Comparison of dosimetry recommendations for clinical proton beams

Independent dose per monitor unit review of eight U.S.A. proton treatment facilities

PURPOSE

Compare the dose per monitor unit at different proton treatment facilities using three different dosimetry methods.

METHODS

Measurements of dose per monitor unit were performed by a single group at eight facilities using 11 test beams and up to six different clinical portal treatment sites. These measurements were compared to the facility reported dose per monitor unit values.

RESULTS

Agreement between the measured and reported doses was similar using any of the three dosimetry methods. Use of the ICRU 59 ND,w based method gave results approximately 3% higher than both the ICRU 59 NX and ICRU 78 (TRS-398) ND,w based methods.

CONCLUSIONS

Any single dosimetry method could be used for multi-institution trials with similar conformity between facilities. A multi-institutional trial could support facilities using both the ICRU 59 NX based and ICRU 78 (TRS-398) ND,w based methods but use of the ICRU 59 ND,w based method should not be allowed simultaneously with the other two until the difference is resolved.

Dosimetry for ion beam radiotherapy

Recently, ion beam radiotherapy (including protons as well as heavier ions) gained considerable interest. Although ion beam radiotherapy requires dose prescription in terms of iso-effective dose (referring to an iso-effective photon dose), absorbed dose is still required as an operative quantity to control beam delivery, to characterize the beam dosimetrically and to verify dose delivery. This paper reviews current methods and standards to determine absorbed dose to water in ion beam radiotherapy, including (i) the detectors used to measure absorbed dose, (ii) dosimetry under reference conditions and (iii) dosimetry under non-reference conditions. Due to the LET dependence of the response of films and solid-state detectors, dosimetric measurements are mostly based on ion chambers. While a primary standard for ion beam radiotherapy still remains to be established, ion chamber dosimetry under reference conditions is based on similar protocols as for photons and electrons although the involved uncertainty is larger than for photon beams. For non-reference conditions, dose measurements in tissue-equivalent materials may also be necessary. Regarding the atomic numbers of the composites of tissue-equivalent phantoms, special requirements have to be fulfilled for ion beams. Methods for calibrating the beam monitor depend on whether passive or active beam delivery techniques are used. QA measurements are comparable to conventional radiotherapy; however, dose verification is usually single field rather than treatment plan based. Dose verification for active beam delivery techniques requires the use of multi-channel dosimetry systems to check the compliance of measured and calculated dose for a representative sample of measurement points. Although methods for ion beam dosimetry have been established, there is still room for developments. This includes improvement of the dosimetric accuracy as well as development of more efficient measurement techniques.

Protontherapy of eye tumours in the UK: a review of treatment at Clatterbridge

The Scanditronix MC-60 PF cyclotron at Clatterbridge was commissioned in 1984 for fast neutrontherapy trials. It also produced a 60.0 MeV clinical beam suitable for treating ocular tumours with a maximum penetration of 31 mm (water) and a 0.9 mm fall-off. An additional treatment room was built with an ocular beamline constructed in-house. The first group of eye patients was treated in June 1989, making this the first hospital-based proton facility. More than 1700 eye patients have been treated by the only UK proton service.

Experimental determination of beam quality factors,kQ, for two types of Farmer chamber in a 10 MV photon and a 175 MeV proton beam

Absorbed doses determined with a sealed water calorimeter operated at 4 degrees C are compared with the results obtained using ionization chambers and the IAEA TRS-398 code of practice in a 10 MV photon beam (TPR(20,10) = 0.734) and a 175 MeV proton beam (at a depth corresponding to the residual range, R(res) = 14.7 cm). Three NE 2571 and two FC65-G ionization chambers were calibrated in terms of absorbed-dose-to-water in (60)Co at the Swedish secondary standard dosimetry laboratory, directly traceable to the BIPM. In the photon beam quality, calorimetry was found to agree with ionometry within 0.3%, confirming the k(Q) values tabulated in TRS-398. In contrast, a 1.8% deviation was found in the proton beam at 6 g cm(-2) depth, suggesting that the TRS-398 tabulated k(Q) values for these two ionization chamber types are too high. Assuming no perturbation effect in the proton beam for the ionization chambers, a value for (w(air)/e)(Q) of 33.6 J C(-1) +/- 1.7% (k = 1) can be derived from these measurements. An analytical evaluation of the effect from non-elastic nuclear interactions in the ionization chamber wall indicates a perturbation effect of 0.6%. Including this estimated result in the proton beam would increase the determined (w(air)/e)(Q) value by the same amount.

Monte Carlo simulation of a protontherapy platform devoted to ocular melanoma

Patients with ocular melanoma have been treated since June 1991 at the medical cyclotron of the Centre Antoine Lacassagne (CAL). Positions and sizes of the ocular nozzle elements were initially defined based on experimental work, taking as a pattern functional existing facilities. Nowadays Monte Carlo (MC) calculation offers a tool to refine this geometry by adjusting size and place of beam modeling devices. Moreover, the MC tool is a useful way to calculate the dose and to evaluate the impact of secondary particles in the field of radiotherapy or radiation protection. Both LINAC and cyclotron producing x rays, electrons, protons, and neutrons are available in CAL, which suggests choosing MCNPX for its particle versatility. As a first step, the existing installation was input in MCNPX to check its aptitude to reproduce experimentally measured depth-dose profile, lateral profile, output-factor (OF), and absolute dose. The geometry was defined precisely and described from the last achromatic bending magnet of our proton beam line to the position of treated eyes. Relative comparisons of percentage depth-dose and lateral profiles, performed between measured data and simulations, show an agreement of the order of 2% in dose and 0.1 mm in range accuracy. These comparisons, carried out with and without beam-modifying device, yield results compatible to the required precision in ocular melanoma treatments, as long as adequate choices are made on MCNPX input decks for physics card. Absolute dose and OF issued from calculations and measurements were also compared. Results obtained for these two kinds of data, carried out in the simplified situation of an unmodulated beam, indicate that MC calculation could effectively complement measurements. These encouraging results are a large source of motivation to promote further studies, first in a new design of the ocular nozzle, and second in the analysis of the influence of beam-modifying devices attached to the final patient collimator, such as wedge or compensators, on dose values.

Advances in the determination of absorbed dose to water in clinical high-energy photon and electron beams using ionization chambers

During the last two decades, absorbed dose to water in clinical photon and electron beams was determined using dosimetry protocols and codes of practice based on radiation metrology standards of air kerma. It is now recommended that clinical reference dosimetry be based on standards of absorbed dose to water. Newer protocols for the dosimetry of radiotherapy beams, based on the use of an ionization chamber calibrated in terms of absorbed dose to water, N(D,w), in a standards laboratory's reference quality beam, have been published by several national or regional scientific societies and international organizations. Since the publication of these protocols multiple theoretical and experimental dosimetry comparisons between the various N(D,w) based recommendations, and between the N(D,w) and the former air kerma (NK) based protocols, have been published. This paper provides a comprehensive review of the dosimetry protocols based on these standards and of the intercomparisons of the different protocols published in the literature, discussing the reasons for the observed discrepancies between them. A summary of the various types of standards of absorbed dose to water, together with an analysis of the uncertainties along the various steps of the dosimetry chain for the two types of formalism, is also included. It is emphasized that the NK-N(D,air) and N(D,w) formalisms have very similar uncertainty when the same criteria are used for both procedures. Arguments are provided in support of the recommendation for a change in reference dosimetry based on standards of absorbed dose to water.

Dosimetry of clinical neutron and proton beams: an overview of recommendations

Neutron therapy beams are obtained by accelerating protons or deuterons on Beryllium. These neutron therapy beams present comparable dosimetric characteristics as those for photon beams obtained with linear accelerators; for instance, the penetration of a p(65)+Be neutron beam is comparable with the penetration of an 8 MV photon beam. In order to be competitive with conventional photon beam therapy, the dosimetric characteristics of the neutron beam should therefore not deviate too much from the photon beam characteristics. This paper presents a brief summary of the neutron beams used in radiotherapy. The dosimetry of the clinical neutron beams is described. Finally, recent and future developments in the field of physics for neutron therapy is mentioned. In the last two decades, a considerable number of centres have established radiotherapy treatment facilities using proton beams with energies between 50 and 250 MeV. Clinical applications require a relatively uniform dose to be delivered to the volume to be treated, and for this purpose the proton beam has to be spread out, both laterally and in depth. The technique is called 'beam modulation' and creates a region of high dose uniformity referred to as the 'spread-out Bragg peak'. Meanwhile, reference dosimetry in these beams had to catch up with photon and electron beams for which a much longer tradition of dosimetry exists. Proton beam dosimetry can be performed using different types of dosemeters, such as calorimeters, Faraday cups, track detectors and ionisation chambers. National standard dosimetry laboratories will, however, not provide a standard for the dosimetry of proton beams. To achieve uniformity on an international level, the use of an ionisation chamber should be considered. This paper reviews and summarises the basic principles and recommendations for the absorbed dose determination in a proton beam, utilising ionisation chambers calibrated in terms of absorbed dose to water. These recommendations are based on the recent IAEA TRS398 Code of Practice: 'Absorbed Dose Determination in External Beam Radiotherapy: An International Code of Practice for Dosimetry based on Standards of Absorbed Dose to Water'.

Verification of absolute ionization chamber dosimetry in a proton beam using carbon activation measurements

Reference ionization chamber dosimetry implemented in a clinical proton beam and based on the ICRU 59 recommendations has been verified with an independent carbon activation method. The 12C(p,pn)11C nuclear reaction was used to measure the beam fluence and entrance dose. A method to transfer from the entrance dose to the dose at the ion chamber calibration position has been developed. Measurements performed in a monochromatic 200 MeV beam show that the ratio of absolute doses measured using the carbon activation and the ion chamber methods is 1.017 +/- 0.03 (type A uncertainty). This result is within the uncertainties of both methods employed, which are estimated at +/- 4.3% (carbon activation) and +/- 2.7% (ion chamber calibration).

Dosimetry for ocular proton beam therapy at the Harvard Cyclotron Laboratory based on the ICRU Report 59

The Massachusetts General Hospital, the Harvard Cyclotron Laboratory (HCL), and the Massachusetts Eye and Ear Infirmary have treated almost 3000 patients with ocular disease using high-energy external-beam proton radiation therapy since 1975. The absorbed dose standard for ocular proton therapy beams at HCL was based on a fluence measurement with a Faraday cup (FC). A majority of proton therapy centers worldwide, however, use an absorbed dose standard that is based on an ionization chamber (IC) technique. The ion chamber calibration is deduced from a measurement in a reference 60Co photon field together with a calculated correction factor that takes into account differences in a chamber's response in 60Co and proton fields. In this work, we implemented an ionization chamber-based absolute dosimetry system for the HCL ocular beamline based on the recommendations given in Report 59 by the International Commission on Radiation Units and Measurements. Comparative measurements revealed that the FC system yields an absorbed dose to water value that is 1.1% higher than was obtained with the IC system. That difference is small compared with the experimental uncertainties and is clinically insignificant. In June of 1998, we adopted the IC-based method as our standard practice for the ocular beam.

Dosimetry using plane-parallel ionization chambers in a 75 MeV clinical proton beam

Reference ionization chamber dosimetry in clinical proton beams is generally performed with cylindrical ionization chambers. However, when the measurement is performed in the presence of a large depth dose gradient or in a narrow spread out Bragg peak (SOBP), it could be advisable to use a plane-parallel chamber. Few recommendations and studies have been devoted to this subject. In this paper, experimental information on perturbation correction factors for four plane-parallel ionization chamber types in proton beams is presented. The experiments were performed in 75 MeV modulated and non-modulated proton beams. Monte Carlo calculations have been performed to support the conclusions of the experimental work. Overall, we were not able to find experimental evidence for significant differences between the secondary electron perturbation correction factors for plane-parallel chambers and those for a cylindrical NE2571. We found experimental ratios of perturbation correction factors that did not differ by more than 0.6% from unity for a Roos and two NACP02 chambers, and by not more than 1.2% for a Calcam-2 and two Markus chambers. Monte Carlo simulations result in corrections that are limited to 0.6% in absolute value, but given the overall uncertainties of the measurements, the deviations of the correction factors from unity could not be resolved from the experimental results. The results of the simulations thus support the experimental conclusion that perturbation correction factors for the set of plane-parallel chambers in both proton beams (relative to NE2571) do not deviate from unity by more than 1.2%. This confirms, within the experimental uncertainties, the assumption that the overall perturbation correction factor for a plane-parallel chamber in a low-energy proton beam is unity, made in IAEA TRS-398 and other dosimetry protocols. Given the large uncertainties of the gradient correction factors to be applied when using a cylindrical ionization chamber in a narrow SOBP or in the presence of a strong depth dose gradient, the level of agreement between plane-parallel and cylindrical ionization chambers observed in this study shows that plane-parallel chambers are a reliable alternative for reference dosimetry in low-energy proton beams.

Proton beam dosimetry for radiosurgery: implementation of the ICRU Report 59 at the Harvard Cyclotron Laboratory

Recent proton dosimetry intercomparisons have demonstrated that the adoption of a common protocol, e.g. ICRU Report 59, can lead to improved consistency in absorbed dose determinations. We compared absorbed dose values, measured in the 160 MeV proton radiosurgery beamline at the Harvard Cyclotron Laboratory, based on ionization chamber methods with those from a Faraday cup technique. The Faraday cup method is based on a proton fluence determination that allows the estimation of absorbed dose with the CEMA approximation, under which the dose is equal to the fluence times the mean mass stopping power. The ionization chamber technique employs an air-kerma calibration coefficient for 60Co radiation and a calculated correction in order to take into account the differences in response to 60Co and proton beam radiations. The absorbed dose to water, based on a diode measurement calibrated with a Faraday cup technique, is approximately 2% higher than was obtained from an ionization chamber measurement. At the Bragg peak depth, the techniques agree to within their respective uncertainties, which are both approximately 4% (1 standard deviation). The ionization chamber technique exhibited superior reproducibility and was adopted in our standard clinical practice for radiosurgery.