ABSTRACT: We examined the adequacy of existing shielding guidelines using five-year clinical data from a busy CyberKnife center. From June 2006 through July 2011, 1,370 patients were treated with a total of 4,900 fractions and 680,691 radiation beams using a G4 CyberKnife. Prescription dose and total monitor units (MU) were analyzed to estimate the shielding workload and modulation factor. In addition, based on the beam's radiation source position, targeting position, MU, and beam collimator size, the MATLAB program was used to project each beam toward the shielding barrier. The summation of the projections evaluates the distribution of the shielding load. On average, each patient received 3.6 fractions, with an average 9.1 Gy per fraction prescribed at the 71.1% isodose line, using 133.7 beams and 6,200 MU. Intracranial patients received an average of 2.7 fractions, with 8.6 Gy per fraction prescribed at the 71.4% isodose line, using 133 beams and 5,083 MU. Extracranial patients received an average of 3.94 fractions, with 9.2 Gy per frac- tion prescribed at the 71% isodose line, using 134 beams and 6,514 MU. Most- used collimator sizes for intracranial patients were smaller (7.5 to 20 mm) than for extracranial patients (20 to 40 mm). Eighty-five percent of the beams exited through the floor, and about 40% of the surrounding wall area received no direct beam. For the rest of the wall, we found "hot" areas that received above-average MU. The locations of these areas were correlated with the projection of the nodes for extracranial treatments. In comparison, the beam projections on the wall were more spread for intracranial treatments. The maximum MU any area received from intracranial treatment was less than 0.25% of total MU used for intracranial treatments, and was less than 1.2% of total MU used for extracranial treatments. The combination of workload, modulation factor, and use factor in our practice are about tenfold less than recommendations in the existing CyberKnife shielding guidelines. The current guidelines were found to be adequate for shielding, even in a busy center. There may be a potential to reduce shielding in areas with no or few direct beams in the current G4 model. Since a newer model CyberKnife (M6) has recently been introduced, the patterns of usage reported here may be changed in the future. The uneven distribution of use factor we have found may, however, be considered in the vault design.
