Mean energy, energy-range relationships and depth-scaling factors for clinical electron beams

Using Monte Carlo simulations we have studied the electron mean energy, Eo, and the most probable energy, Eo,p, at the phantom surface and their relationships with half-value depth, R50, and the practical range, Rp, for a variety of beams from five commercial medical accelerators with an energy range of 5-50 MeV. It is difficult to obtain a relation between R50 and Eo for all electrons at the surface because the number of scattered lower-energy electrons varies with the machine design. However, using only direct electrons to calculate Eo, there is a relationship which is in close agreement with that calculated using monoenergetic beams by Rogers and Bielajew [Med. Phys. 13, 687-694 (1986)]. We show that the empirical formula Eo,p = 0.22 + 1.98Rp + 0.0025R2p describes accurately the relationship between Rp and Eo,p for clinical beams of energies from 5 to 50 MeV with an accuracy of 3%. The electron mean energy, Ed, is calculated as a function of depth in water as well as plastic phantoms and is compared both with the relation, Ed = Eo (1-d/Rp), employed in AAPM protocols and with values in the IAEA Code of Practice. The conventional relations generally overestimate Ed over the entire therapeutic depth, e.g., the AAPM and IAEA overestimate Ed at dmax by up to 20% for an 18 MeV beam from a Clinac 2100C. It is also found that at all depths mean energies are 1%-3% higher near the field edges than at the central axis. We calculated depth-scaling factors for plastic phantoms by scaling the depth in plastics to the water-equivalent depth where the mean energies are equal. The depth-scaling factor is constant with depth in a given beam but there is a small variation ( < 1.5%) depending on the incident beam energies. Depth-scaling factors as a function of R50 in plastic or water are presented for clear polystyrene, white polystyrene and PMMA phantom materials. The calculated depth-scaling factor is found to be equal to R50water/R50plastic. This is just the AAPM definition of effective density but there are up to 2% discrepancies between our calculated values and those recommended by the AAPM and the IAEA protocols. We find that the depth-scaling factors obtained by using the ratio of continuous-slowing-down ranges are inaccurate and overestimate our calculated values by 1%-2% in all cases. We also find that for accurate work, it is incorrect to use a simple 1/r2 correction to convert from parallel beam depth-dose curves to point source depth-dose curves, especially for high-energy beams.     

Study of dosimetry consistency for kilovoltage x-ray beams

In this paper, the consistency of kilovoltage (tube potentials between 40 and 300 kV) x-ray beam dosimetry using the "in-air" method and the in-phantom measurement has been studied. The procedures for the measurement of the central-axis depth-dose curve, which serve as a link between the dose at the reference depth to the dose elsewhere in a phantom, were examined. The uncertainties on the measured dose distributions were analyzed with the emphasis on the surface dose measurement. The Monte Carlo method was used to calculate the perturbation correction factors for a photon diode and a NACP plane-parallel ionization chamber at different depths in a water phantom irradiated by 100-300 kV (2.43 mm Al-3.67 mm Cu half-value layer) x-ray beams. The depth-dose curves measured with these two detectors, after correcting for the perturbation effect (up to 15% corrections), agreed with each other to within 1.5%. Comparisons of the doses at the phantom surface and at 2 cm depth in water for photon beams of 100-300 kV tube potential obtained using the "backscatter" method and those using the "in-phantom" measurement have shown that the "in-air" method can be equally applied to this energy range if the depth-dose curve can be measured accurately. To this end, measured depth ionization curves require depth-dependent correction factors.     

Target, purging magnet and electron collector design for scanned high-energy photon beams

A new method for producing very narrow and intense 50 MV bremsstrahlung beams with a half-width as low as 35 mm at a distance of 1 m from the target is presented. Such a beam is well suited for intensity modulation using scanned photon beams. An algorithm has been developed to minimize the width of the bremsstrahlung beam generated in a multilayer target by varying the individual layer thicknesses and atomic numbers under given constraints on the total target thickness and the mean energy of the transmitted electrons. Under such constraints the narrowest possible bremsstrahlung beam is obtained with a target composed of layers of monotonically increasing atomic number starting with the lowest possible value at the entrance side where the electrons impinge. It is also shown that the narrowest photon beam profile is associated with the highest possible forward photon yield. To be able to use the optimized target clinically it is desirable to be able to collect and stop all the electrons that are transmitted through the target. The electrons are most efficiently collected if they are kept close together, i.e. by minimizing the multiple scatter of the electrons and consequently the half-width of the generated bremsstrahlung beam. This is achieved by a thin low-atomic-number target. A dedicated electron stopper has been developed and integrated with the purging magnet. When the electron stopper is combined with a purging magnet, a primary photon collimator and a multileaf collimator, almost all of the transmitted electrons and their associated bremsstrahlung contamination can effectively be collected. The narrow photon beams from thin low-atomic-number targets have the additional advantage of producing the hardest and most penetrative photon spectrum possible, which is ideal for treating large deep-seated tumours.     

Studies on the desamidation of bovine collagen

A variable air-volume, parallel-plate extrapolation chamber forming an integral part of a Solid Water phantom was built to determine the absorbed dose in Solid Water directly. The sensitive air-volume of the extrapolation chamber is controlled through the movement of the chamber piston by means of a micrometer mounted to the phantom body. The relative displacement of the piston is monitored by a calibrated mechanical distance travel indicator with a precision on the order of 0.002 mm. Irradiations were carried out with cobalt-60 gamma rays, x-ray beams ranging from 4 to 18 MV, and electron beams between 6 and 22 MeV. The absorbed dose at a given depth in Solid Water is proportional to the ionization gradient measured in the Bragg-Gray cavity region with an extrapolation chamber embedded in the Solid Water phantom. The discrepancies between the doses determined in Solid Water with our uncalibrated extrapolation chamber and doses obtained with a calibrated standard thimble ionization chamber are at most 1% for photon and electron beams at all megavoltage clinical energies. Uncalibrated extrapolation chamber thus offer a simple and practical alternative to other techniques used in output measurements of megavoltage photon and electron machines.     

Negative regulation of the anti-human immunodeficiency virus and chemotactic activity of human stromal cell-derived factor 1alpha by CD26/dipeptidyl peptidase IV

A method to characterize the energy distribution in the whole photon field is valuable when designing an accelerator for choosing target and flattening filter or scan pattern. Another field of application is beam characterization for treatment planning systems or other dosimetric purposes. This work is focused on the energy distribution in different 50 MV bremsstrahlung beams with different scanning of electrons on three different targets. Fluence differential in energy and angle at the exit of each target has been determined by Monte Carlo calculations for a narrow beam. Data for broad beams were obtained by convolution of the narrow beams with different scan patterns. Photon energy fluence differential in energy at SSD 100 were thus found to be rather different for the targets studied. The results are presented as mean energy profiles and narrow beam half-value layer (HVL) in water. Two different experimental setups were used to measure HVL at the central axis and at off-axis positions. The two methods gave results which differ by 5%-6% and the calculated data where within these experimental results. In conclusion, the presented method for characterization of the photon field energy distribution is well within the experimental results and can thus be used to improve accelerator design or dosimetric calculations, e.g., for treatment planning.     

A comparative study of dosimetric properties of Plastic Water and Solid Water in brachytherapy applications

In this study the dosimetric properties of Plastic Water and Solid Water phantom materials are evaluated using Monte Carlo photon transport simulations. In particular, their water-equivalence with respect to absorption and attenuation of photons in the brachytherapy energy range are examined. For the given chemical compositions of the materials, the linear attenuation coefficients were calculated for photons of 1 keV-2 MeV. Moreover, absorbed doses to water in each phantom material were calculated at distances of 0.5-12.0 cm from point sources of 20 keV to 60Co gamma rays. These results show that at low photon energies (below 100 keV), there are substantial differences (up to a factor of 5) between the absorbed dose in Plastic Water and that in liquid water. The differences decrease as photon energy increases, and they become insignificant at 60Co gamma rays, as claimed by the manufacturer. In contrast, calculations show that the difference in absorbed dose in Solid Water from that in liquid water, over the entire range of photon energies employed in this study, is less than 25%. The results of this study demonstrate the necessity of careful dosimetric evaluation of a new phantom material, before its clinical application, particularly in energy ranges outside those referred to by the manufacturer.     

Monte Carlo simulation of a miniature, radiosurgery x-ray tube using the ITS 3.0 coupled electron-photon transport code

A miniature, interstitial x-ray generator has recently been developed and is currently undergoing clinical trials for the treatment of brain tumors. The maximum photon energy from this x-ray tube is 50 keV, although most of the initial testing has been carried out at 40 keV. Dose rates of up to 2 Gy/min in a water phantom at a distance of 10 mm from the tube tip are produced. In this paper we describe the modeling and simulation of x-ray production from this device using the ITS 3.0 Monte Carlo code. Verification of the simulation of x-ray production in the device was carried out by comparing predictions of spatial photon distribution, energy spectrum, and dose versus depth in water with experimentally obtained measurements. Agreement between the simulated results and experimental measurements was fairly good when comparing the angular distribution of photons emitted from the x-ray tube and very good when comparing dose rate versus depth in a water phantom. Discrepancies observed when comparing the calculated and measured estimates of characteristic line radiation were reduced by incorporation of a modification to the ITS code. Possible causes of the remaining discrepancy in bremsstrahlung intensity are discussed.     

Field study on the distribution of Entamoeba histolytica and Entamoeba dispar in the northern Philippines as detected by the polymerase chain reaction

The influence of the electron contamination at in vivo dosimetry with diodes on the patient surface has been investigated by introducing different accessories in the beam path and by changing the field size and SSD. The results show a clear correlation between the electron contamination at an effective measuring depth of the diode and the signal from the patient diode. When the electron contamination is taken into account the agreement between the diode values and the absorbed dose is greatly improved. More accurate in vivo dosimetry with less error margins is therefore possible if better predictions of the electron contamination in high-energy photon beams can be performed.     

Beam characteristics and clinical possibilities of a new compact treatment unit design combining narrow pencil beam scanning and segmental multileaf collimation

Not until the last decade has flexible intensity modulated three-dimensional dose delivery techniques with photon beams become a clinical reality, first in the form of heavy metal transmission blocks and other beam compensators, then in dynamic and segmented multileaf collimation, and most recently by scanning high-energy narrow electron and photon beams. The merits of various treatment unit and bremsstrahlung target designs for high-energy photon therapy are investigated theoretically for two clinically relevant target sites, a cervix and a larynx cancer both in late stages. With an optimized bremsstrahlung target it is possible to generate photon beams with a half-width of about 3 cm at a source to axis distance (SAD) of 100 cm and an initial electron energy of 50 MeV. By making a more compact treatment head and shortening the SAD, it is possible to reduce the half-width even further to about 2 cm at a SAD of 70 cm and still have sufficient clearance between the collimator head and the patient. One advantage of a reduced SAD is that the divergence of the beam for a given field size on the patient is increased, and thus the exit dose is lowered by as much as 1%/cm of the patient cross section. A second advantage of a reduced SAD is that the electron beam on the patient surface will be only about 8 mm wide and very suitable for precision spot beam scanning. It may also be possible to reduce the beamwidth further by increasing the electron energy up to about 60 MeV to get a photon beam of around 15 mm half-width and an electron beam as narrow as 5 mm. The compact machine will be more efficient and easy to work with, due to the small gantry and the reduced isocentric height. For a given target volume and optimally selected static multileaf collimator, it is no surprise that the narrowest possible scanned elementary bremsstrahlung beam generates the best possible treatment outcome. In fact, by delivering a few static field segments with individually optimized scan patterns, it is possible to combine the advantage of being able to fine tune the fluence distribution by the scanning system with the steeper dose gradients that can be delivered by a few static multileaf collimator segments. It is demonstrated that in most cases a few collimator segments are sufficient and often a single segment per beam portal may suffice when narrow scanned photon beams are employed, and they can be delivered sequentially with a negligible time delay. A further advantage is the increase of therapeutically useful photons and improved patient protection, since the pencil beam is only scanned where the leaf collimator is open. Consequently, some of the problems associated with dynamic multileaf collimation such as the tongue and groove and edge leakage effects are significantly reduced. Fast scanning beam techniques combined with good treatment verification systems allow interesting future possibilities to counteract patient and internal organ motions in real time.     

Conversion of ionization measurements to radiation absorbed dose in non-water density material

The radiation absorbed dose to non-water equivalent materials of interest in radiotherapy is the dose to lung and the dose to bone. The measurement and calculation of dose to the lung has been of great interest and much effort has gone into the development of accurate lung dose calculation methods. The radiation absorbed dose to the bone is usually not calculated and most absorbed dose calculations have been done without correcting for the presence of bone. For the lower megavoltage photon beams this may be appropriate, however, as the energy of the photon beam increases, the region of electronic disequilibrium becomes larger and pair production which depends on the atomic number of the material becomes significant. Therefore the bone will produce greater perturbations of the dose distribution. The dose to lung-equivalent material is uniquely obtained from ionization measurements. However, in bone-equivalent materials two different calculations of absorbed dose are possible: the absorbed dose to soft tissue plastic (polystyrene) within bone-equivalent material and the dose to the bone-equivalent material itself. Both can be calculated from ionization measurements in phantoms. These two calculations result in significantly different doses in a heterogeneous phantom composed of polystyrene and aluminium (a bone substitute). The dose to a thin slab of polystyrene in aluminium is much higher than the dose to the aluminium itself at the same depth in the aluminium. Monte Carlo calculations confirm that the calculation of dose to polystyrene in aluminium can be accurately carried out using existing dosimetry protocols. However, the conversion of ionization measurements to absorbed dose to high atomic number materials cannot be accurately carried out with existing protocols and appropriate conversion factors need to be determined.     

A dermatoglyphic study of the thenar/first interdigital area of the palm in females and males with sex chromosomal abnormalities

We have measured the effect of a 10-kG magnetic field on the dose distribution of electrons in a polystyrene phantom. Isodensity plots and depth-dose curves are presented for 22- and 28-MeV electron beams with and without the magnetic field applied. The measurements show that magnetic fields as low as 10 kG can produce a substantial modification of the absorbed dose distribution. When compared with the zero-magnetic-field distribution of the same energy, the magnetic field significantly improves the Dmax- surface dose ratio and increases the fall off in dose past the Dmax region.     

Electron contamination in clinical high energy photon beams

The electron contamination in photon beams has been investigated by means of contaminating lepton depth doses and dose profiles in different geometries with two 20 MV beams. Different components of this contamination have been investigated separately by systematically adding contamination to a "clean" reference field. At 20 MV, the air generated electrons were found to be almost negligible compared to the electrons originating from the accelerator head when measurements were performed in standard fields at SSDs between 80 and 120 cm. The total electron part of the depth dose curve was then almost the same, i.e., independent of SSD, when the collimator opening was held fixed. However, when different accessories such as a shaping block and different attenuating plates were located in the beam path below the collimators, a large SSD dependence of the electron contamination was noticed. A comparison was also made between two machines, one equipped with a multileaf collimator, with similar beam qualities at 20 MV. These measurements indicate that the interior view of the treatment head seen by the detector (mainly the flattening filter, monitor chamber, or other electron generating material) influences the magnitude of the electron contamination. When the collimator opening is decreased the electron contamination will also decrease as parts of the electron source will be shielded by the collimator blocks.     

Measurement of Prepl Pwall factors in electron beams and in a 60Co beam for plane-parallel chambers

This paper describes a method to measure the product of Prepl Pwall correction factors for ionization chambers and presents our measured values of Prepl Pwall for Markus plane-parallel chambers in electron beams. It is shown that the measured values of Prepl Pwall can be fitted to an equation, Prepl Pwall = c1 + c2 R50 + c3 (R50)2, for Markus chambers at the new reference depth for electron beams (6 MeV < or = nominal energy E < or = 20 MeV). We also present our measured values of Prepl Pwall for NACP and Markus chambers in a water phantom irradiated in a 60Co beam.     

Two replica blotting methods for fast immunological analysis of common proteins in two-dimensional electrophoresis

Knowledge of the photon spectrum of a radiotherapy beam is often needed for three-dimensional (3-D) dose calculations using Monte Carlo methods and/or algorithms employing energy deposition kernels. Direct measurement of the x-ray energy fluence spectrum is not feasible for the high-energy photon beams used clinically. In this paper, the spectrum is extracted from basic beam data that are readily obtained for a clinical beam. We describe the photon spectrum using just two parameters. One parameter, which determines the high-energy part of the spectrum, is obtained using the measured dose in the buildup region for a small field, where electron contamination of the beam can be neglected. The other parameter is extracted from the photon beam attenuation in water. The results compare favorably to spectra generated from Monte Carlo simulations.     

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.     

Production and dosimetry of copper L ultrasoft x-rays for biological and biochemical investigations

Ultrasoft x-rays provide a unique tool for investigating the intracellular mechanisms of radiation action. Secondary electrons are produced with a well defined energy and a range comparable with that of critical structures in the cell. Copper L characteristic x-rays of weighted average energy of 956 eV interact within the cell, mainly with the oxygen atom, typically producing a photoelectron with energy 424 eV (95%) followed by an Auger electron with an average energy of 505 eV, with a combined continuous slowing down approximation (csda) range of approximately 40 nm. The attenuation through the cell is similar to that of carbon K x-rays (277 eV, single electron), therefore a useful comparison can be made due to similar dose-averaging factors but different electron configurations (total range, and pairs versus singlets). The production, absorption, dosimetry and biological implications of Cu L x-rays using the Medical Research Council cold cathode source is described extending the number of energies available for study in the ultrasoft region. Design parameters were optimized to overcome the inherently low L-characteristic-to-bremsstrahlung yield ratio. Surface absorbed dose rates of 1 Gy min-1 have been obtained with a bremsstrahlung contamination of less than 0.5%. A confocal microscope was used to make thickness measurements on live cells to allow careful determination of the mean absorbed dose. Survival curves for V79-4 Chinese hamster cells were obtained, showing that Cu L x-rays are substantially more lethal per unit dose than are hard x-rays or gamma-rays, with a relative biological effectiveness (RBE) of 1.8. The data are consistent with the hypothesis that clustered damage at the DNA/chromatin level produced by low-energy electrons is biologically more effective.     

Monte Carlo and analytical calculation of proton pencil beams for computerized treatment plan optimization

Proton pencil beams in water, in a format suitable for treatment planning algorithms and covering the radiotherapy energy range (50-250 MeV), have been calculated using a modified version of the Monte Carlo code PTRAN. A simple analytical model has also been developed for calculating proton broad-beam dose distributions which is in excellent agreement with the Monte Carlo calculations. Radial dose distributions are also calculated analytically and narrow proton pencil-beam dose distributions derived. The physical approximations in the Monte Carlo code and in the analytical model together with their limitations are discussed. Examples showing the use of the calculated set of proton pencil beams as input to an existing photon treatment planning algorithm based on biological optimization are given for fully 3D scanned proton pencil beams; these include intensity modulated beams with range shift and scanning in the transversal plane.     

Investigation of the chamber correction factor (k(ch)) for the UK secondary standard ionization chamber (NE2561/NE2611) using medium-energy x-rays

This paper evaluates the characteristics of ionization chambers for the measurement of absorbed dose to water for medium-energy x-rays. The values of the chamber correction factor, k(ch), used in the IPEMB code of practice for the UK secondary standard (NE2561/NE2611) ionization chamber are derived and their constituent factors examined. The comparison of the chambers' responses in air revealed that of the chambers tested only the NE2561, NE2571 and NE2505 exhibit a flat (within 5%) energy response in air. Under no circumstances should the NACP, Sanders electron chamber, or any chamber that has a wall made of high atomic number material, be used for medium-energy x-ray dosimetry. The measurements in water reveal that a chamber that has a substantial housing, such as the PTW Grenz chamber, should not be used to measure absorbed dose to water in this energy range. The value of k(ch) for an NE2561 chamber was determined by measuring the absorbed dose to water and comparing it with that for an NE2571 chamber, for which k(ch) data have been published. The chamber correction factor varies from 1.023 +/- 0.03 to 1.018 +/- 0.001 for x-ray beams with HVL between 0.15 and 4 mm Cu. The values agree with that for an NE2571 chamber within the experimental uncertainty. The corrections due to the stem, waterproof sleeve and replacement of the phantom material by the chamber for an NE2561 chamber are described.     

Contamination of a 15-MV photon beam by electrons and scattered photons

The 15-MV photon beam of a linear accelerator (Siemens Mevatron 20) was studied for electron and scattered photon contamination. The surface dose, attributable almost entirely to contamination electrons, has a Gaussian lateral distribution, a linear dependence on field width for square fields, and an inverse square dependence on distance from the bottom of the fixed head assembly. This geometrical dependence is consistent with the proposal that the field flattening filter is the main source of electron contamination when accessories are absent. A tissue-maximum-ratio curve in the build-up region for the electron and photon contamination was produced utilizing the linearity of dose with respect to field width. The derived contamination curve inside was similar to the measured build-up curve outside the field. The primary photon component, obtained by subtracting the contaminant contribution, showed no dependence on field size, source-to-probe distance, or presence of accessories.