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DOE OSTI2015

SU-E-I-55: The Contribution to Skin Dose Due to Scatter From the Patient Table and the Head Holder During Fluoroscopy

Purpose: To determine contributions to skin dose due to scatter from the table and head holder used during fluoroscopy, and also to explore alternative design material to reduce the scatter dose. Methods: Measurements were made of the primary and scatter components of the xray beam exiting the patient table and a cylindrical head holder used on a Toshiba Infinix c-arm unit as a function of kVp for the various beam filters on the machine and for various field sizes. The primary component of the beam was measured in air with the object placed close to the x-ray tube with an air gap between it and a 6 cc parallel-plate ionization chamber and with the beam collimated to a size just larger than the chamber. The primary plus scatter radiation components were measured with the object moved to a position in the beam next to the chamber for larger field sizes. Both sets of measurements were preformed while keeping the source-to-chamber distance fixed. The scatter fraction was estimated by taking the ratio of the difference between the two measurements and the reading that included both primary and scatter. Similar measurements were also made for a 2.3 cm thick Styrofoam block which could substitute for the patient support. Results: The measured scatter fractions indicate that the patient table as well as the head holder contributes an additional 10–16% to the patient entrance dose depending on field size. Forward scatter was reduced with the Styrofoam block so that the scatter fraction was about 4–5%. Conclusion: The results of this investigation demonstrated that scatter from the table and head holder used in clinical fluoroscopy contribute substantially to the skin dose. The lower contribution of scatter from Styrofoam suggests that there is an opportunity to redesign patient support accessories to reduce the skin dose. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corporation Equipment Grant.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-J-57: First Development of Adapting to Intrafraction Relative Motion Between Prostate and Pelvic Lymph Nodes Targets

Purpose Large intrafraction relative motion of multiple targets is common in advanced head and neck, lung, abdominal, gynaecological and urological cancer, jeopardizing the treatment outcomes. The objective of this study is to develop a real-time adaptation strategy, for the first time, to accurately correct for the relative motion of multiple targets by reshaping the treatment field using the multi-leaf collimator (MLC). Methods The principle of tracking the simultaneously treated but differentially moving tumor targets is to determine the new aperture shape that conforms to the shifted targets. Three dimensional volumes representing the individual targets are projected to the beam’s eye view. The leaf openings falling inside each 2D projection will be shifted according to the measured motion of each target to form the new aperture shape. Based on the updated beam shape, new leaf positions will be determined with optimized trade-off between the target underdose and healthy tissue overdose, and considerations of the physical constraints of the MLC. Taking a prostate cancer patient with pelvic lymph node involvement as an example, a preliminary dosimetric study was conducted to demonstrate the potential treatment improvement compared to the state-of- art adaptation technique which shifts the whole beam to track only one target. Results The world-first intrafraction adaptation system capable of reshaping the beam to correct for the relative motion of multiple targets has been developed. The dose in the static nodes and small bowel are closer to the planned distribution and the V45 of small bowel is decreased from 110cc to 75cc, corresponding to a 30% reduction by this technique compared to the state-of-art adaptation technique. Conclusion The developed adaptation system to correct for intrafraction relative motion of multiple targets will guarantee the tumour coverage and thus enable PTV margin reduction to minimize the high target dose to the adjacent organs-at-risk. The authors acknowledge funding support from the Australian NHMRC Australia Fellowship and NHMRC Project Grant No. APP1042375.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-08: A Beam Source Model for Monte Carlo Simulations of a Double-Scattering Proton Beam Delivery System Using Beam Current Modulation

Purpose: To reconstruct phase-space information upstream of patient specific collimators for Monte Carlo simulations using only radiotherapy planning system data. Methods: The proton energies are calculated based on residual ranges, e.g., sum of prescribed ranges in a patient and SSD. The Kapchinskij and Vladimirskij (KV) distribution was applied to sample proton’s x-y positions and momentum direction and the beam shape was assumed to be a circle. Free parameters, e.g., the initial energy spread and the emittance of KV distribution were estimated from the benchmarking with commissioning data in a commercial treatment planning system for an operational proton therapy center. The number of histories, which defines the height of individual pristine Bragg peaks (BP) of Spread-out Bragg peak (SOBP), are weighted based on beam current modulation and a correction factor is applied to take into account the fluence reduction as the residual range decreases due to the rotation of the range modulator wheel. The timedependent behaviors, e.g., the changes of the residual range and histories per a pristine BP, are realized by utilizing TOPAS (Tool for Particle Simulation). Results: Benchmarking simulations for selected SOBPs ranging 7.5 cm to 15.5 cm matched within 2 mm in range and up to 5 mm in SOBP width against measurement data in water phantom. We found this model tends to underestimate entrance dose by about 5 % in comparison to measurement. This was attributed to the situation that the energy distribution used in the model was limited in its granularity at the limit of single energy spectrum for the narrow angle modulator steps used in the proximal pull back region of the SOBPs. Conclusion: Within these limitations the source modeling method proved itself an acceptable alternative of a full treatment head simulation when the machine geometry and materials information are not available.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-55: A Novel Applicator for High Dose Rate Brachytherapy Treatments of Ocular Conjunctiva

Purpose: To evaluate the clinical feasibility of IntraBeam intra operative kV irradiation beam device for ocular conjunctiva treatments. The Intra-Beam system offers a 4.4 mm diameter needle applicator, that is not suitable for treatment of a large surface with limits access. We propose an adaptor that will answer to this clinical need and provide initial dosimetry. Methods: The dose distribution of the needle applicator is non uniform and hence not suitable for treatment of relatively large surfaces. We designed an adapter to the needle applicator that will filter the X-rays and produce a conformal dose distribution over the treatment area while shielding surfaces to be spared. Dose distributions were simulated using FLUKA is a fully integrated particle physics Monte Carlo simulation package. Results: We designed a wedge applicator made of Polythermide window and stainless steel for collimating. We compare the dose distribution to that of the known needle and surface applicators. Conclusion: Initial dosimetry shows feasibility of this approach. While further refinements to the design may be warranted, the results support construction of a prototype and confirmation of the Monte Carlo dosimetry with measured data.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-67: A Quality Assurance Procedure for VMAT Delivery Technique with Multiple Verification Metric Using TG-119 Protocol

Purpose: A successful VMAT plan delivery includes precise modulations of dose rate, gantry rotational and multi-leaf collimator shapes. The purpose of this research is to construct routine QA protocol which focuses on VMAT delivery technique and to obtain a baseline including dose error, fluence distribution and mechanical accuracy during VMAT. Methods: The mock prostate, head and neck (HN) cases supplied from AAPM were used in this study. A VMAT plans were generated in Monaco TPS according to TG-119 protocol. Plans were created using 6 MV and 10 MV photon beams for each case. The phantom based measurement, fluence measurement and log files analysis were performed. The dose measurement was performed using 0.6 cc ion chamber, which located at isocenter. The fluence distribution were acquired using the MapCHECK2 mounted in the MapPHAN. The trajectory log files recorded inner 20 leaf pairs and gantry angle positions at every 0.25 sec interval were exported to in-house software developed by MATLAB and determined those RMS values. Results: The dose difference is expressed as a ratio of the difference between measured and planned doses. The dose difference for 6 MV was 0.91%, for 10 MV was 0.67%. In turn, the fluence distribution using gamma criteria of 2%/2 mm with a 50% minimum dose threshold for 6 MV was 98.8%, for 10 MV was 97.5%, respectively. The RMS values of MLC for 6 MV and 10 MV were 0.32 mm and 0.37 mm, of gantry were 0.33 degree and 0.31 degree. Conclusion: In this study, QA protocol to assess VMAT delivery accuracy is constructed and results acquired in this study are used as a baseline of VMAT delivery performance verification.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-335: Dosimetric Investigation of An Advanced Rotating Gamma Ray System for Imaged Guided Radiation Therapy

Purpose: Co-60 beams have unique dosimetric properties for cranial treatments and thoracic cancers. The conventional concern about the high surface dose is overcome by modern system designs with rotational treatment techniques. This work investigates a novel rotational Gamma ray system for image-guided, external beam radiotherapy. Methods: The CybeRT system (Cyber Medical Corp., China) consists of a ring gantry with either one or two treatment heads containing a Gamma source and a multileaf collimator (MLC). The MLC has 60 paired leaves, and the maximum field size is either 40cmx40cm (40 pairs of 0.5cm central leaves, 20 pairs of 1cm outer leaves), or 22cmx40cm (32 pairs of 0.25cm central leaves, 28 pairs of 0.5cm outer leaves). The treatment head(s) can swing 35° superiorly and 8° inferiorly, allowing a total of 43° non-coplanar beam incident. The treatment couch provides 6-degrees-of-freedom motion compensation and the kV cone-beam CT system has a spatial resolution of 0.4mm. Monte Carlo simulations were used to compute dose distributions and compare with measurements. A retrospective study of 98 previously treated patients was performed to compare CybeRT with existing RT systems. Results: Monte Carlo results confirmed the CybeRT design parameters including output factors and 3D dose distributions. Its beam penumbra/dose gradient was similar to or better than that of 6MV photon beams and its isocenter accuracy is 0.3mm. Co-60 beams produce lower-energy secondary electrons that exhibit better dose properties in low-density lung tissues. Because of their rapid depth dose falloff, Co-60 beams are favorable for peripheral lung tumors with half-arc arrangements to spare the opposite lung and critical structures. Superior dose distributions were obtained for head and neck, breast, spine and lung tumors. Conclusion: Because of its accurate dose delivery and unique dosimetric properties of C-60 sources, CybeRT is ideally suited for advanced SBRT as well as conventional RT. This work was partially supported by Cyber Medical Corp.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-359: Emulation of Yb-169 Gamma-Ray Spectrum Using Metal-Filtered 250 KVp X-Rays for Pre-Clinical Studies of Gold Nanoparticle-Aided Radiation Therapy

Purpose: To develop an external beam surrogate of the Yb-169 brachytherapy source applying a filter-based spectrum modulation technique to 250 kVp x-rays. In-vitro/vivo studies performed with the modulated 250 kVp beam will help gauge the benefits of implementing gold nanoparticle-aided radiotherapy with the Yb-169 source. Methods: A previously validated MCNP5 model of the Phillips RT-250 orthovoltage unit was used to obtain the percentage depth dose (PDD) and filtered photon spectra for a variety of filtration and irradiation conditions. Photon spectra were obtained using the average flux F4 tally in air right after all collimation. A 30 x 30 x 30 cm{sup 3} water phantom was used to compute the PDD along the central axis (CAX) under the standards conditions of a 10 x 10 cm{sup 2} field size at 50 cm SSD. Cylindrical cells of 4 cm in diameter and the energy deposition F6 tally were used along the CAX to score the doses down to 20 cm depth. The number of particle history was set to 2 x 10{sup 8} in order to keep the relative uncertainty within each cell < 0.3%. The secondary electron spectrum within a gold-loaded tissue due to each photon spectrum was also calculated using EGSnrc and compared with that due to Yb-169 gamma rays. Results: Under the practical constraints for the spectrum modulation task, 250 kVp x-rays filtered by a 0.25 mm Erbium (Er) foil produced the best match with Yb-169 gamma rays, in terms of PDD and, more importantly, secondary electron spectrum. Conclusion: Modulation of 250kVp x-ray spectrum by an Er-filter was found effective in emulating the gamma ray spectrum of Yb-169. Possible benefits as predicted from the current MC model such as enhanced radiosensitization with the Er-filtered beam (as a surrogate of Yb-169) was confirmed with a separate in-vitro study. Supported by DOD/PCRP grant W81XWH-12-1-0198.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-404: Evaluation of the Effect of Spine Hardware for CyberKnife Spinal Stereotactic Radiosurgery

Purpose: Spine hardware made of high-Z materials such as titanium has the potential to affect the dose distribution around the metal rods in CyberKnife spinal stereotactic radiosurgery (SRS) treatments. The purpose of this work was to evaluate the magnitude of such effect retrospectively for clinical CyberKnife plans. Methods: The dose calculation was performed within the MultiPlan treatment planning system using the ray tracing (RT) and Monte Carlo (MC) method. A custom density model was created by extending the CT-to-Density table to titanium density of 4.5 g/cm3 with the CT number of 4095. To understand the dose perturbation caused by the titanium rod, a simple beam setup (7.5 mm IRIS collimator) was used to irradiate a mimic rod (5 mm) with overridden high density. Five patient spinal SRS cases were found chronologically from 2010 to 2015 in our institution. For each case, the hardware was contoured manually. The original plan was re-calculated using both RT and MC methods with and without rod density override without changing clinical beam parameters. Results: The simple beam irradiation shows that there is 10% dose increase at the interface because of electron backscattering and 7% decrease behind the rod because of photon attenuation. For actual clinical plans, the iso-dose lines and DVHs are almost identical (<2%) for calculations with and without density override for both RT and MC methods. However, there is a difference of more than 10% for D90 between RT and MC method. Conclusion: Although the dose perturbation around the metal rods can be as large as 10% for a single beam irradiation, for clinical treatments with complex beam composition the effect of spinal hardware to the PTV and spinal dose is minimal. As such, the MC dose algorithm without rod density override for CyberKnife spinal SRS is acceptable.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-415: Experimental Determination of the Relative Stopping Power of TRUFILL N-BCA Liquid Embolic System in a Clinical Proton Beam

Purpose: Patients who undergo n-BCA glue embolization as part of treatment for AVMs are later referred for proton therapy. Knowing the relative stopping power of the glue accurately allows us to perform accurate dose calculations. In this study we experimentally determine the relative stopping power of an n-BCA mixture in a 126 MeV and 149.6 MeV proton beams. Methods: One unit of the TRUFILL™ n-BCA liquid embolic system consists of 1g unit of n-BCA, 1g unit of Tantalum powder and one 10mL vial of Ethiodized oil. The physician mixed 3:1 Ethiodized oil to n-BCA. Five units (20cc) of the n-BCA liquid embolic glue were prepared and placed in a 6cm x 3cm x3cm Lucite container. The container was placed in front of a water tank in the proton beam path. A diamond detector (active volume 0.004mm3) was used to measure distal edge of depth dose of a modulated 126 MeV proton beam collimated using a 3cm brass aperture. The procedure was repeated with a container carrying the same amount of water placed in front of the water tank. The difference in the depth dose measured with glue and with water was used to determine the relative stopping power of the glue. The same determination was done earlier at 149.6 MeV using a different smaller sample (4cc) of n-BCA. Results: The relative stopping power of this particular n-BCA mixture was determined to be 1.06 at both 126 MeV and 149.6 MeV. We are working on obtaining the composition data of the n-BCA glue so we can perform Monte Carlo calculations. Conclusion: Accurate value of the stopping power of the n-BCA glue in the proton beam was determined to be 1.06. It will improve the accuracy of dose calculations in proton radiosurgery procedures on AVM patients with n-BCA embolization.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-427: Feasibility Study for Evaluation of IMRT Dose Distribution Using Geant4-Based Automated Algorithms

Purpose: For intensity-modulated radiation therapy (IMRT) treatment planning validation using Monte Carlo (MC) simulations, a precise and automated procedure is necessary to evaluate the patient dose distribution. The aim of this study is to develop an automated algorithm for IMRT simulations using DICOM files and to evaluate the patient dose based on 4D simulation using the Geant4 MC toolkit. Methods: The head of a clinical linac (Varian Clinac 2300 IX) was modeled in Geant4 along with particular components such as the flattening filter and the multi-leaf collimator (MLC). Patient information and the position of the MLC were imported from the DICOM-RT interface. For each position of the MLC, a step- and-shoot technique was adopted. PDDs and lateral profiles were simulated in a water phantom (50×50×40 cm{sup 3}) and compared to measurement data. We used a lung phantom and MC-dose calculations were compared to the clinical treatment planning used at the Seoul National University Hospital. Results: In order to reproduce the measurement data, we tuned three free parameters: mean and standard deviation of the primary electron beam energy and the beam spot size. These parameters for 6 MV were found to be 5.6 MeV, 0.2378 MeV and 1 mm FWHM respectively. The average dose difference between measurements and simulations was less than 2% for PDDs and radial profiles. The lung phantom study showed fairly good agreement between MC and planning dose despite some unavoidable statistical fluctuation. Conclusion: The current feasibility study using the lung phantom shows the potential for IMRT dose validation using 4D MC simulations using Geant4 tool kits. This research was supported by Korea Institute of Nuclear safety and Development of Measurement Standards for Medical Radiation funded by Korea research Institute of Standards and Science. (KRISS-2015-15011032)

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-431: Feasiblity of Using CT Scout Images for 2D LDR Brachytherpay Planning

Purpose: i) To show the feasibility of using CT scout images for 2D low-dose rate brachytherapy planning with BrachyVision (version 10.4); ii) to show their advantages and disadvantages over DRRs. Methods: A phantom was constructed to house a Fletcher-Suite applicator. The phantom is made of Styrofoam with metal BBs positioned at well-defined separations. These markers are used to assess the image distortion in the scout images. Unlike DRRs, scout images are distorted only in the direction normal to the couch direction; therefore, they needed to be scaled unidirectionally prior to importing into BrachyVision. In addition to confirming the scaling is performed correctly by measuring distances between well-positioned BB, we also compare a LDR plan using scout images to a 3D CT-based plan. Results: There is no distortion of the image along the couch direction due to the collimation of the CT scanner. The distortion in the transverse plane can be corrected by multiplying by the ratio of distances between source-to-isocenter and source-to-detector. The results show the distance separations between BBs as measured in scout images and by a caliber are within a few millimeters. Dosimetrically, the difference between the dose rates to points A and B based on scout images and on 3D CT are less than a few percents. The accuracy can be improved by correcting for the distortion on the transverse plane. Conclusion: It is possible to use CT scout images for 2D planning in BrachyVision. This is an advantage because scout images have no metal artifacts often present in CT images or DRRs. Another advantage is the lack of distortion in the couch direction. One major disadvantage is that the image distortion due to beam divergence can be large. This is due to the inherent short distance between source-to-isocenter and source-to-detector on a CT scanner.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-463: Impact to Total Scatter Factors On the Calculated Dose Distribution in Radiosurgery

Purpose: To assess the impact of relative measurements: off axis ratios (OAR), tissue phantom ratios (TPR) and especially total scatter factor (TSF) on the calculated dose distribution in stereotactic radiosurgery with circular cones. Methods: Six detectors were employed to characterize circular collimated photon beams of 6 MV: three diodes (SFD, E, SRS), one ionization chamber (CC01) and two radiochromic films (EBT, EBT2). The relative measurements were incorporated in the treatment planning system (TPS) in order to compare and analyze the calculated dose distributions (DD). Each dose distribution was re-scaled by the TSF to observe its effect in the final dose distribution. The comparison was performed by using the gamma index. A Monte Carlo generated dosimetry was used as reference. Results: The results showed that in terms of relative dosimetry all the detectors have a good agreement within 2%, with the exception of the CC01 and EBT2 film. However, the analysis performed with the dose distributions re-scaled relative to the TSF for each detector showed that the impact it was not only to the isocenter dose. The dose to the PTV and normal tissue showed differences up to 13% depending of the dosimeter used for TSF measurements. Conclusion: With the exception of the CC01 ionization chamber and EBT2 radiochromic film, all the studied dosimeters were adequate for the measurement of OAR and TPR. However, attention must be put in the measurement of TSF. The use of the wrong detector does not only affect the isocenter dose, it may have an impact in the PTV and normal tissue dose.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-534: Level of Residual Radioactivity of Activated Parts of a Decommissioned Cyclotron

Purpose: CTI cyclotron RDS-111 was used at the Hong Kong Sanatorium and Hospital (HKSH) to produce radiopharmaceuticals and radioactive tracers for diagnostic scans between 1999 and 2007. During the operation, some machine components became radioactive by activation. For the safety of staff, decommissioning took place in 2009, two years after the cyclotron had stopped operation. This study investigates the residual radioactivity and radionuclides found in different cyclotron components in 2014 in compliance with the local regulations in Hong Kong for transfer of radioactive waste. Methods: A representative sample of each part was counted using a high-purity germanium detector (manufacturer: ORTECT) for at least four hours. GammaVision, a multichannel analyzer software, was used to identify the radionuclides found in the cyclotron components, as well as the associated activities. A standard library and a Mariscotti peak search algorithm were used to identify the present radionuclides. Only radionuclides with half-life greater than 180 days were considered. Results: Among the components, the Havar target foil has the highest specific activity ((4.6±0.6)×10{sup 2} Bq/g), with Co-60 being the most prominent ((3.8±0.5)×10{sup 2} Bq/g). The total activity of the target foil, however, is still low due to its small mass of 0.04 g. Radioisotopes Mn-54 (46±6 Bq/g), Na-22 (6.8±0.8 Bq/g), Co-57 (7.3±0.9 Bq/g), and Fe-59 (6.0±0.9 Bq/g) have also been detected in the target foil. The target window holder and the vacuum window register a specific activity of 88.3±0.6 Bq/g and 48.6±0.1 Bq/g, respectively. Other components, such as the collimator, the target tube, the valve body and the beamline, are also found with trace amounts of radionuclides. Conclusion: Even seven years after the cyclotron had stopped operation, some components still exhibited residual radioactivity from activation exceeding the IAEA clearance levels. Special consideration for radiological protection may need to be taken in the disposal of the cyclotron parts.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2015

SU-E-T-545: MLC Distance Travelled as a Predictor for Motor Failure

Purpose: To study the frequency of Multi-Leaf Collimator (MLC) leaf failures, investigate methods to predict them and reduce linac downtime. Methods: A Varian HD120 MLC was used in our study. The hyperterminal MLC errors logged from 06/2012 to 12/2014 were collected. Along with the hyperterminal errors, the MLC motor changes and all other MLC interventions by the linear accelerator engineer were recorded. The MLC dynalog files were also recorded on a daily basis for each treatment and during linac QA. The dynalog files were analyzed to calculate root mean square errors (RMS) and cumulative MLC travel distance per motor. An in-house MatLab code was used to analyze all dynalog files, record RMS errors and calculate the distance each MLC traveled per day. Results: A total of 269 interventions were recorded over a period of 18 months. Of these, 146 included MLC motor leaf change, 39 T-nut replacements, and 84 MLC cleaning sessions. Leaves close to the middle of each side required the most maintenance. In the A bank, leaves A27 to A40 recorded 73% of all interventions, while the same leaves in the B bank counted for 52% of the interventions. On average, leaves in the middle of the bank had their motors changed approximately every 1500m of travel. Finally, it was found that the number of RMS errors increased prior to an MLC motor change. Conclusion: An MLC dynalog file analysis software was developed that can be used to log daily MLC usage. Our eighteen-month data analysis showed that there is a correlation between the distance an MLC travels, the RMS and the life of the MLC motor. We plan to use this tool to predict MLC motor failures and with proper and timely intervention, reduce the downtime of the linac during clinical hours.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-E-T-557: Monte Carlo Modeling of Philips RT-250 Orthovoltage Unit for Beam Spectrum Modulation

Purpose: To develop and validate a Monte Carlo (MC) model of a Phillips RT-250 orthovoltage unit to test various beam spectrum modulation strategies for in vitro/vivo studies. A model of this type would enable the production of unconventional beams from a typical orthovoltage unit for novel therapeutic applications such as gold nanoparticle-aided radiotherapy. Methods: The MCNP5 code system was used to create a MC model of the head of RT-250 and a 30 × 30 × 30 cm{sup 3} water phantom. For the x-ray machine head, the current model includes the vacuum region, beryllium window, collimators, inherent filters and exterior steel housing. For increased computational efficiency, the primary x-ray spectrum from the target was calculated from a well-validated analytical software package. Calculated percentage-depth-dose (PDD) values and photon spectra were validated against experimental data from film and Compton-scatter spectrum measurements. Results: The model was validated for three common settings of the machine namely, 250 kVp (0.25 mm Cu), 125 kVp (2 mm Al), and 75 kVp (2 mm Al). The MC results for the PDD curves were compared with film measurements and showed good agreement for all depths with a maximum difference of 4 % around dmax and under 2.5 % for all other depths. The primary photon spectra were also measured and compared with the MC results showing reasonable agreement between the two, validating the input spectra and the final spectra as predicted by the current MC model. Conclusion: The current MC model accurately predicted the dosimetric and spectral characteristics of each beam from the RT-250 orthovoltage unit, demonstrating its applicability and reliability for beam spectrum modulation tasks. It accomplished this without the need to model the bremsstrahlung xray production from the target, while significantly improved on computational efficiency by at least two orders of magnitude. Supported by DOD/PCRP grant W81XWH-12-1-0198.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-E-T-559: Monte Carlo Simulation of Cobalt-60 Teletherapy Unit Modeling In-Field and Out-Of-Field Doses for Applications in Computational Radiation Dosimetry

Purpose: Mean organ doses from structures located in field and outside of field boundaries during radiotherapy treatment must be considered when looking at secondary effects. Treatment planning in patients with 40 years of follow-up does not include 3-D treatment planning images and did not estimate dose to structures out of the direct field. Therefore, it is of interest to correlate actual clinical events with doses received. Methods: Accurate models of radiotherapy machines combined with whole body computational phantoms using Monte Carlo methods allow for dose reconstructions intended for studies on late radiation effects. The Theratron-780 radiotherapy unit and anatomically realistic hybrid computational phantoms are modeled in the Monte Carlo radiation transport code MCNPX. The major components of the machine including the source capsule, lead in the unit-head, collimators (fixed/adjustable), and trimmer bars are simulated. The MCNPX transport code is used to compare calculated values in a water phantom with published data from BJR suppl. 25 for in-field doses and experimental data from AAPM Task Group No. 36 for out-of-field doses. Next, the validated cobalt-60 teletherapy model is combined with the UF/NCI Family of Reference Hybrid Computational Phantoms as a methodology for estimating organ doses. Results: The model of Theratron-780 has shown to be agree with percentage depth dose data within approximately 1% and for out of field doses the machine is shown to agree within 8.8%. Organ doses are reported for reference hybrid phantoms. Conclusion: Combining the UF/NCI Family of Reference Hybrid Computational Phantoms along with a validated model of the Theratron-780 allows for organ dose estimates of both in-field and out-of-field organs. By changing field size, position, and adding patient-specific blocking more complicated treatment set-ups can be recreated for patients treated historically, particularly those who lack both 2D/3D image sets.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-560: Monte Carlo Simulation of the Neutron Radiation Field Around a Medical 18 MV Linac

Purpose: Today the majority of radiation therapy treatments are performed at medical electron linear accelerators (linacs). The accelerated electrons are used for the generation of bremsstrahlung photons. The use of higher electron respectively photon energies has some advantages over lower energies such as the longer dose build-up. However photons with energies higher than ∼7 MeV can additionally to the interaction with bound electrons undergo inelastic reactions with nuclei. These photonuclear reactions lead to the emission of fast neutrons which contaminate the primary photon field. The neutrons might penetrate through the collimators and deliver out-of-field dose to the patient. Furthermore the materials inside the linac head as well as the air inside the treatment room get activated which might deliver dose to the medical employees even when the linac is not in operation. A detailed knowledge of these effects is essential for adequate radiation protection of the employees and an optimal patient treatment. Methods: It is a common method to study the radiation fields of such linacs by means of Monte Carlo simulations. For the investigation of the effects caused by photonuclear reactions a typical linac in high energy mode (Varian Clinac 18 MV-X) as well as the surrounding bunker were modelled and simulated using the Monte Carlo code FLUKA which includes extensive nuclear reaction and neutron transport models additional to electron-photon transport as well as capabilities for a detailed study of effective dose distributions and activation yields. Results: Neutron spectra as well as neutron effective dose distributions within the bunker were obtained, reaching up to some mSv/Gy in the patient’s plane. The results are normalized per Gy in the depth dose maximum at 10×10 cm{sup 2} field size. Therefore an absolute interpretation is possible. Conclusion: The obtained data gives a better understanding of the photonuclear reaction caused effects.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2015

SU-E-T-588: Optimization of Imaging Following 223Ra Administration in Targeted Alpha-Emitting Radionuclide Therapy of Bone Metastases

Purpose: With a growing demand of alpha-emitting radiopharmaceuticals, especially Xofigo ({sup 223}RaCl{sub 2}) which is used in the treatment of metastatic bone disease, the optimization of dosimetry becomes necessary. Indeed, in Europe, as stated on the council directive 2013/59/euratom, exposures of target volumes for radiotherapeutic purposes shall be individually planned taking into account that doses to non-target volumes and tissues shall be as low as reasonably achievable. To that aim, the possibility of imaging {sup 223}Ra was first investigated. Methods: The experiments were conducted at the Hopital Europeen Georges Pompidou with an Infinia Hawkeye 4 gamma camera, equipped with a medium-energy collimator. Imaging parameters, such as sensibility, spatial resolution and energy spectrum, were determined using several physical phantoms with a source of 6 MBq of {sup 223}Ra. Bone metastases were modeled with a NEMA Body Phantom to investigate image degradation based on the concentration of {sup 223}Ra. Results: The acquired energy spectrum allowed to visualize several photon peaks: at 85, 154 and 270 keV. Camera sensitivity measured from the phantom study was 102.3 cps/MBq for the 85 keV ± 20 %, 89.9 cps/MBq for the 154 ± 20 % window and 65.4 cps/MBq for the 270 ± 10 % window. The spatial resolution (full-width at half-maximum) was respectively 1.7, 1.9 and 1.8 cm for the three energy windows. SPECT/CT images of NEMA Body Phantom without and with attenuation have permitted to determine the best reconstruction parameters. Conclusion: This study has demonstrated that it is possible to obtain clinically relevant information from images of {sup 223}Ra. All these results will be valuable to analyze biodistribution imaging of the radiopharmaceutical in the patient body and go further in the reconstruction of patient images in order to personalize the dosimetry.

62 RADIOLOGY AND NUCLEAR MEDICINE↗