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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Technical Report: Reference photon dosimetry data for Varian accelerators based on IROC-Houston site visit data.

PURPOSE: Accurate data regarding linear accelerator (Linac) radiation characteristics are important for treatment planning system modeling as well as regular quality assurance of the machine. The Imaging and Radiation Oncology Core-Houston (IROC-H) has measured the dosimetric characteristics of numerous machines through their on-site dosimetry review protocols. Photon data are presented and can be used as a secondary check of acquired values, as a means to verify commissioning a new machine, or in preparation for an IROC-H site visit. METHODS: Photon data from IROC-H on-site reviews from 2000 to 2014 were compiled and analyzed. Specifically, data from approximately 500 Varian machines were analyzed. Each dataset consisted of point measurements of several dosimetric parameters at various locations in a water phantom to assess the percentage depth dose, jaw output factors, multileaf collimator small field output factors, off-axis factors, and wedge factors. The data were analyzed by energy and parameter, with similarly performing machine models being assimilated into classes. Common statistical metrics are presented for each machine class. Measurement data were compared against other reference data where applicable. RESULTS: Distributions of the parameter data were shown to be robust and derive from a student's t distribution. Based on statistical and clinical criteria, all machine models were able to be classified into two or three classes for each energy, except for 6 MV for which there were eight classes. Quantitative analysis of the measurements for 6, 10, 15, and 18 MV photon beams is presented for each parameter; supplementary material has also been made available which contains further statistical information. CONCLUSIONS: IROC-H has collected numerous data on Varian Linacs and the results of photon measurements from the past 15 years are presented. The data can be used as a comparison check of a physicist's acquired values. Acquired values that are well outside the expected distribution should be verified by the physicist to identify whether the measurements are valid. Comparison of values to this reference data provides a redundant check to help prevent gross dosimetric treatment errors.

Changing practice patterns of Gamma Knife versus linear accelerator-based stereotactic radiosurgery for brain metastases in the US.

OBJECTIVE: Single-fraction stereotactic radiosurgery (SRS) is a crucial component in the management of limited brain metastases from non-small cell lung cancer (NSCLC). Intracranial SRS has traditionally been delivered using a frame-based Gamma Knife (GK) platform, but stereotactic modifications to the linear accelerator (LINAC) have made an alternative approach possible. In the absence of definitive prospective trials comparing the efficacy and toxicities of treatment between the 2 techniques, nonclinical factors (such as technology accessibility, costs, and efficiency) may play a larger role in determining which radiosurgery system a facility may choose to install. To the authors' knowledge, this study is the first to investigate national patterns of GK SRS versus LINAC SRS use and to determine which factors may be associated with the adoption of these radiosurgery systems. METHODS: The National Cancer Data Base was used to identify patients > 18 years old with NSCLC who were treated with single-fraction SRS to the brain between 2003 and 2011. Patients who received "SRS not otherwise specified" or who did not receive a radiotherapy dose within the range of 12-24 Gy were excluded to reduce the potential for misclassification. The chi-square test, t-test, and multivariable logistic regression analysis were used to compare potential demographic, clinicopathologic, and health care system predictors of GK versus LINAC SRS use, when appropriate. RESULTS: This study included 1780 patients, among whom 1371 (77.0%) received GK SRS and 409 (23.0%) underwent LINAC SRS. Over time, the proportion of patients undergoing LINAC SRS steadily increased, from 3.2% in 2003 to 30.8% in 2011 (p < 0.001). LINAC SRS was adopted more rapidly by community versus academic facilities (overall 29.2% vs 17.2%, p < 0.001). On multivariable analysis, 4 independent predictors of increased LINAC SRS use emerged, including year of diagnosis in 2008-2011 versus 2003-2007 (adjusted OR [AOR] 2.04, 95% CI 1.52-2.73, p < 0.001), community versus academic facility type (AOR 2.04, 95% CI 1.60-2.60, p < 0.001), non-West versus West geographic location (AOR 4.50, 95% CI 2.87-7.09, p < 0.001), and distance from cancer reporting facility of < 20 versus ≥ 20 miles (AOR 1.57, 95% CI 1.21-2.04, p = 0.001). CONCLUSIONS: GK remains the most commonly used single-fraction SRS modality for NSCLC brain metastases in the US. However, LINAC-based SRS has been rapidly disseminating in the past decade, especially in the community setting. Wide geographic variation persists in the distribution of GK and LINAC SRS cases. Further comparative effectiveness research will be needed to evaluate the impact of these shifts on SRS-related toxicities, local control, and survival, as well as treatment costs and efficiency.

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.

Target optimization for the photonuclear production of radioisotopes.

In this paper we discuss the optimum shape of a target for photonuclear production of radioisotopes using an electron linear accelerator. Different target geometries such as right cylinder, conical frustum, Gaussian volume of revolution and semi-ellipsoid have been considered for the production of (67)Cu via (68)Zn(γ,p)(67)Cu photonuclear reaction. The specific activity (SA) of (67)Cu was simulated for each target shape. Optimum ratio of radius to height for cylindrical targets was found to be between 0.2 and 0.25 for target masses ranging from 20 g to 100 g. It was shown that while some unconventional target shapes, such as semi-elliptical volume of revolution, result in slightly higher specific activities than cylindrical targets, the advantage is not significant and is outweighed by the complexity of the target production and handling. Power deposition into the target was modeled and the trade-off between the maximization of (67)Cu yield and the minimization of target heating has been discussed. The (67)Cu case can easily be extended for production of many other isotopes.

Can small field diode correction factors be applied universally?

BACKGROUND AND PURPOSE: Diode detectors are commonly used in dosimetry, but have been reported to over-respond in small fields. Diode correction factors have been reported in the literature. The purpose of this study is to determine whether correction factors for a given diode type can be universally applied over a range of irradiation conditions including beams of different qualities. MATERIALS AND METHODS: A mathematical relation of diode over-response as a function of the field size was developed using previously published experimental data in which diodes were compared to an air core scintillation dosimeter. Correction factors calculated from the mathematical relation were then compared those available in the literature. RESULTS: The mathematical relation established between diode over-response and the field size was found to predict the measured diode correction factors for fields between 5 and 30 mm in width. The average deviation between measured and predicted over-response was 0.32% for IBA SFD and PTW Type E diodes. Diode over-response was found to be not strongly dependent on the type of linac, the method of collimation or the measurement depth. CONCLUSIONS: The mathematical relation was found to agree with published diode correction factors derived from Monte Carlo simulations and measurements, indicating that correction factors are robust in their transportability between different radiation beams.

Development and reproducibility evaluation of a Monte Carlo-based standard LINAC model for quality assurance of multi-institutional clinical trials.

Technical developments in radiotherapy (RT) have created a need for systematic quality assurance (QA) to ensure that clinical institutions deliver prescribed radiation doses consistent with the requirements of clinical protocols. For QA, an ideal dose verification system should be independent of the treatment-planning system (TPS). This paper describes the development and reproducibility evaluation of a Monte Carlo (MC)-based standard LINAC model as a preliminary requirement for independent verification of dose distributions. The BEAMnrc MC code is used for characterization of the 6-, 10- and 15-MV photon beams for a wide range of field sizes. The modeling of the LINAC head components is based on the specifications provided by the manufacturer. MC dose distributions are tuned to match Varian Golden Beam Data (GBD). For reproducibility evaluation, calculated beam data is compared with beam data measured at individual institutions. For all energies and field sizes, the MC and GBD agreed to within 1.0% for percentage depth doses (PDDs), 1.5% for beam profiles and 1.2% for total scatter factors (Scps.). Reproducibility evaluation showed that the maximum average local differences were 1.3% and 2.5% for PDDs and beam profiles, respectively. MC and institutions' mean Scps agreed to within 2.0%. An MC-based standard LINAC model developed to independently verify dose distributions for QA of multi-institutional clinical trials and routine clinical practice has proven to be highly accurate and reproducible and can thus help ensure that prescribed doses delivered are consistent with the requirements of clinical protocols.

Optimal location of radiation therapy centers with respect to geographic access.

PURPOSE: To develop a framework with which to evaluate locations of radiation therapy (RT) centers in a region based on geographic access. METHODS AND MATERIALS: Patient records were obtained for all external beam radiation therapy started in 2011 for the province of British Columbia, Canada. Two metrics of geographic access were defined. The primary analysis was percentage of patients (coverage) within a 90-minute drive from an RT center (C90), and the secondary analysis was the average drive time (ADT) to an RT center. An integer programming model was developed to determine optimal center locations, catchment areas, and capacity required under different scenarios. RESULTS: Records consisted of 11,096 courses of radiation corresponding to 161,616 fractions. Baseline geographic access was estimated at 102.5 minutes ADT (each way, per fraction) and 75.9% C90. Adding 2 and 3 new centers increased C90 to 88% and 92%, respectively, and decreased ADT by between 43% and 61%, respectively. A scenario in which RT was provided in every potential location that could support at least 1 fully utilized linear accelerator resulted in 35.3 minutes' ADT and 93.6% C90. CONCLUSIONS: The proposed framework and model provide a data-driven means to quantitatively evaluate alternative configurations of a regional RT system. Results suggest that the choice of location for future centers can significantly improve geographic access to RT.

Workforce profile for allied health professions in Queensland Public Health cancer care services with linear accelerators.

PURPOSE: This article profiles staffing levels for all allied health professionals in Queensland Public Health cancer care services to determine whether linear accelerator hours per clinical day are a potentially useful predictor of workforce requirements. Currently, radiation therapists and radiation oncology medical physicists have developed professional guidelines for calculating staffing full-time equivalents (FTEs) related to linear accelerator hours per clinical day. METHODS: Queensland Public Health service managers were surveyed using a self-reported standardized data collection tool, requesting the FTE allied health staff provided for a number of services, including cancer care. Linear accelerator hours per clinical day were also collected. A linear regression model was employed to determine the relationship with the allied health workforce FTEs at linear accelerator sites. RESULTS: High correlations existed between linear accelerator hours per clinical day and radiation therapists (0.99), radiation oncology medical physicists (0.95), pharmacy services (pharmacists and assistants combined; 0.91), and rehabilitation allied health staff (> 0.95). A linear regression model was employed to determine the allied health pharmacy service and rehabilitation workforce FTEs. CONCLUSION: In the four Queensland Public Health cancer care services with linear accelerators, radiation therapists, radiation oncology medical physicists, pharmacy services, and rehabilitation allied health staff, cancer care staff are highly correlated with linear accelerator hours per clinical day. The findings support identifying and establishing alternative denominators for allied health workforce requirements in cancer care beyond those of expert knowledge, opinion, and consensus.