Response corrections for solid-state detectors in megavoltage photon dosimetry

Dosimetric characterization of a small-scale (Zn,Cd)S:Ag inorganic scintillating detector to be used in radiotherapy

PURPOSE

In modern radiotherapy techniques, to ensure an accurate beam modeling process, dosimeters with high accuracy and spatial resolution are required. Therefore, this work aims to propose a simple, robust, and a small-scale fiber-integrated X-ray inorganic detector and investigate the dosimetric characteristics used in radiotherapy.

METHODS

The detector is based on red-emitting silver-activated zinc-cadmium sulfide (Zn,Cd)S:Ag nanoclusters and the proposed system has been tested under 6 MV photons with standard dose rate used in the patient treatment protocol. The article presents the performances of the detector in terms of dose linearity, repeatability, reproducibility, percentage depth dose distribution, and field output factor. A comparative study is shown using a microdiamond dosimeter and considering data from recent literature.

RESULTS

We accurately measured a small field beam profile of 0.5 × 0.5 cm² at a spatial resolution of 100 µm using a LINAC system. The dose linearity at 400 MU/min has shown less than 0.53% and 1.10% deviations from perfect linearity for the regular and smallest field. Percentage depth dose measurement agrees with microdiamond measurements within 1.30% and 2.94%, respectively for regular to small field beams. Besides, the stem effect analysis shows a negligible contribution in the measurements for fields smaller than 3x3 cm². This study highlights the drastic decrease of the convolution effect using a point-like detector, especially in small dimension beam characterization. Field output factor has shown a good agreement while comparing it with the microdiamond dosimeter.

CONCLUSION

All the results presented here anticipated that the developed detector can accurately measure delivered dose to the region of interest, claim accurate depth dose distribution hence it can be a suitable candidate for beam characterization and quality assurance of LINAC system.

Characterization of a microSilicon diode detector for small-field photon beam dosimetry

This study characterized a new unshielded diode detector, the microSilicon (model 60023), for small-field photon beam dosimetry by evaluating the photon beams generated by a TrueBeam STx and a CyberKnife. Temperature dependence was evaluated by irradiating photons and increasing the water temperature from 11.5 to 31.3°C. For Diode E, microSilicon, microDiamond and EDGE detectors, dose linearity, dose rate dependence, energy dependence, percent-depth-dose (PDD), beam profiles and detector output factor (OFdet) were evaluated. The OFdet of the microSilicon detector was compared to the field output factors of the other detectors. The microSilicon exhibited small temperature dependence within 0.4%, although the Diode E showed a linear variation with a ratio of 0.26%/°C. The Diode E and EDGE detectors showed positive correlations between the detector reading and dose rate, whereas the microSilicon showed a stable response within 0.11%. The Diode E and microSilicon demonstrated negative correlations with the beam energy. The OFdet of microSilicon was the smallest among all the detectors. The maximum differences between the OFdet of microSilicon and the field output factors of microDiamond were 2.3 and 1.6% for 5 × 5 mm2 TrueBeam and 5 mm φ CyberKnife beams, respectively. The PDD data exhibited small variations in the dose fall-off region. The microSilicon and microDiamond detectors yielded similar penumbra widths, whereas the other detectors showed steeper penumbra profiles. The microSilicon demonstrated favorable characteristics including small temperature and dose rate dependence as well as the small spatial resolution and output factors suitable for small field dosimetry.

ENERGY RESPONSE FACTOR of BeO DOSEMETER CHIPS: A MONTE CARLO SIMULATION AND GENERAL CAVITY THEORY STUDY

The objective of this study is to determine the energy response factors for BeO optically simulated dosemeter (OSLD) using general cavity theory and Monte Carlo (MC) simulations. A virtual phantom is constructed in EGSnrc MC program and energy response of BeO OSLDs were simulated at 5 cm depth for x-ray beams ranging from 1.25 to 25 MV and at 2 cm for beams with <250 kV including ISO 4037 narrow beam energies in a virtual water phantom. The energy response factor for a given radiation quality relative to 60Co was determined for BeO and compared to the Al2O3:C and LiF:Mg,Ti dosemeters. Burlin cavity theory calculations were done using mean photon energy (MPE) of the beam spectra, while EGSnrc software package was used to carry out MC simulation of full spectra. The cavity theory and MC methods agreed well within the 0.7%. Energy response of x-ray beams at MV range showed a maximum of 1.5% under-response. At energies higher than 150 kV (105 keV MPE) showed no significant difference while a significant under-response were observed at 100 kV (53 keV MPE) and 50 kV (29 keV MPE), ~8 and ~12%, respectively. BeO, Al2O3:C and LiF:Mg,Ti dosemeters exhibited very similar energy response at higher energies mainly in the MeV range. At 50 kV (29 keV MPE), however, BeO dosemeter under responded by a factor of 0.878, while Al2O3:C and LiF:Mg,Ti dosemeters over responded by a factor of 3.2 and 1.44, respectively. Furthermore, at low energies, BeO energy response showed dependence on photon spectra. For instance, at 100 kV, the difference was ~8, ~6 and 2% for 53, 60 and 83 keV MPE (ISO 4037N-100), respectively. Furthermore, calibration with 137Cs instead of 60Co resulted up to 1.8% differences in energy response. Both energy spectrum and calibration methods make considerable differences in energy response of OSLDs. This study concludes that BeO chips are nearly energy independent at energies higher than 100 keV MPE, while Al2O3:C dosemeters show an extremely enhanced energy-response ranging between 1.44 and 3.2 at energies between 170 and 29 keV MPE mainly due to dominance of photoelectric effect.

Impact of detector selections on inter-institutional variability of flattening filter-free beam data for TrueBeam™ linear accelerators

This study evaluates the type of detector influencing the inter-institutional variability in flattening filter-free (FFF) beam-specific parameters for TrueBeam™ linear accelerators (Varian Medical Systems,Palo Alto, CA, USA). Twenty-four beam data sets, including the percent depth dose (PDD), off-center ratio (OCR), and output factor (OPF) for modeling within the Eclipse (Varian Medical Systems) treatment planning system, were collected from 19 institutions. Although many institutions collected the data using CC13 (IBA Dosimetry, Schwarzenbruck, Germany) or PTW31010 semiflex (PTW Freiburg, Freiburg, Germany) ionization chambers, some institutions used diode detectors, diamond detectors, and ionization chambers with smaller cavities. The OCR data included penumbra width, full width at half maximum (FWHM), and FFF beam-specific parameters, including unflatness and slope. The data measured by CC13/PTW31010 ionization chambers were compared with those measured by all other detectors. PDD data demonstrated the variations within ±1% at the dose fall-off region deeper than peak depth. The penumbra widths of the OCR measured with the CC13/PTW31010 detectors were significantly larger than those measured with all other detectors (P < 0.05). Especially the EDGE detector (Sun Nuclear Corp., Melbourne, FL, USA) and the microDiamond detectors (model 60019; PTW Freiburg) demonstrated much smaller penumbra values compared to those of the CC13/PTW31010 detectors for the 30 × 30 mm² field. There was no difference in the FWHM, unflatness, and slope parameters between the values for the CC13/PTW31010 detectors and all other detectors. OPF curves demonstrated small variations, and the relative difference from the mean value of each data point was almost within 1% for all field sizes. Although the penumbra region exhibited detector-dependent variations, all other parameters showed tiny interunit variations regardless of the detector type.

Evaluation of machine log files/MC-based treatment planning and delivery QA as compared to ArcCHECK QA

PURPOSE

A treatment planning/delivery QA tool using linac log files (LF) and Monte Carlo (MC) dose calculation is investigated as a standalone alternative to phantom-based patient-specific QA (ArcCHECK (AC)).

METHODS

Delivering a variety of fields onto MapCHECK2 and ArcCHECK, diode sensitivity dependence on dose rate (in-field) and energy (primarily out-of-field) was quantified. AC and LF QAs were analyzed with respect to delivery complexity by delivering 12 × 12 cm static fields/arcs comprised of varying numbers of abutting sub-fields onto ArcCHECK. About 11 clinical dual-arc VMAT patients planned using Pinnacle's convolution-superposition (CS) were delivered on ArcCHECK and log file dose (LF-CS and LF-MC) calculated. To minimize calculation time, reduced LF-CS sampling (1/2/3/4° control point spacing) was investigated. Planned ("Plan") and LF-reconstructed CS and MC doses were compared with each other and AC measurement via statistical [mean ± StdDev(σ)] and gamma analyses to isolate dosimetric uncertainties and quantify the relative accuracies of AC QA and MC-based LF QA.

RESULTS

Calculation and ArcCHECK measurement differed by up to 1.5% in-field due to variation in dose rate and up to 5% out-of-field. For the experimental segment-varying plans, despite CS calculation deviating by as much as 13% from measurement, Plan-MC and LF-MC doses generally matched AC measurement within 3%. Utilizing 1° control point spacing, 2%/2 mm LF-CS vs AC pass rates (97%) were slightly lower than Plan-CS vs AC pass rates (97.5%). Utilizing all log file samples, 2%/2 mm LF-MC vs AC pass rates (97.3%) were higher than Plan-MC vs AC (96.5%). Phantom-dependent, calculation algorithm-dependent (MC vs CS), and delivery error-dependent dose uncertainties were 0.8 ± 1.2%, 0.2 ± 1.1%, and 0.1 ± 0.9% respectively.

CONCLUSION

Reconstructing every log file sample with no increase in computational cost, MC-based LF QA is faster and more accurate than CS-based LF QA. Offering similar dosimetric accuracy compared to AC measurement, MC-based log files can be used for treatment planning QA.

A multi-centre analytical study of small field output factor calculations in radiotherapy

An audit methodology was developed and applied for output factor (OF) calculations in radiotherapy. The auditees were asked to calculate OFs for field sizes from 10 × 10 cm² to 2 × 2 cm². Sixty five beams were audited; missing reference OFs were interpolated. The calculated OFs were in 73% of cases higher than the reference data. The smaller the field size, the higher the overestimations which were observed in the higher fraction of cases. Treatment planning systems generally overestimated OFs for small fields. The reference dataset helped radiotherapy centres to identify discrepancies which were higher than typical.

Dosimetric characterization of Elekta stereotactic cones

Purpose

Dosimetry of small fields defined by stereotactic cones remains a challenging task. In this work, we report the results of commissioning measurements for the new Elekta stereotactic conical collimator system attached to the Elekta VersaHD linac and present the comparison between the measured and Monte Carlo (MC) calculated data for the 6 MV FFF beam. In addition, relative output factor (ROF) dependence on the stereotactic cone aperture variation was studied and penumbra comparison for small MLC‐based and cone‐based fields was performed.

Methods

Cones with nominal diameters of 15 mm, 12.5 mm, 10 mm, 7.5 mm, and 5 mm were employed in our study. Percentage depth dose (PDD), off‐axis ratios (OAR), and ROF were measured using a stereotactic field diode (SFD). BEAMnrc code was used for MC simulations.

Results

MC calculated and measured PDDs for all cones agreed within 1%/0.5 mm, and OAR profiles agreed within 1%/0.5 mm. ROF obtained from the measurements and MC calculations agreed within 2% for all cone sizes. Small‐field correction factors for the SFD detector K_{field,3 × 3}(SFD) were derived using MC calculations as a baseline and were found to be 0.982, 0.992, 0.997, 1.015, and 1.017 for the 5, 7.5, 10, 12.5, and 15‐mm cones respectively. The difference in ROF was about 10%, 6%, 3.5%, 3%, 2.5%, and 2% for ±0.3 mm variations in 5, 7.5, 10, 12.5, and 15‐mm cone aperture respectively. In case of single static field, cone‐based collimation produced a sharper penumbra compared to the MLC‐based.

Conclusions

Accurate MC simulation can be an effective tool for verification of dosimetric measurements of small fields. Due to the very high sensitivity of output factors on the cone diameter, manufacture‐related variations in cone size may lead to considerable variations in dosimetric characteristics of stereotactic cones.

Separation of scatter from small MV beams and its effect on detector response

PURPOSE

Separating the scatter from the primary component of a MV beam to study detector response separately in each case for a better understanding of the role of different effects influencing the response in nonstandard fields.

METHODS

Detector response in three different experimental setups was investigated for a variety of different types (diamond, shielded and unshielded diodes, ionization chamber and film): (a). Detectors positioned in water under a thin steel pole blocking the central part of the beam, yielding only the response to the scatter part of the beam. (b). Detectors positioned in air under a PMMA cap to approximate the contribution of the primary beam without scatter. (c). Detectors positioned in water in the standard open field configuration to obtain a superposition of both.

RESULTS

Detector differences became more clearly observable when the primary beam was blocked and detector behavior heavily depended on the construction type. It was possible to calculate the response in the open fields from the values measured in the blocked configuration with 1% accuracy for all studied field sizes between 0.8 and 10 cm and for all detectors.

CONCLUSIONS

The limitations of clinically used detectors in nonstandard situations were illustrated in the extreme situation of just scattered radiation reaching the detector. By experimentally separating scatter from the primary beam, the roles of different effects on the detector response were observed.

Curtailing patient-specific IMRT QA procedures from 2D dose error distribution

A patient-specific quality assurance (QA) test is conducted to verify the accuracy of dose delivery. It generally consists of three verification processes: the absolute point dose difference, the planar dose differences at each gantry angle, and the planar dose differences by 3D composite irradiation. However, this imposes a substantial workload on medical physicists. The objective of this study was to determine whether our novel method that predicts the 3D delivered dose allows certain patient-specific IMRT QAs to be curtailed. The object was IMRT QA for the pelvic region with regard to point dose and composite planar dose differences. We compared measured doses, doses calculated in the treatment planning system, and doses predicted by in-house software. The 3D predicted dose was reconstructed from the per-field measurement by incorporating the relative dose error distribution into the original dose grid of each beam. All point dose differences between the measured and the calculated dose were within ±3%, whereas 93.3% of them between the predicted and the calculated dose were within ±3%. As for planar dose differences, the gamma passing rates between the calculated and the predicted dose were higher than those between the calculated and the measured dose. Comparison and statistical analysis revealed a correlation between the predicted and the measured dose with regard to both point dose and planar dose differences. We concluded that the prediction-based approach is an accurate substitute for the conventional measurement-based approach in IMRT QA for the pelvic region. Our novel approach will help medical physicists save time on IMRT QA.

Small field detector correction factors: effects of the flattening filter for Elekta and Varian linear accelerators

Flattening filter‐free (FFF) beams are becoming the preferred beam type for stereotactic radiosurgery (SRS) and stereotactic ablative radiation therapy (SABR), as they enable an increase in dose rate and a decrease in treatment time. This work assesses the effects of the flattening filter on small field output factors for 6 MV beams generated by both Elekta and Varian linear accelerators, and determines differences between detector response in flattened (FF) and FFF beams. Relative output factors were measured with a range of detectors (diodes, ionization chambers, radiochromic film, and microDiamond) and referenced to the relative output factors measured with an air core fiber optic dosimeter (FOD), a scintillation dosimeter developed at Chris O'Brien Lifehouse, Sydney. Small field correction factors were generated for both FF and FFF beams. Diode measured detector response was compared with a recently published mathematical relation to predict diode response corrections in small fields. The effect of flattening filter removal on detector response was quantified using a ratio of relative detector responses in FFF and FF fields for the same field size. The removal of the flattening filter was found to have a small but measurable effect on ionization chamber response with maximum deviations of less than ±0.9% across all field sizes measured. Solid‐state detectors showed an increased dependence on the flattening filter of up to ±1.6%. Measured diode response was within ±1.1% of the published mathematical relation for all fields up to 30 mm, independent of linac type and presence or absence of a flattening filter. For 6 MV beams, detector correction factors between FFF and FF beams are interchangeable for a linac between FF and FFF modes, providing that an additional uncertainty of up to ±1.6% is accepted.

PACS number(s): 87.55.km, 87.56.bd, 87.56.Da

Three-dimensional dose prediction based on two-dimensional verification measurements for IMRT

Dose verifications for intensity‐modulated radiation therapy (IMRT) are generally performed once before treatment. A 39‐fraction treatment course for prostate cancer delivers a dose prescription of 78 Gy in eight weeks. Any changes in multileaf collimator leaf position over the treatment course may affect the dosimetry. To evaluate the magnitude of deviations from the predicted dose over an entire treatment course with MLC leaf calibrations performed every two weeks, we tracked weekly changes in relative dose error distributions measured with two‐dimensional (2D) beam‐by‐beam analysis. We compared the dosimetric results from 20 consecutive patient‐specific IMRT quality assurance (QA) tests using beam‐by‐beam analysis and a 2D diode detector array to the dose plans calculated by the treatment planning system (TPS). We added back the resulting relative dose error measured weekly into the original dose grid for each beam. To validate the prediction method, the predicted doses and dose distributions were compared to the measurements using an ionization chamber and film. The predicted doses were in good agreement, within 2% of the measured doses, and the predicted dose distributions also presented good agreement with the measured distributions. Dose verification results measured once as a pretreatment QA test were not completely stable, as results of weekly beam‐by‐beam analysis showed some variation. Because dosimetric errors throughout the treatment course were averaged, the overall dosimetric impact to patients was small.

PACS numbers: 87.55.D‐, 87.55.dk, 87.55.km, 87.55.Qr

The clinical impact of detector choice for beam scanning

Recently, the developers of Eclipse have recommended the use of ionization chambers for all profile scanning, including for the modeling of VMAT and stereotactic applications. The purpose of this study is to show the clinical impact caused by the choice of detector with respect to its ability to accurately measure dose in the penumbra and tail regions of a scanned profile. Using scan data acquired with several detectors, including an IBA CC13, a PTW 60012, and a Sun Nuclear EDGE Detector, three complete beam models are created, one for each respective detector. Next, using each beam model, dose volumes are retrospectively recalculated from actual anonymous patient plans. These plans include three full‐arc VMAT prostate plans, three left chest wall plans delivered using irregular compensators, two half‐arc VMAT lung plans, three MLC‐collimated static‐field pairs, and two SBRT liver plans. Finally, plans are reweighted to deliver the same number of monitor units, and mean dose‐to‐target volumes and organs at risk are calculated and compared. Penumbra width did not play a role. Dose in the tail region of the profile made the largest difference. By overresponding in the tail region of the profile, the 60012 diode detector scan data affected the beam model in such a way that target doses were reduced by as much as 0.4% (in comparison to CC13 and EDGE data). This overresponse also resulted in an overestimation of dose to peripheral critical structure, whose dose consisted mainly of scatter. This study shows that, for modeling the 6 MV beam of Acuros XB in Eclipse Version 11, the choice to use a CC13 scanning ion chamber or an EDGE Detector was an unimportant choice, providing nearly identical models in the treatment planning system.

PACS number: 87.55.kh

Characterization of recombination effects in a liquid ionization chamber used for the dosimetry of a radiosurgical accelerator

Most modern radiation therapy devices allow the use of very small fields, either through beamlets in Intensity-Modulated Radiation Therapy (IMRT) or via stereotactic radiotherapy where positioning accuracy allows delivering very high doses per fraction in a small volume of the patient. Dosimetric measurements on medical accelerators are conventionally realized using air-filled ionization chambers. However, in small beams these are subject to nonnegligible perturbation effects. This study focuses on liquid ionization chambers, which offer advantages in terms of spatial resolution and low fluence perturbation. Ion recombination effects are investigated for the microLion detector (PTW) used with the Cyberknife system (Accuray). The method consists of performing a series of water tank measurements at different source-surface distances, and applying corrections to the liquid detector readings based on simultaneous gaseous detector measurements. This approach facilitates isolating the recombination effects arising from the high density of the liquid sensitive medium and obtaining correction factors to apply to the detector readings. The main difficulty resides in achieving a sufficient level of accuracy in the setup to be able to detect small changes in the chamber response.

Application of spherical diodes for megavoltage photon beams dosimetry

PURPOSE

External beam radiation therapy (EBRT) usually uses heterogeneous dose distributions in a given volume. Designing detectors for quality control of these treatments is still a developing subject. The size of the detectors should be small to enhance spatial resolution and ensure low perturbation of the beam. A high uniformity in angular response is also a very important feature in a detector, because it has to measure radiation coming from all the directions of the space. It is also convenient that detectors are inexpensive and robust, especially to perform in vivo measurements. The purpose of this work is to introduce a new detector for measuring megavoltage photon beams and to assess its performance to measure relative dose in EBRT.

METHODS

The detector studied in this work was designed as a spherical photodiode (1.8 mm in diameter). The change in response of the spherical diodes is measured regarding the angle of incidence, cumulated irradiation, and instantaneous dose rate (or dose per pulse). Additionally, total scatter factors for large and small fields (between 1 × 1 cm(2) and 20 × 20 cm(2)) are evaluated and compared with the results obtained from some commercially available ionization chambers and planar diodes. Additionally, the over-response to low energy scattered photons in large fields is investigated using a shielding layer.

RESULTS

The spherical diode studied in this work produces a high signal (150 nC/Gy for photons of nominal energy of 15 MV and 160 for 6 MV, after 12 kGy) and its angular dependence is lower than that of planar diodes: less than 5% between maximum and minimum in all directions, and 2% around one of the axis. It also has a moderated variation with accumulated dose (about 1.5%/kGy for 15 MV photons and 0.7%/kGy for 6 MV, after 12 kGy) and a low variation with dose per pulse (± 0.4%), and its behavior is similar to commercial diodes in total scatter factor measurements.

CONCLUSIONS

The measurements of relative dose using the spherical diode described in this work show its feasibility for the dosimetry of megavoltage photon beams. A particularly important feature is its good angular response in the MV range. They would be good candidates for in vivo dosimetry, and quality assurance of VMAT and tomotherapy, and other modalities with beams irradiating from multiple orientations, such as Cyberknife and ViewRay, with minor modifications.

Implementation and validation of a fluence pencil kernels model for GaN-based dosimetry in photon beam radiotherapy

Gallium nitride (GaN), a direct-gap semiconductor that is radioluminescent, can be used as a transducer yielding a high signal from a small detecting volume and thus potentially suitable for use in small fields and for high dose gradients. A common drawback of semiconductor dosimeters with effective atomic numbers higher than soft tissues is that their responses depend on the presence of low energy photons for which the photoelectric cross section varies strongly with atomic number, which may affect the accuracy of dosimetric measurements. To tackle this 'over-response' issue, we propose a model for GaN-based dosimetry with readout correction. The local photon spectrum is calculated by convolving fluence pencil kernel spectra with the beam aperture fluence distribution. The response of a GaN detector is modelled by combining large cavity theory and small cavity theory for the low and high energy components of the local spectrum. Monte Carlo simulations are employed for determination of specific correction factors for different GaN transducer sizes and irradiation conditions. Some model parameters such as the cut-off energy and partitioning energy are discussed. The accuracy of the GaN dosimetric response model has been evaluated for tissue phantom ratio experiments along the central axis. These experiments have shown that calculated and measured GaN responses stay within ±3% at all depths beyond the build-up depth. The calculated GaN response factor is also in good agreement with measured data (±2.5%). The validated model with response compensation improves significantly the accuracy of dosimetric measurements: below 2.5% deviation as compared to 13% without compensation, for a 10 × 10 cm(2) field, at depth from 1.5 to 22 cm.

Dynamic conformal arc cranial stereotactic radiosurgery: implications of multileaf collimator margin on dose-volume metrics

OBJECTIVE

The effect of multileaf collimator (MLC) margin on target and normal tissue dose-volume metrics for intracranial stereotactic radiosurgery (SRS) was assessed.

METHODS

118 intracranial lesions of 83 SRS patients formed the basis of this study. For each planning target volume (PTV), five separate treatment plans were generated with MLC margins of -1, 0, 1, 2 and 3 mm, respectively. Identical treatment planning parameters were employed with a median of five dynamic conformal arcs using the Varian/BrainLab high-definition MLC for beam shaping. Prescription dose (PD) was such that 22 Gy covered at least 95% of the PTV. Dose-volume and dose-response comparative metrics included conformity index, heterogeneity index, dose gradient, tumour control probability (TCP) and normal tissue complication probability (NTCP).

RESULTS

Target dose heterogeneity decreased with increasing MLC margin (p<0.001); mean heterogeneity index decreased from 70.4 ± 12.7 to 10.4 ± 2.2%. TCP decreased with increasing MLC margin (p<0.001); mean TCP decreased from 81.0 ± 2.3 to 62.2 ± 1.8%. Normal tissue dose fall-off increased with MLC margin (p<0.001); mean gradient increased from 3.1 ± 0.9 mm to 5.3 ± 0.7 mm. NTCP was optimal at 1 mm MLC margin. No unambiguous correlation was observed between NTCP and PTV volume. Plan delivery efficiency generally improved with larger margins (p<0.001); mean monitor unit per centigray of the PD decreased from 3.60 ± 1.30 to 1.56 ± 0.13. Conclusion Use of 1 mm MLC margins for dynamic conformal arc-based cranial radiosurgery resulted in optimal tumour control and normal tissue sparing. Clinical significance of these comparative findings warrants further investigation.

The Radiological Physics Center's standard dataset for small field size output factors

Delivery of accurate intensity‐modulated radiation therapy (IMRT) or stereotactic radiotherapy depends on a multitude of steps in the treatment delivery process. These steps range from imaging of the patient to dose calculation to machine delivery of the treatment plan. Within the treatment planning system's (TPS) dose calculation algorithm, various unique small field dosimetry parameters are essential, such as multileaf collimator modeling and field size dependence of the output. One of the largest challenges in this process is determining accurate small field size output factors. The Radiological Physics Center (RPC), as part of its mission to ensure that institutions deliver comparable and consistent radiation doses to their patients, conducts on‐site dosimetry review visits to institutions. As a part of the on‐site audit, the RPC measures the small field size output factors as might be used in IMRT treatments, and compares the resulting field size dependent output factors to values calculated by the institution's treatment planning system (TPS). The RPC has gathered multiple small field size output factor datasets for X‐ray energies ranging from 6 to 18 MV from Varian, Siemens and Elekta linear accelerators. These datasets were measured at 10 cm depth and ranged from 10×10 cm2 to 2×2 cm2. The field sizes were defined by the MLC and for the Varian machines the secondary jaws were maintained at a 10×10 cm2. The RPC measurements were made with a micro‐ion chamber whose volume was small enough to gather a full ionization reading even for the 2×2 cm2 field size. The RPC measured output factors are tabulated and are reproducible with standard deviations (SD) ranging from 0.1% to 2.4%, while the institutions' calculated values had a much larger SD range, ranging up to 7.9%. The absolute average percent differences were greater for the 2×2 cm2 than for the other field sizes. The RPC's measured small field output factors provide institutions with a standard dataset against which to compare their TPS calculated values. Any discrepancies noted between the standard dataset and calculated values should be investigated with careful measurements and with attention to the specific beam model.

PACS number: 87.53.Bn

Evaluating dosimetric accuracy of flattening filter free compensator-based IMRT: measurements with diode arrays

PURPOSE

Compensator-based IMRT coupled with the high dose rate flattening filter free (FFF) beams offers an intriguing possibility of delivering an intensity modulated radiation field in just a few seconds. As a first step, the authors evaluate the dosimetric accuracy of the treatment planning system (TPS) FFF beam model with compensators.

METHODS

A 6 MV FFF beam from a TrueBeam accelerator (Varian Medical Systems, Palo Alto CA) was modeled in PINNACLE TPS (v. 9.0, Philips Radiation Oncology, Fitchburg WI). Flat brass slabs from 0.3 to 7 cm thick and an 18° brass wedge were used to adjust the beam model. A 2D (MAPCHECK) and 3D (ARCCHECK) diode arrays (Sun Nuclear Corp, Melbourne FL), were investigated for use with the compensator FFF beams. Corrections for diode sensitivity caused by the spectral changes in the beam were introduced. Four compensator plans based on the AAPM TG-119 report were developed. A composite ion chamber measurement, beam by beam MAPCHECK measurements, and a composite ARCCHECK measurement were performed. The array results were analyzed with the same thresholds as in TG-119 report-3%/3 mm with global dose normalization-as well as with the more stringent combinations of the gamma analysis criteria.

RESULTS

The FFF beam shows a greater variation of the effective attenuation coefficient with brass thickness due to the prevalence of the low energy photons compared to the conventional 6X beam. As a result, a compromise had to be made while trying to achieve dose agreement for a combination of field sizes, brass thicknesses, and measurement depths (≥5 cm in water). An agreement of measured and calculated dose to within 1% was observed for brass thicknesses up to 2 cm. For the 3 cm slab, an error of up to 2.8% was noted for the field sizes above 10 × 10 cm(2), and up to 3.8% for the 5 × 5 cm(2) field. Both diode arrays exhibit a substantial sensitivity drop as the compensator thickness increases, reaching 10% for a 7 cm brass slab. A simple correction based on the brass thickness along the ray was introduced to counteract this effect. Pooled for five profiles, the average ratio of uncorrected and corrected MAPCHECK to ion chamber readings are 0.966 and 1.008, respectively. With the proper correction, all MAPCHECK measurement to calculation comparisons exhibit 100% γ(3%/3 mm) passing rates with global dose-error normalization. For the TG-119-type plans, the average γ(2%/2 mm) passing rate with local normalization is 94% (range 87.8%-98.3%). The lower ARCCHECK γ-analysis passing rates (corrected for diode sensitivity) are predictable based on the observed PDD discrepancies. However, with the 3%/3 mm thresholds and global normalization, the average γ-analysis passing rate is 96.4% (range 89.9%-100%).

CONCLUSIONS

MAPCHECK analysis demonstrates high passing rates with the stringent γ(2%/2 mm) and local normalization criteria combination. The geometry of the ARCCHECK array creates a stress test for the FFF TPS model because of the shallow depth of the entrance diodes and large air cavity. Hence, the ARCCHECK γ-analysis passing rates are lower than with the MAPCHECK, while still on par with TG-119.

Optimizing the accuracy of a helical diode array dosimeter: a comprehensive calibration methodology coupled with a novel virtual inclinometer

PURPOSE

The goal of any dosimeter is to be as accurate as possible when measuring absolute dose to compare with calculated dose. This limits the uncertainties associated with the dosimeter itself and allows the task of dose QA to focus on detecting errors in the treatment planning (TPS) and/or delivery systems. This work introduces enhancements to the measurement accuracy of a 3D dosimeter comprised of a helical plane of diodes in a volumetric phantom.

METHODS

We describe the methods and derivations of new corrections that account for repetition rate dependence, intrinsic relative sensitivity per diode, field size dependence based on the dynamic field size determination, and positional correction. Required and described is an accurate "virtual inclinometer" algorithm. The system allows for calibrating the array directly against an ion chamber signal collected with high angular resolution. These enhancements are quantitatively validated using several strategies including ion chamber measurements taken using a "blank" plastic shell mimicking the actual phantom, and comparison to high resolution dose calculations for a variety of fields: static, simple arcs, and VMAT. A number of sophisticated treatment planning algorithms were benchmarked against ion chamber measurements for their ability to handle a large air cavity in the phantom.

RESULTS

Each calibration correction is quantified and presented vs its independent variable(s). The virtual inclinometer is validated by direct comparison to the gantry angle vs time data from machine log files. The effects of the calibration are quantified and improvements are seen in the dose agreement with the ion chamber reference measurements and with the TPS calculations. These improved agreements are a result of removing prior limitations and assumptions in the calibration methodology. Average gamma analysis passing rates for VMAT plans based on the AAPM TG-119 report are 98.4 and 93.3% for the 3%/3 mm and 2%/2 mm dose-error/distance to agreement threshold criteria, respectively, with the global dose-error normalization. With the local dose-error normalization, the average passing rates are reduced to 94.6 and 85.7% for the 3%/3 mm and 2%/2 mm criteria, respectively. Some algorithms in the convolution/superposition family are not sufficiently accurate in predicting the exit dose in the presence of a 15 cm diameter air cavity.

CONCLUSIONS

Introduction of the improved calibration methodology, enabled by a robust virtual inclinometer algorithm, improves the accuracy of the dosimeter's absolute dose measurements. With our treatment planning and delivery chain, gamma analysis passing rates for the VMAT plans based on the AAPM TG-119 report are expected to be above 91% and average at about 95% level for γ(3%/3 mm) with the local dose-error normalization. This stringent comparison methodology is more indicative of the true VMAT system commissioning accuracy compared to the often quoted dose-error normalization to a single high value.

Commissioning compensator-based IMRT on the Pinnacle treatment planning system

We present a systematic approach to commissioning of the compensator‐based IMRT in Pinnacle treatment planning system for commercially manufactured brass compensators. Some model parameters for the beams modulated by the variable‐thickness compensators can only be associated with a single compensator thickness. To intelligently choose that thickness for beam modeling, we empirically determined the most probable filter thickness occurring within the modulated portion of the compensators typically used in clinics. We demonstrated that a set of relative output factors measured with the brass slab of most probable thickness (2 cm) differs from the traditionally used open field set, and leads to improved agreement between measurements and calculations, particularly for the larger field sizes. By iteratively adjusting the modifier scatter factor and filter density, the calculated effective attenuation of the flat filters was brought to within 2% of the ion chamber measurement for the clinically‐relevant range of filter thicknesses, depths and filed sizes. Beam hardening representation in Pinnacle provides for adequate depth dose modeling beyond the depth of about 5 cm. Disagreement at shallower depth for the large field sizes is likely due to the algorithm's inability to account for the low‐energy scattered photons generated in the filter. The average ion chamber point dose error at isocenter for ten clinical compensator‐based IMRT plans was under 1%. A biplanar 3D diode dosimeter was calibrated and validated for use with the compensators. The average gamma analysis (3%/3 mm) passing rate for ten IMRT plans was 98.9%± 1.0%. The device is particularly attractive because it easily generates dose comparisons at both the fraction and beam levels. Overlaying dose profiles for individual beams would easily uncover any errors in compensator orientation.

PACS number: 87.55Qr

Evaluation of a new VMAT QA device, or the "X" and "O" array geometries

We introduce a logical process of three distinct phases to begin the evaluation of a new 3D dosimetry array. The array under investigation is a hollow cylinder phantom with diode detectors fixed in a helical shell forming an “O” axial detector cross section (ArcCHECK), with comparisons drawn to a previously studied 3D array with diodes fixed in two crossing planes forming an “X” axial cross section (Delta⁴). Phase I testing of the ArcCHECK establishes: robust relative calibration (response equalization) of the individual detectors, minor field size dependency of response not present in a 2D predecessor, and uncorrected angular response dependence in the axial plane. Phase II testing reveals vast differences between the two devices when studying fixed‐width full circle arcs. These differences are primarily due to arc discretization by the TPS that produces low passing rates for the peripheral detectors of the ArcCHECK, but high passing rates for the Delta⁴. Similar, although less pronounced, effects are seen for the test VMAT plans modeled after the AAPM TG119 report. The very different 3D detector locations of the two devices, along with the knock‐on effect of different percent normalization strategies, prove that the analysis results from the devices are distinct and noninterchangeable; they are truly measuring different things. The value of what each device measures, namely their correlation with – or ability to predict – clinically relevant errors in calculation and/or delivery of dose is the subject of future Phase III work.

PACS number: 87.55Qr

A silicon strip detector dose magnifying glass for IMRT dosimetry

PURPOSE

Intensity modulated radiation therapy (IMRT) allows the delivery of escalated radiation dose to tumor while sparing adjacent critical organs. In doing so, IMRT plans tend to incorporate steep dose gradients at interfaces between the target and the organs at risk. Current quality assurance (QA) verification tools such as 2D diode arrays, are limited by their spatial resolution and conventional films are nonreal time. In this article, the authors describe a novel silicon strip detector (CMRP DMG) of high spatial resolution (200 microm) suitable for measuring the high dose gradients in an IMRT delivery.

METHODS

A full characterization of the detector was performed, including dose per pulse effect, percent depth dose comparison with Farmer ion chamber measurements, stem effect, dose linearity, uniformity, energy response, angular response, and penumbra measurements. They also present the application of the CMRP DMG in the dosimetric verification of a clinical IMRT plan.

RESULTS

The detector response changed by 23% for a 390-fold change in the dose per pulse. A correction function is derived to correct for this effect. The strip detector depth dose curve agrees with the Farmer ion chamber within 0.8%. The stem effect was negligible (0.2%). The dose linearity was excellent for the dose range of 3-300 cGy. A uniformity correction method is described to correct for variations in the individual detector pixel responses. The detector showed an over-response relative to tissue dose at lower photon energies with the maximum dose response at 75 kVp nominal photon energy. Penumbra studies using a Varian Clinac 21EX at 1.5 and 10.0 cm depths were measured to be 2.77 and 3.94 mm for the secondary collimators, 3.52 and 5.60 mm for the multileaf collimator rounded leaf ends, respectively. Point doses measured with the strip detector were compared to doses measured with EBT film and doses predicted by the Philips Pinnacle treatment planning system. The differences were 1.1% +/- 1.8% and 1.0% +/- 1.6%, respectively. They demonstrated the high temporal resolution capability of the detector readout system, which will allow one to investigate the temporal dose pattern of IMRT and volumetric modulated are therapy (VMAT) deliveries.

CONCLUSIONS

The CMRP silicon strip detector dose magnifying glass interfaced to a TERA ASIC DAQ system has high spatial and temporal resolution. It is a novel and valuable tool for QA in IMRT dose delivery and for VMAT dose delivery.

Measurement of output factors for small photon beams

A variety of detectors and procedures for the measurement of small field output factors are discussed in the current literature. Different detectors with or without corrections are recommended. Correction factors are often derived by Monte Carlo methods, where the bias due to approximations in the model is difficult to judge. Over that, results appear to be contradictory in some cases. In this work, output factors were measured for field sizes from 4 mm up to 180 mm side length with different detectors. A simple linear correction for the energy response of solid state detectors is proposed. This led to identical values down to 8 mm field size, as long as the size of the detector is small against the field size. The correction was of the order of a few percent. For a shielded silicon diode it was well below 1%. A physically meaningful function is proposed in order to calculate output factors for arbitrary field sizes with high accuracy.

Effect of electron contamination of a 6 MV x-ray beam on near surface diode dosimetry

In critical organ in vivo x-ray dosimetry, the relative contaminating electron contribution to the total dose and total detector response outside the field will be different to the corresponding contributions at the central axis detector calibration position, mainly due to the effects of shielding in the linear accelerator head on the electron and x-ray energy spectrum. To investigate these contributions, the electron energy response of a Scanditronix PFD diode was measured using electrons with mean energies from 0.45 to 14.6 MeV, and the Monte Carlo code MCNP-4C was used to calculate the electron energy spectra on the central axis, and at 1 and 10 cm outside the edge of a 4 x 4, 10 x 10 and a 15 x 15 cm(2) 6 MV x-ray field. The electron contribution to the total dose varied from about 8% on the central axis of the smallest field to about 76% at 10 cm outside the edge of the largest field. The electron contribution to the total diode response varied from about 7-8% on the central axis of all three fields to about 58% at 10 cm outside the edge of the smallest field. The results indicated that a near surface x-ray dose measurement with a diode outside the treatment field has to be interpreted with caution and requires knowledge of the relative electron contribution specific to the measurement position and field size.

Dosimetric characteristics of a new unshielded silicon diode and its application in clinical photon and electron beams

Shielded p-silicon diodes, frequently applied in general photon-beam dosimetry, show certain imperfections when applied in the small photon fields occurring in stereotactic or intensity modulated radiotherapy (IMRT), in electron beams and in the buildup region of photon beam dose distributions. Using as a study object the shielded p-silicon diode PTW 60008, well known for its reliable performance in general photon dosimetry, we have identified these imperfections as effects of electron scattering at the metallic parts of the shielding. In order to overcome these difficulties a new, unshielded diode PTW 60012 has been designed and manufactured by PTW Freiburg. By comparison with reference detectors, such as thimble and plane-parallel ionization chambers and a diamond detector, we could show the absence of these imperfections. An excellent performance of the new unshielded diode for the special dosimetric tasks in small photon fields, electron beams and build-up regions of photon beams has been observed. The new diode also has an improved angular response. However, due to its over-response to low-energy scattered photons, its recommended range of use does not include output factor measurements in large photon fields, although this effect can be compensated by a thin auxiliary lead shield.