palo Alto, CA), 361 measured head scatter factors for square, rectangular, asymmetric, and arbitrarily shaped fields, formed by either the X and Y jaws, the MLC and Y jaws, or by the MLC alone, were compared with model calculations. Results show that 93.4% of calculated values match corresponding experimental points to within 0.5%, the average deviation being 0.23% and the maximum deviation 0.9%. Thus, as a consequence of this work, the different influence of the X jaws, the Y jaws, and the MLC on head scatter factors is quantitatively described. In particular, it is demonstrated that in the case of radially symmetric scattering, the collimator exchange effect arises as a result of the different distances of the X and Y jaws from the focal spot.

Dosimetric prerequisites for routine clinical use of photon emitting brachytherapy sources with average energy higher than 50 kev

This paper presents the recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Therapeutic Radiology and Oncology (ESTRO) on the dosimetric parameters to be characterized, and dosimetric studies to be performed to obtain them, for brachytherapy sources with average energy higher than 50 keV that are intended for routine clinical use. In addition, this document makes recommendations on procedures to be used to maintain vendor source strength calibration accuracy. These recommendations reflect the guidance of the AAPM and the ESTRO for its members, and may also be used as guidance to vendors and regulatory agencies in developing good manufacturing practices for sources used in routine clinical treatments.

EGS4 dosimetry calculations for cylindrically symmetric brachytherapy sources

Computer algorithms for electron binding correction to Compton scattering and for detailed simulation of K-edge characteristic x-ray production were incorporated into EGS4 unix version 2.0. Based on detailed modelling of the internal structures of sources, the modified version was used to calculate dose rate constants, radial dose functions, and anisotropy functions on the long axis for an 125I model 6711 source, 169Yb Type 5 and Type 8 sources, and a stainless steel clad (SS) 192Ir source. The geometry of these sources is cylindrically symmetric. Calculated results are generally in good agreement with corresponding values recommended by TG-43 and Monte Carlo results published by other authors. The influence of electron binding in Compton scattering on the calculated dose distribution for an 125I model 6711 source in water, and of different characteristic x-ray production models for 125I model 6711 and 192Ir SS sources, were also studied.

Measurement of photon beam backscatter from collimators to the beam monitor chamber using target-current-pulse-counting and telescope techniques

Backscattered radiation (BSR) arising from field-defining collimators and entering the beam monitor chamber (BMC) may contribute to observed variations in medical linear accelerator photon beam output with collimator setting. Measuring the magnitude of such contributions for particular accelerators under specified operating conditions is therefore important when attempting to understand and model accelerator head scatter. The present work was conducted to confirm some backscatter measurements for collimating jaws reported previously and to extend these to include other accelerators and a multileaf collimator (MLC). BSR reaching the BMC from the jaws of Clinac 600C, 2100C and 2300CD accelerators and from an MLC on the 2300CD was investigated using both target-current-pulse-counting and telescope methods. Our measurements show that for the Clinac 600C BSR-dependent output variations are negligible. However, for the 2100C and 2300CD BSR-dependent relative output increased in an almost linear fashion, by up to 2.4% for 15 and 18 MV beams, and by up to 1.7% for 6 MV beams, as the field size varied from 5 x 5 cm2 to 40 x 40 cm2. The magnitude of BSR dependent upon collimator location in the head, as expected, thereby contributing to the collimator exchange effect. An earlier study at our centre using the telescope method had reported higher BSR levels. This discrepancy was resolved when corrections for telescope block and room scatter, previously assumed negligible, were made.

Monte Carlo dosimetry of the VariSource high dose rate 192Ir source

The purpose of the work is to calculate basic dosimetry data for a VariSource high dose rate 192Ir source in water. These basic dosimetry data, expressed in the dose calculation formalism endorsed by the Interstitial Collaborative Working Group and AAPM Task group 43, include the dose rate constant, the radial dose function, and the anisotropy function. A modified version of the EGS4 Monte Carlo code was used to calculate (1) the transverse-axis dose distribution at radial distances from 0.1 to 14 cm, (2) the two-dimensional dose distribution for axial and radial distances from 0.1 cm to 10 cm, and (3) the air-kerma strength, for the VariSource high dose rate 192Ir source. From these Monte Carlo results the basic dosimetry data were derived. The calculated dose rate constant for the high dose rate source is 1.044 +/- 0.2% cGy h-1 per unit air-kerma strength. The anisotropy function exhibits 40%-60% deviations from isotropy at positions on the long axis. The radial dose function for the source is nearly identical to that for a microSelectron high dose rate 192Ir source, except at radial distances smaller than 0.5 cm where values for VariSource are 1.7%-2.8% smaller. These basic dosimetry data were compared with corresponding results from other authors for high and low dose rate 192Ir sources, as well as with Meisbergers fitting formula.

Linear accelerator photon beam quality at off‐axis points

Transmitted intensity through water was measured in a narrow-beam geometry for different energy x-ray beams from commercial accelerators. In order to accurately obtain the attenuation coefficient of the incident beam using transmission data, a novel formula was developed based on consideration of beam hardening in phantom. The value of the attenuation coefficient obtained by fitting transmission data to this formula was found to be independent of the absorber thickness used in experiments, whereas the attenuation coefficient obtained from the traditional formula, I(x) = I0 exp(-mux), changed by up to 7% with absorber thickness for a given beam. The beam hardening coefficient obtained from our formula indicates that the attenuation coefficient in water changes by about 0.33% per cm near the surface for the high-energy photon beams studied. Variations in beam quality with off-axis distance were subsequently investigated using the new formula. Results show that the attenuation coefficient at the water surface increased by about 15% for 15 and 18 MV beams, and by 11%-13% for 6 MV beams, when the off-axis distance at 100 cm from the source was changed from 0 to 18 cm. Consideration of the physics of bremsstrahlung production suggests that these variations should be mainly determined by the shape of the flattening filter, i.e., by the path length of rays traversing the filter in different directions. This expectation was confirmed by observing that the attenuation coefficient at the phantom surface can be related to the ray path of the beam in the flattening filter using the new transmission formula.