Effect of Detector Orientation and Influence of Jaw Position in the Determination of Small-field Output Factor with Various Detectors for High-energy Photon Beams

Background

Accurate dose measurements are difficult in small fields due to charge particle disequilibrium, partial source occlusion, steep dose gradient, and the finite size of the detector.

Aim

The study aims to determine the output factor using various detectors oriented in parallel and perpendicular orientations for three different tertiary collimating systems using 15 MV photon beams. In addition, this study analyzes how the output factor could be affected by different configurations of X and Y jaws above the tertiary collimators.

Materials and Methods

Small field output factor measurements were carried out with three detectors for different tertiary collimating systems such as BrainLab stereotactic cones, BrainLab mMLC and Millennium MLC namely. To analyze the effect of jaw position on output factor, measurements have been carried out by positioning the jaws at the edge, 0.25, 0.5, and 1.0 cm away from the tertiary collimated field.

Results

The data acquired with 15 MV photon beams show significant differences in output factor obtained with different detectors for all collimating systems. For smaller fields when compared to microDiamond, the SRS diode underestimates the output by up to -1.7% ± 0.8% and -2.1% ± 0.3%, and the pinpoint ion chamber underestimates the output by up to -8.1% ± 1.4% and -11.9% ± 1.9% in their parallel and perpendicular orientation respectively. A large increase in output factor was observed in the small field when the jaw was moved 0.25 cm symmetrically away from the tertiary collimated field.

Conclusion

The investigated data on the effect of jaw position inferred that the position of the X and Y jaw highly influences the output factors of the small field. It also confirms that the output factor highly depends on the configuration of X and Y jaw settings, the tertiary collimating system as well as the orientation of the detectors in small fields.

Evaluation of International Atomic Energy Agency Technical Report Series-483 Detector-specific Output Correction Factor for Various Collimator Systems

Aim

In this study, a 6MV flattening filter (FF) and 6MV FF Free (FFF) photon beam small-field output factors (OF) were measured with various collimators using different detectors. The corrected OFs were compared with the treatment planning system (TPS) calculated OFs.

Materials and Methods

OF measurements were performed with four different types of collimators: Varian Millennium multi-leaf collimator (MLC), Elekta Agility MLC, Apex micro-MLC (mMLC) and a stereotactic cone. Ten detectors (four ionization chambers and six diodes) were used to perform the OF measurements at a depth of 10 cm with a source-to-surface distance of 90 cm. The corrected OF was calculated from the measurements. The corrected OFs were compared with existing TPS-generated OFs.

Results

The use of detector-specific output correction factor (OCF) in the PTW diode P detector reduced the OF uncertainty by <4.1% for 1 cm × 1 cm Sclin. The corrected OF was compared with TPS calculated OF; the maximum variation with the IBA CC01 chamber was 3.75%, 3.72%, 1.16%, and 0.90% for 5 mm stereotactic cone, 0.49 cm × 0.49 cm Apex mMLC, 1 cm × 1 cm Agility MLC, and 1 cm × 1 cm Millennium MLC, respectively.

Conclusion

The technical report series-483 protocol recommends that detector-specific OCF should be used to calculate the corrected OF from the measured OF. The implementation of OCF in the TPS commissioning will reduce the small-field OF variation by <3% for any type of detector.

The PTW microSilicon diode: Performance in small 6 and 15 MV photon fields and utility of density compensation

PURPOSE

We have experimentally and computationally characterized the PTW microSilicon 60023-type diode's performance in 6 and 15 MV photon fields ≥5 × 5 mm² projected to isocenter. We tested the detector on- and off-axis at 5 and 15 cm depths in water, and investigated whether its response could be improved by including within it a thin airgap.

METHODS

Experimentally, detector readings were taken in fields generated by a Varian TrueBeam linac and compared with doses-to-water measured using Gafchromic film and ionization chambers. An unmodified 60023-type diode was tested along with detectors modified to include 0.6, 0.8, and 1.0 mm thick airgaps. Computationally, doses absorbed by water and detectors' sensitive volumes were calculated using the EGSnrc/BEAMnrc Monte Carlo radiation transport code. Detector response was characterized using k Q c l i n , 4 cm f c l i n , 4 cm , a factor that corrects for differences in the ratio of dose-to-water to detector reading between small fields and the reference condition, in this study 5 cm deep on-axis in a 4 × 4 cm² field.

RESULTS

The greatest errors in measurements of small field doses made using uncorrected readings from the unmodified 60023-type detector were over-responses of 2.6% ± 0.5% and 5.3% ± 2.0% determined computationally and experimentally, relative to the reading-per-dose in the reference field. Corresponding largest errors for the earlier 60017-type detector were 11.9% ± 0.6% and 11.7% ± 1.4% over-responses. Adding even the thinnest, 0.6 mm, airgap to the 60023-type detector over-corrected it, leading to under-responses of up to 4.8% ± 0.6% and 5.0% ± 1.8% determined computationally and experimentally. Further, Monte Carlo calculations indicate that a detector with a 0.3 mm airgap would read correctly to within 1.3% on-axis. The ratio of doses at 15 and 5 cm depths in water in a 6 MV 4 × 4 cm² field was measured more accurately using the unmodified 60023-type detector than using the 60017-type detector, and was within 0.3% of the ratio measured using an ion chamber. The 60023-type diode's sensitivity also varied negligibly as dose-rate was reduced from 13 to 4 Gy min^-1 by decreasing the linac pulse repetition frequency, whereas the sensitivity of the 60017-type detector fell by 1.5%.

CONCLUSIONS

The 60023-type detector performed well in small fields across a wide range of beam energies, field sizes, depths, and off-axis positions. Its response can potentially be further improved by adding a thin, 0.3 mm, airgap.

Cema-based formalism for the determination of absorbed dose for high-energy photon beams

PURPOSE

Determination of absorbed dose is well established in many dosimetry protocols and considered to be highly reliable using ionization chambers under reference conditions. If dosimetry is performed under other conditions or using other detectors, however, open questions still remain. Such questions frequently refer to appropriate correction factors. A converted energy per mass (cema)-based approach to formulate such correction factors offers a good understanding of the specific response of a detector for dosimetry under various measuring conditions and thus an estimate of pros and cons of its application.

METHODS

Determination of absorbed dose requires the knowledge of the beam quality correction factor k_Q,Qo , where Q denotes the quality of a user beam and Qo is the quality of the radiation used for calibration. In modern Monte Carlo (MC)-based methods, k_Q,Qo is directly derived from the MC-calculated dose conversion factor, which is the ratio between the absorbed dose at a point of interest in water and the mean absorbed dose in the sensitive volume of an ion chamber. In this work, absorbed dose is approximated by the fundamental quantity cema. This approximation allows the dose conversion factor to be substituted by the cema conversion factor. Subsequently, this factor is decomposed into a product of cema ratios. They are identified as the stopping power ratio water to the material in the sensitive detector volume, and as the correction factor for the fluence perturbation of the secondary charged particles in the detector cavity caused by the presence of the detector. This correction factor is further decomposed with respect to the perturbation caused by the detector cavity and that caused by external detector properties. The cema-based formalism was subsequently tested by MC calculations of the spectral fluence of the secondary charged particles (electrons and positrons) under various conditions.

RESULTS

MC calculations demonstrate that considerable fluence perturbation may occur particularly under non-reference conditions. Cema-based correction factors to be applied in a 6-MV beam were obtained for a number of ionization chambers and for three solid-state detectors. Feasibility was shown at field sizes of 4 × 4 and 0.5 cm × 0.5 cm. Values of the cema ratios resulting from the decomposition of the dose conversion factor can be well correlated with detector response. Under the small field conditions, the internal fluence correction factor of ionization chambers is considerably dependent on volume averaging and thus on the shape and size of the cavity volume.

CONCLUSIONS

The cema approach is particularly useful at non-reference conditions including when solid-state detectors are used. Perturbation correction factors can be expressed and evaluated by cema ratios in a comprehensive manner. The cema approach can serve to understand the specific response of a detector for dosimetry to be dependent on (a) radiation quality, (b) detector properties, and (c) electron fluence changes caused by the detector. This understanding may also help to decide which detector is best suited for a specific measurement situation.

Dose calculation accuracy for photon small fields in treatment planning systems with comparison by Monte Carlo simulations

Purpose: Advanced radiation therapy techniques use small fields in treatment planning and delivery. Small fields have the advantage of more accurate dose delivery, but with the cost of some complications in dosimetry. Different dose calculation algorithms imported in various treatment planning systems (TPSs) which each of them has different accuracy. Monte Carlo (MC) simulation has been reported as one of the accurate methods for calculating dose distribution in radiation therapy. The aim of this study was the evaluation of TPS dose calculation algorithms in small fields against 2 MC codes.

Methods: A linac head was simulated in 2 MC codes, MCNPX, and GATE. Then three small fields (0.5×0.5, 1×1 and 1.5×1.5 cm2) were simulated with 2 MC codes, and also these fields were planned with different dose calculation algorithms in Isogray and Monaco TPS. PDDs and lateral dose profiles were extracted and compared between MC simulations and dose calculation algorithms.

Results: For 0.5×0.5 cm2 field mean differences in PDDs with MCNPX were 2.28, 4.6, 5.3, and 7.4% and with GATE were -0.29, 2.3, 3 and 5% for CCC, superposition, FFT and Clarkson algorithms respectively. For 1×1 cm2 field mean differences in PDDs with MCNPX were 1.58, 0.6, 1.1 and 1.4% and with GATE were 0.77, 0.1, 0.6 and 0.9% for CCC, superposition, FFT and Clarkson algorithms respectively. For 1.5×1.5 cm2 field mean differences in PDDs with MCNPX were 0.82, 0.4, 0.6 and -0.4% and with GATE were 2.38, 2.5, 2.7 and 1.7% for CCC, superposition, FFT and Clarkson algorithms respectively.

Conclusions: Different dose calculation algorithms were evaluated and compared with MC simulation in small fields. Mean differences with MC simulation decreased with the increase of field sizes for all algorithms.

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.

Monte Carlo simulation and dosimetry measurements of an experimental approach for in vitro HDR brachytherapy irradiation

Irradiation of tumor cell lines is a useful way to investigate the effects of ionizing radiation on biological molecules. We designed an easy and reproducible approach for in vitro experimental high dose rate brachytherapy, which was simulated by a Monte Carlo code and dosimetrically characterized by experimental methods to evaluate the correspondence between planned doses and doses absorbed by the cells. This approach is an acrylic platform containing T25 tissue culture flasks and multiwell tissue culture plates. It allows nine parallel needles carrying an ¹⁹²Ir source to irradiate the adherent cells. The whole system composed of the acrylic platform, tissue culture flasks and ¹⁹²Ir source tracking was simulated by the Monte Carlo N-Particle transport code (MCNPX). Dosimetric measurements were taken by well ionization chamber and radiochromic films. There was a slight difference, averaging from 2% to 7%, between the MCNPX results and film dosimetry results regarding uniform radiation created by the source arrangement. The results showed different values for planned and measured doses in each cell culture plate, which was attributed to the non-equivalent water material used and to the lack of full scattering coming from the top of the platform. This last contribution was different for each tissue culture plate and an individual dose correction factor was calculated. The dose correction factor must be applied to match the planned dose and the actual doses absorbed by the cells. The designed approach is an efficient tool for in vitro brachytherapy experiments for most commercial cell culture plates.

Reference dosimetry of modulated and dynamic photon beams

In the late 1980s, a new technique was proposed that would revolutionize radiotherapy. Now referred to as intensity-modulated radiotherapy, it is at the core of state-of-the-art photon beam delivery techniques, such as helical tomotherapy and volumetric modulated arc therapy. Despite over two decades of clinical application, there are still no established guidelines on the calibration of dynamic modulated photon beams. In 2008, the IAEA-AAPM work group on nonstandard photon beam dosimetry published a formalism to support the development of a new generation of protocols applicable to nonstandard beam reference dosimetry (Alfonso et al 2008 Med. Phys. 35 5179-86). The recent IAEA Code of Practice TRS-483 was published as a result of this initiative and addresses exclusively small static beams. But the plan-class specific reference calibration route proposed by Alfonso et al (2008 Med. Phys. 35 5179-86) is a change of paradigm that is yet to be implemented in radiotherapy clinics. The main goals of this paper are to provide a literature review on the dosimetry of nonstandard photon beams, including dynamic deliveries, and to discuss anticipated benefits and challenges in a future implementation of the IAEA-AAPM formalism on dynamic photon beams.

Density compensated diodes for small field dosimetry: comprehensive testing and implications for design

PURPOSE

In small megavoltage photon fields, the accuracies of an unmodified PTW 60017-type diode dosimeter and six diodes modified by adding airgaps of thickness 0.6-1.6 mm and diameter 3.6 mm have been comprehensively characterized experimentally and computationally. The optimally thick airgap for density compensation was determined, and detectors were micro-CT imaged to investigate differences between experimentally measured radiation responses and those predicted computationally.

METHODS

Detectors were tested on- and off-axis, at 5 and 15 cm depths in 6 and 15 MV fields ≥ 0.5 × 0.5 cm². Computational studies were carried out using the EGSnrc/BEAMnrc Monte Carlo radiation transport code. Experimentally, radiation was delivered using a Varian TrueBeam linac and doses absorbed by water were measured using Gafchromic EBT3 film and ionization chambers, and compared with diode readings. Detector response was characterized via the [Formula: see text] formalism, choosing a 4 × 4 cm² reference field.

RESULTS

For the unmodified 60017 diode, the maximum error in small field doses obtained from diode readings uncorrected by [Formula: see text] factors was determined as 11.9% computationally at +0.25 mm off-axis and 5 cm depth in a 15 MV 0.5 × 0.5 cm² field, and 11.7% experimentally at -0.30 mm off-axis and 5 cm depth in the same field. A detector modified to include a 1.6 mm thick airgap performed best, with maximum computationally and experimentally determined errors of 2.2% and 4.1%. The 1.6 mm airgap deepened the modified dosimeter's effective point of measurement by 0.5 mm. For some detectors significant differences existed between responses in small fields determined computationally and experimentally, micro-CT imaging indicating that these differences were due to within-tolerance variations in the thickness of an epoxy resin layer.

CONCLUSIONS

The dosimetric performance of a 60017 diode detector was comprehensively improved throughout 6 and 15 MV small photon fields via density compensation. For this approach to work well with good detector-to-detector reproducibility, tolerances on dense component dimensions should be reduced to limit associated variations of response in small fields, or these components should be modified to have more water-like densities.

Monte carlo model and output factors of elekta infinity™ 6 and 10 MV photon beam

Aim

This study aimed to commission the Elekta Infinity™ working in 6 and 10 MV photon beam installed in Concord International Hospital, Singapore, and compare the OFs between MC simulation and measurement using PTW semiflex and microDiamond detector for small field sizes.

Material and Methods

There are two main steps in this study: modelling of Linac 6 and 10 MV photon beam and analysis of the output factors for field size 2 × 2-10 × 10 cm². The EGSnrc/BEAMnrc-DOSXYZnrc code was used to model and characterize the Linac and to calculate the dose distributions in a water phantom. The dose distribution and OFs were compared to the measurement data in the same condition.

Results

The commissioning process was only conducted for a 10 × 10 cm² field size. The PDD obtained from MC simulation showed a good agreement with the measurement. The local dose difference of PDDs was less than 2% for 6 and 10 MV. The initial electron energy was 5.2 and 9.4 MeV for 6 and 10 MV photon beam, respectively. This Linac model can be used for dose calculation in other situations and different field sizes because this Linac has been commissioned and validated using Monte Carlo simulation. The 10 MV Linac produces higher electron contamination than that of 6 MV.

Conclusions

The Linac model in this study was acceptable. The most important result in this work comes from OFs resulted from MC calculation. This value was more significant than the OFs from measurement using semiflex and microDiamond for all beam energy and field sizes because of the CPE phenomenon.

Evaluation of the IAEA-TRS 483 protocol for the dosimetry of small fields (square and stereotactic cones) using multiple detectors

The IAEA TRS 483 protocol¹ for the dosimetry of small static fields in radiotherapy was used to calculate output factors for the Elekta Synergy linac at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA). Small field output factors for both square and circular fields were measured using nine different detectors. The “corrected” output factors (ratio of detector readings multiplied by the appropriate correction factor from the protocol) showed better consistency compared to the “uncorrected” output factors (ratio of detector readings only), with the relative standard deviation decreasing by approximately 1% after the application of the relevant correction factors. Comparisons relative to an arbitrarily chosen PTW 60019 microDiamond detector showed a reduction of maximal variation for the corrected values of approximately 3%. A full uncertainty budget was prepared to analyze the consistency of the output factors. Agreement within uncertainties between all detectors and field sizes was found, except for the 15 mm circular field. The results of this study show that the application of IAEA TRS 483¹ when measuring small fields will improve the consistency of small field measurements when using multiple detectors contained within the protocol.

Reconstruction of the electron source intensity distribution of a clinical linear accelerator using in-air measurements and a genetic algorithm

Background and purpose

The electron source intensity distribution of a clinical linear accelerator has a great influence on the calculation of output factors for small radiation fields where source occlusion by the collimating devices takes place. The purpose of this study was to present a new method for the electron source reconstruction problem.

Materials and methods

The measurements were performed in-air using diode and 6 MV 1 × 1 cm² photon field in flattening filter-free mode. In Monte Carlo simulation, an electron target area was divided into a number of square subsources. Then, the in-air doses in 2D silicon chip array were calculated individually from each subsource. A genetic algorithm search was applied in order to determine the optimal weight factors for all subsources that provide the best agreement between simulated and measured doses.

Results

It was found that the reconstructed electron source intensity from a clinical linear accelerator has the two-dimensional elliptical double Gaussian distribution. The source intensity distribution consisted of two intensity components along the in-plane (x) and cross-plane (y) directions characterized by full width half-maximum (FWHM): FWHM_x1 = 0.27 cm, FWHM_x2 = 0.08 cm, FWHM_y1 = 0.24 cm, FWHM_y2 = 0.06 cm, where broader components are 81% and 53% of the total intensity along × and y axis respectively.

Conclusions

The obtained results demonstrated an elliptical double Gaussian intensity distribution of the incident electron source. We anticipate that the proposed method has universal applications independent of the type of linear accelerator, modality or energy.

An Experimental Slope Method for a More Accurate Measurement of Relative Radiation Doses using Radiographic and Radiochromic Films and Its Application to Megavoltage Small-Field Dosimetry

PURPOSE

An experimental method using the linear portion of the relative film dose-response curve for radiographic and radiochromic films is presented, which can be used to determine the relative depth doses in a variety of very small, medium, and large radiation fields and relative output factors (ROFs) for small fields.

MATERIALS AND METHODS

The film slope (FS) method was successfully applied to obtain the percentage depth doses (PDDs) for external beams of photon and electrons from a Synergy linear accelerator (Elekta AB, Stockholm, Sweden) under reference conditions of 10 cm × 10 cm for photon beam and nominal 10 cm × 10 cm size applicator for electron beam. For small-field dosimetry, the FS method was applied to EDR2 films (Carestream Health, Rochester, NY) for 6 MV photon beam from a linac (Elekta AB, Stockholm, Sweden) and small, circular radiosurgery cones (Elekta AB, Stockholm, Sweden) with diameters of 5, 7.5, 10, 12.5, and 15 mm. The ROFs for all these cones and central axis PDDs for 5, 10, and 15 mm diameter cones were determined at source-to-surface distance of 100 cm. The ROFs for small fields of CyberKnife system were determined using this technique with Gafchromic EBT3 film (Ashland, NJ, USA). The PDDs and ROFs were compared with ion chamber (IC) and Monte Carlo (MC) simulated values.

RESULTS

The maximum percentage deviation of PDD_FS with PDD_IC for 4, 6, and 15 MV photon beams was within 1.9%, 2.5%, and 1.4%, respectively, up to 20-cm depth. The maximum percentage deviation of PDD_FS with PDD_IC for electron beams was within 3% for energy range studied of 8-15 MeV. The gamma passing rates of PDD_FS with PDD_IC were above 96.5% with maximum gamma value of >2, occurring at the zero depths for 4, 6, and 15 MV photons. For electron beams, the gamma passing rates between PDD_FS with PDD_IC were above 97.7% with a maximum gamma value of 0.9, 1.3, and 0.7 occurring at the zero depth for 8, 12, and 15 MeV. For small field of 5-mm cone, the ROF_FS was 0.665 ± 0.021 as compared to 0.674 by MC method. The maximum percentage deviation between PDD_FS and PDD_MC was 3% for 5 mm and 10 mm and 2% for 15 mm cones with 1D gamma passing rates, respectively, of 95.5%, 96%, and 98%. For CyberKnife system, the ROF_FS using EBT3 film and MC published values agrees within 0.2% for for 5 mm cone.

CONCLUSIONS

The authors have developed a novel and more accurate method for the relative dosimetry of photon and electron beams. This offers a unique method to determine PDD and ROF with a high spatial resolution in fields of steep dose gradient, especially in small fields.

Comparison of detector performance in small 6 MV and 6 MV FFF beams using a Versa HD accelerator

1. BACKGROUND & PURPOSE

Investigate the applicability of a series of detectors in small field dosimetry and the possible differences between their responses to FF and FFF beams. This work extends upon the series of detectors used by other authors to also include metal-oxide-semiconductor field-effect transistors (MOSFETs) detectors and radiochromic film. We also included a later correction of output factors (OFs) recommended by the recently published IAEA´s code of practice TRS 483 on dosimetry of small static fields used in external beam radiotherapy.

2. MATERIALS & METHODS

The OFs, profiles, and PDDs of 6 MV and 6 MV FFF beams were measured with 11 different detectors using field sizes between 0.6 × 0.6 cm2 and 10 × 10 cm2.

3. RESULTS

The OFs of the FFF beams were lower than those of the FF beams for field sizes larger than 3 × 3 cm2 but higher for field sizes smaller than 3 × 3 cm2. After applying the IAEA´s TRS 483 corrections, the final OFs were compatible with our initial results when considering uncertainties involved. Small-volume detectors are preferable for measuring the penumbra of these small fields where this attribute is higher in the crossline direction than in the inline direction. The R100 of equivalent-quality FFF beams was higher compared to the corresponding flattened beams.

4. CONCLUSIONS

We observed no difference for the dose responses between 6 MV and 6 MV FFF beams for any of the detectors. OF results, profiles and PDDs were clearly consistent with the previously published literature regarding the Versa HD linac. Correcting our first OFs, taken as ratio of detector charges, with the IAEA´s TRS 483 corrections to obtain the final OFs, did not make the former significantly different.

Estimation of Dosimetric Parameters based on KNR and KNCSF Correction Factors for Small Field Radiation Therapy at 6 and 18 MV Linac Energies using Monte Carlo Simulation Methods

BACKGROUND

Estimating dosimetric parameters for small fields under non-reference conditions leads to significant errors if done based on conventional protocols used for large fields in reference conditions. Hence, further correction factors have been introduced to take into account the influence of spectral quality changes when various detectors are used in non-reference conditions at different depths and field sizes.

OBJECTIVE

Determining correction factors (K_NR and K_NCSF) recommended recently for small field dosimetry formalism by American Association of Physicists in Medicine (AAPM) for different detectors at 6 and 18 MV photon beams.

METHODS

EGSnrc Monte Carlo code was used to calculate the doses measured with different detectors located in a slab phantom and the recommended K_NR and K_NCSF correction factors for various circular small field sizes ranging from 5-30 mm diameters. K_NR and K_NCSF correction factors were determined for different active detectors (a pinpoint chamber, EDP-20 and EDP-10 diodes) in a homogeneous phantom irradiated to 6 and 18 MV photon beams of a Varian linac (2100C/D).

RESULTS

K_NR correction factor estimated for the highest small circular field size of 30 mm diameter for the pinpoint chamber, EDP-20 and EDP-10 diodes were 0.993, 1.020 and 1.054; and 0.992, 1.054 and 1.005 for the 6 and 18 MV beams, respectively. The K_NCSF correction factor estimated for the lowest circular field size of 5 mm for the pinpoint chamber, EDP-20 and EDP-10 diodes were 0.994, 1.023, and 1.040; and 1.000, 1.014, and 1.022 for the 6 and 18 MV photon beams, respectively.

CONCLUSION

Comparing the results obtained for the detectors used in this study reveals that the unshielded diodes (EDP-20 and EDP-10) can confidently be recommended for small field dosimetry as their correction factors (K_NR and K_NCSF) was close to 1.0 for all small field sizes investigated and are mainly independent from the electron beam spot size.

Quality assurance of Cyberknife robotic stereotactic radiosurgery using an angularly independent silicon detector

Purpose

The aim of this work was to evaluate the use of an angularly independent silicon detector (edgeless diodes) developed for dosimetry in megavoltage radiotherapy for Cyberknife in a phantom and for patient quality assurance (QA).

Method

The characterization of the edgeless diodes has been performed on Cyberknife with fixed and IRIS collimators. The edgeless diode probes were tested in terms of basic QA parameters such as measurements of tissue‐phantom ratio (TPR), output factor and off‐axis ratio. The measurements were performed in both water and water‐equivalent phantoms. In addition, three patient‐specific plans have been delivered to a lung phantom with and without motion and dose measurements have been performed to verify the ability of the diodes to work as patient‐specific QA devices. The data obtained by the edgeless diodes have been compared to PTW 60016, SN edge, PinPoint ionization chamber, Gafchromic EBT3 film, and treatment planning system (TPS).

Results

The TPR measurement performed by the edgeless diodes show agreement within 2.2% with data obtained with PTW 60016 diode for all the field sizes. Output factor agrees within 2.6% with that measured by SN EDGE diodes corrected for their field size dependence. The beam profiles’ measurements of edgeless diodes match SN EDGE diodes with a measured full width half maximum (FWHM) within 2.3% and penumbra widths within 0.148 mm. Patient‐specific QA measurements demonstrate an agreement within 4.72% in comparison with TPS.

Conclusion

The edgeless diodes have been proved to be an excellent candidate for machine and patient QA for Cyberknife reproducing commercial dosimetry device measurements without need of angular dependence corrections. However, further investigation is required to evaluate the effect of their dose rate dependence on complex brain cancer dose verification.

Monte Carlo and analytic modeling of an Elekta Infinity linac with Agility MLC: Investigating the significance of accurate model parameters for small radiation fields

PURPOSE

To explain the deviation observed between measured and Monaco calculated dose profiles for a small field (i.e., alternating open-closed MLC pattern). A Monte Carlo (MC) model of an Elekta Infinity linac with Agility MLC was created and validated against measurements. In addition, an analytic model which predicts the fluence at the isocenter plane was used to study the impact of multiple beam parameters on the accuracy of dose calculations for small fields.

METHODS

A detailed MC model of a 6 MV Elekta Infinity linac with Agility MLC was created in EGSnrc/BEAMnrc and validated against measurements. An analytic model using primary and secondary virtual photon sources was created and benchmarked against the MC simulations and the impact of multiple beam parameters on the accuracy of the model for a small field was investigated. Both models were used to explain discrepancies observed between measured/EGSnrc simulated and Monaco calculated dose profiles for alternating open-closed MLC leaves.

RESULTS

MC-simulated dose profiles (PDDs, cross- and in-line profiles, etc.) were found to be in very good agreements with measurements. The best fit for the leaf bank rotation was found to be 9 mrad to model the defocusing of Agility MLC. Moreover, a very good agreement was observed between results from the analytic model and MC simulations for a small field. Modifying the radial size of the incident electron beam in the BEAMnrc model improved the agreement between Monaco and EGSnrc calculated dose profiles by approximately 16% and 30% in the position of maxima and minima, respectively.

CONCLUSION

Accurate modeling of the full-width-half-maximum (FWHM) of the primary photon source as well as the MLC leaf design (leaf bank rotation, etc.) is essential for accurate calculations of dose delivered by small radiation fields when using virtual source or MC models of the beam.

Commissioning and evaluation of a radiochromic EBT3 film dosimetry system

Purpose

This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.

Materials and Methods

A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.

Results

The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.

Conclusion

Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.

Detectors assessment for stereotactic radiosurgery with cones

The purpose of this work is to assess eight detectors performance for output factor (OF), percent depth dose (PDD), and beam profiles in a 6‐MV Clinac stereotactic radiosurgery mode for cone irradiation using Monte Carlo simulation as reference. Cones with diameters comprised between 30 and 4 mm have been studied. The evaluated detectors were ionization chambers: pinpoint and pinpoint 3D, diodes: SRS, P and E, Edge, MicroDiamond and EBT3 radiochromic films. The results showed that pinpoints underestimate OF up to −2.3% for cone diameters ≥10 mm and down to −12% for smaller cones. Both nonshielded (SRS and E) and shielded diodes (P and Edge) overestimate the OF respectively up to 3.3% and 5.2% for cone diameters ≥10 mm and in both cases more than 7% for smaller cones. MicroDiamond slightly overestimates the OF, 3.7% for all the cones and EBT3 film is the closest to Monte Carlo with maximum difference of ±1% whatever the cone size is. For the profiles and the PDD, particularly for the small cones, the size of the detector predominates. All diodes and EBT3 agree with the simulation within ±0.2 mm for beam profiles determination. For PDD curve all the active detectors response agree with simulation up to 1% for all the cones. EBT3 is the more accurate detector for beam profiles and OF determinations of stereotactic cones but it is restrictive to use. Due to respectively inappropriate size of the sensitive volume and composition, pinpoints and diodes do not seem appropriate without OF corrective factors below 10 mm diameter cone. MicroDiamond appears to be the best detector for OF determination regardless all cones. For off‐axis measurements, the size of the detector predominates and for PDD all detectors give promising results.

Dosimetric determination of tissue maximum ratios in small fields

Aims

This exploration is intended to measure tissue maximum ratios (TMRs) in smaller fields through CC01 detector and to compare CC01 measured TMRs with Pinnacle treatment planning software (TPS) calculated TMRs.

Materials and methods

CC01 compact chamber detector was used to measure TMR in water phantom for 6 and 18 MV beam delivered from Varian linear accelerator. Pinnacle TPS was employed in this study to calculate TMR from the measured percentage depth doses data. CC01 measured TMR data was compared with the calculated TMR data at depths from 5 to 20 cm for field sizes varying from 1 to 10 cm2.

Results

For the smallest given field size of 1 cm2, CCO1 measured 13·95% higher TMR value for 18 MV beam than that for 6 MV beam. At 20 cm depth for 1 cm2 field size, TMR due to 18 MV beam was 52·4% higher than the TMR due to 6 MV beam. For 6 MV beam, the maximum difference appeared between the measured TMR and pinnacle calculated TMR was 2·8% and for 18 MV beam, the maximum difference was 4%.

Conclusion

For both 6 and 18 MV beam, there was good agreement between CC01 measured and Pinnacle calculated TMRs for the field sizes ranging from 1 to 10 cm2. This exploration can be extended to the determination of other dosimetric parameters like TARs, TPRs in small fields.

Decomposition of the dose conversion factor based on fluence spectra of secondary charged particles: Application to lateral dose profiles in photon fields

PURPOSE

The dose conversion factor plays an important role in the dosimetry by enabling the absorbed dose in the sensitive volume of a detector to be converted into the absorbed dose in the surrounding medium (in most cases water). The purpose of this paper is to demonstrate that a specific fluence-based approach for the decomposition of the dose conversion factor is in particular useful for the interpretation of the influences of detector properties on measurements under nonreference conditions.

METHODS

Data for the dose conversion factor and secondary fluence spectra were obtained by the Monte Carlo method. The calculation of the secondary charged particle fluence (electrons and positrons) in the sensitive detector volume was imbedded into the code for the calculation of absorbed dose in the detector. The decomposition method into subfactors is based on the use of these fluence data applied to a stepwise transition from the dose at the point of measurement next to a pure water detector and finally to the fully simulated detector geometry. Each subfactor is obtained as a ratio, at which the stopping power only is different in the numerator and the denominator or at which the fluence only is different in the numerator and the denominator. This method was applied at photon dose profiles obtained in water at different radiation qualities and with various detectors of cylindrical type.

RESULTS

The resulting subfactors can be well identified as a stopping power ratio and as perturbation factors each reflecting particular detector properties. Two of them (f1 and f4 ) are equivalent with perturbation factors which have already been introduced by other authors previously. These are the volume perturbation factor and the extracameral perturbation factor. Subfactor f2 denoted as medium perturbation factor was found to resemble the density perturbation factor. Results obtained for the volume perturbation factor applied to dose profiles measured with cylindrical detectors confirm that the volume effect can be well described by a convolution of the true profile in water with a Gaussian kernel. It was found that the sigma parameter depends on the cylinder radius only and amounts almost exactly to half of its value. The medium perturbation factor strongly depends on the density of the detector medium. For an air-filled detector, the influence of the air again can be described by a Gauss convolution, however, with a less good agreement. For detectors with a density of the cavity medium larger than that of water, for instance, for a diamond detector, it was found that there is a tendency of compensation between the volume averaging effect and the medium effect.

CONCLUSION

The fluence-based decomposition of the dose conversion factor leads to a fluence-based formulation of perturbation factors, referred to as volume, medium, and extracameral perturbation factor. These factors offer useful explanations for the behavior of detectors in nonreference conditions. An example was given for cylindrical detectors at dose profile measurements.

Origins of the changing detector response in small megavoltage photon radiation fields

Differences in detector response between measured small fields, f _clin, and wider reference fields, f _msr , can be overcome by using correction factors [Formula: see text] or by designing detectors with field-size invariant responses. The changing response in small fields is caused by perturbations of the electron fluence within the detector sensitive volume. For solid-state detectors, it has recently been suggested that these perturbations might be caused by the non-water-equivalent effective atomic numbers Z of detector materials, rather than by their non-water-like densities. Using the EGSnrc Monte Carlo code we have analyzed the response of a PTW 60017 diode detector in a 6 MV beam, calculating the [Formula: see text] correction factor from computed doses absorbed by water and by the detector sensitive volume in 0.5  ×  0.5 and 4  ×  4 cm² fields. In addition to the 'real' detector, fully modelled according to the manufacturer's blue-prints, we calculated doses and [Formula: see text] factors for a 'Z  →  water' detector variant in which mass stopping-powers and microscopic interaction coefficients were set to those of water while preserving real material densities, and for a 'density  →  1' variant in which densities were set to 1 g cm^-3, leaving mass stopping-powers and interaction coefficients at real levels. [Formula: see text] equalled 0.910  ±  0.005 (2 standard deviations) for the real detector, was insignificantly different at 0.912  ±  0.005 for the 'Z  →  H₂O' variant, but equalled 1.012  ±  0.006 for the 'density  →  1' variant. For the 60017 diode in a 6 MV beam, then, [Formula: see text] was determined primarily by the detector's density rather than its atomic composition. Further calculations showed this remained the case in a 15 MV beam. Interestingly, the sensitive volume electron fluence was perturbed more by detector atomic composition than by density; however, the density-dependent perturbation varied with field-size, whereas the Z-dependent perturbation was relatively constant, little affecting [Formula: see text].

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.

Output factor determination based on Monte Carlo simulation for small cone field in 10-MV photon beam

The difficulty of measuring output factor (OPF) in a small field has been frequently discussed in recent publications. This study is aimed to determine the OPF in a small field using 10-MV photon beam and stereotactic conical collimator (cone). The OPF was measured by two diode detectors (SFD, EDGE detector) and one micro-ion chamber (PinPoint 3D chamber) in a water phantom. A Monte Carlo simulation using simplified detector model was performed to obtain the correction factor for the detector measurements. About 12% OPF difference was observed in the measurement at the smallest field (7.5 mm diameter) for EDGE detector and PinPoint 3D chamber. By applying the Monte Carlo-based correction factor to the measurement, the maximum discrepancy among the three detectors was reduced to within 3%. The results indicate that determination of OPF in a small field should be carefully performed. Especially, detector choice and appropriate correction factor application are very important in this regard.

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.

Application of Geant4 Monte Carlo simulation in dose calculations for small radiosurgical fields

The Geant4 toolkit was used to develop a Monte Carlo (MC)-based engine for accurate dose calculations in small radiation field sizes. The Geant4 toolkit (version 10.1.p02) was used to simulate 6-MV photon beam of a Varian2100C linear accelerator that is being used for stereotactic radiosurgery (SRS) treatment with small radiation fields. Geometric models of 3 in-house designed radiosurgical divergent cones, with the diameters of their projections at the isocenter being 10, 20, and 30 mm, were simulated. The accuracy of the MC simulation technique was examined by reproducing several different simulated dosimetric parameters of the primary beams with the experimental data. The dose distributions are first checked for single beams for each cone, then standard multiple field (SMF) techniques are applied. A sample set of DICOM files from computed tomography (CT) scan imaging of a patient's head was converted to the Geant4 geometry format to implement MC-based engine for a clinical test. To validate the accuracy of the MC-based calculations for SMF arrangements, the isodose lines from MC simulation in water phantom were compared with the measured isodose lines using EBT3 Gafchromic film in Solid Water phantoms. Agreements between measured and simulated depth dose values and beam profiles for SRS cones were generally within 2%/2 mm. For output factors, the largest discrepancy was observed for 10 mm SRS cone, which was 1.7%. For SMF techniques, in SRS cones, the MC simulation and EBT3 Gafchromic film dosimetry were in acceptable agreement (5%/5 mm). Excellent agreement between the results of the MC-based and measured dose values for both single and SMF techniques in SRS cones indicates the ability of the Geant4 toolkit to be applied as the platform for treatment planning of advanced radiotherapy techniques.

Monte Carlo and experimental determination of correction factors for gamma knife perfexion small field dosimetry measurements

Detector-, field size- and machine-specific correction factors are required for precise dosimetry measurements in small and non-standard photon fields. In this work, Monte Carlo (MC) simulation techniques were used to calculate the [Formula: see text] and [Formula: see text] correction factors for a series of ionization chambers, a synthetic microDiamond and diode dosimeters, used for reference and/or output factor (OF) measurements in the Gamma Knife Perfexion photon fields. Calculations were performed for the solid water (SW) and ABS plastic phantoms, as well as for a water phantom of the same geometry. MC calculations for the [Formula: see text] correction factors in SW were compared against corresponding experimental results for a subset of ionization chambers and diode detectors. Reference experimental OF data were obtained through the weighted average of corresponding measurements using TLDs, EBT-2 films and alanine pellets. [Formula: see text] values close to unity (within 1%) were calculated for most of ionization chambers in water. Greater corrections of up to 6.0% were observed for chambers with relatively large air-cavity dimensions and steel central electrode. A phantom correction of 1.006 and 1.024 (breaking down to 1.014 from the ABS sphere and 1.010 from the accompanying ABS phantom adapter) were calculated for the SW and ABS phantoms, respectively, adding up to [Formula: see text] corrections in water. Both measurements and MC calculations for the diode and microDiamond detectors resulted in lower than unit [Formula: see text] correction factors, due to their denser sensitive volume and encapsulation materials. In comparison, higher than unit [Formula: see text] results for the ionization chambers suggested field size depended dose underestimations (being significant for the 4 mm field), with magnitude depending on the combination of contradicting phenomena associated with volume averaging and electron fluence perturbations. Finally, the presence of 0.5 mm air-gap between the diodes' frontal surface and their phantom-inserts may considerably influence OF measurements, reaching 4.6% for the Razor diode.

Investigating the Electronic Portal Imaging Device for Small Radiation Field Measurements

Purpose:

With the advent of state-of-the-art treatment technologies, the use of small fields has increased, and dosimetry in small fields is highly challenging. In this study, the potential use of Varian electronic portal imaging device (EPID) for small field measurements was explored for 6 and 15 MV photon beams.

Materials and Methods:

The output factors and profiles were measured for a range of jaw-collimated square field sizes starting from 0.8 cm × 0.8 cm to 10 cm × 10 cm using EPID. For evaluation purpose, reference data were acquired using Exradin A16 microionization chamber (0.007 cc) for output factors and stereotactic field diode for profile measurements in a radiation field analyzer.

Results:

The output factors of EPID were in agreement with the reference data for field sizes down to 2 cm × 2 cm and for 2 cm × 2 cm; the difference in output factors was +2.06% for 6 MV and +1.56% for 15 MV. For the lowest field size studied (0.8 cm × 0.8 cm), the differences were maximum; +16% for 6 MV and +23% for 15 MV photon beam. EPID profiles of both energies were closely matching with reference profiles for field sizes down to 2 cm × 2 cm; however, penumbra and measured field size of EPID profiles were slightly lower compared to its counterpart.

Conclusions:

EPID is a viable option for profile and output factor measurements for field sizes down to 2 cm × 2 cm in the absence of appropriate small field dosimeters.

Measurement of Total Scatter Factor for Stereotactic Cones with Plastic Scintillation Detector

Advanced radiotherapy modalities such as stereotactic radiosurgery (SRS) and image-guided radiotherapy may employ very small beam apertures for accurate localized high dose to target. Accurate measurement of small radiation fields is a well-known challenge for many dosimeters. The purpose of this study was to measure total scatter factors for stereotactic cones with plastic scintillation detector and its comparison against diode detector and theoretical estimates. Measurements were performed on Novalis Tx^™ linear accelerator for 6MV SRS beam with stereotactic cones of diameter 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm. The advantage of plastic scintillator detector is in its energy dependence. The total scatter factor was measured in water at the depth of dose maximum. Total scatter factor with plastic scintillation detector was determined by normalizing the readings to field size of 10 cm × 10 cm. To overcome energy dependence of diode detector for the determination of scatter factor with diode detector, daisy chaining method was used. The plastic scintillator detector was calibrated against the ionization chamber, and the reproducibility in the measured doses was found to be within ± 1%. Total scatter factor measured with plastic scintillation detector was 0.728 ± 0.3, 0.783 ± 0.05, 0.866 ± 0.55, 0.885 ± 0.5, and 0.910 ± 0.06 for cone sizes of 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. Total scatter factor measured with diode detector was 0.733 ± 0.03, 0.782 ± 0.02, 0.834 ± 0.07, 0.854 ± 0.02, and 0.872 ± 0.02 for cone sizes of 6 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. The variation in the measurement of total scatter factor with published Monte Carlo data was found to be −1.3%, 1.9%, −0.4%, and 0.4% for cone sizes of 7.5 mm, 10 mm, 12.5 mm, and 15 mm, respectively. We conclude that total scatter factor measurements for stereotactic cones can be adequately carried out with a plastic scintillation detector. Our results show a high level of consistency within our data and compared well with published data.

Experimental determination of the PTW 60019 microDiamond dosimeter active area and volume

PURPOSE

Small field output correction factors have been studied by several research groups for the PTW 60019 microDiamond (MD) dosimeter, by comparing the response of such a device with both reference dosimeters and Monte Carlo simulations. A general good agreement is observed for field sizes down to about 1 cm. However, evident inconsistencies can be noticed when comparing some experimental results and Monte Carlo simulations obtained for smaller irradiation fields. This issue was tentatively attributed by some authors to unintentional large variations of the MD active surface area. The aim of the present study is a nondestructive experimental determination of the MD active surface area and active volume.

METHODS

Ten MD dosimeters, one MD prototype, and three synthetic diamond samples were investigated in the present work. 2D maps of the MD response were recorded under scanned soft x-ray microbeam irradiation, leading to an experimental determination of the device active surface area. Profiles of the device responses were measured as well. In order to evaluate the MD active volume, the thickness of the diamond sensing layer was independently evaluated by capacitance measurements and alpha particle detection experiments. The MD sensitivity, measured at the PTW calibration laboratory, was also used to calculate the device active volume thickness.

RESULTS

An average active surface area diameter of (2.19 ± 0.02) mm was evaluated by 2D maps and response profiles of all the MDs. Average active volume thicknesses of (1.01 ± 0.13) μm and (0.97 ± 0.14) μm were derived by capacitance and sensitivity measurements, respectively. The obtained results are well in agreement with the nominal values reported in the manufacturer dosimeter specifications. A homogeneous response was observed over the whole device active area. Besides the one from the device active volume, no contributions from other components of the housing nor from encapsulation materials were observed in the 2D response maps.

CONCLUSIONS

The obtained results demonstrate the high reproducibility of the MD fabrication process. The observed discrepancies among the output correction factors reported by several authors for MD response in very small fields are very unlikely to be ascribed to unintentional variations of the device active surface area and volume. It is the opinion of the authors that the role of the volume averaging as well as of other perturbation effects should be separately investigated instead, both experimentally and by Monte Carlo simulations, in order to better clarify the behaviour of the MD response in very small fields.

Influence of the jaw tracking technique on the dose calculation accuracy of small field VMAT plans

PURPOSE

The aim of this study was to evaluate experimentally the accuracy of the dose calculation algorithm AcurosXB in small field highly modulated Volumetric Modulated Arc Therapy (VMAT).

METHOD

The 1000SRS detector array inserted in the rotational Octavius 4D phantom (PTW) was used for 3D dose verification of VMAT treatments characterized by small to very small targets. Clinical treatment plans (n = 28) were recalculated on the phantom CT data set in the Eclipse TPS. All measurements were done on a Varian TrueBeamSTx, which can provide the jaw tracking technique (JTT). The effect of disabling the JTT, thereby fixing the jaws at static field size of 3 × 3 cm² and applying the MLC to shape the smallest apertures, was investigated for static fields between 0.5 × 0.5-3 × 3 cm² and for seven VMAT patients with small brain metastases. The dose calculation accuracy has been evaluated by comparing the measured and calculated dose outputs and dose distributions. The dosimetric agreement has been presented by a local gamma evaluation criterion of 2%/2 mm.

RESULTS

Regarding the clinical plans, the mean ± SD of the volumetric gamma evaluation scores considering the dose levels for evaluation of 10%, 50%, 80% and 95% are (96.0 ± 6.9)%, (95.2 ± 6.8)%, (86.7 ± 14.8)% and (56.3 ± 42.3)% respectively. For the smallest field VMAT treatments, discrepancies between calculated and measured doses up to 16% are obtained. The difference between the 1000SRS central chamber measurements compared to the calculated dose outputs for static fields 3 × 3, 2 × 2, 1 × 1 and 0.5 × 0.5 cm² collimated with MLC whereby jaws are fixed at 3 × 3 cm² and for static fields shaped with the collimator jaws only (MLC retracted), is on average respectively, 0.2%, 0.8%, 6.8%, 5.7% (6 MV) and 0.1%, 1.3%, 11.7%, 21.6% (10 MV). For the seven brain mets patients was found that the smaller the target volumes, the higher the improvement in agreement between measured and calculated doses after disabling the JTT.

CONCLUSION

Fixing the jaws at 3 × 3 cm² and using the MLC with high positional accuracy to shape the smallest apertures in contrast to the JTT is currently found to be the most accurate treatment technique.

Implementation of a double Gaussian source model for the BEAMnrc Monte Carlo code and its influence on small fields dose distributions

The shape of the radiation source of a linac has a direct impact on the delivered dose distributions, especially in the case of small radiation fields. Traditionally, a single Gaussian source model is used to describe the electron beam hitting the target, although different studies have shown that the shape of the electron source can be better described by a mixed distribution consisting of two Gaussian components. Therefore, this study presents the implementation of a double Gaussian source model into the BEAMnrc Monte Carlo code. The impact of the double Gaussian source model for a 6 MV beam is assessed through the comparison of different dosimetric parameters calculated using a single Gaussian source, previously commissioned, the new double Gaussian source model and measurements, performed with a diode detector in a water phantom. It was found that the new source can be easily implemented into the BEAMnrc code and that it improves the agreement between measurements and simulations for small radiation fields. The impact of the change in source shape becomes less important as the field size increases and for increasing distance of the collimators to the source, as expected. In particular, for radiation fields delivered using stereotactic collimators located at a distance of 59 cm from the source, it was found that the effect of the double Gaussian source on the calculated dose distributions is negligible, even for radiation fields smaller than 5 mm in diameter. Accurate determination of the shape of the radiation source allows us to improve the Monte Carlo modeling of the linac, especially for treatment modalities such as IMRT, were the radiation beams used could be very narrow, becoming more sensitive to the shape of the source.

PACS number(s): 87.53.Bn, 87.55.K, 87.56.B‐, 87.56.jf

Determination of boundaries between ranges of high and low gradient of beam profile

AIM

This work addresses the problem of treatment planning system commissioning by introducing a new method of determination of boundaries between high and low gradient in beam profile.

BACKGROUND

The commissioning of a treatment planning system is a very important task in the radiation therapy. One of the main goals of this task is to compare two field profiles: measured and calculated. Applying points of 80% and 120% of nominal field size can lead to the incorrect determination of boundaries, especially for small field sizes.

MATERIALS AND METHODS

The method that is based on the beam profile gradient allows for proper assignment of boundaries between high and low gradient regions even for small fields. TRS 430 recommendations for commissioning were used.

RESULTS

The described method allows a separation between high and low gradient, because it directly uses the value of the gradient of a profile. For small fields, the boundaries determined by the new method allow a commissioning of a treatment planning system according to the TRS 430, while the point of 80% of nominal field size is already in the high gradient region.

CONCLUSIONS

The method of determining the boundaries by using the beam profile gradient can be extremely helpful during the commissioning of the treatment planning system for Intensity Modulated Radiation Therapy or for other techniques which require very small field sizes.