{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:42:32Z","timestamp":1768214552306,"version":"3.49.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,30]],"date-time":"2023-04-30T00:00:00Z","timestamp":1682812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Stereotactic radiosurgery (SRS) relies on small fields to ablate lesions. Currently, linac based treatment is delivered via circular cones using a 6 MV beam. There is interest in both lower energy photon beams, which can offer steeper dose fall off as well as higher energy photon beams, which have higher dose rates, thus reducing radiation delivery times. Of interest in this study is the 2.5 MV beam developed for imaging applications and both the 6 and 10 MV flattening\u2010filter\u2010free (FFF) beams, which can achieve dose rates up to 2400 cGy\/min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aims to assess the benefit and feasibility among different energy beams ranging from 2.5 to 10 MV beams by evaluating the dosimetric effects of each beam and comparing the dose to organs\u2010at\u2010risk (OARs) for two separate patient plans. One based on a typical real patient tremor utilizing a 4\u00a0mm cone and the other a typical brain metastasis delivered with a 10\u00a0mm cone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Monte Carlo codes BEAMnrc\/DOSXYZnrc were used to generate beams of 2.5 MV, 6 MV\u2010FFF, 6 MV\u2010SRS, 6 MV, 10 MV\u2010FFF, and 10 MV from a Varian TrueBeam except 6 MV\u2010SRS, which is taken from a Varian TX model linear accelerator. Each beam's energy spectrum, mean energy, %dd curve, and dose profile were obtained by analyzing the simulated beams. Calculated patient dose distributions were compared among six different energy beam configurations based on a realistic treatment plan for thalamotomy and a conventional brain metastasis plan. Dose to OARs were evaluated using dose\u2013volume histograms for the same target dose coverage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean energies of photons within the primary beam projected area were insensitive to cone sizes and the values of percentage depth\u2013dose curves (%dd) at <jats:italic>d<\/jats:italic>\u00a0=\u00a05\u00a0cm and SSD\u00a0=\u00a095\u00a0cm for a 4\u00a0mm (10\u00a0mm) cone ranges from 62.6 (64.4) to 82.2 (85.7) for beam energy ranging from 2.5 to 10 MV beams, respectively. Doses to OARs were evaluated among these beams based on real treatment plans delivering 15\u00a0000 and 2200\u00a0cGy to the target with a 4 and 10\u00a0mm cone, respectively. The maximum doses to the brainstem, which is 10\u00a0mm away from the isocenter, was found to be 434 (300), 632 (352), 691 (362), 733 (375), 822 (403), and 975 (441)\u00a0cGy for 2.5 MV, 6 MV\u2010FFF, 6 MV\u2010SRS, 6 MV, 10 MV\u2010FFF, and 10 MV beams delivering 15\u00a0000 (2200) cGy target dose, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using the 6 MV\u2010SRS as reference, changes of the maximum dose (691 cGy) to the brain stem are \u221237%, \u22129%, +6%, +19%, and 41% for 2.5 MV, 6 MV\u2010FFF, 6 MV, 10 MV\u2010FFF, and 10 MV beams, respectively, based on the thalamotomy plan, where the \u201c\u2010\u201d or \u201c+\u201d signs indicate the percentage decrease or increase. Changes of the maximum dose (362 cGy) to brain stem, based on the brain metastasis plan are much less for respective beam energies. The sum of 21 arcs beam\u2010on time was 39 min on our 6 MV\u2010SRS beam with 1000 cGy\/min for thalamotomy. The beam\u2010on time can be reduced to 16 min with 10 MV\u2010FFF.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16435","type":"journal-article","created":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T02:50:25Z","timestamp":1682909425000},"page":"5201-5211","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The effects of different photon beam energies in stereotactic radiosurgery with cones"],"prefix":"10.1002","volume":"50","author":[{"given":"George X.","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth L.","family":"Homann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,30]]},"reference":[{"issue":"4","key":"e_1_2_8_2_1","first-page":"316","article-title":"The stereotaxic method and radiosurgery of the brain","volume":"102","author":"Leksell L","year":"1951","journal-title":"Acta Chir Scand"},{"issue":"2","key":"e_1_2_8_3_1","first-page":"1","article-title":"ICRU report 91. 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