Precise radiochromic film dosimetry using a flat-bed document scanner

Investigation of intracranial peripheral dose arising from the treatment of large lesions with Leksell GammaKnife Perfexion

This investigation involves quantifying the extent of intracranial peripheral dose arising from simulated targets situated in the skull-base or upper-spine region using the Leksell GammaKnife Perfexion treatment unit. For each of three spherical target volumes--denoted as Vs (4 cm3), VM (18 cm3), and VL (60 cm3)--three treatment plans were manually generated, one for each of the three collimator sizes--4, 8, and 16 mm. Each of the plans was delivered to a spherical dosimetry phantom with an insert containing EBT Gafchromic film. The total dose at 70 mm from the targets' edges, %D(70 mm), was measured as a function of elevation angle and expressed as a percentage of the prescription dose. The film insert was placed centered in the median sagittal plane (Leksell X = 100) and %D(70 mm) was measured for the angular range from 0 degree (superior/along Z axis) to 90 degrees (anterior/along Y axis). For a given collimator i, the irradiation time ti to treat a spherical target of volume V using the 50% isodose line was observed to follow a power-law relationship of the form ti = Ai(V/ Vi)n where Ai was the maximum dose divided by collimator dose rate and Vi was the volume encompassed by the 50% isodose line for a single shot. The mean value of n was 0.61 (range: 0.61-0.62). Along the superior (Z) direction (angle=0 degree) and up to angles of around 30 degrees, the %D(70 mm) was always highest for the 4 mm plans, followed by the 8 mm, followed by the 16 mm. In this angular range, the maximum measured %D(70 mm) was 1.7% of the prescription dose. The intracranial peripheral dose along the superior direction (combined scatter and leakage dose) resulting from irradiation of upper-spine or base-of-skull lesions is measured to be less than 2% of the prescription dose, even for very large (60 cm3) targets. The results of this study indicate that, for a given target volume, treatment plans consisting of only 4 mm shots yield larger peripheral dose in the superior direction than 8 mm shot only plans, which in turn yield larger peripheral dose than 16 mm shot only plans.

Evaluation of the eclipse electron Monte Carlo dose calculation for small fields

Varian Medical Systems (Palo Alto, CA) has implemented the Monte Carlo electron dose calculation algorithm (eMC) in the Eclipse treatment planning system. Previous algorithms for electron treatment planning were limited in their calculation ability for small field depth doses and monitor units. An old rule of thumb to approximate the limiting cutout size for an electron field was determined by the lateral scatter equilibrium and approximated by E (MeV)/2.5 in centimeters of water. In this study, we compared eMC calculations and measurements of depth doses, isodose distributions, and monitor units for several different energy and small field cutout size combinations at different SSDs. Measurements were made using EBT film (International Specialty Products, Wayne, NJ) and a PinPoint ion chamber (PTW‐New York Corp., Hicksville, NY). Our results indicate that the eMC algorithm can accurately predict depth doses, isodose distributions, and monitor units (within 2.5%) for field sizes as small as 3.0 cm diameter for energies in the 6 to 20 MeV range at 100 cm SSD. Therefore, the previous energy dependent rule of thumb does not apply to the Eclipse electron Monte Carlo code. However, at extended SSDs (105–110 cm), the results show good agreement (within 4%) only for higher energies (12, 16, and 20 MeV) for a field size of 3 cm.

PACS number: 87.53.Hv

Optimizing the dynamic range extension of a radiochromic film dosimetry system

The authors present a radiochromic film dosimetry protocol for a multicolor channel radiochromic film dosimetry system consisting of the external beam therapy (EBT) model GAFCHROMIC film and the Epson Expression 1680 flat-bed document scanner. Instead of extracting only the red color channel, the authors are using all three color channels in the absorption spectrum of the EBT film to extend the dynamic dose range of the radiochromic film dosimetry system. By optimizing the dose range for each color channel, they obtained a system that has both precision and accuracy below 1.5%, and the optimized ranges are 0-4 Gy for the red channel, 4-50 Gy for the green channel, and above 50 Gy for the blue channel.

A comprehensive evaluation of the PRESAGE/optical-CT 3D dosimetry system

This work presents extensive investigations to evaluate the robustness (intradosimeter consistency and temporal stability of response), reproducibility, precision, and accuracy of a relatively new 3D dosimetry system comprising a leuco-dye doped plastic 3D dosimeter (PRESAGE) and a commercial optical-CT scanner (OCTOPUS 5x scanner from MGS Research, Inc). Four identical PRESAGE 3D dosimeters were created such that they were compatible with the Radiologic Physics Center (RPC) head-and-neck (H&N) IMRT credentialing phantom. Each dosimeter was irradiated with a rotationally symmetric arrangement of nine identical small fields (1 x 3 cm2) impinging on the flat circular face of the dosimeter. A repetitious sequence of three dose levels (4, 2.88, and 1.28 Gy) was delivered. The rotationally symmetric treatment resulted in a dose distribution with high spatial variation in axial planes but only gradual variation with depth along the long axis of the dosimeter. The significance of this treatment was that it facilitated accurate film dosimetry in the axial plane, for independent verification. Also, it enabled rigorous evaluation of robustness, reproducibility and accuracy of response, at the three dose levels. The OCTOPUS 5x commercial scanner was used for dose readout from the dosimeters at daily time intervals. The use of improved optics and acquisition technique yielded substantially improved noise characteristics (reduced to approximately 2%) than has been achieved previously. Intradosimeter uniformity of radiochromic response was evaluated by calculating a 3D gamma comparison between each dosimeter and axially rotated copies of the same dosimeter. This convenient technique exploits the rotational symmetry of the distribution. All points in the gamma comparison passed a 2% difference, 1 mm distance-to-agreement criteria indicating excellent intradosimeter uniformity even at low dose levels. Postirradiation, the dosimeters were all found to exhibit a slight increase in opaqueness with time. However, the relative dose distribution was found to be extremely stable up to 90 h postirradiation indicating excellent temporal stability. Excellent interdosimeter reproducibility was also observed between the four dosimeters. Gamma comparison maps between each dosimeter and the average distribution of all four dosimeters showed full agreement at the 2% difference, 2 mm distance-to-agreement level. Dose readout from the 3D dosimetry system was found to agree better with independent film measurement than with treatment planning system calculations in penumbral regions and was generally accurate to within 2% dose difference and 2 mm distance-to-agreement. In conclusion, these studies demonstrate excellent precision, accuracy, robustness, and reproducibility of the PRESAGE/optical-CT system for relative 3D dosimetry and support its potential integration with the RPC H&N credentialing phantom for IMRT verification.

Rotational total skin electron irradiation with a linear accelerator

The rotational total skin electron irradiation (RTSEI) technique at our institution has undergone several developments over the past few years. Replacement of the formerly used linear accelerator has prompted many modifications to the previous technique. With the current technique, the patient is treated with a single large field while standing on a rotating platform, at a source-to-surface distance of 380 cm. The electron field is produced by a Varian 21EX linear accelerator using the commercially available 6 MeV high dose rate total skin electron mode, along with a custom-built flattening filter. Ionization chambers, radiochromic film, and MOSFET (metal oxide semiconductor field effect transistor) detectors have been used to determine the dosimetric properties of this technique. Measurements investigating the stationary beam properties, the effects of full rotation, and the dose distributions to a humanoid phantom are reported. The current treatment technique and dose regimen are also described.

Radiographic film dosimetry for IMRT fields in the nearsurface buildup region

Radiographic film dosimetry provides fast, convenient 2‐D dose distributions, but is challenged by the dependence of film response on scatter conditions (i.e., energy dependence). Verification of delivered dose in the surface buildup region is important for intensity modulated radiation therapy (IMRT) when volumes of interest encroach on these regions (e.g., head/neck, breast). The current work demonstrates that film dosimetry can accurately predict the dose in the buildup region for IMRT, since 1) film dosimetry can be performed with sufficient accuracy for small fields and 2) IMRT is delivered by a series of “small” segments (step and shoot IMRT). This work evaluates the accuracy of X‐OMAT V (XV) and Extended Dose Range (EDR) film for measurements from 2 mm to 15 mm depths for small fields and clinical IMRT beams. Film measurements have been compared to single point measurements made with a stereotactic diode and parallel plate ionization chamber (P11) and thermoluminescent dosimeters (TLD) at various depths for square (diode, P11) and IMRT (diode, TLD) fields. Film calibration was performed using an 8‐field step exposure on a single film at 5 cm depth, which has been corrected to represent either small field or large field depth dependent film calibration techniques. Up to 10% correction for film response variation as a function of depth was required for measurements in the buildup region. A depth‐dependent calibration can sufficiently improve the accuracy for IMRT calculation verification (i.e., ≤5% uncertainty). A small field film calibration technique was most appropriate for IMRT field measurements. Improved buildup region dose measurements for clinical IMRT fields promotes improved dose estimation performance for (inverse) treatment planning and allows more quantitative treatment delivery validation.

PACS numbers: 87.53.‐j, 87.53.Dq

Temperature and hydration effects on absorbance spectra and radiation sensitivity of a radiochromic medium

The effects of temperature on real time changes in optical density (DeltaOD) of GAFCHROMIC EBT film were investigated. The spectral peak of maximum change in absorbance (lambdamax) was shown to downshift linearly when the temperature of the film was increased from 22 to 38 degrees C. The DeltaOD values were also shown to decrease linearly with temperature, and this decrease could not be attributed to the shift in lambdamax. A compensation scheme using lambdamax and a temperature-dependent correction factor was investigated, but provided limited improvement. Part of the reason may be the fluctuations in hydration of the active component, which were found to affect both position of absorbance peaks and the sensitivity of the film. To test the effect of hydration, laminated and unlaminated films were desiccated. This shifted both the major and minor absorbance peaks in the opposite direction to the change observed with temperature. The desiccated film also exhibited reduced sensitivity to ionizing radiation. Rehydration of the desiccated films did not reverse the effects, but rather gave rise to another form of the polymer with absorbance maxima upshifted further 20 nm. Hence, the spectral characteristics and sensitivity of the film can be dependent on its history, potentially complicating both real-time and conventional radiation dosimetry.

High-resolution, small animal radiation research platform with x-ray tomographic guidance capabilities

PURPOSE

To demonstrate the computed tomography, conformal irradiation, and treatment planning capabilities of a small animal radiation research platform (SARRP).

METHODS AND MATERIALS

The SARRP uses a dual-focal spot, constant voltage X-ray source mounted on a gantry with a source-to-isocenter distance of 35 cm. Gantry rotation is limited to 120 degrees from vertical. X-rays of 80-100 kVp from the smaller 0.4-mm focal spot are used for imaging. Both 0.4-mm and 3.0-mm focal spots operate at 225 kVp for irradiation. Robotic translate/rotate stages are used to position the animal. Cone-beam computed tomography is achieved by rotating the horizontal animal between the stationary X-ray source and a flat-panel detector. The radiation beams range from 0.5 mm in diameter to 60 x 60 mm(2). Dosimetry is measured with radiochromic films. Monte Carlo dose calculations are used for treatment planning. The combination of gantry and robotic stage motions facilitate conformal irradiation.

RESULTS

The SARRP spans 3 ft x 4 ft x 6 ft (width x length x height). Depending on the filtration, the isocenter dose outputs at a 1-cm depth in water were 22-375 cGy/min from the smallest to the largest radiation fields. The 20-80% dose falloff spanned 0.16 mm. Cone-beam computed tomography with 0.6 x 0.6 x 0.6 mm(3) voxel resolution was acquired with a dose of <1 cGy. Treatment planning was performed at submillimeter resolution.

CONCLUSION

The capability of the SARRP to deliver highly focal beams to multiple animal model systems provides new research opportunities that more realistically bridge laboratory research and clinical translation.

Design and dosimetry of a few leaf electron collimator for energy modulated electron therapy

Despite the capability of energy modulated electron therapy (EMET) to achieve highly conformal dose distributions in superficial targets it has not been widely implemented due to problems inherent in electron beam radiotherapy such as planning dosimetry accuracy, and verification as well as a lack of systems for automated delivery. In previous work we proposed a novel technique to deliver EMET using an automated "few leaf electron collimator" (FLEC) that consists of four motor-driven leaves fit in a standard clinical electron beam applicator. Integrated with a Monte Carlo based optimization algorithm that utilizes patient-specific dose kernels, a treatment delivery was incorporated within the linear accelerator operation. The FLEC was envisioned to work as an accessory tool added to the clinical accelerator. In this article the design and construction of the FLEC prototype that match our compact design goals are presented. It is controlled using an in-house developed EMET controller. The structure of the software and the hardware characteristics of the EMET controller are demonstrated. Using a parallel plate ionization chamber, output measurements were obtained to validate the Monte Carlo calculations for a range of fields with different energies and sizes. Further verifications were also performed for comparing 1-D and 2-D dose distributions using energy independent radiochromic films. Comparisons between Monte Carlo calculations and measurements of complex intensity map deliveries show an overall agreement to within +/- 3%. This work confirms our design objectives of the FLEC that allow for automated delivery of EMET. Furthermore, the Monte Carlo dose calculation engine required for EMET planning was validated. The result supports the potential of the prototype FLEC for the planning and delivery of EMET.

An investigation of the accuracy of an IMRT dose distribution using two- and three-dimensional dosimetry techniques

Complex dose delivery techniques like intensity-modulated radiation therapy (IMRT) require dose measurement in three dimensions for comprehensive validation. Previously, we demonstrated the feasibility of the "PRESAGE/optical-computed tomography (CT)" system for the three-dimensional verification of simple open beam dose distributions where the planning system was known to be accurate. The present work extends this effort and presents the first application of the PRESAGE/optical-CT system for the verification of a complex IMRT distribution. A highly modulated 11 field IMRT plan was delivered to a cylindrical PRESAGE dosimeter (16 cm in diameter and 11 cm in height), and the dose distribution was readout using a commercial scanning-laser optical-CT scanner. Comparisons were made with independent GAFCHROMIC EBT film measurements, and the calculated dose distribution from a commissioned treatment planning system (ECLIPSE). Isodose plots, dose profiles, gamma maps, and dose-volume histograms were used to evaluate the agreement. The isodose plots and dose profiles from the PRESAGE/optical-CT system were in excellent agreement with both the EBT measurements and the ECLIPSE calculation at all points except within 3 mm of the outer edge of the dosimeter where an edge artifact occurred. Excluding this 3 mm rim, gamma map comparisons show that all three distributions mutually agreed to within a 3% (dose difference) and 3 mm (distance-to-agreement) criteria. A 96% gamma pass ratio was obtained between the PRESAGE and ECLIPSE distributions over the entire volume excluding this rim. In conclusion, for the complex IMRT plan studied, and in the absence of inhomogeneities, the ECLIPSE dose calculation was found to agree with both independent measurements, to within 3%, 3 mm gamma criteria.

Radiation transmission, leakage and beam penumbra measurements of a micro-multileaf collimator using GafChromic EBT film

Micro‐multileaf collimator systems coupled to linear accelerators for radioneurosurgery treatments require a rigorous dosimetric characterization in order to be used in 3D conformal and intensity modulated stereotactic radiosurgery and radiotherapy applications. This characterization involves high precision measurements of leaf transmission, leakage and beam penumbra through the collimation system and requires the use of detectors with high spatial resolution, high sensitivity and practically no energy dependence. In this work the use of GafChromic EBT radiochromic film to measure the basic dosimetric properties of the m3‐mMLC (BrainLAB, Germany) micro‐multileaf collimator system integrated to a 6 MV linear accelerator, is reported. Results show that average values of transmission and leakage radiation are 0.93±0.05% and 1.08±0.08%, respectively. The 80–20% beam penumbra were found to be 2.26±0.11 mm along the leaf side (perpendicular to leaf motion) and 2.31±0.11 mm along the leaf end (parallel to leaf motion) using square field sizes ranging from 9.1 to 1.8 cm. These measurements are in agreement with values reported in the literature for the same type of mMLC using different radiation detectors.

PACS number: 87.56.N‐

Dosimetric verification of intensity modulated radiation therapy of 172 patients treated for various disease sites: comparison of EBT film dosimetry, ion chamber measurements, and independent MU calculations

Three independent dose verification methods for intensity modulated radiation therapy (IMRT) were evaluated. Planar IMRT dose distributions were delivered to EBT film and scanned with the Epson Expression 1680 flatbed scanner. The measured dose distributions were then compared to those calculated with a Pinnacle treatment planning system. The IMRT treatments consisted of 7 to 9 6-MV beams for different treatment sites. The films were analyzed using FilmQA (3cognition LLC, Great Neck, NY) software. Comparisons between measured and calculated dose distributions are reported as dose difference (DD) (pixels within +/- 5%), distance to agreement (DTA) (3 mm), as well as gamma values (gamma) (dose = +/- 3%, distance = 2 mm). Point dose measurements with an ion chamber at isocenter were compared to dose calculated at that point. An independent monitor units (MUs) calculation program was also used for verification. For the film dose distributions, DD values varied from 92% to 97%, with head-and-neck and lung treatments showing lower values. Gamma varied from 93% to 98%, and DTA was well above 99%. The isocenter dose measurements deviated from 0.008 to 0.028 from the calculated dose. The larger deviations were attributed to high-dose gradients at the isocenter. RadCalc MU calculations gave differences from 0.027 to 0.079. The larger differences observed were for beams crossing large areas of heterogeneous tissue and were attributed to the limitations of the simple path-length correction method employed in RadCalc. In conclusion, the 3 independent verification methods for each IMRT patient at our institution demonstrated very good agreement between measurements and calculations and gave us the confidence that our IMRT treatments are delivered accurately.

Design and evaluation of a HDR skin applicator with flattening filter

The purposes of this study are: (i) to design field flattening filters for the Leipzig applicators of 2 and 3 cm of inner diameter with the source traveling parallel to the applicator contact surface, which are accessories of the microSelectron-HDR afterloader (Nucletron, Veenendaal, The Netherlands). These filters, made of tungsten, aim to flatten the heterogeneous dose distribution obtained with the Leipzig applicators. (ii) To estimate the dose rate distributions for these Leipzig+filter applicators by means of the Monte Carlo (MC) method. (iii) To experimentally verify these distributions for prototypes of these new applicators, and (iv) to obtain the correspondence factors to measure the output of the applicators by the user using an insert into a well chamber. The MC GEANT4 code has been used to design the filters and to obtain the dose rate distributions in liquid water for the two Leipzig+filter applicators. In order to validate this specific application and to guarantee that realistic source-applicator geometry has been considered, an experimental verification procedure was implemented in this study, in accordance with the updated recommendations of the American Association of Physicists in Medicine Task Group No. 43 U1 Report. Thermoluminescent dosimeters, radiochromic film, and a pin-point ionization chamber in a plastic [polymethylmethacrylate (PMMA)] phantom were used to verify the MC results for the two applicators of a microSelectron-HDR afterloader with the mHDR-v2 source. To verify the output of the Leipzig +filter applicators, correspondence factors were deduced for the well chambers HDR100-plus (Standard Imaging, Inc., Middleton, WI) and TM33004 (PTW, Freiburg, Germany) using a specific insert for both applicators. The doses measured in the PMMA phantom agree within experimental uncertainties with the dose obtained by the MC calculations. Percentage depth dose and off-axis profiles were obtained normalized at a depth of 3 mm along the central applicator axis in a cylindrical 20 x 20 cm water phantom. A table of output factors, normalized to 1 U of source air kerma strength at this depth, is presented. Correspondence factors were obtained for the two well chambers considered. The matrix data obtained in the MC simulation with a grid separation of 0.5 mm has been used to build a data set in a convenient format to model these distributions for routine use with a brachytherapy treatment planning system.

Verification procedure for isocentric alignment of proton beams

We present a technique--based on the Lutz, Winston, and Maleki test used in stereotactic linear accelerator radiosurgery--for verifying whether proton beams are being delivered within the required spatial coincidence with the gantry mechanical isocenter. Our procedure uses a proton beam that is collimated by a circular aperture at its central axis and is then intercepted by a small steel sphere rigidly supported by the patient couch. A laser tracker measurement system and a correction algorithm for couch position assures precise positioning of the steel sphere at the mechanical isocenter of the gantry. A film-based radiation dosimetry technique, chosen for the good spatial resolution it achieves, records the proton dose distribution for optical image analysis. The optical image obtained presents a circular high-dose region surrounding a lower-dose area corresponding to the proton beam absorption by the steel sphere, thereby providing a measure of the beam alignment with the mechanical isocenter. We found the self-developing Gafchromic EBT film (International Specialty Products, Wayne, NJ) and commercial Epson 10000 XL flatbed scanner (Epson America, Long Beach, CA) to be accurate and efficient tools. The positions of the gantry mechanical and proton beam isocenters, as recorded on film, were clearly identifiable within the scanning resolution used for routine alignment testing (0.17 mm per pixel). The mean displacement of the collimated proton beam from the gantry mechanical isocenter was 0.22 +/- 0.1 mm for the gantry positions tested, which was well within the maximum deviation of 0.50 mm accepted at the Proton Therapy Center in Houston.

Clinical application of GAFCHROMIC EBT film for in vivo dose measurements of total body irradiation radiotherapy

The GAFCHROMIC EBT film model is a fairly new film product designed for absorbed dose measurements of high-energy photon beams. In vivo dosimetry for total body irradiation (TBI) remains a challenging task due to the extended source-to-surface distance (SSD), low dose rates, and the use of beam spoilers. EBT film samples were used for dose measurements on an anthropomorphic phantom using a TBI setup. Additionally, in vivo measurements were obtained for two TBI patients. Phantom results verified the suitability of the EBT film for TBI treatment in terms of accuracy, reproducibility, and dose linearity. Doses measured were compared to conventional dosimeter measurements using thermoluminescent dosimeters (TLDs), resulting in an agreement of 4.1% and 6.7% for the phantom and patient measurements, respectively. Results obtained from the phantom and patients confirm that GAFCHROMIC EBT films are a suitable alternative to TLDs as an in vivo dosimeter in TBI radiotherapy.

Experimental verification of magnetic field dose effects for the MRI-accelerator

The MRI-linear accelerator system, currently being developed, is designed such that the patient is irradiated in the presence of a magnetic field. This influences the dose distribution due to the Lorentz force working on the secondary electrons. Simulations have shown that the following dose effects occur: the build-up distance is reduced, the lateral profile becomes asymmetric in the direction orthogonal to the magnetic field and at tissue-air interfaces the dose increases due to returning electrons. In this work, GafChromic film measurements were performed in the presence of a magnetic field to experimentally quantify these dose effects. Depth-dose curves were measured in a PMMA-air-PMMA phantom and the lateral profiles were measured in a homogeneous PMMA phantom with the photon beam protruding over the edges of the phantom. The measurement results confirmed the magnetic field dose effects that were predicted by simulations. This enabled us to verify Geant4 Monte Carlo simulations of these MRI-linac specific dose effects: the relative agreement for the depth-dose curves between measurements and simulations was within 2.2%/1.8 mm. The relative agreement for the lateral profiles was 2.3%/1.7 mm. Overall, the magnetic field dose effects that are expected for irradiation with the MRI-linac can be modelled using Geant4 Monte Carlo simulations within measurement accuracy.

Dosimetric characterization of GafChromic EBT film and its implication on film dosimetry quality assurance

The suitability of radiochromic EBT film was studied for high-precision clinical quality assurance (QA) by identifying the dose response for a wide range of irradiation parameters typically modified in highly-conformal treatment techniques. In addition, uncertainties associated with varying irradiation conditions were determined. EBT can be used for dose assessment of absorbed dose levels as well as relative dosimetry when compared to absolute absorbed dose calibrated using ionization chamber results. For comparison, a silver halide film (Kodak EDR-2) representing the current standard in film dosimetry was included. As an initial step a measurement protocol yielding accurate and precise results was established for a flatbed transparency scanner (Epson Expression 1680 Pro) that was utilized as a film reading instrument. The light transmission measured by the scanner was found to depend on the position of the film on the scanner plate. For three film pieces irradiated with doses of 0 Gy, approximately 1 Gy and approximately 7 Gy, the pixel values measured in portrait or landscape mode differed by 4.7%, 6.2% and 10.0%, respectively. A study of 200 film pieces revealed an excellent sheet-to-sheet uniformity. On a long time scale, the optical development of irradiated EBT film consisted of a slow but steady increase of absorbance which was not observed to cease during 4 months. Sensitometric curves of EBT films obtained under reference conditions (SSD = 95 cm, FS = 5 x 5 cm(2), d = 5 cm) for 6, 10 and 25 MV photon beams did not show any energy dependence. The average separation between all curves was only 0.7%. The variation of the depth d (range 2-25 cm) in the phantom did not affect the dose response of EBT film. Also the influence of the radiation field size (range 3 x 3-40 x 40 cm(2)) on the sensitometric curve was not significant. For EDR-2 films maximum differences between the calibration curves reached 7-8% for X6MV and X25MV. Radiochromic EBT film, in combination with a flatbed scanner, presents a versatile system for high-precision dosimetry in two dimensions, provided that the intrinsic behaviour of the film reading device is taken into account. EBT film itself presents substantial improvements on formerly available models of radiographic and a radiochromic film and its dosimetric characteristics allow us to measure absorbed dose levels in a large variety of situations with a single calibration curve.

In vivo EBT radiochromic film dosimetry of electron beam for Total Skin Electron Therapy (TSET)

EBT radiochromic films were used to determine skin-dose maps for patients undergone Total Skin Electron Therapy (TSET). Gafchromic EBT radiochromic film is one of the newest radiation-induced auto-developing photon and electron-beam analysis films available for therapeutic radiation dosimetry in radiotherapy applications. EBT films can be particularly useful in TSET; due to patient morphology, underdosed regions typically occur, and the radiochromic film represents a suitable candidate for monitoring them. In this study, TSET was applied to treat cutaneous T-cell lymphoma. The technique for TSET was implemented by using an electron beam with a nominal energy of 6MeV. The patient was treated in a standing position using dual angled fields in order to obtain the greatest dose uniformity along the patient's longitudinal axis. The electron beam energy was degraded by a PMMA filter. The in vivo dose distribution was determined through the use of EBT films, as well as of thermoluminescent dosimeters for comparison (TLDs). EBT results showed a reasonable agreement with TLDs data.

Optically stimulated luminescence (OSL) of carbon-doped aluminum oxide (Al2O3:C) for film dosimetry in radiotherapy

INTRODUCTION AND PURPOSE

Conventional x-ray films and radiochromic films have inherent challenges for high precision radiotherapy dosimetry. Here we have investigated basic characteristics of optically stimulated luminescence (OSL) of irradiated films containing carbon-doped aluminum oxide (Al2O3:C) for dosimetry in therapeutic photon and electron beams.

MATERIALS AND METHODS

The OSL films consist of a polystyrene sheet, with a top layer of a mixture of single crystals of Al2O3:C, ground into a powder, and a polyester base. The total thickness of the films is 0.3 mm. Measurements have been performed in a water equivalent phantom, using 4, 6, 10, and 18 MV photon beams, and 6-22 MeV electron beams. The studies include assessment of the film response (acquired OSL signal/delivered dose) on delivered dose (linearity), dose rate (1-6 Gy/min), beam quality, field size and depth (6 MV, ranges 4 x 4-30 x 30 cm2, dmax-35 cm). Doses have been derived from ionization chamber measurements. OSL films have also been compared with conventional x-ray and GafChromic films for dosimetry outside the high dose area, with a high proportion of low dose scattered photons. In total, 787 OSL films have been irradiated.

RESULTS

Overall, the OSL response for electron beams was 3.6% lower than for photon beams. Differences between the various electron beam energies were not significant. The 6 and 18 MV photon beams differed in response by 4%. No response dependencies on dose rate were observed. For the 6 MV beam, the field size and depth dependencies of the OSL response were within +/-2.5%. The observed inter-film response variation for films irradiated with the same dose varied from 1% to 3.2% (1 SD), depending on the measurement day. At a depth of 20 cm, 5 cm outside the 20 x 20 cm2 6 and 18 MV beams, an over response of 17% was observed. In contrast to GafChromic and conventional x-ray films, the response of the Al2O3:C films is linear in the clinically relevant dose range 0-200 cGy.

CONCLUSIONS

Measurement of the OSL signal of irradiated films containing Al2O3:C is a promising technique for film dosimetry in radiotherapy with no or small response variations with dose rate, beam quality, field size and depth, and a linear response from 0 to 200 cGy.

Evaluation of GAFCHROMIC® EBT film for CyberKnife® dosimetry

External beam therapy (EBT) GAFCHROMIC film is evaluated for dosimetry and characterization of the CyberKnife radiation beams. Percentage depth doses, lateral beam profiles, and output factors are measured in solid water using EBT GAFCHROMIC film (International Specialty Products, Wayne, NJ) for the 6 MV radiation beams of diameter 5 to 60 mm produced by the CyberKnife (Accuray, Sunnyvale, CA). The data are compared to those measured with the PTW 60008 diode and the Wellhofer CC01 ion chamber in water. For the small radiation field sizes used in stereotactic radiosurgery, lateral electronic disequilibrium and steep dose gradients exist in a large portion of these fields, requiring the use of high-resolution measurement techniques. For small beams, the detector size approaches the dimensions of the beam and adversely affects measurement accuracy in regions where the gradient varies across the detector. When film is the detector, the scanning system is usually the resolution-limiting component. Radiographic films based upon silver halide (AgH) emulsions are widely used for relative dosimetry of external radiation treatment beams in the megavoltage energy range, because of their good spatial resolution and capability to provide integrated dosimetry over two dimensions. Film dosimetry, however, has drawbacks due to its steep energy dependence at low photon energies as well as film processor and densitometer artifacts. EBT radiochromic film, introduced in 2004 specifically for IMRT dosimetry, may be a detector of choice for the characterization of small radiosurgical beams, because of its near-tissue equivalence, radiation beam energy independence, high spatial resolution, and self developing properties. For radiation beam sizes greater than 10 mm, the film measurements were identical to those of the diode and ion chamber. For the smaller beam diameters of 7.5 and 5 mm, however, there were differences in the data measured with the different detectors, which are attributed to their different spatial resolution and non-water-equivalence.

Verification of cell irradiation dose deposition using a radiochromic film

We describe a technique for the MTT assay that irradiates all cells at once by a combination of couch movement and a step-and-shoot irradiation technique on a linear accelerator with 6 MV and 18 MV photon beams. In two experimental setups, we obtained maximum to minimum dose ranges of 10 for the constant MU/bin (monitor units per bin) setup and 20 for the variable MU/bin technique. The irradiation technique described is dose rate independent and it can be used on any teletherapy irradiation machine. We also employed radiochromic film dosimetry to verify dose delivered in each of the wells within the dish. It is shown that for the lowest doses, relative dose variation within wells reaches a value of 6%. We also demonstrated that the radiochromic film positioned below the 96-well plate does not underestimate dose deposited within each compartment by more than 2% due to the vertical dose gradient.

The small-animal radiation research platform (SARRP): dosimetry of a focused lens system

A small animal radiation platform equipped with on-board cone-beam CT and conformal irradiation capabilities is being constructed for translational research. To achieve highly localized dose delivery, an x-ray lens is used to focus the broad beam from a 225 kVp x-ray tube down to a beam with a full width half maximum (FWHM) of approximately 1.5 mm in the energy range 40-80 keV. Here, we report on the dosimetric characteristics of the focused beam from the x-ray lens subsystem for high-resolution dose delivery. Using the metric of the average dose within a 1.5 mm diameter area, the dose rates at a source-to-surface distance (SSD) of 34 cm are 259 and 172 cGy min(-1) at 6 mm and 2 cm depths, respectively, with an estimated uncertainty of +/-5%. The per cent depth dose is approximately 56% at 2 cm depth for a beam at 34 cm SSD.

High dose-rate brachytherapy source position quality assurance using radiochromic film

Traditionally, radiographic film has been used to verify high-dose-rate brachytherapy source position accuracy by co-registering autoradiographic and diagnostic images of the associated applicator. Filmless PACS-based clinics that do not have access to radiographic film and wet developers may have trouble performing this quality assurance test in a simple and practical manner. We describe an alternative method for quality assurance using radiochromic-type film. In addition to being easy and practical to use, radiochromic film has some advantages in comparison with traditional radiographic film when used for HDR brachytherapy quality assurance.

Energy dependence (75kVp to 18MV) of radiochromic films assessed using a real-time optical dosimeter

The response of radiochromic film, GafChromic EBT, was investigated for dependence on x-ray beam energy using a previously reported real-time optical readout approach. X-ray beams of energy from 75 kVp to 18 MV were employed. The dose-induced change in optical density for the EBT film was compared to values obtained for GafChromic HS and MD-55 films, exposed under the same conditions. All responses were normalized to that obtained for 60Co irradiation. While change in optical density for 1 Gy of applied dose as measured with HS and MD-55 films decreased by approximately 40% at low energies, the mean change in optical density of EBT film remained within 3% of that in the 60Co beam over the entire energy range.

Precautions and strategies in using a commercial flatbed scanner for radiochromic film dosimetry

The purpose of this study was to investigate the value of a commercially available flatbed scanner for film dosimetry with radiochromic film for external radiotherapy. The EPSON Pro 1680 Expression scanner was examined as a densitometer for two-dimensional film dosimetry with Gafchromic EBT film. An accurate and efficient scanning procedure was established. Possible drift and warm-up effects of the scanner were studied and the direct physical influence of the scanner light on the radiochromic film was assessed. Next, we investigated the scan field uniformity. Also, we examined if the accuracy of radiochromic film was improved by subtracting the optical density of the unirradiated blank film from the optical density of the irradiated film. To assess the accuracy of Gafchromic EBT film when the EPSON scanner was used as a densitometer, the depth dose of a 2 x 15 cm(2) field and the in-plane and cross-plane profiles of a 15 x 15 cm(2) field were measured and compared with diamond detector measurements. When taking consecutive scans, we found that the optical density taken from the first scan was about 1% higher than the optical density taken from subsequent scans. We attribute this to the warming up of the lamp of the scanner. Longer-term drift of the scanner was found to be absent. We found that the use of a correction matrix was necessary to correct for the non-uniform scanner response over the scan field. Subtracting the optical density of the unirradiated blank film from the irradiated film improves the precision of the Gafchromic EBT film. Depth dose and profile measurements with Gafchromic EBT film and the diamond detector are in agreement within 2.5%. The EPSON Pro 1680 Expression scanner is an excellent tool for accurate two-dimensional film dosimetry with Gafchromic EBT film provided that some precautions and corrections are taken into account.

Absorption spectroscopy of EBT model GAFCHROMIC™ film

The introduction of radiochromic films has solved some of the problems associated with conventional 2D radiation detectors. Their high spatial resolution, low energy dependence, and near-tissue equivalence make them ideal for measurement of dose distributions in radiation fields with high dose gradients. Precise knowledge of the absorption spectra of these detectors can help to develop more suitable optical densitometers and potentially extend the use of these films to other areas such as the measurement of the radiation beam spectral information. The goal of this study is to present results of absorption spectra measurements for the new GAFCHROMIC film, EBT type, exposed to 6 MV photon beam in the dose range from 0 to 6 Gy. Spectroscopic analysis reveals that in addition to the two main absorption peaks, centered at around 583 and 635 nm, the absorption spectrum in the spectral range from 350 to 800 nm contains six more absorption bands. Comparison of the absorption spectra reveals that previous HD-810, MD-55, as well as HS GAFCHROMIC film models, have nearly the same sensitive layer base material, whereas the new EBT model, GAFCHROMIC film has a different composition of its sensitive layer. We have found that the two most prominent absorption bands in EBT model radiochromic film do not change their central wavelength position with change in a dose deposited to the film samples.

Comparison of the Epson Expression 1680 flatbed and the Vidar VXR-16 Dosimetry PRO™ film scanners for use in IMRT dosimetry using Gafchromic and radiographic film

Intensity-modulated radiotherapy (IMRT) treatment plan verification is often done using Kodak EDR2 film and a Vidar Dosimetry PRO film digitizer. However, since many hospitals are moving towards a filmless environment, access to a film processor may not be available. Therefore, we have investigated a newly available Gafchromic EBT film for IMRT dosimetry. Planar IMRT dose distributions are delivered to both EBT and EDR2 film and scanned with the Vidar VXR-16 as well as an Epson Expression 1680 flatbed scanner. The measured dose distributions are then compared to those calculated with a Pinnacle treatment planning system. The IMRT treatments consisted of 7-9 6 MV beams for treatment of prostate, head and neck, and a few other sites. The films were analyzed using FilmQATM (3cognition LLC) software. Comparisons between measured and calculated dose distributions are reported as dose difference (DD) (pixels within +/-5%), distance to agreement (DTA) (3 mm), as well as gamma values (y) (dose= +/-3%, dist. =2 mm). Using EDR2 with the Vidar scanner is an established technique and agreement between calculated and measured dose distributions was better than 90% in all indices (DD, DTA, and gamma). However, agreement with calculations deteriorated reaching the lower 80% for EBT film scans with the Vidar scanner in logarithmic mode. The EBT Vidar scans obtained in linear mode showed an improved agreement to the upper 80% range, but artifacts were still observed across the scan. These artifacts were very distinct in all EBT scans and can be attributed to the way the film is transported through the scanner. In the Epson scanner both films are rigidly immobilized and the light source scans over the film. It was found that the Epson scanner performed equally well with both types of film giving agreement to better than 90% in all indices.

Pencil beam approach for correcting the energy dependence artifact in film dosimetry for IMRT verification

The higher sensitivity to low-energy scattered photons of radiographic film compared to water can lead to significant dosimetric error when the beam quality varies significantly within a field. Correcting for this artifact will provide greater accuracy for intensity modulated radiation therapy (IMRT) verification dosimetry. A procedure is developed for correction of the film energy-dependent response by creating a pencil beam kernel within our treatment planning system to model the film response specifically. Film kernels are obtained from EGSnrc Monte Carlo simulations of the dose distribution from a 1 mm diameter narrow beam in a model of the film placed at six depths from 1.5 to 40 cm in polystyrene and solid water phantoms. Kernels for different area phantoms (50 x 50 cm2 and 25 x 25 cm2 polystyrene and 30 x 30 cm2 solid water) are produced. The Monte Carlo calculated kernel is experimentally verified with film, ion chamber and thermoluminescent dosimetry (TLD) measurements in polystyrene irradiated by a narrow beam. The kernel is then used in convolution calculations to, predict the film response in open and IMRT fields. A 6 MV photon beam and Kodak XV2 film in a polystyrene phantom are selected to test the method as they are often used in practice and can result in large energy-dependent artifacts. The difference in dose distributions calculated with the film kernel and the water kernel is subtracted from film measurements to obtain a practically film artifact free IMRT dose distribution for the Kodak XV2 film. For the points with dose exceeding 5 cGy (11% of the peak dose) in a large modulated field and a film measurement inside a large polystyrene phantom at depth of 10 cm, the correction reduces the fraction of pixels for which the film dose deviates from dose to water by more than 5% of the mean film dose from 44% to 6%.

Comparison of Kodak EDR2 and Gafchromic EBT film for intensity-modulated radiation therapy dose distribution verification

The quantitative dose validation of intensity-modulated radiation therapy (IMRT) plans require 2-dimensional (2D) high-resolution dosimetry systems with uniform response over its sensitive region. The present work deals with clinical use of commercially available self-developing Radio Chromic Film, Gafchromic EBT film, for IMRT dose verification. Dose response curves were generated for the films using a VXR-16 film scanner. The results obtained with EBT films were compared with the results of Kodak extended dose range 2 (EDR2) films. The EBT film had a linear response between the dose range of 0 to 600 cGy. The dose-related characteristics of the EBT film, such as post irradiation color growth with time, film uniformity, and effect of scanning orientation, were studied. There was up to 8.6% increase in the color density between 2 to 40 hours after irradiation. There was a considerable variation, up to 8.5%, in the film uniformity over its sensitive region. The quantitative differences between calculated and measured dose distributions were analyzed using DTA and Gamma index with the tolerance of 3% dose difference and 3-mm distance agreement. The EDR2 films showed consistent results with the calculated dose distributions, whereas the results obtained using EBT were inconsistent. The variation in the film uniformity limits the use of EBT film for conventional large-field IMRT verification. For IMRT of smaller field sizes (4.5 x 4.5 cm), the results obtained with EBT were comparable with results of EDR2 films.