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Phys. Med. Bi d , 1991, Vol. 36, No 7, 861-920.

Printed in the UK
Review
Monte Carlo techniques in medical radiation physics
Pedro Andreo
Department of Radiation Physics, Ka~olimlta Institute and University of Stockholm.
Box 60211,104 01 Stockholm, Sweden
Received 31 Auys t 1990, in final form 27 February 1991
Contents
1. Introduction
1.1. Scope of this review
2. The basics of the Monte Carlo practice
2.1. Random numbers and other computational details
2.2. Photon transport
2.3. Electron transport
2.3.1. Condensed history (macroscopic) techniques
2.3.2. Detailed history (microscopic) techniques
2.3.3. Variance reduction in electron transport
3. Macroscopic Monte Carlo codes in the public domain
4. Applications in medical radiation physics
4.1. Nuclear medicine
4.1.1. Detectors
4.1.2. Imaging correction techniques
4.1.3. Absorbed dose calculations
4.2.1. Detection systems
4.2.2. Determination of physical quantities in diagnostic radiology
4.2.3. Radiation protection aspects
4.3.1. Teletherapy sources and dosimetry equipment
4.3.2. In-phantom simulations
4.3.3. Treatment planning applications
4.3.4. Calculations in brachytherapy
4.4. Radiation protection
4.5. Applications based on microscopic Monte Carlo techniques
4.5.1. Electron microscopy
4.5.2.
4.2. Diagnostic radiology
4.3. Radiotherapy physics
Radiation track structure and microdosimetry
5. Inverse Monte Carlo techniques
6. Vectorized and parallel Monte Carlo simulation
7. Conclusions
Acknowledgments
References
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1. Introduction
Since the review article by Raeside (1976), where the principles of the Monte Carlo
method and its first applications in medical physics were described, the number of
publications in this field using the simulation of the transport of radiation continues
to increase. Following Nahum (1988a), today practically one scientific article per issue
is being published in Physics in Medicine and Biology for instance, and a similar rate
can be observed in parallel journals. Several hooks with comprehensive reviews, tech-
nical descriptions or proceedings from Monte Carlo courses, have also been published
recently (Morin 1988, J enkins el a/ 1988, Kase et a/ 1990).
At the time of the 1976 review article by Raeside most of the Monte Carlo work had
been developed at large research centers using mainframe computer systems. This was
the case with most of todays well known Monte Carlo codes such as ETRAN (Berger
and Seltzer 1968), EGS (Ford and Nelson 1978), MCNP (Thompson 1979, based on
previous codes by Cashwell el a/ 1972, 1973), or MORSE (Straker el a/ 1976), some
of which will be discussed in this article. The basic references in the field of photon
and electron transport simulation were already available at that time (Cashwell and
Everett 1959, Berger 1963, etc).
A number of Monte Carlo codes were written during the 1970s for application to
medical physics, mainly radiotherapy physics. The codes developed by Patau (1972),
Nahum (1976) and Abou Mandour (1978) belong to this group, all of them devel-
oped on mainframe computer systems and with a strong emphasis on the simulation
of electron transport. This aspect explains the weight given to data calculated with
ETRAN for comparisons, as the other codes mentioned were generally related to either
reactor neutron/photon physics (MCNP, MORSE) or high-energy physics (EGS). The
availability of minicomputers (mainly DEC/PDP-II) in many medical institutions made
possible the development of smaller Monte Carlo codes capable of simulating either
specific problems in radiotherapy physics with photon beams (Webb and Parker 1978,
Webb 1979), the transport of photons in Compton-scatter tissue densitometry (Bat-
tista and Bronskill 1978) or the full electromagnetic cascade used to derive quantities
for electron dosimetry in water (Andreo 1980, 1981).
The power of many of the mainframe computer systems initially used for Monte
Carlo simulations is available today in many departments of hospital physics around
the world, sometimes even on the desk of a hospital physicist. At the same time,
some of the general purpose computer codes have become widely distributed through
institutions like the Radiation Shielding Information Center (RSIC) at Oak Ridge
National Laboratory in USA or the Nuclear Energy Agency Data Bank (NEA) at
Gif-sur-Yvette (France) in Europe. The result is a broader group of scientists with
knowledge of Monte Carlo techniques; as a consequence, the range of applications for
the Monte Carlo method continues to increase.
1.1. Scope o f l h i s reuiew
The main purpose of this work is to review the techniques and applications of the
Monte Carlo method in medical radiation physics since Raesides review article in
1976. Emphasis will be given to applications where photon and/or electron transport
in matter is simulated. Although the method has also been applied to neutrons and
heavy charged particles in radiotherapy physics (cf Biiche and Przybilla 1981, Sisterson
et a/ 1989, Smith et a/ 1989), or in the simulation of their track structures (cf Paretzke
1987) the considerably smaller number of applications with these particles, and the
Monte Carlo techniques in medical radiaiion physics 863
limited space for this review, excludes them from a detailed survey. The use of Monte
Carlo techniques in non-radiation medical physics also falls outside the scope of this
review.
Some practical aspects of Monte Carlo practice, mainly related to random num-
hers and other computational details, will be discussed in connection with common
computing facilities available in hospital environments. Basic aspects of electron and
photon transport will he reviewed, followed by the presentation of the Monte Carlo
codes widely available in the public domain. Applications in different areas of medical
radiation physics, such as nuclear medicine, diagnostic x-rays, radiotherapy physics
(including dosimetry), and radiation protection, and also microdosimetry and electron
microscopy, will he presented. Actual and future trends in the field, like Inverse Monte
Carlo methods, vectorization of codes and parallel processors calculations will also be
discussed.
2. The basi cs of the Monte Carl o practi ce
The general principles of the Monte Carlo method have been discussed by Raeside
(1976) and more recently by Turner et a1 (1985). They have also been introduced in
a number of other publications (cf Cashwell and Everett 1959, Shreider 1966, Carter
and Cashwell 1975, J ames 1980, Lund 1981) and their repetition will be avoided here
as much as possible. In what follows some emphasis is given to basic and practical
ideas of interest in medical physics.
2.1. Random numbers and oi her computational details
Random numbers will be treated first as they play a fundamental role in Monte Carlo
calculations. Philosophical arguments on sets of truly-random, pseudo-random
and quasi-random numbers will not he considered here. The basic ideas on random
number generators (RNGS) have been discussed i n the initial references cited here;
updated (and more complete) reviews have been given by J ames (1980, 1990) and
Ehrman (1981). The classic by Knuth (1969) is still mandatory in the field of RNGs
and Sowey (1972) has given about 300 references on random number generation and
testing covering the period 1927 to 1971.
Although some new trends in RNGs have been described recently, including in-
telligent random number techniques (learning and biasing) such as those used in the
MCNP code (Booth 1988), Lehmers method is still the most commonly used for RNGs.
I t is called the multiplicative-linear-congruential method. Given a modulus M , a mul-
tiplier A, and a starting value to (seed), random numbers ti are generated according
to
ti = (AEi-1 + E ) modulo M
(1)
where B is a constant. I n multiplicative-linear-congruential generators M is usually
chosen to be 2, b being the number of bits in the integer representation of data in
the computer. Constants A and B are chosen to give a well behaved RNG, which is
a difficult task. Congruential RNGs generally have a maximum repetition period of
length 2-2M when M is a power of 2, or M - 1 if A4 is prime (Ehrman 1981), which
is long enough for most Monte Carlo simulations.
864 P Andreo
The length of the period of a RNG must he long enough to avoid repetitions in
the sequence of numbers used during the simulation process, as otherwise correla-
tions can he produced. There are simulations, however, where the set of independent
numbers needed might exceed the repetition period of the RNG being used. When
the generator is well behaved, even if the sequence of numbers is used more than
once, the probability of having more than one particle history starting in the same
position of the sequence of random numbers is practically negligible. This means that
when the end of the sequence is reached it will be started again during some of the
sampling procedures used along the simulation. The final effect will he equivalent to
initiating the sequence of random numbers using different seeds, but it should be
investigated for each computer/RNG/application configuration. The risk of repetition
can he decreased using RNGs with very long periods, such as the McGill University
package Super-Duper in IBM assembler (cf J ames 1980, 1990) or RNG64 due to Biela-
jew (1986), both of which produce periods as long as one might expect from a 64-bit
machine. The use of such RNGs however needs longer calculation times than the gen-
erators previously reported and their choice must he based on a careful evaluation.
This authors experiences of the simulation of ionization chambers within a phantom,
where hundreds of millions of histories of CO photons were simulated using the EGS
code, did not show any change in the results or in the extremely slow convergence of
the low uncertainty being sought when RNG64 or the standard generator in EGS (see
later) was used.
The RNG of congruential type which has probably received more attention in the
Monte Carlo literature is the infamous RANDU, distributed by IBM (1968) in comput-
ers of their 360 and 370 series, where A = 65539, B = 0 and M = Z31 (32-bit integer,
bit zero reserved for the sign, and a period of Z31 - 1). The same RNG has also been
implemented by DEC in minicomputer-based operative systems with 16-hit integer
arithmetic (RT-11, RSX-IIM, etc), where i t is possible to call for modulus 232 using two
registers which allow the use of the modulus to any power by shifting. (For compati-
bility between VAX-11 and PDP- I1 FORTRAN, VAX/VMS offers the option of using this
generator also (DEC 1984).) The predicted period for DECs RANDU is 230 (in 32-hit
DEC machines hit 15 is sign hit) and it produces identical output random numbers to
IBMs generator. The large availability of DEC PDP-11 machines in hospital physics
environments during the last 15 years has led to a widespread use of this generator
(cf Battista and Bronskill 1978, Bond el a/ 1978, Audreo 1980, etc).
A long period is not the only desirable property in a RNG and different tests
must be applied to verify the true randomness of the sequence. Knuth (1969) is still
the standard source of information on random tests, which Morin el a/ (1988) have
performed on 16-bit minicomputers for RNGs used in different applications of interest
in medical physics. Even if the generator RANDU passed the majority of tests, the
so called Marsaglia effect or how random numbers fall mainly in planes (Marsaglia
1968), has shown that this generator produces correlated triplets of random numbers
(cf Coldwell 1974). The use of techniques where vi-tuple random numbers are used for
decision-making or branching is common in transport simulation, which should warn
us against the use of such RNGs. An improvement of the properties of RANDU has
been obtained by changing the multiplier A from 65539 to 69069 (Marsaglia 1972),
which is the standard RNG used in VAX FORTRAN ( MTHWANDOM) with M = Z32, and
in the SLAC RNI generator. Another RNG commonly used today in medical physics
calculations is the SLAC RN6 generator which has A = 663608 941 and B = 0 and is
included in the EGS code. Both generators have similar properties regarding period
Monte Carlo techniques in medical radiation physics 865
length and number of planes in 3-space, RN6 being faster, especially with the in-
line coding included in EGS which avoids subroutine calls (cf Ehrman 1981). Theory
predicts a period of about lo9 for these two generators, but a repetition of 2, 3 and 4
consecutive numbers can be found in certain implementations after generating 3. 5 x IO7
random numbers approximately. In VAX FORTRAN the RNG generates numbers in
the interval 0 5 << 1 (DEC 1984), which can yield obvious run-time errors when
expressions like In(e), which are frequent in particle transport, are used. One can
alternatively use In(1 - C) which is as random as f . SLAC RN6 on the other hand
generates numbers in the interval 0 5 <5 I , and therefore a detailed condition to
avoid the generation of zeros should be included.
A very interesting review of RNGs has been published recently by J ames (1990),
where it is recommended that old-firshioned generators (like the multiplicative-linear-
congruential previously described) should be archived and made available only upon
special request for historical purposes or in situations where the user really wants a
bad generator and Fibonacci and shift register (also known as Tansworthe) generators
should be used instead. Furthermore they should be implemented in the form of
subroutines returning an array of random numbers rather than a function returning
one number each time. Fibonacci RNGs are based on the series with the same name
(where each element is the sum of the two preceding elements) but use some arithmetic
or logical operation between two numbers which have occurred somewhere earlier in
the sequence, not necessarily the last two:
I
where @ is a binary or logical operation and p and q are the lags (henceforth the name
of l agged Fibonacci sequences) defined such that p > q. Shift register RNGs are also
based on this formula but with M = 2; therefore only single bits are generated, which
are collected into words using a shift register. J ames (1990) has given the FORTRAN
code of the generators RANMAR and ACARRY of the lagged Fibonacci type, with
periods of Z 1 4 4 ( ~ 2 x respectively (!), whi ch are completely
portable, that is they give bit-identical results on all machines, with at least 24-bit
mantissas in the floating-point representation. An in-line version of RANMAR l i as
just become available for the EGS Monte Carlo system (Bielajew 1990a).
A problem that has not received enough attention in certain Monte Carlo calcu-
lations is that of truncation errors (different from round-off errors, characteristic of
computer hardware). I t is well known that the use of single or double precision can
yield different results for certain Monte Carlo computations. This is the reason why
some Monte Carlo codes which are available for different word-length computers are
coded in double precision when they are used on 32-bit machines (for instance ITS,
cf Halbleib and Mehlhorn 1984). This might be of importance, for instance, during
the simulation of electron transport where extremely short pathlenghts are sometimes
selected, especially in the proximity of boundaries. In those cases the use of double
precision for certain variables should not be excluded without careful verification; the
price of an increase in computation time may be well worth paying.
The treatment of uncertainties in Monte Carlo calculations deserve some addi-
tional comments. The classification of uncertainties recommended by CIPM (1981)
for experimental methods may also be adopted i i i Monte Carlo procedures (Andreo
and Fransson 1989, Andreo 199Oa). In such recommendations, t,he classification of
uncertainties commonly used, namely random and systematic uncertainties, have
and Z570(xz
866 P Andreo
been replaced by uncertainties of category A (objective, evaluated using statistical
methods) and category B (subjective, estimated by any other method). Uncertain-
ties in both categories are specified by standard deviations (or variances) which can
he combined using the general propagation law for uncertainties. However, whereas
the evaluation of variances i n category A is achieved using statistical procedures,
both in experiments and in Monte Carlo calculations, uncertainties in category B
(non-statistical methods) are more difficult to evaluate in Monte Carlo calculations
as multiple steps are involved (programming; tabulation of data, in many cases with
unknown uncertainties; etc). A conservative estimate is to make both categories of
uncertainties (A and B) equal and combine them in quadrature; a multiplicative factor
can then be used to obtain an overall uncertainty (CIPM 1981).
To evaluate uncertainties of category A (i.e. with statistical methods), some Monte
Carlo codes divide the total number of histories to be simulated into a number of
batches, and statistical uncertainties are evaluated using the mean values of the vari-
ables (tallies) scored i n each batch. Typically, 10 batches are used in Monte Carlo
calculations as with EGS user-codes (Rogers 1982) or ITS (Halbleib and Mehlhorn
1984), although they treat the re-start of a calculation differently. Bond et al (1978)
have referred to 15-100 hatches for each simulation. A different procedure consists
of scoring both the quantity of interest (cumulative tally) and its squared value (cu-
mulative squares of the tally) whenever a particle is transported a given pathlength
(cf Shteider 1966). Uncertainties can then be evaluated during the simulation of each
history (inside the main loop of the simulation), and the process is equivalent to a.-
suming that every history is a batch on its own. This is the method used, for instance,
in the codes MCNP (Soran 1980) or MCEF (Andreo 1980,1981). As can be observed i n
figure 1 for Gaussian distributed numbers, only when a very large number of batches
is considered in the first technique, will the statistical evaluation approach the correct
estimation given by the second method.
2.2. Phot on fransporl
Most codes dealing mainly with photon transport assume that electrons generated
through different interactions are absorbed on the spot and the simulation process
becomes therefore relatively simple. All the physical interactions of photons (or neu-
trons) are completely simulated following the general techniques described by Raeside
(1976) or Turner et al (1985), for example, without much comput,ational effort. From
the exponential attenuation distribution, the appropriate cumulative distribution can
be evaluated and the distance s between interactions in a medium ( s t ep l engt h) is
determined by
s = -Xl n(l - () (3)
A being the mean free path at the photon energy at the beginning of the step and f a
random number, 0 5 E < 1. The type of interaction event ocurring after the step s is
sampled from the appropriate relative probabilities pi (ratios of single cross sections
to the total cross section), using their cumulative distribution function Pi. Another
random number selects the interaction event i(() such that
j - 1 j
CPi = Pj -1 5 E < c p i = Pj (4)
1 s o
a
,. ~
E=
0
r? 0 1.00
c U
.
-
f
0
0
In
0.50
I , , , . " " , , , ' . , , . , I , , I . . -
0
0
0.
9
-
'* '. m 0 . 0 : 0.i . ~~eooooeoeeoeoooeloooeo~
0
: i
0
868 P Andrea
(1983, 1986) whereas a weighted sampling from the Thompson distribution has been
used by Chen et a/ (1980). The significance of electron binding corrections in the
scattering of low-energy photons has been investigated by Beernink et a/ (1983) and
Williamson et nl (1984); they have concluded that neglecting these effects results in
a significant underestimation of scattering angles which are of importance in Monte
Carlo calculations.
The small number of interactions that take place when photons traverse matter has
motivated the development of variance reduction techniques to decrease uncertain-
ties that can be evaluated by statistical methods (i.e. category A). In such techniques
the natural physics (and scoring procedures of tallies) is manipulated in a number
of different ways so as to increase the relative occurrence of certain events. Forced
interactions, importance sampling, Russian roulette, particle spliting, etc are com-
monly used techniques well described in many of the classic references on the field (cf
Cashwell and Everett 1959, Carter and Cashwell 1975, etc) which were also briefly
discussed by Raeside (1976). A collision density estimator to increase the efficiency of
small-angle scatter calculations i n x-ray diagnostic has been developed by Persliden
and Alm-Carlsson (1986); and Gardner e l nl (1987) have derived algorithms to force
scattered radiation into detectors of different shape. An up-to-date review describing
the techniques in more common use today has been given by Bielajew and Rogers
I t is interesting to note that some applications have been developed, mainly in
the area of radiotherapy physics, which can be considered as an important variance
reduction technique. I n general they combine Monte Carlo and analytical techniques,
yielding results that would otherwise require extremely long CPU-times for a direct
simulation. A simple application, where Monte Carlo calculated depth-doses for mo-
noenergetic photons have been used to produce data for bremsstrahlung spectra, has
been reported by Andreo and Nahum (1985) as equivalent to the direct Monte Carlo
simulation of millions of photons. A more elaborated approach consists in the convo-
lution of spatial absorbed dose distributions from monoenergetic photons to determine
dose distributions for radiotherapy treatment planning (see section 4.3.3), which yields
results corresponding to the direct simulation of billions of photon histories (cf Ah-
nesjo et a/ 1987). The potential of this method has not been yet applied to some
of the problems which demand intensive variance reduction techniques, such as the
simulation of ionization chambers for radiotherapy dosimetry which are described in
section 4.3.1.
(1988).
2.9. Electron transport
For the simulation of the complete electromagnetic cascade the inclusion of electron
transport adds a new dimension to the problem. In principle, the direct simulation of
all the physical interactions (sometimes referred to as microscopic simulation) could
be used for electrons, as i t has been described for photons or neutrons. The only diffi-
culty in doing so is to keep track of all generations of electrons and photons produced
during successive interactions. Thei r transport has to be considered in a systematic
way until all the particles have been simulated. However, the very large number of
interactions that take place during electron slowing down (of the order of IO4 collisions
in aluminium, from 0.5 MeV to 1 keV, cf Berger and Wang 1988), makes i t unrealistic
to simulate all the physical interactions in the majority of applications. This aspect
has motivated the development of the so called condensed history or macroscopic
Monte Carlo techniques in medical radiation physics 869
techniques (Sidei el a/ 1957, Schneider and Cormack 1959), where interactions are
grouped in different ways.
2.3.1. Condensed history (macroscopic) techniques. The principles of the condensed
history technique will he described following the classical review on Monte Carlo
charged particle transport by Berger (1963). Physical interactions of electrons are
classified into groups which provide a detailed macroscopic picture of the physical
process:
SO,Sl , s2,. . . , sn,. . .
EO, El , Ez, , , . , En, ,
UO,Ul ,UZ.. . . , U, , . .
TO, PI , PZ, ..., r. ,...
where s, is the distance travelled, E, the energy, U, the direction and rn the position
of the electron. The transition from step n to n + 1 accounts for many interactions
where multiple collision models, like multiple scattering or stopping-power theory, are
considered. The step size (distance travelled or energy loss between two steps) has to
be chosen in such a way that the total number of steps is kept as small as possible,
as computation time will be proportional to the number of steps. On the other hand,
the step size has to be such that multiple collision models for angular deflections and
energy losses are valid, that is short pathlengths and many single interactions per step.
According to Berger (1963) the condensed history technique can be classified in
two procedures:
(1) Class I , which groups all the interactions and uses a predetermined set of
pathlengths, the random sampling of interactions being performed at the end of the
step. The simplest choice is a constant pathlength. The disadvantage is that the
angular deflection increases from step to step as the electron energy decreases, which
demands further re-sizing in order to be able to use a multiple scattering theory.
Logarithmic spacing is a better selection as angular deflections change little from step
to step. This is chosen so that, on average, the energy is reduced by a constant factor
k per step, that is the fraction of energy lost per step is constant.
(2) Class 11, or mixed procedures, which groups only minor collisions where en-
ergy losses or deflections are small, but considers the individual sampling of ninjor
events or catastrophic collisions, where a large energy loss or deviation occurs (fig-
ure 2). Further details of the technique can be found in Berger (1963) and Andreo
(1985). An extension of Class I1 procedures has been introduced by Andreo and
Brahme (1984) to account for energy losses and deflections below the threshold of
catastrophic collisions, using restricted energy-loss straggling and restricted multiple
scattering during the classification between major and minor events.
In particular,
the initial state of knock-on electrons and bremsstrahlung photons is unambiguosly
defined, angular deviations can be treated more accurately and the correlation between
energy loss and angular deflection is always conserved. On the other hand, Class I
schemes can include complete energy-loss straggling which is inherently independent
of the electron transport cut-off ( Tc) and threshold energies of knock-on electrons
(78). The dependence on Ta is an i mportant limitation of Class I1 schemes, as the
sampling of electron energy-loss straggling is limited to the interval [Ta, 0.5To] ( [ E, TO]
Class I I schemes have some advantages over Class I procedures.
870 P Andreo
E.
e 4
dieMceMueUsQ
Figure 2. Energy-distance diagram of the Class I1 procedure used to describe the electron (and
photon) tracks ahown in the upper part of the figure. Electron 'ca1astrophic'collirionJ occur at posi-
tions 1 (bremsstrahlung interaction), 2 and 3 (knodi-on inelastic collisions), and 5 (elastic collision,
no energy loss). The photon is scattered by a Compton interaction at position 4. All secondary
electrons (bottom of lower figure) are followed down to the transport cut-off of the simulation, E,.,,
where they are absorbed ( S t ar s ) . The broken descendent line from Eo corresponds to a calculation
of the electron energy loss based on the continuous-slowing-d~~,, approximation ( CSDA) .
for positrons) which might become critical during the treatment of low-energy electrons
(below 100 keV). To overcome this limitation, restricted-Class I I procedures (Andreo
and Brahme 1984) perform an additional sampling below Ts which makes energy
straggling independent of the threshold energy of knock-on electron production. The
technique need to be developed further to include, for example, binding effects in
inelastic collisions.
The consideration of 'catastrophic' collisions in a Class I1 scheme is analogous
to the transport of photons, where all the interactions are considered individually.
For electrons a 'catastrophic' mean free path may he defined, Acat , obtained from
the addition of single events, such as inelastic, A,,,,, elastic, A.,, and bremsstralung
interactions, Abrem. The distance (step length) between major events is again given by
equation (3), i.e. s = -ACatIn(l -<) (cf Andreo 1985). In fact by changing the thresh-
olds of catastrophic events it would be possible to perform a continuous transition
from full grouping (macroscopic) to singleinteraction (microscopic) simulation.
2.9.2. Detailed history ('microscopic 7 techniques. Most existing charged particle
Monte Carlo codes are based on the multiple collision models for scattering and energy
Monte Carlo techniques i n medical radiation physics 871
loss previously mentioned. The majority of applications used in radiotherapy physics
(the main area of medical physics where high-energy electron transport has become of
importance) are based on these procedures. There are, however, important limitations
with such models, for instance when geometrical regions (or distance to boundaries)
are very small, when dealing with very low-energy transfers (smaller than or close to
binding energies) or when the transport of low-energy electrons, below, say, 100 keV
has to be simulated. In these situations either the number of collisions is not enough
to consider a process as multiple, or the physics behind the theory itself is violated.
In many of these cases the condensed histories approach has to be abandoned and the
simulation of the transport has to be performed using single-interaction models. This
is the case with the majority of the Monte Carlo applications simulating track-length
structures, microdosimetry or electron microscopy.
As already mentioned, the microscopic Monte Carlo technique i n electron trans-
port is identical to the approach used in photon (or neutron) simulation. In this sense,
the techniqne itself is simpler than the macroscopic model as it does not depend on ad-
ditional parameters governing the grouping and distance between collisions. However,
depending on the electron energy, the physics involved might become considerably
more complicated. There are still a number of poorly known cross sections at very
low energy and, in certain instances, the simulation in condensed media must rely on
experimental data extrapolated from gas-phase data, sometimes using Fano plots (UT
against In") to minimize energy dependence.
The complexity of the techniques used in microscopic modelling varies consider-
ably, although a common approach is to neglect bremsstrahlung interactions. Simple
models used in early applications, in electron microscopy for example, have been
based on the simulation of all the elastic scattering events, calculating the step length
between consecutive collisions with the elastic-mean free path. Energy losses were
determined from the Bethe theory of stopping power and, in some cases, an approx-
imation to account for energy-loss straggling has been included. An improvement to
this model has been to take inelastic collisions into account, the mean free path being
based on U,, + aine,, which is the basic techniqne commonly used today. From this
point on, the main difference between existing microscopic Monte Carlo applications
lies mainly in the different theories, models or experimental data used to account for
energy-loss single-processes contributing to (such as electronic ionization and ex-
citation), and refinements to treat atomicshell structure (according to Paretzke (1987)
molecular changes become important at residual energies below, say, 10 eV). Other
differences like the accuracy of elastic cross sections (from screened Rutherford cross
sections to Mott partial wave expansions), or the generation and transport of sec-
ondary and higher-order generation electrons can also be mentioned. Detailed reviews
on the different approaches used in electron microscopy and radiation track structure
(and microdosimetry) have been given by Kyser (1981) and Paretzke (1987) respec-
tively. An up-to-date review of cross sections at low-energies for different materials
(mainly gases and liquid water) has been performed by Grosswendt (1988a).
2.9.9. Variance reduclion in eleclron transport. Variance reduction techniques devel-
oped for application to photon transport are, i n principle, also applicable to electrons,
but in general the simulations do not involve events which are particularly rare. Apart
from correlated sampling techniques, where different particles are simulated using the
same sequence of random numbers, the techniques in common use are mostly based
on a careful study of the physics of the problem. 'Running-parameters' used in the
P Andreo
Mont e Carlo techniques i n medical radiation physi cs
873
874 P Andreo
simulation, such as transport cut-off and threshold energies for secondary electron and
photon production become extremely important. In Class I1 schemes for instance, the
threshold for the production of knock-on electrons Ts can be set equal to the energy
cut-off T, for the transport (provided that energy-loss straggling is properly taken into
account), as i t is time consuming to create a particle which will not be simulated.
Other techniques are directly related to the geometry of the problem. In general
T, should be chosen such that an electron which has been slowed down to such cut-off
has a small probability of crossing to a different region. More details are involved in
the so called range rejection or electron trapping techniques, where the history of an
electron without the energy to escape from a certain region, or alternatively to reach
another region, will be disregarded; this requires the determination of the electron
range and comparison with the distance to the closest boundary (figure 3(a)). Less
time consuming is the inclusion of regions where the transport cut-off T,, is larger
than i n the volume of interest, which can be considered as the simplest technique.
A virtual envelope surrounding such a volume of interest can be considered, whose
dimensions are chosen such that an electron outside the envelope cannot reach the
volume of interest, and the additional transport cut-off T,, is chosen on this basis
(figure 3 ( b ) ) .
Figure 3. Variance reduction techniques in electron transport. (a) Range vejection or elrctron
trapping technique: an electron et (z,y,z)o is requested to travel down to (z,y,z,)~. Even if the
energy To is larger than the electron transport cut-off, T, , in most c a e s the history can be disregarded
as the CSDA range 70 is shorter than the distance to the closest boundary d. An energy trapping
Tt..p can he selected to check the condition TO <d only when To <Tt,,,. (b) Virtual envel ope
technique: a region E is defined having a thickness t and the same electron trqnsport cut-otl Tc as
the vol ume of interest V. Electrons produced outside the region E U V will be able to reach V only if
their CSDA range is longer than t . A cut-otl T,, (larger than T, ) can be set outside E U V such that
the CSDA range associated with the electron energy T,, js smaller than t. Radiation yield sliould be
investigated prior to the selection ofTtrap or Tc, .
Similar region-by-region analysis can be performed to relax the requirements
on the fraction of energy loss, maximum allowable travelling distance or any other
run-time parameter used in general to achieve a more detailed traneport through the
volumes of interest. I n all cases i t is important to realize that ignoring an electron
history involves excluding the probability of bremsstrahlung emission, which could
otherwise result in energy deposition in different regions. Therefore the radiation yield
Monte Carlo techniques i n medical radiation physics 875
at the different cut-off energies in the simulated medium should always be investigated
and kept reasonably low.
3. Macroscopi c Monte Carlo codes in the publ i c domain
Some of the Monte Carlo codes developed in large research centres are used today for
research in medical physics. This has been possible with the availability of considerable
computing power in hospital physics departments, together with a well supported
distribution of the codes (through the RSIC at ORNL or the European NEA Data
Bank, for instance). Table 1 lists the Monte Carlo codes and systems cited by their
name throughout this review.
Two such codes, ETRAN and EGS, or results computed with them, have become
widespread and a brief discussion of their different approaches in dealing with the
simulation of radiation transport will be given here. Readers wishing to expand the
summary given here are referred to the so called Erice book (J enkins et al 1988)
where the two codes are treated in depth. Other generally available Monte Carlo
codes like MORSE (cf Palta 1981) or OGRE (cf Nilsson and Bralime 1981) have also
been used in medical physics calculations, but their use has been less extensive than
the two codes which will be described.
The ETRAN Monte Carlo model, an acronym for electron-transport (Berger and
Seltzer 1968), was originally developed at the National Bureau of Standards, USA,
to simulate the transport of electrons and photons involving energies up to a few
MeV, being extended later on for calculations at higher energies. The extension of
the (ETRAN-based) ITS system of codes to the multi-GeV region, has been developed
recently (Miller 1989). Since the late 1960s, ETRAN has been used in calculations
related to the dosimetry of therapeutic beams, mainly electrons (Berger and Seltzer
1969, 1982; Berger el ol 1975). I t has provided most of the Monte Carlo results
included in the ICRU Report 35 on electron dosimetry (ICRU 1984a) and most of
todays electron dosimetry procedures are based on data computed with this code (cf
Andreo 1988a). ETRAN is a Class I code, which emphasizes the physics of electron
transport, its main characteristics being the accurate treatment of electron multi-
ple scattering (using the theory of Goudsmit and Sauuderson) and bremsstrahlung
interactions (including cross sections differential i n energy and angle). To take into
account low-energy transport, ETRAN includes characteristic x-rays from the K-shell
and Auger electrons after the emission of a photoelectron, but neglects coherent scat-
tering and binding corrections to incoherent scattering (cf Seltzer 1988) which have
been included in an updated version of the ITS system.
Discrepancies between calculations with ETRAN and other Monte Carlo codes (and
experiments) have been reported in the literature (Andreo 1980, 1981; Andreo and
Brahme 1981, 1984). Such discrepancies have been of importance in the determina-
tion of quantities of interest in electron dosimetry, snch as the variation of the mean
energy of primary electrons with depth, where the values calculated with ETRAN were
consistently higher than those obtained with the code MCEF (Andreo and Brahme
1981). I t was suggested by these authors that the disagreements were caused by the
different treatment of energy-loss straggling in the respective Monte Carlo codes, as
ETRAN (Class I) performs a sampling from the Landau/Blunck-Leisegang distribu-
tion whereas MCEF (Class 11) combines restricted stopping-power with a sampling
from the M~l l er distribution. Discrepancies in electron depth-dose distributions, com-
pared with experiments and other Monte Carlo calculations, have also heen shown
876 P Andreo
to be noticeable, especially in the build-up region and the slope of the fall-off sec-
tion (Andreo and Brahme 1984). Rogers and Bielajew (1986) have demonstrated that
ETRAN underestimated the mean collision energy loss as a result of underestimating
the number of large energy-loss events, which confirmed the findings of Andreo and
Brahme (1981). According to Seltzer (1988) the energy-loss underestimation was due
to the incorrect energy-loss sampling procedure from the energy straggling distrihu-
tion used in ETRAN. RSIC (1988) has reported the implementation of the corrected
straggling algorithm in the ITS system of Monte Carlo codes, primarily based on the
ETRAN code (Halbleib and Mehlhorn 1984).
The ETRAN model provides sophisticated electron transport techniques hut does
not include the treatment of any geometries other than those of infinite media or
plane-parallel slabs of different materials (Seltzer and Berger 1987). The family of
ITS coda provides geometrical packages of increasing complexity based on the ETRAN
system (Halbleib 1988). ITS consists of three main codes, TIGER, CYLTRAN and AC-
CEPT, which allow the user to simulate electron and photon transport down to 1 keV
in plane-parallel slabs, cylindrical geometry or any combination of the geometrical
bodies included in its default combinatorial package, respectively. The ITS system
also consists of special versions of these three codes (called P-codes) which include
ionization of all shells and atomic relaxation from the K, L, M and N shells. Upon
installation of the system, the use of the codes is quite straightforward, programming
is not needed and a simulation is based on a set of few order-independent input state-
ments (source, transport cut-offs and geometry, etc). At the time of writing, the ITS
system is being distributed as version 2.1. Unfortunately, the electron stopping-power
data included in this version is based on the Sternheimer and Peierls (1971) approxi-
mation to determine the correction due to the density effect in stopping-powers. As is
well known this correction yields stopping powers which differ from the actual recom-
mended values (ICRU 1984b). The cross section generator XGEN is being updated to
account for recent changes in physical data in a forthcoming version 3, which includes
ICRU-37 electron stopping-powers, numerical bremsstrahlung cross sections differential
in photon energy, coherent scattering with binding corrections, and binding correc-
tions to incoherent scattering (Halbleib et a/ 1990). A developing version of the new
cross section data generator has been used by Andreo (199Ob) to compute electron
depth-dose distributions which have been compared with calculations with MCEF and
EGS. Very good agreement among the three codes but large discrepancies with the
existing ETRAN results used today in electron dosimetry (figure 4) was found.
The EGS (Electron Gamma Shower) Monte Carlo system was originally developed
at SLAC to simulate high-energy electromagnetic cascades. Version 3 of the system
(Ford and Nelson 1978) has been in use at high-energy accelerator centres (SLAC,
CERN, etc) for many years, although applications i n medical physics were infrequent
(cf Nelson and J enkins 1980). I ts high-energy origin, where forward scattering dom-
inates, is the main reason for some of the weaknesses of the physics in EGS com-
pared with ETRAN: multiple electron scattering according to the theory of hloliere,
bremsstrahlung differential in energy only and a simple treatment of low-energy elec-
trons and photons. According to the classification giveir here, EGS is a Class 11 code
where the production of knock-on electrons and bremsstrahlung are treated individu-
ally. As a consequence, one ofthe requirements to run the system is to define tlireshold
energies for such events and precompute data (using the code PEGS) for each thresh-
old, which in general will vary for different types of calculation. The entire EGS system
is written in MORTRAN, a FORTRAN pre-processor that includes powerful macro ca-
Monte Carlo techniques in medical radiation physi cs 877
2.8
2.4
-
n
5
2
- 2.0
'L
CD
1.6
c
0
-
-
-
gl 1.2
n
at
U
5 0.8
a!
c
a!
0.4
0.0
0 50 100 150 200 250 300
depth (mm)
Figure 4. Comparison of depth-dose data for plene-parallel monoenergetic electron beams in water
cal ~l at ed with different Monte Carlo codes: ITS system (full lines), EGSI system (chain), MCEF
(broken) and previous ETRAN (long-chain wi t h diamond). Eleclrori incident energies of IO, 20 and
50 MeV (adapted from Andreo (1990b)).
pabilities. However, MORTRAN has debugging characteristics which are difficult to get
acquainted with.
During recent years the low-energy electron transport in EGS has been improved,
mainly by the inclusion of user-defined restrictions in step-sizes (maximum energy
loss and distance travelled per step, following Berger (1963)), yielding a more accu-
rate system (cf Rogers 1984). A new version has been released, EGS4 (Nelson el a/
1985), which has added electron transport dawn to 1 keV and Rayleigh scattering
to the original physics in the code. Further improvements to the system have been
developed by Bielajew and Rogers (1986a, 1987) including an angular distribution for
the emission of photoelectrons and a powerful algorithm called PRESTA. The latter
includes a pathlength correction to account for the detour due to multiple scatter-
ing of calculated straight paths, lateral correlation acording to Berger (1963), and a
boundary crossing algorithm which allows very large step sizes except near medium
boundaries (step sizes vary depending on the distance to the boundary). PRESTA is
based on the Moliere multiple-scattering theory, but whereas Moliere considered his
theory to be valid for a number of collisions WO > 20, the algorithm considers instead
WO > e (base of natural logarithms), which is the mathematical (instead of physical)
limit of the theory. For many simulations PRESTA has simplified some of the cumber-
some problems previously involved in user-defined restrictions in step-sizes, and has
overcome default limitations in the EGS system mainly regarding multiple scattering.
I t still requires further improvements to deal properly with step-size dependence and
878 P Andrea
backscatter; in addition, the problem of minimum step-sizes when different energy
cut-offs (Tc and Ts in different regions for instance) are used in a simulation is a non-
negligible limitation. The strong influence of recent developments in radiation physics
has led to new improvements in the code, such as the implementation of ICRU-37
stopping-powers (Duane el a1 1989). The sampling of bremsstrahlung photon angles
bas also been incorporated in connection with the simulation of targets for therapeutic
accelerators (Bielajew el a/ 1989).
One of the important characteristics of the EGS system is the high degree of flex-
ibility in its operation; at the same time this demands a great deal of programming
effort. I t is important to note that the EGS system is not a stand-alone Monte Carlo
code, but a package that the user must link to his/ber own main code and to :user-
written routines, describing the tracking of the transport through the geometry of the
problem and the scoring algorithms to extract the relevant quantities from the trans-
port. In a simple way i t could be compared with a mathematical or plotting library, as
the user connects with the EGS system through COMMON blocks, macros and calls to
two user-callable subroutines, HATCH and SHOWER. The resulting Monte Carlo code
(user-code according to the terminology used in the EGS manual) is therefore largely
programmer-dependent and subject to individual errors. To avoid ambiguities regard-
ing the reliability of results which in general are only specified as calculated with
EGS, a proper name should be given to the user-code when referring to calculations
using the EGS system. Some of the user-codes developed at NRCC are now widely
available through the EGS distribution package.
I t has to be emphasized that the coding of the simulation geometry is the most
challenging programming aspect in EGS and a very important component of any other
Monte Carlo code. In general i t is necessary to determine the intersection of the track
of a particle with a given surface. Mathematical tools for different types of surfaces are
given as subroutines in the EGS package (cf Nelson and J enkins 1988), which the user
must connect with his own routines. Most of the EGS user-codes in medical physics
calculations are, however, based on simple cylindrical geometries. This is also the
case for calculations with other Monte Carlo codes. More sophisticated approaches
are available, the combinatorial geometry package, CG (Guber el Q/ 1967) being by
far the most commonly used due to its simplicity for the user. The combinatorial
geometry describes three-dimensional complex bodies using Boolean algebra with a
few elementary bodies such as parallelepipeds (RPP), spheres (SFH), cylinders (RCC),
wedges (WED), etc, which can be oriented arbitrarily in the space. Although the use
of the combinatorial geometry is possible in the EGS system, its implementation bas
not received much attention. The ITS code ACCEPT (as well as the MORSECG code,
cf Straker el a/ 1976) is, on the other hand, fully based on this mathematical package
which does not require more than a few lines to construct any spatial geometry (cf
Nelson and J enkins 1988, Halbleib 1988). A different geometry technique has been
implemented in MCNP (Thompson et a1 1980), where instead of pre-defined geometrical
bodies, the user defines geometrical cells using first- and second-degree surfaces (and
some special fourth-degree, like elliptical tori) which are combined by using Boolean
operators.
I t may be of interest to know the differences between the two main Monte Carlo
codes, EGS and ITS, that can handle most geometries, energies down to 1 keV, and
any material composed of elements with atomic numbers Z from 1 to 100. Rogers and
Bielajew (1988, 199Oa) have compared some aspects of the two codes from the EGS-
developet point of view, but opinions based on independent experiences with both
Monte Carlo techniques i n medical radiation physics 879
codes will he given here. The accurate physics included in the actual ETRAN and
ITS systems, mainly regarding multiple scattering (cf Berger and Wang (1988) for a
detailed comparison between the theories included in the two codes), bremsstrahlung,
and, in general, the transport ofelectrons at low-energies (below, say, 100 keV), makes
them superior in all the problems where such phenomena are of importance. For in-
stance, below 20 keV or so, Berger (1973) has shown that a modified screening pa-
rameter from Molieres theory (a constant between l and 2) should be used, but this
is not considered in calculations using EGS user-codes. I n particular, the treatment
of energy-loss straggling in low-energy electron transport might become imprecise in
EGS (and in any other Class I1 code without restricted energy straggling, cf Andreo
and Brahme (1984)) as the energy of secondary electrons is not sampled below the
threshold for the production of knock-on electrons. EGS also has limitations in sim-
ulating low-energy photons (energy less than 50 keV or so) as it neglects binding
corrections in coherent and incoherent scattering. Positrons are also simulated dif-
ferently in the two codes. Whereas ETRAN treats them as electrons (except for the
emission of annihilation photons when the posit,ron slows to rest), EGS takes into ac-
count electron-positron differences in collision energy losses, inelastic scattering and
in-flight annihilation. The superiority of EGS i n this topic is, however, limited as
i t ignores differences in radiative energy losses (and therefore in radiation yield, cf
ICRU 1984h), bremstrahlung cross sect,ions and multiple scattering; furthermore, the
lack of spin dependence in Molieres theory does not allow an implemcntation of true
positron multiple scattering, which is intrinsically possible in the more accurate theory
of Goudsmit-Saunderson included in ETRAN or ITS.
I mportant limitations to the two codes (and to any other code based on the con-
densed history technique) appear at the time of treating electron scattering during
boundary crossings, where the pathlength of the electron has to be truncated. This
might result in segment lengths where the use of a theory for electron multiple scatter-
ing is no longer justified. ETRAN and the ITS codes determine the direction at the time
of crossing by sampling from a Gaussian approximation to the Goudsmidt-Saunderson
distribution (Berger and Seltzer 1968, Seltzer 1988), where the mean-square angle is
assumed to he proportional to the fraction of the step to the boundary; the electron
is forced to cross the boundary througli the rejection of any sampled angle which
would direct i t hack into the initial material (Lockwood el a1 1976). The EGS system,
on the contrary, forces the validity of Molieres theory down to I collision approxi-
mately, which imposes a restriction for the minimum step length allowable t,i.. The
occurrence of a step smaller than tmin switches-off the sampling from the Moliere dis-
tribution and no deflection of the initial direction of the electron occurs. The PRESTA
algorithm in EGS4 optimizes the distance to a boundary to avoid as much as possible
a violation of t,i. (which is restricted to e collisions in this case), but the sampling
is also switched-off when an unavoidable very short electron step occurs. Divergent
results at high atomic numbers produced by these two approximations for the sim-
ulation of backscattering experiments with CO y-rays can be observed in figure 5,
together with discrepancies even at low atomic numbers.
The way in which the two Monte Carlo systems classify boundaries is also different.
For most EGS user-codes all scoring regions are separated by in~erfaces, eveu if they
are made of the same material; this also requires boundary clieckiiig calculations in the
simulation of homogeneous media. In ETRAN and ITS interface boundaries are only
considered to separate different materials and not to define scoring regions, where no
special action is taken if an electron track crosses them. In general this will make
880 P Andrea
..
(D
$ 0. 601
10 100
atom10 number back wal l
Figure 5. A benchmark of cYLTRAN (ITS 1 . 1 t XGEN3 ) and DOSa ZI o ( E GS q P R E S T A + P E o S ~ ) sim-
ulating experiments with 6oCo y-rays that involve interface effects (based on a large plane-parallel
ionization chamber with interchangeable front and back walls, cf Nilsson et a1 (1988)). Experiments
(crosses, broken line) correspond t o a fixed aluminium front wall and varying Zs in the back walls,
cavi t y hei&t 1 mm; results are normalized to t hecae AI-AI front-back walls. The simulations use a
realistic input CO y-spectrum (Rogers cl nl 1988), transport electrons and photons down to 1 keV,
force photons to interact in the chamber, and perform electron range rejection lor energies below 0.5%
radiation yield. Both EGS (open symbols) and I TS (closed symbols) include the latest enhancements
in cross section data described in the text. The RANMAR random number generator i s implemented
in EGS (James 1990, Bielajew 1990a). Uncertainties are less than 1% in all calculations (one standard
deviation, category-A).
ITS faster than EGS for calculations in homogeneous media when a similar pathlength
division is used.
The EGS system, on the other hand, is a flexible and open code, and with some
training i t is relatively easy to program modifications or extract information on trans-
port related quantities. This is particularly useful to implement variance reduction
techniques in a user-code. ETRAN and the ITS codes are black-boxes where program-
ming is not needed but changes are very difficult to perform. Several key parameters
are needed to run EGS codes successfully, and it sometimes require careful compar-
isons and analysis of the different options available. This might even take longer than
the simulation of the problem itself. In ITS codes, input data according to the user
manual is the main requirement to run a code; the lack of flexibility of ITS to perform
very special calculations, compared with EGS, is compensated by the use of thoroughly
checked and verified codes. Finally, the size of computer RAM memory and disk space
needed to run and store the ITS system can be three times that for EGS due to the
large amount of tabulated data and length of FORTRAN source code files.
The so called All-Particle Method approach (Cullen e l Q I 1988), presently under
development at the Lawrence Livermore laboratory, might become of special interest in
the near future. The system will include the transport of neutrons, photons, electrons
and light charged particles as well as the coupling between all species of particles.
The code will include a sophisticated geometry package and the latest nuclear and
atomic database presently under development at Livermore (cf Cullen and Perkins
Monte Carlo techniques i n rnedzcal radiotion physics 881
1989, Perkins and Cullen 1989). The main goal of the all-particle method in electron
transport will be to implement a stratified model where macroscopic and microscopic
Monte Carlo techniques will be switched alternately depending on the energy of the
electron; in this way each technique will be used in the energy region where it works
more efficiently.
4. Applications in medical radiation physi cs
Applications of the Monte Carlo method in medical radiation physics will be dealt
with in this section. The continuously increasing number of these applications during
recent years contrasts with the very few references available at the time of the review
by Raeside (1976).
Five main groups will be considered here, namely nuclear medicine, x-ray diag-
nostics, radiotherapy physics and dosimetry, radiation protection calculations and
transport simulation using microscopic Monte Carlo codes. This classification relies
on subjective criteria, as in most cases the boundaries of each group are not strict
and overlapping is unavoidable. This is particularly so in applications dealing with
radiation protection aspects, both in diagnostic radiology and nuclear medicine, which
will be discussed within these groups. A few radiation protection calculations will be
treated separately. The same is true for absorbed dose calculations using radioactive
sources, which will be treated as sealed or unsealed sources, the first type being in-
cluded in therapy and the later in nuclear medicine. The simulation of the response
of detectors used to measure spectra of low-energy photons will be included both in
nuclear medicine and to a lesser extent in x-ray diagnostic applications.
4.1. Nuclear medicine
As pointed out by Raeside (1976), nuclear medicine is the area where most of the
early Monte Carlo calculations in the field were performed. A characteristic shared
by most of the existing applications, both old and new ones, is that the codes are
mainly based on the simulation of photons only, that is any electrons generated are
considered to he absorbed at the location where they are produced. Such an approach
is justified by the low energy of the photons being simulated and therefore by the
short ranges of the electrons generated and their negligible bremsstrahlung production.
Calculations regarding absorbed dose distributions for beta sources clearly fall outside
this general characteristic. Three main subgroups of applications will be considered,
namely detectors, image reconstruction and dosimetry.
4.1.1. Defectors. The Monte Carlo simulation of detector responses and efficiencies is
probably one of the areas in nuclear medicine, and in nuclear physics in general, which
has received most attention. The detailed techniques described by Zerby (1963) can be
referred to as an early guide for this kind of simulation. There are studies of detectors
which include high energies (and therefore incorporate the transport of electrons), but
they generally also include energies low enough to be of interest for nuclear medicine.
This is the case with the tabulations of the response of 3 in x 3 in NaI detectors
between 100 keV and 20 MeV by Berger and Seltzer (1972), and the simulations of
planar and cylindrical Ge(Li) detectors between 100 keV and 12 MeV due to Gross-
wendt and Waibel(1975). Rogers (1982) has reported simulations for incident photons
above 300 keV using cylindrical detectors of different materials which in some cases
882 P Andreo
include the effect of the detector housing. Calculations below 300 keV including the
same effect have been performed by Saito and Moriuchi (1984) for NaI(TI) detectors
with different shapes and volumes.
The design of positron emission tomography (PET) systems using the Monte Carlo
method has received considerable attention and a large number of applications have
been developed. Derenzo (1981) has simulated arrays of detectors of different materials
(NaI(TI), CsF, Ge, plastic detectors, etc) and sizes, as well as other parameters of
influence such as the effect of inter-crystal septa. He concluded that narrow bismuth
germanate (BGO) had the best detection efficiency. The optimization of the optical
coupling between BGO crystals and photomultiplier tubes was undertaken by Derenzo
and Riles (1982) simulating the reflection and scattering along the detection system.
The Monte Carlo method has been also used in the design of multi-ring PET cameras
used for three-dimensional imaging by Dahlbom el a/ (1989), who have investigated
the influence of the inter-plane septa for different source geometries, concluding that
the removal of the septa can increase the efficiency of the system by a considerable
amount (almost a factor of six). The simulation of a large multiplane PET camera
using the EGS system has been reported by Del Guerra el a1 (1983).
The effect of the collimation in a Compton-scatter tissue densitometry scanner has
been studied by Battista and Bronskill (1978) in a detailed publication. Monte Carlo
techniques have also been employed to determine the geometric response of collima
tors in scintillation gamma-cameras and single photon emission tomography (SPECT)
detection systems. Metz el a/ (1980) have simulated circular and triangular collimator
hole shapes at several collimator-source distances to verify analytical expressions for
the transfer function of the collimation system of gamma-cameras. The development
of other computer codes to simulate collimators and analyse their performances has
been reported by Ljungberg and Strand (1989); recently Gantet el a/ (1990) have
used a personal computer to simulate specific collimation equipment for scintillation
cameras and SPECT.
4.1.2. Imoging correciion techniques. Monte Carlo calculations have been found to be
powerful tools to quantify and correct for photon scattering, which usually produces
blurring of the image and loss of contrast in nuclear medicine imaging procedures. A
full simulation of a point-source-phantom-detector assembly allows the determination
of the scatter component of the entire system (figure 6) which can be unfolded from
the total image to yield an image whithout scattering contribution.
Multiple scattering in Compton-scatter tissue densitometry has been analysed by
Battista and Bronskill (1978), who concluded that the contamination from high or-
der scattering contains a Considerable fraction of photons having energies identical to
those of single scattered photons. The effect could be minimized, but not be elimi-
nated, by improving the detector resolution. Speller and IIorrocks (1988) have studied
multiple scatter effects at lower energies, including incident diagnostic x-ray spectra,
and obtained correction factors for clinical use in tissue densitometry.
In SPECT, the original Monte Carlo simulat,ions of Beck el al (1982) have provided
a method for evaluating scatter correction methods and analysing the contribution
of different orders of scattering to the acquired images. Calculations were strongly
based on variance reduction techniques, photons being restricted within a given solid
angle, and forced to interact with the medium and to be detected. This Monte Carlo
SPECT research programme has been fruitfully continued for several years by the group
at Duke University, USA. Floyd el a/ (1984) have simulated the energy and spatial
F
10000
10
Mont e Carlo techniques i n niedical radi at i on physi cs
101
c
-14
-_
-.
._-
'. .
'.
.-
10 14 2 6
rnl
Energy Window 127-155 keV
883
k eV
Fi gure 6. Schematic diagram of the principle of scintillation camera detection and its Monte Carlo
simulation including phantom and collimation effects. ( a) For an ideal detector, only photons per-
pendicular to the collimator will be detected (full lines); in practice, primaryphotonr within a certain
solid angle will be recorded (dotted line); due t o the finite energy resolution of the system, photons
scatteredin the phantom willalso be detected (brokenlines). ( a ) The energy pulse-height distribution
due to primary and scattered photons can be measured or calculated (full line); it can be separated
into diKeerent contributions (total scattering or dilferent orders of photon scattering) using a Monte
Carlo simulation (from Ljungherg cl n f 1990, with permission).
distributions obtained from a line source. They found that second-order scattered pho-
tons overlap with non-scattered photons in the photopeak and exhibit an exponential
spatial projection; higher order events appear outside the peak and can be excluded
using a narrow window. Floyd el a/ (1985a) have used Monte Carlo techniques to eval-
uate and justify the empirical development of the two windows subtraction technique
proposed by J aszczak et a/ (1984); they showed that the underlying assumptions were
valid. Following existing analytical treatments, a deconvolution algorithm for scatter
correction has been developed by Floyd el a/ (1985b); Compton scatter is modelled as
a convolution of the non-scattered projection with an exponential function describing
the scatter component, whose parameters are obtained by fitting Monte carlo simu-
lations of line sources in water. The search for unified reconstruction algorithms led
this group to the development of SPECT Inverse Monte Carlo reconstruction techniques
884 P Andre0
that are discussed in section 5 . Simple solutions for scatter correction have also been
proposed by Floyd el a1 (1988), who presented an analytical polynomial function to
relate the scatter fraction to different variables of SPECT systems; the function is a fit
to Monte Carlo calculations of the dependence of scattering with depth, energy and
detecting window.
A recent comparison between the dual-window and convolution correction tech-
niques based on Monte Carlo simulations has been presented by Ljungberg et al(1990),
who found that both techniques underestimate the contribution of scattered photons,
and that the depth-dependence of scatter parameters is not taken into account in the
existing algorithms. Ljungherg (1990) has developed a depth-dependent scatter cor-
rection technique based on Monte Carlo calculations of scatter functions at different
lateral positions and depths within a phantom showing enhancement in the image
contrast.
Compton scattering effects on PET profiles in water have been simulated by Logan
and Bernstein (1983) for comparison with convolution using an exponential function
for scatter compensation. Bruno e t a1 (1984) have reported good agreement between
Monte Carlo simulations and scattering experiments on a positron tomograph, whereas
Bendriem el a1 (1987) have used simulated data to evaluate scatter profiles and scatter
fraction and to derive a scatter deconvolution filter.
4.1.3. Absorbed dose calculations. The determination of absorbed dose in different
organs due to internal irradiation has traditionally been based on tabulations given
by the Medical Internal Radiation Dose (MIRD) Committee of the Society of Nuclear
Medicine in USA through their so-called MIRD Pamphlets. Some of these Pam-
phlets have made extensive use of Monte Carlo calculations to derive specific absorbed
fractions for photons and electrons, that is the fraction of the emitted energy per unit
mass of the medium, which is absorbed at a distance from the source, and they were
already in use at the time of the 1976 review article by Raeside. During the last decade
most of the absorbed dose Monte Carlo calculations involving y-emitter radionuclides
have been performed with brachytherapy sources and in consequence will be treated
in section 4.3.4.
Interest in dose calculations with @-emitters has been revived with the applica-
tion of labelled monoclonal antibodies to radioimmunotherapy. The term kernel
to denote the spatial distribution of absorbed dose around point-isotropic sources of
electrons was used originally by Berger (1973). He has calculated kernels for monoen-
ergetic electrons with energies between 10 MeV and 0.5 keV using a combination of
macroscopic (full grouping of interactions) and microscopic (single interactions) Monte
Carlo techniques for electron energies above and below 20 keV respectively. Details
of the microscopic code together with valuable discussions on the limitations of Bethe
stopping-power (restricted) and Molieres theory of multiple scattering at low energy
have been given by Berger (1972). Another microscopic Monte Carlo code developed
at ORNL (OREC, cf section 4. 5. 2) has been used by Turner el a1 (1988) in applications
related to P-ray dosimetry in tissue-equivalent materials, finding good agreement with
experimental dose distributions.
Based on the Monte Carlo results of Berger (1973), Prestwich el al (1989) have
evaluated kernels for certain nuclides of interest in radioimmunotherapy by weighting
the data for monoenergetic electrons over @-ray spectra. An EGS user-code has been
used recently by Simpkin and Mackie (1990) to compute p dosekernels for monoener-
getic electrons (3 MeV-50 keV) and @-emitters. They have compared their results with
Monle Carlo techn.iques in medical radiation physics 885
the previously described calculations by Berger, finding systematic differences at high
energies (justified in terms of the incorrect sampling of energy-loss straggling in the old
version of ETRAN). The agreement was better at low energies even though the 10 keV
energy cut-off used in the EGS user-code should make the treatment of energy-loss
straggling inaccurate. Good agreement was obtained with results for 1 MeV obtained
with an updated version of the ETRAN code.
4.2. Diagnostic radiology
The main goal of the application of Monte Carlo techniques to diagnostic radiology is
the optimization of diagnostic procedures to improve the image-quality/patient-dose
ratio. Many publications in the field have dealt exclusively with radiation protection
aspects of different diagnostic techniques, but the amount of scientific work investigat-
ing physical quantities or characteristics of the detection systems bas been increasing
since the early 1980s. A very interesting and general aspect of these applications
has been the improvement of sampling techniques from certain photon interactions
(mainly coherent scattering, see section 2. 2). Electron transport has been systemat-
ically excluded from these simulations for reasons similar to those given for nuclear
medicine applications (short electron ranges and negligible bremsstrahlung).
The extensive work in the field done by Chans and Dois team (University of
Chicago) deserves special mention. It covers different aspects of the three snbgroups
considered here and has been described in detail in a review by Chau and Doi (1988),
which is recommended to those readers wishing to expand this summary.
4.2.1. Detection sysf ems. The use of the Monte Carlo method to investigate ba-
sic components of the detection system in diagnostic radiology started in the early
1970s. DePalma and Gasper (1972) have simulated photographic emulsion layers to
obtain modulation transfer functions (MTF) of different emulsions. Morlotti (1975)
has performed simulations to obtain MTF and x-ray efficiency for fluorescent screens
to investigate the performance of different phosphors. A Mont,e Carlo code which
includes binding corrections to coherent and incoherent scattering (cf Chan and Doi
1983b) has been used by Chan and Doi (1983a, 1984a) to investigate x-ray energy
absorption i n different screen phosphors, including energy, angular dependence and
quantum noise.
As in the preceding section, the effect of image contrast degradation due to scat-
tered radiation has been one of the basic items where Monte Carlo studies have proven
to be useful. The performance of anti-scatter grids has been investigated by Kalender
(1981a) computing the scatter transmission of different grids. Chan and Doi (1982)
have evaluated anti-scatter grids using the contrast improvement factor and the Bucky
factor as benefit and cost indicators. This study was complemented with further sim-
ulations and experimental verifications of a number of clinical systems by Chan el ai
(1985a). The use of an air gap technique as opposed to a grid to reduce scattered ra-
diation from small fields has been proposed by Persliden (1986), who has investigated
the influence of air gaps for different detectors i n various conditions. Applications of
the Monte Carlo technique to the study of anti-scatter grids in mammography have
been developed by Dance and Day (1984) where the effect of divergent beams has been
included. Chan el al (1985b) have conducted a comprehensive study on the applica-
tion of ultra-high-strip-density grids to mammography, to improve the image contrast,
where the effect of various grid parameters has been simulated. A tissue-equivalent
.
886 P Andre0
filter to reduce scatter radiation in the peripheral region in mammographic imaging
has been investigated by Lam and Chan (1990).
The energy response of detectors commonly used in the measurement of x-ray
spectra ( Ge, Si(Li) and Nal) has been investigated by Chen et 01 (1980), where meth-
ods for correcting the measured spectra were examined. Seltzer (1981) has calculated
the response of intrinsic germanium detectors giving the results as a set of formulae
valid for any energy (up to 300 keV) and detector size. Characteristic x-rays from the
germanium have been included in his calculations, but coherent scattering and binding
effects in incoherent scattering were excluded (see the description of ETRAN in sec-
tion 3). A similar study for 21 commercially available detectors has been undertaken
by Chan et al (1984), finding consistent differences with the results of Seltzer (1981),
which have been explained in terms of the exclusion of coherent scattering and binding
effects. The influence of a tungsten absorption edge filter on the x-ray spectra from
diagnostic units has been investigated using experimental and Monte Carlo methods
by Yamaguchi el al (1983). Analogous simulations have been performed hy Kulkarni
and Supe (1984a) for a mammography unit. The fraction of photoelectrons escap-
ing from small silicon detectors has been investigated by Aoki and Koyama (1990),
who calculated correction factors for different detector sizes which enable spectral
measurements to be made comparable with Ge detectors.
4.2.2. Determination of physical quantities in diagnostic radiology. The computation
of quantities related to the scattering of photons has been strongly biased towards
determination of scatter-to-primary ratios or scatter fractions both using calculated
photon fluences or absorbed doses and, to a lesser extent, towards spatial distributions
of scattered radiation. Most calculations are based on the scattering of a monoener-
getic photon pencil beam incident on a parallelepiped or slab water phantom.
Kalender (1981b) has calculated scatter fractions for different detectors and various
object thicknesses, varying also the field size, detector-object distance and incident en-
ergy (monoenergetic photons between 30-150 keV). Chan and Doi (1983b, 1985) have
derived quantities such as scatter fraction, energy spectra (including mean energies),
angular distributions (including mean exit angle), and spatial distributions of the scat-
tered radiation in water and perspex. Neitzel et al (l 985) have calculated pencil beam
radial profiles in water and the transition to broad beams, studying the importance
of coherent and single incoherent scattering. The small-angle distribution of photons
transmitted through water slabs has been computed by Persliden and Alm-Carlsson
(1986) using a collision density estimator which combines analytical calculations and
Monte Carlo simulations. The ITS/ACCEPT code has been used by Barnea and Dick
(1986) to simulate experimental arrangements by other authors (using polystyrene
instead of water as in most other calculations) and to make comparisons with some of
the results previously mentioned.
4.2.3.
I n evaluating the potential risks of x-rays in
diagnostic radiology, Chan and Doi (1984b) have calculated the spatial distributions
of energy deposition from pencil beams in water slabs, together with rad/R conversion
factors and scatter-to-primary ratios for absorbed doses in a phantom. The conversion
factors were used to estimate absorbed doses at different locations in the phantom for
a given absorbed dose in the recording system, and to select an optimal energy. The
factors necessary to obtain the energy imparted to a phantom from measurements of
the collision kerma in air have been determined by Persliden and Ah-Carlsson (1984).
Radiation protection aspects.
.
Mont e Carlo techniques in medical radiation physics a87
As an application in computed tomography, a Monte Carlo code has been developed
by Beck el al (l 983) to estimate absorbed doses in specific regions within a cylindrical
phantom exposed to rotating x-ray sources.
Studies on absorbed doses from radiological examinations have been mainly domi-
nated by mammography during the last decade. Doi and Chan (1980) have determined
'rad/R' conversion factors and backscatter factors in mammography taking into ac-
count x-ray spectra. Their values were found to be considerably higher than previously
reported values based on TLD measurements. Calculations of backscatter factors by
Grosswendt (1984) for different field sizes were systematically lower than those of Doi
and Chan (1980), although the geometry used in the latter (pencil beams) would be
more appropriate for very large field sizes. Dance (1980) has developed a Monte Carlo
code for the computation of integral dose per unit incident exposure from monoen-
ergetic photons within the energy interval used in mammography; the results have
been extended to x-ray spectra by numerical integration. Various filtrations of spec-
tra have been used to derive absorbed dose in the brea3t from a given dose to the
recording system using a detailed geometry (see figure 7). Recent simulations have
been performed by Dance (1990) to determine conversion factors to estimate the mean
glandular breast dose from measurement,s of the incident air kerma to a PMMA phan-
tom. The differing composition of the breast in different age groups has been taken
into account by Kulkarni and Supe (1984b).
F oml spot
Of x - r q t " k
Compressed
brmst
corsette
ond det ect or
Figure 7. Geometry used in the Monte Carlo calculalions of integral absorbed dose i n ma~mno.
graphic radiology examinations by Dance (1980) (wit11 permission).
4. 3. Radiotherapy physics
Burliu et al (1973) have indicated a number of situations where Monte Carlo methods
could play an important role in medical radiology. Since then, applications to radio-
therapy and dosimetry have become the most widespread kind of simulations during
the last decade, following developments during the late 1970s. An important aspect
888 P Andreo
of modern applications is understanding the significance of the transport of secondary
electrons in the energy range of radiotherapy; this had been underestimated (and
omitted) in some of the inspiring early applications.
Most recent developments in the', area are based on one of the two major public
codes previously described, EGS and ETRAN or ITS, and their use continues to increase.
The number of existing applications b&ed on these or other Monte Carlo codes is today
so large that only selected cases can be presented here. Further details and references
can he found in recent reviews by Mackie (1990) and Rogers and Bielajew (199Oa) on
applications of the method to radiotherapy and dosimetry respectively.
4.9.1. Tele-therapy sources and dosimetry equipment A large number of investigations
have considered simplified configurations of external electron and photon radiotherapy
sources. This is the case with the calculations of Patau el a1 (1975) on the energy and
angular spread of electron beams emerging from foils, and studies of Berger and Seltzer
(1978) on the effect of scattering foils in electron central-axis depth-doses, where the
influence of energy and angular spread has been considered. Manfredotti et a1 (1987)
have considered a simple geometry to simulate an electron collimator and score distri-
butions of quantities at a phantom surface which were used later in three-dimensional
dose-planning simulations. Electron spectra after foils and air have been calculated by
Andreo el a1 (1989) in relation to ionization chamber electron dosimetry. For photon
beams McCall et a1 (1978) have calculated spectra from different high-energy x-ray
targets and flattening filters using the EGS system, and Nilsson and Brahme (1981)
have investigated scattered photons from flattening filters and collimators in thera-
peutic photon beams. Patau et a1 (1978) have pioneered the complete simulation of
a photon beam, including the photon generation in a W-Cu target, the transport
through a flattening filter and collimator, and attenuation in slabs of different mate-
rials; they have investigated the energy and angular spectra of photons and electrons
at every location using a simplified geometry.
simulations of 6oCo sources and therapy treatment heads using detailed geometry
have become ofgreat importance. Pioneer calculations of Berger have been reported by
ICRU (1970) for encapsulated 6oCo sources, where photons scattered by the tungsten
sleeve were the most important component of the 6oCo spectrum. Similar calculations
have been reported by Nan ef a/ (1987) and Rogers et 01 (1988), including collima-
tors and filters to simulate in detail the treatment head'of a 6oCo unit. Petti et a1
(1983a, 1983b) have investigated the electron contamination in photon beams, for the
first time simulating in great detail the treatment head of a clinical accelerator; the
energy and angular distributions of both photons and contaminating electrons at the
phantom surface, and their origin, ha;e been determined using the EGS code. Similar
detailed simulations also based on the EGS system have been performed by Mohan et
a1 (1985) for photon beam spectra from different acceleratvrs, and by Udale (1988)
for electron beams to investigate surface doses due to electron contamination by the
beam defining system (figure 8). Detailed investigations on reflecting electron appli-
cators and scattering foils in clinical accelerators had been described previously by
Ahou Mandour (1978). I t should be pointed out that all these EGS-based calculations
of bremsstrahlung angular distributions, or spectra at different angles, have used the
default crude approximation for the photon emission angle 8., = mc2/ Eo, Eo being
the electron total energy and me2 the electron rest energy. As discussed in section 3,
Bielajew et a1 (1989) have implemented the sampling of bremsstrahlung photon angles
in the EGS system; they have found important discrepancies in the radial variation
Monte Carlo techniques i n medical radiation physics 889
of photon spectra compared with calculations using this approximation which might
invalidate some of the results mentioned
Mirror -\
A
Phantom -
I bl
C o s A a c 0 t
Figure 8. Detailed and schematic diagrams of the geometry used in the Monte Carlo simulation of
the treatment head 01 a therapeutic electron accelerator using the EGS I system. The different c-es
shown in the schematic diagram produced a progressive improvement in the agreement between the
calculated and experimental depth-dose distributions of a 10 MeV electron beam (from Udale 1988,
with permission).
A common aspect of the simplified and detailed simulations of therapy sources,
when in-phantom studies are included (such as determination of depth-doses or spec-
tra), is the use of a two-step Monte Carlo procedure. During the first step, the energy
and/or angular distributions of the radiation field are determined down to the phan-
tom surface after passing through foils, collimators, air, etc. A second step is used for
the in-phantom simulation itself, and these distributions are sampled independently
to define the initial state of the incident particles. The lack of correlation during the
sampling of broad energy and angular distributions during the second step has been
pointed out by Andreo and Fransson (1989) for electron beams, which should be a
warning for other applications where the siniulations are divided into two parts,
The simulation of the response of ionization chambers exposed to 6oCo beams in
air has received considerable attention and raised controversies, but there are still
discrepancies which are not yet fully understood (see for instance figure 5 ) . The
importance of accurate electron transport and the production of interface artifacts
in regions which are small compared with elec'tron step sizes, has been discussed
extensively by Bielajew et a / (1985) and Smyth (19%) (cf also Smytli and McEwan
(1986) and Bielajew and Rogers (1986b)). This topic has been reviewed in depth by
Nahum (1988b). The small number of interactions within the ion chamber volume
890 P Andreo
requires the use of variance reduction techniques. Even so, computation times needed
to achieve low uncertainties (less than 1%) are extremely long, specially when ion
chambers are simnlated inside a phantom (cf Nilsson et al 1988) where hundreds of
hours of CPU are often needed. Thi s can be considered the major limitation of a direct
Monte Carlo simulation, unless more sophisticated variance reduction techniques are
used (which usually requires an in-depth knowledge of the code). The combination of
analytical and Monte Carlo methods (see section 2.2) has not yet been used in this
area.
Bond et a/ (1978) and Nath and Schulz (1981) have simulated the response of
ion chambers and determined wall correction factors for CO y-rays in air which
are in common use today in the majority of national and international recommended
procedures for dosimetry. McEwan and Smyth (1983, 1984) and Rogers el ol (1985)
have found, however, important discrepancies between their results and those of Nath
and Schulz (1981) for the simulation of chamber response, attributable to defects
in the Monte Carlo code of the latter authors, whereas differences in the calculated
correction factors (which are ratios of responses) were within statistical uncertainties.
Simulations of ion chambers including the effect of the central electrode at the energy of
CO y-rays have been reported by Smyth and McEwan (1984) and Rogers et a! (1985),
both finding good agreement with existing experimental data. The stated uncertainties
in both set of calculations were on most occasions larger than the correction itself,
which confirms the dificulties i n simulating ion chambers previously discussed.
Bielajew (199Ob) has developed an analytical theory to derive correction factors
for thick-walled ion chambers exposed to WO beams in air, which has been verified
using Monte Carlo calculations. Bielajew has simulated some of the chambers from
various national primary standards dosimetry laboratories and found discrepancies
with Correction factors being used in the laboratories. Further simulations by Rogers
and Bielajew (1990b), to determine wall correction factors for these standard cham-
hers, have also shown differences with the values actually being used; fortunately the
discrepancies, in practice, compensate for each other. To avoid brute force calcu-
lations of the chamber response, to obtain correction factors as ratios of responses,
direct ratios of quantities that provide an alternative definition of the correction factor
were scored instead during the simulation. This results in a drastic improvement in
computation time, being equivalent to a correlated sampling technique.
Recent applications of the Monte Carlo method have simnlated gap effects in
graphite calorimeters (Boutillon 1989); corrections for such effects had been neglected
so far by most standards laboratories but have been found to be non-negligible.
4.3.2. In-phantom simulations. A better understanding of the physics of radiation
transport in matter has been achieved with the use of Monte Carlo techniques and
the potential of switching on/off different interactions. Calculations by Seltzer et
al (1978). Andreo and Brahme (1983), Nahum and Brahme (1985), etc, belong to
this group, where second and higher order components of different quantities have
been investigated in electron beams. The basic geometry of point-monodirectional
beams, known as pencil beams, has proved to be of great interest as the fundamen-
tal component of broad beams and for treatment planning algorithms. Berger and
Seltzer (1978, 1982) and Andreo (1980, 1981) have performed extensive calculations
of energy deposition for electron pencil beam-infinite beams based on the so called
reciprocity relationship (cf ICRU 1984a). The topic has been reviewed in detail by An-
dreo (1988h). Electron depth-doses and ranges for broad beams have been obtained by
Monte Carlo techniques i n medical radiation physics 89 1
numerous authors, and the investigations by Rogers and Bielajew (1986), Grosswendt
and Roos (1989) and Andreo (199Ob) can he added to the references for pencil beams
previously given.
The calculation of other physical quantities in a phantom, like energy spectra,
mean energy, stopping-power ratios, energy-absorption coefficient ratios, etc, has been
cultivated extensively. The initial calculations by Berger and Seltzer (1969) of elec-
tron spectra and water/air stopping-power ratios (sW,*j r ) for monoenergetic electron
beams (Berger el al 1975; see also ICRU 1984a), have been improved by develop-
ments by Nahum (1976, 1978) for the evaluation of Spencer-Attix ~ ~ , ~ i ~ including
a track-end term. Andreo (199Ob) has recently calculated stopping-power ratios for
monoenergetic electrons, both with the EGS system and the MCEF code, finding ex-
cellent agreement between the two codes. The effect of energy and angular spread on
has been investigated by Audreo et al (1989). I t was found that the method
recommended in dosimetry protocols yields sw,&i r values that differ by less than 1%
from those obtained from direct Monte Carlo calculations for beams with very large
energy and angular spread. These calculations have been extended by Andreo and
Fransson (1989) to include low-energy electron contamination using the realistic elec-
tron beams simulated by Udale (1988), confirming the results previously mentioned.
The depth and radial variation of the mean energy in electron beams, together with
the practical implications in electron dosimetry, has been investigated by Andreo and
Brahme (1981).
For photon beams, Nahum (1976, 1978) was the first to calculate stopping-power
ratios based on the Monte Carlo method to derive electron slowing-down spectra at dif-
ferent depths. The technique has been used by Andreo and Nahum (1985) to compute
sw+ir values for monoenergetic photon beams, developing a method to weight such
data and obtain stopping-power ratios for bremsstrahlung spectra that were verified
by Monte Carlo simulations of the complete spectra. Stopping-power ratios correlated
consistently with the quality of photon beams have been computed by Andreo and
Brahme (1986), who found large discrepancies with existing recommendations of sw,+i r
values based on the nominal accelerating potential of an accelerator ( MV) . These in-
vestigations were performed for a large number of bremsstrahlung spectra (figure 9)
and also included the effect on ~ ~ , ~ i ~ of the electron contamination in photon beams
and dependence with depth and field size. The results have been used to calculate
stopping-power ratios for different materials and derive ion chamber correction fac-
tors by Andreo et al (1986); this work giving the complete set of data used today
in the majority of dosimetry protocols. A review of Monte Carlo techniques applied
to calculations of electron spectra in water produced by electron and photon beams,
and further determination of stopping-power ratios, has been performed by Andreo
(1988~). Mass energy-absorption coefficient ratios for high-energy photon beams have
been computed by Cunningham el 01 (1986). The same set of bremsstrahlung spec-
tra used by Andreo and Brahme (198G) to calculate stopping-power ratios has been
used as input for further calculations of p.,/pratios by Cunningham (cf IAEA 1987),
producing a consistent set of data for photon dosimetry.
4.3.3. %atmenl planning applications. Several investigators have repeatedly indi-
cated the non-feasibility of direct treatment planning applications of the Monte Carlo
method using then current standard computer technology due to the long computa-
tion times involved (cf Nahum 1985, 1988a; Mackie 1989). The main validity of the
method has been in verifying algorithms and techniques and, more recently, providing
892 P Andreo
TPR200Il Wf or l Wmmx1Wmmf l el d
Fi gure 9. Waterlair stopping power ratios as a function of the beam quality for a broad range of
photon beams with large variations in spectral shape. The beam quality is specified as the ratio of
absorbed doses at 200 mm and 100 mm depth for a 100 nun x 100 mm field size at the position of
the detector (parallel beam configuration). Triangles, data for monoenergetic photon beams; open
squares, for bremsstrahlung thin target spectra; full squares, for thick target spectra (thickness equal
t o one CSDA range in tungsten); full circles, for accelerator spectra published in the literature; full
line, data for realistic clinical spectra used in dosimetry protocols since 1987. The spectra wer e used
as input for Monte Carlo calculations of electron Buence at different depths in a water phantom (from
Andreo 1989).
data for new dose planning procedures.
The special case of inhomogeneities and interfaces has received great attention,
and as with ion chamber simulation, the need for accurate simulation of the transport
of secondary electrons has been demonstrated (cf Nahum 1988b). Calculations by
Webb (1979) using the code of Webb and Parker (1978) ignored electron transport
in a 6oCo beam and therefore did not predict correctly the energy deposited close
to the interface. Webb and Fox (1980) used the same code to verify inhomogeneity
correction algorithms in photon treatment planning. Further Monte Carlo calculations
at interfaces with %o beams have also been reported by Horowitz et al (1986),
whereas Seltzer and Berger (1987) have included high-energy photons and electrons
as well. The ITS system has been used recently by Das et al (1990) to calculate
electron spectra at interfaces and investigate the validity of stopping-power ratios used
to compute absorbed dose from measurements at interfaces with high-energy photons.
For electron beams, treatment planning standard inhomogeneities have been simulated
by Shortt e t a/ (1986) and compared wibh experiments, showing that the EGS system
can be used to calculate benchmarks against which treatment planning algorithms can
be compared.
The use of Monte Carlo techniques in calculations related to electron pencil beam
algorithms based on the theory of Fermi-Eyges has been successfully employed by
several investigators. Lax e t a/ (1983) used Monte-Carlo-calculated pencil beams
(from MCEF and ETRAN) to fit the parameters of a multi-Gaussian function, the basic
component of a generalized Gaussian algorithm. Bielajew e t al(1987) and Manfredotti
el 01 (1987) used the EGS system to verify different approximations and performance
of electron pencil-beam algorithms, whereas Bruinvis el a/ (1989) calculated range
straggling functions which have been implemented in a given pencil-beam algorithm.
Monte Carlo techniques an medical radiation physics 893
The traditional technique, used in low-energy photon-beam dose-planning algorithms,
of separating dose into primary and scatter components, has been investigated by
Mohan and Chui (1985). They have criticized the physical basis of such approach;
however the Monte Carlo method has been used by Kijewski et al (1986) and Rice
and Chin (1990), among others, to develop further improvements in this separation
technique.
Calculation methods for photon beams based on the convolution of Monte Carlo
calculated kernels, describing the energy deposited by charged particles during photon
interactions, have been proposed simultaneously by Mackie et al (1985) and Chui
(1985) (cf also Mohan et a1 1986). Ahnesjo et a/ (1987) have further developed the
method and used the code MCEF to generate a database of kernels of monoenergetic
photons (figure IO). The set of data has also been used for the reconstruction of
bremsstrahlung spectra from clinical accelerators (Ahnesjo and Andreo 1989) and for
the calculation of isotropic pencil beams for inverse Monte Carlo treatment planning
(Eklof et a1 1990). Mackie et al (1988) have computed EGS-based kernels, which have
been compared by Mackie (1990) with the MCEF-based data, finding good agreement.
The scaling method used in such convolution procedures when inhomogeneities are
present has been investigated by Woo and Cunningham (1990).
Recent developments have addressed the possibility of performing direct Monte
Carlo calculations in three dimensions using CT images, despite the long computation
times involved, and new approaches have been suggested. An important argument
for the use of Monte Carlo simulations in the presence of inhomogeneities is that
experimental determinations of absorbed dose might be question in transition regions
due to the lack of electron equilibrium at high photon arid electron energies, where
detector responses are uncertain. The first attempt by Manfredotti et a / (1987), used
for comparisons with a pencil beam algorithm, was based on a three-dimensional
phantom instead of true CT images, but the final goal of computing three-dimensional
dose distributions in small volumes is the same. Calculations in phantoms and actual
CT data have been reported by Chui and Mohan (1988), stressing the importance of
CT-based Monte Carlo simulations as benchmarks against which other approximate
algorithms or dose planning systems could be compared. A very interesting algorithm
to speed-up the direct simulation has been developed by Manfredotti et al (1990),
where the very large number of regions existing i n a CT slice is numerically decreased,
reducing then the time spent in boundary crossing or checking during the simulation.
The algorithm, called UNI ON and based 011 the EGS system, considers a number of pre-
defined volumes of interest and joins regions out,side having tlie same density to form
a much smaller number of larger boxes (figure 11). If transport parameters i u such
boxes are considered less restrictive than in the volume of interest (see section 2. 3. 3),
further time reduction could be achieved.
4. 3. 4. Calcvlalions in brachytherapy. Wi th a few exceptions, most of the existing
Monte Carlo calculations in brachytherapy refer to dose distributions or specific dose
constants in water of lZ5I sources. On some occasions, the simulations have been based
on very detailed geometries.
Williamson et a/ (1983a) have simulated a well detector for the calibration of
sources, and found discrepancies with tlie predictions of the Sievert integral model.
This topic has been emphasized by Williamson el a / (1983b) using Monte Carlo simula-
tions of encapsulated sources to compare with the Sievert integral, consistently finding
overestimations of the exposure rate per unit activity predicted by the integral, Build-
894 P Andr ea
Figure 10. Monte Carlo calculated kernels of monoenergetic photon beams in water using the
code MCEF (Andreo 1980. 1981). Incident photon energies ar e 1, 5, 20 and 50 MeV (left-right,
topbottom). The kernels represent the distribution of the energy deposited by charged particles of
successive generations produced by photons interacting at a point situated at a depth of 60 mm (1 tic
= 10 mm). The importance of the electron transport (bright zone) at high photon energies can be
compared with that at l ow energies where most energy is deposited at the first point of interaction
(from Ahnesj6 1990).
up factors for low-energy photons (100-15 keV, including lZ5I) have been computed
by Herbold e l ol (1988) using EGS.
Webb and Fox (1979) have computed the dose distribution in water of a number
of point isotropic brachytherapy sources commonly used in the UK during the late
1970s, their results being given as radial distributions of the dose-rate. Dale (1982)
has included Rayleigh scattering in similar calculations for different tissues and nu-
clides (including lZ5l and 13'Cs), finding small disagreements with the specific dose
constants for water determined by Webb and Fox (1979). Further analysis of his data,
emphasizing the results for '"1, has been given by Dale (1983).
Dose distributions in water around commercially available '''I sources (seeds) have
been simulated by Burns and Raeside (1987). Scarbrough et al (1990) used the EGS
system and included K-edge photons to calculate similar distributions. Specific dose
constants for the same source model have been computed by Williamson (1988) using
the detailed geometry of the source and including the emission of K-, L- and M-edge
x-rays. Less sophisticated calculations have been performed by Cygler e l ~l (1990) to
investigate the effect of gold and silver backings using EGS. Chiu-Tsao el ol (1986)
Monte Carlo techniques in medical radiation physics 895
Figure 11. Details of an algoritbrn to joiu contiguous regions in a CT slice having tbe same density,
what decreaJ es the number of boundary crossing and checking during tbe Monte Carlo simulation. (a)
CT slices of an anthropomolphic Rando phantom, where a mandible level is selected. (b) CT matrix
(160 x 160) of the selected slice having a. spatial resolution of 2.2 nun x 2. 2 mm wi l l , CT nmnben
replaced by density; both air (oropharinx) and bone (mandible and vertebrae) are left without a grid
for sake of clarity. ( c ) Resulting image after the application of the UNION algorithm. which keeps the
same inhomogeneities border as tbe original matrix. (d) A large volume of interest is selected having
the same resolution as the original matrix; tbe nuniber of geometrical regions is considerable reduced
(from Manfredotti et a/ 1990, with perniieeion).
have used the MORSE code to compute lZ5I and 6oCo dose distributions at distances
used for eye plaque therapy and therefore snialler than in the simulations previously
cited.
896 P Andrea
4.4. Radiation protection
Specific Monte Carlo applications have been developed in the field of radiation
protection which can he classified as an additionalgroup to those considered in nuclear
medicine and x-ray diagnostic.
Following the mathematical descriptions of Snyder e l a/ (1969) of anthropomor-
phic phantoms for the MIRD-5 pamphlet, Cristy (1980) has developed age-dependent
hermaphrodite phantoms for the calculation of internal exposures. Extensive work on
sex-specific phantoms has been undertaken at Gesellschaft fur Strahlenund Umwelt-
forschung (GSF) for the calculation of dose from external photon sources in a variety
of situations. The mathematical phantoms Adam and Eva (figure 12) have been de-
scribed by Kramer et a/ (1982), and a number of reports have been published by GSF
dealing with organ doses after a number of diagnostic and therapeutic procedures (cf
Williams el a/ 1984, Drexler et a/ 1984, etc).
Figure 12. Perspective superpositions of verticd planes tllrougli the male (Adam) and leitiale (Eva)
mathematical phantom used i n Monte Carlo calculations of absorbed doses from external photon
sources (from Kramer el a1 1082, wi t h permission).
Calculations related to the ICRU sphere, instead of using anthropomorphic phan-
toms, have been performed by Dimbylow and Francis (1984) among others. An inter-
esting aspect of their photon Monte Carlo code is that it includes electron transport
(only under the continuous-slowing-down approximation (CSDA)), which is unusual in
radiation protection applications despite the high-energy photon limit usually consid-
ered (around 10 MeV). An up-to-date review of ICRU sphere calculations has been
given by Grosswendt (1988b).
A few applications in the field have been concerned with the shielding of medical
Monte Carlo techniques i n medical radiation physics 897
diagnostic or therapeutic units. Simpkiii (1990) has used the EGS system to compute
the transmission of x-ray spectra from computed tomography units through different
materials, the results being fitted to a specific analytical model. Nelson and LaRiviere
(1984) have combined calculations with the EGS and MORSE codes to evaluate the
shielding of medical x-ray accelerators of different energies (up to 25 MeV).
4.5. Applicalions based on microscopic Monte Carlo techniques
The need for Monte Carlo calculations based on the electrons detailed history (or mi-
croscopic) techniques was accentuated in section 2.3.2. Most applications in this area
have emphasized different aspects of the physics included in the codes. This can be
justified in terms of the complexity of the phenomena governing the transport of low-
energy electrons, and the main difference between existing codes and applications lies
in the details of how the different interactions are treated. Bremsstrahlung production
has been usually neglected due to the low energy of the incident electrons, although
some cases have considered initial energies and media where this assumption is not
justified. With a few exceptions the energy range of the primary electrons is mainly
below 100 keV. The consideration of secondary and higher-order generated electrons
is, however, a general difference between the two groups subjectively chosen here to
classify microscopic applications.
4.5.1. Eledron microscopy. Traditionally, electron microscopy and related areas have
not been included in the field of medical radiation physics. They have been included
in this review because the description of the physics included in the Monte Carlo codes
will help the reader to understand the more sophisticated approaches used i n some
applications dealing with radiation track structures and microdosimetry. Most devel-
opments in this area are based on existing theoretical cross sections. In what follows,
only applications including inelastic processes separated into different contributions
will be considered; simple approaches based only on individual elastic collisions and
the CSDA to account for energy losses (cf Williamson and Duncan 1986) will not be
discussed in this section.
For primary electron energies between 15 and 20 keV, Shimizu el al (197G) have
used a number of elementary excitation processes (conduction-electron, plasmon and
L-shell electron excitations) contributing to inelastic scattering. The approach has
provided good agreement with experiments for both energy and angular distributions
in aluminium films. A different model using Gryzinski excitation functions for both
core (L-shell) and valence electrons has been developed by Adesida el a1 (1980) for
materials where not all the inelastic functions are available; they also found good
agreement with experimental data for energy and angular distribution, together with
backscattering and transmission coefficients, for the same energy range i n aluminium,
silicon and PMMA. An interesting aspect of the latter approach has been the use of
the screening parameter of Nigam in the Rutherford elastic cross section, and the
consideration of angular deflections for each inelastic event. Further details of the
physical models used to account for elastic scattering and discrete contribotions to
inelastic scattering have been given by Kyser (1981), who has reviewed some of the
Monte Carlo techniques used in electron microscopy, microanalysis and microlithogra-
phy. Applications to magnetic contrast and spatial resolution have also been described
in this review.
Electron transmission, backscattering and absorption in solid targets have been
investigated by Akkerman and Chernov (1980) for incident energies in the range 10
898 P Andreo
to 30 keV, electron transport being simulated down to 100 eV. In this calculation,
electron-hole excitations computed from dielectric theory were added to plasmon ex-
citations and ionization processes. A comparison between individual collision and
condensed history techniques has been performed by Akkerman and Gibrekhterman
(1985) for electrons below 50 keV in different elements. They have found that the
two main errors in macroscopic techniques, namely the neglect of lateral deviation
along a path and the incorrect calculation of energy losses (due to neglect of plasma
and electron-hole excitations), might compensate for each other as the results appear
to be correct in some cases. Approximate atomic number and energy ranges for the
validity of condensed history techniques have been suggested in this interesting work.
A different approach to deal with energy losses from all inelastic collisions has
been developed by Liljequist (1985) with a simple generalized oscillator-strength
density model. Although the model was applied to conversion electron Mossbauer
spectroscopy, the simplicity of the resulting Monte Carlo code has been strwed in
successful comparisons with some of the more sophisticated approaches previously
referred to.
Applications including higher energies have been developed by Terrisol and Patau
(1978); they have calculated energy loss distributions for 1 MeV electrons crossing
aluminium foils with thicknesses i n the micrometre range; they found good agreement
with experimental results obtained with electron microscopes. Their Monte Carlo code
is based on calculations of the mean free path using an elastic screened relativistic
Mott cross section (taken from Berger et a/ 1970) and inelastic processes consisting of
ionization (Gryzinski cross sections) and excitation in the conduction band. Martinez
and Balladore (1979) have calculated angular and spatial distributions, and related
beam transmission at different angles, for 1-3 MeV electrons scattered by gold and
carbon foils with different thicknesses.
4.5.2. Radiaiion irack structure and microdosimetry. Although initial developments in
the field were based on theoretical cross sections, the importance of experimental data
at low-energies to overcome limitations of the existing theories was acknowledged in
the late 1970s. Many of the experiments available have been performed for gases, and
data have been extrapolated to condensed media, or extended to other energies, using
Fano plots. Different aspects of the techniques used in this area have been excellently
reviewed by Pareztke (1987), which together with the more updated compilation of
data given by Groaswendt (1988a), constitute a valuable source of information in this
area.
As in many other aspects of Monte Carlo electron transport, pioneer calculations
by Berger have greatly contributed to later developments in the field. A Class 11-like
procedure has been used by Berger (1970) to calculate energy spectra and spatial
distributions of energy deposition from 5 keV electrons in spherical regions in water.
The transport has considered all individual elastic scattering events, as well as inelas-
tic collisions producing knock-on electrons with energies greater than 200 eV. Energy
losses between collisions have been calculated using a stopping-power restricted to
200 eV. This initial work has discussed some of the limitations of the cross sections
used (screened Rutherford and Mdller), mainly those aspects related to the screen-
ing correction of the elastic cross section and binding effects in the inelastic collisions.
Both limitations have been approximately corrected for in later calculations of the spa-
tial distribution of energy deposited in the atmosphere by Berger el a/ (1970), where
limitations of the Moliere screening parameter have been analysed. The resulting code
Monte Carlo fechni pes in medical radiation physics 899
has been used further by Berger (1972) to calculate spatial distributions of absorbed
dose in water for different electron energies and emission angles in tracks of heavy
charged particles, and to determine microdosimetric event-size spectra from tritium
Prays in micro-spheres in water and propane. Further detailed calculations of elec-
tron kernels i n water (cf Berger 1973) together with statistical distributions of energy
deposition events and their perturbation in gas-filled cavities surrounded by solid walls
have been reported by Berger (1974).
Researchers at ORNL have undertaken a project to build a Monte Carlo electron
transport code (OREC) based on a large number of inelastic cross sections for liquid
water, calculated mainly from dielectric response functions and experimental data.
Up to 21 separate events, from ionization and excitation to radical formation and
dissociative events, have been reported by Hamm el a1 (1976) to obtain mean free
paths used during the Monte Carlo procedure to calculate kernels of 1 and 10 keV
electrons down to 10 eV in water. The same code bas been used by Hamm el a/
(1978a) to study probability distributions for the number of ionizations and distri-
butions of energy-loss in different size volume elements, together with single-event
spectra. Electron slowing-down spectra in liquid water and statistical fluctuations in
the ionization yield for primary electrons between 1 keV and 1 MeV followed down to
10 eV have been calculated by Hamm et a1 (1978b); at low energies, energy spectra
and spatial correlation of energy transfer were found to be nearly independent of the
initial electron energy in agreement with previous findings of Paretzke (1976) in water
vapour using the code MOCA (cf Paretzke et al 1974).
The importance of low-energy secondary electrons in the mechanisms of energy
absorption and track structure of low LET particles has been emphasized by Paretzke
(1976) at GSF, using a Monte Carlo code largely based on experimental cross sections
for water vapour (figure 13). A comparative joint study between distributions of differ-
ent quantities in water in liquid and vapour phases (single collision and slowing-down
electron spectra, spatial distributions of energy deposition, etc) has been performed
by Turner el a/ (1982) using the codes OREC and MOCA developed at ORNL and GSF
respectively.
Berger (1981) has discussed the spatial correlation of ionizations i n water in terms
of a restricted ionization yield (defined as the number of ionizations, per 100 eV, which
are preceded by another ionization on the track within a distance s or closer) which
has been calculated for various separation distances s and electron energies up to
1 MeV. The calculations apply to liquid water, hut experimental (extrapolated) data
for water vapour have been used for excitation, dissociative excitation and ionization
interactions; elastic scattering bas been based on atomic cross sections for hydrogen
and oxygen together with experimental data at some energies. These results have
indicated that most significant spatial correlations occur in regions of the order of
nauometres, but not in micrometre regions.
Track structures in liquid water including the production of ions and excitations
have been described by Terrisol and Patau (1981) for 30 keV electrons in liquid wa-
ter, which have been used in the calculation of proximity functions. Turner el a/
(1983) have included the detailed time evolution of chemical species around tracks in
water, developing a model to describe the formation and spatial distribution of such
species after electrons have been slowed down to 7.4 eV (assumed threshold for elec-
tronic excitation of liquid water); the Monte Carlo code has been used to calculate
Fricke G-values for 5 and 1 keV electrons. The code has been re-examined by Wright
et a1 (1985) regarding details of the pre-chemical and chemical reaction stages, and
900 P Andrea
Figure 13.
(adapted from Paretzke 1987, with pemission).
significant improvements have been reported for the calculations of physical and chem-
ical reactions produced in irradiated water containing DNA. In a recent application of
this code Bolch el a/ (1990) have investigated the production of free ammnonia in
aquaeous solutions of glycylglycine, irradiated by x-rays and 6oCo y-rays, whose ra-
diation chemistry is relatively simple; very good agreement with experimental results
has shown the result of a unique attempt at simulating, on a nanometre scale, the
events occurring within an irradiated solution.
Calculations for gases have been performed by different groups at Toulouse
(University Paul Sabatier) and Braunschweig (Physikalisch-Technische-Bundesanstalt,
PTB) which are largely based on experimental data for different gases. The difficulty
in collecting data explains why, in general, each independent investigation has dealt
with only a few gases. Terrisol and Patau (1974) have simulated the transport of 1
and 0.5 keV electrons down to 20 eV in hydrogen to calculate energy deposition distri-
butions, ranges, and W values (both for ionization and excitation) which were found
to be in good agreement with experimental results from other investigators. Their
code was based mainly on theoretical cross sections for ionization and excitation. Fur-
ther improvements, considering total inelastic cross sections based on experimental
data, have been developed by Terrisol el a/ (1976) to calculate similar quantities and
event-size spectra in different gases (oxygen, nitrogen, carbon dioxide, methane, air,
etc). Terrisol ef a/ (1978) have extended these calculations to liquid water. Distri-
butions of spatial energy dissipation and ionization, practical ranges, W values and
backscattering coefficients in nitrogen and air have been calculated by Grosswendt
and Waibel (1978); electron energies between 50 eV and 5 keV were considered in
this investigation, which also included the influence of electrostatic fields existing in
typical ionization chambers. The treatment of elastic scattering was based on the
Elutic, ionization, and excitation cross sections for electron impact on wat er vapor
I
Monle Carlo lechniques i n medical radiation physics 90 1
developments of Berger el al (1970), whereas for ionization and excitation processes
existing analytical functions were used. Similar quantities have been calculated in
methane by Waibel and Grosswendt (1983). Electron slowing down spectra in hydro-
gen and statistical fluctuations in the ionization yield for primary electrons between
20 eV and 5 keV have been calculated by Grosswendt (1982), and by Grosswendt
and Waibel (1985) in methane, carbon dioxide and a gaseous mixture of methane and
argon.
5. Inverse Monte Carlo tecliniques
The term Inverse Monte Carlo (IMC), a concept introduced by Dunn (1981), has
been used to describe a numerical method for solving a class of inverse problems.
I t has been used successfully in nuclear medicine imaging using SPECT (Floyd el al
1985c, 1986a, b) and in the design of compensating filters for photons in radiotherapy
accelerators (Dunn el al 1987). Other applications have been developed which are
based also on this technique although different terms, like inverse treatment planning
(cf Lind and Brahme 1987) have been used. The basic concepts of IMC will now he
introduced following the development of Dunn (1981).
A general formulation can be used to describe the calculation of the expectation
value (r(y)) from the outcome r(z,y) of a stochastic process which is a function of
the random variable I and perhaps another independent variable y:
J - CU
where f(z) is a probability density distribution governing the variable I.
A conventional Monte Carlo technique, henceforth called direct, will estimate
(r(y)) at discrete values of y, given z( x, y) and f(z). By the law of large numbers
(sum of a large number of random variables converges to the expected mean value) i t
can be written
where & is a random sample from I(.). i (y) is a Monte Carlo estimate of ( ~ ( y ) ) , i.e.
The IMC technique used to solve equation (5) consists of finding f(z) given z( z, y) and
z(y) at discrete values of y, which is equivalent to solving a Fredholm integral equation
of the first kind. Two different, procedures have been used to solve this equation using
Monte Carlo methods, and both have been called IMC in the literature.
One procedure is based on iterative direct Monte Carlo calculations. I n general
there will be a set of parameters a of the desired function f , i.e. f(z, a) ; the approach
consists in searching these parameters a unt,il some objective function O( a) is mini-
mized. The method, in gencral, is to choose an initial estimate of ai, perform a direct
Monte Carlo simulation sampling from the assumed f(x, a, ) to compute i (yi ), and
then iterate the Monte Carlo simulation until the calculated i(yi) matches the known
902 P Andreo
value of r ( y ; ) . The direct simulation is performed for each discrete value z(y) where
all the parameters a are iteratively searched. Some approaches of this type simply
select a set of parameters a at random, compute a model (which can be a simple func-
tion) and compare with predicted or experimental data to decide if the parameters
are acceptable or not (cf Keen and McGreevy 1990).
The second procedure consists in non-iterative Monte Carlo simulations, and is
based on inversion techniques as will be seen later; at some stage the method involves a
direct (non-iterative) Monte Carlo simulation to obtain the function z(z, y), sometimes
referred to as the kernel. As inversion methods are very often based on iterative
techniques, this way of solving the final step of the procedure has added confusion
to the iterative or non-iterative characteristics of the simulation itself. In the present
work, the term non-iterative IMC is then used for an inversion method based on a
non-iterative Monte Carlo simulation, and this is independent of the technique used
t o treat the inversion problem itself.
The non-iterative I MC is strongly related to the variance reduction technique in
direct simulation called importance sampling, where the sampling process from f(z) is
altered by using random numbers from a modified distribution, f'(z), instead. This
introduces a bias which is corrected for with a weighting factor f ( z ) / p( z ) , so that
the estimate F ( y ) is an unbiased estimator of ( ~ ( y ) ) , that is
where ti is a random sample from f'(z). A typical example is when photon
interactions are forced to occur within a given distance A, where the conventional
sampling of the distance between interactions, given by equation (3), is substituted
by the importance sampling described by
s = -Xin[l- [(I - e-'/')]
(11)
where the weight factor is (1 - e-'/').
In the non-iterative IMC, given 11 discrete values of y at which z( z, y) and t ( y ) are
known, the approach consists in finding a set m(m 5 n) of parameters a o f f , such
that
f(z) = aj z E (.j,zj+i)>.i = . . , m
= O otherwise
or
Monte Carlo iechnigues i n medico1 radiolion physics 903
Using imporlance sampling, the method involves one direct simulation using an as-
sumed known probability density distribution f ( z ) such that
whexe ti are sampled from f ( z ) . Everything is known in this expression except the
a, i.e. it consists of a system of n equations with m unknowns that can in principle
be solved, at least numerically. I f f is linear in a, then
which can be solved by straightforward matrix inversion. I f f is nonlinear in a then
a nonlinear inversion is needed. The method is then a single-step procedure, that is
just one direct simulation is needed and therefore the Monte Carlo process is non-
iterative. Depending on the specific problem, the elements of [ A] computed with
one direct simulation may not be adequate to construct all the elements of (21. I n
this case a different simulation would be required for each element of [ z ] although
approximations have been used to avoid this requirement.
An interesting application of the non-iterative IMC method has beeu performed by
Floyd el a1 (1986a, b) for image reconstruction from acquired projection profiles in
SPECT. Equation (15) was written as
where pj describes the projection data, si the source distribution, and t i j represents
the contribution to each projection element j of the scatter from each source element
i in a phantom. [ t i j ] is calculated using a single direct simulation, identical to those
used in scatter correction techniques, to determine the matrix of probabilities for the
phantom-camera setup. The source has been assumed to have rotationally symmetric
attenuation, and the simulation performed for only one projection angle; values for
other angles were obtained by interpolation on a cylindrical grid. In subsequent steps,
given the acquired clinical projections P , the inversion of equation (16) determines the
imageS. The reconstruction discussed here yielded 11 520 (64 x 180) equations in 4096
(64 x 64) unknowns, where the use of an array processor reduced the computation time
to a few seconds per iteration during the inversion procedure. Further developments
have been performed by Floyd et a1 (1986b) for the improvement of the inversion
procedure using a Maximum Likelihood Estimation algorithm.
A similar technique has been used for optimizing of radiation therapy treatment
planning (also referred to as inverse treatment planning), cf Lind and Brahme (1987),
where equation (15) has been written in the form
I n this case dj describes the desired dose distribution in the target volume (see fig-
ure 14), ki j is the contribution from the elementary irradiation kernel j at position i,
and fi is the spatial distribution of the source (kernel density) which has to be calcu-
lated. The kernel It = [ k i j ] is calculated using a single direct Monte Carlo simulation
as described in section 4.3.3.
904 P Andreo
Figure 14. Illustrationof the use of non-iterative ( I MC) techniques to generate auni fom dose in the
target volume (oesophagus) by scanning s multileaf collimator over the palient. Slit photon beam
kemels, K , based on direct non-iterative Monte Carlo calculations of energy deposition kernels using
the MCEF code ( Ki h a n et a1 1988), are scanned with a density F to generate the required incident
beam D. In the IMC procedure D and K ar e known, and F is determined by inverse techniques
(adapted from Brahme et 01 1988).
Dunn el ol (1987) have applied the method for the design of compensating filters
in high-energy photon therapeutic beams, where the goal is to produce a desired
photon fluence profile Q at certain depth. For simplicity the application considered
solid angles subintervals to specify photon directions and filter thicknesses, Q(n,) and
t ( n j ) , using M subregions (subindex k) i n the phantom and m subregions (subindex
j) in the filter. I n this case, equation (15) was written in the form
[QIM = I A l ~ , m [ ~ l m + ~ [ B l ~ , m [ P l m (18)
where aj = e-#*; (j = 1,. . , , m solid angle elements), p is the total attenuation
coefficient, pj = ( 1 - aj) and e = C T C ~ ~ ~ ~ ~ ~ / ~ . Elements Ak,j are the direct Monte
Carlo determinations of photons that do not interact in a unit thickness filter and
Bk,, those that do interact, obtained from one simulation including interactions in the
phantom. Equation (18) has to be solved for each t ( Oj ) , which i n the case A4 = m can
be achieved using simple matrix inversion and in the case M > m requires nonlinear
techniques.
In some of the practical cases reported in this section, most efforts have been
directed towards the inversion procedure needed to solve equation (15), or equivalently,
equations (16-18). I t is important to point out that the term non-iterative IMC can be
applied only in those cases where the kernel is obtained using Monte Carlo methods,
but not when i t is obtained by analytical means. The situation can be compared
with the use of convolution methods using photon kernels in radiotherapy, where both
Monte-Carlebased and analytical kernels have been used.
6. Vectori zed and parallel Monte Carl o siniulatioii
Most Monte Carlo applications referred to dnring this work have been developed on
traditional or scalar computers where each instruction is processed one at a time (single
Monte Carlo techniques in medical radialion physics 905
instruction, single data stream, SISD). Vector computers where a single instruction is
executed simultaneously on an entire list of numbers or vector (single instruction,
multiple data streams, SIMD), have been proved to yield much higher performances.
The CRAY-1, first installed in the middle 1970s, was the first commercially successful
vector processor, initiating the era of supercomputers.
Only a couple of years ago, supercomputer speed was measured in MFLOPS (lo6
floating-point operations per second). This was the unit specified by Nahum (1988a),
who has used a benchmarking study by Dongarra (1988) to est,imate the CPU time
needed by different computers to calculate a radiotherapy photon-beam dose distri-
bution with an uncertainty of 2% in a phantom divided into 5 mm sided cubes. This
would take about 500 h on a VAX-11/780 (0.25 MFLOPs using single precision in the
Dongarra study). An estimation of about 600 h to achieve the same uncertainty has
been given also by Mackie (1989) for 10 million electron histories between 5 and 25
MeV, which is one order of magnitude larger than that specified by Nahum (1988a) for
electron beams. Nahum estimated that a CR.AY supercomputer, rated at 15 MFLOPS,
would need ahout 4.5 h for the photon calculation.
Todays large machines meamre their speed in GFLOPS (10 operationsfs), and
present performance figures make direct treatment planning on patients perfectly fea-
sible. An estimation based on Dongarras results for a CRAY Y-MP/832 (8 processors,
6 ns clock cycle) running the LINPACK test, 195 MFLOPS, can be used to verify this
statement; one arrives at a figure of about 50 min for the radiotherapy calculation.
The specifications given by Leghart (1990) for the CRAY Y -MP, the present CRAY C-90
(16 processors, 4 ns clock cycle), and the next gallium arsenide (GaAs) based CRAY-3
(16 processors, 2 us clock cycle), can also be used to estimate peak performancest of
2.7, 8, and 16 GFLOPS respectively. Assuming that the peak-performancefL1NPACK-
test ratio remains approximately constant, it can he estimated that the GRAY C-90 and
the CRAY-3 would need 16 and 8 min, respectively, to perform the treatment planning
calculation using a phantom divided into 5 mm sided cubes and 2% uncertainty.
The CRAY-4 (planned for 1992) will operate at a clock rate of 1 ns and deliver 128
GFLOPS using 64 processors (Bell 1989). Tomorrows speed (about 1995), with the
full development of massive parallel-processing supercomputers, will he measured in
TFLOPS operationsfs), i.e. the power ofmore than 10 million personal computers.
Any estimation done with supercomputers today will therefore be obsolete in a few
years.
As a consequence of the immense speedup of calculations in different areas of sci-
ence with the use of vector machines, i n combination with highly vectorized programs,
Monte Carlo researchers have turned their efforts towards the vectorization of Monte
Carlo codes. This means the reorganization of a program so that the maximum number
of operations can he executed through vector processing. However, the conventional
t According t o Dongsma (1988), the peak performance is a theoretical figure given by computer
mandacturelg when describing a system. I1 is obtained by counting the nuniber of floating-point
additions and multiplications (full precision) thal can be completed during a period of time, usually
the clock cyde time. A GRAY c-90, with a clock cycle of 4 m during which bolh an addition and a
multiplication can be completed in each one of its possible 16 processors yields
I
2 operations 1 cycle
I cycle 4 ns
16 processors =8 GFLOPS
906 P Andrea
Monte Carlo approach with a history-based algorithm, where particle histories are
independent, does not lend itself to vectorization. This is due to the random nature
of the particle simulation, where each step of a history is determined by statistical
means, which naturally influences other possible generated particles. As each particle
follows its own random walk, an array of particles cannot be operated in common
and therefore the vector approach where identical instructions are performed on each
vector element (particle) will fail. In addition the computer coding of the simulation
process involves many conditional statements which inhibit vector processing.
An alternative to the history-based Monte Carlo coding has been suggested with
event-based codes, where a vector of particles is processed for one type of event (free
flights, collisions, boundary crossings and termination of the histories). This approach
fulfils the requirements of the vectorized concept. Brown and Martin (1984) have
analysed in detail the configuration of Monte Carlo codes for vectorization, connecting
the scalar and the vectorial approach. A review of vectorized Monte Carlo has been
performed by Martin and Brown (1987), where they describe variations of event-
based algorithms together with speedup results published by different groups on both
neutron and photon transport simulations with vectorized codes.
There are some important aspects in the vectorization and use of vectorized codes
which deserve comments. The programming effort needed to recode an existing Monte
Carlo code is a significant undertaking, together with the benchmarking of the new
code against the old scalar code. The vectorized code can only be executed on a
vector machine. Even if most of the published comparisons between vectorized and
scalar codes show asignificant speedup factor with vector machines (Brown and Martin
(1984) have reported speedups of up to 40 times), the real breakthrough for vectorized
Monte Carlo in particle transport has riot Iriaterialized. There are large discrepancies
in the vectorjscalar performance ratio reported by different authors, but for a well
known code like EGS4, Miura (1987) has reported a modest speedup of 8 times with
the vectorized EGS4V.
Supercomputer technology has evolved into smaller, mass-produced systems, mini-
supercomputers and parallel processor environments. Mini-supercomputers, deliver
about a quarter to half the performance of a supercomputer for only one-tenth of the
price. With the market now dominated by Convex, DEC and IBM have just entered
in the arena with the VAX woo (16 ns clock time, up to 500 MFLOPs with 4 processors)
and J -models in the 3090 series (14.5 ns) respectively, and the new IBM Summit
generation is expected soon (cf Emmen and Hollenberg 1990). By 1991 almost half
of all high-performance mini-supercomputers will use parallel processing technology,
compared with 22% in 1986 (Leghart 1990).
Parallel processing utilizes multiple arrays of CPUS operating in union, allowing
the computers to process information 10 to 100 times faster than older single-processor
systems. Parallel computers are designated as MI MD, multiple instruction streams in-
dependently operating on multiple data streams. Several architectures are available, a
widely accepted classification being the shared-memory multiprocessor concept (with
a common bus connecting all CPUS) and the multicomputer concept where each proces-
sor has its own small RAM and communicates with other processors through high-speed
serial links (cf Stein 1988, Bell 1989). A drawback of the shared-memory configuration
is the limited bus bandwidth, which can be saturated when different processors try to
access the memory simultaneously. This is called the von Neumann bottleneck, which
does not exists in multicomputer architecture.
Communications are the central problem for parallel computers when a host
Monte Carlo techniques in medical radialion physics 907
processor is connected to an array of perhaps hundreds of parallel processors, each
with its own memory. Solutions like hypercube computers have been developed, where
the processors are connected together as if they were at the corners of a multidimen-
sional cube. The Intel iPSC can have 128 node processors, each based on a 80836 chip;
all are connected via Ethernet to a host computer, also 80836-based. The NCUBE fits
8192 processors in such architecture, achieving 27 GFLOPS. A forthcoming Connection
Machine will have 65536 processors, etc. New classifications have been suggested for
parallel computers: those with less than 33 processors are called moderately parallel;
between 33 and 1000 processors are highly parallel; and those with more than 1000
are classified as massively parallel (Leghart 1990).
Special attention has been given to the so called transputer, a small multicom
puter building block whose design lends itself to parallel computingeven in a personal
computer. The transputer T800 from INMOS is a processor with 2 or 4 Mbyte of RAM.
Operating at 30 MHz, it delivers 2.25 IEEE 32-bit MFLOPS. I t incorporates 4 Kbyte
of on-chip static memory (not cache memory per se) and four link interfaces used for
communication with other transputers at a capacity of 120 Mbit s- link I / o , the
equivalent of 12 Ethernets (Stein 1988). Plug-in boards have been developed for both
the IBM PC and the Macintosh. Connecting several transputers together thus form a
multicomputer system where the simulation of different particles can, in theory, run
independently on each processori~thus making a parallel machine out of a personal
computer.
Although parallel architecture seems to he the ideal solution for Monte Carlo
calculations, software aspects represent again the primary bottleneck to a rapid im-
plementation. Design of true parallel processing operating systems, taking care of the
communication between different processors, and the design of optimization language
compilers, distributing computational loading among the processors while keeping
input and output data in a host computer, are the major obstacles of the implemen-
tation. Debugging tools are also difficult to develop for similar reasons. Software has
been one of the key problems slowing down the acceptance of parallel processing, and
whereas hardware speed has increased at a compound rate of 3% per month, yield-
ing to a thousand-fold improvement over. the past 20 years, software development has
increased only at a compound rate of about 5% per year (Leghart 1990).
A more realistic approach in medical physics Monte Carlo calculations can be
achieved today by using existing or newly built networks in hospital environments.
Figure 15 shows results obtained running the code MCEF on different computers, where
depth-dose distributions in water for plane-parallel electron beams of5 MeV have been
calculated. Some interesting aspects can be observed. First the Convex C-210 mini-
supercomputer, running in scalar mode, is about 16 times faster than a VAX-11/780,
microVAX-I1 etc, but i t is only 5 times faster than a micr0VAX-3800 and a VAXstation
3100/38 operating under VMS, or an HP 9000/375 workstation (Motorola68030 at 50 Hz
with cache memory) operating under Unix (HP-UX). This shows that under certain
circumstances, standard benchmarks (such as LI NPACK, which has yielded 12 MFLOPS
for the Convex C-210 in the Dongarras study) can be misleading and that to gauge
a systems performance accurately, the benchmark program should resemble that for
which the system will be used. Second, a Macintosh Ilfx (68030 at 40 Hz, no cache
memory) runs the code practically at the same speed as a microVAX-3600 and a
VAXstation 3100/30 under VMS, or the HP 9000/370 workstation under Unix (68030
at 33 Hz with cache memory). This is about the same speed as reported by Ma
and Nahum (1990) running EGS4 on one T8oo transputer. In a short time the new
908 P Andreo
VAXSt 3100138
VAXst 3100130
VAX 8200
VAX 780
VAX 750 FPA
mi croVAX II
ml croVAX 3800
mi croVAX 3500
Maci ntosh i Ix
Maci ntosh l l f x
HPs1 90001370
HPsl 90001375
Convex C-210
5 MeV electrons in water
full cascade Simulated down Io 275 keV
0 5 10 15 20
Performance relative to a VAX-111780
Figure 15. Comparison of Monte Carlo calculations on different computers using the code MCEF to
simulate the transport of 5 MeV electrons in water. CPU times are normalized to that of a VAX.IIIIBO
computer. The insert shows an enlargement of the results obtained with computers typically existing
at a hospital environment. All VAXes operating under VMS, Convex and HPS under Convex Unix and
HP-UX respectively.
Motorola 68040 chip will be available, increasing these performances. A network
based on such micro or minicomputers can emulate the performance of a Convex
mini-supercomputer at a small fraction of the cost, thus making it possible to perform
today's lengthy Monte Carlo simulations at much higher speed. Similar solutions have
been presented by Mackie (1989) at a slightly higher cost using RI%-based (Reduced
Instruction Set Computing chips) DEC stations claiming the speed equivalent of 100
VAX-11/780 computers. Improved performances can be obtained today with the new
IBM RS/GOW RISC workstations, that running the LINPACK benchmark at a rate of 7.5
MFLOPS have become the fastest floating-point units available, outside of a mainframe.
A final important item in recent computer technology has been the new (RISC) scalar
chip Intel 80860. According to Margulis (1989) this 'personal supercomputer' or 'one-
chip supercomputer' can operate up to 50 MHz and achieve superscalar performance
executing three operations per clock cycle (the 1BM RS/600 also shares such capability).
At 40 MHz, the Intel 80860 yields 10 MFLOPS for the LINPACK benchmark, or 33 VAX
MIPS (million VAX-like instructions/s) for the Stanford integer benchmark.
7. Concl usi ons
The large number of applications referred to in this work shows the usefulness, and
considerable success, of the Monte Carlo method as an instrument in different areas of
medical radiation physics. The different techniques used in the field have contributed
to the development of sophisticated calculational tools of great value in radiation
Monte Carlo techniques i n medical radiation physics 909
physics. The increasing availability of fast computers and networks at hospitals, and
the existence of well documented and supported public codes, will surely enlarge the
number of scientific applications and communications in the future.
I t is however important to be aware of the limitations of the method. The Monte
Carlo method is not a magic black box that provides the correct answer to all kind
of simulations. Some shortcomings of the commonly used macroscopic techniques for
electron transport, for example, have been discussed in this review. These suggest the
combination of macroscopic and microscopic techniques in energy ranges or geometries
where each technique is most efficient. A major issue refers to approximations which
are only valid for certain applications, like the neglect of electron transport, but which
have been implemented in applications where they are not valid, yielding erroneous
resnl ts .
Tests and comparisons of the Monte Carlo code being used with other wel l known
codes and experiments is mandatory; even if the actual simulation cannot be com-
pared, i t is always possible to select related cases for which results are avai l abl e. Un-
fortunately a non-negligible percentage of the existing codes have not been compared
with other codes or experimental results. A recommendation can be given here: Be
sceptical of the results of anybody elses Monte Carlo computer code. Be especially
sceptical of your own code. No matter how you word your disclaimer, you wi l l still
carry the can filled with your own bugs (Bielajew 1990a, private communication).
Acknowl edgments
Detailed comments and suggestions on t,he manuscript from Anders Brahme, Annette
Fransson and Alan E Nahum are gratefully acknowledged. Sincere thanks are due to
colleagues Alex Bielajew, Rock Mackie and Dave Rogers for their contributions to the
field and discussions during many years; very special thanks to Martin Berger and
Alan Najum.
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