Dosimetric study of bevel factors in IOERT with mobile linacs: Towards a unified code of practice

BACKGROUND

Dosimetry in intraoperative electron radiotherapy (IOERT) poses distinct challenges, especially with inclined applicators deviating from international protocols. Ion recombination in ionization chambers, electron beam degradation due to scattering in cylindrical applicators, coupled with a lack of a well-defined beam quality surrogate, complicate output factor determination with ionization chambers. Synthetic diamond-based detectors, offer potential solutions; however, their suitability requires further exploration.

PURPOSE

This study addresses output factor determination for beveled applicators. Objectives include assessing the suitability of PTW microDiamond detectors and determining correction factors for ionization chamber measurements based on energy variations at the depth of maximum dose (zmax) for beveled applicators. Experimental data are compared against results obtained from Monte Carlo simulations.

METHODS

We conducted measurements using both PTW microDiamond and IBA CC01 detectors. In addition to benchmarking bevel factors with penEasy, we employed Monte Carlo simulations to determine angular response correction factors for microDiamond detectors and to evaluate energy variations at zmax for beveled applicators.

RESULTS

The findings indicate that angular response correction factors are unnecessary for microDiamond detectors with beveled applicators. However, variations in mean energy at zmax potentially impact absorbed dose calculations with ionization chambers, particularly with the most inclined applicators.

CONCLUSIONS

Based on our results, the study recommends using microDiamond detectors over cylindrical ionization chambers for output factor determination in IOERT with inclined applicators. Addressing energy variations at zmax is crucial to improve accuracy in ionization chamber measurements. These findings have implications for dosimetry protocols in IOERT, contributing to enhanced delivery in clinical practice.

Dosimetric impact of calibration coefficients determined using linear accelerator photon and electron beams for ionization chamber in an on-site dosimetry audit

This study aimed to clarify the dosimetric impact of calibration beam quality for calibration coefficients of the absorbed dose to water for an ionization chamber in an on-site dosimetry audit. Institution-measured doses of 200 photon and 184 electron beams were compared with the measured dose using one year data before and after the calibration of the ionization chamber used. For photon and electron reference dosimetry, the agreements of the institution-measured dose against two measured doses in this audit were evaluated using the calibration coefficients determined using 60Co (${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$) and linear accelerator (linac) (${N}_{D,\mathrm{w},Q}$) beams. For electron reference dosimetry, the agreement of two institution-measured doses against the measured dose was evaluated using${N}_{D,\mathrm{w},Q}$. Institution-measured doses were evaluated using direct- and cross-calibration coefficients. For photon reference dosimetry, the mean differences and standard deviation (SD) of institution-measured dose against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.4% and -0.3% ± 0.4%, respectively. For electron reference dosimetry, the mean differences and SD of institution-measured dose using the direct-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},{}^{60}\mathrm{Co}}$ and ${N}_{D,\mathrm{w},Q}$ were 1.3% ± 0.8% and 0.8% ± 0.8%, respectively. Further, the mean differences and SD of institution-measured dose using the cross-calibration coefficient against the measured dose using ${N}_{D,\mathrm{w},Q}$ were -0.1% ± 0.6%. For photon beams, the dosimetric impact of introducing calibration coefficients determined using linac beams was small. For electron beams, it was larger, and the measured dose using ${N}_{D,\mathrm{w},Q}$ was most consistent with the institution-measured dose, which was evaluated using a cross-calibration coefficient.

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.

Monte Carlo calculated beam quality correction factors for high energy electron beams

PURPOSE

As the dosimetry protocol TRS 398 is being revised and the ICRU report 90 provides new recommendations for density correction as well as the mean ionization energies of water and graphite, updated beam quality correction factors kQ are calculated for reference dosimetry in electron beams and for independent validation of previously determined values.

METHODS

Monte Carlo simulations have been performed using EGSnrc to calculate the absorbed dose to water and the dose to the active volumes of ionization chambers SNC600c, SNC125c and SNC350p (all Sun Nuclear, A Mirion Medical Company, Melbourne, FL). Realistic clinical electron beam spectra were used to cover the entire energy range of therapeutic electron accelerators. The Monte Carlo simulations were validated by measurements on a clinical linear accelerator. With regards to the cylindrical chambers, the simulations were performed according to the setup recommendations of TRS 398 and AAPM TG 51, i.e. with and without consideration of a reference point shift by rcav/2.

RESULTS

kQ values as a function of the respective beam quality specifier R50 were fitted by recommended equations for electron beam dosimetry in the range of 5 MeV to 18 MeV. The fitting curves to the calculated values showed a root mean square deviation between 0.0016 and 0.0024.

CONCLUSION

Electron beam quality correction factors kQ were calculated by Monte Carlo simulations for the cylindrical ionization chambers SNC600c and SNC125c as well as the plane parallel ionization chamber SNC350p to provide updated data for the TRS 398 and TG 51 dosimetry protocols.

A multicenter study of modified electron beam output calibration

PURPOSE

This study aims to assess the accuracy of a modified electron beam calibration based on the IAEA TRS-398 and AAPM-TG-51 in multicenter radiotherapy.

METHODS

This study was performed using the Elekta and Varian Linear Accelerator electron beams with energies of 4-22 MeV under reference conditions using cylindrical (PTW 30013, IBA FC65-G, and IBA FC65-P) and parallel-plate (PTW 34045, PTW 34001, and IBA PPC-40) chambers. The modified calibration used a cylindrical chamber and an updatedk ' Q $k{^{\prime}}_Q$ based on Monte Carlo calculations, whereas TRS-398 and TG-51 used cylindrical and parallel-plate chambers for reference dosimetry. The dose ratio of the modified calibration procedure, TRS-398 and TG-51 were obtained by comparing the dose at the maximum depth of the modified calibration to TRS-398 and TG-51.

RESULTS

The study found that all cylindrical chambers' beam quality conversion factors determined with the modified calibration( k ' Q ) $( {{{k^{\prime}}}_Q} )$ to the TRS-398 and TG-51 vary from 0.994 to 1.003 and 1.000 to 1.010, respectively. The dose ratio of modified/TRS-398cyl and modified/TRS-398parallel-plate, the variation ranges were 0.980-1.014 and 0.981-1.019, while for the counterpart modified/TG-51cyl was found varying between 0.991 and 1.017 and the ratio of modified/TG-51parallel-plate varied in the range of 0.981-1.019.

CONCLUSION

This multi-institutional study analyzed a modified calibration procedure utilizing new data for electron beam calibrations at multiple institutions and evaluated existing calibration protocols. Based on observed variations, the current calibration protocols should be updated with detailed metrics on the stability of linac components.

Charge collection efficiency of commercially available parallel-plate ionisation chambers in ultra-high dose-per-pulse electron beams

Objective. This investigation aims to experimentally determine the charge collection efficiency (CCE) of six commercially available parallel-plate ionisation chamber (PPIC) models in ultra-high dose-per-pulse (UHDPP) electron beams.Approach. The CCE of 22 PPICs has been measured in UHDPP electron beams at the National Metrology Institution of Germany (PTB). The CCE was determined for a dose per pulse (DPP) range between 0.1 and 6.4 Gy (pulse duration of 2.5μs). The results obtained with the different PPICs were compared to evaluate the reproducibility, intra- and inter-model variation, and the performance of a CCE empirical model.Main results. The intra-model variation was, on average, 4.0%, which is more than three times the total combined relative standard uncertainty and was found to be greater at higher DPP (up to 20%). The inter-model variation for the PPIC with 2 mm electrode spacing, which was found to be, on average, 10%, was also significant compared to the relative uncertainty and the intra-model variation. The observed CCE variation could not be explained only by the expected deviation of the electrode spacing from the nominal value within the manufacturing tolerance. It should also be noted that a substantial polarity effect, between 0.914(5) and 1.201(3), was observed, and significant intra- and inter-model variation was observed on this effect.Significance. For research and pre-clinical study, the commercially available PPIC with a well-known CCE (directly measured for the specific chamber) and with a small electrode spacing could be used for relative and absolute dosimetry with a lower-limit uncertainty of 1.6% (k= 1) in the best case. However, to use a PPIC as a secondary standard in UHDPP electron beams for clinical purposes would require new model development to reduce the ion recombination, the polarity effect, and the total standard uncertainty on the dose measurement.

Modified calibration protocols in electron beam dosimetry: comparison with IAEA TRS-398 and AAPM TG-51

This study aimed to compare absolute calibration outputs based on the protocols of the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398, the American Association of Physicists in Medicine (AAPM) Task Group (TG)-51, and modified calibration approach. The electron beam output calibration followed the IAEA TRS-398 and AAPM TG-51 protocols, both of which required cylindrical chambers and parallel plates. However, the use of cylindrical chambers is not recommended at low energies because of the large fluence-correction factor. TG-51 recommended cross-calibration of the parallel-plate chamber against the cylindrical chamber in a high-energy electron beam. In 2020, an electron beam dosimetry modification was introduced that used a cylindrical ionisation chamber at all energies and updated the data for beam quality conversion factors. This modification provided a lower deviation than that reported in AAPM TG-51. Thus, the modified calibration based on TRS-398 was applied in the present study, which yielded results below the permissible tolerance. The beam calibration at 6, 8, 10, 12, and 15 MeV energies was carried out for two Elekta linear accelerators.. Electron beam dosimetry followed the AAPM TG-51 and TRS-398 protocols, and modified calibration were performed to measure the dose at the maximum depth expressed in dose/monitor units (cGy/MU). Charge-reading measurements were measured using ionisation chambers PTW 30013, IBA CC13, and Exradin A11. The average absorbed dose ratios were 1.004 and 1.009 using the modified calibration and TRS-398 and modified calibration and TG-51, respectively. Therefore, based on IAEA TRS-398, the results were below the tolerance limit (±2%).

Experimental investigation of the effective point of measurement for plane-parallel chambers used in electron beam dosimetry

In this study, the effective point of measurement (EPOM) for plane-parallel ionization chambers in clinical high-energy electron beams was determined experimentally. Previous studies have reported that the EPOM of plane-parallel chambers is shifted several tens of millimeters downstream from the inner surface of the entrance window to the cavity. These findings were based on the Monte Carlo (MC) simulation, and few experimental studies have been performed. Thus, additional experimental validations of the reported EPOMs were required. In this study, we investigated the EPOMs of three plane-parallel chambers (NACP-02, Roos and Advanced Markus) for clinical electron beams. The EPOMs were determined by comparing the measured percentage depth-dose (PDD) of the plane-parallel chambers and the PDD obtained using the microDiamond detector. The optimal shift to the EPOM was energy-dependent. The determined EPOM showed no chamber-to-chamber variation, thereby allowing the use of a single value. The mean optimal shifts were 0.104 ± 0.011, 0.040 ± 0.012, and 0.012 ± 0.009 cm for NACP-02, Roos, and Advanced Markus, respectively. These values are valid in the R₅₀ range from 2.40 to 8.82 cm, which correspond to 6-22 MeV. Roos and Advanced Markus exhibited similar results to those of the previous studies, but NACP-02 showed a larger shift. This is probably due to the uncertainty of the entrance window of NACP-02. Therefore, it is necessary to carefully consider where the optimal EPOM is located when using this chamber.

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.

Experimental determination of the effective point of measurement for cylindrical ionization chambers in megavoltage photon beams

Current dosimetry protocols specify an effective point of measurement (EPOM) shift of 0.6r for a cylindrical ionization chamber in photon beams. However, prior studies have reported that this shift was excessively large. The objective of this study was to experimentally evaluate the EPOM shifts in photon beams for cylindrical ionization chambers, which are widely used in clinical practice, and thus determine the appropriate EPOM shift. A microdiamond detector, which is a semiconductor detector with a small sensitive volume, was used as a reference detector, and the EPOM shifts of 11 types of cylindrical ionization chambers were evaluated at 6 MV and 10 MV. The depth shift from the percent depth dose (PDD) of the reference detector to that of the evaluated chamber was calculated using the least-squares method and was defined as the EPOM shift. The EPOM shift of the 10 MV condition was slightly larger than that of the 6 MV condition. However, because this trend was not observed for all chambers, the results of the two energies were averaged, and the EPOM shifts were determined to be 0.33r-0.43r (± 0.05) for 10 types of ionization chambers, and 0.03r (± 0.03) for the A1SL chamber. The shifts for all ionization chambers were smaller than 0.6r, indicating that the recommended EPOM shifts were overestimated and the absorbed dose was underestimated at the calibration depth. Hence, the appropriate EPOM shift of the 10 types of ionization chambers was 0.4r (the geometric center of the A1SL chamber), with a dose uncertainty of 0.05%.

The probe-format graphite calorimeter, Aerrow, for absolute dosimetry in ultra-high pulse dose rate electron beams

PURPOSE

The purpose of this investigation is to evaluate the use of a probe-format graphite calorimeter, Aerrow, as an absolute and relative dosimeter of high-energy pulse dose rate (UHPDR) electron beams for in-water reference and depth-dose type measurements, respectively.

METHODS

In this paper, the calorimeter system is used to investigate the potential influence of dose per pulses delivered up to 5.6 Gy, the number of pulses delivered per measurement and its potential for relative measurement (depth dose curve measurement). The calorimeter system is directly compared against an Advanced Markus ion chamber. The finite element method was used to calculate heat transfer corrections along the percentage depth dose of a 20 MeV electron beam. Monte Carlo-calculated dose conversion factors necessary to calculate absorbed dose to-water at a point from the measured dose-to-graphite are also presented.

RESULTS

The comparison of Aerrow against a fully calibrated Advanced Markus chamber, corrected for the saturation effect, has shown consistent results in terms of dose to water determination. The measured reference depth is within 0.5 mm from the expected value from Monte Carlo simulation. The relative standard uncertainty estimated for Aerrow was 1.06%, which is larger compared to alanine dosimetry (McEwen et al. https://doi.org/10.1088/0026-1394/52/2/272) but has the advantage of being a real time detector.

CONCLUSION

In this investigation, it was demonstrated that the Aerrow probe-type graphite calorimeter can be used for relative and absolute dosimetry in water in an UHPDR electron beam. To the author's knowledge, this is the first reported use of an absorbed dose calorimeter for an in-water percentage depth dose curve measurement. The use of the Aerrow in quasi-adiabatic mode has greatly simplified the signal readout, compared to isothermal mode, as the resistance was directly measured with a high-stability Digital-Multimetre (DMM). This article is protected by copyright. All rights reserved.

Modified electron beam output calibration based on IAEA Technical Report Series 398

Purpose

The recently worldwide standard measurement of electron beam reference dosimetry include the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)‐398 and Association of Physicists in Medicine (AAPM) Task Group (TG)‐51 protocols. Muir et al. have modified calibration methods for electron beam calibration based on AAPM TG‐51. They found that the use of cylindrical chambers at low energy gave acceptable results. In this study, we propose and report a modified calibration for electron beam based on IAEA TRS‐398, the standard reference dosimetry protocol worldwide.

Methods

This work was carried out with energies of 6, 8, 10, 12, and 15 MeV. The electron beam is generated from Elektra Synergy Platform and Versa HD linear accelerator. The charge readings were measured with PTW 30013, IBA CC13, Exradin A1Sl, and Exradin A11 chambers connected to the electrometer. The dose calculation uses an equation of modified calibration for electron beam using the updated kQ factor in previous work. The absorbed dose to water for electron beam is expressed in dose per monitor unit (cGy/MU). Thus, we compared dose per monitor unit (D/MU) calculation using a modified calibration to TRS‐398.

Results

In this work, we have succeeded in implementing the modified calibration of electron beam based on TRS‐398 by applying a cylindrical chamber in all energy beams and using the updated kQ factor. The ratio of the absorbed dose to water between original and modified calibration protocols of TRS‐398 (D_w) for the cylindrical chamber was 1.002 on the Elekta Synergy Platform and 1.000 on the Versa HD while for the parallel‐plate chamber it was 1.013 on the Elekta Synergy Platform and 1.014 on the Versa HD. Based on these results, both the cylindrical and parallel‐plate chambers are still within the tolerance limit allowed by the TRS‐398 protocol, which is ±2%. Therefore, modified calibration based on TRS‐398 gives acceptable results and is simpler to use clinically.

Dosimetric accuracy of a cross-calibration coefficient for plane-parallel ionization chamber obtained in low-energy electron beams using various cylindrical dosimeters

Introduction: The accuracy of the cross-calibration procedure depends on ionization chamber type, both used as reference one and under consideration. Also, the beam energy and phantom medium could influence the precision of cross calibration coefficient, resulting in a systematic error in dose estimation and thus could influence the linac beam output checking. This will result in a systematic mismatch between dose calculated in treatment planning system and delivered to the patient.

Material and methods: The usage of FC65-G, CC13 and CC01 thimble reference chambers as well as 6, 9, and 15 MeV electron beams has been analyzed. A plane-parallel PPC05 chamber was calibrated since scarce literature data are available for this dosimeter type. The influence of measurement medium and an effective point of measurement (EPOM) on obtained results are also presented.

Results: Dose reconstruction precision of ~0.1% for PPC05 chamber could be obtained when cross-calibration is based on a thimble CC13 chamber. Nd,w,Qcross obtained in beam ≥ 9MeV gives 0.1 – 0.5% precision of dose reconstruction.

Without beam quality correction, 15 MeV Nd,w,Qcross is 10% lower than Co-60 Nd,w,0. Various EPOM shifts resulted in up to 0.6% discrepancies in Nd,w,Qcross values.

Conclusions: Ionization chamber with small active volume and tissue-equivalent materials supplies more accurate cross-calibration coefficients in the range of 6 – 15 MeV electron beams. In the case of 6 and 9 MeV beams, the exact position of an effective point of measurement is of minor importance. In-water cross-calibration coefficient can be used in a solid medium without loss of dose accuracy.

Monte Carlo methods for device simulations in radiation therapy

Monte Carlo (MC) simulations play an important role in radiotherapy, especially as a method to evaluate physical properties that are either impossible or difficult to measure. For example, MC simulations (MCSs) are used to aid in the design of radiotherapy devices or to understand their properties. The aim of this article is to review the MC method for device simulations in radiation therapy. After a brief history of the MC method and popular codes in medical physics, we review applications of the MC method to model treatment heads for neutral and charged particle radiation therapy as well as specific in-room devices for imaging and therapy purposes. We conclude by discussing the impact that MCSs had in this field and the role of MC in future device design.

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.

Ion chamber and film-based quality assurance of mixed electron-photon radiation therapy

PURPOSE

In previous work, we demonstrated that mixed electron-photon radiation therapy (MBRT) produces treatment plans with improved normal tissue sparing and similar target coverage, when compared to photon-only plans. The purpose of this work was to validate the MBRT delivery process on a Varian TrueBeam accelerator and laying the groundwork for a patient-specific quality assurance (QA) protocol based on ion chamber point measurements and 2D film measurements.

METHODS

MC beam models used to calculate the MBRT dose distributions of each modality (photons/electrons) were validated with a single-angle beam MBRT treatment plan delivered on a slab of Solid Water phantom with a film positioned at a depth of 2 cm. The measured film absorbed dose was compared to the calculated dose. To validate clinical deliveries, a polymethyl methacrylate (PMMA) cylinder was machined and holes were made to fit an ionization chamber. A complex MBRT plan involving a photon arc and three electron delivery angles was created with the aim of reproducing a clinically realistic dose distribution in typical soft tissue sarcoma tumours of the extremities. The treatment plan was delivered on the PMMA cylinder. Point measurements were taken with an Exradin A1SL chamber at two nominal depths: 1.4 cm and 2.1 cm. The plan was also delivered on a second identical phantom with an insert at 2 cm depth, where a film was placed. An existing EGSnrc user-code, SPRRZnrc, was modified to calculate the stopping power ratios between any materials in the same voxelized geometry used for dose calculation purposes. This modified code, called SPRXYZnrc, was used to calculate a correction factor, k MBRT , accounting for the differences in electron fluence spectrum at the measurement point compared to that at reference conditions. The uncertainty associated with neglecting potential ionization chamber fluence perturbation correction factors using this approach was estimated.

RESULTS

The film measurement from the Solid Water phantom treatment plan was in good agreement with the simulated dose distribution, with a gamma pass rate of 96.1% for a 3%/2 mm criteria. For the PMMA phantom delivery, for the same gamma criteria, the pass rate was 97.3%. The ion chamber measurements of the total delivered dose agreed with the MC-simulated dose within 2.1%. The beam quality correction factors amounted to, at most, a 4% correction on the ion chamber measurement. However, individual contribution of low electron energies proved difficult to precisely measure due to their steep dose gradients, with disagreements of up to 28% ± 15% at 2.1 cm depth (6 MeV). Ion chamber measurement procedure of electron beams was achieved in less than 5 min, and the entire validation process including phantom setup was performed in less than 30 min.

CONCLUSION

The agreement between measured and simulated MBRT doses indicates that the dose distributions obtained from the MBRT treatment planning algorithm are realistically achievable. The SPRXYZnrc MC code allowed for convenient calculations of k MBRT simultaneously with the dose distributions, laying the groundwork for patient-specific QA protocol practical for clinical use. Further investigation is needed to establish the accuracy of our ionization chamber correction factors k MBRT calculations at low electron energies.

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.

The effective point of measurement for depth-dose measurements in small MV photon beams with different detectors

PURPOSE

The effective point of measurement (EPOM) of cylindrical ionization chambers differs from their geometric center. The exact shift depends on chamber construction details, above all the chamber size, and to some degree on the field-size and beam quality. It generally decreases as the chamber dimensions get smaller. In this work, effective points of measurement in small photon fields of a range of cylindrical chambers of different sizes are investigated, including small chambers that have not been studied previously.

METHODS

In this investigation, effective points of measurement for different ionization chambers (Farmer type, scanning chambers, micro-ionization chambers) and solid state detectors were determined by measuring depth-ionization curves in a 6 MV beam in field sizes between 2 × 2 cm² and 10 × 10 cm² and comparing those curves with curves measured with plane-parallel chambers.

RESULTS

It was possible to average the results to one shift per detector, as the results were sufficiently independent of the studied field sizes. For cylindrical ion chambers, shifts of the EPOM were determined to be between 0.49 and 0.30 times the inner chamber radius from the reference point.

CONCLUSIONS

We experimentally confirmed the previously reported decrease of the EPOM shift with decreasing detector size. Highly accurate data for a large range of detectors, including new very small ones, were determined. Thus, small chambers noticeably differ from the 0.5-times to 0.6-times the inner chamber radius recommendations in current dosimetry protocols. The detector-individual EPOMs need to be considered for measurements of depth-dose curves.

Technical Note: On the use of cylindrical ionization chambers for electron beam reference dosimetry

PURPOSE

To investigate the use of cylindrical chambers for electron beam dosimetry independent of energy by studying the variability of relative ion chamber perturbation corrections, one of the main concerns for electron beam dosimetry with cylindrical chambers.

METHODS

Measurements are made with sets of cylindrical and plane-parallel reference-class chambers as a function of depth in water in 8 MeV and 18 MeV electron beams. The ratio of chamber readings for similar chambers is normalized in a high-energy electron beam and can be thought of as relative perturbation corrections. Data are plotted as a function of mean electron energy at depth for a range of depths close to the phantom surface to R₈₀ , the depth at which the ionization falls to 80% of its maximum value. Additional, similar measurements are made in a Virtual Water® phantom with cylindrical chambers at the reference depth in a 4 MeV electron beam.

RESULTS

The variability of relative ion chamber perturbation corrections for nominally identical cylindrical Farmer-type chambers is found to be less than 0.4%, no worse than plane-parallel chambers with similar specifications.

CONCLUSIONS

This work discusses several issues related to the use of plane-parallel ion chambers and suggests that reference-class cylindrical chambers may be appropriate for reference dosimetry of all electron beams. This would simplify the reference dosimetry procedure and improve accuracy of beam calibration.

Insight gained from responses to surveys on reference dosimetry practices

Purpose

To present the results and discuss potential insights gained through surveys on reference dosimetry practices.

Methods

Two surveys were sent to medical physicists to learn about the current state of reference dosimetry practices at radiation oncology clinics worldwide. A short survey designed to maximize response rate was made publicly available and distributed via the AAPM website and a medical physics list server. Another, much more involved survey, was sent to a smaller group of physicists to gain insight on detailed dosimetry practices. The questions were diverse, covering reference dosimetry practices on topics like measurements required for beam quality specification, the actual measurement of absorbed dose and ancillary equipment required like electrometers and environment monitoring measurements.

Results

There were 190 respondents to the short survey and seven respondents to the detailed survey. The diversity of responses indicates nonuniformity in reference dosimetry practices and differences in interpretation of reference dosimetry protocols.

Conclusions

The results of these surveys offer insight on clinical reference dosimetry practices and will be useful in identifying current and future needs for reference dosimetry.