Dosimetric characterization and behaviour in small X-ray fields of a microchamber and a plastic scintillator detector

Grid/lattice therapy: consideration of small field dosimetry

Small-field dosimetry used in special procedures such as gamma knife, Cyberknife, Tomotherapy, IMRT, and VMAT has been in evolution after several radiation incidences with very significant (70%) errors due to poor understanding of the dosimetry. IAEA-TRS-483 and AAPM-TG-155 have provided comprehensive information on small-fields dosimetry in terms of code of practice and relative dosimetry. Data for various detectors and conditions have been elaborated. It turns out that with a suitable detectors dose measurement accuracy can be reasonably (±3%) achieved for 6 MV beams for fields >1×1 cm2. For grid therapy, even though the treatment is performed with small fields created by either customized blocks, multileaf collimator (MLC), or specialized devices, it is multiple small fields that creates combined treatment. Hence understanding the dosimetry in collection of holes of small field is a separate challenge that needs to be addressed. It is more critical to understand the scattering conditions from multiple holes that form the treatment grid fields. Scattering changes the beam energy (softer) and hence dosimetry protocol needs to be properly examined for having suitable dosimetric parameters. In lieu of beam parameter unavailability in physical grid devices, MLC-based forward and inverse planning is an alternative path for bulky tumours. Selection of detectors in small field measurement is critical and it is more critical in mixed beams created by scattering condition. Ramification of small field concept used in grid therapy along with major consideration of scattering condition is explored. Even though this review article is focussed mainly for dosimetry for low-energy megavoltage photon beam (6 MV) but similar procedures could be adopted for high energy beams. To eliminate small field issues, lattice therapy with the help of MLC is a preferrable choice.

Validation of Microionization Chambers in Small-field Dosimetry

Aim

This study aims to validate the Razor Nano Chamber (RNC) and Razor Chamber (RC) dosimetric characteristics in a small field. The dosimetric parameters of the two chambers were compared.

Materials and Methods

The chamber characteristics of leakage (pre and post), stability, energy dependency, dose linearity, dose rate effect, stem effect, angular dependency, ion recombination effect, and polarity effect were studied. Relative dose measurements of the percentage depth dose, profile measurement, and output factor (OF) measurements were performed for small fields. All measurements were performed in a Theratron 780E telecobalt unit and an Elekta Versa HD™ Linear Accelerator.

Results and Discussion

The measured pre- and postirradiation leakage and energy dependency were within 0.5% of the acceptable limit. In the stability check, the standard error and standard error of mean were 0.047% and 0.068%, respectively, for both RNC and RC. The deviation in the angular responses of the RNC and RC ion chambers was negligible. In the ion recombination measurements, both the RNC and RC were overestimated for the 10 flattening filter-free photon beam. In small fields, there were no significant differences in the kpol values for either chamber. The RNC showed good agreement in the relative dose measurements compared to the RC.

Conclusion

RNC and RC showed good agreement in small-field dosimetry. The RNC angular dependency and OF showed a superior response compared to the RC because of the small volume spherical shape and high spatial resolution, which gives a reduced penumbra and no volume averaging effect.

Small field output factor measurement and verification for CyberKnife robotic radiotherapy and radiosurgery system using 3D polymer gel, ionization chamber, diode, diamond and scintillator detectors, Gafchromic film and Monte Carlo simulation

The dosimetry of small fields has become tremendously important with the advent of intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery, where small field segments or very small fields are used to treat tumors. With high dose gradients in the stereotactic radiosurgery or radiotherapy treatment, small field dosimetry becomes challenging due to the lack of lateral electronic equilibrium in the field, x-ray source occlusion, and detector volume averaging. Small volume and tissue-equivalent detectors are recommended to overcome the challenges. With the lack of a perfect radiation detector, studies on available detectors are ongoing with reasonable disagreement and uncertainties. The joint IAEA and AAPM international code of practice (CoP) for small field dosimetry, TRS 483 (Alfonso et al., 2017) provides guidelines and recommendations for the dosimetry of small static fields in external beam radiotherapy. The CoP provides a methodology for field output factor (FOF) measurements and use of field output correction factors for a series of small field detectors and strongly recommends additional measurements, data collection and verification for CyberKnife (CK) robotic stereotactic radiotherapy/radiosurgery system using the listed detectors and more new detectors so that the FOFs can be implemented clinically. The present investigation is focused on using 3D gel along with some other commercially available detectors for the measurement and verification of field output factors (FOFs) for the small fields available in the CK system. The FOF verification was performed through a comparison with published data and Monte Carlo simulation. The results of this study have proved the suitability of an in-house developed 3D polymer gel dosimeter, several commercially available detectors, and Gafchromic films as a part of small field dosimetric measurements for the CK system.

The influence of basic plan parameters on calculated small field output factors - A multicenter study

PURPOSE

The influence of basic plan parameters such as slice thickness, grid resolution, algorithm type and field size on calculated small field output factors (OFs) was evaluated in a multicentric study.

METHODS AND MATERIALS

Three computational homogeneous water phantoms with slice thicknesses (ST) 1, 2 and 3 mm were shared among twenty-one centers to calculate OFs for 1x1, 2x2 and 3x3 cm² field sizes (FSs) (normalized to 10x10 cm² FS), with their own treatment planning system (TPS) and the energy clinically used for stereotactic body radiation therapy delivery. OFs were calculated for each combination of grid resolution (GR) (1, 2 and 3 mm) and ST and finally compared with the OFs measured for the TPS commissioning. A multivariate analysis was performed to test the effect of basic plan parameters on calculated OFs.

RESULTS

A total of 509 data points were collected. Calculated OFs are slightly higher than measured ones. The multivariate analysis showed that Center, GR, algorithm type, and FS are predictive variables of the difference between calculated and measured OFs (p < 0.001). As FS decreases, the spread in the difference between calculated and measured OFs became larger when increasing the GR. Monte Carlo and Analytical Anisotropic Algorithms, presented a dependence on GR (p < 0.01), while Collapsed Cone Convolution and Acuros did not. The effect of the ST was found to be negligible.

CONCLUSIONS

Modern TPSs slightly overestimate the calculated small field OFs compared with measured ones. Grid resolution, algorithm, center number and field size influence the calculation of small field OFs.

Report of AAPM Task Group 155: Megavoltage photon beam dosimetry in small fields and non-equilibrium conditions

Small-field dosimetry used in advance treatment technologies poses challenges due to loss of lateral charged particle equilibrium (LCPE), occlusion of the primary photon source, and the limited choice of suitable radiation detectors. These challenges greatly influence dosimetric accuracy. Many high-profile radiation incidents have demonstrated a poor understanding of appropriate methodology for small-field dosimetry. These incidents are a cause for concern because the use of small fields in various specialized radiation treatment techniques continues to grow rapidly. Reference and relative dosimetry in small and composite fields are the subject of the International Atomic Energy Agency (IAEA) dosimetry code of practice that has been published as TRS-483 and an AAPM summary publication (IAEA TRS 483; Dosimetry of small static fields used in external beam radiotherapy: An IAEA/AAPM International Code of Practice for reference and relative dose determination, Technical Report Series No. 483; Palmans et al., Med Phys 45(11):e1123, 2018). The charge of AAPM task group 155 (TG-155) is to summarize current knowledge on small-field dosimetry and to provide recommendations of best practices for relative dose determination in small megavoltage photon beams. An overview of the issue of LCPE and the changes in photon beam perturbations with decreasing field size is provided. Recommendations are included on appropriate detector systems and measurement methodologies. Existing published data on dosimetric parameters in small photon fields (e.g., percentage depth dose, tissue phantom ratio/tissue maximum ratio, off-axis ratios, and field output factors) together with the necessary perturbation corrections for various detectors are reviewed. A discussion on errors and an uncertainty analysis in measurements is provided. The design of beam models in treatment planning systems to simulate small fields necessitates special attention on the influence of the primary beam source and collimating devices in the computation of energy fluence and dose. The general requirements for fluence and dose calculation engines suitable for modeling dose in small fields are reviewed. Implementations in commercial treatment planning systems vary widely, and the aims of this report are to provide insight for the medical physicist and guidance to developers of beams models for radiotherapy treatment planning systems.

Miniaturized scintillator dosimeter for small field radiation therapy

The concept of a miniaturized inorganic scintillator detector is demonstrated in the analysis of the small static photon fields used in external radiation therapy. Such a detector is constituted by a 0.25 mm diameter and 0.48 mm long inorganic scintillating cell (1.6 × 10^-5cm³detection volume) efficiently coupled to a narrow 125μm diameter silica optical fiber using a tiny photonic interface (an optical antenna). The response of our miniaturized scintillator detector (MSD) under 6 MV bremsstrahlung beam of various sizes (from 1 × 1 cm²to 4 × 4 cm²) is compared to that of two high resolution reference probes, namely, a micro-diamond detector and a dedicated silicon diode. The spurious Cerenkov signal transmitted through our bare detector is rejected with a basic spectral filtering. The MSD shows a linear response regarding the dose, a repeatability within 0.1% and a radial directional dependence of 0.36% (standard deviations). Beam profiling at 5 cm depth with the MSD and the micro-diamond detector shows a mismatch in the measurement of the full widths at 80% and 50% of the maximum which does not exceed 0.25 mm. The same difference range is found between the micro-diamond detector and a silicon diode. The deviation of the percentage depth dose between the MSD and micro-diamond detector remains below 2.3% within the first fifteen centimeters of the decay region for field sizes of 1 × 1 cm², 2 × 2 cm²and 3 × 3 cm²(0.76% between the silicon diode and the micro-diamond in the same field range). The 2D dose mapping of a 0.6 × 0.6 cm²photon field evidences the strong 3D character of the radiation-matter interaction in small photon field regime. From a beam-probe convolution theory, we predict that our probe overestimates the beam width by 0.06%, making our detector a right compromise between high resolution, compactness, flexibility and ease of use. The MSD overcomes problem of volume averaging, stem effects, and despite its water non-equivalence it is expected to minimize electron fluence perturbation due to its extreme compactness. Such a detector thus has the potential to become a valuable dose verification tool in small field radiation therapy, and by extension in Brachytherapy, FLASH-radiotherapy and microbeam radiation therapy.

[Characterization of Small Volume Plastic Scintillation Detector]

Some radiation detectors are used for quality assurance and measured to radiation dose for high precision external beam radiotherapy. Recently, plastic scintillation detectors for MeV X-ray measurement are commercially released. The purpose of this study was to evaluate the performance of a commercial plastic scintillation detector with respect to the dose linearity, dose rate dependence, and the output coefficient compared the ionization chamber and the semiconductor detector using each different X-ray energy with or without flattening filter. The result that the dose linearity of each detector showed a linear response in any detectors. Dose rate dependence of plastic scintillation detector was increased when setting dose rate was changed, especially setting to low dose rate. The output coefficient of plastic scintillation detector was equivalent as that of the semiconductor detector even in smallest irradiation field. In conclusion, it was suggested that the plastic scintillation detector is a suitable detector in dose verification measurements for high precision external beam radiotherapy, although we must be with care to low dose rate measurements.

Temporal separation of Cerenkov radiation and scintillation using a clinical LINAC and artificial intelligence

Convolutional neural network (CNN) type artificial intelligences were trained to estimate the Cerenkov radiation present in the temporal response of a LINAC irradiated scintillator-fiber optic dosimeter. The CNN estimate of Cerenkov radiation is subtracted from the combined scintillation and Cerenkov radiation temporal response of the irradiated scintillator-fiber optic dosimeter, giving the sole scintillation signal, which is proportional to the scintillator dose. The CNN measured scintillator dose was compared to the background subtraction measured scintillator dose and ionisation chamber measured dose. The dose discrepancy of the CNN measured dose was on average 1.4% with respect to the ionisation chamber measured dose, matching the 1.4% average dose discrepancy of the background subtraction measured dose with respect to the ionisation chamber measured dose. The developed CNNs had an average time of 3 ms to calculate scintillator dose, permitting the CNNs presented to be applicable for dosimetry in real time.