National Council on Radiation Protection Report #151 Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray

Radiotherapy Facilities GammaPeter J. Biggs Ph.D., Massachusetts General Hospital, M h tt G l H it l Harvard Medical School, Boston, MA 02114 , RSMI 2009, Lisbon - July 19, 2009

December D b 2005

RSMI 2009, Lisbon - July 19, 2009

Why Update NCRP 49?

- NRCP 49 (1976)was a medical physics protection guideline - ~30 yrs between publication of NCRP 49 and 151 - NCRP 51 added additional high energy data (1977) however this report was primarily for however, particle accelerators rather than medical linacs - NCRP 79 added neutron methodology and data dd d h d l dd (1984)
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Why Update NCRP 49? y p

- NCRP 51 was updated in 2003 (NCRP 144) this initiated a request to produce a medical accelerator only document. document - The AAPM formed TG 57 (J. Deye, chair; R. Wu, co( y chair) in around 1997 to address this problem and this was later subsumed into NCRP Scientific committee 46-13 - Primarily, it was realized that existing reports did not reflect common practice in the field nor provide adequate methodology and up-to-date data th d l d t d t d t

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Rationale for Update (NCRP # 151)

1. 2. 3. 4. 5. 5 6. 7. 7 Introduction of dual energy machines gy Upgrading facilities with laminated shielding New modalities and special procedures oda t es a d spec a p ocedu es Improved calculational methodology Additional and improved data Time-averaged dose rate considerations Special considerations

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1. Dual Energy Machines gy

- Dual energy machines have been around for a long time, but became mainstream only when adopted by linear accelerators. - As a conservative approach, only high energy was originally considered for shielding (3D CRT), but with popularity of IMRT at 6MV, that has changed (Wl>>Wp, W Ws).
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1. Dual Energy Machines

- How to split the workload between high and low energy and still be conservative - PJB rule of thumb: Assume 100% high energy for the primary and consider dual energies for out of out-of plane leakage. The scatter and leakage adjacent to the primary is a toss-up - Change in workload vs. time:
- Anecdote: For a 6/18 MV machine the energy use prior gy p to IMRT was 20%/80% (MU). With 28% IMRT patient load, the use was 70%/30%

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2. Why Laminated Shielding? y g

- A simple and, perhaps sole, solution to upgrading a vault holding a 60Co unit to a linear accelerator (note also, beamstopper vs. no beamstopper) - For low energies, since only photons are involved, calculation is straightforward. - For high energies, however, the issue of photoneutron production and subsequent capture gamma rays arises and this is a complex issue i d hi i l i

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3. New Modalities
Different modalities include: 1. Robotic arm machines (Cyberknife) - no fixed isocenter - all barriers except ceiling are primary barriers - uses only 6 MV Tomotherapy ( py (helical) ) - radiotherapy CT - also uses only 6 MV - uses extra shielding so the 0.1% rule does not apply g pp y - uses a beam stopper Tomotherapy (serial) - device attached to conventional linac (MIMIC) - uses table indexer to simulate helical Rx - not in much use now

2.

3.

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3. Special Procedures (1)

- W have come a long way from the 4 fi ld box treatment We h l f th field b t t t arrangement, using many different procedures, including: 1. 1 IMRT - usually only at 6 MV (Verhay et. al.) - Leakage workload >>primary, scatter workload primary, - Serial tomotherapy has highest relative leakage workload - F h li l tomotherapy, 100% of workload For helical t th f kl d - for conventional linacs, can be 70% or more of the workload - use factors may also be different

RSMI 2009, Lisbon - July 19, 2009

3. Special Procedures (2)

2. 2 Stereotactic radiosurgery/radiotherapy St t ti di / di th
- use factors are substantially different from 3D CRT - high dose for radiosurgery, but long set-up times

3.

TBI

- P, L workload is greater than Rx dose - source of scatter radiation is not at the isocenter

4.

IORT

- dedicated facilities (not now in vogue) require lead/BPE barriers for retrofitting ORs - mobile linacs do not require a shielded room, except, perhaps, for a mobile lead barrier. Neutrons have been source of discussion recently, bil l d b i N h b f di i l but appear not to be problematic

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4. Calculational Methodology
While much of the methodology for low energy photons has carried over, albeit with improved over data, there has been much research on high energy processes, including:
1. Laminated primary shielding (primarily empirical) 2. Refined calculations for neutron dose at the maze door (Wu-McGinley vs. Kersey) vs 3. Refined calculations for capture gamma rays at the end of a maze (McGinley) 4. 4 Direct shielded doors for high energy linacs

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5. Additional Data
- Updated occupancy factors (in conjunction with NCRP #147) - Pi Primary TVL continue TVL1 and TVLe practice from TVLs i d i f NCRP #51 but values are slightly different - Leakage TVLs (90) also now uses the same convention - Scatter fractions: 6 MV corrected and higher energies added - Scatter TVLs for energies other than 6 MV, plus lead. - Tabulated albedo factors for concrete as well as iron and lead

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6. Time Averaged Dose Rate vs. IDR

- In response to practices in a few states in the US, in 2000, the NCRP issued a statement regarding the application of instantaneous dose rates in assessing adequacy of radiation i t t d t i i d f di ti protection - The NCRP has never recommended dose limits for periods shorter than one month (only for the embryo-fetus in occupational situations NCRP Report No. 116) p p ) - The weekly exposure limit is conventionally taken to be 1/50 x the annual limit namely 0.02 mSv/wk limit, 0 02

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6. Time Averaged Dose Rate: NCRP

- Conversion of annual limits to instantaneous dose rates leads to linking protective measures to the time characteristics of the machine (lower the dose rate?) - Specifically the use of a measured instantaneous dose rate at maximum x ray output does not represent the radiation x-ray environment of the facility - This problem is exacerbated by the introduction of flattening filter-free linacs where the dose rate can x5 - Need to consider the workload and use factor together with g the IDR when evaluating a barrier

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7. Special considerations
- Skyshine: - this was included in NCRP #51, but no #51 experimental verification, for photons or neutrons, had been provided until now - side scattered photon radiation - Groundshine radiation G ou ds e d o - Activation - Ozone production

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Examples
NCRP #151 makes a point of using concrete examples to emphasize the calculational methodology This was used in NCRP #49, except that there were only three calculations P, L and S respectively I contrast, the examples in Chapter 7 cover 53 pages out In h l i Ch of a total of 157 pages (excluding appendices), roughly 1/3 - increased complexity of the calculations Detailed calculations are given for 6 barriers as well as the maze door with consideration given to TADR and modifications for IMRT. There is also a section on IMRT calculations for a robotic arm machine

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Summary
- NCRP #151 provides a significant improvement in the methodology and data needed by the shielding designer for a modern radiotherapy department - It covers all aspects of the calculational methodology and provides sufficient data for these calculations - However there are still some calculations that cannot However, easily be solved using a spreadsheet, that would benefit from further insight

RSMI 2009, Lisbon - July 19, 2009

Thank you for your attention!

Muito obrigado pela sua ateno!

RSMI 2009, Lisbon - July 19, 2009