Glass rod detectors for small field, stereotactic radiosurgery dosimetric audit

The IAEA remote audit of small field dosimetry for testing the implementation of the TRS-483 code of practice

BACKGROUND

The TRS‑483, an IAEA/AAPM International Code of Practice on dosimetry of small static photon fields, underwent testing via an IAEA coordinated research project (CRP). Alongside small field output factors (OFs) measurements using active dosimeters by CRP participants, the IAEA Dosimetry Laboratory received a mandate to formulate a remote small field dosimetry audit method using its passive dosimetry systems.

PURPOSE

This work aimed to develop a small field dosimetry audit methodology employing radiophotoluminescent dosimeters (RPLDs) and radiochromic films. The methodology was subsequently evaluated through a multicenter pilot study with CRP participants.

METHODS

The developments included designing and manufacturing a dosimeter holder set and the characterization of an RPLD system for measurements in small photon fields using the new holder. The audit included verification of small field OFs and lateral beam profiles for small fields. At first, treatment planning system (TPS) calculated OFs were checked against a reference data set that was available for conventional linacs. Second, calculated OFs were verified through the RPLD measurement of point doses in a machine-specific reference field, 4 cm × 4 cm, 2 cm × 2 cm, and 1 cm × 1 cm, corresponding size circular fields or nearest achievable field sizes. Lastly, profile checks in in-plane and cross-plane directions were done for the two smallest fields by comparing film measurements with TPS calculations at 20%, 50%, and 80% isodose levels.

RESULTS

RPLD correction factors for small field measurements were approximately unity. However, they influenced the dose determination's overall uncertainty in small fields, estimated at 2.30% (k = 1 level). Considering the previous experience in auditing reference beam output following the TRS-398 Code of Practice, the acceptance limit of 5% for the ratio of the dose determined by RPLD to the dose calculated by TPS, DRPLD/DTPS, was considered adequate. The multicenter pilot study included 15 participants from 14 countries (39 beams). Consistent with the previous findings, the results of the OF check against the reference data confirmed that TPSs tend to overestimate OFs for the smallest fields included in this exercise. All except three RPLD measurement results were within the acceptance limit, and the spread of results increased for smaller field sizes. The differences between the film measured and TPS calculated dose profiles were within 3 mm for most of the beams checked; deviated results revealed problems with TPS commissioning and calibration of the treatment unit collimation systems.

CONCLUSION

The newly developed small field dosimetry audit methodology proved effective and successfully complemented the CRP OF measurements by participants with RPLD audit results.

Evaluation of a New Method for CyberKnife Treatment for Central Lung and Mediastinal Tumors by Tracheobronchial Tracking

BACKGROUND

CyberKnife treatment for central lung tumors and mediastinal tumors can be difficult to perform with marker less.

PURPOSE

We aimed to evaluate a novel tracheobronchial-based method (ie, tracheobronchial tracking) for the purpose of minimally invasive CyberKnife treatment for central lung and mediastinal tumors.

METHODS

Five verification plans were created using an in-house phantom. Each plan included five irradiation sessions. The reference plan irradiated and tracked the simulated tumor (using the target tracking volume, TTV). Trachea plans tracked the simulated tracheo-bronchus and irradiated the simulated tumor and included two types of subplans: correlated plans in which the displacement of the simulated tracheobronchial and the simulated tumor were correlated, and non-correlated plans in which these factors were not correlated. Moreover, 15 mm and 25 mm TTVs were evaluated for each plan. The sin waveform and the patient's respiratory waveform were prepared as the respiratory model. Evaluations were performed by calculating the dose difference between the radiophotoluminescent glass dosimeter (RPLD)-generated mean dose values (generated by the treatment planning system, TPS) and the actual absorbed RPLD dose. Statistical analyses were performed to evaluate findings for each plan. Correlation and prediction errors were calculated for each axis of each plan using log files to evaluate tracking accuracy.

RESULTS

Dose differences were statistically significant only in comparisons with the non-correlated plan. When evaluated using the sin waveform, the mean values for correlation and prediction errors in each axis and for all plans were less than 0.6 mm and 0.1 mm, respectively. In the same manner, they were less than 1.1 mm and 0.2 mm when evaluated using the patient's respiratory waveform.

CONCLUSION

Our newly-developed tracheobronchial tracking method would be useful in facilitating minimally invasive CyberKnife treatment in certain cases of central lung and mediastinal tumors.

Determination of field output correction factors of radiophotoluminescence glass dosimeter and CC01 ionization chamber and validation against IAEA-AAPM TRS-483 code of practice

PURPOSE

To determine the field output correction factors of the radiophotoluminescence glass dosimeter (RPLGD) in parallel and perpendicular orientations with reference to CC01, the ionization chamber.

METHODS

The dose to a small water volume and the sensitive volume of the RPLGD and the IBA-CC01 were determined for 6-MV, 100-cm SAD, 10-cm depth using egs_chamber user-code. The RPLGD in perpendicular and parallel orientations to the beam axis were studied. The field output correction factors of each detector for 0.5 × 0.5 to 10 × 10 cm² field sizes were determined. These field output correction factors were validated by comparing field output factors against data determined from IAEA-AAPM TRS-483 code of practice.

RESULTS

The field output correction factors of all detectors were within 5% for field sizes down to 0.8 × 0.8 cm². For 0.5 × 0.5 cm², the field output correction factors of CC01, RPLGD in perpendicular and parallel orientations differed from unity by 14%, 19%, and 5%, respectively. The percentage difference between field output factors determined using RPLGD and CC01 data, corrected using the field output correction factors determined in this work and measurements with CC01 data corrected using TRS-483, was less than 3% for all field sizes, except for the smallest field size of RPLGD in perpendicular orientation and the CC01.

CONCLUSIONS

The field output correction factors of RPLGD and CC01 are reported. The validation proves that RPLGD in parallel orientation combined with the field output correction factors is the most suitable for determining the field output factors for the smallest field used in this study.

Report of AAPM Task Group 155: Megavoltage photon beam dosimetry in small fields and non-equilibrium conditions

Small-field dosimetry used in advance treatment technologies poses challenges due to loss of lateral charged particle equilibrium (LCPE), occlusion of the primary photon source, and the limited choice of suitable radiation detectors. These challenges greatly influence dosimetric accuracy. Many high-profile radiation incidents have demonstrated a poor understanding of appropriate methodology for small-field dosimetry. These incidents are a cause for concern because the use of small fields in various specialized radiation treatment techniques continues to grow rapidly. Reference and relative dosimetry in small and composite fields are the subject of the International Atomic Energy Agency (IAEA) dosimetry code of practice that has been published as TRS-483 and an AAPM summary publication (IAEA TRS 483; Dosimetry of small static fields used in external beam radiotherapy: An IAEA/AAPM International Code of Practice for reference and relative dose determination, Technical Report Series No. 483; Palmans et al., Med Phys 45(11):e1123, 2018). The charge of AAPM task group 155 (TG-155) is to summarize current knowledge on small-field dosimetry and to provide recommendations of best practices for relative dose determination in small megavoltage photon beams. An overview of the issue of LCPE and the changes in photon beam perturbations with decreasing field size is provided. Recommendations are included on appropriate detector systems and measurement methodologies. Existing published data on dosimetric parameters in small photon fields (e.g., percentage depth dose, tissue phantom ratio/tissue maximum ratio, off-axis ratios, and field output factors) together with the necessary perturbation corrections for various detectors are reviewed. A discussion on errors and an uncertainty analysis in measurements is provided. The design of beam models in treatment planning systems to simulate small fields necessitates special attention on the influence of the primary beam source and collimating devices in the computation of energy fluence and dose. The general requirements for fluence and dose calculation engines suitable for modeling dose in small fields are reviewed. Implementations in commercial treatment planning systems vary widely, and the aims of this report are to provide insight for the medical physicist and guidance to developers of beams models for radiotherapy treatment planning systems.

Energy response of radiophotoluminescent glass dosimeter for diagnostic kilovoltage x-ray beams

PURPOSE

This study aimed to investigate the energy response of a radiophotoluminescent glass dosimeter (RGD) for diagnostic kilovoltage x-ray beams by Monte Carlo (MC) calculations and measurements.

METHODS

The uniformity and reproducibility of GD-352M (with Sn filter) and GD-302M (no filter) were tested with 45 RGDs in free air. Subsequently, the RGD response was obtained as a function of an Al-HVL using the parameter, quality index (QI), which is defined as the ratio of the effective energy (keV) to the maximum energy (keV) of the photons. The x-ray fluence spectra with QI of 0.4, 0.5, and 0.6 were set for tube voltages of 50 ~ 137.6 kVp. The RGD response was calculated in free air using the MC method and verified by the air kerma, K_air, measured using an ionization chamber.

RESULTS

The uniformity and reproducibility of the 45 RGDs were ± 2.3% and ± 2.7% for GD-352M and ± 0.7% and ± 1.6% for GD-302M at the one standard deviation level, respectively. The calculated RGD response was 0.965 to 1.062 at Al-HVL 2.73 mm or more for GD-352M and varied from 3.9 to 2.8 for GD-302M. Both RGD responses exhibited a good correlation with the Al-HVL for the given QI. K_air measured by RGDs for each beam quality with a QI of 0.5 was in the range of -5%~0.8% for GD-352M and -1.8%~3% for GD-302M, relative to the chamber measurements.

CONCLUSIONS

The RGD response was indicated as a function of the Al-HVL for the given QI, and it presented a good correlation with the Al-HVL.

Comparative analysis between 5 mm and 7.5 mm collimators in CyberKnife radiosurgery for trigeminal neuralgia

Trigeminal neuralgia (TN) is treated in CyberKnife (Accuray Inc, Sunnyvale, USA) with the 5 mm collimator whose dosimetric inaccuracy is higher than the other available collimators. The 7.5 mm collimator which is having less dosimetric uncertainty can be an alternative for 5 mm collimator provided the dose distribution with 7.5 mm collimator is acceptable. Aim of this study is to analyze the role of 7.5 mm collimator in CyberKnife treatment plans of TN. The treatment plans with 5 mm collimators were re-optimized with 7.5 mm collimator and a bi-collimator system (5 mm and 7.5 mm). The treatment plans were compared for target coverage, brainstem doses, and the dose to normal tissues. The target and brainstem doses were comparable. However, the conformity indices were 2.31 ± 0.52, 2.40 ± 0.87 and 2.82 ± 0.51 for 5 mm, bi-collimator (5mm and 7.5 mm), 7.5 mm collimator plans respectively. This shows the level of dose spillage in 7.5 mm collimator plans. The 6 Gy dose volumes in 7.5 mm plans were 1.53 and 1.34 times higher than the 5 mm plan and the bi-collimator plans respectively. The treatment time parameters were lesser for 7.5 mm collimators. Since, the normal tissue dose is pretty high in 7.5 mm collimator plans, the use of it in TN plans can be ruled out though the treatment time is lesser for these 7.5 mm collimator plans.

Dose linearity and monitor unit stability of a G4 type cyberknife robotic stereotactic radiosurgery system

Dose linearity studies on conventional linear accelerators show a linearity error at low monitor units (MUs). The purpose of this study was to establish the dose linearity and MU stability characteristics of a cyberknife (Accuray Inc., USA) stereotactic radiosurgery system. Measurements were done at a depth of 5 cm in a stereotactic dose verification phantom with a source to surface distance of 75 cm in a Generation 4 (G4) type cyberknife system. All the 12 fixed-type collimators starting from 5 to 60 mm were used for the dose linearity study. The dose linearity was examined in small (1–10), medium (15–100) and large (125–1000) MU ranges. The MU stability test was performed with 60 mm collimator for 10 MU and 20 MU with different combinations. The maximum dose linearity error of –38.8% was observed for 1 MU with 5 mm collimator. Dose linearity error in the small MU range was considerably higher than in the medium and large MU ranges. The maximum error in the medium range was –2.4%. In the large MU range, the linearity error varied between –0.7% and 1.2%. The maximum deviation in the MU stability was –3.03%.

Estimate of organ radiation absorbed doses in clinical CT using the radiation treatment planning system

Organ absorbed doses in computed tomography (CT) scans can be measured with anatomical phantoms but not inside the human body. In this study, a straightforward method was investigated to estimate organ doses in clinical CT using the radiation treatment planning system (RTPS) and compared them with experimental results of photoluminescence dosemeters (PLD). In a heterogeneous phantom, the average difference between PLD and RTPS values were -5.0% for the body and 7.1% for the lung. Using CT data, organ doses in 30 clinical cases were then calculated. There was a significant inverse correlation between the calculated values of organ doses and body mass index (BMI, correlation coefficients (r) = -0.69 (whole body), -0.80 (right lung), -0.81 (left lung), -0.76 (spinal cord), -0.74 (vertebra bone), -0.74 (heart), and -0.79 (oesophagus), all p < 0.01). An RTPS can be a simple and useful tool for estimating equivalent doses inside the human body, during whole-body CT scans.

Study of a spherical phantom for Gamma knife dosimetry

Four 16 cm diameter spherical phantoms were modeled in this study: a homogenous water phantom, and three water phantoms with 1 cm thick shell each made of different materials (PMMA, Plastic Water™ and polystyrene). The PENELOPE Monte Carlo code was utilized to simulate photon beams from the Leksell Gamma Knife (LGK) unit and to determine absorbed dose to water (Dw) from a single 18 mm beam delivered to each phantom. A score spherical volume of 0.007 cm³ was used to simulate the dimensions of the sensitive volume of the Exradin A‐16 ionization chamber, in the center of the phantom. In conclusion, the PMMA shell filled with water required a small correction for the determination of the absorbed dose, while remaining within the statistical uncertainty of the calculations (±0.71). Plastic Water™ and polystyrene shells can be used without correction. There is a potential advantage to measuring the 4 mm helmet output using these spherical water phantoms.

PACS numbers: 87.10.Rt, 87.50.cm

Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels

Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.

Lessons from recent accidents in radiation therapy in France

Many accidents in radiotherapy have been reported in France over the last years. This is due to the recent legal obligation to declare to the national safety authorities any significant incident relative to the use of ionising radiation including medical applications. The causes and consequences of the most serious events in radiotherapy are presented in this paper. Lessons can be learned from possible technical dysfunctions, from human errors or organisational weaknesses as to how such events can be prevented. The technical aspects are addressed here: in particular, dosimetric issues.