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      Out‐of‐field doses and neutron dose equivalents for electron beams from modern Varian and Elekta linear accelerators

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          Abstract

          Out‐of‐field doses from radiotherapy can cause harmful side effects or eventually lead to secondary cancers. Scattered doses outside the applicator field, neutron source strength values, and neutron dose equivalents have not been broadly investigated for high‐energy electron beams. To better understand the extent of these exposures, we measured out‐of‐field dose characteristics of electron applicators for high‐energy electron beams on two Varian 21iXs, a Varian TrueBeam, and an Elekta Versa HD operating at various energy levels. Out‐of‐field dose profiles and percent depth‐dose curves were measured in a Wellhofer water phantom using a Farmer ion chamber. Neutron dose was assessed using a combination of moderator buckets and gold activation foils placed on the treatment couch at various locations in the patient plane on both the Varian 21iX and Elekta Versa HD linear accelerators. Our findings showed that out‐of‐field electron doses were highest for the highest electron energies. These doses typically decreased with increasing distance from the field edge but showed substantial increases over some distance ranges. The Elekta linear accelerator had higher electron out‐of‐field doses than the Varian units examined, and the Elekta dose profiles exhibited a second dose peak about 20 to 30 cm from central‐axis, which was found to be higher than typical out‐of‐field doses from photon beams. Electron doses decreased sharply with depth before becoming nearly constant; the dose was found to decrease to a depth of approximately E(MeV)/4 in cm. With respect to neutron dosimetry, Q values and neutron dose equivalents increased with electron beam energy. Neutron contamination from electron beams was found to be much lower than that from photon beams. Even though the neutron dose equivalent for electron beams represented a small portion of neutron doses observed under photon beams, neutron doses from electron beams may need to be considered for special cases.

          PACS number(s): 87.55.N‐, 87.55.ne, 87.56.bd, 87.56.jf

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          Most cited references19

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          Clinical electron-beam dosimetry: report of AAPM Radiation Therapy Committee Task Group No. 25.

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            Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy.

            To measure the photon and neutron out-of-treatment-field dose equivalents to various organs from different treatment strategies (conventional vs. intensity-modulated radiation therapy [IMRT]) at different treatment energies and delivered by different accelerators. Independent measurements were made of the photon and neutron out-of-field dose equivalents resulting from one conventional and six IMRT treatments for prostate cancer. The conventional treatment used an 18-MV beam from a Clinac 2100; the IMRT treatments used 6-MV, 10-MV, 15-MV, and 18-MV beams from a Varian Clinac 2100 accelerator and 6-MV and 15-MV beams from a Siemens Primus accelerator. Photon doses were measured with thermoluminescent dosimeters in a Rando phantom, and neutron fluence was measured with gold foils. Dose equivalents to the colon, liver, stomach, lung, esophagus, thyroid, and active bone marrow were determined for each treatment approach. For each treatment approach, the relationship between dose equivalent per MU, distance from the treatment field, and depth in the patient was examined. Photon dose equivalents decreased approximately exponentially with distance from the treatment field. Neutron dose equivalents were independent of distance from the treatment field and decreased with increasing tissue depth. Neutrons were a significant contributor to the out-of field dose equivalent for beam energies > or =15 MV. Out-of-field photon and neutron dose equivalents can be estimated to any point in a patient undergoing a similar treatment approach from the distance of that point to the central axis and from the tissue depth. This information is useful in determining the dose to critical structures and in evaluating the risk of associated carcinogenesis.
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              Secondary neutron spectra from modern Varian, Siemens, and Elekta linacs with multileaf collimators.

              Neutrons are a by-product of high-energy x-ray radiation therapy (threshold for [gamma,n] reactions in high-Z material -7 MeV). Neutron production varies depending on photon beam energy as well as on the manufacturer of the accelerator. Neutron production from modern linear accelerators (linacs) has not been extensively compared, particularly in terms of the differences in the strategies that various manufacturers have used to implement multileaf collimators (MLCs) into their linac designs. However, such information is necessary to determine neutron dose equivalents for different linacs and to calculate vault shielding requirements. The purpose of the current study, therefore, was to measure the neutron spectra from the most up-to-date linacs from three manufacturers: Varian 21EX operating at 15, 18, and 20 MV, Siemens ONCOR operating at 15 and 18 MV, and Elekta Precise operating at 15 and 18 MV. Neutron production was measured by means of gold foil activation in Bonner spheres. Based on the measurements, the authors determined neutron spectra and calculated the average energy, total neutron fluence, ambient dose equivalent, and neutron source strength. The shapes of the neutron spectra did not change significantly between accelerators or even as a function of treatment energy. However, the neutron fluence, and therefore the ambient dose equivalent, did vary, increasing with increasing treatment energy. For a given nominal treatment energy, these values were always highest for the Varian linac. The current study thus offers medical physicists extensive information about the neutron production of MLC-equipped linacs currently in operation and provides them information vital for accurate comparison and prediction of neutron dose equivalents and calculation of vault shielding requirements.
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                Author and article information

                Contributors
                SFKry@mdanderson.org
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                08 July 2016
                July 2016
                : 17
                : 4 ( doiID: 10.1002/acm2.2016.17.issue-4 )
                : 442-455
                Affiliations
                [ 1 ] Department of Radiation Physics The University of Texas M. D. Anderson Cancer Center Houston TX USA
                Author notes
                [*] [* ]Corresponding author: Stephen F. Kry, Department of Radiation Physics, Unit 607, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA; phone: (713) 563 2594; fax: (713) 794 1364; email: SFKry@ 123456mdanderson.org
                Article
                ACM20442
                10.1120/jacmp.v17i4.6216
                5690067
                27455499
                0b38597c-b9cc-4299-95d8-bf72acb3ff7b
                © 2016 The Authors.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 November 2015
                : 03 March 2016
                Page count
                Figures: 9, Tables: 4, References: 23, Pages: 14, Words: 5887
                Funding
                Funded by: National Cancer Institute, United States Department of Health and Human Services
                Award ID: CA180803
                Categories
                Radiation Measurements
                Radiation Measurements
                Custom metadata
                2.0
                acm20442
                July 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.5 mode:remove_FC converted:16.11.2017

                therapeutic electron beam,radiation leakage dose,electron applicator leakage,neutron dose equivalent,neutron source strength

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