Integrating a MRI scanner with a 6 MV radiotherapy accelerator: dose increase at tissue-air interfaces in a lateral magnetic field due to returning electrons.

In the framework of the development of the integration of a MRI-scanner with a linear accelerator, the influence of a lateral, magnetic field on the dose distribution has to be determined. Dose increase is expected at tissue-air boundaries, due to the electron return effect (ERE): electrons entering air will describe a circular path and return into the phantom causing extra dose deposition. Using IMRT with many beam directions, this exit dose will not constitute a problem. Dose levels behind air cavities will decrease because of the absence of electrons crossing the cavity. The ERE has been demonstrated both by simulation and experiment. Monte Carlo simulations are performed with GEANT4, irradiating a water-air-water phantom in a lateral magnetic field. Also an air tube in water has been simulated, resulting in slightly twisted regions of dose increase and decrease. Experimental demonstration is achieved by film measurement in a perspex-air-perspex phantom in an electromagnet. Although the ERE causes dose increase before air cavities, relatively flat dose profiles can be obtained for the investigated cases using opposite beam configurations. More research will be necessary whether this holds for more realistic geometries with the use of IMRT and whether the ERE can be turned to our advantage when treating small tumour sites at air cavities.