Measurements of phantom scatter factors for small field sizes in high energy x rays

An alternate method to measure the phantom scatter factor in small fields is provided for high energy photon beams. The measurement technique is based on the density scaling theorem described by O'Connor [Phys. Med. Biol. 1, 352-369 (1957)]. The phantom scatter factor (Sp) is measured in balsa and cedar wood to give effective field sizes in 3 x 3 to 0.5 x 0.5 cm2 water. The extrapolated zero area phantom scatter factor from the average data of balsa and cedar is 0.45. This indicates that the variation of output is largely due to a sharp decrease in the phantom scatter factor for small field sizes.     

Blocked field effects on collimator scatter factors

In routine dosimetry we assume separability of the collimator (Sc) and phantom (Sp) scatter components that together comprise the total scatter factor (Sc,p). In practice, the addition of blocking also affects the photon fluence attributable to the treatment head and flattening filter in a complicated way. The reduced aperture blocks out some of the head scatter contribution, while the block and tray add back secondary scatter. In the following we present techniques for directly measuring the aperture effect on Sc in air or in a full-scatter phantom. The change in Sc is found to be a scaleable quantity that can be modelled as a simple linear fit to the ratio of projected open-to-blocked equivalent square fields. Measurements have been made for 6, 18 and 24 MV photon beams on one Varian 2500 and two Varian 2100c accelerators. Results indicate a progressive loss of collimator scatter contribution with increased field blocking that is amplified with increasing energy. Block and tray scatter only contribute significantly to Sc for large fields and treatment distances of 80 cm or less. Application of these corrections in monitor unit calculations is presented.     

A dual source photon beam model used in convolution/superposition dose calculations for clinical megavoltage x-ray beams

A realistic photon beam model based on Monte Carlo simulation of clinical linear accelerators was implemented in a convolution/superposition dose calculation algorithm. A primary and an extra-focal sources were used in this beam model to represent the direct photons from the target and the scattered photons from other head structures, respectively. The effect of the finite size of the extra-focal source was modeled by a convolution of the source fluence distribution with the collimator aperture function. Relative photon output in air (Sc) and in phantom (Scp) were computed using the convolution method with this new photon beam model. Our results showed that in a 10 MV photon beam, the Sc, Sp (phantom scatter factor), and Scp factors increased by 11%, 10%, and 22%, respectively, as the field size changed from 3 x 3 cm2 to 40 x 40 cm2. The variation of the Sc factor was contributed mostly by an increase of the extra-focal radiation with field size. The radiation backscattered into the monitor chamber inside the accelerator head affected the Sc by about 2% in the same field range. The output factors in elongated fields, asymmetric fields, and blocked fields were also investigated in this study. Our results showed that if the effect of the backscattered radiation was taken into account, output factors in these treatment fields can be predicted accurately by our convolution algorithm using the dual source photon beam model.     

Calculation of backscatter factors for diagnostic radiology using Monte Carlo methods

Backscatter factors were determined for x-ray beams relevant to diagnostic radiology using Monte Carlo methods. The phantom size considered most suitable for calibration of dosimeters is a cuboid of 30 x 30 cm2 front surface and 15 cm depth. This phantom size also provides a good approximation to adult patients. Three different media were studied: water, PMMA and ICRU tissue; the source geometry was a point source with varying field size and source-to-phantom distance. The variations of the backscatter factor with phantom medium and field geometry were examined. From the obtained data, a set of backscatter factors was selected and proposed for adoption as a standard set for the calibration of dosimeters to be used to measure diagnostic reference doses.     

Physicians'' refusal to provide life-prolonging medical interventions

Phantom scatter factors, for square fields of various sizes, have been determined at a fixed reference depth of 10 cm, separately in different institutes, for a large number of linear accelerators under the auspices of the Netherlands Commission on Radiation Dosimetry. The method used for these measurements has been described in a previous paper. The present article describes the conversion of the measured values into a comprehensive and consistent data set, that gives the phantom scatter factor as a function of field size (from 4 cm up to 40 cm) and quality index (from 0.600 up to 0.800).     

Measurement of off-axis and peripheral skin dose using radiochromic film

A radiotheraphy skin dose profile can be obtained with radiochromic film. The central axis skin dose relative to Dmax for a 10 x 10 cm2 field size was found to be 22%, 17% and 15.5% for 6 MV, 10 MV and 18 MV photon beams. Peripheral dose increased with increasing field size. At 10 MV the skin dose 2 cm outside the geometric field edge was measured as 6%, 10% and 17% for 10 x 10 cm2, 20 x 20 cm2 and 30 x 30 cm2 field sizes respectively. Off-axis skin dose decreased as distance increased from central axis for fields with Perspex block trays. For a 20 x 20 cm2 field, an approximately 5-8% drop in percentage skin dose was observed from central axis to the beam edge.     

The effect of the nasopharyngeal air cavity on x-ray interface doses

We investigated the impact of air cavities in head and neck cancer patients treated by photon beams based on clinical set-ups. The phantom for investigation was constructed with a cubic air cavity of 4 x 4 x 4 cm3 located at the centre of a 30 x 30 x 16 cm3 solid water slab. The cavity cube was used to resemble an extreme case for the nasal cavity. Apart from measuring the dose profiles and central axis percentage depth dose distribution, the dose values in 0.25 x 0.25 x 0.25 cm3 voxels at regions around the air cavity were obtained by Monte Carlo simulations. A mean dose value was taken over the voxels of interest at each depth for evaluation. Single-field results were added to study parallel opposed field effects. For 10 x 10 cm2 parallel opposed fields at 4, 6 and 8 MV, the mean dose at regions near the lateral interfaces of the cavity cube were decreased by 1 to 2% due to the lack of lateral scatter, while the mean dose near the proximal and distal interfaces was increased by 2 to 4% due to the greater transmission through air. Secondary build-up effects at points immediately beyond the air cavity cube are negligible using field sizes greater than 4 x 4 cm2. For most head and neck treatment, the field sizes are usually 6 x 6 cm2 or greater, and most cavity volumes are smaller than our chosen dimensions. Therefore, the influence of closed air cavities on photon interface doses is not significant in clinical treatment set-ups.     

Insertion of pea lectin into a phospholipid monolayer

Scattered radiation is one of several physical perturbations that limit the accuracy of quantitative measurements in single-photon emission computed tomography (SPECT). Improvement in detector energy resolution leads to a reduction of scatter counts and a corresponding improvement in the quantitative accuracy of the SPECT measurement. In this study, simulated SPECT projections of a simple myocardial perfusion phantom were used to investigate the effect of detector energy resolution on the data. The phantom consists of a spherical shell of radionuclide within a 15 cm radius water-filled cylinder. Each projection contains on the order of 3 x 10(5) counts. The results demonstrate that a full-width, half-maximum energy resolution of 3-4 keV is sufficient to render the error due to scatter insignificant compared to the uncertainty due to photon statistics in this case. Further simulations verify that because smaller objects produce less scatter, they can be imaged accurately with degraded energy resolution. These results are useful when designing prototype systems that utilize solid-state detectors and low-noise electronics to achieve improved energy resolution.     

Intracerebroventricular administration of neuropeptide Y to normal rats increases obese gene expression in white adipose tissue

Dose planning programs originally intended for use with symmetric fields have been adapted for use with asymmetric fields. An accurate representation of the change in primary beam quality with off-axis distance and depth is essential for accurate dose calculation and is usually represented in the computer as a primary radiation profile or primary off-center ratio (POCR). The original field edge correction (FEC) method described by Cadman [Med. Phys. 22, 457 (1995)] to determine POCRs has been extended to allow accurate POCR values to be obtained to an off-axis distance defined by the corners of the largest field, typically at an off-axis distance of 28.3 cm. This technique requires only routine symmetric field measurements including beam profiles, TMRs, and collimator and phantom scatter factors. The POCRs obtained using the FEC technique were used to generate off-center ratios (OCRs) using the boundary factor technique of Chui et al. [Med. Phys. 15, 92 (1988)]. Excellent agreement with measured values was obtained for cross-beam OCRs using a 10 x 10-cm2 field defined by a single set of asymmetric jaws with a field center offset of 15 cm and for diagonal OCRs using a 20 x 20-cm2 field with each pair of jaws in a half-blocked configuration.     

The variation in output of symmetric, asymmetric and irregularly shaped wedged radiotherapy fields

A model for calculating the variation in output of symmetric, asymmetric and irregularly shaped wedged radiotherapy fields is presented. The variation in output from the treatment head when a wedge is used is calculated by dividing the output into a primary component and one due to scattered radiation. The scatter component is then further subdivided into contributions from elements which have a 1 cm x 1 cm cross-sectional area at the isocentre. The scatter from each element is determined as the contribution from the head scatter component modified by the presence of the wedge and a contribution due to additional scattered radiation from the wedge. The relative intensity of the scattered radiation from the wedge is modelled using a simple first scatter approximation. In this approximation the magnitude of the scatter is given by a t exp(-mu t) function where t is the thickness of the wedge for the selected element. The magnitude of the primary component and the relative intensity of scatter from each element are then obtained by an iterative fit to measured data. The technique has been applied to two different internally mounted wedge designs, for a standard treatment head, two asymmetric treatment heads and two similar multileaf collimators, over a range of energies between 4 and 20 MV. Calculations agree with measured values over a range of field sizes and shapes to within 1.5%.     

Head scatter modelling for irregular field shaping and beam intensity modulation

Scattered radiation from within the treatment head can contribute significant dose to all parts of a radiotherapy treatment field. A multileaf collimator may be used to create an arbitrarily shaped field, and may also be used, under dynamic control, to modulate the beam intensity over the field. This method of intensity modulation is effectively a superposition of a large number of fields which have the same beam direction, but different shapes, and some of these shapes may have unusually small dimensions, particularly in the direction of the leaf movement. Two models for predicting the head scatter under these conditions have been investigated. These are a first-order Compton scatter approximation from the flattening filter, and an empirical fit to measured data using an exponential function. The first model only considers scatter from the flattening filter and has been applied to field sizes between 2 cm by 2 cm and 10 cm by 10 cm, where agreements are all within 1%. However it is not satisfactory at larger field sizes where small scatter contributions, from scattering sources other than the flattening filter, are integrated over large areas. The second model uses measured data between 4 cm by 4 cm and 30 cm by 30 cm to optimize the exponential function and is used to calculate the head scatter contribution for all field sizes. In this case good agreement is achieved over the full field size range, and hence this is a more generally applicable model. Results are presented for static irregularly shaped fields and intensity modulated beams created using a Philips multileaf collimator.     

Mammography grid performance

PURPOSE: To measure directly the grid performance of mammography units for the range of breast thicknesses and x-ray tube potentials encountered in clinical practice. MATERIALS AND METHODS: Contrast improvement factors and Bucky factors were determined for four mammographic units as a function of x-ray tube potential (25, 30, and 35 kVp), phantom thickness (2, 4, and 8 cm) and, on one unit, three target-filter combinations. Three units used a linear grid; one, a cellular grid. Two methods were used for nongrid measurements. RESULTS: For all units tested, contrast improvement factor increased with increased phantom thickness and with increased kilovolt peak level for the 8-cm-thick phantom and changed little with kilovolt peak level for 2- and 4-cm-thick phantoms. At 25 and 30 kVp, contrast improvement factor performance with the linear grids was comparable; with the cellular grid, it was 5%-10% higher. In all cases, the Bucky factor increased with increased phantom thickness and decreased with increased tube potential. CONCLUSION: Differences in grid performance exist. At 25 and 30 kVp, the cellular grid exhibited superior contrast improvement factor performance, whereas one of the linear grids exhibited superior Bucky factor performance. Measured contrast improvement and Bucky factors are dependent on nongrid technique. Cassette tunnels introduce scatter and should not be used with nongrid or magnification techniques.     

Evidence for a significantly higher than expected depth dependence of wedge transmission factors on the 4 MV beam of a new dual energy accelerator

Wedge transmission factors have been measured for two sets of physical wedges for the 4 MV beam of a new dual energy linear accelerator as a function of field size and depth. The field size dependence of these factors has been compared with the 4 MV beam from another, single-energy linear accelerator and a difference of a factor of approximately 2 has been observed in the relative wedge transmission factors between the two machines.     

Calculated energy response correction factors for LiF thermoluminescent dosemeters employed in the seventh EULEP dosimetry intercomparison

Several dosimetry intercomparisons for whole body irradiation of mice have been organized by the European Late Effects Project Group (EULEP). These studies were performed employing a mouse phantom loaded with LiF thermoluminescent dosemeters (TLDs). In-phantom, the energy response of the LiF TLDs differs from free-in-air, due to spectral differences caused by attenuation and scatter of x-rays. From previous studies, energy response correction factors in-phantom relative to free-in-air were available for full scatter conditions. In the more recent intercomparisons, however, full scatter conditions were not always employed by the participants. Therefore, Monte Carlo calculations of radiation transport were performed to verify the LiF TLD energy response correction factors in-phantom relative to free-in-air for full scatter conditions and to obtain energy response correction factors for geometries where full scatter conditions are not met. For incident x-rays with HVLs in the 1 to 3.5 mm Cu range, the energy response correction factor in-phantom deviates by 2 to 4 per cent from that measured free-in-air. This is in reasonable agreement with previously published results. The energy response correction factors obtained from the present study refer to a calibration in terms of muscle tissue dose in-phantom using 60Co gamma rays. For geometries where full scatter conditions are not fulfilled, the energy response correction factors are different by up to about 3 per cent at maximum from that at full scatter conditions. The dependence of the energy response correction factor as a function of the position in-phantom is small, i.e. about 1 per cent at maximum between central and top or bottom positions.     

Calculating dose and output factors for wedged photon radiotherapy fields using a convolution/superposition method

To account for clinical divergent and polychromatic photon beams, we have developed kernel tilting and kernel hardening correction methods for convolution dose calculation algorithms. The new correction methods were validated by Monte Carlo simulation. The accuracy and computation time of the our kernel tilting and kernel hardening correction methods were also compared to the existing approaches including terma divergence correction, dose divergence correction methods, and the effective mean kernel method with no kernel hardening correction. Treatment fields of 10 x 10-40 x 40 cm2 (field size at source to axis distance (SAD)) with source to source distances (SSDs) of 60, 80, and 100 cm, and photon energies of 6, 10, and 18 MV have been studied. Our results showed that based on the relative dose errors at a depth of 15 cm along the central axis, the terma divergence correction may be used for fields smaller than 10 x 10 cm2 with a SSD larger than 80 cm; the dose divergence correction with an additional kernel hardening correction can reduce dose error and may be more applicable than the terma divergence correction. For both these methods, the dose error increased linearly with the depth in the phantom; the 90% isodose lines at the depth of 15 cm were shifted by about 2%-5% of the field width due to significant underestimation of the penumbra dose. The kernel hardening effect was less prominent than the kernel tilting effect for clinical photon beams. The dose error by using nonhardening corrected kernel is less than 2.0% at a depth of 15 cm along the central axis, yet it increased with a smaller field size and lower photon energy. The kernel hardening correction could be more important to compute dose in the fields with beam modifiers such as wedges when beam hardening is more significant. The kernel tilting correction and kernel hardening correction increased computation time by about 3 times, and 0.5-1 times, respectively. This can be justified by more accurate dose calculations for the majority of clinical treatments.     

Microdosimetric analysis of radiation from a clinical mammography machine using realistic breast phantoms and a miniature proportional counter

We have measured the microdosimetric spectra of a Senographe 600T mammography machine employing an Mo target with 0.8 mm Be inherent filtration and 0.03 mm Mo added filtration, giving a half-value layer of 0.35 mm A1 at 28 kVp. In all of our measurements a large collimator producing a 24 cm x 30 cm field at 65 cm was used. Two different phantom compositions differing in the ratio of adipose to fibroglandular tissue were compared, using simulated breast material from Nuclear Associates. Spectra were taken at various depths and locations in simulated breasts of 3.4 and 5 cm thickness. The detector used was a miniature proportional counter having outer dimensions of 5 cm x 1.8 cm diameter, with a sensitive volume 0.5 mm x 0.5 mm. The small dimensions of the counter and the cavity allowed total embedding in the breast material with minimal disturbance of the photon and secondary electron spectrum. Our results show that there can be changes in the radiation quality amounting to as much as 17% (as measured by the dose mean lineal energy. yD) between breasts of different thickness, at the same relative position within the breast. There is little difference due to breast composition.     

Characteristics of secondary electrons produced by 6, 10 and 24 MV x-ray beams

Megavoltage x-ray beams generated by linear accelerators (linacs) deliver their maximum dose a few centimetres below the treatment or phantom surface. This skin-sparing effect is degraded by the generation of secondary electrons as the x-ray beam passes to the patient or phantom. This work measures the characteristics of these electrons. A light-weight electromagnet was constructed that could be mounted in the block-tray position, 58 cm from the x-ray source of a Varian Clinac 2100C or 2500 linac. A field strength as high as 0.1500 T was generated, which was strong enough to sweep secondary electrons out of a 10 cm x 10 cm field. For 6, 10 and 24 MV x-ray beams, secondary contamination electrons produced 18, 38 and 65% of the surface dose, corresponding to 3, 5 and 12% of the maximum dose, respectively. A parameterized depth-dose curve for the contamination electrons was produced and was valid for all the x-ray energies studied.     

Microdosimetric specification of the radiation quality of a d(48.5)+Be fast neutron therapy beam produced by a superconducting cyclotron

The proportional counter microdosimetric technique has been employed to quantify variations in the quality of a d(48.5)+Be fast neutron beam passing through a homogeneous water phantom. Single event spectra have been measured as a function of spatial location in the water phantom and field size. The measured spectra have been separated into component spectra corresponding to the gamma, recoil proton and alpha plus heavy recoil ion contribution to the total absorbed dose. The total absorbed dose normalized to the "monitor units" used in daily clinical use has been calculated from the measured spectra and compared to the data measured with calibrated ion chambers. The present measurements agree with the ion chamber data to within 5%. The RBE of the neutron beam is assumed to be proportional to the microdosimetric parameter y* for the dose ranges pertinent to fractionated neutron therapy. The relative variations in y*, assumed to be representative of variations in the RBE are mapped as a function of field size and spatial location in the phantom. A variation in the RBE of about 4% for points within and 8% for points outside a 10 cm x 10 cm field is observed. The variations in the RBE within the beam are caused by an increase in the gamma component with depth. An increase in the RBE of about 4% is observed with increasing field size which is attributed to a change in the neutron spectrum. Compared to the uncertainties in the prescribed dose, associated with uncertainties in the clinically used RBE, variation in the RBE between various tissues, and other dosimetric uncertainties caused by factors such as patient inhomogeneities, patient setup errors, patient motion, etc., the measured spatial RBE variations are not considered significant enough to be incorporated into the treatment planning scheme.     

Characterisation of flavodoxin NADP+ oxidoreductase and flavodoxin; key components of electron transfer in Escherichia coli

The phantom scatter correction factor Sp of megavoltage photon beams can be accurately described using a three-Gaussian fit. The model leads to six parameters, with which Sp(r) is described as a smooth function of the field radius r for beam qualities in the range from 60Co up to 25 MV. The parameters allow Sp values to be calculated at intermediate beam energies and for any field shape. Calculated Sp(X, Y) values for rectangular fields (X, Y) can be subsequently used as reference values to compare with measured Sp(X, Y) values, for example when appraising a new beam.     

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.