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Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group.

Publication ,  Journal Article
Xiao, Y; Kry, SF; Popple, R; Yorke, E; Papanikolaou, N; Stathakis, S; Xia, P; Huq, S; Bayouth, J; Galvin, J; Yin, F-F
Published in: J Appl Clin Med Phys
May 8, 2015

This report describes the current state of flattening filter-free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high-dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out-of-field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity-modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated.

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Published In

J Appl Clin Med Phys

DOI

EISSN

1526-9914

Publication Date

May 8, 2015

Volume

16

Issue

3

Start / End Page

5219

Location

United States

Related Subject Headings

  • United States
  • Technology Assessment, Biomedical
  • Radiotherapy, Conformal
  • Radiation Protection
  • Practice Guidelines as Topic
  • Particle Accelerators
  • Nuclear Medicine & Medical Imaging
  • Health Physics
  • Filtration
  • Equipment Failure Analysis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Xiao, Y., Kry, S. F., Popple, R., Yorke, E., Papanikolaou, N., Stathakis, S., … Yin, F.-F. (2015). Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group. J Appl Clin Med Phys, 16(3), 5219. https://doi.org/10.1120/jacmp.v16i3.5219
Xiao, Ying, Stephen F. Kry, Richard Popple, Ellen Yorke, Niko Papanikolaou, Sotirios Stathakis, Ping Xia, et al. “Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group.J Appl Clin Med Phys 16, no. 3 (May 8, 2015): 5219. https://doi.org/10.1120/jacmp.v16i3.5219.
Xiao Y, Kry SF, Popple R, Yorke E, Papanikolaou N, Stathakis S, et al. Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group. J Appl Clin Med Phys. 2015 May 8;16(3):5219.
Xiao, Ying, et al. “Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group.J Appl Clin Med Phys, vol. 16, no. 3, May 2015, p. 5219. Pubmed, doi:10.1120/jacmp.v16i3.5219.
Xiao Y, Kry SF, Popple R, Yorke E, Papanikolaou N, Stathakis S, Xia P, Huq S, Bayouth J, Galvin J, Yin F-F. Flattening filter-free accelerators: a report from the AAPM Therapy Emerging Technology Assessment Work Group. J Appl Clin Med Phys. 2015 May 8;16(3):5219.

Published In

J Appl Clin Med Phys

DOI

EISSN

1526-9914

Publication Date

May 8, 2015

Volume

16

Issue

3

Start / End Page

5219

Location

United States

Related Subject Headings

  • United States
  • Technology Assessment, Biomedical
  • Radiotherapy, Conformal
  • Radiation Protection
  • Practice Guidelines as Topic
  • Particle Accelerators
  • Nuclear Medicine & Medical Imaging
  • Health Physics
  • Filtration
  • Equipment Failure Analysis