Abstract: Intraoperative radiotherapy using mobile linear accelerators is used for a wide variety of malignancies. However, when large fields are used in combination with high energies, a deterioration of the flatness dose profile is measured with respect to smaller fields and lower energies. Indeed, for the LIAC HWL of Sordina, this deterioration is observed for the 12 MeV beam combined with 10 cm (or larger) diameter applicator. Aimed to solve this problem, a flattening filter has been designed and validated evaluating the feasibility of its usage at the upper part of the applicator. The design of the filter was based on Monte Carlo simulations because of its accuracy in modeling components of clinical devices, among other purposes. The LIAC 10 cm diameter applicator was modeled and simulated independently by two different research groups using two different MC codes, reproducing the heterogeneity of the 12 MeV energy beam. Then, an iterative process of filter design was carried out. Finally, the MC designed conical filter with the optimal size and height to obtain the desired flattened beam was built in-house using a 3D printer. During the experimental validation of the applicator-filter, percentage depth dose, beam profiles, absolute and peripheral dose measurements were performed to demonstrate the effectiveness of the filter addition in the applicator. These measurements conclude that the beam has been flattened, from 5.9% with the standard configuration to 1.6% for the configuration with the filter, without significant increase of the peripheral dose. Consequently, the new filter-applicator LIAC configuration can be used also in a conventional surgery room. A reduction of 16% of the output dose and a reduction of 1.1 mm in the D50 of the percentage depth dose was measured with respect to the original configuration. This work is a proof-of-concept that demonstrates that it is possible to add a filter able to flatten the beam delivered by the Sordina LIAC HWL. Future studies will focus on more refined technical solutions fully compatible with the integrity of the applicator, including its sterilization, to be safely introduced in the clinical practice.

Abstract: The design and construction of geometries for Monte Carlo calculations is an error-prone, time-consuming, and complex step in simulations describing particle interactions and transport in the field of medical physics. The software VoxelMages has been developed to help the user in this task. It allows to design complex geometries and to process DICOM image files for simulations with the general-purpose Monte Carlo code PENELOPE in an easy and straightforward way. VoxelMages also allows to import DICOM-RT structure contour information as delivered by a treatment planning system. Its main characteristics, usage and performance benchmarking are described in detail.

Abstract: Purpose. To estimate Type B uncertainties in absorbed-dose calculations arising from the different implementations in current state-of-the-art Monte Carlo (MC) codes of low-energy photon cross-sections (<200 keV). Methods. MC simulations are carried out using three codes widely used in the low-energy domain: PENELOPE-2018, EGSnrc, and MCNP. Three dosimetry-relevant quantities are considered: mass energy-absorption coefficients for water, air, graphite, and their respective ratios; absorbed dose; and photon-fluence spectra. The absorbed dose and the photon-fluence spectra are scored in a spherical water phantom of 15 cm radius. Benchmark simulations using similar cross-sections have been performed. The differences observed between these quantities when different cross-sections are considered are taken to be a good estimator for the corresponding Type B uncertainties. Results. A conservative Type B uncertainty for the absorbed dose (k = 2) of 1.2%-1.7% (<50 keV), 0.6%-1.2% (50-100 keV), and 0.3% (100-200 keV) is estimated. The photon-fluence spectrum does not present clinically relevant differences that merit considering additional Type B uncertainties except for energies below 25 keV, where a Type B uncertainty of 0.5% is obtained. Below 30 keV, mass energy-absorption coefficients show Type B uncertainties (k = 2) of about 1.5% (water and air), and 2% (graphite), diminishing in all materials for larger energies and reaching values about 1% (40-50 keV) and 0.5% (50-75 keV). With respect to their ratios, the only significant Type B uncertainties are observed in the case of the water-to-graphite ratio for energies below 30 keV, being about 0.7% (k = 2). Conclusions. In contrast with the intermediate (about 500 keV) or high (about 1 MeV) energy domains, Type B uncertainties due to the different cross-sections implementation cannot be considered subdominant with respect to Type A uncertainties or even to other sources of Type B uncertainties (tally volume averaging, manufacturing tolerances, etc). Therefore, the values reported here should be accommodated within the uncertainty budget in low-energy photon dosimetry studies.

Abstract: Three different correction factors for measurements with the parallel-plate ionization chamber PTW T34013 on the Esteya electronic brachytherapy unit have been investigated. This chamber type is recommended by AAPM TG-253 for depth-dose measurements in the 69.5 kV x-ray beam generated by the Esteya unit. Monte Carlo simulations using the PENELOPE-2018 system were performed to determine the absorbed dose deposited in water and in the chamber sensitive volume at different depths with a Type A uncertainty smaller than 0.1%. Chamber-to-chamber differences have been explored performing measurements using three different chambers. The range of conical applicators available, from 10 to 30 mm in diameter, has been explored. Using a depth-independent global chamber perturbation correction factor without a shift of the effective point of measurement yielded differences between the absorbed dose to water and the corrected absorbed dose in the sensitive volume of the chamber of up to 1% and 0.6% for the 10 mm and 30 mm applicators, respectively. Calculations using a depth-dependent perturbation factor, including or excluding a shift of the effective point of measurement, resulted in depth-dose differences of about +/- 0.5% or less for both applicators. The smallest depth-dose differences were obtained when a shift of the effective point of measurement was implemented, being displaced 0.4 mm towards the center of the sensitive volume of the chamber. The correction factors were obtained with combined uncertainties of 0.4% (k = 2). Uncertainties due to chamber-to-chamber differences are found to be lower than 2%. The results emphasize the relevance of carrying out detailed Monte Carlo studies for each electronic brachytherapy device and ionization chamber used for its dosimetry.

Abstract: The AAPM TG-43 brachytherapy dosimetry formalism, introduced in 1995, has become a standard for brachytherapy dosimetry worldwide; it implicitly assumes that charged-particle equilibrium (CPE) exists for the determination of absorbed dose to water at different locations, except in the vicinity of the source capsule. Subsequent dosimetry developments, based on Monte Carlo calculations or analytical solutions of transport equations, do not rely on the CPE assumption and determine directly the dose to different tissues. At the time of relating dose to tissue and dose to water, or vice versa, it is usually assumed that the photon fluence in water and in tissues are practically identical, so that the absorbed dose in the two media can be related by their ratio of mass energy-absorption coefficients. In this work, an efficient way to correlate absorbed dose to water and absorbed dose to tissue in brachytherapy calculations at clinically relevant distances for low-energy photon emitting seeds is proposed. A correction is introduced that is based on the ratio of the water-to-tissue photon energy-fluences. State-of-the art Monte Carlo calculations are used to score photon fluence differential in energy in water and in various human tissues (muscle, adipose and bone), which in all cases include a realistic modelling of low-energy brachytherapy sources in order to benchmark the formalism proposed. The energy-fluence based corrections given in this work are able to correlate absorbed dose to tissue and absorbed dose to water with an accuracy better than 0.5% in the most critical cases (e.g. bone tissue).