An integrated physico-chemical approach for explaining the differential impact of FLASH versus conventional dose rate irradiation on cancer and normal tissue responses.

The linear accelerator (linac) is the accepted workhorse in radiotherapy in 2006. The first medical linac treated its first patient, in London, in 1953, so the use of these machines in clinical practice has been almost co-existent with the lifetime of Physics in Medicine and Biology. This review is a personal selection of things the authors feel are interesting in the history, particularly the early history, and development of clinical linacs. A brief look into the future is also given. One significant theme throughout is the continuity of ideas, building on previous experience. We hope the review might re-connect younger radiotherapy physicists in particular with some of the history and emphasize the continual need, in any human activity, to remain aware of the past, in order to make best use of past experience when taking decisions in the present.

/pdf/back-to-the-future-the-history-and-development-of-the-5c090oib9k.pdf

Back to the future: the history and development of the clinical linear accelerator.

PHASER: A platform for clinical translation of FLASH cancer radiotherapy.

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.

http://www.uthgsbsmedphys.org/GS02-0093/3.3b-Howell_MedPhys_2010.pdf

Secondary neutron spectra from modern Varian, Siemens, and Elekta linacs with multileaf collimators

The accuracy with which Monte Carlo models of photon beams generated by linear accelerators (linacs) can describe small-field dose distributions depends on the modeled width of the electron beam profile incident on the linac target. It is known that the electron focal spot width affects penumbra and cross-field profiles; here, the authors explore the extent to which source occlusion reduces linac output for smaller fields and larger spot sizes. A BEAMnrc Monte Carlo linac model has been used to investigate the variation in penumbra widths and small-field output factors with electron spot size. A formalism is developed separating head scatter factors into source occlusion and flattening filter factors. Differences between head scatter factors defined in terms of in-air energy fluence, collision kerma, and terma are explored using Monte Carlo calculations. Estimates of changes in kerma-based source occlusion and flattening filter factors with field size and focal spot width are obtained by calculating doses deposited in a narrow 2 mm wide virtual "milliphantom" geometry. The impact of focal spot size on phantom scatter is also explored. Modeled electron spot sizes of 0.4-0.7 mm FWHM generate acceptable matches to measured penumbra widths. However the 0.5 cm field output factor is quite sensitive to electron spot width, the measured output only being matched by calculations for a 0.7 mm spot width. Because the spectra of the unscattered primary (psi(pi)) and head-scattered (psi(sigma)) photon energy fluences differ, miniphantom-based collision kerma measurements do not scale precisely with total in-air energy fluence psi = (psi(pi) + psi(sigma) but with (psi(pi)+ 1.2psi(sigma)). For most field sizes, on-axis collision kerma is independent of the focal spot size; but for a 0.5 cm field size and 1.0 mm spot width, it is reduced by around 7% mostly due to source occlusion. The phantom scatter factor of the 0.5 cm field also shows some spot size dependence, decreasing by 6% (relative) as spot size is increased from 0.1 to 1.0 mm. The dependence of small-field source occlusion and output factors on the focal spot size makes this a significant factor in Monte Carlo modeling of small (< 1 cm) fields. Changes in penumbra width with spot size are not sufficiently large to accurately pinpoint spot widths. Consequently, while Monte Carlo models based exclusively on large-field data can quite accurately predict small-field profiles and PDDs, in the absence of experimental methods of determining incident electron beam profiles it will remain necessary to measure small-field output factors, fine-tuning modeled spot sizes to ensure good matching between the Monte Carlo and the measured output factors.

Monte Carlo modeling of small photon fields: quantifying the impact of focal spot size on source occlusion and output factors, and exploring miniphantom design for small-field measurements.

Medical Electron Accelerators

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Medical Electron Accelerators