The purpose of this study was to determine the dose enhancement factor (DEF) of gold nanoparticles in a dosimeter gel and construct percentage depth dose curves, using the Optical CT system and the Monte Carlo simulation model, to determine the effect of increasing the dose caused by increasing the concentration of gold nanoparticles at depths in the gel.

The Magic-f Gel was made based on the relevant protocol in the physics lab. To determine the amount of the increase in the absorbed dose, the gold nanoparticles were added to the gel and irradiated. An increase in the dose after adding nanoparticles to the gel vials was estimated both with the Optical CT system and by the Monte Carlo simulation method.

Dose enhancement curves for doses of 2, 4 and 6 Gy were prepared for gel vials without adding nanoparticles, and nanoparticle gels at concentrations 0·17, 3 and 6 mM. Also, the DEF was estimated. For the 0·17 mM molar gel, the DEF for 2, 4 and 6 Gy was 0·7, 0·743 and 0·801, respectively. For the 3 mM gel, it was 1·98, 2·5 and 2·2, and for the 6 mM gel, it was 37·4, 4·24 and 4·71, respectively.

The enhancement of the dose after adding gold nanoparticles was confirmed both by experimental data and by simulation data.

Multiform glioblastoma (MG) represents 70% of all gliomas, with half of patients older than 65 years with median survival of 12–18 months, hypofractionation seeks to reduce the intensity and duration of treatment without impacting on survival rates. The objective was to determine the global survival and recurrence-free survival of adults over 70 years old with MG treated with hypofractionated radiotherapy and standard scheme. The review of patients older than 70 years treated with radiotherapy from 2013 to 2016 was performed.

Twenty-four patients were analysed, with a median follow-up of 239 days, and there is no difference in overall survival 12·3 versus 10·5 months (p = 0·55) and recurrence-free survival 8·3 versus 3·4 months (p = 0·48) between both schemes, conventional versus hypofractioanted, respectively.

The results in this study show that hypofractionated scheme could be comparable in overall survival and recurrence-free survival to conventional fractionation, but a longer patients’ trial should be done.

Cancer during pregnancy has an incidence of 1/1,000, and when diagnosed, the most common ones are breast cancer (1/10,000), Hodgkin’s lymphoma (1/6,000), and head and neck cancer (1/10,000). If a diagnosis is made during pregnancy, the treatment cannot wait until delivery, and there is concern about the effects that radiotherapy may have on the foetus. The multidisciplinary group has to assess and ethically make decisions with regard to the mother and foetus.

A 35-year-old female, a carrier of Behcet’s disease, underwent 5 years of treatment with hydroxychloroquine, prednisone and low-molecular-weight heparin (the patient being a carrier of Behcet’s disease, there is a high risk for cancer of the oral cavity and oropharynx with an HR of 2·11, so the cancer could be related to the tonsil). The patient’s oncological situation started on December 2017 with a volume increase in preauricular, parotid and right mandibular angle, with a progressive growth. At this time, the foetus was of 17·5 weeks of gestation. An oral cavity tumour that invaded the right retromolar triangle was observed, and upon biopsy, a basaloid squamous cell carcinoma was diagnosed.

Radiotherapy treatment was started at 22 weeks of gestation; intensity-modulated radiation therapy (IMRT) was planned with a dose of 69·96 Gy to the primary tumour and 59·4 Gy to ganglion levels II, III and IV, bilaterally in 33 fractions. At fraction 27 a significant decrease in tumour volume was noted, so adaptive radiotherapy was performed to complete the treatment. Currently the patient has no clinical evidence of tumour pathology.

The risk of radiation exposure in pregnant women (after 20 weeks of gestation), being treated for cancers of the tonsil, reaching the foetus is minimal, with a reduced risk of a few or no effects.

Radiotherapy in tonsil cancer has been shown to be effective in combination with chemotherapy for local control of the disease. In the case of this pregnant patient, radiotherapy, as the only modality, provided local control and little exposure of radiation to the foetus.

To investigate discrepancies in dose calculation algorithms used for lung stereotactic body radiotherapy (SBRT) plans.

In total, 30 patients lung SBRT treatment plans, initially generated using BrainLab Pencil Beam (BL_PB) algorithm for 10 Gy×5 Fractions to the planning target volume (PTV) were included in the study. These plans were recalculated using BrainLab Monte Carlo (BL_MC), Eclipse AAA (EC_AAA), Eclipse Acuros XB (EC_AXB) and ADAC Pinnacle CCC (AP_CCC) algorithms. Dose volume histograms of PTV were used to calculate dosimetric and radiobiological quality indices, and equivalent dose to 2 Gy per fraction using linear-quadratic-linear model. The BL_MC algorithm is considered gold standard tool to compare PTV parameters and quality indices to investigate dose calculation discrepancies of abovementioned plans.

BL_PB overestimates doses that may be due to inability of the algorithm to properly account for electron scattering and transport in inhomogeneous medium. Compared with BL_MCNO plans, the EC_AAA and EC_AXB yield lower homogeneity indices and overestimate the dose in the penumbra region, whereas AP_CCC plans were comparable for small PTV (≈8 cc) and had significant difference for large PTV.

BL_PB algorithm overestimates PTV doses than BL_MC calculated doses. The EC_AAA, EC_AXB and AP_CCC algorithms calculate doses within acceptable limits of radiotherapy dose delivery recommendations.

In this study, the radiation contamination dose (RCD) for different combinations of electron energy/distance, applicator and radius around the light intraoperative accelerator (LIAC), a high dose per pulse dedicated intraoperative electron radiotherapy machine, has been estimated. Being aware about the amount of RCDs is highly recommended for linear medical electron accelerators.

Monte Carlo Nuclear Particles (MCNP) code was used to simulate the LIAC® head and calculate RCDs. Experimental RCDs measurements were also done by Advanced Markus chamber inside a MP3-XS water phantom. Relative differences of simulations and measurements were calculated.

RCD reduction by distance from the machine follows the inverse-square law, as expected. The RCD was decreased by increasing angle from applicator walls opposed to the electron beam direction. The maximum differences between the simulation and measurement results were lower than 3%.

The RCD is strongly dependent on electron beam energy, applicator size and distance from the accelerator head. Agreement between the MCNP results and ionometric dosimetry confirms the applicability of this simulation code in modelling the intraoperative electron beam and obtaining the dosimetric parameters. The RCD is a parameter that would restrict working with LIAC in an unshielded operative room.

As the number of proton therapy facilities has steadily increased, the need for the tool to provide precise dose simulation for complicated clinical and research scenarios also increase. In this study, the treatment head of Mevion HYPERSCAN pencil beam scanning (PBS) proton therapy system including energy modulation system (EMS) and Adaptive Aperture™ (AA) was modelled using TOPAS (TOolkit for PArticle Simulation) Monte Carlo (MC) code and was validated during commissioning process.

The proton beam characteristics including integral depth doses (IDDs) of pristine Bragg peak and in-air beam spot sizes were simulated and compared with measured beam data. The lateral profiles, with and without AA, were also verified against calculation from treatment planning system (TPS).

All beam characteristics for IDDs and in-air spot size agreed well within 1 mm and 10% separately. The full width at half maximum and penumbra of lateral dose profile also agree well within 2 mm.

The TOPAS MC simulation of the MEVION HYPERSCAN PBS proton therapy system has been modelled and validated; it could be a viable tool for research and verification of the proton treatment in the future.

The accuracy of two calculation algorithms of the Varian Eclipse treatment planning system (TPS), the electron Monte Carlo algorithm (eMC) and general Gaussian pencil beam algorithm (GGPB) for calculating peripheral dose distribution of electron beams was investigated.

Peripheral dose measurements were carried out for 6, 9, 12, 15, 18 and 22 MeV electron beams using parallel plate ionisation chamber and EBT3 film in the slab phantom. Measurements were performed for 6×6, 10×10 and 25×25 cm2 cone sizes at dmax of each energy up to 20 cm beyond the field edges. The measured and TPS calculated data were compared.

The TPS underestimated the out-of-field doses. The difference between measured and calculated doses increase with the cone size. For ionisation chamber measurement, the largest deviation between calculated and measured doses is <4·29% using the eMC, but can increase up to 8·72% of the distribution using GGPB. For film measurement, the minimum gamma analysis passing rates between measured and calculated dose distributions for all field sizes and energies used in this study were 91·2 and 74·7% for eMC and GGPB, respectively.

The use of GGPB for planning large field treatments with 6 MeV could lead to inaccuracies of clinical significance.

Monte Carlo calculation method is considered to be the most accurate method for dose calculation in radiotherapy. The purpose of this research is comparison between 6 MV Primus LINAC simulation output with commissioning data using EGSnrc and build a Monte Carlo geometry of 6 MV Primus LINAC as realistically as possible. The BEAMnrc and DOSXYZnrc (EGSnrc package) Monte Carlo model of the LINAC head was used as a benchmark.

In the first part, the BEAMnrc was used for the designing of the LINAC treatment head. In the second part, dose calculation and for the design of 3D dose file were produced by DOSXYZnrc. The simulated PDD and beam profile obtained were compared with that calculated using commissioning data. Good agreement was found between calculated PDD (1·1%) and beam profile using Monte Carlo simulation and commissioning data. After validation, TPR20,10, TMR and Sp values were calculated in five different field.

Good agreement was found between calculated values by using Monte Carlo simulation and commissioning data. Average differences for five field sizes in this approach is about 0·83% for Sp. for TPR20,10 differences for field sizes 10×10 cm2 is 0·29% and for TMR in five field sizes, the average value is ~1·6%.

In conclusion, the BEAMnrc and DOSXYZnrc codes package have very good accuracy in calculating dose distribution for 6 MV photon beam and it can be considered as a promising method for patient dose calculations and also the Monte Carlo model of primus linear accelerator built in this study can be used as method to calculate the dose distribution for cancer patients.

This study deals with the characteristics of simultaneous photon and electron beams in homogenous and inhomogeneous phantoms by experimental and Monte Carlo dosimetry, for therapeutic purposes. Materials and methods: Both 16 and 20 MeV high-energy electron beams were used as the original beam to strike perforated lead sheets to produce the mixed beam. The dosimetry results were achieved by measurement in an ion chamber in a water phantom and film dosimetry in a Perspex nasal phantom, and then compared with those calculated through a simulation approach. To evaluate two-dimensional dose distribution in the inhomogeneous medium, the dose–area histogram was obtained.

The highest percentage of photon contribution in mixed beam was found to be 36% for 2-mm thickness of lead layer with holes diameter of 0·2 cm for a 20 MeV primary electron energy. For small fields, the percentage depth dose parameters variations were found to be similar to pure electron beam within ±2%. The most feasible flatness in beam profile was 11% for pure electron and 7% for the mixed beam. Penumbra changes as function of depth was about ten times better than in pure electron field.

The results present some dosimetric advantages that can make this study a platform for the production of simultaneous mixed beams in future linear accelerators (LINACs), which through redesign of the LINAC head, which could lead to setup error reduction and a decrease of intra-fractional tumour cells repair.

This study aims to evaluate dosimetric parameters like percentage depth dose, dosimetric field size, depth of maximum dose surface dose, penumbra and output factors measured using IBA CC01 pinpoint chamber, IBA stereotactic field diode (SFD), PTW microDiamond against Monte Carlo (MC) simulation for 6 MV flattening filter-free small fields.

The linear accelerator used in the study was a Varian TrueBeam® STx. All field sizes were defined by jaws. The required shift to effective point of measurement was given for CC01, SFD and microdiamond for depth dose measurements. The output factor of a given field size was taken as the ratio of meter readings normalised to 10 × 10 cm2 reference field size without applying any correction to account for changes in detector response. MC simulation was performed using PRIMO (PENELOPE-based program). The phase space files for MC simulation were adopted from the MyVarian Website.

Variations were seen between the detectors and MC, especially for fields smaller than 2 × 2 cm2 where the lateral charge particle equilibrium was not satisfied. Diamond detector was seen as most suitable for all measurements above 1 × 1 cm2. SFD was seen very close to MC results except for under-response in output factor measurements. CC01 was observed to be suitable for field sizes above 2 × 2 cm2. Volume averaging effect for penumbra measurements in CC01 was observed. No detector was found suitable for surface dose measurement as surface ionisation was different from surface dose due to the effect of perturbation of fluence. Some discrepancies in measurements and MC values were observed which may suggest effects of source occlusion, shift in focal point or mismatch between real accelerator geometry and simulation geometry.

For output factor measurement, TRS483 suggested correction factor needs to be applied to account for the difference in detector response. CC01 can be used for field sizes above 2 × 2 cm2 and microdiamond detector is suitable for above 1 × 1 cm2. Below these field sizes, perturbation corrections and volume averaging corrections need to be applied.

The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.

Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.

Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.

The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.

An increasing number of external beam treatment modalities including intensity modulated radiation therapy, volumetric modulated arc therapy (VMAT) and stereotactic radiosurgery uses very small fields for treatment planning and delivery. However, there are major challenges in small photon field dosimetry, due to the partial occlusion of the direct photon beam source’s view from the measurement point, lack of lateral charged particle equilibrium, steep dose-rate gradient and volume averaging effect of the detector response and variation of the energy fluence in the lateral direction of the beam. Therefore, experimental measurements of dosimetric parameters such as percent depth doses (PDDs), beam profiles and relative output factors (ROFs) for small fields continue to be a challenge.

In this study, we used a homogeneous water phantom and the heterogeneous anthropomorphic stereotactic end-to-end verification (STEEV) head phantom for all dose measurements and calculations. PDDs, lateral dose profiles and ROFs were calculated in the Eclipse Treatment Planning System version 13·6 using the Acuros XB (AXB) and the analytical anisotropic algorithms (AAAs) in a homogenous water phantom. Monte Carlo (MC) simulations and measurements using the Exradin W1 Scintillator were also accomplished for four photon energies: 6 MV, 6FFF, 10 MV and 10FFF. Two VMAT treatment plans were generated for two different targets: one located in the brain and the other in the neck (close to the trachea) in the head phantom (CIRS, Norfolk, VA, USA). A Varian Truebeam linear accelerator (Varian, Palo Alto, CA, USA) was used for all treatment deliveries. Calculated results with AXB and AAA were compared with MC simulations and measurements.

The average difference of PDDs between W1 Exradin Scintillator measurements and MC simulations, AAA and AXB algorithm calculations were 1·2, 2·4 and 3·2%, respectively, for all field sizes and energies. AXB and AAA showed differences in ROF of about 0·3 and 2·9%, respectively, compared with W1 Exradin Scintillator measured values. For the target located in the brain in the head phantom, the average dose difference between W1 Exradin Scintillator and the MC simulations, AAA and AXB were 0·2, 3·2 and 2·7%, respectively, for all field sizes. Similarly, for the target located in the neck, the respective dose differences were 3·8, 5·7 and 3·5%.

In this study, we compared dosimetric parameters such as PDD, beam profile and ROFs in water phantom and isocenter point dose measurements in an anthropomorphic head phantom representing a patient. We observed that measurements using the W1 Exradin scintillator agreed well with MC simulations and can be used efficiently for dosimetric parameters such as PDDs and dose profiles and patient-specific quality assurance measurements for small fields. In both homogenous and heterogeneous media, the AXB algorithm dose prediction agrees well with MC and measurements and was found to be superior to the AAA algorithm.

The development of magnetic resonance (MR) imaging systems has been extended for the entire radiotherapy process. However, MR images provide voxel values that are not directly related to electron densities, thus MR images cannot be used directly for dose calculation. The aim of this study is to investigate the feasibility of dose calculations to be performed on MR images and evaluate the necessity of re-planning.

A prostate cancer patient was imaged using both MR and computed tomography (CT). The multilevel threshold (MLT) algorithm was used to categorise voxel values in the MR images into three segments (air, water and bone) with homogeneous Hounsfield units (HU). An intensity-modulated radiation therapy plan was generated from CT images of the patient. The plan was then copied to the segmented MR datasets and the doses were recalculated using pencil beam (PB) and collapsed cone (CC) algorithms and Monte Carlo (MC) modelling.

γ Evaluation showed that the percentage of points in regions of interest with γ<1 (3%/3 mm) were more than 94% in the segmented MR. Compared with the planning CT plan, the segmented MR plan resulted in a dose difference of –0·3, 0·8 and –1·3% when using PB, CC and MC algorithms, respectively.

The segmentation and conversion of MR images into HU data using the MLT algorithm, used in this feasibility study, can be used for dose calculation. This method can be used as a dosimetric assessment tool and can be easily implemented in the clinic.