A study of the shielding used to reduce leakage and scattered radiation to the fetus in a pregnant patient treated with a 6-MV external X-ray beam.

A Monte Carlo-based procedure has been developed to assess the shielded fetal doses from 6 MV external photon beam radiation treatments and improve upon existing techniques that are based on AAPM Task Group Report 36 (TG-36). Anatomically realistic models of the pregnant patient representing 3- and 6-mo gestational stages were implemented into the MCNPX code together with a detailed accelerator model that is capable of simulating scattered and leakage radiation from the accelerator head. The phantom was shielded using suggested lead and Cerrobend in different locations and with different thicknesses. Absorbed doses to the fetus both with and without shielding were calculated considering typical mantle, head and neck, and brain treatment plans. The unshielded fetal doses tended to increase with decreasing distance from the field edge to the nearest fetal point and increasing of the field size. The unshielded absorbed doses to the fetus for all treatment plans ranged from a maximum of 4.08 microGy/MU (monitor unit) to a minimum 0.09 microGy/MU. The use of lead or Cerrobend shielding reduced the fetal doses by factors of up to 4. For an optimal shield half-value layer, the dose reduction between lead and Cerrobend was statistically insignificant. The maximum permitted MUs for the mantle treatments with shielding were calculated based on 5 cGy dose limits suggested by TG-36. The study demonstrates an accurate assessing tool that can be used to determine the absorbed dose to the fetus and to design the shielding as part of the treatment planning and risk management.