The physical characteristics of the 15 MV Varian Clinac 2100C

unattened beam
M.A. Najem
a,n
, N.M. Spyrou
a
, Z. Podolyk
a
, F.A. Abolaban
b
a
Department of Physics, University of Surrey, Guildford, Surrey GU2 5XH, UK
b
Nuclear Engineering Department, King Abdualaziz University, PO BOX 80204, Jeddah 21589, Saudi Arabia
H I G H L I G H T S

We made a Monte Carlo simulation to study the dosimetric properties of the unattened beam of the 15 MV Varian Clinac 2100C.

Removing the attening lter increase the dose rate of the beam.

Removing the attening lter decrease the out-of-eld dose.

Removing the attening lter decrease the photoneutron production.

The surface dose to the patient is increased by removing the attening lter.
a r t i c l e i n f o
Article history:
Received 25 September 2012
Accepted 25 April 2013
Available online 4 May 2013
Keywords:
Unattened beam
Dose-rate
Out-of-eld dose
Photoneutron
a b s t r a c t
A 15 MV photon beam of a Varian Clinac 2100C medical linear accelerator operating with and without a
attening lter was simulated using the Monte Carlo code FLUKA in order to calculate differences in
their dosimetric properties. These include: the dose rate, the percentage depth dose on the central axis,
the beam prole, the out-of-eld dose, the surface dose on a 404040 cm
3
water phantom and the
neutron contamination. The results obtained showed that the unattened beam has a dose rate 4.86
times higher than the attened one. The average out-of-eld dose from the edge of the eld to the edge
of the phantom was reduced by 44%, the neutron uence at the isocentre was reduced by 77% and the
surface neutron dose-equivalent was reduced from 2.1170.05 to 0.4070.01 mSv(n) Gy
1
(X) after
normalising both beams to give the same dose at d
max
(the depth of maximum dose). However, the
photon surface dose of the unattened beam increased by 13%. From this information, it can be
concluded that the unattened beam can lead to better treatment outcome and may reduce the beam-on
time which may be required for specic cases.
& 2013 Elsevier Ltd. All rights reserved.
1. Introduction
Even though new radiotherapy methods are in use or under
development to treat cancers, linear accelerators (linacs) are still the
most frequently used treatment technique for this purpose. During
the last two decades, several developments have been introduced to
linac applications such as Intensity-Modulated Radiotherapy (IMRT),
Image-Guided Radiotherapy (IGRT), Stereotactic Body Radiotherapy
(SBRT) and others. The main purpose of these techniques is to deliver
a high dose to tumours and as low dose as possible to normal tissues
(Meyer et al., 2007). However, by using conventional linacs, several
problems limit the ability of these techniques to obtain the optimum
result of the overall treatment course. These problems arise from the
relatively low dose rate, the high neutron contamination level when
they are operated at energies higher than 8 MV due to the photo-
neutron production process and the relatively high out-of-eld dose
arising from the high head scatter ratio. One way to compensate for
these problems is to remove the attening lter (FF) from the head of
the linac (the major source of head scatter) or known as the
Flattening Filter Free mode (FFF) (Georg et al., 2011; Kry et al.,
2008; Vassiliev et al., 2006). Other advantages of removing the FF
have been found such as enhancing the portal imaging device
response and the possibility of reducing the shielding cost (Georg
et al., 2011). Several studies have been conducted on photon beam
energy modes at 6, 10 and 18 MV in order to study the effect of the
removal of the FF on beam characteristics (Cashmore, 2008; Mesbahi,
2009). To authors knowledge, no one has studied the effect of the
15 MV unattened beam for Varian linacs and the only work done by
Chofor et al. (2011) was on a Siemens linac. The main purpose of this
work is to study the effect of removing the FF from the 15 MV photon
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Radiation Physics and Chemistry
0969-806X/$ - see front matter & 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.radphyschem.2013.04.035
n
Corresponding author. Tel.: +44 1483689432; fax: +44 1483686781.
E-mail address: m.najem@surrey.ac.uk (M.A. Najem).
Radiation Physics and Chemistry 95 (2014) 205209
beam of a Varian Clinac 2100C on beam characteristics including the
neutron level.
2. Materials and methods
The 15 MV Varian Clinac 2100C, with and without FF, was
simulated using a Monte Carlo (MC) code FLUKA. The advantages
of this code are (Ferrari et al., 2005):
1. The feasibility to simulate not only linac heads and/or phan-
toms but also to simulate detectors, treatment rooms, imaging
devices, other accelerators (e.g. cyclotrons) etc.
2. It can simulate the interaction and transportation in matter of
about 60 different particles such as photons, electrons, positrons
and neutrons. Thus, the photoneutron production from the high
energy linac can be simulated accurately using this code.
2.1. MC parameters
The actual geometry of the 15 MV Varian Clinac 2100C linac head
used in the simulation was obtained from the Varian manufacturer.
Fig. 1 illustrates the geometry of the Varian linac head simulated using
FLUKA. The incident electron beam hitting the target was simulated as
a pencil beam of energy 15 MeV and a diameter 3 mm. The PHOTO-
NUC card (a simulation parameter in FLUKA) was turned on to
activate the photoneutron reaction. A 404040 cm
3
water
phantom was simulated at a source surface distance (SSD) equal
to 100 cm. The jaws and the multi-leaf collimators (MLCs) were
xed to form a 1010 cm
2
eld-size at the phantom surface.
The water phantom was divided into voxels in order to calculate
the photon dose, neutron uence and neutron dose-equivalent.
The voxel size in photon calculations was set to 0.5
0.50.25 cm
3
and to 11 1 cm
3
for neutron calculations. The
number of histories was set to 210
9
primary electrons in each
setup (FF and FFF modes) to reduce the statistical uncertainty to an
acceptable level. Each simulation was run on a university computer
(Intel 16 Core, 2.8 GHz CPU, 16 GB RAM) with a UNIX operating
system.
2.2. MC validation
To validate the simulation, the calculated percentage depth doses
(PDDs) of the FF beam in the central axis of the water phantomwere
compared with PDDs data obtained from Royal Surrey County
Hospital (RSCH), Guildford, UK. Fig. 2 shows the PDD curves of the
15 MV FF beam simulated and measured. The difference between
them was less than 2% at all points.
2.3. PDD, surface dose, beam prole and out-of-eld dose
The PDDs for both congurations were calculated in the water
phantom. The statistical uncertainty for all points was less than 1%.
The surface dose was obtained within the rst 1 cm inside the water
phantom on the central axis. The beam proles for both beams FF
and FFF were calculated for the water phantom at d
max
. The out-of-
eld doses at d
max
from the edge of the eld to the edge of the
phantom were also calculated after normalising both beams to give
the same dose at d
max
. The statistical uncertainty of peripheral doses
was less than 0.5% inside the eld and less than 3.5% up to the
phantom edge.
2.4. Dose rate
The difference in dose rates for the 15 MV FF and FFF beams was
also calculated at d
max
on the central axis of the water phantom. The
result was compared with that for the 15 MV Siemens linac obtained
by Chofor et al. (2011).
2.5. Neutron uences and neutron dose-equivalent
The neutron uences in air and in the phantom for both beams
were calculated. The neutron uence in air was obtained at 1 cm
above the phantom on the central axis. The neutron uence and neu-
tron dose-equivalent in the phantomwere calculated along the central
axis of the phantom in order to calculate the depth at maxi-
mum neutron uence and study the change in dose-equivalent when
the FF is removed after normalising both beams to give the same
photon dose at d
max
. The statistical uncertainty for all neutron
measurements was less than 10%.
Fig. 1. The simulated geometry of the 15 MV Varian Clinac 2100C linac with
attening lter using FLUKA.
Fig. 2. The PDD curves of the 15 MV Varian linac FF beam simulated ( ) and
obtained from RSCH () for a 10 10 cm
2
eld-size in a water phantom.
M.A. Najem et al. / Radiation Physics and Chemistry 95 (2014) 205209 206
3. Results and discussion
3.1. PDDs at the central axis and surface dose
The PDDs for both 15 MV FF and FFF beams are shown in Fig. 3.
The results obtained show no change in d
max
where they were
found for both to be 2.7570.13 cm and agreed with the measured
d
max
obtained from the RSCH which was 2.8070.03 cm. The reason
for this is that the dose deposited directly from the FFF beam
transfers the d
max
towards the phantom surface due to the softness
of the FFF X-ray spectrum, whereas the reduction in the head
scatter and leakage transfers the d
max
towards the larger depths
(Vassiliev et al., 2006). We can also see that the FFF beam undergoes
slightly faster fall-off after d
max
and rises again from the softness of
the FFF X-ray spectrum compared with that of the FF one. The PDDs
of the 15 MV FFF beam after d
max
were found to be equivalent to
those of the 12 MV FF beam (BJR, 1996). The surface doses up to
1 cm inside the phantom for the FFF beam were found to be higher
than those for the FF one. The difference between them was about
13%. Wang et al. (2012) found that the difference for a 1010 cm
2
eld-size between the FF and FFF is about 7.7% and 10% for 6 and
10 MV beams, respectively. They concluded that the difference
between them is clinically insignicant. However, it should be
noted that the difference between the FF and FFF increases with
beamenergy and it might be insignicant for one treatment fraction
dose but if the total dose from all fractions was considered, this
difference might add an extra dose to the patient surface which can
be substantial.
3.2. Dose rate
Fig. 4 shows the depth doses per primary electron for both FF
and FFF beams in a water phantom. The dose rate of the 15 MV
Varian FFF beamwas found to be 4.86 times higher than that for the
FF one. This result is different from that calculated by Chofor et al.
(2011) for the 15 MV Siemens linac since they found it to be only
3.96 times higher. This is due to from the difference in the FF
composition of a Varian (tungsten) and a Siemens (steel). This result
is lying between the 6 and 18 MV beams, which were 2.3 and
5.5 times higher than the FF ones, respectively (Vassiliev et al.,
2006). The increase in the dose rate reduces the beam-on time and
that can be useful for several treatment cases such as SBRT lung
cancer and respiratory gating in treatments requiring organ motion
control (Wang et al., 2012). Additionally, it was found in vitro that
the increase in the dose rate could increase the cancer-killing factor
for a number of cancerous cells (Lohse et al., 2011).
3.3. Beam prole and out-of-eld dose
The beam proles and out-of-eld doses for both the FF and the
FFF beams are shown in Figs. 5 and 6. From Fig. 5, can be seen the
failing in the uniformity (atness) of the FFF beam which results
clearly from the removal of the FF. This result does not present any
problem on dose calculations since new techniques have been
introduced such as IMRT which can compensate for this effect by
adapting the multi-leaf collimators (MLCs) during the treatment
course (Vassiliev et al., 2006). The out-of-eld dose for the FFF
beam from the edge of the eld to the edge of the phantom, as
seen in Fig. 6, was reduced. The average reduction in all points was
about 44%. This reduction results from the decrease in head
scatter. Also, it can be seen from the same gure that the reduction
in out-of-eld dose o3 cm from the eld edge is more than that
at a distance 43 cm, and that agreed with Kry's et al. (2010) result
and this effect has a major impact on reducing secondary induced
cancer since Diallo et al. (2009) found 49% of secondary induced
cancers happen at the eld edge.
3.4. Neutron uence in air
The neutron uence for the FF beam at the isocentre was
(10.570.5) 10
6
n cm
2
Gy
1
(X) and it was close to that obtained
by Kry et al. (2005) and Howell et al. (2006) which were (9.270.6)
10
6
and (9.470.3) 10
6
n cm
2
Gy
1
(X), respectively. The neutron
uence of the FFF beam was found to be (2.5070.06) 10
6
n cm
2
Gy
1
(X). Therefore, neutron uence was reduced by 77%. This
reduction is greater than that obtained by Chofor et al. (2011) since
they found the neutron strength for the Siemens linac was reduced
by 71%. The reason for this is that the FF for the Siemens linac is
made of steel, which has a lower photoneutron cross-section
compared with the tungsten FF of the Varian linac.
3.5. Neutron uence and dose-equivalent in phantom
The neutron percentage depth uences for the FF and FFF
beams were calculated as seen in Fig. 7. Both beams have the same
slope because removing FF affects only the number of neutrons
created and not the neutron uence distribution. From the results,
the depth at maximum neutron uence d
max-n
for both beams was
found to be 2.070.5 cm and that agreed with what was obtained
Fig. 3. PDDs of the 15 MV FF (solid line) and FFF (dashed line) beams for a
1010 cm
2
eld-size in a water phantom.
Fig. 4. Depth dose in the central axis per primary electron for FF (dashed line) and
FFF (solid line) beams.
M.A. Najem et al. / Radiation Physics and Chemistry 95 (2014) 205209 207
by Martnez-Ovalle et al. (2011) who found the d
max-n
to be
2.3170.07 cm in ICRU tissue equivalent phantom. The increase
in neutron uence up to d
max-n
results from the full scatter scheme
inside the phantom. In addition, the neutron dose-equivalent was
calculated in the water phantom for both beams as seen in Fig. 8.
From this gure, it can be found that the surface neutron dose-
equivalent for the FF beam was 2.1170.05 mSv(n) Gy
1
(X) and it
was close to that obtained by Howell et al. (2006) and by Golnik
et al. (2004), which were 1.8570.07 and 2.971.3 mSv(n) Gy
1
(X),
respectively. The reason for the maximum neutron dose-
equivalent at the phantom surface and not in the d
max-n
is because
the average neutron energy and the quality factor Q at the surface
are higher than in d
max-n
(Kry et al., 2009). This value was about
77% higher than that for the FFF case, which was 0.4870.01 mSv(n)
Gy
1
(X) due to the decrease in the number of neutrons produced
per Gy. The reduction in neutron dose-equivalent reduces the
possibility of induced secondary cancers.
4. Conclusion
The dosimetric properties of the unattened beam for a 15 MV
Varian Clinac 2100C linac with emphasis on the photoneutron
production were calculated using MC simulation. It was found that
the dose rate for the unattened beam was increased 4.86 times
compared with the attened one. This increase is useful in a number
of treatment cases such as SBRT lung cancer. Obviously, the removal
of FF reduces the out-of-eld dose, where it was found reduced, in
this work, by 44%. The neutron uence and neutron dos-equivalent
were also reduced by 77%. These reductions have a signicant
impact on decreasing the probability of induced secondary cancer.
The photon surface dose was found to be about 13% higher than the
attened beam. The increase in surface dose from all treatment
fractions might increase the patient surface dose and that needs
further investigation. From these results, it can be concluded that
the unattened beam can enhance the outcome of new treatment
techniques and can provide a step forward toward the optimum
results of RT treatments.
Acknowledgement
The authors thank the radiotherapy department at RSCH for
providing us with the PDD data of the 15 MV photon beam.
Fig. 6. The differences in out-of-eld doses from the eld edge to the phantom
edge for FF (--) and FFF (--) beams.
Fig. 7. Percentage depth neutron uences in phantom for the FF (--) and FFF
(--) beams.
Fig. 8. The neutron dose-equivalent in phantom for the FF (--) and FFF
(--) beams.
Fig. 5. Beam proles for a 10 10 cm
2
of the 15 MV beam with () and without
( ) FF after normalising both beams to obtain the same dose on the central axis.
M.A. Najem et al. / Radiation Physics and Chemistry 95 (2014) 205209 208
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