Using weighted power mean for equivalent square estimation.

PURPOSE: Equivalent Square (ES) enables the calculation of many radiation quantities for rectangular treatment fields, based only on measurements from square fields. While it is widely applied in radiotherapy, its accuracy, especially for extremely elongated fields, still leaves room for improvement. In this study, we introduce a novel explicit ES formula based on Weighted Power Mean (WPM) function and compare its performance with the Sterling formula and Vadash/Bjärngard's formula. METHODS: The proposed WPM formula is ESWPMa,b=waα+1-wbα1/α for a rectangular photon field with sides a and b. The formula performance was evaluated by three methods: standard deviation of model fitting residual error, maximum relative model prediction error, and model's Akaike Information Criterion (AIC). Testing datasets included the ES table from British Journal of Radiology (BJR), photon output factors (Scp ) from the Varian TrueBeam Representative Beam Data (Med Phys. 2012;39:6981-7018), and published Scp data for Varian TrueBeam Edge (J Appl Clin Med Phys. 2015;16:125-148). RESULTS: For the BJR dataset, the best-fit parameter value α = -1.25 achieved a 20% reduction in standard deviation in ES estimation residual error compared with the two established formulae. For the two Varian datasets, employing WPM reduced the maximum relative error from 3.5% (Sterling) or 2% (Vadash/Bjärngard) to 0.7% for open field sizes ranging from 3 cm to 40 cm, and the reduction was even more prominent for 1 cm field sizes on Edge (J Appl Clin Med Phys. 2015;16:125-148). The AIC value of the WPM formula was consistently lower than its counterparts from the traditional formulae on photon output factors, most prominent on very elongated small fields. CONCLUSION: The WPM formula outperformed the traditional formulae on three testing datasets. With increasing utilization of very elongated, small rectangular fields in modern radiotherapy, improved photon output factor estimation is expected by adopting the WPM formula in treatment planning and secondary MU check.

Constancy checks of well-type ionization chambers with external-beam radiation units.

Constancy checks of a well-type ionization chamber should be performed regularly as part of a quality assurance regime. The goal of this work was to test the feasibility of using a linear accelerator and an orthovoltage unit to check the constancy of a well-type chamber's response to an external radiation source. The reproducibility, linearity with dose, variation with dose-rate, and variation between energy-matched units of the well-type chamber response when exposed to 6 MV beams was examined. The robustness to errors in establishing the measurement conditions, including setting the source-to-surface distance and gantry angle, rotation of the chamber around the central axis of the beam, and the effect of changing the length of the chamber cable exposed to the field, were tested. The reproducibility and linearity with dose of the chamber response, and robustness to errors in establishing the measurement conditions for 100 kVp and 250 kVp beams from an orthovoltage unit, were also examined. The combined uncertainty, including contributions from errors in establishing the reference conditions, for well-type chamber measurements using a 6 MV beam from a linear accelerator is 1.0%. The combined uncertainties for measurements using 100 and 250 kVp beams were 1.8% and 1.5%, respectively. When focus-source distance errors were reduced to ≤ 1 mm, the combined uncertainties for the 100 and 250 kVp beams were 1.2% and 1.1%, respectively, when the dose to the chamber was confined to the linear region of the dose-response curve. The response of a well-type chamber should remain constant to within 1.2% when exposed to a constant dose from an external beam unit, if reference conditions can be reproducibly established. However, the uncertainty for establishing reference conditions for output measurements for an orthovoltage unit can be reduced, which would justify a reduction of the tolerance for constancy measurements.

Clinical implementation of photon beam flatness measurements to verify beam quality.

This work describes the replacement of Tissue Phantom Ratio (TPR) measurements with beam profile flatness measurements to determine photon beam quality during routine quality assurance (QA) measurements. To achieve this, a relationship was derived between the existing TPR15/5 energy metric and beam flatness, to provide baseline values and clinically relevant tolerances. The beam quality was varied around two nominal beam energy values for four matched Elekta linear accelerators (linacs) by varying the bending magnet currents and reoptimizing the beam. For each adjusted beam quality the TPR15/5 was measured using an ionization chamber and Solid Water phantom. Two metrics of beam flatness were evaluated using two identical commercial ionization chamber arrays. A linear relationship was found between TPR15/5 and both metrics of flatness, for both nominal energies and on all linacs. Baseline diagonal flatness (FDN) values were measured to be 103.0% (ranging from 102.5% to 103.8%) for 6 MV and 102.7% (ranging from 102.6% to 102.8%) for 10 MV across all four linacs. Clinically acceptable tolerances of ± 2% for 6 MV, and ± 3% for 10 MV, were derived to equate to the current TPR15/5 clinical tolerance of ± 0.5%. Small variations in the baseline diagonal flatness values were observed between ionization chamber arrays; however, the rate of change of TPR15/5 with diagonal flatness was found to remain within experimental uncertainty. Measurements of beam flatness were shown to display an increased sensitivity to variations in the beam quality when compared to TPR measurements. This effect is amplified for higher nominal energy photons. The derivation of clinical baselines and associated tolerances has allowed this method to be incorporated into routine QA, streamlining the process whilst also increasing versatility. In addition, the effect of beam adjustment can be observed in real time, allowing increased practicality during corrective and preventive maintenance interventions.

[Status report of Hungarian radiotherapy based on treatment data, available infrastucture, and human resources]. / A magyar sugárterápia helyzete a betegellátási adatok, a rendelkezésre álló infrastruktúra és emberi eroforrás tükrében.

The purpose of the study is to report the status of Hungarian radiotherapy (RT) based on the assessment of treatment data in years 2012 to 2014, available infrastructure, and RT staffing. Between December 2014 and January 2015, a RT questionnaire including 3 parts (1. treatment data; 2. infrastructure; 3. staffing) was sent out to all Hungarian RT centers (n=12). All RT centers responded to all questions of the survey. 1. Treatment data: In 2014, 33,162 patients were treated with RT: 31,678 (95.5%) with teletherapy, and 1484 (4.5%) with brachytherapy (BT). Between 2012 and 2014, the number of patients treated with radiotherapy increased with 6.6%, but the number of BT patients decreased by 11%. Forty-two percent of all patients were treated in the two centers of the capital: 9235 patients (28%) at the National Institute of Oncology (NIO), and 4812 (14%) at the Municipial Oncoradiology Center (MOC). Out of the patients treated on megavoltage RT units (n=22,239), only 901 (4%) were treated with intensity-modulated RT (IMRT), and 2018 (9%) with image-guided RT (IGRT). In 2014, 52% of all BT treatments were performed in Budapest: NIO - 539 patients (36%); MOC - 239 patients (16%); and BT was not available in 3 RT centers. Prostate I-125 seed implants and interstitial breast BT was utilized in one, prostate HDR BT in two, and head&neck implants in three centers. 2. Infrastructure: Including ongoing development projects funded by the European Union, by the end of year 2015, 39 megavoltage teletherapy units, and 12 HDR BT units will be in use in 13 available Hungarian RT centers. 3. Staffing: Actually, 92 radiation oncologists (RO), 29 RT residents, 61 medical physicists, and 229 radiation therapy technologists are working in 12 RT centers. There are 23 vacant positions (including 11 RO positions) available at the Hungarian RT centers. According to the professional minimal requirements and WHO guidelines, the implementation of 11 new linear accelerators, and 1 BT units are needed in Hungary. Further resources for the development and upgrade of RT infrastructure and capacity should be allocated to RT centers in Budapest. Brachytherapy and modern teletherapy (e.g. IMRT and IGRT) are underutilized in Hungary compared to other European countries. Implementation of continuous education and practical training programs in leading Hungarian and international RT centers are suggested in an effort to a wider implementation of modern RT techniques in Hungarian RT centers.

Measuring the wobble of radiation field centers during gantry rotation and collimator movement on a linear accelerator.

PURPOSE: The isocenter accuracy of a linear accelerator is often assessed with star-shot films. This approach is limited in its ability to quantify three dimensional wobble of radiation field centers (RFCs). The authors report a Winston-Lutz based method to measure the 3D wobble of RFCs during gantry rotation, collimator rotation, and collimator field size change. METHODS: A stationary ball-bearing phantom was imaged using multileaf collimator-shaped radiation fields at various gantry angles, collimator angles, and field sizes. The center of the ball-bearing served as a reference point, to which all RFCs were localized using a computer algorithm with sub-pixel accuracy. Then, the gantry rotation isocenter and the collimator rotation axis were derived from the coordinates of these RFCs. Finally, the deviation or wobble of the individual RFC from the derived isocenter or rotation axis was quantified. RESULTS: The results showed that the RFCs were stable as the field size of the multileaf collimator was varied. The wobble of RFCs depended on the gantry angle and the collimator angle and was reproducible, indicating that the mechanical imperfections of the linac were mostly systematic and quantifiable. It was found that the 3D wobble of RFCs during gantry rotation was reduced after compensating for a constant misalignment of the multileaf collimator. CONCLUSIONS: The 3D wobble of RFCs can be measured with submillimeter precision using the proposed method. This method provides a useful tool for checking and adjusting the radiation isocenter tightness of a linac.

Validation of a new control system for Elekta accelerators facilitating continuously variable dose rate.

PURPOSE: Elekta accelerators controlled by the current clinically used accelerator control system, Desktop 7.01 (D7), uses binned variable dose rate (BVDR) for volumetric modulated arc therapy (VMAT). The next version of the treatment control system (Integrity) supports continuously variable dose rate (CVDR) as well as BVDR. Using CVDR opposed to BVDR for VMAT has the potential of reducing the treatment time but may lead to lower dosimetric accuracy due to faster moving accelerator parts. Using D7 and a test version of Integrity, differences in ability to control the accelerator, treatment efficiency, and dosimetric accuracy between the two systems were investigated. METHODS: Single parameter tests were designed to expose differences in the way the two systems control the movements of the accelerator. In these tests, either the jaws, multi leaf collimators (MLCs), or gantry moved at constant speed while the dose rate was changed in discrete steps. The positional errors of the moving component and dose rate were recorded using the control systems with a sampling frequency of 4 Hz. The clinical applicability of Integrity was tested using 15 clinically used VMAT plans (5 prostate, 5 H&N, and 5 lung) generated by the SmartArc algorithm in PINNACLE. The treatment time was measured from beam-on to beam-off and the accuracy of the dose delivery was assessed by comparing DELTA4 measurements and PINNACLE calculated doses using gamma evaluation. RESULTS: The single parameter tests showed that Integrity had an improved feedback between gantry motion and dose rate at the slight expense of MLC control compared to D7. The single parameter test did not reveal any significant differences in the control of either jaws or backup jaws between the two systems. These differences in gantry and MLC control together with the use of CVDR gives a smoother Integrity VMAT delivery compared to D7 with less abrupt changes in accelerator motion. Gamma evaluation (2% of 2 Gy and 2 mm) of the calculated doses and DELTA4 measured doses corrected for systematic errors showed an average pass rate of more than 97.8% for both D7, Integrity BVDR, and Integrity CVDR deliveries. Direct comparisons between the measured doses using strict gamma criteria of 0.5% and 0.5 mm showed excellent agreement between D7 and Integrity delivered doses with average pass rates above 95.7%. Finally, the Integrity control system resulted in a significant 35% (55 +/- 13 s) reduction in treatment time, on average. CONCLUSIONS: Single parameter tests showed that the two control systems differed in their feedbac loops between MLC, gantry, and dose rate. These differences made the VMAT deliveries more smooth using the new Integrity treatment control system, compared to the current Desktop 7.01. Together with the use of CVDR, which results in less abrupt changes in dose rate, this further increases the smoothness of the delivery. The use of CVDR for VMAT with the Integrity desktop results in a significant reduction in treatment time compared to BVDR with an average reduction of 35%. This decrease in delivery time was achieved without compromising the dosimetric accuracy.

Optimized beam shaping assembly for a 2.1-MeV proton-accelerator-based neutron source for boron neutron capture therapy.

Boron Neutron Capture Therapy (BNCT) is facing a new era where different projects based on accelerators instead of reactors are under development. The new facilities can be placed at hospitals and will increase the number of clinical trials. The therapeutic effect of BNCT can be improved if a optimized epithermal neutron spectrum is obtained, for which the beam shape assembly is a key ingredient. In this paper we propose an optimal beam shaping assembly suited for an affordable low energy accelerator. The beam obtained with the device proposed accomplishes all the IAEA recommendations for proton energies between 2.0 and 2.1 MeV. In addition, there is an overall improvement of the figures of merit with respect to BNCT facilities and previous proposals of new accelerator-based facilities.

Monte Carlo simulation of the effect of miniphantom on in-air output ratio.

PURPOSE: The aim of the study was to quantify the effect of miniphantoms on in-air output ratio measurements, i.e., to determine correction factors for in-air output ratio. METHODS: Monte Carlo (MC) simulations were performed to simulate in-air output ratio measurements by using miniphantoms made of various materials (PMMA, graphite, copper, brass, and lead) and with different longitudinal thicknesses or depths (2-30 g/cm2) in photon beams of 6 and 15 MV, respectively, and with collimator settings ranging from 3 x 3 to 40 x 40 cm2. EGSnrc and BEAMnrc (2007) software packages were used. Photon energy spectra corresponding to the collimator settings were obtained from BEAMnrc code simulations on a linear accelerator and were used to quantify the components of in-air output ratio correction factors, i.e., attenuation, mass energy absorption, and phantom scatter correction factors. In-air output ratio correction factors as functions of miniphantom material, miniphantom longitudinal thickness, and collimator setting were calculated and compared to a previous experimental study. RESULTS: The in-air output ratio correction factors increase with collimator opening and miniphantom longitudinal thickness for all the materials and for both energies. At small longitudinal thicknesses, the in-air output ratio correction factors for PMMA and graphite are close to 1. The maximum magnitudes of the in-air output ratio correction factors occur at the largest collimator setting (40 x 40 cm2) and the largest miniphantom longitudinal thickness (30 g/cm2): 1.008 +/- 0.001 for 6 MV and 1.012 +/- 0.001 for 15 MV, respectively. The MC simulations of the in-air output ratio correction factor confirm the previous experimental study. CONCLUSIONS: The study has verified that a correction factor for in-air output ratio can be obtained as a product of attenuation correction factor, mass energy absorption correction factor, and phantom scatter correction factor. The correction factors obtained in the present study can be used in studies involving in-air output ratio measurements using miniphantoms.

Error Types and Associations of Clinically Significant Events Within Food and Drug Administration Recalls of Linear Accelerators and Related Products.

PURPOSE: Medical devices in radiation therapy undergo a complex process of Food and Drug Administration (FDA) approval. Little is known about which processes within the radiation therapy medical device industry are most prone to events involving wrong dose, volume, or targeting in radiation therapy treatment. METHODS AND MATERIALS: We carried out a retrospective analysis of the United States FDA Medical Device Recalls database for recalls of products classified as "Accelerator, Linear, Medical" from 2010 to 2016. Each recall event was classified using a modified Delphi method among 3 experts in safety according to product type, error category, and severity score. Error categories included inconvenience; suboptimal plan or treatment; incorrect dose, volume, or targeting; and nonradiation injury risk. Variables investigated were product type, recall year, FDA-determined cause, and quantity of units recalled. Univariate and multivariate logistic regression were used to identify factors prognostic of incorrect dose, volume, or targeting. RESULTS: We identified a total of 250 recall events between 2010 and 2016, with 165 eligible for analysis. Linear accelerators (LINACs) (28%) and LINAC control software (19%) were the most frequently recalled products. The most common FDA-determined causes for recalls were software design (42%) and device design (26%). On univariate analysis (P < .05), LINAC control software (odds ratio [OR] 5.4) and oncology information system or treatment management system (OR 3.9) versus LINACs and software design (OR 3.4) versus device design were associated with wrong dose, volume, or targeting events. On multivariate analysis, only the association with LINAC control software (OR 3.7) persisted for wrong dose, volume, or targeting events. CONCLUSIONS: Review of these data shows that problems with LINAC control software were associated with incorrect dose delivery at a 4-fold higher rate than errors with LINACs. Manufacturers should focus on improvements in software design to minimize dose- and targeting-related errors to patients.

Determination of electron energy, spectral width, and beam divergence at the exit window for clinical megavoltage x-ray beams.

Monte Carlo simulations of x-ray beams typically take parameters of the electron beam in the accelerating waveguide to be free parameters. In this paper, a methodology is proposed and implemented to determine the energy, spectral width, and beam divergence of the electron source. All treatment head components were removed from the beam path, leaving only the exit window. With the x-ray target and flattener out of the beam, uncertainties in physical characteristics and relative position of the target and flattening filter, and in spot size, did not contribute to uncertainty in the energy. Beam current was lowered to reduce recombination effects. The measured dose distributions were compared with Monte Carlo simulation of the electron beam through the treatment head to extract the electron source characteristics. For the nominal 6 and 18 MV x-ray beams, the energies were 6.51 +/- 0.15 and 13.9 +/- 0.2 MeV, respectively, with the uncertainties resulting from uncertainties in the detector position in the measurement and in the stopping power in the simulations. Gaussian spectral distributions were used, with full widths at half maximum ranging from 20 +/- 4% at 6 MV to 13 +/- 4% at 18 MV required to match the fall-off portion of the percent-depth ionization curve. Profiles at the depth of maximum dose from simulations that used the manufacturer-specified exit window geometry and no beam divergence were 2-3 cm narrower than measured profiles. Two simulation configurations yielding the measured profile width were the manufacturer-specified exit window thickness with electron source divergences of 3.3 degrees at 6 MV and 1.8 degrees at 18 MV and an exit window 40% thicker than the manufacturer's specification with no beam divergence. With the x-ray target in place (and no flattener), comparison of measured to simulated profiles sets upper limits on the electron source divergences of 0.2 degrees at 6 MV and 0.1 degrees at 18 MV. A method of determining source characteristics without mechanical modification of the treatment head, and therefore feasible in clinics, is presented. The energies and spectral widths determined using this method agree with those determined with only the exit window in the beam path.

Clinic based transfer of the N(D,W)(60Co) calibration coefficient using a linear accelerator.

Ionization chambers used for reference dosimetry require a local secondary standard ionization chamber with a 60Co absorbed dose to water calibration coefficient N(D,W)(60Co) traceable to a national primary standards dosimetry laboratory or an accredited secondary dosimetry calibration laboratory. Clinic based (in-house) transfer of this coefficient to tertiary reference ionization chambers has traditionally been accomplished with chamber cross calibration in water using a 60Co beam; however, access to 60Co teletherapy machines has become increasingly limited for clinic based physicists. In this work, the accuracy of alternative methods of transferring the N(D,W)(60Co) calibration coefficient using 6 and 18 MV photon beams from a linear accelerator in lieu of 60Co has been investigated for five different setups and four commonly used chamber types.

A simple approach to using an amorphous silicon EPID to verify IMRT planar dose maps.

A simplified method of verifying intensity modulated radiation therapy (IMRT) fields using a Varian aS500 amorphous silicon electronic portal imaging device (EPID) is demonstrated. Unlike previous approaches, it does not involve time consuming or complicated analytical processing of the data. The central axis pixel response of the EPID, as well as the profile characteristics obtained from images acquired with a 6 MV photon beam, was examined as a function of field size. Ion chamber measurements at various depths in a water phantom were then collected and it was found that at a specific depth d(ref), the dose response and profile characteristics closely matched the results of the EPID analysis. The only manipulation required to be performed on the EPID images was the multiplication of a matrix of off axis ratio values to remove the effect of the flood field calibration. Similarly, d(ref) was found for 18 MV. Planar dose maps at d(ref) in a water phantom for a bar pattern, a strip pattern, and 14 clinical IMRT fields from two patient cases each being from a separate anatomical region, i.e., head and neck as well as the pelvis, for both energies were generated by the Pinnacle planning system (V7.4). EPID images of these fields were acquired and converted to planar dose maps and compared directly with the Pinnacle planar dose maps. Radiographic film dosimetry and a MapCHECK dosimetry device (Sun Nuclear Corporation, Melbourne, FL) were used as an independent verification of the dose distribution. Gamma analysis of the EPID, film, and Pinnacle planar dose maps generated for the clinical IMRT fields showed that approximately 97% of all points passed using a 3% dose/3 mm DTA tolerance test. Based on the range of fields studied, the author's results appear to justify using this approach as a method to verify dose distributions calculated on a treatment planning system, including complex intensity modulated fields.

Japanese Structure Survey of Radiation Oncology in 2011.

We evaluated the evolving structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From March 2012 to August 2015, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2011. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 211 000 and 250 000, respectively. Additionally, the estimated cancer incidence was 851 537 cases with approximately 24.8% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (LINAC; n = 836), telecobalt (n = 3), Gamma Knife (n = 46), 60Co remote afterloading system (RALS; n = 24), and 192Ir RALS (n = 125). The LINAC system used dual-energy functions in 619 units, 3D conformal radiotherapy functions in 719 and intensity-modulated radiotherapy (IMRT) functions in 412. There were 756 JRS or JASTRO-certified radiation oncologists, 1018.5 full-time equivalent (FTE) radiation oncologists, 2026.7 FTE radiotherapy technologists, 149.1 FTE medical physicists, 141.5 FTE radiotherapy quality managers and 716.3 FTE nurses. The frequency of IMRT use significantly increased during this time. To conclude, although there was a shortage of personnel in 2011, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility.

Linear-accelerator X-ray output: a multicentre chamber-based intercomparison study in Australia and New Zealand.

This paper describes the process and results of a survey of linear accelerator outputs as part of an Australasian Level III Dosimetry Intercomparison. This study involved the measurement of accelerator output under reference conditions ('Level I') with a small-volume ionisation chamber in water for 47 beams at 36 radiotherapy centres using the IAEA TRS 398 dose-to-water protocol. The mean ratio of measured to locally-determined accelerator output was 1.003 +/- 0.009 (1 standard deviation) with a range from 0.981 to 1.024. No correlation could be found between output ratio and accelerator type or local output calibration protocol. The small-volume chamber used satisfied most requirements for the study though showed some variation in sensitivity via repeated cross-calibration with a chamber calibrated at a primary standards laboratory.

Effect of each component of a LINAC therapy head on neutron and photon spectra.

Linear accelerators (LINACs) are widely applied in radiotherapy for their versatility and flexibility. Monte Carlo simulations were made to find the neutron and photon spectra at the isocenter (IC) of a LINAC operating at 10, 15, 18, and 24 MV by the MCNPX code. A detailed model of the LINAC head, consisting of flattening filter, secondary collimator, primary collimator, and multi-leaf collimator were used in the calculations. The effect of eliminating any of these components on contamination of a neutron spectrum and a photon spectrum was assessed. Photon and neutron ambient equivalent doses were found, and comparisons were made for the various structures. Lethargy neutron spectra at the IC were compared with spectra computed with the function reported by Tosi et al., which describes well neutron spectra for the energy region beyond 1 MeV, although tending to undervalue energy spectra below 1 MeV. The findings show that the photon and neutron fluences are enhanced when eliminating a LINAC component. The neutron and photon doses increased except when removing the primary collimator.

Stereotactic radiosurgery for benign brain tumors: Results of multicenter benchmark planning studies.

PURPOSE: Stereotactic radiosurgery (SRS) is strongly indicated for treatment of surgically inaccessible benign brain tumors. Various treatment platforms are available, but few comparisons have included multiple centers. As part of a national commissioning program, benchmark planning cases were completed by all clinical centers in the region. METHODS AND MATERIALS: Four benign cases were provided, with images and structures predelineated, including intracanalicular vestibular schwannoma (VS), larger VS, skull base meningioma, and secreting pituitary adenoma. Centers were asked to follow their local practice, and plans were reviewed centrally using metrics for target coverage, selectivity, gradient falloff, and normal tissue sparing. RESULTS: Sixty-eight plans were submitted using 18 different treatment platforms. Fourteen plans were subsequently revised following feedback, and review of 5 plans led to a restriction of service on 2 platforms (2 centers). Prescription doses were consistent for VS and meningioma submissions, but a wide range of doses were used for the pituitary case. All centers prioritized coverage, with the prescription isodose covering ≥95% of 78/82 target volumes. Lower values may be expected next to air cavities when using advanced algorithms, and in general may be acceptable for some benign lesions. Selectivity was much more variable, and in some cases this was combined with high gradient index and/or >1 mm margin, resulting in large volumes of normal tissue being irradiated. Normal tissue doses were more variable across linear accelerator (LINAC)-based plans than with Gamma Knife or CyberKnife, and dose spillage seemed independent of prescription isodose (inhomogeneity). This may reflect the variety of LINAC-based approaches represented or the necessary tradeoff between different objectives. CONCLUSIONS: These benchmarking exercises have highlighted areas of different clinical practice and priorities and potential for improvement. The subsequent sharing of plan data and margin philosophies between the neurosurgery and oncology communities allowed for meaningful comparison between centers and their peers.

Tabulated square-shaped source model for linear accelerator electron beam simulation.

CONTEXT: Using this source model, the Monte Carlo (MC) computation becomes much faster for electron beams. AIMS: The aim of this study was to present a source model that makes linear accelerator (LINAC) electron beam geometry simulation less complex. SETTINGS AND DESIGN: In this study, a tabulated square-shaped source with transversal and axial distribution biasing and semi-Gaussian spectrum was investigated. SUBJECTS AND METHODS: A low energy photon spectrum was added to the semi-Gaussian beam to correct the bremsstrahlung X-ray contamination. After running the MC code multiple times and optimizing all spectrums for four electron energies in three different medical LINACs (Elekta, Siemens, and Varian), the characteristics of a beam passing through a 10 cm × 10 cm applicator were obtained. The percentage depth dose and dose profiles at two different depths were measured and simulated. RESULTS: The maximum difference between simulated and measured percentage of depth doses and dose profiles was 1.8% and 4%, respectively. The low energy electron and photon spectrum and the Gaussian spectrum peak energy and associated full width at half of maximum and transversal distribution weightings were obtained for each electron beam. The proposed method yielded a maximum computation time 702 times faster than a complete head simulation. CONCLUSIONS: Our study demonstrates that there was an excellent agreement between the results of our proposed model and measured data; furthermore, an optimum calculation speed was achieved because there was no need to define geometry and materials in the LINAC head.

EURADOS intercomparison exercise on Monte Carlo modelling of a medical linear accelerator.

BACKGROUND: In radiotherapy, Monte Carlo (MC) methods are considered a gold standard to calculate accurate dose distributions, particularly in heterogeneous tissues. EURADOS organized an international comparison with six participants applying different MC models to a real medical linear accelerator and to one homogeneous and four heterogeneous dosimetric phantoms. AIMS: The aim of this exercise was to identify, by comparison of different MC models with a complete experimental dataset, critical aspects useful for MC users to build and calibrate a simulation and perform a dosimetric analysis. RESULTS: Results show on average a good agreement between simulated and experimental data. However, some significant differences have been observed especially in presence of heterogeneities. Moreover, the results are critically dependent on the different choices of the initial electron source parameters. CONCLUSIONS: This intercomparison allowed the participants to identify some critical issues in MC modelling of a medical linear accelerator. Therefore, the complete experimental dataset assembled for this intercomparison will be available to all the MC users, thus providing them an opportunity to build and calibrate a model for a real medical linear accelerator.

Quantitative Approach to Failure Mode and Effect Analysis for Linear Accelerator Quality Assurance.

PURPOSE: To determine clinic-specific linear accelerator quality assurance (QA) TG-142 test frequencies, to maximize physicist time efficiency and patient treatment quality. METHODS AND MATERIALS: A novel quantitative approach to failure mode and effect analysis is proposed. Nine linear accelerator-years of QA records provided data on failure occurrence rates. The severity of test failure was modeled by introducing corresponding errors into head and neck intensity modulated radiation therapy treatment plans. The relative risk of daily linear accelerator QA was calculated as a function of frequency of test performance. RESULTS: Although the failure severity was greatest for daily imaging QA (imaging vs treatment isocenter and imaging positioning/repositioning), the failure occurrence rate was greatest for output and laser testing. The composite ranking results suggest that performing output and lasers tests daily, imaging versus treatment isocenter and imaging positioning/repositioning tests weekly, and optical distance indicator and jaws versus light field tests biweekly would be acceptable for non-stereotactic radiosurgery/stereotactic body radiation therapy linear accelerators. CONCLUSIONS: Failure mode and effect analysis is a useful tool to determine the relative importance of QA tests from TG-142. Because there are practical time limitations on how many QA tests can be performed, this analysis highlights which tests are the most important and suggests the frequency of testing based on each test's risk priority number.

Linear accelerator radiosurgery for arteriovenous malformations: Updated literature review.

Arteriovenous malformations (AVMs) are the leading causing of intra-cerebral haemorrhage. Stereotactic radiosurgery (SRS) is an established treatment for arteriovenous malformations (AVM) and commonly delivered using Gamma Knife within dedicated radiosurgery units. Linear accelerator (LINAC) SRS is increasingly available however debate remains over whether it offers an equivalent outcome. The aim of this project is to evaluate the outcomes using LINAC SRS for AVMs used within a UK neurosciences unit and review the literature to aid decision making across various SRS platforms. Results have shown comparability across platforms and strongly supports that an adapted LINAC based SRS facility within a dynamic regional neuro-oncology department delivers similar outcomes (in terms of obliteration and toxicity) to any other dedicated radio-surgical platform. Locally available facilities can facilitate discussion between options however throughput will inevitably be lower than centrally based dedicated national radiosurgery units.