This paper presents a detailed investigation into the calculation of perturbation and beam quality correction factors for ionization chambers in high-energy photon beams with the use of Monte Carlo simulations. For a model of the NE2571 Farmer-type chamber, all separate perturbation factors as found in the current dosimetry protocols were calculated in a fixed order and compared to the currently available data. Furthermore, the NE2571 Farmer-type and a model of the PTW31010 thimble chamber were used to calculate the beam quality correction factor kQ. The calculations of kQ showed good agreement with the published values in the current dosimetry protocols AAPM TG-51 and IAEA TRS-398 and a large set of published measurements. Still, some of the single calculated perturbation factors deviate from the commonly used ones; especially prepl deviates more than 0.5%. The influence of various sources of uncertainties in the simulations is investigated for the NE2571 model. The influence of constructive details of the chamber stem shows a negligible dependence on calculated values. A comparison between a full linear accelerator source and a simple collimated point source with linear accelerator photon spectra yields comparable results. As expected, the calculation of the overall beam quality correction factor is sensitive to the mean ionization energy of graphite used. The measurement setup (source-surface distance versus source-axis distance) had no influence on the calculated values.

Monte Carlo (MC) calculations are a fundamental tool for the investigation of ionization chambers (ICs) in radiation fields, and for calculations in the scope of IC reference dosimetry. Geant4, as used for the toolkit TOPAS, is a major general purpose code, generally suitable for investigating ICs in primary proton beams. To provide reliable results, the impact of parameter settings and the limitations of the underlying condensed history (CH) algorithm need to be known. A Fano cavity test was implemented in Geant4 (10.03.p1) for protons, based on the existing version for electrons distributed with the Geant4 release. This self-consistent test allows the calculation to be compared with the expected result for the typical IC-like geometry of an air-filled cavity surrounded by a higher density material. Various user-selectable parameters of the CH implementation in the EMStandardOpt4 physics-list were tested for incident proton energies between 30 and 250 MeV. Using TOPAS (3.1.p1) the influence of production cuts was investigated for bare air-cavities in water, irradiated by primary protons. Detailed IC geometries for an NACP-02 plane-parallel chamber and an NE2571 Farmer-chamber were created. The overall factor f as a ratio between the dose-to-water and dose to the sensitive air-volume was calculated for incident proton energies between 70 and 250 MeV. The Fano test demonstrated the EMStandardOpt4 physics-list with the WentzelIV multiple scattering model as appropriate for IC calculations. If protons start perpendicular to the air cavity, no further step-size limitations are required to pass the test within 0.1%. For an isotropic source, limitations of the maximum step length within the air cavity and its surrounding as well as a limitation of the maximum fractional energy loss per step were required to pass within 0.2%. A production cut of  ⩽5 μm or  ∼15 keV for all particles yielded a constant result for f of bare air-filled cavities. The overall factor f for the detailed NACP-02 and NE2571 chamber models calculated with TOPAS agreed with the values of Gomà et al (2016 Phys. Med. Biol. 61 2389) within statistical uncertainties (1σ) of<0.3% for almost all energies with a maximum deviation of 0.6% at 250 MeV for the NE2571. The selection of hadronic scattering models (QGSP_BIC versus QGSP_BERT) in TOPAS impacted the results at the highest energies by 0.3%  ±  0.1%. Based on the Fano cavity test, the Geant4/TOPAS Monte Carlo code, in its investigated version, can provide reliable results for IC calculations. Agreement with the detailed IC models and the published values of Gomà et al can be achieved when production cuts are reduced from the TOPAS default values. The calculations confirm the reported agreement of Gomà et al for [Formula: see text] with IAEA-TRS398 values within the given uncertainties. An additional uncertainty for the MC-calculated [Formula: see text] of  ∼0.3% by hadronic interaction models should be considered.

To assess if apertures shall be mounted upstream or downstream of a range shifting block if these field-shaping devices are combined with the pencil-beam scanning delivery technique (PBS). The lateral dose fall-off served as a benchmark parameter. Both options realizing PBS-with-apertures were compared to the uniform scanning mode. We also evaluated the difference regarding the out-of-field dose caused by interactions of protons in beam-shaping devices. The potential benefit of the downstream configuration over the upstream configuration was estimated analytically. Guided by this theoretical evaluation a mechanical adapter was developed which transforms the upstream configuration provided by the proton machine vendor to a downstream configuration. Transversal dose profiles were calculated with the Monte-Carlo based dose engine of the commercial treatment planning system RayStation 6. Two-dimensional dose planes were measured with an ionization chamber array and a scintillation detector at different depths and compared to the calculation. Additionally, a clinical example for the irradiation of the orbit was compared for both PBS options and a uniform scanning treatment plan. Assuming the same air gap the lateral dose fall-off at the field edge at a few centimeter depth is 20% smaller for the aperture-downstream configuration than for the upstream one. For both options of PBS-with-apertures the dose fall-off is larger than in uniform scanning delivery mode if the minimum accelerator energy is 100 MeV. The RayStation treatment planning system calculated the width of the lateral dose fall-off with an accuracy of typically 0.1 mm-0.3 mm. Although experiments and calculations indicate a ranking of the three delivery options regarding lateral dose fall-off, there seems to be a limited impact on a multi-field treatment plan.

Current dosimetry protocols (AAPM, IAEA, IPEM, DIN) recommend parallel-plate ionization chambers for dose measurements in clinical electron beams. This study presents detailed Monte Carlo simulations of beam quality correction factors for four different types of parallel-plate chambers: NACP-02, Markus, Advanced Markus and Roos. These chambers differ in constructive details which should have notable impact on the resulting perturbation corrections, hence on the beam quality corrections. The results reveal deviations to the recommended beam quality corrections given in the IAEA TRS-398 protocol in the range of 0%-2% depending on energy and chamber type. For well-guarded chambers, these deviations could be traced back to a non-unity and energy-dependent wall perturbation correction. In the case of the guardless Markus chamber, a nearly energy-independent beam quality correction is resulting as the effects of wall and cavity perturbation compensate each other. For this chamber, the deviations to the recommended values are the largest and may exceed 2%. From calculations of type-B uncertainties including effects due to uncertainties of the underlying cross-sectional data as well as uncertainties due to the chamber material composition and chamber geometry, the overall uncertainty of calculated beam quality correction factors was estimated to be <0.7%. Due to different chamber positioning recommendations given in the national and international dosimetry protocols, an additional uncertainty in the range of 0.2%-0.6% is present. According to the IAEA TRS-398 protocol, the uncertainty in clinical electron dosimetry using parallel-plate ion chambers is 1.7%. This study may help to reduce this uncertainty significantly.

BackgroundOver the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients.MethodsPooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival.ResultsThe number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97–0.97), sex (OR 1.18, 95% CI 1.11–1.25), date of diagnosis (OR 1.05, 95% CI 1.04–1.06), ‘diagnosis during screening’ (OR 3.24, 95% CI 2.50–4.19) and place of residence (OR 1.23, 95% CI 1.16–1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8–83.9%).ConclusionsNo distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2963-0) contains supplementary material, which is available to authorized users.

Current dosimetry protocols (AAPM, IAEA, DIN) recommend the use of parallel-plate ionization chambers for the measurement of absorbed dose-to-water in clinical electron beams. For well-guarded plane-parallel chambers, it is assumed that the perturbation correction pQ is unity for all electron energies. In this study, we present detailed Monte Carlo simulations with the EGSnrc code for the widely used Roos parallel-plate chamber which is, besides other plane-parallel chamber types, recommended in all protocols. We have calculated the perturbation corrections pcav and pwall for a wide range of electron energies and for 60Co. While our results confirm the recommended value of unity for the cavity perturbation pcav, the wall-correction factor pwall depends on electron energy and decreases with increasing electron energy. For the lowest electron energies in this study (R50 approximately 2 cm), pwall deviates from unity by up to 1.5%. Using the perturbation factors for the different electron energies and those for the reference beam quality, 60Co, we have calculated the beam quality correction factor kQ. For electron energies E0>9 MeV (R50>4 cm), the calculated values are in good agreement with the data published in the IAEA protocol. Deviations in the range of 0.5-0.8% are found for R50<3 cm.

Some clinical indications require small fields with sharp lateral dose gradients, which is technically challenging in proton beam therapy. This holds especially true for low-range fields applied with the spot scanning technique, where large beam profiles entering from the beam-line or the insertion of range shifting blocks lead to large lateral gradients. We regard the latter case and solve it by shifting the range shifting block far upstream in conjunction with a collimating aperture close to the patient. The experiments of the current work are based on a commercial proton therapy treatment head designed for several delivery modes. In a research environment of the spot-scanning delivery mode a range shifter is inserted downstream of the scanning magnets in a slot which is usually employed only in a scattering delivery mode. This configuration is motivated by equations assuming a simple model of proton transport. In the experiments lateral dose planes are acquired with a scintillation screen and radiochromic films. Dose distributions are calculated with the Monte Carlo dose engine of the RayStation treatment planning system. We demonstrate that proton fields with 80%–20% lateral dose fall-off values between 1.4 mm and 4.0 mm can be achieved for water equivalent depths between 0 cm and 10 cm. The simulated lateral dose profiles agree with the experimental dose profiles. The sharpening of the field edges is set off by a broadening of the proton spots towards the center of the fields. This limits the clinical application mainly to small fields for which the distal and proximal conformality is of minor importance.

Background and purpose: PENH is a recently coded module for simulation of proton transport in conjunction with the Monte Carlo code PENELOPE. PENELOPE applies class II simulation to all type of interactions, in particular, to elastic collisions. PENH uses calculated differential cross sections for proton elastic collisions that include electron screening effects as well as nuclear structure effects. Proton-induced nuclear reactions are simulated from information in the ENDF-6 database or from alternative nuclear databases in ENDF format. The purpose of this work is to benchmark this module by simulating absorbed dose distributions from a single finite spot size proton pencil beam in water. Materials and methods: Monte Carlo simulations with PENH are compared with simulation results from TOPAS Monte Carlo (v3.1p2) and RayStation Monte Carlo (v6). Different beam models are examined in terms of mean energy and energy spread to match the measured profiles. The phase-space file is derived from experimental measurements. Simulated absorbed dose distributions are compared to experimental data obtained with the ionization chamber array MatriXX 2D detector (IBA Dosimetry) in a water tank. The experiments were conducted with a clinical IBA pencil beam scanning dedicated nozzle. In all simulations a Fermi-Eyges phase-space representation of a single finite spot size proton pencil beam is used. Results: In general, there is a good agreement between simulated results and experimental data up to a distance of 3 cm from the central axis. In the core region (region where the dose is more than 10% of the maximum dose) PENH shows, overall, the smallest deviations from experimental data, with the largest radial rms (root mean square) smaller than 0.2. The results achieved by TOPAS and RayStation in that region are very close to those of PENH. For the halo region, that is the area of the dose distribution outside the core region reaching down to 0.01% of the maximum intensity, the largest rms achieved by TOPAS is always smaller than 0.5, yielding better results than the rest of the codes. Conclusion: The physics modeling of the PENELOPE/PENH code yields results consistent with measurements in the dose range relevant for proton therapy. The discrepancies between PENH appearing at distances larger than 3 cm from the central-beam axis are accountable to the lack of neutron simulation in this code. In contradistinction, TOPAS has a better agreement with experimental data at large distances from the central-beam axis because of the simulation of neutrons.