Improvement of the penumbra for small radiosurgical fields using flattening filter free low megavoltage beams

Background: In stereotactic radiosurgery, sharp beam edges have clear advantages to spare normal tissues. In general, the dose gradient is a limiting factor in minimizing dose to nearby critical structures for clinical cases. Therefore the penumbral width should be diminished. Methods: A Varian Clinac 2100 linear accelerator equipped with in-house designed radiosurgical collimator was modeled using the EGSnrc/BEAMnrc Monte Carlo code and compared with the measurements. The 0.015 cm(3) PinPoint chamber was used to measure the 6 MV photon beam characteristics and to validate Monte Carlo calculations. Additional to the standard (STD) linac, a flattening filter free (FFF) linac was simulated. Percent depth doses, beam profiles and output factors were calculated for small field sizes with diameter of 5, 10, 20 and 30 mm with DOSXYZnrc. The mean energy and photon fluence at the water surface were calculated with BEAMDP for both FFF linac and STD linacs. Results: The penumbra width (80%-20%) was decreased by 0.5, 0.3, 0.2 and 0.2 mm for field sizes of 5, 10, 20 and 30 mm respectively when removing the FE The fluence of photons at the surface increased up to 3.6 times and the mean energy decreased by a factor of 0.69 when removing the FE The penumbra width (80%-20%) decreased by 17% when a 2 MeV monoenergetic electron pencil beam incident on the target is used instead of 6.2 MeV. Conclusions: It was found that the penumbra of small field sizes is decreased by removing the FF. Likewise using low megavoltage photons reduced the beam penumbra maintaining adequate penetration and skin sparing.