Energy response of EBT3 radiochromic films: implications for dosimetry in kilovoltage range

Clinical implementation and patient-specific quality assurance solutions for real-time target tracking and dynamic delivery in Radixact synchrony

BACKGROUND

The installation and testing of the first Radixact with Synchrony system in Colombia marked a significant milestone in Latin America's medical landscape. There was a need to devise a robust quality assurance protocol to comprehensively evaluate both dose delivery and motion tracking accuracy. However, testing experiences under clinical conditions have not been extensively reported. Additionally, there are limited recommended measuring devices for Synchrony evaluation.

PURPOSE

To validate and implement an alternative setup for dynamic-PSQA while testing Synchrony's functionality under clinical scenarios, including real-patient motion traces, and to provide guidance to new centers undergoing clinical implementation of Helical Synchrony.

METHODS

This approach involves using the Iba miniPhantomR with strategically placed fiducial markers for configuring Gafchromic-films and array-based setups. When paired with the CIRS Dynamic Platform, this enables an innovative dynamic setup with trackable features for Synchrony delivery testing. Assessment scenarios, including compensation (M1S1) and no-motion compensation (M1S0), were evaluated using 2D-gamma pass rate analysis with multiple clinical gamma criteria. The Synchrony-Simulation feature was used to assess pre-treatment performance and capture the patient's target motion pattern. Synchrony for common clinical cases with patient's motion-traces was validated.

RESULTS

The results for M1S0 and M1S1 demonstrated consistency with previous studies evaluating Synchrony functionality. Analysis using different gamma criteria unveiled dosimetric differences and impacts across various motion ranges. The application of effective kV-dose subtraction for array-based methods is of upmost importance when evaluating dynamic-PSQA with stringent gamma-criteria. However, no significant kV-dose impact on EBT3-Film was detectable.

CONCLUSION

Two implemented configurations for dynamic-PSQA setups were validated and successfully integrated into our clinic. We addressed both the benefits and limitations of array-based and film-based methods. The functionality and limitations of Synchrony were evaluated using the proposed setups. The potential utility of Synchrony-Simulation, along with the proposed patient-case classification table, can offer valuable support for new users during the clinical implementation of Synchrony treatments.

Monte Carlo calculated absorbed-dose energy dependence of EBT3 and EBT4 films for 5-200 MeV electrons and 100 keV-15 MeV photons

PURPOSE

To use Monte Carlo simulations to study the absorbed-dose energy dependence of GAFChromic EBT3 and EBT4 films for 5-200 MeV electron beams and 100 keV-15 MeV photon beams considering two film compositions: a previous EBT3 composition (Bekerat et al.) and the final composition of EBT3/current composition of EBT4 (Palmer et al.).

METHODS

A water phantom was simulated with films at 5-50 mm depth in 5 mm intervals. The water phantom was irradiated with flat, monoenergetic 5-200 MeV electron beams and 100 and 150 keV kilovoltage and 1-15 MeV megavoltage photon beams and the dose to the active layer of the films was scored. Simulations were rerun with the films defined as water to compare the absorbed-dose response of film to water,f - 1 ( Q ) = D f i l m D w a t e r $f^{-1}(Q)=\frac{D_{film}}{D_{water}}$ .

RESULTS

For electrons, the Bekerat et al. composition had variations inf - 1 ( Q ) $f^{-1}(Q)$ of up to( 1.9 ± 0.1 ) % $(1.9\,\pm \,0.1)\%$ from 5 to 200 MeV. Similarly, the Palmer et al. composition had differences inf - 1 ( Q ) $f^{-1}(Q)$ up to( 2.5 ± 0.2 ) % $(2.5 \pm 0.2)\%$ from 5 to 200 MeV. For photons,f - 1 ( Q ) $f^{-1}(Q)$ varied up to( 2.4 ± 0.3 ) % $(2.4 \pm 0.3)\%$ and( 4.5 ± 0.7 ) % $(4.5 \pm 0.7)\%$ from 100 keV to 15 MeV for the Bekerat et al. and Palmer et al. compositions, respectively. The depth of films did not appear to significantly affectf - 1 ( Q ) $f^{-1}(Q)$ for photons at any energy and for electrons at energies > $>$  50 MeV. However, for 5 and 10 MeV electrons, decreases of up to( 10.2 ± 1.1 ) % $(10.2 \pm 1.1)\%$ inf - 1 ( Q ) $f^{-1}(Q)$ were seen due to stacked films and increased beam attenuation in films compared to water.

CONCLUSIONS

The up to( 2.5 ± 0.2 ) % $(2.5 \pm 0.2)\%$ and( 4.5 ± 0.7 ) % $(4.5 \pm 0.7)\%$ variations inf - 1 ( Q ) $f^{-1}(Q)$ for electrons and photons, respectively, across the energies considered in this study indicate the importance of calibrating films with the energy intended for measurement. Additionally, this work emphasizes potential issues with stacking films to measure depth dose curves, particularly for electron beams with energies ≤ $\le$ 10 MeV.

Response characterization of radiochromic OC-1 films in photon, electron, and proton beams

BACKGROUND

Radiochromic film (RCF) dosimeters with their high spatial resolution and tissue equivalent properties are conveniently used for two-dimensional and small-field dosimetry. OC-1 is a new model of RCF dosimeter that was commercially introduced recently. Due to its novelty there is a need to characterize its response in various radiation beam types.

PURPOSE

To study the response of OC-1 RCFs to megavoltage clinical x-ray, electron, and proton beams, as well as kilovoltage x-ray beams used in a small animal research irradiator.

MATERIALS AND METHODS

OC-1 RCFs were cut into ∼4 × 4 cm2 pieces. RCF samples were irradiated at various dose levels in the range 0.5-120 Gy using different modalities; a small animal radiation research platform (SARRP) (220 kVp), a medical linear accelerator (6 MV, 10 MV, 15 MV, 6 MV FFF, 10 MV FFF photon beams, as well as 6 and 20 MeV electron beams), and a gantry-mounted proton therapy synchrocyclotron. In order to study any dependency on the fractionation scheme, same dose was delivered at several fractions to a set of films. Different dose rates in the range 200-600 MU/min were delivered to a set of films to investigate any dose rate dependency. The films were scanned pre-irradiation and at 48 h post-irradiation using a flatbed scanner. The net optical density (OD) was measured for red, green, and blue color channel for each film. The orientation dependency was studied by scanning the films at eight different orientations. In order to study the temporal evolution of the response of the films, film samples were irradiated at 10 and 50 Gy using 6 MV photon beams and were scanned upon irradiation at certain time intervals up to 3 months. The spectral response of the films were studied over the visible range using a spectrometer.

RESULTS

For megavoltage photon, electron, and plateau region of the proton beams, we did not observe a significant dependency on the beam quality, dose rate, and fractionation scheme. At the kV beam, an unusual over-response was observed in the films' net OD. An orientation dependency in the response of the films with a sinusoidal trend was observed. The response of the films increased with time following a double or triple exponential trend. The spectral absorption peaks were blue-shifted with dose.

CONCLUSION

OC-1 RCFs were found to be reliable dosimeters with no significant energy dependency in MV range for photon and electron beams including the FFF beams. They over-respond when irradiated by kV x-ray beams compared to MV x-ray beams. Caution must be exercised to maintain the orientation of the films when scanning. Due to the temporal growth in the net OD of the films, same post-irradiation time interval must be used for scanning the calibration and test films.

Development and optimisation of grid inserts for a preclinical radiotherapy system and corresponding Monte Carlo beam simulations

Objective. To develop a physical grid collimator compatible with the X-RAD preclinical radiotherapy system and create a corresponding Monte Carlo (MC) model.Approach. This work presents a methodology for the fabrication of a grid collimator designed for utilisation on the X-RAD preclinical radiotherapy system. Additionally, a MC simulation of the grid is developed, which is compatible with the X-RAD treatment planning system. The grid was manufactured by casting a low melting point alloy, cerrobend, into a silicone mould. The silicone was moulded around a 3D-printed replica of the grid, enabling the production of diverging holes with precise radii and spacing. A MC simulation was conducted on an equivalent 3D grid model and validated using 11 layers of GAFChromic EBT-3 film interspersed in a 3D-printed water-equivalent phantom. A 3D dose distribution was constructed from the film layers, enabling a direct comparison with the MC Simulation.Main results. The film and the MC dose distribution demonstrated a gamma passing rate of 99% for a 1%, 0.5 mm criteria with a 10% threshold applied. The peak-to-valley dose ratio and output factor at the surface were determined to be 20.4 and 0.79, respectively.Significance. The pairing of the grid collimator with a MC simulation can significantly enhance the practicality of grid therapy on the X-RAD. This combination enables further exploration of the biological implications of grid therapy, supported by a knowledge of the complex dose distributions. Moreover, this methodology can be adapted for use in other systems and scenarios.

Dosimetric characterization of a novel UHDR megavoltage X-ray source for FLASH radiobiological experiments

A first irradiation platform capable of delivering 10 MV X-ray beams at ultra-high dose rates (UHDR) has been developed and characterized for FLASH radiobiological research at TRIUMF. Delivery of both UHDR (FLASH mode) and low dose-rate conventional (CONV mode) irradiations was demonstrated using a common source and experimental setup. Dose rates were calculated using film dosimetry and a non-intercepting beam monitoring device; mean values for a 100 μA pulse (peak) current were nominally 82.6 and 4.40 × 10-2 Gy/s for UHDR and CONV modes, respectively. The field size for which > 40 Gy/s could be achieved exceeded 1 cm down to a depth of 4.1 cm, suitable for total lung irradiations in mouse models. The calculated delivery metrics were used to inform subsequent pre-clinical treatments. Four groups of 6 healthy male C57Bl/6J mice were treated using thoracic irradiations to target doses of either 15 or 30 Gy using both FLASH and CONV modes. Administration of UHDR X-ray irradiation to healthy mouse models was demonstrated for the first time at the clinically-relevant beam energy of 10 MV.

A formalism for traceable dosimetry in superficial electronic brachytherapy (eBT)

Objective. Despite the number of treatments performed with electronic brachytherapy (eBT) there is no uniform methodology for reference dosimetry for international traceability to primary dosimetry standards in different eBT systems. The objective of this study is to propose a formalism for traceability reference dosimetry in superficial eBT, that is easy to apply in the clinic. This method was investigated for an Elekta Esteya with one applicator.Approach. The calibration x-ray spectrum at the primary standards dosimetry laboratory was matched to the measured eBT photon spectrum. Subsequently, two ionization chambers of different types were calibrated at the primary standard dosimetry laboratory (PSDL) in terms of air kerma against a primary standard. The chambers were used to measure ionization chamber reading ratios in-air at different distances from the applicator. Monte Carlo based air kerma ratios were calculated at different positions from the eBT applicator as well as backscatter factors in water and average mass energy absorption ratios in water and in air. Relative measurements with radiochromic films were performed in a water phantom to determine the ratio of absorbed dose to water,Dw, at the surface toDwat 1 cm depth in water. These were compared with Monte Carlo calculations.Main results. Calculations and measurements were combined to estimate theDwat the surface and at 1 cm depth in water. Ionization chamber agreement of the surface dose was 1.7%, within an uncertainty of 6.8% (k= 2). They agreed with the manufacturer dosimetry within 1.8%, with an uncertainty of 5.0% (k= 2). The feasibility of the formalism and methodology for the Esteya system was demonstrated.Significance. This study proposes a method for harmonization of traceable reference dosimetry for eBT contact treatments which does not involve a detailed simulation of the ionization chamber. The method demonstrated feasibility for one eBT system using one surface applicator. In the future the method could be applied for different eBT systems.

Organ dose in CT: Comparison between measurements and computational methods

PURPOSE

This study aims to compare two methods for the organ dose evaluation in computed tomography (CT) in the head- and thorax regions: an experimental method, using radiochromic films, and a computational one, using a commercial software.

METHODS

Gafchromic® XR-QA2 and EBT-3 were characterized in terms of energetic, angular, and irradiation configurations dependence. Two free-in-air irradiation calibration configurations were employed using a CT scanner: with the sensitive surface of the film orthogonal (OC) and parallel (PC) to the beam axis. Different dose-response curves were obtained by varying the irradiation configurations and the beam quality (BQ). Subsequently, films were irradiated within an anthropomorphic phantom using CT-thorax and -head protocols, and the organ dose values obtained were compared with those provided by the commercial software.

RESULTS

At different configurations, an unchanged dose response was achieved with EBT-3, while a dose response of 15% was obtained with XR-QA2. By varying BQ, XR-QA2 showed a different response below 10%, while EBT-3 showed a variation below 5% for dose values >20 mGy. For films irradiation angle equal to 90°, the normalized to 0° relative response was 41% for the XR-QA2 model and 83% for the EBT-3 one. Organ dose values obtained with EBT-3 for both configurations and with XR-QA2 for OC were in agreement with the DW values, showing percentage discrepancies of less than 25%.

CONCLUSIONS

The obtained results showed the potential of EBT-3 in CT patient dosimetry since the lower angular dependence, compared to XR-QA2, compensates for low sensitivity in the diagnostic dose range.

Energy-dependence investigation for a range of clinically used detectors from 70 kV to 6 MV

PURPOSE

Accurate measurement of out-of-field dose in radiotherapy directly impacts beam data modeling in treatment planning systems, verification of implanted electronic devices/lens/fetus dose, secondary cancer risk estimation, and organ-at-risk dose reporting. When performing out-of-field dosimetry, it is therefore imperative that the response of the detector has been well characterized. Due to the softening of the radiation beam out-of-field, many detectors will exhibit energy dependence. This study investigated the energy dependence of a range of clinical available detectors over typical energies experienced out-of-field.

METHODS

The response of detectors to photon beams from 70 kV to 6 MV was measured. The relative change in response from 6 MV down to 70 kV highlighted the expected deviation in the response of detectors that would typically be calibrated in-field for use out-of-field.

RESULTS

The Pinpoint detector displayed the most energy-independent response over the energy range investigated. The Micro-Lion detector was the only detector to show an under-response to all low-energy beams relative to 6 MV. The diode-type detectors showed the largest energy dependence.

CONCLUSIONS

When considering detectors for use in out-of-field dose measurements, it is important that the energy dependence is investigated over a low-energy range as out-of-field the energy spectra comprise a larger component of photons in the 50-100-keV range. This study highlights the variation in response of a range of clinically available detectors to low-energy radiation beams relative to 6 MV for out-of-field dosimetry. The Pinpoint detector was the most energy-independent detector with a response close to unity over the entire energy range investigated.

A preclinical radiotherapy dosimetry audit using a realistic 3D printed murine phantom

Preclinical radiation research lacks standardized dosimetry procedures that provide traceability to a primary standard. Consequently, ensuring accuracy and reproducibility between studies is challenging. Using 3D printed murine phantoms we undertook a dosimetry audit of Xstrahl Small Animal Radiation Research Platforms (SARRPs) installed at 7 UK centres. The geometrically realistic phantom accommodated alanine pellets and Gafchromic EBT3 film for simultaneous measurement of the dose delivered and the dose distribution within a 2D plane, respectively. Two irradiation scenarios were developed: (1) a 10 × 10 mm2 static field targeting the pelvis, and (2) a 5 × 5 mm2 90° arc targeting the brain. For static fields, the absolute difference between the planned dose and alanine measurement across all centres was 4.1 ± 4.3% (mean ± standard deviation), with an overall range of - 2.3 to 10.5%. For arc fields, the difference was - 1.2% ± 6.1%, with a range of - 13.1 to 7.7%. EBT3 dose measurements were greater than alanine by 2.0 ± 2.5% and 3.5 ± 6.0% (mean ± standard deviation) for the static and arc fields, respectively. 2D dose distributions showed discrepancies to the planned dose at the field edges. The audit demonstrates that further work on preclinical radiotherapy quality assurance processes is merited.

Development of Standard X-Ray Beams for Calibration of Radiobiology Cabinet and Conformal Irradiators

This work seeks to develop standard X-ray beams that are matched to radiobiology X-ray irradiators. The calibration of detectors used for dose determination of these irradiators is performed with a set of standard X rays that are more heavily filtered and/or lower energy, which leads to a higher uncertainty in the dose measurement. Models of the XRad320, SARRP, and the X-ray tube at the University of Wisconsin Medical Radiation Research Center (UWMRRC) were created using the BEAMnrc user code of the EGSnrc Monte Carlo code system. These models were validated against measurements, and the resultant modeled spectra were used to determine the amount of added filtration needed to match the X-ray beams at the UWMRRC to those of the XRad320 and SARRP. The depth profiles and half-value layer (HVL) simulations performed using BEAMnrc agreed to measurements within 3% and 3.6%, respectively. A primary measurement device, a free-air chamber, was developed to measure air kerma in the medium energy range of X rays. The resultant spectra of the matched beams had HVL's that matched the HVL's of the radiobiology irradiators well within the 3% criteria recommended by the International Atomic Energy Agency (IAEA) and the average energies agreed within 2.4%. In conclusion, three standard X-ray beams were developed at the UWMRRC with spectra that more closely match the spectra of the XRad320 and SARRP radiobiology irradiators, which will aid in a more accurate dose determination during calibration of these irradiators.

Evaluation of Dose Distribution in Optimized Stanford Total Skin Electron Therapy (TSET) Technique in Rando Anthropomorphic Phantom using EBT3 Gafchromatic Films

Background:

The Total Skin Electron Therapy (TSET) targets the whole of skin using 6 to 10 MeV electrons in large field size and large Source to Surface Distance (SSD). Treatment in sleeping position leads to a better distribution of dose and patient comfort.

Objective:

This study aims to investigate the uniformity of absorbed dose in the sleeping Stanford technique on the Rando phantom using dosimetry.

Material and Methods:

It is an experimental study which was performed using 6 MeV electron irradiation produced by Varian accelerator in the AP and PA positions with gantry angles of 318/3, 0 and 41/5 degrees, and RAO, LAO, RPO and LPO with 291/4 gantry angle and 45 degrees of collimator angle in the sleeping position.

Results:

The results show that the dose uniformity achieved in this technique is in the range of (100 ± 25%) and, the dose accuracy was 6%.

Conclusion:

Total Skin Electron Therapy (TSET) technique in sleeping position is very suitable for elderly and disabled patients, and meets the required dose uniformity. Furthermore, the use of a flattening filter is recommended for the more dose distribution uniformity.

Evaluation of skin dose and skin toxicity in patients undergoing intraoperative radiotherapy for early breast cancer

PURPOSE

This study aims to evaluate in vivo skin dose delivered by intraoperative radiotherapy (IORT) and determine the factors associated with an increased risk of radiation-induced skin toxicity.

METHODOLOGY

A total of 21 breast cancer patients who underwent breast-conserving surgery and IORT, either as IORT alone or IORT boost plus external beam radiotherapy (EBRT), were recruited in this prospective study. EBT3 film was calibrated in water and used to measure skin dose during IORT at concentric circles of 5 mm and 40 mm away from the applicator. For patients who also had EBRT, the maximum skin dose was estimated using the radiotherapy treatment planning system. Mid-term skin toxicities were evaluated at 3 and 6 months post-IORT.

RESULTS

The average skin dose at 5 mm and 40 mm away from the applicator was 3.07 ± 0.82 Gy and 0.99 ± 0.28 Gy, respectively. Patients treated with IORT boost plus EBRT received an additional skin dose of 41.07 ± 1.57 Gy from the EBRT component. At 3 months post-IORT, 86% of patients showed no evidence of skin toxicity. However, the number of patients suffering from skin toxicity increased from 15% to 38% at 6 months post-IORT. We found no association between the IORT alone or with the IORT boost plus EBRT and skin toxicity. Older age was associated with increased risk of skin toxicities. A mathematical model was derived to predict skin dose.

CONCLUSION

EBT3 film is a suitable dosimeter for in vivo skin dosimetry in IORT, providing patient-specific skin doses. Both IORT alone and IORT boost techniques resulted in similar skin toxicity rates.

Integrating X-ray kV millimetric field dosimetry with a synthetic diamond detector into the treatment planning system commissioning of a preclinical irradiator

PURPOSE

Small animal irradiators are equipped with x-ray beams and cone collimators with millimeter dimensions to be used in preclinical research. The use of small fields in the kV energy range may require the application of energy-dependent, field size-dependent, or depth-dependent correction factors to the dosimetric data acquired for treatment planning system (TPS) commissioning purposes to obtain accurate dose values. Considering that these corrections are also detector dependent, the suitability of a synthetic single-crystal diamond detector for small-field relative dosimetry in a preclinical irradiator (220-kVp) was evaluated to avoid the necessity of applying correction factors during TPS commissioning.

METHODS

The detector response was assessed during the transition for field sizes ranging from 20 × 20 mm² to 3 × 3 mm² , using the small animal radiation research platform (SARRP). The percentage depth dose distributions (PDDs), lateral profiles and output factors (OFs) were measured. The PDDs for the synthetic diamond detector were compared to the distributions acquired using a small-volume microchamber (0.016 cm³ ) and with Monte Carlo calculations using the MC3D in-house software package. The profiles and OFs were compared to the data from a silicon solid-state detector and to radiochromic film data provided by the manufacturer; for the OF determination, measurements made using a microchamber were added for comparison. The performance of several detectors used as references was previously validated for relative dosimetry in preclinical irradiators. A commercial TPS was commissioned for the factor-based algorithm, using the data acquired with the diamond detector, and no additional correction factors were applied. To verify the performance of the TPS and the accuracy of the dosimetric methodology, radiochromic film irradiation in water was conducted, and two-dimensional (2D) dose distributions in the coronal and axial planes were compared under different gamma criteria.

RESULTS

Compared with the microchamber and MC3D distributions, the agreement of the PDDs using the synthetic diamond detector was better than 2%. The profile data exhibited very good agreement compared with the data from the silicon detector, with an average and a maximum difference of 0.31 and 0.39 mm in the penumbras, respectively. Compared with the data from the radiochromic film, the average and maximum differences were equal to 0.77 and 0.89 mm, respectively. Very good agreement, within 1%, was obtained between the OFs measured with the synthetic diamond detector and the radiochromic film, compared only for the cone collimators. The validation of the TPS commissioning using gamma criteria compared to film showed an average passing rate of 100% and 93.2% with a global gamma criterion of 1 mm/3% for the coronal and axial planes, respectively, including the 3 × 3 mm² field size and penumbra regions.

CONCLUSIONS

Synthetic diamond is a suitable detector for the complete relative dosimetry of small x-ray fields. The commissioning of the TPS with its own beam dosimetric data exhibited encouraging results even in a 3 × 3 mm² field and penumbra region. This methodology allows for the prediction of 2D dose distributions with an accuracy in water ranging from 3 to 5% compared to the 2D distribution from film dosimetry.

Dosimetry investigation of a prototype of 169Yb seed brachytherapy for use in circular stapler

This study aims to investigate dosimetry parameters for the new design of ¹⁶⁹Yb seed in the form of a surgical staple for circular staplers commonly used in the abdominal incision and the esophageal and gastric surgery, which facilitates the precise placement. This seed includes a titanium tube with the inner diameter and outer diameter 0.68 mm and 2.2 mm, respectively, and length of 0.8 mm. Both sides of the tube are closed by titanium wires with the thickness of 0.65 mm by the laser. Natural ytterbium oxide is used after the thermal neutron activation; it is necessary for cooling time of 40 days. The dosimetry parameters were calculated based on the TG-43U1 using Monte Carlo MCNP5 code. The experimental dosimetry was performed by EBT3 radiochromic film to determine 2D dosimetry at near distance of the source and validate the MC code. The dose rate constant of MC calculation was obtained at 1.39cGyh^-1U^-1 ± 4% with the difference of 5% compared to another study. The dose distribution was symmetrical along the Z-axis and Y-axis (around the seed) and there was a uniform activity inside the tube. The distinction of dose rate was not noticeable at the 90 and 270 degrees on the Z-axis, which indicated a slight effect on staple legs in the matter of delivery dose. However, to understand dose distribution and introduce this source in a pre-clinical study, 3D dosimetry as well as further studying the heterogeneous function is required.

Out-of-field doses from radiotherapy using photon beams: A comparative study for a pediatric renal treatment

PURPOSE

First, this experimental study aims at comparing out-of-field doses delivered by three radiotherapy techniques (3DCRT, VMAT (two different accelerators), and tomotherapy) for a pediatric renal treatment. Secondly, the accuracy of treatment planning systems (TPS) for out-of-field calculation is evaluated.

METHODS

EBT3 films were positioned in pediatric phantoms (5 and 10 yr old). They were irradiated according to four plans: 3DCRT (Clinac 2100CS, Varian), VMAT (Clinac 2100CS and Halcyon, Varian), and tomotherapy for a same target volume. 3D dose determination was performed with an in-house Matlab tool using linear interpolation of film measurements. 1D and 3D comparisons were made between techniques. Finally, measurements were compared to the Eclipse (Varian) and Tomotherapy (Accuray) TPS calculations.

RESULTS

Advanced radiotherapy techniques (VMATs and tomotherapy) deliver higher out-of-field doses compared to 3DCRT due to increased beam-on time triggered by intensity modulation. Differences increase with distance to target and reach a factor of 3 between VMAT and 3DCRT. Besides, tomotherapy delivers lower doses than VMAT: although tomotherapy beam-on time is higher than in VMAT, the additional shielding of the Hi-Art system reduces out-of-field doses. The latest generation Halcyon system proves to deliver lower peripheral doses than conventional accelerators. Regarding TPS calculation, tomotherapy proves to be suitable for out-of-field dose determination up to 30 cm from field edge whereas Eclipse (AAA and AXB) largely underestimates those doses.

CONCLUSION

This study shows that the high dose conformation allowed by advanced radiotherapy is done at the cost of higher peripheral doses. In the context of treatment-related risk estimation, the consequence of this increase might be significative. Modern systems require adapted head shielding and a particular attention has to be taken regarding on-board imaging dose. Finally, TPS advanced dose calculation algorithms do not certify dose accuracy beyond field edges, and thus, those doses are not suitable for risk assessment.

Physics and biology of ultrahigh dose-rate (FLASH) radiotherapy: a topical review

Ultrahigh dose-rate radiotherapy (RT), or 'FLASH' therapy, has gained significant momentum following various in vivo studies published since 2014 which have demonstrated a reduction in normal tissue toxicity and similar tumor control for FLASH-RT when compared with conventional dose-rate RT. Subsequent studies have sought to investigate the potential for FLASH normal tissue protection and the literature has been since been inundated with publications on FLASH therapies. Today, FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. FLASH-RT is considered by some as having the potential to 'revolutionize radiotherapy'. The goal of this review article is to present the current state of this intriguing RT technique and to review existing publications on FLASH-RT in terms of its physical and biological aspects. In the physics section, the current landscape of ultrahigh dose-rate radiation delivery and dosimetry is presented. Specifically, electron, photon and proton radiation sources capable of delivering ultrahigh dose-rates along with their beam delivery parameters are thoroughly discussed. Additionally, the benefits and drawbacks of radiation detectors suitable for dosimetry in FLASH-RT are presented. The biology section comprises a summary of pioneering in vitro ultrahigh dose-rate studies performed in the 1960s and early 1970s and continues with a summary of the recent literature investigating normal and tumor tissue responses in electron, photon and proton beams. The section is concluded with possible mechanistic explanations of the FLASH normal-tissue protection effect (FLASH effect). Finally, challenges associated with clinical translation of FLASH-RT and its future prospects are critically discussed; specifically, proposed treatment machines and publications on treatment planning for FLASH-RT are reviewed.

A new approach to radiochromic film dosimetry based on non-local means

Radiochromic film in conjunction with flatbed scanners are frequently employed as dosimeters for advanced techniques in radiotherapy. Their strengths are as follows: light element composition, low energy dependence, near biological tissue equivalence and high spatial resolution. However, they have some weaknesses as well: non-uniformities, read out noise, and scanning artifacts. Several processing protocols have been proposed intending to correct the perturbations these weaknesses produce. The aim of this paper is to present a new processing protocol for radiochromic film dosimetry based on a non-local means denoising algorithm. Three dose distributions of open square fields and a spatial combination of these fields using different angles of incidence and monitor units have been employed to validate the protocol. The dose distributions are traceable to ionization chamber measurements. Additionally, a real dose distribution of a treatment was used to simulate scanning data with noise and scanning lateral artifact, and to study how the protocol behaves under these perturbations. The same measured raw data have been processed by means of an implementation of the multichannel protocol (multigaussian method). It has been found that the proposed protocol reduces dose uncertainty even though it uses fewer scans than the multichannel protocol.

Dose- rather than fluence-averaged LET should be used as a single-parameter descriptor of proton beam quality for radiochromic film dosimetry

PURPOSE

The dose response of Gafchromic EBT3 films exposed to proton beams depends on the dose, and additionally on the beam quality, which is often quantified with the linear energy transfer (LET) and, hence, also referred to as LET quenching. Fundamentally different methods to determine correction factors for this LET quenching effect have been reported in literature and a new method using the local proton fluence distribution differential in LET is presented. This method was exploited to investigate whether a more practical correction based on the dose- or fluence-averaged LET is feasible in a variety of clinically possible beam arrangements.

METHODS

The relative effectiveness (RE) was characterized within a high LET spread-out Bragg peak (SOBP) in water made up by the six lowest available energies (62.4-67.5 MeV, configuration " b 1 ") resulting in one of the highest clinically feasible dose-averaged LET distributions. Additionally, two beams were measured where a low LET proton beam (252.7 MeV) was superimposed on " b 1 ", which contributed either 50% of the initial particle fluence or 50% of the dose in the SOBP, referred to as configuration " b 2 " and " b 3 ," respectively. The proton LET spectrum was simulated with GATE/Geant4 at all measurement positions. The net optical density change differential in LET was integrated over the local proton spectrum to calculate the net optical density and therefrom the beam quality correction factor. The LET dependence of the film response was accounted for by an LET dependence of one of the three parameters in the calibration function and was determined from inverse optimization using measurement " b 1 ." This method was then validated on the measurements of " b 2 " and " b 3 " and subsequently used to calculate the RE at 900 positions in nine clinically relevant beams. The extrapolated RE set was used to derive a simple linear correction function based on dose-averaged LET ( L d ) and verify the validity in all points of the comprehensive RE set.

RESULTS

The uncorrected film dose deviated up to 26% from the reference dose, whereas the corrected film dose agreed within 3% in all three beams in water (" b 1 ", " b 2 " and " b 3 "). The LET dependence of the calibration function started to strongly increase around 5 keV/μm and flatten out around 30 keV/μm. All REs calculated from the proton fluence in the nine simulated beams could be approximated with a linear function of dose-averaged LET (RE = 1.0258-0.0211 μm/keV L d ). However, no functional relationship of RE- and fluence-averaged LET could be found encompassing all beam energies and modulations.

CONCLUSIONS

The film quenching was found to be nonlinear as a function of proton LET as well as of the dose-averaged LET. However, the linear relation of RE on dose-averaged LET was a good approximation in all cases. In contrast to dose-averaged LET, fluence-averaged LET could not describe the RE when multiple beams were applied.

Experimental characterization of magnetically focused electron contamination at the surface of a high-field inline MRI-linac

PURPOSE

The fringe field of the Australian MRI-linac causes contaminant electrons to be focused along the central axis resulting in a high surface dose. This work aims to characterize this effect using Gafchromic film and high-resolution detectors, MOSkin^TM and microDiamond. The secondary aim is to investigate the influence of the inline magnetic field on the relative dose response of these detectors.

METHODS

The Australian MRI-linac has the unique feature that the linac is mounted on rails allowing for measurements to be performed at different magnetic field strengths while maintaining a constant source-to-surface distance (SSD). Percentage depth doses (PDD) were collected at SSD 1.82 m in a solid water phantom positioned in a low magnetic field region and then at isocenter of the MRI where the magnetic field is 1 T. Measurements for a range of field sizes were taken with the MOSkin^TM , microDiamond, and Gafchromic^® EBT3 film. The detectors' relative responses at 1 T were compared to the near 0 T PDD beyond the region of electron contamination, that is, 20 mm depth. The near surface measurements inside the MRI bore were compared among the different detectors.

RESULTS

Skin dose in the MRI, as measured with the MOSkin^TM , was 104.5% for 2.1 × 1.9 cm² , 185.6% for 6.1 × 5.8 cm² , 369.1% for 11.8 × 11.5 cm² , and 711.1% for 23.5 × 23 cm² . The detector measurements beyond the electron contamination region showed agreement between the relative response at 1 T and near 0 T. Film was in agreement with both detectors in this region further demonstrating their relative response is unaffected by the magnetic field.

CONCLUSIONS

Experimental characterization of the high electron contamination at the surface was performed for a range of field sizes. The relative response of MOSkin^TM and microDiamond detectors, beyond the electron contamination region, were confirmed to be unaffected by the 1-T inline magnetic field.

Off-axis dose distribution with stand-in and stand-off configurations for superficial radiotherapy treatments

Current practice when delivering dose for superficial skin radiotherapy is to adjust the monitor units so that the prescribed dose is delivered to the central axis of the superficial unit applicator. Variations of source‐to‐surface distance due to patient’s anatomy protruding into the applicator or extending away from the applicator require adjustments to the monitor units using the inverse square law. Off‐axis dose distribution varies significantly from the central axis dose and is not currently being quantified. The dose falloff at the periphery of the field is not symmetrical in the anode–cathode axis due to the heel effect. This study was conducted to quantify the variation of dose across the surface being treated and model a simple geometric shape to estimate a patient’s surface with stand‐in and stand‐off. Isodose plots and color‐coded dose distribution maps were produced from scans of GAFChromic EBT‐3 film irradiated by a Gulmay D3300 orthovoltage x‐ray therapy system. It was clear that larger applicators show a greater dose falloff toward the periphery than smaller applicators. Larger applicators were found to have a lower percentage of points above 90% of central axis dose (SA90). Current clinical practice does not take this field variation into account. Stand‐in can result in significant dose falloff off‐axis depending on the depth and width of the protrusion, while stand‐off can result in a flatter field due to the high‐dose region near the central axis being further from the source than the peripheral regions. The central axis also received a 7% increased or decreased dose for stand‐in or stand‐off, respectively.

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.

Experimental determination of the gadolinium dose enhancement in phantom irradiated with low energy X-ray sources by a spectrophotometer -Gafchromic-EBT3 dosimetry system

This work reports the experimental determination of dose enhancement produced in phantoms containing target volumes doped with Gadolinium and irradiated with low-energy X-ray beams. EBT3 Gafchromic films were immersed into 5 ml target volumes to simulate tumor filling with 100% ultra-pure water (blank sample) and ultra-pure water infused with Gd solution (Omniscan®) in different concentration (9-24 mg/ml). The dose enhancement due to excitation of Gd K-edge (50.2 keV) was evaluated in terms of the increment in optical density, obtained by a Spectrophotometer-Gafchromic-EBT3 dosimetry system calibrated in terms of the dose-response for 1-8 Gy range. The dose enhancement was evaluated in two condition: a beam quality with spectrum above the absorption edge in a medium with and without Gd; and two beam qualities (above and below the absorption edge) in a medium with a fixed Gd concentration (18 mg/ml). The obtained results confirmed increments in relative dose enhancement according to Gd concentrations up to 18 mg/ml, with a dose enhancement of 1.1 Gy and an average percentage enhancement of 28.4%. For higher values of concentration, the attenuation interaction of the primary beam is more relevant instead of dose enhancement process. On the other hand, the dose enhancement obtained to comparison the spectra above and below the absorption edge, shown results up to 3.3 Gy of enhancement and average percentage enhancement of 88%.

Dosimetry of a portable in vivo x-ray fluorescence system using EBT3 radiochromic film

PURPOSE

In vivo x-ray fluorescence is a non-invasive analytical technique for determining trace and toxic element exposures. In this work we measure the dose for a portable handheld x-ray system (pXRF).

MATERIALS AND METHODS

We used EBT3 radiochromic film calibrated with a clinical orthovoltage unit for absolute dose measurement. Films were placed on a human phantom and irradiated with the Tracer III-SD pXRF at tube potentials of 40 and 45 kVp with various levels of filtration.

RESULTS

Using settings that result in the best detection limits, the highest absorbed point dose to the skin was 0.3 Gy, the equivalent dose to a 1 cm2 area was 54 mSv, and the whole-body effective dose was less than 1 μSv for a standard 3-min in vivo measurement of strontium or lead. Recent work has demonstrated that 1 s and 30 s measurements are feasible for bone strontium measurements, which would lead to significantly lower doses.

CONCLUSIONS

Our results are in agreement with a previous dosimetry study of another portable x-ray device and indicate that it is safe for in vivo measurements of elements such as strontium and lead, only after appropriate dose validation and with appropriate beam filtration in place.

Evaluation of Dose Rate and Photon Energy Dependence of Gafchromic EBT3 Film Irradiating with 6 MV and Co-60 Photon Beams

Gafchromic films are utilized for two-dimensional dose distribution measurements, especially in radiotherapy. In this study, we investigated a close connection between energy and dose rate of Gafchromic EBT3 films irradiating with 6 MV and Co-60 photon beams over a broad dose range. EBT3 films were exposed to 6 MV and Co-60 photon beams using 4 and 2 Gy/min dose rates over a 10-400 cGy dose range. The films were scanned in red, green, and blue channels to obtain the optical density (OD)-dose curves. The OD-dose curves resulted from three-color scans for different photon energies and dose rates were compared by statistical independent t-test. For the radiations of Co-60 and 6 MV photon beams, the highest correlation was obtained between the 2 and 4 Gy/min dose rates with red and green channels, respectively. Moreover, the red channel had a greater OD response per dose value, following the green and blue channels. There was no significant difference between different photon energies' (Co-60 and 6 MV) and dose rates' (2 and 4 Gy/min) dependence on OD-dose response of EBT3 films over a broad domain of radiation dose, except for different photon energies in the blue channel. Our results revealed that the OD-dose response of EBT3 films is independent on photon energies (Co-60 and 6 MV) and dose rate (2 and 4 Gy/min) in the evaluated dose range (10-400 cGy). Therefore, the EBT3 films are suitable, consistent, and reliable instruments for dose measurements in radiotherapy.

Characterizing a Geant4 Monte Carlo model of a multileaf collimator for a TrueBeam™ linear accelerator

PURPOSE

The purpose of this work was to develop and validate a multileaf collimator (MLC) model for a TrueBeam™ linac using Geant4 Monte Carlo (MC) simulation kit.

METHODS

A Geant4 application was developed to accurately represent TrueBeam™ linac. Pre-computed phase-space file in a plane just above the jaws was used for radiation transport. A Varian 120 leaf Millennium™ MLC was modeled using geometry and material specifications provided by the manufacturer using Geant4 constructs. Leaf characteristics e.g. tongue-groove design, variable thickness, interleaf gap were simulated. The linac model was validated by comparing simulated dose profiles and depth-doses with experimental data using an ionization chamber in water. Dosimetric characteristics of the MLC such as inter- and intra-leaf leakage, penumbra effect, MLC leaf positioning, and dynamic characteristics were also investigated.

RESULTS

For the depth dose curves, 99% of the calculated data points agree within 1% of the experimental values for the 4 × 4 cm² and 10 × 10 cm² and within 2% of the experimental values for 20 × 20, 30 × 30 and 40 × 40 cm² jaw defined fields. The cross-plane dose profiles show agreement <2% for depths up to 10 cm and to within 4% beyond 10 cm. MLC dosimetric characterization with MC agree well with film measurements. The rounded leaf penumbra remained constant throughout the range of leaf motion.

CONCLUSIONS

The TrueBeam™ linac equipped with 120-leaf MLC was successfully modeled using Geant4. The accuracy of the model was verified by comparing the simulations with experiments. The model may be utilized for independent dose verification and QA of IMRT.

EBT3 Films in Low Solar Ultraviolet and X-Ray Dose Measurement: A Comparative Analysis

The purpose of this study is to investigate the potentiality of Gafchromic external beam therapy 3 (EBT3) film to measure low dosage of solar ultraviolet (SUV; 0-10 600 mJ/cm2) and x-ray (0-750 mGy) radiation. In this experiment, 2 groups of EBT3 films were prepared with size 2 cm × 1 cm. The first group of films was exposed by incremental SUV dose in the middle of the day. The other group was irradiated by x-ray at 100 kVp, 100 mA, and 2 S of tube voltage, tube current, and exposure time, respectively. The measured SUV consists of 90% ultraviolet A (UVA) and 10% ultraviolet B. The film discoloration was represented by visible absorbance spectroscopy technique using Jaz spectrometer from Ocean Optics Inc. Simple linear regression produced high accuracy with coefficients of determination, r 2 of 0.9804 and root mean square error (RMSE) of 434.88 mJ/cm2 for the measurement of SUV dose. On the other hand, r 2 of 0.98 and RMSE of 31 mGy was produced for the measurement of x-ray dose. The application of multiple linear regression enhanced the measurement accuracy with R 2 of 99% and 99.7% and RMSE of 327.06 mJ/cm2 and 15.045 mGy for SUV and x-ray dose, respectively. The spectral analysis shows a promising measurement at selected wavelengths for SUV and x-ray dose.

Dosimetry of indigenously developed 177Lu patch source for surface brachytherapy-Experimental and Monte Carlo methods

This paper describes the evaluation of dosimetry characteristics of an in-house developed ¹⁷⁷Lu skin patch source for treatment of non-melanoma skin cancer. A ¹⁷⁷Lu skin patch source based on Nafion-115 membrane backbone containing 3.46 ± 0.01 mCi of activity was used. Activity measurement of the patch source was based on gamma ray spectrometry using a HPGe detector. The efficiencies of the HPGe detector were fitted using an orthogonal polynomial function. The absorbed dose rate to water at 5 μm depth in water was determined using an extrapolation chamber, EBT3 Gafchromic film and compared with Monte Carlo methods. The correction factors such as Bragg-Gray stopping power ratio of water-to-air and chamber wall material being different from water, needed to be applied on measurements for establishing the dose rate at 5 μm depth, were calculated using the Monte Carlo method. Absorbed dose rate at 5 μm depth in water (surface dose rate) measured using an extrapolation chamber and EBT3 Gafchromic film were 9.9 ± 0.7 and 8.2 ± 0.1 Gy h^-1 mCi^-1 respectively for the source activity of 3.46 ± 0.01 mCi. The surface dose rate calculated using the Monte Carlo method was 8.7 ± 0.2 Gy h^-1 mCi^-1, which agrees reasonably well with measurement. The measured dose rate per mCi offers scope for ascertaining treatment time required to deliver the dose for propitious therapeutic outcome. Additionally, on-axis depth dose and lateral dose profiles at 5 μm and 1 mm depth in water phantom were also calculated using the Monte Carlo method.

Investigation of a source model for a new electronic brachytherapy tandem by film measurement

PURPOSE

To investigate the accuracy of a vendor-supplied source model for a new Xoft Axxent 0-degree titanium tandem by film measurement.

METHODS

We measured the anisotropy factors at varying distances and angles from the tandem in water using radiochromic film (Gafchromic EBT3) and an Epson Perfection v750 desktop flatbed scanner (US Epson, Long Beach, CA). A 0-degree tandem was placed vertically in a water phantom. Four pieces of film, each at varying depths, were positioned orthogonal to the longitudinal axis of the tandem for azimuthal anisotropy measurements. Polar anisotropy measurements were taken with the film aligned parallel to the tandem. An absolute dose calibration for the film was verified with a PTW 34013 Soft X-Ray Chamber. The film measurements were analyzed using different color channels. The measured polar anisotropy for varying source positions was compared to the vendor's data. Azimuthal anisotropy was measured as a function of the radius and angle, and normalized to the mean value over all angles at the specified radius.

RESULTS

The azimuthal anisotropy of the tandem and source was found to be consistent for different positions along the tandem's longitudinal axis and at varying distances from the tandem. Absolute dose using a calibrated parallel plate chamber showed agreement to within 2% of expected TPS values. The custom tandem, which has a thicker tip than the wall, was attenuating the 50 kV photons more than expected, at the angles where the photons had more wall material to traverse. This discrepancy was verified at different distances from the tandem and with different measurement techniques. As distance increased, anisotropy values had better agreement.

CONCLUSIONS

We quantified the agreement between the measured and provided anisotropy factors for a new Xoft Axxent 0-degree titanium tandem. Radiochromic film response at low kV energy was also investigated. Our results showed that vendor-supplied TG-43 values were appropriate for clinical use at majority of the angles. A rigorous quality assurance method for new electronic brachytherapy sources and applicators, along with complete knowledge of all dosimetric measuring tools, should be implemented for all parts of the verification and commissioning process.

Verification of high-dose-rate brachytherapy treatment planning dose distribution using liquid-filled ionization chamber array

Purpose

This study aims to investigate the dosimetric performance of a liquid-filled ionization chamber array in high-dose-rate (HDR) brachytherapy dosimetry. A comparative study was carried out with air-filled ionization chamber array and EBT3 Gafchromic films to demonstrate its suitability in brachytherapy.

Material and methods

The PTW OCTAVIUS detector 1000 SRS (IA 2.5-5 mm) is a liquid-filled ionization chamber array of area 11 x 11 cm² and chamber spacing of 2.5-5 mm, whereas the PTW OCTAVIUS detector 729 (IA 10 mm) is an air vented ionization chamber array of area 27 x 27 cm² and chamber spacing of 10 mm. EBT3 films were exposed to doses up to a maximum of 6 Gy and evaluated using multi-channel analysis. The detectors were evaluated using test plans to mimic a HDR intracavitary gynecological treatment. The plan was calculated and delivered with the applicator plane placed 20 mm from the detector plane. The acquired measurements were compared to the treatment plan. In addition to point dose measurement, profile/isodose, gamma analysis, and uncertainty analysis were performed. Detector sensitivity was evaluated by introducing simulated errors to the test plans.

Results

The mean point dose differences between measured and calculated plans were 0.2% ± 1.6%, 1.8% ± 1.0%, and 1.5% ± 0.81% for film, IA 10 mm, and IA 2.5-5 mm, respectively. The average percentage of passed gamma (global/local) values using 3%/3 mm criteria was above 99.8% for all three detectors on the original plan. For IA 2.5-5 mm, local gamma criteria of 2%/1 mm with a passing rate of at least 95% was found to be sensitive when simulated positional errors of 1 mm was introduced.

Conclusion

The dosimetric properties of IA 2.5-5 mm showed the applicability of liquid-filled ionization chamber array as a potential QA device for HDR brachytherapy treatment planning systems.

Verification of Acuros XB dose algorithm using 3D printed low-density phantoms for clinical photon beams

The transport-based dose calculation algorithm Acuros XB (AXB) has been shown to accurately account for heterogeneities primarily through comparisons with Monte Carlo simulations. This study aims to provide additional experimental verification of AXB for clinically relevant flattened and unflattened beam energies in low density phantoms of the same material. Polystyrene slabs were created using a bench-top 3D printer. Six slabs were printed at varying densities from 0.23 to 0.68 g/cm3 , corresponding to different density humanoid tissues. The slabs were used to form different single and multilayer geometries. Dose was calculated with Eclipse™ AXB 11.0.31 for 6MV, 15MV flattened and 6FFF (flattening filter free) energies for field sizes of 2 × 2 and 5 × 5 cm2 . EBT3 film was inserted into the phantoms, which were irradiated. Absolute dose profiles and 2D Gamma analyses were performed for 96 dose planes. For all single slab configurations and energies, absolute dose differences between the AXB calculation and film measurements remained <3% for both fields in the high-dose region, however, larger disagreement was seen within the penumbra. For the multilayered phantom, percentage depth dose with AXB was within 5% of discrete film measurements. The Gamma index at 2%/2 mm averaged 98% in all combinations of fields, phantoms and photon energies. The transport-based dose algorithm AXB is in good agreement with the experimental measurements for small field sizes using 6MV, 6FFF and 15MV beams adjacent to various low-density heterogeneous media. This work provides preliminary experimental grounds to support the use of AXB for heterogeneous dose calculation purposes.

Investigation of EBT3 radiochromic film's response to humidity

PURPOSE

The aim of this work is to investigate the effects of immersing EBT3 radiochromic film in water and to evaluate its contribution to the total uncertainty in dose determination.

MATERIALS AND METHODS

We used 3 cm × 3 cm EBT3 radiochromic films irradiated in the range of 0-70 Gy to study the impact of water immersion on the change in net optical density. These films were placed in a water container for a period of 24 h. The net optical density was measured before (0 h) and after of the immersion in water (1, 3, 6, 12, 18, and 24 h). The absorbance spectrum of the EBT3 radiochromic film was measured at 0 h and 24 h after immersion in water. The uncertainty in dose determination due to the effects of keeping the EBT3 radiochromic film submerged in water at 0, 1, and 24 h were recorded in the red, green, and blue channels.

RESULTS

We observed an increase in the net optical density as an effect on the film due to its immersion in water. The penetration of the water at the edges of the radiochromic film was observed to be a function of time during which the film remained in the water. On the other hand, the penetration of water at the edges of the film was found to be independent of irradiation dose.

CONCLUSIONS

EBT3 radiochromic film is found more resistant to water penetration through the edges than its predecessors. However, there is evidence that suggest that liquid water damage the Nylon cover layer of the film by changing its optical properties. Therefore, it is recommended to build a new calibration curve for radiochromic films for a specific situation involving dose measurements in liquid water.

Simplified method for creating a density-absorbed dose calibration curve for the low dose range from Gafchromic EBT3 film

Radiochromic film dosimeters have a disadvantage in comparison with an ionization chamber in that the dosimetry process is time-consuming for creating a density-absorbed dose calibration curve. The purpose of this study was the development of a simplified method of creating a density-absorbed dose calibration curve from radiochromic film within a short time. This simplified method was performed using Gafchromic EBT3 film with a low energy dependence and step-shaped Al filter. The simplified method was compared with the standard method. The density-absorbed dose calibration curves created using the simplified and standard methods exhibited approximately similar straight lines, and the gradients of the density-absorbed dose calibration curves were −32.336 and −33.746, respectively. The simplified method can obtain calibration curves within a much shorter time compared to the standard method. It is considered that the simplified method for EBT3 film offers a more time-efficient means of determining the density-absorbed dose calibration curve within a low absorbed dose range such as the diagnostic range.

Characterization of a 2.5 MV inline portal imaging beam

A new megavoltage (MV) energy was recently introduced on Varian TrueBeam linear accelerators for imaging applications. This work describes the experimental characterization of a 2.5 MV inline portal imaging beam for commissioning, routine clinical use, and quality assurance purposes. The beam quality of the 2.5 MV beam was determined by measuring a percent depth dose, PDD, in water phantom for 10 × 10 cm2 field at source-to-surface distance 100 cm with a CC13 ion chamber, plane parallel Markus chamber, and GafChromic EBT3 film. Absolute dosimetric output calibration of the beam was performed using a traceable calibrated ionization chamber, following the AAPM Task Group 51 procedure. EBT3 film measurements were also performed to measure entrance dose. The output stability of the imaging beam was monitored for five months. Coincidence of 2.5 MV imaging beam with 6 MV therapy beam was verified with hidden-target cubic phantom. Image quality was studied using the Leeds and QC3 phantom. The depth of maximum dose, dmax, and percent dose at 10 cm depth were, respectively, 5.7 mm and 51.7% for CC13, 6.1 mm and 51.9% for Markus chamber, and 5.1 mm and 51.9% for EBT3 film. The 2.5 MV beam quality is slightly inferior to that of a 60Co teletherapy beam; however, an estimated kQ of 1.00 was used for output calibration purposes. The beam output was found to be stable to within 1% over a five-month period. The relative entrance dose as measured with EBT3 films was 63%, compared to 23% for a clinical 6 MV beam for a 10 × 10 cm2 field. Overall coincidence of the 2.5 MV imaging beam with the 6 MV clinical therapy beam was within 0.2 mm. Image quality results for two com-monly used imaging phantoms were superior for the 2.5 MV beam when compared to the conventional 6 MV beam. The results from measurements on two TrueBeam accelerators show that 2.5 MV imaging beam is slightly softer than a therapeutic 60Co beam, it provides superior image quality than a 6 MV therapy beam, and has excellent output stability. These 2.5 MV beam characterization results can serve as reference for clinics planning to commission and use this novel energy-image modality.

Evaluation of MVCT imaging dose levels during helical IGRT: comparison between ion chamber, TLD, and EBT3 films

The purpose of this investigation was to evaluate the dose on megavoltage CT (MVCT) images required for tomotherapy. As imaging possibilities are often used before each treatment and usually used several times before the session, we tried to evaluate the dose delivered during the procedure. For each scanning mode (fine, normal, and coarse), we first established the relative variation of these doses according to different technical parameters (explored length, patient setup). These dose variations measured with the TomoPhant, also known as Cheese phantom, showed the expected variations (due to the variation of scattered radiation) of 15% according to the explored length and ± 5% according to the phantom setup (due to the variation of the point of measurement in the bore). In order to estimate patient doses, an anthropomorphic phantom was used for thermoluminescent and film dosimetry. The degree of agreement between the two methods was very satisfactory (the differences correspond to 5 mGy per imaging session) for the three sites studied (head & neck, thorax, and abdomen). These measurements allowed us to estimate the delivered dose of between 1 cGy and 4 cGy according to the site and imaging mode. Finally, we attempted to investigate a way to calculate this delivered dose in our patients from the study conducted on a cylindrical phantom and by taking into account data from the initial kV-CT scan. The results we obtained were close to our measurements, with discrepancies below 5 mGy per MVCT.

Gafchromic EBT3 film dosimetry in electron beams - energy dependence and improved film read-out

For megavoltage photon radiation, the fundamental dosimetry characteristics of Gafchromic EBT3 film were determined in 60Co gamma ray beam with addition of experimental and Monte Carlo (MC)-simulated energy dependence of the film for 6 MV photon beam and 6 MeV, 9 MeV, 12 MeV, and 16 MeV electron beams in water phantom. For the film read-out, two phase correction of scanner sensitivity was applied: a matrix correction for scanning area and dose-dependent correction by iterative procedure. With these corrections, the uniformity of response can be improved to be within ± 50 pixel values (PVs). To improve the read-out accuracy, a procedure with flipped film orientations was established. With the method, scanner uniformity can be improved further and dust particles, scratches and/or dirt on scan-ner glass can be detected and eliminated. Responses from red and green channels were averaged for read-out, which decreased the effect of noise present in values from separate channels. Since the signal level with the blue channel is considerably lower than with other channels, the signal variation due to different perturbation effects increases the noise level so that the blue channel is not recommended to be used for dose determination. However, the blue channel can be used for the detection of emulsion thickness variations for film quality evaluations with unexposed films. With electron beams ranging from 6 MeV to 16 MeV and at reference measurement conditions in water, the energy dependence of the EBT3 film is uniform within 0.5%, with uncertainties close to 1.6% (k = 2). Including 6 MV photon beam and the electron beams mentioned, the energy dependence is within 1.1%. No notable differences were found between the experimental and MC-simulated responses, indicating negligible change in intrinsic energy dependence of the EBT3 film for 6 MV photon beam and 6 MeV-16 MeV electron beams. Based on the dosimetric characteristics of the EBT3 film, the read-out procedure established, the nearly uniform energy dependence found and the estimated uncertainties, the EBT3 film was concluded to be a suitable 2D dosimeter for measuring electron or mixed photon/electron dose distributions in water phantom. Uncertainties of 3.7% (k = 2) for absolute and 2.3% (k = 2) for relative dose were estimated.

Acceptance, commissioning and clinical use of the WOmed T-200 kilovoltage X-ray therapy unit

OBJECTIVE

The objective of this work was to characterize the performance of the WOmed T-200-kilovoltage (kV) therapy machine.

METHODS

Mechanical functionality, radiation leakage, alignment and interlocks were investigated. Half-value layers (HVLs) (first and second HVLs) from X-ray beams generated from tube potentials between 30 and 200 kV were measured. Reference dose was determined in water. Beam start-up characteristics, dose linearity and reproducibility, beam flatness, and uniformity as well as deviations from inverse square law were assessed. Relative depth doses (RDDs) were determined in water and water-equivalent plastic. The quality assurance program included a dosimetry audit with thermoluminescent dosemeters.

RESULTS

All checks on machine performance were satisfactory. HVLs ranged between 0.45-4.52 mmAl and 0.69-1.78 mmCu. Dose rates varied between 0.2 and 3 Gy min(-1) with negligible time-end errors. There were differences in measured RDDs from published data. Beam outputs were confirmed with the dosimetry audit. The use of published backscatter factors was implemented to account for changes in phantom scatter for treatments with irregularly shaped fields.

CONCLUSION

Guidance on the determination of HVL and RDD in kV beams can be contradictory. RDDs were determined through measurement and curve fitting. These differed from published RDD data, and the differences observed were larger in the low-kV energy range.

ADVANCES IN KNOWLEDGE

This article reports on the comprehensive and novel approach to the acceptance, commissioning and clinical use of a modern kV therapy machine. The challenges in the dosimetry of kV beams faced by the medical physicist in the clinic are highlighted.

Radiochromic film calibration for low-energy seed brachytherapy dose measurement

PURPOSE

Radiochromic film dosimetry is typically performed for high energy photons and moderate doses characterizing external beam radiotherapy (XRT). The purpose of this study was to investigate the accuracy of previously established film calibration procedures used in XRT when applied to low-energy, seed-based brachytherapy at higher doses, and to determine necessary modifications to achieve similar accuracy in absolute dose measurements.

METHODS

Gafchromic EBT3 film was used to measure radiation doses upwards of 35 Gy from 75 kVp, 200 kVp, 6 MV, and (∼28 keV) I-125 photon sources. For the latter irradiations a custom phantom was built to hold a single I-125 seed. Film pieces were scanned with an Epson 10000XL flatbed scanner and the resulting 48-bit RGB TIFF images were analyzed using both FilmQA Pro software andMATLAB. Calibration curves relating dose and optical density via a rational functional form for all three color channels at each irradiation energy were determined with and without the inclusion of uncertainties in the measured optical densities and dose values. The accuracy of calibration curve variations obtained using piecewise fitting, a reduced film measurement area for I-125 irradiation, and a reduced number of dose levels was also investigated. The energy dependence of the film lot used was also analyzed by calculating normalized optical density values.

RESULTS

Slight differences were found in the resulting calibration curves for the various fitting methods used. The accuracy of the calibration curves was found to improve at low doses and worsen at high doses when including uncertainties in optical densities and doses, which may better represent the variability that could be seen in film optical density measurements. When exposing the films to doses > 8 Gy, two-segment piecewise fitting was found to be necessary to achieve similar accuracies in absolute dose measurements as when using smaller dose ranges. When reducing the film measurement area for the I-125 irradiations, the accuracy of the calibration curve was degraded due to the presence of localized film heterogeneities. No degradation in the calibration curves was found when reducing the number of calibration points down to only 4, but with piecewise fitting, 6 calibration points as well as a blank film are required. Variations due to photon energy in film optical density of up to 3% were found above doses of 2 Gy.

CONCLUSIONS

A modified procedure for performing EBT3 film calibration was established for use with low-energy brachytherapy seeds and high dose exposures. The energy dependence between 6 MV and I-125 photons is significant such that film calibrations should be done with an appropriately low-energy source when performing low-energy brachytherapy dose measurements. Two-segment piecewise fitting with the inclusion of errors in measured optical density as well as dose was found to result in the most accurate calibration curves. Above doses of 1 Gy, absolute dose measurements can be made with an accuracy of 1.6% for 6 MV beams and 5.7% for I-125 seed exposures if using the I-125 source for calibration, or 2.3% if using the 75 kVp photon beam for calibration.

Role of in vivo dosimetry with radiochromic films for dose verification during cutaneous radiation therapy

PURPOSE

To evaluate the role of in vivo dosimetry with radiochromic films for dose verification in cutaneous radiation therapy (RT).

METHODS

Five patients with 8 cutaneous or sub-cutaneous malignancies of the face, neck, trunk and extremity receiving RT were included. Orthovoltage, megavoltage photon therapies were applied based on anatomic location. The delivered dose for each target was measured with GAFCHROMIC EBT3TM film. The differences between the prescribed and measured doses in each target were analyzed based on the RT characteristics, target location and custom patient set up. The accuracy of EBT3TM film measurement was verified by measurements in a solid water phantom.

RESULTS

The mean measured dose was -3.2% (-9.6% to +2.3%, P=0.86) lower than prescribed over 23 measurements. A wide range of under dose was detected in orthovoltage therapy when a gap existed between skin and a closed-ended applicator surface. The magnitude of the under dosage was correlated with the degree of the gap (P=0.01). The phantom study confirmed the accuracy of GAFCHROMIC EBT3TM film measurement and found that the low measured dose in orthovoltage therapy was caused by the deviation from the inverse square law (ISL) of the beam output at extended source surface distance (SSD) for closed-ended applicators.

CONCLUSIONS

A significantly low delivered dose for extended SSD orthovoltage therapy was demonstrated during cutaneous RT. The dose fall-off with distance is not completely compensated by the ISL standoff correction for orthovoltage therapy. GAFCHROMIC EBT3™ film is a useful and accurate tool for quality assurance of patients receiving a curative intended cutaneous RT.