Technical Note: On GAFChromic EBT-XD film and the lateral response artifact

Reading of gafchromic EBT-3 film using an overhead scanner

Gafchromic film, a commercially available radiochromic film, has been developed and widely used as an effective tool for radiation dose verification and quality assurance in radiotherapy. However, the orientation effect in scanning a film remains a concern for practical application in beam profile monitoring. To resolve this issue, the authors introduced a novel method using an overhead scanner (OHS) coupled with a tracing light board instead of a conventional flatbed scanner (FBS) to read Gafchromic EBT3 films. We investigated the orientation effect of the EBT3 film with a regular hexagonal shape after irradiation with 5 Gy x-rays (160 kV, 6.3 mA) and compared the digitized images acquired using a commercially available OHS (CZUR Aura) and a conventional FBS (EPSON GT-X980). As a result, RGB color intensities acquired from the OHS showed significantly lower orientation effect of the color intensities of RGB components than those from FBS. This finding indicates the high potential of the proposed method for achieving more precise two-dimensional dosimetry. Further studies are required to confirm the effectiveness of this method under different irradiation conditions over a wider dose range.

Development and characterization of the first proton minibeam system for single-gantry proton facility

BACKGROUND

Minibeam represents a preclinical spatially fractionated radiotherapy modality with great translational potential. The advantage lies in its high therapeutic index (compared to GRID and LATTICE) and ability to treat at greater depth (compared to microbeam). Proton minibeam radiotherapy (pMBRT) is a synergy of proton and minibeam. While the single-gantry proton facility has gained popularity due to its affordability and compact design, it often has limited beam time available for research purposes. Conversely, given the current requirement of pMBRT on specific minibeam hardware collimators, necessitates a reproducible and fast setup to minimize pMBRT treatment time and streamline the switching time between pMBRT and conventional treatment for clinically translation.

PURPOSE

The contribution of this work is the development and characterization of the first pMBRT system tailored for single-gantry proton facility. The system allows for efficient and reproducible plug-and-play setup, achievable within minutes.

METHODS

The single room pMBRT system is constructed based on IBA ProteusONE proton machine. The end of nozzle is attached with beam modifying accessories though an accessory drawer. A small snout is attached to the accessory drawer and used to hold apertures and range shifters. The minibeam aperture consists of two components: a fitting ring and an aperture body. Three minibeam apertures were manufactured. The first-generation apertures underwent qualitatively analysis with film, and the second generation aperture underwent more comprehensive quantitative measurement. The reproducibility of the setup is accessed, and the film measurements are performed to characterize the pMBRT system in cross validation with Monte Carlo (MC) simulations.

RESULTS

We presented initial results of large field pMBRT aperture and the film measurements indicates the effect of source-to-isocenter distance = 930 cm in Y proton scanning direction. Consistent with TOPAS MC simulation, the dose uniformity of pMBRT field <2 cm is demonstrated to be better than 2%, rendering its suitability for pre-clinical studies. Subsequently, we developed the second generation of aperture with five slits and characterized the aperture with film dosimetry studies and compared the results to the benchmark MC. Comprehensive film measurements were also performed to evaluate the effect of divergence, air gap and gantry-angle dependency and repeatability and revealing a consistent performance within 5%. Furthermore, the 2D gamma analysis indicated a passing rate exceeding 99% using 3% dose difference and 0.2 mm distance agreement criteria. We also establish the peak valley dose ratio and the depth dose profile measurements, and the results are within 10% from MC simulation.

CONCLUSIONS

We have developed the first pMBRT system tailored for a single-gantry proton facility, which has demonstrated accuracy in benchmark with MC simulations, and allows for efficient plug-and-play setup, emphasizing efficiency.

Active and passive dosimetry for beta-emitting radiopharmaceutical therapy agents in a custom SPECT/CT compatible phantom

Objective. This work introduces a novel approach to performing active and passive dosimetry for beta-emitting radionuclides in solution using common dosimeters. The measurements are compared to absorbed dose to water (Dw) estimates from Monte Carlo (MC) simulations. We present a method for obtaining absorbed dose to water, measured with dosimeters, from beta-emitting radiopharmaceutical agents using a custom SPECT/CT compatible phantom for validation of Monte Carlo based absorbed dose to water estimates.Approach. A cylindrical, acrylic SPECT/CT compatible phantom capable of housing an IBA EFD diode, Exradin A20-375 parallel plate ion chamber, unlaminated EBT3 film, and thin TLD100 microcubes was constructed for the purpose of measuring absorbed dose to water from solutions of common beta-emitting radiopharmaceutical therapy agents. The phantom is equipped with removable detector inserts that allow for multiple configurations and is designed to be used for validation of image-based absorbed dose estimates with detector measurements. Two experiments with131I and one experiment with177Lu were conducted over extended measurement intervals with starting activities of approximately 150-350 MBq. Measurement data was compared to Monte Carlo simulations using the egs_chamber user code in EGSnrc 2019.Main results. Agreement withink= 1 uncertainty between measured and MC predictedDwwas observed for all dosimeters, except the A20-375 ion chamber during the second131I experiment. Despite the agreement, the measured values were generally lower than predicted values by 5%-15%. The uncertainties atk = 1 remain large (5%-30% depending on the dosimeter) relative to other forms of radiation therapy.Significance. Despite high uncertainties, the overall agreement between measured and simulated absorbed doses is promising for the use of dosimeter-based RPT measurements in the validation of MC predictedDw.

Lateral response artifact correction method using image stitching technique in radiochromic film dosimetry

PURPOSE

Lateral response artifact (LRA) is caused by the interaction between film and flatbed scanner in the direction perpendicular to the scanning direction. This can significantly affect the accuracy of patient-specific quality assurance (QA) in cases involving large irradiation fields. We hypothesized that by utilizing the central area of the flatbed scanner, where the magnitude of LRA is relatively small, the LRA could be mitigated effectively. This study proposes a practical solution using the image-stitching technique to correct LRA for patient-specific QA involving large irradiation fields.

METHODS

Gafchromic™ EBT4 film and Epson Expression ES-G11000 flatbed scanner were used in this study. The image-stitching algorithm requires a spot between adjacent images to combine them. The film was scanned at three locations on a flatbed scanner, and these images were combined using the image-stitching technique. The combined film dose was then calculated and compared with the treatment planning system (TPS)-calculated dose using gamma analysis (3%/2 mm). Our proposed LRA correction was applied to several films exposed to 18 × 18 cm2 open fields at doses of 200, 400, and 600 cGy, as well as to four clinical Volumetric Modulated Arc Therapy (VMAT) treatment plans involving large fields.

RESULTS

For doses of 200, 400, and 600 cGy, the gamma analysis values with and without LRA corrections were 95.7% versus 67.8%, 95.5% versus 66.2%, and 91.8% versus 35.9%, respectively. For the clinical VMAT treatment plan, the average pass rate ± standard deviation in gamma analysis was 94.1% ± 0.4% with LRA corrections and 72.5% ± 1.5% without LRA corrections.

CONCLUSIONS

The effectiveness of our proposed LRA correction using the image-stitching technique was demonstrated to significantly improve the accuracy of patient-specific QA for VMAT treatment plans involving large irradiation fields.

Comparative study on measurements of radiochromic films using portable colorimeters

The recently proposed method for on-site radiation dosimetry by a combination of radiochromic film and portable colorimeter was tested for six combinations of two popular Gafchromic films (EBT3 and EBT-XD) and three commercially available portable colorimeters (nix pro2, nix spectro2 and Spectro1 Pro; abbreviated to "NixP", "NixS" and "SpoP", respectively). EBT3 and EBT-XD were irradiated with X-rays (160 kV, 6.3 mA) up to 40 Gy and 80 Gy, respectively, and the radiation-induced color levels of RGB and CMYK components were measured with the three colorimeters. Angle dependence was examined by reading at 15° intervals. As a result, it was judged that all combinations would work effectively under certain irradiation conditions. NixP and NixS were applicable to a wider dose range for both films, while SpoP fit a lower dose range. On the other hand, SpoP showed an advantageous feature of no angular dependence in reading films, while NixP and NixS showed significant angle-dependent changes. These differences are considered to be attributable to the different geometries of LED light emission, which came from all directions (360°) in SpoP, 4 directions in NixP, and 8 directions in NixS. These findings are expected to expand the applicability of the novel method to various occasions of on-site dosimetry.

Initial experience with an electron FLASH research extension (FLEX) for the Clinac system

PURPOSE

Radiotherapy delivered at ultra-high-dose-rates (≥40 Gy/s), that is, FLASH, has the potential to effectively widen the therapeutic window and considerably improve the care of cancer patients. The underlying mechanism of the FLASH effect is not well understood, and commercial systems capable of delivering such dose rates are scarce. The purpose of this study was to perform the initial acceptance and commissioning tests of an electron FLASH research product for preclinical studies.

METHODS

A linear accelerator (Clinac 23EX) was modified to include a non-clinical FLASH research extension (the Clinac-FLEX system) by Varian, a Siemens Healthineers company (Palo Alto, CA) capable of delivering a 16 MeV electron beam with FLASH and conventional dose rates. The acceptance, commissioning, and dosimetric characterization of the FLEX system was performed using radiochromic film, optically stimulated luminescent dosimeters, and a plane-parallel ionization chamber. A radiation survey was conducted for which the shielding of the pre-existing vault was deemed sufficient.

RESULTS

The Clinac-FLEX system is capable of delivering a 16 MeV electron FLASH beam of approximately 1 Gy/pulse at isocenter and reached a maximum dose rate >3.8 Gy/pulse near the upper accessory mount on the linac gantry. The percent depth dose curves of the 16 MeV FLASH and conventional modes for the 10 × 10 cm2 applicator agreed within 0.5 mm at a range of 50% of the maximum dose. Their respective profiles agreed well in terms of flatness but deviated for field sizes >10 × 10 cm2 . The output stability of the FLASH system exhibited a dose deviation of <1%. Preliminary cell studies showed that the FLASH dose rate (180 Gy/s) had much less impact on the cell morphology of 76N breast normal cells compared to the non-FLASH dose rate (18 Gy/s), which induced large-size cells.

CONCLUSION

Our studies characterized the non-clinical Clinac-FLEX system as a viable solution to conduct FLASH research that could substantially increase access to ultra-high-dose-rate capabilities for scientists.

In vivodosimetry in cancer patients undergoing intraoperative radiation therapy

In vivodosimetry (IVD) is an important tool in external beam radiotherapy (EBRT) to detect major errors by assessing differences between expected and delivered dose and to record the received dose by individual patients. Also, in intraoperative radiation therapy (IORT), IVD is highly relevant to register the delivered dose. This is especially relevant in low-risk breast cancer patients since a high dose of IORT is delivered in a single fraction. In contrast to EBRT, online treatment planning based on intraoperative imaging is only under development for IORT. Up to date, two commercial treatment planning systems proposed intraoperative ultrasound or in-room cone-beam CT for real-time IORT planning. This makes IVD even more important because of the possibility for real-time treatment adaptation. Here, we summarize recent developments and applications of IVD methods for IORT in clinical practice, highlighting important contributions and identifying specific challenges such as a treatment planning system for IORT. HDR brachytherapy as a delivery technique was not considered. We add IVD for ultrahigh dose rate (FLASH) radiotherapy that promises to improve the treatment efficacy, when compared to conventional radiotherapy by limiting the rate of toxicity while maintaining similar tumour control probabilities. To date, FLASH IORT is not yet in clinical use.

Technical note: Energy dependence of the Gafchromic EBT4 film: Dose-response curves for 70 kV, 6 MV, 6 MV FFF, 10 MV FFF, and 15 MV x-ray beams

BACKGROUND

EBT4 was newly released for radiotherapy quality assurance to improve the signal-to-noise ratio in radiochromic film dosimetry. It is important to know its dose-response characteristics before its use in the clinic.

PURPOSE

This study aims to investigate and compare the dose-response curves of the Gafchromic EBT4 film for megavoltage and kilovoltage x-ray beams with different dose levels, scanning spatial resolutions, and sizes of region of interest (ROI).

METHODS

EBT4 film (Lot#07052201) calibration strips (3.5 × 20 cm2 ) were exposed to a 10×10 cm2 open field at doses of 0, 63, 125, 500, 750, 1000 cGy using 6 MV photon beam. EBT4 film strips from the same lot were then exposed to each x-ray beam (6 MV, 6 MV FFF, 10 MV FFF, 15 MV, and 70 kV) at six dose values (50, 100, 300, 600, 800, 1000 cGy). A full sheet (25 × 20 cm2 ) of EBT4 film was irradiated at each energy with 300 cGy for profile comparison with the treatment planning calculation. At two different spatial resolutions of 72 and 300 dpi, each film piece was scanned three consecutive times in the center of an Epson 10000XL flatbed scanner in 48-bit color. The scanned images were analyzed using FilmQA Pro. For each scanned image, an ROI of 2 × 2 cm2 at the field center was selected to obtain the average pixel value with its standard deviation in the ROI. An additional ROI of 1 cm diameter circle was also used to evaluate the impact of ROI shape and size, especially for FFF beams. The dose value, average dose-response value, and associated uncertainty were determined for each energy and relative responses were analyzed. The Student's t-test was performed to evaluate the statistical significance of the dose-response values with different color channels, ROI shapes, and spatial resolutions.

RESULTS

The dose-response curves for the five x-ray energies were compared in three color channels. Weak energy dependence was found among the megavoltage beams. No significant differences (average ∼1.1%) were observed for all doses in this study among 6 MV, 6 MV FFF, 10 MV FFF, and 15 MV beams, regardless of spatial resolution and color channel. However, a statistically significant difference in dose-response was observed up to 12% between 70 kV and 6 MV beams.

CONCLUSIONS

The dose-response curves for Gafchromic EBT4 films were nearly independent of the energy of the photon beams among 6 MV, 6 MV FFF, 10 MV FFF, and 15 MV. For very low-energy photons (e.g., 70 kV), a separate calibration from the same low-energy x-ray is necessary.

Characterization of scanning orientation and lateral response artifact for EBT4 Gafchromic film

The purpose of this study was to investigate the impact of scanning orientation and lateral response artifact (LRA) effects on the dose-response of EBT4 films and compare it with that of EBT3 films. Dose-response curves for EBT3 and EBT4 films in red-green-blue (RGB) color channels in portrait orientation were created for unexposed films and for films exposed to doses ranging from 0 to 1 000 cGy. Portrait and landscape orientations of the EBT3 and EBT4 films were scanned to investigate the scanning orientation effect in the red channel. EBT3 and EBT4 films were irradiated to assess the LRA in the red channel using a field size of 15 × 15 cm² and delivered doses of 200, 400, and 600 cGy. Films were scanned at the edge of the scanner bed, and the measured doses were compared with the treatment planning system (TPS) calculated doses at a position 100 mm lateral to the scanner center. At a dose of 200 cGy, the differences in optical density (OD) in the red, green, and blue color channels between EBT3 and EBT4 films were 0.035 (24.8%), 0.042 (49.7%), and 0.022 (64.4%), respectively. The EBT4 film slightly improved the scanning orientation compared to the EBT3 film. The OD difference in the different scanning orientations for the EBT3 and EBT4 films was 0.015 (6.8%) and 0.007 (3.9%), respectively, at a dose of 200 cGy. This is equivalent to a 20 or 10 cGy variation at a dose of 200 cGy. Compared with the TPS calculation, the measurement doses for EBT3 and EBT4 films irradiated at 200 cGy were approximately 16% and 13% higher, respectively, at the 100 mm off-centered position. The EBT4 film showed an improvement concerning the impact of LRA compared with the EBT3 film. This study demonstrated that the response of EBT4 film to a dose in the blue channel was less sensitive and showed an improvement in the scanning orientation and LRA effects.

Evaluation of HyperArc™ using film and portal dosimetry quality assurance

HyperArc™ is a stereotactic radiotherapy modality designed for targeting multiple brain metastases using a single isocenter with multiple non-coplanar arcs. This study aimed to assess the efficacy of two patient-specific quality assurance methods, film and the Varian Portal Dosimetry System with Varian's HyperArc™ technique and raise important considerations in the customisation of patient-specific quality assurance to accommodate HyperArc™ delivery. Assessment criteria included gamma analysis and mean dose at full width half maximum. The minimum metastasis size, maximum off-axis distance and suitable energy were identified and validated. Patient-specific quality assurance procedures were applied to a range of clinically relevant brain metastasis plans. Initial investigation into energy selection showed no significant differences in gamma pass rates using 6MV, 6MV FFF, or 10MV FFF for metastasis sizes greater than 15 mm diameter at the isocenter. Gamma pass rates (2%/2mm) for 15 mm metastases at the isocenter for all energies were greater than 96.0% for portal dosimetry and greater than 98.7% for film. Fields of size 15 mm placed at various distances (10-70 mm) from the isocenter resulted in a maximum mean dose difference of 1.5% between film and planned. Clinically relevant plans resulted in a maximum mean dose difference for selected metastases of 1.0% between film and plan and a maximum point dose difference of 2.9% between portal dose and plan. Portal dose image prediction was a quick and convenient quality assurance tool for metastases larger than 15 mm near the isocenter but provided diminished geometrical relevance for off-axis metastases. Film QA required exacting procedures but offered the ability to assess the accuracy of geometrical targeting for off-axis metastases and provided dosimetric accuracy for metastases to well below 15 mm diameter.

Total skin electron therapy vertical profiles measured using radiochromic film

BACKGROUND

Vertical dose profiles of Total Skin Electron Therapy (TSET) electron fields are often measured using ionization chambers (ICs); however, resulting protocols are tedious and time consuming due to complex gantry arrangements, numerous point dose measurements and extra-cameral corrections. This inefficiency is reduced when using radiochromic film (RCF) dosimetry through simultaneous dose sampling and the elimination of IC-related measurement corrections.

PURPOSE

To investigate the feasibility of RCF dosimetry for TSET vertical profile measurements and establish a novel RCF based vertical profile quality assurance protocol.

METHODS

Thirty-one vertical profiles were measured using GAFChromic^® EBT-XD RCF on two matched linear accelerators (linacs) over 1.5 years. Absolute dose was quantified using a triple channel calibration method. Two IC profiles were collected for comparison to RCF profiles. Twenty-one archived IC measured profiles from two different matched linacs from 2006 to 2011 were analyzed. Inter- and intra-profile dose variability was compared between dosimeters. The time required for the RCF and IC protocols was compared.

RESULTS

RCF measured inter-profile variability ranged from 0.66%-5.16% and 1.30%-3.86% for the two linacs. A 0.2%-5.4% inter-profile variability was observed for archived IC measured profiles. RCF measured intra-profile variability ranged from 10.0%-15.8%; six of 31 profiles exceeded the EORTC ± 10% limit. Archived IC measured profiles exhibited lower intra-profile variability (4.5%-10.4%). RCF and IC measured profiles agreed in the center of the field; however, RCF doses measured 170-179 cm above the TSET treatment box base were ∼7% greater. Modification to the RCF phantom eliminated this discrepancy, resulting in comparable intra-profile variability and agreeance with the ±10% limit. Measurement times were reduced from 3 h (IC protocol) to 30 min (RCF protocol).

CONCLUSIONS

RCF dosimetry improves protocol efficiency. RCF has been established as a valuable dosimeter for TSET vertical profile quantification when compared to ICs as the gold standard.

Comparative study of SRS end-to-end QA processes of a diode array device and an anthropomorphic phantom loaded with GafChromic XD film

PURPOSE

End-to-end testing (E2E) is a necessary process for assessing the readiness of the stereotactic radiosurgery (SRS) program and annual QA of an SRS system according to the AAPM MPPG 9a. This study investigates the differences between using a new SRS MapCHECK (SRSMC) system and an anthropomorphic phantom film-based system in a large network with different SRS delivery techniques.

METHODS AND MATERIALS

Three SRS capable Linacs (Varian Medical Systems, Palo Alto, CA) at three different regional sites were chosen to represent a hospital network, a Trilogy with an M120 multi-leaf collimator (MLC), a TrueBeam with an M120 MLC, and a TrueBeam Stx with an HD120 MLC. An anthropomorphic STEEV phantom (CIRS, Norfolk, VA) and a phantom/diode array: StereoPHAN/SRSMC (Sun Nuclear, Melbourne, FL) were CT scanned at each site. The new STV-PHANTOM EBT-XD films (Ashland, Bridgewater, NJ) were used. Six plans with various complexities were measured with both films and SRSMC in the StereoPHAN to establish their dosimetric correlations. Three SRS cranial plans with a total of sixteen fields using dynamic conformal arc and volumetric-modulated arc therapy, with 1-4 targets, were planned with Eclipse v15.5 treatment planning system (TPS) using a custom SRS beam model for each machine. The dosimetric and localization accuracy were compared. The time of analysis for the two systems by three teams of physicists was also compared to assess the throughput efficiency.

RESULTS

The correlations between films and SRSMC were found to be 0.84 (p = 0.03) and 0.16 (p = 0.76) for γ (3%, 1 mm) and γ (3%, 2 mm), respectively. With film, the local dose differences (ΔD) relative to the average dose within the 50% isodose line from the three sites were found to be -3.2%-3.7%. The maximum localization errors (E_local ) were found to be within 0.5 ± 0.2 mm. With SRSMC, the ΔD was found to be within 5% of the TPS calculation. E_local were found to be within 0.7 to 1.1 ± 0.4 mm for TrueBeam and Trilogy, respectively. Comparing with film, an additional uncertainty of 0.7 mm was found with SRSMC. The delivery and analysis times were found to be 6 and 2 h for film and SRSMC, respectively.

CONCLUSIONS

The SRS MapCHECK agrees dosimetrically with the films within measurement uncertainties. However, film dosimetry shows superior sub-millimeter localization resolving power for the MPPG 9a implementation.

Performance evaluation of an LED flatbed scanner for triple channel film dosimetry with EBT3 and EBT-XD film

We investigate the properties of a light emitting diode (LED) flatbed scanner for use with EBT3 and EBT-XD film types in a clinical radiochromic film (RCF) dosimetry program with modern treatment techniques. The flatbed scanner was characterised in terms of lateral and longitudinal response, X-Y scaling integrity, scanning reproducibility, scanner warm up dependence and film orientation dependence. The preferred lateral response artefact (LRA) corrections are investigated for the LED light source. Supporting evidence is provided regarding the dose independent nature of the corrections while also providing results suggesting a potential film type independence. Results from 2D gamma analysis of four patient treatments were compared between the new 12000XL and existing 10000XL model. Lastly, a dose uncertainty analysis was performed for the film-scanner system combination. It may be concluded that the lateral response variation requires correction while the longitudinal response variation is insignificant. The linear scaling in the lateral and longitudinal directions are within 0.5% and the scanner reproducibility is stable. Scanner warm up dependence no longer exists, and effort should be made to maintain all film orientation in a study set within 15°. The LRA corrections are as reported substantially dose independent and there is evidence to support film type independence. Comparative gamma analysis of patient specific dose maps between the EPSON 10000XL (xenon fluorescent lamp) and 12000XL (LED) scanners showed that results are indistinguishable for both film types across the two scanner models when the necessary corrections are applied. Dose uncertainty is in agreement with the literature and can be kept below 3% with necessary corrections applied.

Effect of scanner lens on lateral response artefact in radiochromic film dosimetry

Radiochromic film is a good dosimeter choice for patient QA for complex treatment techniques because of its near tissue equivalency, high spatial resolution and established method of use. Commercial scanners are typically used for film dosimetry, with Epson scanners being the most common. Radiochromic film dosimetry is not straightforward having some well-defined problems which must be considered, one of the main ones being the Lateral Response Artefact (LRA) effect. Previous studies showed that the contributing factors to LRA are from the structure of the active ingredients of the film and the components and construction of the flatbed scanner. This study investigated the effect of the scanner lens on the LRA effect, as part of a wider investigation of scanner design effects and uncertainties. Gafchromic EBT3 films were irradiated with 40 × 40 cm² field size 6 MV beams. Films were analysed using images captured by a Canon 7D camera utilising 18 mm, 50 mm and 100 mm focal length lenses compared to images scanned with a conventional Epson V700 scanner. The magnitude of the LRA was observed to be dependent on the focal length of the lens used to image the film. A substantial reduction in LRA was seen with the use of the 50 mm and 100 mm lenses, by factors of 3–5 for the 50 mm lens and 4–30 for the 100 mm lens compared to conventional desktop scanner techniques. This is expected to be from the longer focal length camera lens system being able to collect more light from distant areas compared to the scanner-based system. This provides an opportunity to design film dosimetry systems that minimise this artefact.

An evaluation of the use of EBT-XD film for SRS/SBRT commissioning of a 1.5 Tesla MR-Linac system

Purpose:

The goal of this study was to evaluate the use of EBT-XD film for SRS/SBRT commissioning in a 1.5T hybrid MR-Linac (MRL).

Method:

The output factors (S_t), from 1x1, 2x2, 3x3 cm², were measured with film in solid water. The results were compared with (1) the measurements by a PTW diamond detector (CVD) and an Exradin® A26MR ion chamber in 3D water phantom; (2) Monte Carlo calculation by Monaco TPS (MTPS) in water. The inline (IN) and crossline (CR) profiles, measured by films and the CVD, were also compared. An SRS plan with two targets was created in MTPS and was measured with EBT-XD film in a StereoPHAN™ phantom serving as an end-to-end test. The 3x3 cm² was used for film calibration with doses ranging from 0 to 28 Gy. Water was added to the phantom-film-phantom interface to reduce the electron-return-effect (ERE). Films were calibrated with One-scan-dosimetry protocol.

Results:

The film S_t were within 1.2% and 2.2% compared to other detectors and MTPS respectively. At the central B-field induced asymmetric region, films were within 0.6% between the CVD and the MTPS, but 5–8% differences were observed in the 40%-5% gradient region in CR due to ERE. The differences in localization and dose were found to be 0.6 mm and 3.3%. The γ(3%/2mm), γ (5%/2mm), γ (5%/1mm) were 97.7%, 99.3%, 94.6%.

Conclusions:

Films can provide accurate dosimetric results under ERE and are valuable for commissioning MRL. Using the One-scan-dosimetry protocol with EBT-XD film for MRL increases accuracy and efficiency in commissioning and QA of SRS/SBRT.

Three-dimensional Winston-Lutz test using reusable polyvinyl alcohol-iodide (PVA-I) radiochromic gel dosimeter

Medical linear-accelerator-based stereotactic radiosurgery (SRS) using a stereotactic apparatus or image-guided radiotherapy system for intracranial lesions is performed widely in clinical practice. In general, Winston-Lutz (WL) tests using films or electric portal imaging devices (EPIDs) have been performed as pre-treatment and routine quality assurance (QA) for the abovementioned treatment. Two-dimensional displacements between the radiation isocentre and mechanical isocentre are analysed from the test; therefore, it is difficult to identify the three-dimensional (3D) isocentre position intuitively. In this study, we developed an innovative 3D WL test for SRS-QA using a novel radiochromic gel dosimeter based on a polyvinyl alcohol-iodide (PVA-I) complex that can be reused after annealing. A WL gel phantom that was consisted of the PVA-I gel dosimeter poured into a tall acrylic container and an embedded small tungsten sphere was used as a position detector. A flatbed scanner was used to analyse the isocentre position. The measured 3D isocentre accuracy from the gel-based WL test was within 0.1 mm compared with that obtained from the EPID-based WL test. Furthermore, excellent reusability of the WL gel phantom was observed in long-term SRS isocentre verification, in which clinical SRS cases involving repeated irradiation and annealing were analysed. These results demonstrate the high accuracy and reliable evaluation of the isocentre position using an innovative test. In addition, the clinical-based routine SRS-QA using the PVA-I gel dosimeter demonstrates a highly convenience while affording an easy and fast analysis process.

Electron FLASH Delivery at Treatment Room Isocenter for Efficient Reversible Conversion of a Clinical LINAC

PURPOSE

In this study, procedures were developed to achieve efficient reversible conversion of a clinical linear accelerator (LINAC) and deliver ultrahigh-dose-rate (UHDR) electron or conventional beams to the treatment room isocenter for FLASH radiation therapy.

METHODS AND MATERIALS

The LINAC was converted to deliver UHDR beam within 20 minutes by retracting the x-ray target from the beam's path, positioning the carousel on an empty port, and selecting 10 MV photon beam energy in the treatment console. Dose rate surface and depth dose profiles were measured in solid water phantom at different field sizes with Gafchromic film and an optically stimulated luminescent dosimeter (OSLD). A pulse controller counted the pulses via scattered radiation signal and gated the delivery for a preset pulse count. A fast photomultiplier tube-based Cherenkov detector measured the per pulse beam output at a 2-ns sampling rate. After conversion back to clinical mode, conventional beam output, flatness, symmetry, field size, and energy were measured for all clinically commissioned energies.

RESULTS

The surface average dose rates at the isocenter for 1-cm diameter and 1.5-in diameter circular fields and for a jaws-wide-open field were 238 ± 5 Gy/s, 262 ± 5 Gy/s, and 290 ± 5 Gy/s, respectively. The radial symmetry of the beams was within 2.4%, 0.5%, and 0.2%, respectively. The doses from simultaneous irradiation of film and OSLD were within 1%. The photomultiplier tube showed the LINAC required ramp up time in the first 4 to 6 pulses before the output stabilized, after which its stability was within 3%.

CONCLUSIONS

At the isocenter of the treatment room, 10 MeV UHDR beams were achieved. The beam output was reproducible but requires further investigation of the ramp up time, equivalent to ∼1 Gy, requiring dose monitoring. The UHDR beam can irradiate both small and large subjects to investigate potential FLASH radiobiological effects in minimally modified clinical settings, and the dose rate can be further increased by reducing the source-to-surface distance.

Clinical utility of Gafchromic film in an MRI-guided linear accelerator

Background

The purpose of this study is to comprehensively evaluate the suitability of Gafchromic EBT3 and EBT-XD film for dosimetric quality assurance in 0.35 T MR-guided radiotherapy.

Methods

A 0.35 T magnetic field strength was utilized to evaluate magnetic field effects on EBT3 and EBT-XD Gafchromic films by studying the effect of film exposure time within the magnetic field using two timing sequences and film not exposed to MR, the effect of magnetic field exposure on the crystalline structure of the film, and the effect of orientation of the film with respect to the bore within the magnetic field. The orientation of the monomer crystal was qualitatively evaluated using scanning electron microscopy (SEM) compared to unirradiated film. Additionally, dosimetric impact was evaluated through measurements of a series of open field irradiations (0.83 × 0.83-cm² to 19.92 × 19.92-cm²) and patient specific quality assurance measurements. Open fields were compared to planned dose and an independent dosimeter. Film dosimetry was applied to twenty conventional and twenty stereotactic body radiotherapy (SBRT) patient specific quality assurance cases.

Results

No visual changes in crystal orientation were observed in any evaluated SEM images nor were any optical density differences observed between films irradiated inside or outside the magnetic field for both EBT3 and EBT-XD film. At small field sizes, the average difference along dose profiles measured in film compared to the same points measured using an independent dosimeter and to predicted treatment planning system values was 1.23% and 1.56%, respectively. For large field sizes, the average differences were 1.91% and 1.21%, respectively. In open field tests, the average gamma pass rates were 99.8% and 97.2%, for 3%/3 mm and 3%/1 mm, respectively. The median (interquartile range) 3%/3 mm gamma pass rates in conventional QA cases were 98.4% (96.3 to 99.2%), and 3%/1 mm in SBRT QA cases were 95.8% (95.0 to 97.3%).

Conclusions

MR exposure at 0.35 T had negligible effects on EBT3 and EBT-XD Gafchromic film. Dosimetric film results were comparable to planned dose, ion chamber and diode measurements.

Alkali Metal Salts of 10,12-Pentacosadiynoic Acid and Their Dosimetry Applications

Wide-dose-range 2D radiochromic films for radiotherapy, such as GAFchromic EBT, are based on the lithium salt of 10,12-pentacosadiynoic acid (Li-PCDA) as the photosensitive component. We show that there are two solid forms of Li-PCDA-a monohydrated form A and an anhydrous form B. The form used in commercial GAFchromic films is form A due to its short needle-shaped crystals, which provide favorable coating properties. Form B provides an enhanced photoresponse compared to that of form A, but adopts a long needle crystal morphology, which is difficult to process. The two forms were characterized by powder X-ray diffraction, Fourier transform infrared spectroscopy, CP-MAS ¹³C solid-state NMR spectroscopy, and thermogravimetric analysis. In sum, these data suggest a chelating bridging bidentate coordination mode for the lithium ions. The sodium salt of PCDA (Na-PCDA) is also reported, which is an ionic cocrystal with a formula of Na⁺PCDA^-·3PCDA. The PCDA and PCDA^- ligands display monodentate and bridging bidentate coordination to the sodium ion in contrast to the coordination sphere of the Li-PCDA forms. In contrast to its lithium analogues, Na-PCDA is photostable.

Alkali Metal Salts of 10,12-Pentacosadiynoic Acid and Their Dosimetry Applications

Wide-dose-range 2D radiochromic films for radiotherapy, such as GAFchromic EBT, are based on the lithium salt of 10,12-pentacosadiynoic acid (Li-PCDA) as the photosensitive component. We show that there are two solid forms of Li-PCDA-a monohydrated form A and an anhydrous form B. The form used in commercial GAFchromic films is form A due to its short needle-shaped crystals, which provide favorable coating properties. Form B provides an enhanced photoresponse compared to that of form A, but adopts a long needle crystal morphology, which is difficult to process. The two forms were characterized by powder X-ray diffraction, Fourier transform infrared spectroscopy, CP-MAS 13C solid-state NMR spectroscopy, and thermogravimetric analysis. In sum, these data suggest a chelating bridging bidentate coordination mode for the lithium ions. The sodium salt of PCDA (Na-PCDA) is also reported, which is an ionic cocrystal with a formula of Na+PCDA-·3PCDA. The PCDA and PCDA- ligands display monodentate and bridging bidentate coordination to the sodium ion in contrast to the coordination sphere of the Li-PCDA forms. In contrast to its lithium analogues, Na-PCDA is photostable.

Correction of lateral response artifacts from flatbed scanners for dual-channel radiochromic film dosimetry

In this study, we evaluated the inter-unit variability of the lateral response artifact for multiple flatbed scanners, focusing on the dual-channel method, and investigated the correction method of the lateral non-uniformity. Four scanners with A3+ paper-size and five scanners with A4 paper-size were evaluated. To generate the dose-response curves, small pieces of the Gafchromic EBT3 and EBT-XD films were irradiated, and five of the pieces were repeatedly scanned by moving them on the scanner to evaluate the lateral non-uniformity. To calculate the dose distribution accounting for the lateral non-uniformity, linear functions of the correction factor, representing the difference between the pixel values at offset position and the scanner midline, were calculated for red and blue color channels at each lateral position. Large variations of the lateral non-uniformity among the scanners were observed, even for the same model of scanner. For high dose, red color showed pixel value profiles similar to symmetric curves, whereas the profiles for low dose were asymmetric. The peak positions changed with dose. With correction of the lateral non-uniformity, the dose profiles of the pyramidal dose distribution measured at various scanner positions and that calculated with a treatment planning system showed almost identical profile shapes at all high-, middle- and low-dose levels. The dual-channel method used in this study showed almost identical dose profiles measured with all A3+ and A4 paper-size scanners at any positions when the corrections were applied for each color channel.

A protocol for absolute dose verification of SBRT/SRS treatment plans using Gafchromic™ EBT-XD films

PURPOSE

To provide a practical protocol for absolute dose verification of stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) treatment plans, based on our clinical experience. It aims to be a concise summary of the main aspects to be considered when establishing an accurate film dosimetry system.

METHODS

Procedures for film calibration and conversion to dose are described for a dosimetry system composed of Gafchromic™ EBT-XD films and a flatbed document scanner. Factors that affect the film-scanner response are also reviewed and accounted for. The accuracy of the proposed methodology was assessed by taking a set of strips irradiated to known doses and its applicability is illustrated for ten SBRT/SRS treatment plans. The film response was converted to dose using red and triple channel dosimetry. The agreement between the planned and measured dose distributions was evaluated using global gamma analysis with criteria of 3%/2mm 10% threshold (TH), 2%/2mm 10% TH, and 2%/2mm 20% TH.

RESULTS

The differences between the expected and determined doses from the strips analysis were 0.9 ± 0.6% for the red channel and 1.1 ± 0.7% for the triple channel method. Regarding the SBRT/SRS plans verification, the mean gamma passing rates were 99.5 ± 1.0% vs 99.6 ± 1.0% (3%/2mm 10% TH), 96.9 ± 3.5% vs 99.1 ± 1.3% (2%/2mm 10% TH) and 98.4 ± 1.8% vs 98.8 ± 1.5% (2%/2mm 20% TH) for red and triple channel dosimetry, respectively.

CONCLUSIONS

The proposed protocol allows for accurate absolute dose verification of SBRT/SRS treatment plans, applying both single and triple channel methods. It may work as a guide for users that intend to implement a film dosimetry system.

Influence of 0.35 T magnetic field on the response of EBT3 and EBT-XD radiochromic films

PURPOSE

To investigate the inconsistency of recent literature on the effect of magnetic field on the response of radiochromic films, we studied the influence of 0.35 T magnetic field on dosimetric response of EBT3 and EBT-XD Gafchromic^TM films.

METHODS

Two different models of radiochromic films, EBT3 and EBT-XD, were investigated. Pieces of films samples from two different batches for each model were irradiated at different dose levels ranging from 1 to 20 Gy using 6 MV flattening filter free (FFF) x-rays generated by a clinical MR-guided radiotherapy system (B = 0.35 T). Film samples from the same batch were irradiated at corresponding dose levels using 6 MV FFF beam from a conventional linac (B = 0) for comparison. The net optical density was measured 48 h postirradiation using a flatbed scanner. The absorbance spectra were also measured over 500-700 nm wavelength range using a fiber-coupled spectrometer with 2.5 nm resolution. To study the effect of fractionated dose delivery to EBT3 (/EBT-XD) films, 8 (/16) Gy dose was delivered in four 2 (/4) Gy fractions with 24 h interval between fractions.

RESULTS

No significant difference was found in the net optical density and net absorbance of the films irradiated with or without the presence of magnetic field. No dependency on the orientation of the film during irradiation with respect to the magnetic field was observed. The fractionated dose delivery resulted in the same optical density as delivering the whole dose in a single fraction.

CONCLUSIONS

The 0.35 T magnetic field employed in the ViewRay^® MR-guided radiotherapy system did not show any significant influence on the response of EBT3 and EBT-XD Gafchromic^TM films.

Methodology for radiochromic film analysis using FilmQA Pro and ImageJ

Radiochromic film (RCF) has several advantageous characteristics which make it an attractive dosimeter for many clinical tasks in radiation oncology. However, knowledge of and strict adherence to complicated protocols in order to produce accurate measurements can prohibit RCF from being widely adopted in the clinic. The purpose of this study was to outline some simple and straightforward RCF fundamentals in order to help clinical medical physicists perform accurate RCF measurements. We describe a process and methodology successfully used in our practice with the hope that it saves time and effort for others when implementing RCF in their clinics. Two RCF analysis software programs which differ in cost and complexity, the commercially available FilmQA Pro package and the freely available ImageJ software, were used to show the accuracy, consistency and limitations of each. The process described resulted in a majority of the measurements across a wide dose range to be accurate within ± 2% of the intended dose using either FilmQA Pro or ImageJ.

Measuring radioenhancement by gold nanofilms: Comparison with analytical calculations

PURPOSE

To measure radioenhancement by gold nanoparticles (GNPs) using gold nanofilms (GNFs).

METHODS

GNFs of 20-100 nm thicknesses were prepared. The GNF attached to radiochromic film (RCF) was irradiated using 50, 220 kVp, and 6 MV X-rays. The radiation doses to the active layer of RCF with and without GNF were measured using an optical flatbed scanner and Raman spectrometer to estimate the dose enhancement factor (DEF). For verification, analytical calculations of DEF within the thickness of active layer and the ranges of secondary electrons were carried out.

RESULTS

The DEFs for GNFs of 20 to 100 nm thicknesses measured by an optical scanner ranged from 2.1 to 6.1 at 50 kVp and 1.6 to 4.9 at 220 kVp. Similarly, the DEFs measured by Raman spectroscopy ranged from 2.6 to 4.6 at 50 kVp and 2.2 to 4.8 at 220 kVp. The calculated DEFs ranged from 1.5 to 3.6 at 50 kVp and from 1.7 to 4.7 at 220 kVp. Almost no dose enhancement was observed in 6 MV X-ray. The analytical DEFs seemed to be underestimated by averaging local enhancement over the entire active layer. However, analytical DEFs within the ranges of secondary electrons was much higher than the measured macroscopic DEFs.

CONCLUSIONS

The experimental and analytical approaches developed in this study could quantitatively estimate radioenhancement by GNPs. Due to a short range of low-energy electrons emitted from gold, the microscopic radioenhancement within the ranges of low-energy electrons would be particularly important in a cell.

Characterization of radiochromic films as a micrometer-resolution dosimeter by confocal Raman spectroscopy

PURPOSE

Micrometer spatial resolution dosimetry has become inevitable for advanced radiotherapy techniques. A new approach using radiochromic films was developed to measure a radiation dose at a micrometer spatial resolution by confocal Raman spectroscopy.

METHODS

The commercial radiochromic films (RCF), EBT3 and EBT-XD, were irradiated with known doses using 50, 100, 200, and 300 kVp, and 6-MV x rays. The dose levels ranged from 0.3 to 50 Gy. The Raman mapping technique developed in our early study was used to readout an area of 100 × 100 µm² on RCF with improved lateral and depth resolutions with confocal Raman spectrometry. The variation in Raman spectra of C-C-C deformation and C≡C stretching modes of diacetylene polymers around 676 and 2060 cm^-1 , respectively, as a function of therapeutic x-ray doses, was measured. The single peak (SP) of C≡C and the peak ratio (PR) of C≡C band height to C-C-C band height with a spatial resolution of 10 µm on both types of RCF were evaluated, averaged, and plotted as a function of dose. An achievable spatial resolution, clinically useful dose range, dosimetric sensitivity, dose uniformity, and postirradiation stability as well as the orientation, energy, and dose rate dependence, of both types of RCFs, were characterized by the technique developed in this study.

RESULTS

A spatial resolution on RCF achieved by SP and PR methods was ~4.5 and ~2.9 µm, respectively. Raman spectroscopy data showed dose nonuniformity of ~11% in SP method and <3% in PR method. The SP method provided dose ranges of up to ~10 and ~20 Gy for EBT3 and EBT-XD films, respectively while the PR method up to ~30 and ~50 Gy. The PR method diminished the orientation effect. The percent difference between landscape and portrait orientations for the EBT3 and the EBT-XD films at 4 Gy had an acceptable level of 1.2% and 2.4%, respectively. With both SP and PR methods, the EBT3 and the EBT-XD films showed weak energy (within ~10% and ~3% for SP and PR methods, respectively) and dose rate dependence (within ~5% and ~3% for SP and PR methods, respectively) and had a stable response after 24-h postirradiation.

CONCLUSIONS

A technique for micrometer-resolution dosimetry was successfully developed by detecting radiation-induced Raman shift on EBT3 and EBT-XD. Both types of RCFs were suitable for micrometer-resolution dosimetry using CRS. With CRS both lateral and depth resolutions on RCF were improved. The PR method provided superior characteristics in dose uniformity, dose ranges, orientation dependence, and laser effect for both types of RCFs. The overall dosimetric characteristics of the RCFs determined by this technique were similar to those known by optical density scanning. The CRS with the PR method is advantageous over other the traditional scanning systems as a spatial resolution of <10 µm on RCF can be achieved with less deviations.

Low-energy proton calibration and energy-dependence linearization of EBT-XD radiochromic films

In this work, we calibrate the newly developed EBT-XD radiochromic films (RCFs) manufactured by Gafchromic^tm using protons in the energy range of 4-10 MeV. Irradiation was performed on the 2 × 6 MV tandem linear accelerator located at the Université de Montréal. The RCFs were digitized using an Epson Perfection V700 flatbed scanner using both the red-green-blue and grayscale channels. The proton fluences were measured with Faraday cups calibrated in absolute terms. The linear energy transfer function within the active layer of the films was calculated using the mass stopping power tables coming from the PSTAR database from the National Institute of Standards and Technology (NIST) to allow retrieval of the deposited dose. We find that the calibration curves for 7 and 10 MeV protons are nearly equivalent. The 4 MeV calibration curves exhibit a quenching effect due to the Bragg peak that falls close to the active layer. A linearization of this energy dependence was developed using a semiempirical parametric model to allow the generation of calibration curves for any incident proton energy within the present range. Excellent correspondence (<5% dose difference for the same netOD) of the 10 MeV calibration curves was noted when compared to existing high-energy proton (148.2 MeV) calibration curves reported in the literature. Our calibration extends the range of operation of EBT-XD films to low-energy proton beam dosimetry.

Radiation dose verification of an X-ray based blood irradiator using EBT3 radiochromic films calibrated using Gamma Knife machine

Aim

Blood irradiators (BI) initial acceptance testing and routine annual dosimetry checks require radiation dose measurements in order to comply with regulatory requirements.

Background

Traditionally thermo-luminescence dosimeters (TLD) have been used to measure the dose. The EBT3 film is reported to be a better dosimeter for low energy X-rays than its predecessors EBT2 and EBT. To the best of our knowledge, the use of EBT3 films to perform dosimetry on X-ray based BI has not been reported yet.

Materials and methods

We performed routine radiation dosimetry checks using EBT3 films on a new X-ray based BI and compared the results with TLD dosimetry. Calibration films were irradiated with radiation beam from a Co-60 Gamma Knife (GK) radiosurgery machine and, alternatively, using an Ir-192 high dose rate (HDR) brachytherapy device. The films were calibrated to cover a wide dose range from 1 to 40 Gy. Such a wide dose range has not been reported yet in BI film dosimetry.

Results

We obtained a relative difference of about 6.6% between doses measured using TLD and those measured using EBT3 films. Both irradiation methods using GK or HDR were found to be adequate for the calibration of the EBT3 Gafchromic films.

Conclusions

We recommend the use of EBT3 films in routine X-ray based BI dosimetry checks. The presented method takes advantage of available radiotherapy equipment that can be efficiently used for EBT3 films calibration. The method is fast, reproducible and saves valuable medical physicist's time.

Monte Carlo calculation of the mass stopping power of EBT3 and EBT-XD films for protons for energy ranges of 50-400 MeV

Objective

The goal of the present study was to calculate the continuous slowing down approximation (CDSA) ranges and derive mass stopping power for EBT3 and EBT-XD films for therapeutic protons energy ranges of 50-400 MeV.

Methods

The MCNPX and TRansport of Ions in Matter (TRIM) Monte Carlo codes were used in this study. Utilizing the published International Commission on Radiation Units and Measurement 49 data for the water mass stopping power and CSDA ranges, the mass stopping powers of EBT3 and EBT-XD films were derived using the approximation proposed by Newhauser and Zhang in 2009.

Results

The calculated CSDA ranges by MCNPX and TRIM in water were first benchmarked to International Commission on Radiation Units and Measurement 49 published data for water, and found to be within 1% with a 1.4-mm maximum difference. The calculated CSDA values in EBT3 film, compared with the measured CSDA ranges in the EBT3 film, were within 2% of the calculated values with a 3-mm maximum difference. The MCNPX and TRIM results for CSDA ranges agreed with each other to within 2.7% for EBT3 film and 4.4% for EBT-XD film. The overall uncertainties of the MCNPX and TRIM-derived CSDA ranges were 3% and 1.3%, respectively.

Conclusion

The mass stopping powers for Gafchromic EBT3 and EBT-XD films were derived.

Microstructure changes in radiochromic films due to magnetic field and radiation

PURPOSE

To correlate the dose response and changes in microscopic structures of the radiochromic films exposed to the clinical magnetic field in the range 1.5-3 T with standard and flattening filter-free (FFF) photon beams.

METHODS

The radiochromic film was cut into 5 × 5 cm² sheets/samples from one batch. These samples were exposed to a 1.5-T and/or 3-T B-fields from an MRI scanner using an abdominal sequence for 7 min before and after irradiation with 6 MV and/or 6 MV FFF beams. Films were placed in a reference condition at 5 cm depth in a solid water phantom and exposed up to 20 Gy. The sample orientation was maintained the same during exposure, readout, and scanning electron microscopic (SEM) analysis. The samples were scanned with an Epson Expression 11000XL in a 48-bit RGB color mode at 300 dpi with red channel. Scanned images were processed in Image J and red channel mean intensity values were recorded. The samples were then coated with 6 nm gold and imaged by SEM Teneo (5 kV, 13 pA) under 2000, 2500, and 3000 magnifications for texture analysis.

RESULTS

The changes in the microstructure of the films in magnetic fields (1.5- and 3.0-T) were dose dependent. The orientation and granular size of samples at higher doses were altered compared to the controls. Needle-shaped structures of the active layer were longer and aligned for samples exposed to higher doses and magnetic field. However, no significant changes in optical density due to the presence of a magnetic field pre/postirradiation up to 20 Gy were observed.

CONCLUSION

Fine structures of the film represent the polymerization characteristics that are affected by the radiation dose in the magnetic field. Upon exposure to radiation, diacetylene monomers undergo polymerization that forms longer chains with a temporal response. Even though this study did not notice any significant changes in optical density due to the presence of magnetic field, this should be studied in simultaneous application of the magnetic field during treatment in a dedicated MR-linac unit.