Monitoring of Radiation Exposure Adjacent to a Linear Accelerator Treatment Bunker with a Highlight Window Cameron Jeffries, Nigel Freeman, Fatema Nasreen and Con Stathopoulos cameron.jeffries@svha.org.au 41 st Australasian Radiation Protection Society Conference
St Vincent s Hospital, Sydney Australia s Second Oldest Hospital Opened in 1857 Moved in 1870 Major public hospital Principal referral hospital Mission to care for the sick, the poor and the homeless 13 September 2016 41st Australasian Radiation Protection Society Conference Page 2
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Linear Accelerator Treatment Bunker Siemens Primus Linear Accelerator Photon beams (6 MV and 10 MV) Electron Beams (6-21 MeV) Conformal 3D RT IMRT Intensity modulated Replaced with an Elekta Versa HD Linear Accelerator in 2013 VMAT Volumetric Mod. Arc Linear Accelerator Treatment Bunker design included a window provide natural light into the treatment bunker improve the patient s experience 13 September 2016 41st Australasian Radiation Protection Society Conference Page 4
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Historical Radiation Monitoring Presbytery building adjacent to the bunker window Original Shielding Design considered radiation levels in the building. Below regulatory criteria 1 msv/a Verification radiation survey by shielding consultant Long term monitoring Quartz Fibre Piano room 0.5 msv above background in 280 days Corrected estimate of 0.65 msv/a Positional monitoring shows consistent dose rate over time. Lead installed over the window 5 mm thickness 13 September 2016 41st Australasian Radiation Protection Society Conference Page 7
Replacement Linear Accelerator - 2013 Shielding assessment requested by St Vincent s Hospital Initial Radiation Survey undertaken for the old linear accelerator Dose rate measured at the window of rooms on each of the 4 levels of the adjacent building: Beam field size 1600 cm 2 and Beam Energy 10 MV, with and without phantom Gantry positioned at 225 o, 240 o and 275 o depending on floor 50 treatments per day, 5 days a week, 52 weeks per year 2.5 Gy and 0.5 min per treatment Significantly higher than historical monitoring Significant concern for our neighbours! SGS Australian Radiation Services Investigated 13 September 2016 41st Australasian Radiation Protection Society Conference Page 8
Review of Historical Operations Clinical Workload Daily patients treatments 60% or less Annual Beam Usage Greater than the assumed 108 hours 75% to 80% of usage at a lower beam energy Includes beam warm up time Year Treatments per day Annual Beam Usage 6MV (h) Annual Beam Usage 10 MV (h) 2005 21 95 19 2006 25 112 39 2007 27 124 43 2008 29 152 39 2009 30 122 37 2010 27 107 35 2011 21 98 24 2012 15 80 21 13 September 2016 41st Australasian Radiation Protection Society Conference Page 9
Review of Historical Operations Gantry Position Cardinal angles ~ 80% of beam usage 315 330 345 0 15 43% 30 45 In building dose rate unknown 300 60 Least fraction of use towards the adjacent building 285 270 10% 12% 75 90 13.6% - 225 º to 315 º 255 105 240 225 13% 135 120 210 195 180 165 150 13 September 2016 41st Australasian Radiation Protection Society Conference Page 10
Retrospective Dose Estimate Established a consistent method of comparison SGS Australian Radiation Services Dose rate measure for all combinations of the following linear accelerator settings: Beam Energy 6 MV and 10 MV Beam Field Size 1600 cm 2 and 400 cm 2 Gantry Position 0º, 90º, 180º, 270º Combined with historical data to estimate annual dose for the years 2005 to 2012 13 September 2016 41st Australasian Radiation Protection Society Conference Page 11
Optimisation of bunker shielding Opportunity to reduce exposure to the adjacent building Primary and Secondary shielding of correct thickness Exposure must be related to the window Not due to direct patient scatter, head leakage radiation Secondary scatter of head leakage and patient scatter radiation Conceptually similar to maze scatter calculation for a single reflection, NCRP151 13 September 2016 41st Australasian Radiation Protection Society Conference Page 12
Wall Scatter Area 13 September 2016 41st Australasian Radiation Protection Society Conference Page 13
New LINAC - Window Shielding Calculated shielding 0.3 m to 0.4 m - concrete Shielding installed at a thickness of 0.6 m Shielding thickness calculated using the following basic parameters Dose Criteria of 0.3 msv/a Clinical workload of 50 treatments/day and 4Gy/treatment Energy of secondary scattered radiation at the window shielding 0.5 MeV Scatter Factor for 45º incidence and 45º reflection Wall scatter area of 15 m 2 13 September 2016 41st Australasian Radiation Protection Society Conference Page 14
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Shielding Verification Measures dose rate 0.3 m inside the window of Room B, only Linear accelerator matched to SGS ARS survey Gantry position, Beam Energy and Beam Field Size Dose rates also measured at a field size of 100 cm 2 Gantry position, Beam energy Replicated the SGS ARS methodology 400 cm 2 and 1600 cm 2 - ONLY Estimated radiation dose of 0.36 msv/a at the window of Room B Estimate varied to also account for 100 cm 2 field size usage Estimated Radiation dose ranged from 0.30 to 0.34 msv/a No need to account for 100 cm 2 13 September 2016 41st Australasian Radiation Protection Society Conference Page 16
VMAT Arc simulation new LINAC Average Radiation Exposure of 4 arc beams in rooms A, B and C. 600 MU/min, 6 Gy to isocentre, 6 and 10 MV, with and without FFF Average of 4 Arc beams in Rooms A, B and C Annual dose estimated by scaling historical beam workload Room B: 0.29 msv/a, (A: 0.24 msv/a, C: 0.25 msv/a) Reminder: 0.36 msv/a for 100% 3DCRT Room B is the Critical Room Uncertainty on the future use of 3DCRT and VMAT 13 September 2016 41st Australasian Radiation Protection Society Conference Page 17
Long Term Area Monitoring Area Monitoring was initiated to verify actual radiation exposure TLD monitoring at 3 positions in room B and Reception (remote) 13 September 2016 41st Australasian Radiation Protection Society Conference Page 18
Monitoring of Actual Operation Area Monitoring - long term But Workload Unknown 50 to 70 treatments per day Short Term Survey Room B Victoreen 951P @ 30 cm Accumulation mode Scaling to annual dose estimate 3 hours monitoring, 2.5 hours background Workload comparison??? 13 September 2016 41st Australasian Radiation Protection Society Conference Page 19
Short Term Monitoring Envelope Background dose rate 0.05 μsv/h Exposure dose 0.2 μsv Monitored Workload 14 treatments Average of 0.014 μsv per treatment Scaling to 50 or 70 treatments per day indicates annual exposure of 170 to 260 μsv Large Uncertainty But in the ballpark 13 September 2016 41st Australasian Radiation Protection Society Conference Page 20
Area Monitoring Results Full year of results available 4 x quarterly Reception result Background TLD Located Closer to Source Monitoring Results Match Design Position Annual Exposure (mgy) Bkground Corrected (mgy) Window 0.60 0.37 Mid-room 0.54 0.31 Door 0.16 0.04 Reception 0.23 Area Monitoring to continue 13 September 2016 41st Australasian Radiation Protection Society Conference Page 21
Acknowledgements Nigel Freeman, Fatema Nasreen and Con Stathopoulos St Vincent s Hospital, Radiation Oncology 13 September 2016 41st Australasian Radiation Protection Society Conference Page 22
Thank You Cameron Jeffries Radiation and Laser Safety Officer cameron.jeffries@svha.org.au 13 September 2016 41st Australasian Radiation Protection Society Conference Page 23