AAPM Task Group 298: Recommendations on certificate program/alternative pathway candidate education and training.

Entry into the field of clinical medical physics is most commonly accomplished through the completion of a Commission on Accreditation of Medical Physics Educational Programs (CAMPEP)-accredited graduate and residency program. To allow a mechanism to bring valuable expertise from other disciplines into clinical practice in medical physics, an "alternative pathway" approach was also established. To ensure those trainees who have completed a doctoral degree in physics or a related discipline have the appropriate background and didactic training in medical physics, certificate programs and a CAMPEP-accreditation process for these programs were initiated. However, medical physics-specific didactic, research, and clinical exposure of those entering medical physics residencies from these certificate programs is often comparatively modest when evaluated against individuals holding Master's and/or Doctoral degrees in CAMPEP-accredited graduate programs. In 2016, the AAPM approved the formation of Task Group (TG) 298, "Alternative Pathway Candidate Education and Training." The TG was charged with reviewing previous published recommendations for alternative pathway candidates and developing recommendations on the appropriate education and training of these candidates. This manuscript is a summary of the AAPM TG 298 report.

A generalized 2D pencil beam scaling algorithm for proton dose calculation in heterogeneous slab geometries.

PURPOSE: Pencil beam algorithms are commonly used for proton therapy dose calculations. Szymanowski and Oelfke ["Two-dimensional pencil beam scaling: An improved proton dose algorithm for heterogeneous media," Phys. Med. Biol. 47, 3313-3330 (2002)] developed a two-dimensional (2D) scaling algorithm which accurately models the radial pencil beam width as a function of depth in heterogeneous slab geometries using a scaled expression for the radial kernel width in water as a function of depth and kinetic energy. However, an assumption made in the derivation of the technique limits its range of validity to cases where the input expression for the radial kernel width in water is derived from a local scattering power model. The goal of this work is to derive a generalized form of 2D pencil beam scaling that is independent of the scattering power model and appropriate for use with any expression for the radial kernel width in water as a function of depth. METHODS: Using Fermi-Eyges transport theory, the authors derive an expression for the radial pencil beam width in heterogeneous slab geometries which is independent of the proton scattering power and related quantities. The authors then perform test calculations in homogeneous and heterogeneous slab phantoms using both the original 2D scaling model and the new model with expressions for the radial kernel width in water computed from both local and nonlocal scattering power models, as well as a nonlocal parameterization of Molière scattering theory. In addition to kernel width calculations, dose calculations are also performed for a narrow Gaussian proton beam. RESULTS: Pencil beam width calculations indicate that both 2D scaling formalisms perform well when the radial kernel width in water is derived from a local scattering power model. Computing the radial kernel width from a nonlocal scattering model results in the local 2D scaling formula under-predicting the pencil beam width by as much as 1.4 mm (21%) at the depth of the Bragg peak for a 220 MeV proton beam in homogeneous water. This translates into a 32% dose discrepancy for a 5 mm Gaussian proton beam. Similar trends were observed for calculations made in heterogeneous slab phantoms where it was also noted that errors tend to increase with greater beam penetration. The generalized 2D scaling model performs well in all situations, with a maximum dose error of 0.3% at the Bragg peak in a heterogeneous phantom containing 3 cm of hard bone. CONCLUSIONS: The authors have derived a generalized form of 2D pencil beam scaling which is independent of the proton scattering power model and robust to the functional form of the radial kernel width in water used for the calculations. Sample calculations made with this model show excellent agreement with expected values in both homogeneous water and heterogeneous phantoms.

Microdosimetric measurements for neutron-absorbed dose determination during proton therapy.

This work presents microdosimetric measurements performed at the Midwest Proton Radiotherapy Institute in Bloomington, Indiana, USA. The measurements were done simulating clinical setups with a water phantom and for a variety of stopping targets. The water phantom was irradiated by a proton spread out Bragg peak (SOBP) and by a proton pencil beam. Stopping target measurements were performed only for the pencil beam. The targets used were made of polyethylene, brass and lead. The objective of this work was to determine the neutron-absorbed dose for a passive and active proton therapy delivery, and for the interactions of the proton beam with materials typically in the beam line of a proton therapy treatment nozzle. Neutron doses were found to be higher at 45° and 90° from the beam direction for the SOBP configuration by a factor of 1.1 and 1.3, respectively, compared with the pencil beam. Meanwhile, the pencil beam configuration produced neutron-absorbed doses 2.2 times higher at 0° than the SOBP. For stopping targets, lead was found to dominate the neutron-absorbed dose for most angles due to a large production of low-energy neutrons emitted isotropically.

Neutron production from beam-modifying devices in a modern double scattering proton therapy beam delivery system.

In this work the neutron production in a passive beam delivery system was investigated. Secondary particles including neutrons are created as the proton beam interacts with beam shaping devices in the treatment head. Stray neutron exposure to the whole body may increase the risk that the patient develops a radiogenic cancer years or decades after radiotherapy. We simulated a passive proton beam delivery system with double scattering technology to determine the neutron production and energy distribution at 200 MeV proton energy. Specifically, we studied the neutron absorbed dose per therapeutic absorbed dose, the neutron absorbed dose per source particle and the neutron energy spectrum at various locations around the nozzle. We also investigated the neutron production along the nozzle's central axis. The absorbed doses and neutron spectra were simulated with the MCNPX Monte Carlo code. The simulations revealed that the range modulation wheel (RMW) is the most intense neutron source of any of the beam spreading devices within the nozzle. This finding suggests that it may be helpful to refine the design of the RMW assembly, e.g., by adding local shielding, to suppress neutron-induced damage to components in the nozzle and to reduce the shielding thickness of the treatment vault. The simulations also revealed that the neutron dose to the patient is predominated by neutrons produced in the field defining collimator assembly, located just upstream of the patient.

The effect of ambient pressure on well chamber response: Monte Carlo calculated results for the HDR 1000 plus.

The determination of the air kerma strength of a brachytherapy seed is necessary for effective treatment planning. Well ionization chambers are used on site at therapy clinics to determine the air kerma strength of seeds. In this work, the response of the Standard Imaging HDR 1000 Plus well chamber to ambient pressure is examined using Monte Carlo calculations. The experimental work examining the response of this chamber as well as other chambers is presented in a companion paper. The Monte Carlo results show that for low-energy photon sources, the application of the standard temperature pressure PTP correction factor produces an over-response at the reduced air densities/pressures corresponding to high elevations. With photon sources of 20 to 40 keV, the normalized PTP corrected chamber response is as much as 10% to 20% over unity for air densities/pressures corresponding to an elevation of 3048 m (10000 ft) above sea level. At air densities corresponding to an elevation of 1524 m (5000 ft), the normalized PTP-corrected chamber response is 5% to 10% over unity for these photon sources. With higher-energy photon sources (>100 keV), the normalized PTP corrected chamber response is near unity. For low-energy beta sources of 0.25 to 0.50 MeV, the normalized PTP-corrected chamber response is as much as 4% to 12% over unity for air densities/pressures corresponding to an elevation of 3048 m (10000 ft) above sea level. Higher-energy beta sources (>0.75 MeV) have a normalized PTP corrected chamber response near unity. Comparing calculated and measured chamber responses for common 103Pd- and 125I-based brachytherapy seeds show agreement to within 2.7% and 1.9%, respectively. Comparing MCNP calculated chamber responses with EGSnrc calculated chamber responses show agreement to within 3.1% at photon energies of 20 to 40 keV. We conclude that Monte Carlo transport calculations accurately model the response of this well chamber. Further, applying the standard PTP correction factor for this well chamber is insufficient in accounting for the change in chamber response with air pressure for low-energy (<100 keV) photon and low-energy (<0.75 MeV)beta sources.

Ion chamber gas-to-wall conversion factors for fast neutron dosimetry.

Modern ionising photon dosimetry is essentially entirely based upon gas-filled cavity determinations. For photons, ion chamber response is largely independent of photon energy almost perfectly transforming absorbed dose in the gas to the surrounding media. Absolute uncertainties are <1-2%. For fast neutron dosimetry, this is certainly not the case. Interpretation of the response of the cavity filling material, usually a gas, to the charged particle spectrum induced in the walls and interacting with the cavity gas is fraught with uncertainties. Despite these challenges, gas filled cavities surrounded by various mixtures, compounds and elements, have proved to be essential for integral determinations of the indirectly ionising neutrons, generating dosimetric quantities, such as kerma and absorbed dose. The transformation from gas response to wall dose is material dependent and varies with neutron energy. This study discusses recent advances in cavity response interpretation using the results from complex nuclear modelling of microscopic cross sections as well as estimates of secondary particle production enabling much improved cavity gas-to-wall media conversion factors.

Brachytherapy dosimetry of 125I and 103Pd sources using an updated cross section library for the MCNP Monte Carlo transport code.

Permanent implantation of low energy (20-40 keV) photon emitting radioactive seeds to treat prostate cancer is an important treatment option for patients. In order to produce accurate implant brachytherapy treatment plans, the dosimetry of a single source must be well characterized. Monte Carlo based transport calculations can be used for source characterization, but must have up to date cross section libraries to produce accurate dosimetry results. This work benchmarks the MCNP code and its photon cross section library for low energy photon brachytherapy applications. In particular, we calculate the emitted photon spectrum, air kerma, depth dose in water, and radial dose function for both 125I and 103Pd based seeds and compare to other published results. Our results show that MCNP's cross section library differs from recent data primarily in the photoelectric cross section for low energies and low atomic number materials. In water, differences as large as 10% in the photoelectric cross section and 6% in the total cross section occur at 125I and 103Pd photon energies. This leads to differences in the dose rate constant of 3% and 5%, and differences as large as 18% and 20% in the radial dose function for the 125I and 103Pd based seeds, respectively. Using a partially updated photon library, calculations of the dose rate constant and radial dose function agree with other published results. Further, the use of the updated photon library allows us to verify air kerma and depth dose in water calculations performed using MCNP's perturbation feature to simulate updated cross sections. We conclude that in order to most effectively use MCNP for low energy photon brachytherapy applications, we must update its cross section library. Following this update, the MCNP code system will be a very effective tool for low energy photon brachytherapy dosimetry applications.