title: Development and optimization of a beam shaper device for a mobile dedicated IOERT accelerator.
abstract: OBJECTIVE
  The aim of this study was to design and build a prototype beam shaper to be used on a dedicated mobile accelerator that protects organs at risk within the radiation field and conforms the beam to the target geometry during intraoperative electron radiotherapy (IOERT). A dosimetric characterization of the beam shaper device was performed based on Monte Carlo (MC) simulations, as well as experimental data, at different energies, field sizes, and source to skin distances.
  
  
  METHODS
  A mobile light intraoperative accelerator (LIAC(®), Sordina, Italy) was used. The design of the beam shaper prototype was based on MC simulations (BEAMnrc∕OMEGA and DOSXYZnrc code) for a selection of materials and thicknesses, as well as for dosimetric characterization. Percentage depth dose (PDD) and profile measurements were performed using a p-type silicon diode and a commercial water phantom, while output factors were measured using a PinPoint ion chamber in a PMMA phantom. Planar doses in planes of interest were carried out using radiochromic films (Gafchromic(TM) EBT and EBT2) in PMMA and in a Solid Water(®) phantom. Several experimental set-ups were investigated with the beam shaper device fixed on the top of the phantom, varying both the short side of the rectangular field and the air gap between the device and the phantom surface, simulating the clinical situation. The output factors (OFs) were determined using different geometrical set-ups and energies.
  
  
  RESULTS
  The beam shaper prototype consists of four blades sliding alongside each other and mounted on a special support at the end of the 10 cm diameter PMMA circular applicator. Each blade is made of an upper layer of 2.6 cm of Teflon(®) and a lower layer of 8 mm of stainless steel. All rectangles inscribed in a 5 cm diameter can be achieved in addition to any "squircle-shaped" field. When one side of the rectangular field is held constant and the second side is reduced, both R(50) and R(max) move towards the phantom surface. Comparing the PDDs obtained with the 5 cm circular applicator and with a 4.4 × 4.4 cm(2) square field (that is the equivalent square of the 5 cm circular field) obtained with the beam shaper, a different behavior was observed in the region extending from the surface to a depth of 50% of the maximum dose. Isodoses measured for rectangular fields used for clinical cases (i.e., 4 × 9 cm(2) 8 MeV) are shown, with different air gaps. For each energy investigated, the normalized OFs slowly increase, when the length of the side decreases down to about 4 cm, and then rapidly decreases for smaller field widths. MC simulation showed an excellent agreement with experimental data (<2%).
  
  
  CONCLUSIONS
  The beam shaper device is able to provide square∕rectangular∕squircle fields with adequate dose homogeneity for mobile dedicated accelerators, thus allowing conformal treatment with IOERT. Monte Carlo simulation can be a very useful tool to simulate any clinical set up and can be used to create a data set to calculate MUs, thereby increasing the accuracy of the delivered dose during IOERT procedures.
authors.affiliation: Laboratory of Medical Physics and Expert Systems, National Cancer Institute Regina Elena, Rome, Italy. soriani@ifo.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Soriani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iaccarino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Felici
authors.forename: Alessia
authors.initials: A
authors.lastname: Ciccotelli
authors.forename: Paola
authors.initials: P
authors.lastname: Pinnaro
authors.forename: Carolina
authors.initials: C
authors.lastname: Giordano
authors.forename: Marcello
authors.initials: M
authors.lastname: Benassi
authors.forename: Marco
authors.initials: M
authors.lastname: D'Andrea
authors.forename: Luca
authors.initials: L
authors.lastname: Bellesi
authors.forename: Lidia
authors.initials: L
authors.lastname: Strigari
mesh_terms: D000054:Acceleration; D004583:Electrons / Q000627:therapeutic use*; D004867:Equipment Design; D007432:Intraoperative Period; D009010:Monte Carlo Method; D011874:Radiometry; D011878:Radiotherapy / Q000295:instrumentation*