AAPM WGTG51 Report 385: Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy electron beams

An Addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water is presented for electron beams with energies between 4 MeV and 22 MeV (1.70 cm ≤ R 50 ≤ 8.70 cm $1.70\nobreakspace {\rm cm} \le R_{\text{50}} \le 8.70\nobreakspace {\rm cm}$ ). This updated formalism allows simplified calibration procedures, including the use of calibrated cylindrical ionization chambers in all electron beams without the use of a gradient correction. Newk Q $k_{Q}$ data are provided for electron beams based on Monte Carlo simulations. Implementation guidance is provided. Components of the uncertainty budget in determining absorbed dose to water at the reference depth are discussed. Specifications for a reference-class chamber in electron beams include chamber stability, settling, ion recombination behavior, and polarity dependence. Progress in electron beam reference dosimetry is reviewed. Although this report introduces some major changes (e.g., gradient corrections are implicitly included in the electron beam quality conversion factors), they serve to simplify the calibration procedure. Results for absorbed dose per linac monitor unit are expected to be up to approximately 2 % higher using this Addendum compared to using the original TG-51 protocol.

A study of polarity effect for various ionization chambers in kilovoltage x-ray beams

BACKGROUND

Ionization chambers play an essential role in dosimetry measurements for kilovoltage (kV) x-ray beams. Despite their widespread use, there is limited data on the absolute values for the polarity correction factors across a range of commonly employed ionization chambers.

PURPOSE

This study aimed to investigate the polarity effects for five different ionization chambers in kV x-ray beams.

METHODS

Two plane-parallel chambers being the Advanced Markus and Roos and three cylindrical chambers; 3D PinPoint, Semiflex and Farmer chamber (PTW, Freiburg, Germany), were employed to measure the polarity correction factors. The kV x-ray beams were produced from an Xstrahl 300 unit (Xstrahl Ltd., UK). All measurements were acquired at 2 cm depth in a PTW-MP1 water tank for beams between 60 kVp (HVL 1.29 mm Al) and 300 kVp (HVL 3.08 mm Cu), and field sizes of 2-10 cm diameter for 30 cm focus-source distance (FSD) and 4 × 4 cm2 - 20 × 20 cm2 for 50 cm FSD. The ionization chambers were connected to a PTW-UNIDOS electrometer, and the polarity effect was determined using the AAPM TG-61 code of practice methodology.

RESULTS

The study revealed significant polarity effects in ionization chambers, especially in those with smaller volumes. For the plane-parallel chambers, the Advanced Markus chamber exhibited a maximum polarity effect of 2.5%, whereas the Roos chamber showed 0.3% at 150 KVp with the 10 cm circular diameter open-ended applicator. Among the cylindrical chambers at the same beam energy and applicator, the Pinpoint chamber exhibited a 3% polarity effect, followed by Semiflex with 1.7%, and Farmer with 0.4%. However, as the beam energy increased to 300 kVp, the polarity effect significantly increased reaching 8.5% for the Advanced Markus chamber and 13.5% for the PinPoint chamber at a 20 × 20 cm2 field size. Notably, the magnitude of the polarity effect increased with both the field size and beam energy, and was significantly influenced by the size of the chamber's sensitive volume.

CONCLUSIONS

The findings demonstrate that ionization chambers can exhibit substantial polarity effects in kV x-ray beams, particularly for those chambers with smaller volumes. Therefore, it is important to account for polarity corrections when conducting relative dose measurements in kV x-ray beams to enhance the dosimetry accuracy and improve patient dose calculations.

Evaluation of ion chamber response for applications in electron FLASH radiotherapy

Ion chambers are required for calibration and reference dosimetry applications in radiation therapy (RT). However, exposure of ion chambers in ultra-high dose rate (UHDR) conditions pertinent to FLASH-RT leads to severe saturation and ion recombination, which limits their performance and usability. The purpose of this study was to comprehensively evaluate a set of commonly used commercially available ion chambers in RT, all with different design characteristics, and use this information to produce a prototype ion chamber with improved performance in UHDR conditions as a first step toward ion chambers specific for FLASH-RT. The Advanced Markus and Exradin A10, A26, and A20 ion chambers were evaluated. The chambers were placed in a water tank, at a depth of 2 cm, and exposed to an UHDR electron beam at different pulse repetition frequency (PRF), pulse width (PW), and pulse amplitude settings on an IntraOp Mobetron. Ion chamber responses were investigated for the various beam parameter settings to isolate their dependence on integrated dose, mean dose rate and instantaneous dose rate, dose-per-pulse (DPP), and their design features such as chamber type, bias voltage, and collection volume. Furthermore, a thin parallel-plate (TPP) prototype ion chamber with reduced collector plate separation and volume was constructed and equally evaluated as the other chambers. The charge collection efficiency of the investigated ion chambers decreased with increasing DPP, whereas the mean dose rate did not affect the response of the chambers (± 1%). The dependence of the chamber response on DPP was found to be solely related to the total dose within the pulse, and not on mean dose rate, PW, or instantaneous dose rate within the ranges investigated. The polarity correction factor (Ppol ) values of the TPP prototype, A10, and Advanced Markus chambers were found to be independent of DPP and dose rate (± 2%), while the A20 and A26 chambers yielded significantly larger variations and dependencies under the same conditions. Ion chamber performance evaluated under different irradiation conditions of an UHDR electron beam revealed a strong dependence on DPP and a negligible dependence on the mean and instantaneous dose rates. These results suggest that modifications to ion chambers design to improve their usability in UHDR beamlines should focus on minimizing DPP effects, with emphasis on optimizing the electric field strength, through the construction of smaller electrode separation and larger bias voltages. This was confirmed through the production and evaluation of a prototype ion chamber specifically designed with these characteristics.

Technical note: Point-by-point ion-recombination correction for accurate dose profile measurement in high dose-per-pulse irradiation field

BACKGROUND

Although flattening filter free (FFF) beams are commonly used in clinical treatment, the accuracy of dose measurements in FFF beams has been questioned. Higher dose per pulse (DPP) such as FFF beams from a linear accelerator may cause problems in dose profile measurements using an ionization chamber due to the change of the charge collection efficiency. Ionization chambers are commonly used for percent depth dose (PDD) measurements. Changes of DPP due to chamber movement during PDD measurement can vary the ion collection efficiency of ionization chambers. In the case of FF beams, the DPP fluctuation is negligible, but in the case of the FFF beams, the DPP is 2.5 ∼ 4 times larger than that of the FF beam, and the change in ion collection efficiency is larger than that of the FF beam. PDD profile normalized by maximum dose depth, 10 cm depth for example, may therefore be affected by the ion collection efficiency.

PURPOSE

In this study, we investigate the characteristics of the ion collection efficiency change depending on the DPP of each ionization chamber in the FFF beam. We furthermore propose a method to obtain the chamber- independent PDD by applying a DPP-dependent ion recombination correction.

METHODS

Prior to investigating the relationship between DPP and charge collection efficiency, Jaffe-plots were generated with different DPP settings to investigate the linearity between the applied voltage and collected charge. The absolute dose measurement using eight ionization chambers under the irradiation settings of 0.148, 0.087, and 0.008 cGy/pulse were performed. Applied voltages for the Jaffe-plots were 100, 125, 150, 200, 250, and 300 V. The ion recombination correction factor Pion was calculated by the two-voltage analysis (TVA) method at the applied voltages of 300 and 100 V. The DPP dependency of the charge collection efficiency for each ionization chamber were evaluated from the DPP- Pion plot. PDD profiles for the 10 MV FFF beam were measured using Farmer type chambers (TN30013, FC65-P, and FC65-G) and mini-type chambers (TN31010, TN31021, CC13, CC04, and FC23-C). The PDD profiles were corrected with ion recombination correction at negative and positive polar applied voltages of 100 and 300 V.

RESULTS

From the DPP-Pion relation for each ionization chamber with DPP ranging from 0.008 cGy/pulse to 0.148 cGy/pulse, all Farmer and mini-type chambers satisfied the requirements described in AAPM TG-51 addendum. However, Pion for the CC13 was most affected by DPP among tested chambers. The maximum deviation among PDDs using eight ionization chambers for 10 MV FFF was about 1%, but the deviation was suppressed to about 0.5% by applying ion recombination correction at each depth.

CONCLUSIONS

In this study, the deviation of PDD profile among the ionization chambers was reduced by the ion recombination coefficient including the DPP dependency, especially for high DPP beams such as FFF beams. The present method is particularly effective for CC13, where the ion collection efficiency is highly DPP dependent.

AAPM WGTG51 Report 374: Guidance for TG-51 reference dosimetry

Practical guidelines that are not explicit in the TG-51 protocol and its Addendum for photon beam dosimetry are presented for the implementation of the TG-51 protocol for reference dosimetry of external high-energy photon and electron beams. These guidelines pertain to: (i) measurement of depth-ionization curves required to obtain beam quality specifiers for the selection of beam quality conversion factors, (ii) considerations for the dosimetry system and specifications of a reference-class ionization chamber, (iii) commissioning a dosimetry system and frequency of measurements, (iv) positioning/aligning the water tank and ionization chamber for depth ionization and reference dose measurements, (v) requirements for ancillary equipment needed to measure charge (triaxial cables and electrometers) and to correct for environmental conditions, and (vi) translation from dose at the reference depth to that at the depth required by the treatment planning system. Procedures are identified to achieve the most accurate results (errors up to 8% have been observed) and, where applicable, a commonly used simplified procedure is described and the impact on reference dosimetry measurements is discussed so that the medical physicist can be informed on where to allocate resources.

Efficient dose-rate correction of silicon diode relative dose measurements

PURPOSE

Silicon diodes are often the detector of choice for relative dose measurements, particularly in the context of radiotherapy involving small photon beams. However, a major drawback lies in their dose-rate dependency. Although ionization chambers are often too large for small field output factor measurements, they are valuable instruments to provide reliable percent-depth dose curves in reference beams. The aim of this work is to propose a practical and accurate method for the characterization of silicon diode dose-rate dependence correction factors using ionization chamber measurements as a reference.

METHODS

The robustness of ionization chambers for percent-depth dose measurements is used to quantify the dose-rate dependency of a diode detector. A mathematical formalism, which exploits the error induced in percent-depth ionization curves for diodes by their dose-rate dependency, is developed to derive a dose-rate correction factor applicable to diode relative measurements. The method is based on the definition of the recombination correction factor given in the addendum to TG 51 and is applied to experimental measurements performed on a CyberKnife M6 radiotherapy unit using a PTW 60012 diode detector. A measurement-based validation is provided by comparing corrected percent-depth ionization curves to measurements performed with a PTW 60019 diamond detector which does not exhibit dose-rate dependence.

RESULTS

Results of dose-rate correction factors for percent-depth ionization curves, off-axis ratios, tissue-phantom ratios and small field output factors are coherent with the expected behavior of silicon diode detectors. For all considered setups and field sizes, the maximum correction and the maximum impact of the uncertainties induced by the correction are obtained for off-axis ratios for the 60 mm collimator, with a correction of 2.5% and an uncertainty of 0.34%. For output factors, corrections range from 0.33% to 0.82% for all field sizes considered, and increase with the reduction of the field size. Comparison of percent-depth ionization curves corrected for dose-rate and for in-depth beam quality variations illustrate excellent agreement with measurements performed using the diamond detector.

CONCLUSIONS

The proposed method allows the efficient and precise correction of the dose-rate dependence of silicon diode detectors in the context of clinical relative dosimetry. This article is protected by copyright. All rights reserved.

Technical Note: The impact of storage humidity on the response of reference-class ionization chambers

PURPOSE

A number of Farmer-type ionization chambers were tested against storage humidity to confirm whether they satisfied the criteria for the long-term stability of reference-class ionization chambers.

METHODS

The ionization chambers were stored for several months in an environment with relative humidity adjustable from 20 % to 80 %. The ionization chambers were removed from the storage environment at variable intervals ranging from 1 d to 70 d and irradiated in a Co-60 radiation beam. The responses for each ionization chamber were evaluated from the measured currents corrected for the atmospheric air density, and were compared with those predicted by the Co-60 half-life.

RESULTS

Certain ionization chambers gave a constant relative response regardless of the storage humidity, while the relative responses of two types of ionization chambers changed as a function of the storage humidity. The difference between the relative responses for the low (20 %∼30 %) and high (70 %∼80 %) storage relative humidity was ∼0.7 %. The response was larger for the high relative humidity storage. Immediately after the storage humidity changed, the relative response started to change by the day, and it took approximately 2 weeks to 2 months for the relative response to converge. For one type of the ionization chamber, the plastic outer wall and the outer electrode were replaced with those made of solid graphite, and it was confirmed that the remodeled ionization chamber did not exhibit the response change.

CONCLUSIONS

The present results and previous reports by other authors indicate that the magnitude of the change depends on the magnitude of the water absorption of the plastic used for the outer wall and/or the electrode of the ionization chamber. Thus, it is important in the selection of the reference-class ionization chamber to note the material and structure of the outer wall and electrode of the ionization chamber. If the ionization chamber has a hygroscopic wall and electrode and it is used as a reference ionization chamber, it is necessary to pay additional attention to the humidity difference for the storage, daily irradiation, and yearly calibration especially in regions with large seasonal humidity fluctuations. This article is protected by copyright. All rights reserved.

Monte Carlo calculated beam quality correction factors for two cylindrical ionization chambers in photon beams

PURPOSE

Although several studies provide data for reference dosimetry, the SNC600c and SNC125c ionization chambers (Sun Nuclear Corporation, Melbourne, FL) are in clinical use worldwide for which no beam quality correction factors k_Q are available. The goal of this study was to calculate beam quality correction factors k_Q for these ionization chambers according to dosimetry protocols TG-51, TRS 398 and DIN 6800-2.

METHODS

Monte Carlo simulations using EGSnrc have been performed to calculate the absorbed dose to water and the dose to air within the active volume of ionization chamber models. Both spectra and simulations of beam transport through linear accelerator head models were used as radiation sources for the Monte Carlo calculations.

RESULTS

k_Q values as a function of the respective beam quality specifier Q were fitted against recommended equations for photon beam dosimetry in the range of 4 MV to 25 MV. The fitting curves through the calculated values showed a root mean square deviation between 0.0010 and 0.0017.

CONCLUSIONS

The investigated ionization chamber models (SNC600c, SNC125c) are not included in above mentioned dosimetry protocols, but are in clinical use worldwide. This study covered this knowledge gap and compared the calculated results with published k_Q values for similar ionization chambers. Agreements with published data were observed in the 95% confidence interval, confirming the use of data for similar ionization chambers, when there are no k_Q values available for a given ionization chamber.

Evaluation of a micro ionization chamber for dosimetric measurements in image-guided preclinical irradiation platforms

Image-guided small animal irradiation platforms deliver small radiation fields in the medium energy x-ray range. Commissioning of such platforms, followed by dosimetric verification of treatment planning, are mostly performed with radiochromic film. There is a need for independent measurement methods, traceable to primary standards, with the added advantage of immediacy in obtaining results. This investigation characterizes a small volume ionization chamber in medium energy x-rays for reference dosimetry in preclinical irradiation research platforms. The detector was exposed to a set of reference x-ray beams (0.5 to 4 mm Cu HVL). Leakage, reproducibility, linearity, response to detector's orientation, dose rate, and energy dependence were determined for a 3D PinPoint ionization chamber (PTW 31022). Polarity and ion recombination were also studied. Absorbed doses at 2 cm depth were compared, derived either by applying the experimentally determined cross-calibration coefficient at a typical small animal radiation platform "user's" quality (0.84 mm Cu HVL) or by interpolation from air kerma calibration coefficients in a set of reference beam qualities. In the range of reference x-ray beams, correction for ion recombination was less than 0.1%. The largest polarity correction was 1.4% (for 4 mm Cu HVL). Calibration and correction factors were experimentally determined. Measurements of absorbed dose with the PTW 31022, in conditions different from reference were successfully compared to measurements with a secondary standard ionization chamber. The implementation of an End-to-End test for delivery of image-targeted small field plans resulted in differences smaller than 3% between measured and treatment planning calculated doses. The investigation of the properties and response of a PTW 31022 small volume ionization chamber in medium energy x-rays and small fields can contribute to improve measurement uncertainties evaluation for reference and relative dosimetry of small fields delivered by preclinical irradiators while maintaining the traceability chain to primary standards.

Stopping-power ratios for electron beams used in total skin electron therapy

PURPOSE

The electron beams for total skin electron therapy (TSET) are often degraded by a scatter plate in addition to extended distances. For electron dosimetry, both the AAPM TG-51 and IAEA TRS-398 recommend the use of two formulas developed by Burns et al [Med. Phys. 23, 489-501 (1996)] to estimate the water-to-air stopping-power ratios (SPRs). Both formulas are based on a fit to SPRs calculated for standard electron beams. This study aims to find: (1) if the formulas are applicable to beams used in TSET and (2) the impact of the ICRU report 90 recommendations on the SPRs for these beams.

METHODS

The EGSnrc Monte Carlo code system is used to generate 6 MeV high dose rate total skin electron (HDTSe) beams used in TSET. The simulated beams are used to calculate dose distributions and SPRs as a function of depth in a water phantom. The fitted SPRs using the empirical formulas are compared with MC-calculated SPRs.

RESULTS

The electron beam quality specifier, the depth in water at which the absorbed dose falls to 50% of its maximum value, R₅₀ , decreases approximately 1 mm for each additional 100-cm extended distance ranging from 2.24 cm at SSD = 100 to 1.72 cm at SSD = 700 cm. For beams passing through a scatter plate, R₅₀ is 1.76 cm (1.14) at SSD = 300 and 1.48 cm (0.85 cm) at SSD = 600 cm with an Acrylic plate thickness of 3 mm (9 mm), respectively. The discrepancy between fitted and MC-calculated SPRs at d_ref as a function of R₅₀ is <0.8%, and in many cases <0.4%. The difference between fitted and MC-calculated SPRs as a function of depth and R₅₀ is within 1% at depths <0.8R₅₀ for beams with R₅₀  ≥ 1.14 cm. The ICRU-90 recommendations decrease SPRs by 0.3%-0.4% compared to the use of data recommended in ICRU-37.

CONCLUSION

The formulas used by the major protocols are accurate enough for clinical beams used in TSET and the error caused using the formulas is <1% to estimate SPRs as a function of depth and R₅₀ for depths <0.8R₅₀ for beams used in TSET with R₅₀  ≥ 1.14 cm. The impact of the ICRU-90 recommendations shows a decrease of SPRs by a fraction of a percent for beams used in TSET.

Water calorimetry-basedkQfactors for Farmer-type ionization chambers in the SOBP of a carbon-ion beam

The dosimetry of carbon-ion beams based on calibrated ionization chambers (ICs) still shows a significantly higher uncertainty compared to high-energy photon beams, a fact influenced mainly by the uncertainty of the correction factor for the beam qualityk_Q. Due to a lack of experimental data,k_Qfactors in carbon-ion beams used today are based on theoretical calculations whose standard uncertainty is three times higher than that of photon beams. To reduce their uncertainty, in this work,k_Qfactors for two ICs were determined experimentally by means of water calorimetry for the spread-out Bragg peak of a carbon-ion beam, these factors are presented here for the first time. To this end, the absorbed dose to water in the¹²C-SOBP is measured using the water calorimeter developed at Physikalisch-Technische Bundesanstalt, allowing a direct calibration of the ICs used (PTW 30013 and IBA FC65G) and thereby an experimental determination of the chamber-specifick_Qfactors. Based on a detailed characterization of the irradiation field, correction factors for several effects that influence calorimetric and ionometric measurements were determined. Their contribution to an overall uncertainty budget of the finalk_Qfactors was determined, leading to a standard uncertainty fork_Qof 0.69%, which means a reduction by a factor of three compared to the theoretically calculated values. The experimentally determined values were expressed in accordance with TRS-398 and DIN 6801-1 and compared to the values given there. A maximum deviation of 2.3% was found between the experiment and the literature.

Survey on utilization of flattening filter-free photon beams in Japan

To understand the current state of flattening filter-free (FFF) beam implementation in C-arm linear accelerators (LINAC) in Japan, the quality assurance (QA)/quality control (QC) 2018-2019 Committee of the Japan Society of Medical Physics (JSMP) conducted a 37-question survey, designed to investigate facility information and specifications regarding FFF beam adoption and usage. The survey comprised six sections: facility information, devices, clinical usage, standard calibration protocols, modeling for treatment planning (TPS) systems and commissioning and QA/QC. A web-based questionnaire was developed. Responses were collected between 18 June and 18 September 2019. Of the 846 institutions implementing external radiotherapy, 323 replied. Of these institutions, 92 had adopted FFF beams and 66 had treated patients using them. FFF beams were used in stereotactic radiation therapy (SRT) for almost all disease sites, especially for the lungs using 6 MV and liver using 10 MV in 51 and 32 institutions, respectively. The number of institutions using FFF beams for treatment increased yearly, from eight before 2015 to 60 in 2018. Farmer-type ionization chambers were used as the standard calibration protocol in 66 (72%) institutions. In 73 (80%) institutions, the beam-quality conversion factor for FFF beams was calculated from TPR20,10, via the same protocol used for beams with flattening filter (WFF). Commissioning, periodic QA and patient-specific QA for FFF beams also followed the procedures used for WFF beams. FFF beams were primarily used in high-volume centers for SRT. In most institutions, measurement and QA was conducted via the procedures used for WFF beams.

High spatial resolution dosimetry with uncertainty analysis using Raman micro-spectroscopy readout of radiochromic films

PURPOSE

The purpose of this work is to develop a new approach for high spatial resolution dosimetry based on Raman micro-spectroscopy scanning of radiochromic film (RCF). The goal is to generate dose calibration curves over an extended dose range from 0 to 50 Gy and with improved sensitivity to low (<2 Gy) doses, in addition to evaluating the uncertainties in dose estimation associated with the calibration curves.

METHODS

Samples of RCF (EBT3) were irradiated at a broad dose range of 0.03-50 Gy using an Elekta Synergy clinical linear accelerator. Raman spectra were acquired with a custom-built Raman micro-spectroscopy setup involving a 500 mW, multimode 785 nm laser focused to a lateral spot diameter of 30 µm on the RCF. The depth of focus of 34 µm enabled the concurrent collection of Raman spectra from the RCF active layer and the polyester laminate. The preprocessed Raman spectra were normalized to the intensity of the 1614 cm^-1 Raman peak from the polyester laminate that was unaltered by radiation. The mean intensities and the corresponding standard deviation of the active layer Raman peaks at 696, 1445, and 2060 cm^-1 were determined for the 150 × 100 µm² scan area per dose value. This was used to generate three calibration curves that enabled the conversion of the measured Raman intensity to dose values. The experimental, fitting, and total dose uncertainty was determined across the entire dose range for the dosimetry system of Raman micro-spectroscopy and RCF.

RESULTS

In contrast to previous work that investigated the Raman response of RCFs using different methods, high resolution in the dose response of the RCF, even down to 0.03 Gy, was obtained in this study. The dynamic range of the calibration curves based on all three Raman peaks in the RCF extended up to 50 Gy with no saturation. At a spatial resolution of 30 × 30 µm² , the total uncertainty in estimating dose in the 0.5-50 Gy dose range was [6-9]% for all three Raman calibration curves. This consisted of the experimental uncertainty of [5-8]%, and the fitting uncertainty of [2.5-4.5]%. The main contribution to the experimental uncertainty was determined to be from the scan area inhomogeneity which can be readily reduced in future experiments. The fitting uncertainty could be reduced by performing Raman measurements on RCF samples at further intermediate dose values in the high and low dose range.

CONCLUSIONS

The high spatial resolution experimental dosimetry technique based on Raman micro-spectroscopy and RCF presented here, could become potentially useful for applications in microdosimetry to produce meaningful dose estimates in cellular targets, as well as for applications based on small field dosimetry that involve high dose gradients.

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.

Examining electrometer performance checks with direct-current generator in a clinic: Assessment of generated charges and implementation of electrometer checks

Purpose

Medical physicists use a suitable detector connected to an electrometer to measure radiotherapy beams. Each detector and electrometer has a lifetime (due to physical deterioration of detector components and electrical characteristic deterioration in electronic electrometer components), long‐term stability [according to IEC 60731:2011, ≤0.5% (reference‐class dosimeter)], and calibration frequency [according to Muir et al. (J Appl Clin Med Phys. 2017; 18:182‐190), generally 2 years]; thus, physicists should check the electrometer and detector separately. However, to the best of our knowledge, only one study (Blad et al., Phys Med Biol. 1998; 43:2385–2391) has reported checking the electrometer independently from the detector. The present study conducts performance checks on electrometers separately from the detector in clinical settings, using an electrometer equipped with a direct current (DC) generator (EMF 521R) capable of injecting DC (effective range: ±20 pA to ±20 nA) into itself or another electrometer.

Methods

First, to check the nonlinearity of the generated currents from ±20 pA to ±20 nA, charges generated from the DC generator were measured with the EMF 521R electrometer. Next, six reference‐class electrometers classified according to IEC 60731:2011 were checked for repeatability at a current of ±20 pA or a minimum effective indicated value meeting IEC 60731:2011, as well as for nonlinearity within the current range from ±20 pA to ±20 nA.

Results

The nonlinearities for the measured currents were less than ±0.05%. The repeatability for the six electrometers was < 0.1%. While the nonlinearity of one electrometer reached up to 0.22% at a current of –20 pA, all six electrometers displayed nonlinearities of less than ±0.1% at currents of ±100 pA or higher.

Conclusions

This work suggests that it is possible to check the nonlinearity and repeatability of clinical electrometers with DCs above the ±30 pA level using a DC generator in a clinic.

Validation of a secondary dose check tool against Monte Carlo and analytical clinical dose calculation algorithms in VMAT

PURPOSE

Patient-specific quality assurance (QA) is very important in radiotherapy, especially for patients with highly conformed treatment plans like VMAT plans. Traditional QA protocols for these plans are time-consuming reducing considerably the time available for patient treatments. In this work, a new MC-based secondary dose check software (SciMoCa) is evaluated and benchmarked against well-established TPS (Monaco and Pinnacle3 ) by means of treatment plans and dose measurements.

METHODS

Fifty VMAT plans have been computed using same calculation parameters with SciMoCa and the two primary TPSs. Plans were validated with measurements performed with a 3D diode detector (ArcCHECK) by translating patient plans to phantom geometry. Calculation accuracy was assessed by measuring point dose differences and gamma passing rates (GPR) from a 3D gamma analysis with 3%-2 mm criteria. Comparison between SciMoCa and primary TPS calculations was made using the same estimators and using both patient and phantom geometry plans.

RESULTS

TPS and SciMoCa calculations were found to be in very good agreement with validation measurements with average point dose differences of 0.7 ± 1.7% and -0.2 ± 1.6% for SciMoCa and two TPSs, respectively. Comparison between SciMoCa calculations and the two primary TPS plans did not show any statistically significant difference with average point dose differences compatible with zero within error for both patient and phantom geometry plans and GPR (98.0 ± 3.0% and 99.0 ± 3.0% respectively) well in excess of the typical 95 % clinical tolerance threshold.

CONCLUSION

This work presents results obtained with a significantly larger sample than other similar analyses and, to the authors' knowledge, compares SciMoCa with a MC-based TPS for the first time. Results show that a MC-based secondary patient-specific QA is a clinically viable, reliable, and promising technique, that potentially allows significant time saving that can be used for patient treatment and a per-plan basis QA that effectively complements traditional commissioning and calibration protocols.

IAEA-AAPM TRS-483-based reference dosimetry of the new RefleXion biology-guided radiotherapy (BgRT) machine

PURPOSE

The purpose of this study is to provide data for the calibration of the recent RefleXion TM biology-guided radiotherapy (BgRT) machine (Hayward, CA, USA) following the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) TRS-483 code of practice (COP) (Palmans et al. International Atomic Energy Agency, Vienna, 2017) and (Mirzakhanian et al. Med Phys, 2020).

METHODS

In RefleXion BgRT machine, reference dosimetry was performed using two methodologies described in TRS-483 and (Mirzakhanian et al. Med Phys, 2020) In the first approach (Approach 1), the generic beam quality correction factor k Q A , Q 0 f A , f ref was calculated using an accurate Monte Carlo (MC) model of the beam and of six ionization chamber types. The k Q A , Q 0 f A , f ref is a beam quality factor that corrects N D , w , Q 0 f ref (absorbed dose to water calibration coefficient in a calibration beam quality Q 0 ) for the differences between the response of the chamber in the conventional reference calibration field f ref with beam quality Q 0 at the standards laboratory and the response of the chamber in the user's A field f A with beam quality Q A . Field A represents the reference calibration field that does not fulfill msr conditions. In the second approach (Approach 2), a square equivalent field size was determined for field A of 10 × 2 cm 2 and 10 × 3 cm 2 . Knowing the equivalent field size, the beam quality specifier for the hypothetical 10 × 10 cm 2 field size was derived. This was used to calculate the beam quality correction factor analytically for the six chamber types using the TRS-398. (Andreo et al. Int Atom Energy Agency 420, 2001) Here, TRS-398 was used instead of TRS-483 since the beam quality correction values for the chambers used in this study are not tabulated in TRS-483. The accuracy of Approach 2 is studied in comparison to Approach 1.

RESULTS

Among the chambers, the PTW 31010 had the largest k Q A , Q 0 f A , f ref correction due to the volume averaging effect. The smallest-volume chamber (IBA CC01) had the smallest correction followed by the other microchambers Exradin-A14 and -A14SL. The equivalent square fields sizes were found to be 3.6 cm and 4.8 cm for the 10 × 2 cm 2 and 10 × 3 cm 2 field sizes, respectively. The beam quality correction factors calculated using the two approaches were within 0.27% for all chambers except IBA CC01. The latter chamber has an electrode made of steel and the differences between the correction calculated using the two approaches was the largest, that is, 0.5%.

CONCLUSIONS

In this study, we provided the k Q A , Q 0 f A , f ref values as a function of the beam quality specifier at the RefleXion BgRT setup ( TPR 20 , 10 ( S ) and % d d ( 10 , S ) x ) for six chamber types. We suggest using the first approach for calibration of the RefleXion BgRT machine. However, if the MC correction is not available for a user's detector, the user can use the second approach for estimating the beam quality correction factor to sufficient accuracy (0.3%) provided the chamber electrode is not made of high Z material.

Feasibility study of using Stereotactic Field Diode for field output factors measurement and evaluating three new detectors for small field relative dosimetry of 6 and 10 MV photon beams

This study assesses the feasibility of using stereotactic field diode (SFD) as an alternate to gaf chromic films for field output factor (FF) measurement and further evaluating three new detectors for small field dosimetry. Varian 21EX linear accelerator was used to generate 6 and 10 MV beams of nominal square fields ranging from 0.5 × 0.5 cm² to 10 × 10 cm². One passive (EBT3 films) and five active detectors including IBA RAZOR diode(RD), SFD, RAZOR nanochamber (RNC), pinpoint chamber (PTW31023), and semiflex chamber (PTW31010) were employed. FFs were measured using films and SFD while beam profiles and percentage depth dose (PDD) distribution were acquired with active detectors. Polarity (k_pol) and recombination (k_s) effects of ion chambers were determined and corrected for output ratio measurement. Correction factors (CF) of RD, RNC, and PTW31023 in axial and radial orientation were also measured. Stereotactic field diode measured FFs have shown good agreement with films (with difference of <1%). RD and RNC measured beam profiles were within 3% deviation from the SFD values. Variation in k_pol with field size for RNC and PTW31023 was up to 4% and 0.4% (for fields ≥ 1 × 1 cm²), respectively, while variation in k_s of PTW31023 was <0.2 %. The maximum values of CF have been calculated to be 5.2%, 2.0%, 13.6%, and 25.5% for RD, RNC, PTW31023‐axial, and PTW31023‐radial respectively. This study concludes that SFD with appropriate CFs as given in TRS 483 may be used for measuring FFs as an alternate to EBT3 films. Whereas RD and RNC may be used for beam profile and PDD measurement in small fields. Considering the limit of usability of 2%, RNC may be used without CF for FF measurement in the smallfields investigated in this study.

Estimation of the cable effect in megavoltage photon beam by measurement and Monte Carlo simulation

PURPOSE

Ionization chambers are widely used for dosimetry with megavoltage photon beams. Several properties of ionization chambers, including the cable effect, polarity effect, and ion recombination loss, are described in standard dosimetry protocols. The cable effect is categorized as the leakage current and Compton current, and careful consideration of these factors has been described not only in reference dosimetry but also in large fields. However, the mechanism of Compton current in the cable has not been investigated thoroughly. The cable effect of ionization chambers in 6 MV X-ray beam was evaluated by measurement, and the mechanism of Compton current was investigated by Monte Carlo simulation.

MATERIALS AND METHODS

Four PTW ionization chambers (TM30013, TM31010, TM31014, and TM31016) with the same type of mounted cable, but different ionization volumes, were used to measure output factor (OPF) and cable effect measurement. The OPF was measured to observe any variation resulting from the cable effect. The cable effect was evaluated separately for the leakage current and Compton current, and its charge per absorbed dose to water per cable length was estimated by a newly proposed method. The behavior of electrons and positrons in the core wire was analyzed and the Compton current for the photon beam was estimated by Monte Carlo simulation.

RESULTS

In OPF measurement, the difference in the electrometer readings by polarity became obvious for the mini- or microchamber and its difference tended to be larger for a chamber with a smaller ionization volume. For the cable effect measurement, it was determined that the contribution of the leakage current to the cable effect was ignorable, while the Compton current was dominant. The charge due to the Compton current per absorbed dose to water per cable length was estimated to be 0.36 ± 0.03 pC Gy^-1  cm^-1 for PTW ionization chambers. As a result, the contribution of the Compton current to the electrometer readings was estimated to be 0.002% cm^-1 for the Farmer-type, 0.011% cm^-1 for the scanning, and 0.088% cm^-1 for microchambers, respectively. By the simulation, it was determined that the Compton current for MV x-ray could be explained by not only recoil electrons due to Compton scattering but also positron due to pair production. The Compton current estimated by the difference in outflowing and inflowing charge was 0.45 pC Gy^-1  cm^-1 and was comparable with the measured value.

CONCLUSION

The cable effect, which includes the leakage current and Compton current, was quantitatively estimated for several chambers from measurements, and the mechanism of Compton current was investigated by Monte Carlo simulation. It was determined that the Compton current is a dominant component of the cable effect and its charge is consistently positive and nearly the same, irrespective of the ionization chamber volume. The contribution of Compton current to the electrometer readings was estimated for chambers. The mechanism of Compton current was analyzed and it was confirmed that the Compton current can be estimated from the difference in outflowing and inflowing charge to and from the core wire.

First-stage validation of a portable imageable MR-compatible water calorimeter

PURPOSE

The purpose of this study is to design a water calorimeter with three goals in mind: (a) To be fully magnetic resonance (MR)-compatible; (b) To be imaged using kV cone beam computed tomography (CBCT), MV portal imaging or MRI for accurate positioning; (c) To accommodate both vertical and horizontal beam incidence, as well as volumetric deliveries or Gamma Knife®. Following this, the calorimeter performance will be measured using an accelerator-based high-energy photon beam.

METHODS

A portable 4°C cooled stagnant water calorimeter was built using MR-compatible materials. The walls consist of layers of acrylic plastic, aerogel-based material acting as thermal insulation, as well as tubing for coolant to flow to keep the calorimeter temperature stable at 4°C. The lid contains additional pathways for coolant to flow through as well as two hydraulically driven stirrers. The water calorimeter was positioned in an Elekta Versa using kV CBCT imaging as well as orthogonal MV image pairs. Absolute absorbed dose to water was then determined under a 6 MV flattening filter-free (FFF) beam. This was compared against reference dosimetry results that were measured under identical conditions with an Exradin A1SL ionization chamber with a calibration coefficient directly traceable to the National Research Council Canada.

RESULTS

The dose to water determined with the calorimeter (n = 30) agreed with the A1SL ionization chamber reference dose measurements (n = 15) to within 0.25%. The uncertainty associated with the water calorimeter absorbed dose measurement was estimated to be 0.54% (k = 1).

CONCLUSIONS

An MR-compatible water calorimeter was successfully built and absolute absorbed dose to water under a conventional 6 MV FFF beam was determined successfully as a first-stage validation of the system.

Calculated beam quality correction factors for ionization chambers in MV photon beams

The beam quality correction factor, [Formula: see text], which corrects for the difference in the ionization chamber response between the reference and clinical beam quality, is an integral part of radiation therapy dosimetry. The uncertainty of [Formula: see text] is one of the most significant sources of uncertainty in the dose determination. To improve the accuracy of available [Formula: see text] data, four partners calculated [Formula: see text] factors for 10 ionization chamber models in linear accelerator beams with accelerator voltages ranging from 6 MV to 25 MV, including flattening-filter-free (FFF) beams. The software used in the calculations were EGSnrc and PENELOPE, and the ICRU report 90 cross section data for water and graphite were included in the simulations. Volume averaging correction factors were calculated to correct for the dose averaging in the chamber cavities. A comparison calculation between partners showed a good agreement, as did comparison with literature. The [Formula: see text] values from TRS-398 were higher than our values for each chamber where data was available. The [Formula: see text] values for the FFF beams did not follow the same [Formula: see text], [Formula: see text] relation as beams with flattening filter (values for 10 MV FFF beams were below fits made to other data on average by 0.3%), although our FFF sources were only for Varian linacs.

A modified formalism for electron beam reference dosimetry to improve the accuracy of linac output calibration

PURPOSE

To present and demonstrate the accuracy of a modified formalism for electron beam reference dosimetry using updated Monte Carlo calculated beam quality conversion factors.

METHODS

The proposed, simplified formalism allows the use of cylindrical ionization chambers in all electron beams (even those with low beam energies) and does not require a measured gradient correction factor. Data from a previous publication are used for beam quality conversion factors. The formalism is tested and compared to the present formalism in the AAPM TG-51 protocol with measurements made in Elekta Precise electron beams with energies between 4 MeV and 22 MeV and with fields shaped with a 10 × 10 cm² clinical applicator as well as a 20 × 20 cm² clinical applicator for the 18 MeV and 22 MeV beams. A set of six ionization chambers are used for measurements (two cylindical reference-class chambers, two scanning-type chambers and two parallel-plate chambers). Dose per monitor unit is derived using the data and formalism provided in the TG-51 protocol and with the proposed formalism and data and compared to that obtained using ionization chambers calibrated directly against primary standards for absorbed dose in electron beams.

RESULTS

The standard deviation of results using different chambers when TG-51 is followed strictly is on the order of 0.4% when parallel-plate chambers are cross-calibrated against cylindrical chambers. However, if parallel-plate chambers are directly calibrated in a cobalt-60 beam, the difference between results for these chambers is up to 2.2%. Using the proposed formalism and either directly calibrated or cross-calibrated parallel-plate chambers gives a standard deviation using different chambers of 0.4%. The difference between results that use TG-51 and the primary standard measurements are on the order of 0.6% with a maximum difference in the 4 MeV beam of 2.8%. Comparing the results obtained with the proposed formalism and the primary standard measurements are on the order of 0.4% with a maximum difference of 1.0% in the 4 MeV beam.

CONCLUSIONS

The proposed formalism and the use of updated data for beam quality conversion factors improves the consistency of results obtained with different chamber types and improves the accuracy of reference dosimetry measurements. Moreover, it is simpler than the present formalism and will be straightforward to implement clinically.

Assessment of ion recombination correction and polarity effects for specific ionization chambers in flattening-filter-free photon beams

PURPOSE

To investigate ion recombination correction and polarity effects in four ion chamber models in flattening-filter-free (FFF) beams to (1) evaluate their suitability for reference dosimetry; (2) assess the accuracy of the two-voltage technique (TVA) against the Bruggmoser formalism; and (3) examine the influence of the accelerator type on the recombination correction.

METHODS

Jaffé plots were created for a variety of microchambers, small-volume and Farmer-type chambers to obtain k_S, the recombination correction factor, using two different types of accelerators. These values were plotted against dose-per-pulse and Jaffé plots for opposite polarities were created to determine which chambers meet the AAPM TG-51 addendum recombination and polarity specifications.

RESULTS

Nearly all small-volume chambers exhibited reference-class behavior with respect to ion recombination and polarity effects. The microchambers exhibited anomalous recombination and polarity effects, precluding their use for reference dosimetry in FFF beams. For the reference-class chambers, agreement between TVA-determined k_S values and Jaffé and Bruggmoser formalisms-determined k_S values was within 0.1%. No significant differences were found between the k_S values obtained with the two different accelerators used in this work.

CONCLUSIONS

This study stresses the need to characterize ion recombination correction and polarity effects for small-volume chambers and microchambers on an individual chamber basis and with the more rigorous criteria of the AAPM TG-51 addendum. Furthermore, the study demonstrated the suitability of the TVA method for chambers that exhibit reference-class behavior in FFF beams. Finally, this work has shown that the recombination correction does not depend on the type of accelerator but on its dose-per-pulse.

Effect of ICRU report 90 recommendations on Monte Carlo calculated kQ for ionization chambers listed in the Addendum to AAPM's TG-51 protocol

PURPOSE

The ICRU has published new recommendations for ionizing radiation dosimetry. In this work, the effect of recommendations on the water-to-air and graphite-to-air restricted mass electronic stopping power ratios (s_{w, air} and s_{g, air} ) and the individual perturbation correction factors P_i was calculated. The effect on the beam quality conversion factors k_Q for reference dosimetry of high-energy photon beams was estimated for all ionization chambers listed in the Addendum to AAPM's TG-51 protocol.

METHODS

The s_{w, air} , s_{g, air} , individual P_i, and k_Q were calculated using EGSnrc Monte Carlo code system and key data of both ICRU report 37 and ICRU report 90. First, the P_i and k_Q were calculated using precise models of eight ionization chambers: NE2571 (Nuclear Enterprise), 30013, 31010, 31021 (PTW), Exradin A12, A12S, A1SL (Standard imaging), and FC-65P (IBA). In this simulation, the radiation sources were one ⁶⁰ Co beam and ten photon beams with nominal energy between 4 MV and 25 MV. Then, the change in k_Q for ionization chambers listed in the Addendum to AAPM's TG-51 protocol was calculated by changing the specification of the simple-model of ionization chamber. The simple-models were made with only cylindrical component modules. In this simulation, the radiation sources of ⁶⁰ Co beam and 24 MV photon beam were used.

RESULTS

The significant changes (p < 0.05) were observed for s_{w, air} , s_{g, air} , the wall correction factor P_wall , and the waterproofing sleeve correction factor P_sleeve . The decrease in s_{w, air} varied from -0.57% for a ⁶⁰ Co beam to -0.36% for the highest beam quality. The decrease in s_{g, air} varied from -0.72% to -1.12% in the same range. The changes in P_wall and P_sleeve were up to 0.41% and 0.14% and those maximum changes were observed for the ⁶⁰ Co beam. All changes in the central electrode correction factor P_cel , the stem correction factor P_stem , and the replacement correction factor P_repl were from -0.02% to 0.12%. Those changes were statistically insignificant (p = 0.07 or more) and were independent of photon energy. The change in k_Q was mainly characterized by the change in s_{w, air} , P_wall , and P_sleeve . The relationship between the change in k_Q and the beam quality index was linear approximately. The changes in k_Q of the simple-models were agreed with those of the precise-models within 0.08%.

CONCLUSION

The effects of ICRU-90 recommendations on k_Q for the ionization chambers listed in the Addendum to AAPM's TG-51 protocol were from -0.15% to 0.30%. To remove the known systematic effect on the clinical reference dosimetry, the k_Q based on ICRU-37 should be updated to the k_Q based on ICRU-90.

Technical Note: Consistency of PTW30013 and FC65-G ion chamber magnetic field correction factors

Purpose

Reference dosimetry in a strong magnetic field is made more complex due to (a) the change in dose deposition and (b) the change in sensitivity of the detector. Potentially it is also influenced by thin air layers, interfaces between media, relative orientations of field, chamber and radiation, and minor variations in ion chamber stem or electrode construction. The PTW30013 and IBA FC65‐G detectors are waterproof Farmer‐type ion chambers that are suitable for reference dosimetry. The magnetic field correction factors have previously been determined for these chamber types. The aim of this study was to assess the chamber‐to‐chamber variation and determine whether generic chamber type‐specific magnetic field correction factors can be applied for each of the PTW30013 and FC65‐G type ion chambers when they are oriented anti‐parallel (ǁ) to, or perpendicular (⊥) to, the magnetic field.

Methods

The experiment was conducted with 12 PTW30013 and 13 FC65‐G chambers. The magnetic field correction factors were measured using a practical method. In this study each chamber was cross‐calibrated against the local standard chamber twice; with and without magnetic field. Measurements with 1.5 T magnetic field were performed with the 7 MV FFF beam of the MRI‐linac. Measurements without magnetic field (0 T) were performed with the 6 MV conventional beam of an Elekta Agility linac. A prototype MR‐compatible PTW MP1 phantom was used along with a prototype holder that facilitated measurements with the chamber aligned 90° counter‐clockwise (⊥) and 180° (ǁ) to the direction of the magnetic field. A monitor chamber was also mounted on the holder and all measurements were normalized so that the effect of variations in the output of each linac was minimized. Measurements with the local standard chamber were repeated during the experiment to quantify the experimental uncertainty. Recombination was measured in the 6 MV beam. Beam quality correction factors were applied. Differences in recombination and beam quality between beams are constant within each chamber type. By comparing the results for the two cross calibrations the magnetic field correction factors can be determined for each chamber, and the variation within the chamber‐type determined.

Results

The magnetic field correction factors within both PTW30013 and FC65‐G chamber‐types were found to be very consistent, with observed standard deviations for the PTW30013 of 0.19% (ǁ) and 0.13% (⊥), and for the FC65‐G of 0.15% (ǁ) and 0.17% (⊥). These variations are comparable with the standard uncertainty (k = 1) of 0.24%.

Conclusion

The consistency of the results for the PTW30013 and FC65‐G chambers implies that it is not necessary to derive a new factor for every new PTW30013 or FC65‐G chamber. Values for each chamber‐type (with careful attention to beam energy, magnetic field strength and beam‐field‐chamber orientations) can be applied from the literature.

TG-51 reference dosimetry for the Halcyon™: A clinical experience

Halcyon™ is a single‐energy (6 MV‐FFF), bore‐enclosed linear accelerator. Patient setup is performed by first aligning to external lasers mounted to the front of the bore, and then loading to isocenter through pre‐defined couch shifts. There is no light field, optical distance indicator or front pointer mechanism, so positioning is verified through MV imaging with kV imaging scheduled to become available in the future. TG‐51 reference dosimetry was successfully performed for Halcyon™ in this imaging‐based setup paradigm. The beam quality conversion factor, k_Q, was determined by measuring %dd(10)_x three ways: (a) using a Farmer chamber with lead filtering, (b) using a Farmer chamber without lead filtering, and (c) using a PinPoint chamber without lead filtering. Values of k_Q were determined to be 0.995, 0.996, and 0.996 by each measurement technique, respectively. Halcyon™'s 6 MV‐FFF beam was found to be broader than other FFF beams produced by Varian accelerators, and profile measurements at d_max showed the beam to vary less than 0.5% over the dimensions of our Farmer chamber's active volume. Reference dosimetry can be performed for the Halcyon™ accelerator simply, without specialized equipment or lead filtering with minimal dosimetric impact. This simplicity will prove advantageous in clinics with limited resources or physics support.

Comparison of k Q factors measured with a water calorimeter in flattening filter free (FFF) and conventional flattening filter (cFF) photon beams

Recently flattening filter free (FFF) beams became available for application in modern radiotherapy. There are several advantages of FFF beams over conventional flattening filtered (cFF) beams, however differences in beam spectra at the point of interest in a phantom potentially affect the ion chamber response. Beams are also non-uniform over the length of a typical reference ion chamber and recombination is usually larger. Despite several studies describing FFF beam characteristics, only a limited number of studies investigated their effect on k _Q factors. Some of those studies predicted significant discrepancies in k _Q factors (0.4% up to 1.0%) if TPR_20,10 based codes of practice (CoPs) were to be used. This study addresses the question to which extent k _Q factors, based on a TPR_20,10 CoP, can be applied in clinical reference dosimetry. It is the first study that compares k _Q factors measured directly with an absorbed dose to water primary standard in FFF-cFF pairs of clinical photon beams. This was done with a transportable water calorimeter described elsewhere. The measurements corrected for recombination and beam radial non-uniformity were performed in FFF-cFF beam pairs at 6 MV and 10 MV of an Elekta Versa HD for a selection of three different Farmer-type ion chambers (eight serial numbers). The ratio of measured k _Q factors of the FFF-cFF beam pairs were compared with the TPR_20,10 CoPs of the NCS and IAEA and the %dd(10) _x CoP of the AAPM. For the TPR_20,10 based CoPs differences less than 0.23% were found in k _Q factors between the corresponding FFF-cFF beams with standard uncertainties smaller than 0.35%, while for the %dd(10) _x these differences were smaller than 0.46% and within the expanded uncertainty of the measurements. Based on the measurements made with the equipment described in this study the authors conclude that the k _Q factors provided by the NCS-18 and IAEA TRS-398 codes of practice can be applied for flattening filter free beams without additional correction. However, existing codes of practice cannot be applied ignoring the significant volume averaging effect of the FFF beams over the ion chamber cavity. For this a corresponding volume averaging correction must be applied.

Small composite field correction factors for the CyberKnife radiosurgery system: clinical and PCSR plans

A formalism has been proposed for small and non-standard photon fields in which [Formula: see text] correction factors are used to correct dosimeter response in small fields (indiviual or composite) relative to that in a larger machine-specific reference (MSR) field. For clinical plans consisting of several fields, a plan-class specific reference (PCSR) plan can also be defined, serving as an intermediate calibration field between the MSR and clinical plans within a certain plan-class. In this work, the formalism was applied in the calculation of [Formula: see text] for 21 clinical plans delivered by the [Formula: see text] radiosurgery system, each plan employing one or two of the smallest diameter collimators: 5 mm, 7.5 mm, and 10 mm. Three detectors were considered: the Exradin A16 and A26 micro chambers, and the W1 plastic scintillator. The clinical plans were grouped into 7 plan-classes according to commonly shared characteristics. The suitability of using a PCSR plan to represent the detector response of each plan within the plan-class was investigated. Total and intermediate correction factors were calculated using the [Formula: see text] Monte Carlo user code. The corrections for the micro chambers were large, primarily due to the presence of the low-density air cavity and the volume averaging effect. The correction for the scintillator was found to be close to unity for most plans, indicating that this detector may be used to measure small clinical plan correction factors in any plan except for those using the 5 mm collimator. The PCSR plan was shown to be applicable to plan-classes comprising isocentric plans only, with plan-classes divided according to collimator size. For non-isocentric plans, the variation of [Formula: see text] as a function of the point of measurement within a single plan, as well as the high inter-plan-class variability of the correction factor, precludes the use of a PCSR plan.

Experimental and Monte Carlo-based determination of the beam quality specifier for TomoTherapyHD treatment units

Reference dosimetry by means of clinical linear accelerators in high-energy photon fields requires the determination of the beam quality specifier TPR_20,10, which characterizes the relative particle flux density of the photon beam. The measurement of TPR_20,10 has to be performed in homogenous photon beams of size 10×10cm² with a focus-detector distance of 100cm. These requirements cannot be fulfilled by TomoTherapy treatment units from Accuray. The TomoTherapy unit provides a flattening-filter-free photon fan beam with a maximum field width of 40cm and field lengths of 1.0cm, 2.5cm and 5.0cm at a focus-isocenter distance of 85cm. For the determination of the beam quality specifier from measurements under nonstandard reference conditions Sauer and Palmans proposed experiment-based fit functions. Moreover, Sauer recommends considering the impact of the flattening-filter-free beam on the measured data. To verify these fit functions, in the present study a Monte Carlo based model of the treatment head of a TomoTherapyHD unit was designed and commissioned with existing beam data of our clinical TomoTherapy machine. Depth dose curves and dose profiles were in agreement within 1.5% between experimental and Monte Carlo-based data. Based on the fit functions from Sauer and Palmans the beam quality specifier TPR_20,10 was determined from field sizes 5×5cm², 10×5cm², 20×5cm² and 40×5cm² based on dosimetric measurements and Monte Carlo simulations. The mean value from all experimental values of TPR_20,10 resulted in TPR_20,10¯=0.635±0.4%. The impact of the non-homogenous field due to the flattening-filter-free beam was negligible for field sizes below 20×5cm². The beam quality specifier calculated by Monte Carlo simulations was TPR_20,10=0.628 and TPR_20,10=0.631 for two different calculation methods. The stopping power ratio water-to-air s_w,a^Δ directly depends on the beam quality specifier. The value determined from all experimental TPR_20,10 data was s_w,a^Δ=1.126±0.1%, which is in excellent agreement with the value directly calculated by Monte Carlo simulations. The agreement is a good indication that the equations proposed by Sauer and Palmans are able to calculate the beam quality specifier under reference conditions from measurements in arbitrary photon field sizes with high accuracy and are applicable for the TomoTherapyHD treatment unit.

Comparison of the recommendations of the AAPM TG ‐51 and TG ‐51 addendum reference dosimetry protocols

This work quantified differences between recommendations of the TG‐51 and TG‐51 addendum reference dosimetry protocols. Reference dosimetry was performed for flattened photon beams with nominal energies of 6, 10, 15, and 23 MV, as well as flattening‐filter free (FFF) beam energies of 6 and 10 MV, following the recommendations of both the TG‐51 and TG‐51 addendum protocols using both a Farmer^® ionization chamber and a scanning ionization chamber with calibration coefficients traceable to absorbed dose‐to‐water (D_w) standards. Differences in D_w determined by the two protocols were 0.1%–0.3% for beam energies with a flattening filter, and up to 0.2% and 0.8% for FFF beams measured with the scanning and Farmer^® ionization chambers, respectively, due to k_Q determination, volume‐averaging correction, and collimator jaw setting. Combined uncertainty was between 0.91% and 1.2% (k = 1), varying by protocol and detector.

Ion recombination and polarity corrections for small-volume ionization chambers in high-dose-rate, flattening-filter-free pulsed photon beams

PURPOSE

To investigate ion recombination and polarity effects in scanning and microionization chambers when used with digital electrometers and high-dose-rate linac beams such as flattening-filter-free (FFF) fields, and to compare results against conventional pulsed and continuous photon beams.

METHODS

Saturation curves were obtained for one Farmer-type ionization chamber and eight small-volume chamber models with volumes ranging from 0.01 to 0.13 cm³ using a Varian TrueBeam™ STx with FFF capability. Three beam modes (6 MV, 6 MV FFF, and 10 MV FFF) were investigated, with nominal dose-per-pulse values of 0.0278, 0.0648, and 0.111 cGy/pulse, respectively, at d_max . Saturation curves obtained using the Theratronics T1000 ⁶⁰ Co unit at the UWADCL and a conventional linear accelerator (Varian Clinac iX) were used to establish baseline behavior. Jaffé plots were fitted to obtain P_ion , accounting for exponential effects such as charge multiplication. These values were compared with the two-voltage technique recommended in TG-51, and were plotted as a function of dose-per-pulse to assess the ability of small-volume chambers to meet reference-class criteria in FFF beams.

RESULTS

Jaffé- and two-voltage-determined P_ion values measured for high-dose-rate beams agreed within 0.1% for the Farmer-type chamber and 1% for scanning and microionization chambers, with the exception of the CC01 which agreed within 2%. With respect to ion recombination and polarity effects, the Farmer-type chamber, scanning chambers and the Exradin A26 microchamber exhibited reference-class behavior in all beams investigated, with the exception of the IBA CC04 scanning chamber, which had an initial recombination correction that varied by 0.2% with polarity. All microchambers investigated, with the exception of the A26, exhibited anomalous polarity and ion recombination behaviors that make them unsuitable for reference dosimetry in conventional and high-dose-rate photon beams.

CONCLUSIONS

The results of this work demonstrate that recombination and polarity behaviors seen in conventional pulsed and continuous photon beams trend accordingly in high-dose-rate FFF linac beams. Several models of small-volume ionization chambers used with a digital electrometer have been shown to meet reference-class requirements with respect to ion recombination and polarity, even in the high-dose-rate environment. For such chambers, a two-voltage technique agreed well with more rigorous methods of determining P_ion . However, the results emphasize the need for careful reference detector selection, and indicate that ionization chambers ought to be extensively tested in each beam of interest prior to their use for reference dosimetry.