Monte Carlo modeling of the origin of contaminant electrons on a 0.5T bi-planar Linac-MR.

INTRODUCTION: In the last decade, hybrid linear accelerator magnetic resonance imaging (Linac-MR) devices have evolved into FDA-cleared clinical tools, facilitating magnetic resonance guided radiotherapy (MRgRT). The addition of a magnetic field to radiation therapy has previously demonstrated dosimetric and electron effects regardless of magnetic field orientation. PURPOSE: This study uses Monte Carlo simulations to investigate the importance and efficacy of the magnetic field design in mitigating surface dose enhancement in the Aurora-RT, focusing specifically on contaminant electrons, their origin, and energy spectrum. METHODS: The Aurora-RT 0.5 T Biplanar Linac-MR device was modeled using the BEAMnrc package using the updated EM macros, a magnetic field map generated from Opera 3D. Simulation generated phasespace data at the distal side of the first magnetic pole plate (89 cm) and at machine isocenter (120 cm) were analyzed with respect to electron energy spectra and electron creation origins, both with and without the static magnetic field. RESULTS: The presence of the main magnetic field was verified to affect the origin and distribution of contaminant electrons, removing them from the air column up to 60 cm from the target, and focusing them along the CAX within the region below. Analysis of the remaining electron energy fluence reveals the net removal of electrons with energies > 2 MeV and generation of electrons with energies < 2 MeV in the presence of the static magnetic field as compared to no magnetic field. Moreover, in the presence of the magnetic field the integral energy contained in the contaminant electrons increases from 89 cm to isocenter but is still 15% less overall than the integral energy contained in contaminant electrons without the magnetic field. CONCLUSION: This study provides an analysis of contaminant electrons in the Aurora-RT 0.5 T Linac-MR, emphasizing the role of magnetic field design in successfully minimizing electron contaminants.

Skin dose investigations on a 0.5 T parallel rotating biplanar linac-MR using Monte Carlo simulations and measurements.

BACKGROUND: The Alberta rotating biplanar linac-MR has a 0.5 T magnetic field parallel to the beamline. When developing a new linac-MR system, interactions of charged particles with the magnetic field necessitate careful consideration of skin dose and tissue interface effects. PURPOSE: To investigate the effect of the magnetic field on skin dose using measurements and Monte Carlo (MC) simulations. METHODS: We develop an MC model of our linac-MR, which we validate by comparison with ion chamber measurements in a water tank. Additionally, MC simulation results are compared with radiochromic film surface dose measurements on solid water. Variations in surface dose as a function of field size are measured using a parallel plate ion chamber in solid water. Using an anthropomorphic computational phantom with a 2 mm-thick skin layer, we investigate dose distributions resulting from three beam arrangements. Magnetic field on and off scenarios are considered for all measurements and simulations. RESULTS: For a 20 × 20 cm2 field size, D 0.2 c c ${D_{0.2cc}}$ (the minimum dose to the hottest contiguous 0.2 cc volume) for the top 2 mm of a simple water phantom is 72% when the magnetic field is on, compared to 34% with magnetic field off (values are normalized to the central axis dose maximum). Parallel plate ion chamber measurements demonstrate that the relative increase in surface dose due to the magnetic field decreases with increasing field size. For the anthropomorphic phantom, D ∼ 0.2 c c ${D_{ \sim 0.2cc}}$ (minimum skin dose in the hottest 1 × 1 × 1 cm3 cube) shows relative increases of 20%-28% when the magnetic field is on compared to when it is off. With magnetic field off, skin D ∼ 0.2 c c ${D_{ \sim 0.2cc}}$ is 71%, 56%, and 21% for medial-lateral tangents, anterior-posterior beams, and a five-field arrangement, respectively. For magnetic field on, the corresponding skin D ∼ 0.2 c c ${D_{ \sim 0.2cc}}$ values are 91%, 67%, and 25%. CONCLUSIONS: Using a validated MC model of our linac-MR, surface doses are calculated in various scenarios. MC-calculated skin dose varies depending on field sizes, obliquity, and the number of beams. In general, the parallel linac-MR arrangement results in skin dose enhancement due to charged particles spiraling along magnetic field lines, which impedes lateral motion away from the central axis. Nonetheless, considering the results presented herein, treatment plans can be designed to minimize skin dose by, for example, avoiding oblique beams and using a larger number of fields.

Influence of intra- and interfraction motion on planning target volume margin in liver stereotactic body radiation therapy using breath hold.

PURPOSE: This study aimed to investigate intra- and interfraction motion during liver stereotactic body radiation therapy for the purpose of planning target volume (PTV) margin estimation, comparing deep inspiration breath hold (DIBH) and deep expiration breath hold (DEBH). METHODS AND MATERIALS: Pre- and posttreatment kV cone beam computed tomography (CT) images were acquired for patients with liver cancer who were treated using stereotactic body radiation therapy with DIBH or DEBH. A total of 188 images were analyzed from 18 patients. Positioning errors were determined based on a comparison with planning CT images and matching to the liver. Treatment did not proceed until errors were ≤3 mm. Standard deviations of random and systematic errors resulting from this image matching process were used to calculate PTV margin estimates. RESULTS: DIBH errors are generally larger than DEBH errors, especially in the anterior-posterior and superior-inferior directions. Posttreatment errors tend to be larger than pretreatment errors, especially for DIBH. Standard deviations of random errors are larger than those of systematic errors. Considering both pre- and posttreatment cone beam CT images, PTV margins for DIBH and DEBH are estimated as anterior-posterior, superior-inferior, right-left = (5.7, 6.3, 3.0) mm and (3.1, 3.4, 2.8) mm, respectively. CONCLUSIONS: This study suggests that DEBH results in more reproducible target positioning, which could in turn justify the use of smaller PTV margins.

Individualized Dose-Escalation of HDR Prostate Brachytherapy Implant to Decrease Required External Beam Radiation Dose: A Retrospective Feasibility Study.

PURPOSE: High-dose-rate brachytherapy (HDR-BT) is commonly combined with external beam radiation therapy (EBRT) for the treatment of localized prostate cancer. Escalating the HDR-BT dose as far as organ-at-risk (OAR) constraints allow, on a personalized basis, would allow for a reduction in EBRT dose while achieving similar total biologic equivalence. The primary objective of this study was to determine the dosimetric feasibility of escalating the HDR-BT dose from 15 Gy to 16 or 17 Gy while continuing to meet OAR constraints from the original 15 Gy plan on an individualized basis. METHODS AND MATERIALS: A total of 53 consecutive HDR-BT plans were retrospectively assessed to determine what percentage of plans could be reoptimized to deliver a dose of 16 Gy or 17 Gy, while meeting defined 15-Gy OAR constraints. Factors independently associated with dose escalation were examined. RESULTS: Thirty-nine plans (74%) and 2 plans (4%) were successfully escalated to a dose of 16 Gy and 17 Gy, respectively. Rectum V80 and urethra Dmax were independently predictive of the ability to dose escalate to 16 Gy. CONCLUSIONS: Individualized HDR-BT dose escalation beyond 15 Gy without compromising OAR constraints is dosimetrically feasible. This approach could allow for a corresponding reduction of EBRT fractions (ie, from 15 to 12 fractions) and would be beneficial in terms of resource savings for departments, convenience for patients, and potentially better tolerance of treatment with the expected reduction in biologically equivalent doses to OARs. A clinical trial is being developed to investigate the efficacy and tolerance of personalized HDR-BT/EBRT dose fractionation for localized intracapsular prostate cancer.

Investigating energy deposition in glandular tissues for mammography using multiscale Monte Carlo simulations.

PURPOSE: To investigate energy deposition in glandular tissues of the breast on macro- and microscopic length scales in the context of mammography. METHODS: Multiscale mammography models of breasts are developed, which include segmented, voxelized macroscopic tissue structure as well as nine regions of interest (ROIs) embedded throughout the breast tissue containing explicitly-modelled cells. Using a 30 kVp Mo/Mo spectrum, Monte Carlo (MC) techniques are used to calculate dose to ∼mm voxels containing glandular and/or adipose tissues, as well as energy deposition on cellular length scales. ROIs consist of at least 1000 mammary epithelial cells and ∼200 adipocytes; specific energy (energy imparted per unit mass; stochastic analogue of the absorbed dose) is calculated within mammary epithelial cell nuclei. RESULTS: Macroscopic dose distributions within segmented breast tissue demonstrate considerable variation in energy deposition depending on depth and tissue structure. Doses to voxels containing glandular tissue vary between ∼0.1 and ∼4 times the mean glandular dose (MGD, averaged over the entire breast). Considering microscopic length scales, mean specific energies for mammary epithelial cell nuclei are ∼30% higher than the corresponding glandular voxel dose. Additionally, due to the stochastic nature of radiation, there is considerable variation in energy deposition throughout a cell population within a ROI: for a typical glandular voxel dose of 4 mGy, the standard deviation of the specific energy for mammary epithelial cell nuclei is 85% relative to the mean. Thus, for a glandular voxel dose of 4 mGy at the centre of the breast, corresponding mammary epithelial cell nuclei will receive specific energies up to ∼9 mGy (considering the upper end of the 1σ standard deviation of the specific energy), while a ROI located 2 cm closer to the radiation source will receive specific energies up to ∼40 mGy. Energy deposition within mammary epithelial cell nuclei is sensitive to cell model details including cellular elemental compositions and nucleus size, underlining the importance of realistic cellular models. CONCLUSIONS: There is considerable variation in energy deposition on both macro- and microscopic length scales for mammography, with glandular voxel doses and corresponding cell nuclei specific energies many times higher than the MGD in parts of the breast. These results should be considered for radiation-induced cancer risk evaluation in mammography which has traditionally focused on a single metric such as the MGD.

Microdosimetric considerations for radiation response studies using Raman spectroscopy.

PURPOSE: Recent Raman spectroscopy (RS) studies of radiation response involve subcellular (µm-scale) sampling volumes and macroscopic doses as low as 0.005 Gy. These studies ignore the stochastic nature of radiation transport and energy deposition, which can lead to considerable microdosimetric "spread" (i.e., variation in energy deposition). The goal of this work is to use Monte Carlo (MC) simulations to investigate the microdosimetric spread across populations of microscopic targets relevant for RS studies of cellular radiation response. METHODS: Simulation geometries involve populations of 1600 cells, with two sizes of sampling volumes (representative of recent RS studies) considered within each nucleus, as well as averaging over multiple sampling volumes in the same nucleus. To investigate variation in microdosimetric spread as a function of dose and target size, simple cubic voxel geometries are also considered. MC simulations are used to score energy imparted per unit mass (specific energy, z) in targets (nuclei, sampling volumes, and voxels), considering doses from a few mGy to several Gy. Three photon spectra are considered: 120 kVp x-ray, cobalt-60, and a 6 MV medical linac. RESULTS: For µm-sized targets, there can be considerable variation in energy deposition across a population of targets: the specific energy distribution is skewed, a large fraction of targets receive no energy, and the standard deviation of the specific energy relative to the mean, σ z / z ¯ , is considerable. These results vary with source energy and (macroscopic) dose: for 60 Co with cylindrical nuclei of 12.8 µm height and diameter, σ z / z ¯ is 17% at 0.02 Gy, decreasing to 2% at 2 Gy. In contrast, for cylindrical sampling volumes with 1 µm diameter and 4 µm height, σ z / z ¯ is 170% at 0.02 Gy and 18% at 2 Gy. Results of MC simulations involving cubic voxel geometries are fit to an equation relating the relative standard deviation of the specific energy to the target volume and dose; additionally, specific energy distributions are compared with normal distributions. CONCLUSIONS: Microdosimetric considerations are important for RS cellular radiation response studies, especially for low doses. The results of this work may motivate changes to current measurement and data analysis methods for RS experiments, and motivate future work comparing MC simulation results with RS measurements to advance understanding of radiation response.