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      Linac primary barrier transmission: Flattening filter free and field size dependence

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          Abstract

          There is widespread consensus in the literature that flattening filter free (FFF) beams have a lower primary barrier transmission than flattened beams. Measurements presented here, however, show that for energy compensated FFF beams, the barrier transmission can be as much as 70% higher than for flattened beams. The ratio of the FFF barrier transmission to the flattened beam barrier transmission increases with increasing barrier thickness. The use of published FFF TVL data for energy compensated FFF beams could lead to an order of magnitude underestimate of the air kerma rate. There are little data in the literature on the field size dependence of the barrier transmission for flattened beams. Barrier transmission depends on the field size at the barrier, not at isocenter Measurements are presented showing the relative dependence of barrier transmission on the field size, measured at the barrier, for 6 MV and 10 MV beams. An analytical fitting formula is provided for the field size dependence. For field sizes greater than about 150 cm in side length, the field size dependence is minimal. For field sizes less than about 100 cm, the transmission declines rapidly as the field size decreases.

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          Flattening filter‐free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group

          This report describes the current state of flattening filter‐free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high‐dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out‐of‐field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity‐modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated. PACS number: 87.53.‐j, 87.53.Bn, 87.53.Ly, 87.55.‐x, 87.55.N‐, 87.56.bc
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            Monte Carlo calculation of nine megavoltage photon beam spectra using the BEAM code.

            A recent paper analyzed the sensitivity to various simulation parameters of the Monte Carlo simulations of nine beams from three major manufacturers of commercial medical linear accelerators, ranging in energy from 4-25 MV. In this work the nine models are used: to calculate photon energy spectra and average energy distributions and compare them to those published by Mohan et al. [Med. Phys. 12, 592-597 (1985)]; to separate the spectra into primary and scatter components from the primary collimator, the flattening filter and the adjustable collimators; and to calculate the contaminant-electron fluence spectra and the electron contribution to the depth-dose curves. Notwithstanding the better precision of the calculated spectra, they are similar to those calculated by Mohan et al. The three photon spectra at 6 MV from the machines of three different manufacturers show differences in their shapes as well as in the efficiency of bremsstrahlung production in the corresponding target and filter combinations. The contribution of direct photons to the photon energy fluence in a 10 x 10 field varies between 92% and 97%, where the primary collimator contributes between 0.6% and 3.4% and the flattening filter contributes between 0.6% and 4.5% to the head-scatter energy fluence. The fluence of the contaminant electrons at 100 cm varies between 5 x 10(-9) and 2.4 x 10(-7) cm(-2) per incident electron on target, and the corresponding spectrum for each beam is relatively invariant inside a 10 x 10 cm2 field. On the surface the dose from electron contamination varies between 5.7% and 11% of maximum dose and, at the depth of maximum dose, between 0.16% and 2.5% of maximum dose. The photon component of the percentage depth-dose at 10 cm depth is compared with the general formula provided by AAPM's task group 51 and confirms the claimed accuracy of 2%.
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              IPEM topical report 1: guidance on implementing flattening filter free (FFF) radiotherapy.

              Flattening filter free (FFF) beams are now commonly available with new standard linear accelerators. These beams have recognised clinical advantages in certain circumstances, most notably the reduced beam-on times for high dose per fraction stereotactic treatments. Therefore FFF techniques are quickly being introduced into clinical use. The purpose of this report is to provide practical implementation advice and references for centres implementing FFF beams clinically. In particular UK-specific guidance is given for reference dosimetry and radiation protection.
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                Author and article information

                Contributors
                Patrick.mcdermott@beaumont.edu
                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
                04 January 2023
                March 2023
                : 24
                : 3 ( doiID: 10.1002/acm2.v24.3 )
                : e13886
                Affiliations
                [ 1 ] Beaumont Health System (now Corewell Health) Royal Oak Michigan USA
                [ 2 ] Beaumont Health System Royal Oak Michigan USA
                [ 3 ] Beaumont Health System Dearborn Michigan USA
                [ 4 ] Beaumont Health System Lenox Michigan USA
                Author notes
                [*] [* ] Correspondence

                Patrick N. McDermott, Beaumont Health System (now Corewell Health), 3601 W. Thirteen Mile Rd, Royal Oak, MI 48073, USA.

                Email: Patrick.mcdermott@ 123456beaumont.edu

                Article
                ACM213886
                10.1002/acm2.13886
                10018660
                36601672
                c48756d5-5fff-421f-b215-5df453fd9a77
                © 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 November 2022
                : 18 July 2022
                : 15 December 2022
                Page count
                Figures: 1, Tables: 2, Pages: 5, Words: 3630
                Categories
                Radiation Protection & Regulations
                Radiation Protection & Regulations
                Custom metadata
                2.0
                March 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.6 mode:remove_FC converted:16.03.2023

                flattening filter free,primary barrier,shielding
                flattening filter free, primary barrier, shielding

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