A preliminary study of multispectral Cherenkov imaging and a Fricke-xylenol orange gel film (MCIFF) for online, absolute dose measurement

BACKGROUND

Cherenkov luminescence imaging has shown potential for relative dose distribution and field verification in radiation therapy. However, to date, limited research utilizing Cherenkov luminescence for absolute dose calibration has been conducted owing to uncertainties arising from camera positioning and tissue surface optical properties.

PURPOSE

This paper introduces a novel approach to multispectral Cherenkov luminescence imaging combined with Fricke-xylenol orange gel (FXG) film, termed MCIFF, which can enable online full-field absolute dose measurement. By integrating these two approaches, MCIFF allows for calibration of the ratio between two spectral intensities with absorbed dose, thereby enabling absolute dose measurement.

METHODS

All experiments are conducted on a Varian Clinac 23EX, utilizing an electron multiplying charge-coupled device (EMCCD) camera and a two-way image splitter for simultaneous capture of two-spectral Cherenkov imaging. In the first part of this study, the absorbance curves of the prepared FXG film, which receives different doses, are measured using a fluorescence spectrophotometer to verify the correlation between absorbance and dose. In the second part, the FXG film is positioned directly under the radiation beam to corroborate the dose measurement capacity of MCIFF across various beams. In the third part, the feasibility of MCIFF is tested in actual radiotherapy settings via a humanoid model, demonstrating its versatility with various radiotherapy materials.

RESULTS

The results of this study indicate that the logarithmic ratios of spectral intensities at wavelengths of 550 ± 50 and 700 ± 100 nm accurately reflect variations in radiation dose (R2 > 0.96) across different radiation beams, particle energies, and dose rates. The slopes of the fitting lines remain consistent under varying beam conditions, with discrepancies of less than 8%. The optical profiles obtained using the MCIFF exhibit a satisfactory level of agreement with the measured results derived from the treatment planning system (TPS) and EBT3 films. Specifically, for photon beams, the lateral distances between the 80% and 20% isodose lines, referred to as the penumbra (P80-20) values, obtained through TPS, EBT3 films, and MCIFF, are determined as 0.537, 0.664, and 0.848 cm, respectively. Similarly, for electron beams, the P80-20 values obtained through TPS, EBT3 films, and MCIFF are found to be 0.432, 0.561, and 0.634 cm, respectively. Furthermore, imaging of the anthropomorphic phantom demonstrates the practical application of MCIFF in real radiotherapy environments.

CONCLUSION

By combining an FXG film with Cherenkov luminescence imaging, MCIFF can calibrate Cherenkov luminescence to absorbed dose, filling the gap in online 2D absolute dose measurement methods in clinical practice, and providing a new direction for the clinical application of optical imaging to radiation therapy.

A protocol for accurate radiochromic film dosimetry using Radiochromic.com

BACKGROUND

Radiochromic films have many applications in radiology and radiation therapy. Generally, the dosimetry system for radiochromic film dosimetry is composed of radiochromic films, flatbed scanner, and film analysis software. The purpose of this work is to present the effectiveness of a protocol for accurate radiochromic film dosimetry using Radiochromic.com as software for film analysis.

MATERIALS AND METHODS

Procedures for image acquisition, lot calibration, and dose calculation are explained and analyzed. Radiochromic.com enables state-of-the-art models and corrections for radiochromic film dosimetry, such as the Multigaussian model for multichannel film dosimetry, and lateral, inter-scan, and re-calibration corrections of the response.

RESULTS

The protocol presented here provides accurate dose results by mitigating the sources of uncertainty that affect radiochromic film dosimetry.

CONCLUSIONS

Appropriate procedures for film and scanner handling in combination with Radiochromic.com as software for film analysis make easy and accurate radiochromic film dosimetry feasible.

Evaluation of monoxide film-based dosimeters for surface dose detection in electron therapy

Generally, electron therapy is applied to tumors on or close to the skin surface. However, this causes a variety of skin-related side effects. To alleviate the risk of these side effects, clinical treatment uses skin dosimeters to verify the therapeutic dose. However, dosimeters suffer from poor accuracy, because their attachment sites are approximated with the help of naked eyes. Therefore, a dosimeter based on a flexible material that can adjust to the contours of the human body is required. In this study, the reproducibility, linearity, dose-rate dependence, and percentage depth ionization (PDI) of PbO and HgO film-based dosimeters are evaluated to explore their potential as large-scale flexible dosimeters. The results demonstrate that both dosimeters deliver impressive reproducibility (within 1.5%) and linearity (≥ 0.9990). The relative standard deviations of the dose-rate dependence of the PbO and HgO dosimeters were 0.94% and 1.16% at 6 MeV, respectively, and 1.08% and 1.25% at 9 MeV, respectively, with the PbO dosimeter outperforming the 1.1% of existing diodes. The PDI analysis of the PbO and HgO dosimeters returned values of 0.014 cm (-0.074 cm) and 0.051 cm (-0.016 cm), respectively at 6 MeV (9 MeV) compared to the thimble chamber and R50. Therefore, the maximum error of each dosimeter is within the allowable range of 0.1 cm. In short, the analysis reveals that the PbO dosimeter delivers a superior performance relative to its HgO counterpart and has strong potential for use as a surface dosimeter. Thus, flexible monoxide materials have the necessary qualities to be used for dosimeters that meet the requisite quality assurance standards and can satisfy a variety of radiation-related applications as flexible functional materials.

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.

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.

MEASUREMENT OF OPERATIONAL QUANTITIES Hp(0.07) AND Hp(3) FOR INDIGENOUSLY DEVELOPED 106Ru/106Rh SOURCE USING AN EXTRAPOLATION CHAMBER

In the present study, a prototype 106Ru/106Rh source was fabricated using high level liquid waste from reactor fuel, fixed in a stainless steel housing with a window and backing made of silver. The study involves measurement of the operational quantities Hp(0.07), Hp(3) and the percentage depth dose (PDD) using an extrapolation chamber. It also involves determination of necessary correction factors to arrive at Hp(0.07) and Hp(3) following International Organisation for Standardisation (ISO) and methods suggested in literature. The study facilitates incorporation of the 106Ru/106Rh source as a beta reference source for quality assurance programme in TLD personnel monitoring as per the guidelines of ISO.

PSEUDO-3D IMRT VERIFICATION WITH EBT3 RADIOCHROMIC FILM

This work proposes a new method for pseudo-3D verification of intensity-modulated radiation therapy (IMRT) dose distributions. Unlike commercial solutions, it uses measured doses only for gamma evaluation. Its resolution is far better than with electronic detectors within the measured plane and comparable in other directions. It is readily available at clinics because it uses existing resources-a slab phantom and EBT3 films. The method was tested on six IMRT clinical cases. An in-house code for 2D and pseudo-3D gamma analysis was written in MATLAB and compared to OmniPro I'mRT.

COMPARISON OF DIFFERENT TECHNIQUES FOR EVALUATION OF DOSE DISTRIBUTIONS IN RADIOTHERAPY USING RADIOCHROMIC EBT3 FILMS

In radiotherapy, radiochromic films can be used for verification of delivery of dose distributions calculated by treatment planning systems. The main objective of this work was to compare three different techniques for evaluation of dose distributions for prostate cancer treatment plans using radiochromic EBT3 films. These techniques are: red channel evaluation taking into account only a response of irradiated film (R), red channel evaluation taking into account a response of unirradiated and irradiated film (Rcor) and multichannel evaluation in FilmQA software (RGB). Also comparison between film and MatriXX measurement was performed. Comparison showed that gamma analysis passing rates strongly depend on evaluation technique and on a model of scanner for digitizing films. The highest gamma passing rates were obtained with red channel evaluation taking into account a response of unirradiated and irradiated film using Epson V750 scanner (Rcor) and multichannel evaluation in FilmQA using Epson 11000XL scanner.

Two-dimensional solid-state array detectors: A technique for in vivo dose verification in a variable effective area

Purpose

We introduce a technique that employs a 2D detector in transmission mode (TM) to verify dose maps at a depth of d_max in Solid Water. TM measurements, when taken at a different surface‐to‐detector distance (SDD), allow for the area at d_max (in which the dose map is calculated) to be adjusted.

Methods

We considered the detector prototype “MP512” (an array of 512 diode‐sensitive volumes, 2 mm spatial resolution). Measurements in transmission mode were taken at SDDs in the range from 0.3 to 24 cm. Dose mode (DM) measurements were made at d_max in Solid Water. We considered radiation fields in the range from 2 × 2 cm² to 10 × 10 cm², produced by 6 MV flattened photon beams; we derived a relationship between DM and TM measurements as a function of SDD and field size. The relationship was used to calculate, from TM measurements at 4 and 24 cm SDD, dose maps at d_max in fields of 1 × 1 cm² and 4 × 4 cm², and in IMRT fields. Calculations were cross‐checked (gamma analysis) with the treatment planning system and with measurements (MP512, films, ionization chamber).

Results

In the square fields, calculations agreed with measurements to within ±2.36%. In the IMRT fields, using acceptance criteria of 3%/3 mm, 2%/2 mm, 1%/1 mm, calculations had respective gamma passing rates greater than 96.89%, 90.50%, 62.20% (for a 4 cm SSD); and greater than 97.22%, 93.80%, 59.00% (for a 24 cm SSD). Lower rates (1%/1 mm criterion) can be explained by submillimeter misalignments, dose averaging in calculations, noise artifacts in film dosimetry.

Conclusions

It is possible to perform TM measurements at the SSD which produces the best fit between the area at d_max in which the dose map is calculated and the size of the monitored target.

Dose-response linearization in radiochromic film dosimetry based on multichannel normalized pixel value with an integrated spectral correction for scanner response variations

PURPOSE

To introduce a model that reproducibly linearizes the response from radiochromic film (RCF) dosimetry systems at extended dose range. To introduce a correction method, generated from the same scanned images, which corrects for scanner temporal response variation and scanner bed inhomogeneity.

METHODS

Six calibration curves were established for different lot numbers of EBT3 GAFCHROMIC™ film model based on four EPSON scanners [10000XL (2 units), 11000XL, 12000XL] at three different centers. These films were calibrated in terms of absorbed dose to water based on TG51 protocol or TRS398 with dose ranges up to 40 Gy. The film response was defined in terms of a proposed normalized pixel value ( n P V RGB ) as a summation of first-order equations based on information from red, green, and blue channels. The fitting parameters of these equations are chosen in a way that makes the film response equal to dose at the time of calibration. An integrated set of correction factors (one per color channel) was also introduced. These factors account for the spatial and temporal changes in scanning states during calibration and measurements. The combination of n P V RGB and this "fingerprint" correction formed the basis of this new protocol and it was tested against net optical density ( n e t O D X = R , G , B ) single-channel dosimetry in terms of accuracy, precision, scanner response variability, scanner bed inhomogeneity, noise, and long-term stability.

RESULTS

Incorporating multichannel features (RGB) into the normalized pixel value produced linear response to absorbed dose (slope of 1) in all six RCF dosimetry systems considered in this study. The "fingerprint" correction factors of each of these six systems displayed unique patterns at the time of calibration. The application of n P V RGB to all of these six systems could achieve a level of accuracy of ± 2.0% in the dose range of interest within modeled uncertainty level of 2.0%-3.0% depending on the dose level. Consistent positioning of control and measurement film pieces and integrating the multichannel correction into the response function formalism mitigated possible scanner response variations of as much as ± 10% at lower doses and scanner bed inhomogeneity of ± 8% to the established level of uncertainty at the time of calibration. The system was also able to maintain the same level of accuracy after 3 and 6 months post calibration.

CONCLUSIONS

Combining response linearity with the integrated correction for scanner response variation lead to a sustainable and practical RCF dosimetry system that mitigated systematic response shifts and it has the potential to reduce errors in reporting relative information from the film response.

High resolution radiochromic film dosimetry: Comparison of a microdensitometer and an optical microscope

PURPOSE

Microbeam radiation therapy is a developing technique that promises superior tumour control and better normal tissue tolerance using spatially fractionated X-ray beams only tens of micrometres wide. Radiochromic film dosimetry at micrometric scale was performed using a microdensitometer, but this instrument presents limitations in accuracy and precision, therefore the use of a microscope is suggested as alternative. The detailed procedures developed to use the two devices are reported allowing a comparison.

METHODS

Films were irradiated with single microbeams and with arrays of 50 µm wide microbeams spaced by a 400 µm pitch, using a polychromatic beam with mean energy of 100 keV. The film dose measurements were performed using two independent instruments: a microdensitometer (MDM) and an optical microscope (OM).

RESULTS

The mean values of the absolute dose measured with the two instruments differ by less than 5% but the OM provides reproducibility with a standard deviation of 1.2% compared to up to 7% for the MDM. The resolution of the OM was determined to be ~ 1 to 2 µm in both planar directions able to resolve pencil beams irradiation, while the MDM reaches at the best 20 µm resolution along scanning direction. The uncertainties related to the data acquisition are 2.5-3% for the OM and 9-15% for the MDM.

CONCLUSION

The comparison between the two devices validates that the OM provides equivalent results to the MDM with better precision, reproducibility and resolution. In addition, the possibility to study dose distributions in two-dimensions over wider areas definitely sanctions the OM as substitute of the MDM.

The effect of magnetic field strength on the response of Gafchromic EBT-3 film

With the advent of MRI-guided radiotherapy, the suitability of commercially available radiation dose detectors needs to be assessed. The aim of this study was to investigate the effect of the magnetic field (B-field) on the response of the Gafchromic EBT-3 films. Moreover, as an independent study, we contribute to clarifying the inconsistency of the results of recent published studies, on the effect of B-field on the sensitivity of Gafchromic films. A 60Co beam was used to irradiate film samples in an electromagnet. An in-house PMMA phantom was designed to fit in the 5 cm gap between the two poles of the magnet. The phantom consists of two symmetrical plates where a film can be inserted. The absorbed dose rate of the 60Co beam for zero B-field was measured using alanine pellets in a Farmer-type holder. A 12-point response curve was created, representing [Formula: see text] as a function of dose, for each of five different B-field strengths (0 T to 2 T). This study finds that there is at most a small effect of the magnetic field on the response of EBT-3 film. In terms of netOD (red channel) the change in response varied from ‒0.0011 at 0.5 T to 0.0045 at 2.0 T, with a standard uncertainty of 0.0030. If uncorrected, this would lead to an error in film-measured dose, for the red channel, of 2.4% at 2 T, with a standard uncertainty on dose of 1.4%. Results are also presented for B-field strengths of 0.5 T, 1 T and 1.5 T, which are all zero within the measurement uncertainty. Comparison between other studies is also presented. Considering the small change on dose determined with EBT-3 when irradiated under the presence of B-field and taking into account the overall uncertainty in dosimetry using EBT-3 film achieved in this work, EBT-3 is assessed to be a suitable detector for relative and absolute dosimetry, with appropriate corrections, in MRI-guided radiotherapy. The results of the current work also elucidate the inconsistency on the reports from previous studies and demonstrate the necessity of similar investigations by independent teams, especially if the existing results may be in conflict.

LET dependent response of GafChromic films investigated with MeV ion beams

The change in optical properties of GafChromic films depends not only on the absorbed dose, but also on the linear energy transfer (LET) of the ionizing radiation. The influence of LET on the film dose-response relationship is especially important when films are applied for dosimetry of energetic charged particles. In the present study, we examined the response of the unlaminated EBT3 and MD-V3 films to proton, deuterium and helium beams with energies in the range of several megaelectronvolts (MeV). Films were exposed to doses up to 200 Gy and a model based on the bimolecular chemical reaction was chosen to fit the measured film signals. The LET in the active layers of the films and the dose correction factors were computed with Monte Carlo software TRIM. Signal quenching, observed for all ion beams in comparison to x-rays, was investigated as a function of the LET in the range of 10-100 keV µm-1. The response of the films got weaker with increasing the LET and showed no dependence on the ion species. The LET effect was quantified by introducing a modified expression for the relative effectiveness (RE) by which a unique RE value is assigned to a single LET. The RE defined in that way decreased from about 90% for LET of 10 keV µm-1 to less than 50% for LET of 100 keV µm-1. Similar behavior was observed for EBT3 and MD-V3 film models.

A NEW GENERATION OF PASSIVE RADON MONITORS: THE FILM-BADGES FOR OCCUPATIONAL EXPOSURES

The passive radon monitors are typically formed by a radon-diffusion chamber, enclosing a track detector or an electret. Recently, new passive Rn monitors have been developed, which are similar to the neutron film badges. These badges present unique characteristics for the assessment of the occupational exposure to radon, such as compactness, fast-time response and any desired response sensitivity. Finally, these badges make it very easy to stop and to start the measurements, as required for assessment of the occupational exposures, which operations are very difficult, if not impossible, to achieve with existing monitors. These radon badges are based on the radon sorption by solid materials, namely plastics for radon absorption and activated carbon cloths for radon adsorption. Plastics may have a rubber-like (e.g. silicone) or a glass-like morphology (e.g. polycarbonate). The most interesting materials for these applications are the glass-like solids, the properties of which are expected to be little dependent on temperature. If radon badges with a large response sensitivity are desired, then adsorptive radiators formed by thin layers of activated carbon tissues are used. The key strategy, adopted for the radon film badges, was to use radiators into which radon diffuses rapidly, in order to ensure a fast-time response for radon monitoring. All the Rn film-badges, listed above, are formed by the same very compact device and may have response sensitivities, which may differ by several orders of magnitude.

CALIBRATION OF GAFCHROMIC EBT3 FILM FOR DOSIMETRY OF SCANNING PROTON PENCIL BEAM (PBS)

Gafchromic EBT3 films are applied in proton radiotherapy for 2D dose mapping because they demonstrate spatial resolution well below 1 mm. However, the film response must be corrected in order to reach the accuracy of dose measurements required for the clinical use. The in-house developed AnalyseGafchromic software allows to analyze and correct the measured response using triple channel dose calibration, statistical scan-to-scan fluctuations as well as experimentally determined dose and LET dependence. Finally, the optimized protocol for evaluation of response of Gafchromic EBT3 films was applied to determine 30 × 40 cm2 dose profiles of the scanning therapy unit at the Cyclotron Centre Bronowice, CCB in Krakow, Poland.

CHARACTERIZATION OF 27 MEV PROTON BEAM GENERATED BY TOP-IMPLART LINEAR ACCELERATOR

The first proton linear accelerator for tumor therapy based on an actively scanned beam up to the energy of 150 MeV, is under development and construction by ENEA-Frascati, ISS and IFO, under the Italian TOP-IMPLART project. Protons up to the energy of 7 MeV are generated by a customized commercial injector operating at 425 MHz; currently three accelerating modules allow proton delivery with energy up to 27 MeV. Beam homogeneity and reproducibility were studied using a 2D ionizing chamber, EBT3 films, a silicon diode, MOSFETs, LiF crystals and alanine dosimetry systems. Measurements were taken in air with the detectors at ~1 m from the beam line exit window. The maximum energy impinging on the detectors surface was 24.1 MeV, an energy suitable for radiobiological studies. Results showed beam reproducibility within 5% and homogeneity within 4%, on a circular surface of 16 mm in diameter.

EXPERIMENTAL EVALUATION OF DOSIMETRIC CHARACTERIZATION OF GAFCHROMIC EBT3 AND EBT-XD FILMS FOR CLINICAL CARBON ION BEAMS

Radiochromic film is a very useful tool for 2D dosimetric measurements in radiotherapy because it is self-developing and has very high-spatial resolution. However, considerable care has to be taken in ion beam radiotherapy owing to the quenching effect of high-linear energy transfer (LET) radiation. In this study, the dose responses of GAFchromic EBT3 and EBT-XD films were experimentally investigated using the clinical carbon ion beam at the Heavy Ion Medical Accelerator in Chiba. Results showed that the relations between absorbed dose and net optical density could be expressed well using an equation proposed by Reinhardt (2015). The quenching effect was evaluated by determining their relative efficiencies for photon irradiation as a function of LET. A correction equation derived in this study allowed the absorbed dose to be determined in the small irradiation field used for carbon ion radiotherapy eye treatments. This study contributes to establishing an absolute dosimetry procedure for heavy ion beams using radiochromic film.

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.

Physics aspects of the Papillon technique-Five decades later

PURPOSE

The Papillon technique using 50-kVp soft X-rays to treat rectal adenocarcinomas was developed and clinically implemented in the 1960s. We describe differences between accurate dosimetry and clinical implementation of this technique that is extending from its very inception to date.

METHODS AND MATERIALS

A renaissance of the Papillon technique occurred with two recently introduced 50-kVp systems: Papillon+ by Ariane and a custom-made rectal applicator (consisting of a surface applicator inserted into a proctoscope) by iCAD's Xoft Axxent Electronic Brachytherapy (eBT) System (iCad, Inc., Sunnyvale, CA). In contrast to the initial design, we investigated the impact of introducing a plastic lid, which would provide more reproducible and more accurate dose delivery across the rectal adenocarcinoma patient population. We use both parallel-plate chamber and radiochromic film dosimeters to determine differences in basic dosimetry characteristics (beam half-value layers, outputs, percent depth doses, and profiles) between the Xoft Electronic Brachytherapy rectal applicator system with and without the plastic lid in place.

RESULTS

Compared to the open-cone applicator, the proposed applicator with the plastic lid produces a slightly harder (more penetrating) beam quality (half-value layer of 1.4 vs. 1.3-mm Al), but with reduced output (by 33%), and a slightly broader beam with flatness not worse than 3% and symmetry not worse than 2%.

CONCLUSIONS

In addition to characterizing beam properties modified by the possible introduction of the plastic cap, we also pointed out and addressed misconceptions in the use of radiochromic films for dose measurements at low-energy photon beams.

Gafchromic EBT-XD film: Dosimetry characterization in high-dose, volumetric-modulated arc therapy

Radiochromic films are important tools for assessing complex dose distributions. Gafchromic EBT-XD films have been designed for optimal performance in the 40-4,000 cGy dose range. We investigated the dosimetric characteristics of these films, including their dose-response, postexposure density growth, and dependence on scanner orientation, beam energy, and dose rate with applications to high-dose volumetric-modulated arc therapy (VMAT) verification. A 10 MV beam from a TrueBeam STx linear accelerator was used to irradiate the films with doses in the 0-4,000 cGy range. Postexposure coloration was analyzed at postirradiation times ranging from several minutes to 48 h. The films were also irradiated with 6 MV (dose rate (DR): 600 MU/min), 6 MV flattening filter-free (FFF) (DR: 1,400 MU/ min), and 10 MV FFF (DR: 2,400 MU/min) beams to determine the energy and dose-rate dependence. For clinical examinations, we compared the dose distribu-tion measured with EBT-XD films and calculated by the planning system for four VMAT cases. The red channel of the EBT-XD film exhibited a wider dynamic range than the green and blue channels. Scanner orientation yielded a variation of ~ 3% in the net optical density (OD). The difference between the film front and back scan orientations was negligible, with variation of ~ 1.3% in the net OD. The net OD increased sharply within the first 6 hrs after irradiation and gradually afterwards. No significant difference was observed for the beam energy and dose rate, with a variation of ~ 1.5% in the net OD. The gamma passing rates (at 3%, 3 mm) between the film- measured and treatment planning system (TPS)-calculated dose distributions under a high dose VMAT plan in the absolute dose mode were more than 98.9%.

EURADOS INTERCOMPARISONS ON WHOLE-BODY DOSEMETERS FOR PHOTONS FROM 2008 TO 2014

Starting in 2008 the European Dosimetry Group (EURADOS) has been performing international intercomparisons on photon whole-body dosemeters for individual monitoring services. These intercomparisons were organised (on a biannual basis) in 2008, 2010, 2012 and 2014, each time with a similar set-up but with small alterations in the subsequent irradiation plans. With an increasing number of participants and participating systems, this intercomparison action has become an important tool for individual monitoring services to test their whole-body dosimetry systems, compare their results with other services or systems and to improve the quality of their dosimetry. The paper presents and compares the results of these four intercomparisons and compares the dosimetric results for the participating system types. Major dosimetric problems of the individual monitoring services are identified, and trends in the dosimetric performance of the different systems are shown. This gives the opportunity to identify some dosimetry issues that should be improved by application of the monitoring services' quality assurance systems and QA procedures.

RESPONSE OF DOSEMETERS IN FIELDS GENERATED BY LASER-ACCELERATED PROTONS

In laser-driven acceleration, ultra-short and intense laser pulses are focussed on targets to generate beams of ionising radiation. One of the most important issues to be addressed is personal monitoring. While traditional dosemeters were designed primarily for measurements in continuous fields, dosemeters for laser laboratories must be capable of working in pulsed fields of pulse length below 1 ps, in a single-shot regime up to the repetition rate of 1 kHz. Responses of conventional dosemeters (films, polyallyldiglycol carbonate, electronic personal dosemeter) to proton bunches of up to 30 MeV energy produced by South Korean PW laser system at the Advanced Photonics Research Institute, Gwangju Institute of Science and Technology were studied, both by means of Monte Carlo simulations and experimentally.

Absolute dosimetric characterization of Gafchromic EBT3 and HDv2 films using commercial flat-bed scanners and evaluation of the scanner response function variability

Radiochromic films (RCF) are commonly used in dosimetry for a wide range of radiation sources (electrons, protons, and photons) for medical, industrial, and scientific applications. They are multi-layered, which includes plastic substrate layers and sensitive layers that incorporate a radiation-sensitive dye. Quantitative dose can be retrieved by digitizing the film, provided that a prior calibration exists. Here, to calibrate the newly developed EBT3 and HDv2 RCFs from Gafchromic™, we used the Stanford Medical LINAC to deposit in the films various doses of 10 MeV photons, and by scanning the films using three independent EPSON Precision 2450 scanners, three independent EPSON V750 scanners, and two independent EPSON 11000XL scanners. The films were scanned in separate RGB channels, as well as in black and white, and film orientation was varied. We found that the green channel of the RGB scan and the grayscale channel are in fact quite consistent over the different models of the scanner, although this comes at the cost of a reduction in sensitivity (by a factor ∼2.5 compared to the red channel). To allow any user to extend the absolute calibration reported here to any other scanner, we furthermore provide a calibration curve of the EPSON 2450 scanner based on absolutely calibrated, commercially available, optical density filters.

VERIFICATION OF INDICATED SKIN ENTRANCE AIR KERMA FOR CARDIAC X-RAY-GUIDED INTERVENTION USING GAFCHROMIC FILM

The aim of this work was to verify the indicated maximum entrance surface air kerma (ESAK) using a GE Innova IGS 520 imaging system during cardiac interventional procedures. Gafchromic XR RV3 films were used for the patient measurements to monitor the maximum ESAK. The films were scanned and calibrated to measure maximum ESAK. Thermoluminescent dosemeters were used to measure the backscatter factor from an anthropomorphic thorax phantom. The measured backscatter factor, 1.53, was in good agreement with Monte Carlo simulations but higher than the one used by the imaging system, 1.20. The median of the ratio between indicated maximum ESAK and measured maximum ESAK was 0.68. In this work, the indicated maximum ESAK by the imaging system's dose map model underestimates the measured maximum ESAK by 32 %. The threshold ESAK for follow-up procedures for patient with skin dose in excess of 2 Gy will be reduced to 1.4 Gy.

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.

Gafchromic XR-QA2 film as a complementary dosimeter for hand-monitoring in CTF-guided biopsies

Computed tomography fluoroscopy (CTF) is a useful imaging technique to guide biopsies, particularly lung biopsies, but it also has the potential for very high hand exposures, despite use of quick-check method and needle holders whenever feasible. Therefore, reliable monitoring is crucial to ensure the safe use of CTF. This is a challenge, because ring dosimeters monitor exposure only at the base of one finger, while the fingertips may be exposed to the highly collimated CT beam. In this work we have explored the possibility of using Gafchromic XR-QA2 self-developing film as a complementary dosimeter to quantify hand exposure during CTF-guided biopsies. A glove used in a previous study and designed to contain 11 TLDs was adapted to include Gafchromic strips 7 mm wide, covering the fingers. A total of 22 biopsies were successfully performed wearing this GafTLD glove under sterile gloves, and the IR reported no difficulty or reduction of dexterity while wearing it. Comparison of dose distributions obtained from digitization of the Gafchromic film strips and absolute Hp(0.07) readings from TLDs showed good agreement, despite some positional uncertainty due to relative movement. Per procedure, doses at the base of the ring finger can be as low as 3%-8% of hand dose maximum. Accumulated dose at the base of the ring finger was four times lower than the dose maximum.

A new transmission methodology for quality assurance in radiotherapy based on radiochromic film measurements

Despite individual quality assurance (QA) being recommended for complex techniques in radiotherapy (RT) treatment, the possibility of errors in dose delivery during therapeutic application has been verified. Therefore, it is fundamentally important to conduct in vivo QA during treatment. This work presents an in vivo transmission quality control methodology, using radiochromic film (RCF) coupled to the linear accelerator (linac) accessory holder. This QA methodology compares the dose distribution measured by the film in the linac accessory holder with the dose distribution expected by the treatment planning software. The calculated dose distribution is obtained in the coronal and central plane of a phantom with the same dimensions of the acrylic support used for positioning the film but in a source-to-detector distance (SDD) of 100 cm, as a result of transferring the IMRT plan in question with all the fields positioned with the gantry vertically, that is, perpendicular to the phantom. To validate this procedure, first of all a Monte Carlo simulation using PENELOPE code was done to evaluate the differences between the dose distributions measured by the film in a SDD of 56.8 cm and 100 cm. After that, several simple dose distribution tests were evaluated using the proposed methodology, and finally a study using IMRT treatments was done. In the Monte Carlo simulation, the mean percentage of points approved in the gamma function comparing the dose distribution acquired in the two SDDs were 99.92% ± 0.14%. In the simple dose distribution tests, the mean percentage of points approved in the gamma function were 99.85% ± 0.26% and the mean percentage differences in the normalization point doses were -1.41%. The transmission methodology was approved in 24 of 25 IMRT test irradiations. Based on these results, it can be concluded that the proposed methodology using RCFs can be applied for in vivo QA in RT treatments.

A comparative study of adult patient doses in film screen and computed radiography in some Sudanese hospitals

A study was performed to compare adult patient doses in film screen (FS) and computed radiography (CR) diagnostic X-ray examinations in some hospitals in Sudan over a period of 1 y; during this period of time, the CR systems were introduced to replace FS systems. Radiation doses were estimated for 354 patients in five hospitals (two FS units and three CR units). Entrance surface air kerma (ESAK) was estimated from incident air kerma using patient exposure parameters and tube output. Dose calculations were performed using CALDOSE X 3.5 Monte Carlo-based software. In FS, third quartile of ESAK values for skull PA, skull LAT, chest PA, pelvis AP, lumbar spine AP and lumbar spine LAT were 1.5, 1.3, 0.3, 1.9, 2.8 and 5.9 mGy, respectively, while in CR, third quartile of ESAK values for the same examinations were 2.7, 1.7, 0.18, 1.7, 3.2 and 10.8 mGy, respectively. Comparable ESAK values were presented in FS and CR units. The results are important for future dose optimisation and setting national diagnostic reference levels.

Micrometer-resolved film dosimetry using a microscope in microbeam radiation therapy

PURPOSE

Microbeam radiation therapy (MRT) is a still preclinical tumor therapy approach that uses arrays of a few tens of micrometer wide parallel beams separated by a few 100 μm. The production, measurement, and planning of such radiation fields are a challenge up to now. Here, the authors investigate the feasibility of radiochromic film dosimetry in combination with a microscopic readout as a tool to validate peak and valley doses in MRT, which is an important requirement for a future clinical application of the therapy.

METHODS

Gafchromic(®) HD-810 and HD-V2 films are exposed to MRT fields at the biomedical beamline ID17 of the European Synchrotron Radiation Facility (ESRF) and are afterward scanned with a microscope. The measured dose is compared with Monte Carlo calculations. Image analysis tools and film handling protocols are developed that allow accurate and reproducible dosimetry. The performance of HD-810 and HD-V2 films is compared and a detailed analysis of the resolution, noise, and energy dependence is carried out. Measurement uncertainties are identified and analyzed.

RESULTS

The dose was measured with a resolution of 5 × 1000 μm(2) and an accuracy of 5% in the peak and between 10% and 15% in the valley region. As main causes for dosimetry uncertainties, statistical noise, film inhomogeneities, and calibration errors were identified. Calibration errors strongly increase at low doses and exceeded 3% for doses below 50 and 70 Gy for HD-V2 and HD-810 films, respectively. While the grain size of both film types is approximately 2 μm, the statistical noise in HD-V2 is much higher than in HD-810 films. However, HD-810 films show a higher energy dependence at low photon energies.

CONCLUSIONS

Both film types are appropriate for dosimetry in MRT and the microscope is superior to the microdensitometer used before at the ESRF with respect to resolution and reproducibility. However, a very careful analysis of the image data is required. Dosimetry at low photon energies should be performed with great caution due to the energy sensitivity of the films. In this respect, HD-V2 films showed to have an advantage over HD-810 films. However, HD-810 films have a lower statistical noise level. When a higher resolution is required, e.g., for the dosimetry of pencil beam irradiations, noise may render HD-V2 films inapplicable.

Establishment of diagnostic reference levels for dental panoramic radiography in Greece

The purpose of the present study was to present the national diagnostic reference levels (DRL) established for panoramic dental examinations in Greece. The establishment of DRL, as a tool for the optimisation of radiological procedures, is a requirement of national regulations. Measurements performed by the Greek Atomic Energy Commission on 90 panoramic systems have been used for the derivation of DRL values. DRL values have been proposed for exposure settings of different patient types (child, small adult and standard adult), both for film and digital imaging. The DRLs for different patient types are grouped in three categories: children, small adults (corresponding to female) and average adults (corresponding to male). Proposed DRLs for these groups are 2.2, 3.3 and 4.1 mGy, respectively. In order to investigate the correlation of DRLs with the available imaging modalities (CR, DR and film), this parameter was taken into account. DR imaging DRL is the lowest at 3.5 mGy, CR imaging the highest at 4.2 mGy and film imaging at 3.7 mGy. In order to facilitate comparison with other studies, kerma-width product values were calculated from Ki, air and field size.

Accuracy of a dose map method assessed in clinical and anthropomorphic phantom situations using Gafchromic films

A dose map method has been integrated on GE x-ray angiographic systems to provide an indication of the local dose distributed on a patient envelope representative of individual patient shapes. Tests have been performed to assess the accuracy of the method by using Gafchromic XR-RV3 films in an anthropomorphic phantom situation and in a clinical situation. Dose values inside different exposed areas have been compared between the film and the dose map method. The dose map results show a good visual agreement for the anthropomorphic phantom situation, and the local doses agreed within better than 15 % compared with the Gafchromic films in both situations.

Examination of the relevance of using radiochromic films in measuring entrance skin dose distribution in conventional digital mammography

Based on manufacturer specifications, radiochromic films are sensitive enough to be used for dosimetry in digital mammography (DM). The aim of this work was to study the feasibility of measuring entrance surface dose (ESD) distribution using Gafchromic XR-QA2 films. The films were irradiated following a standard clinical two-view screening mammography protocol using a full-field digital mammography (FFDM) imaging system. The films were then digitised using a flatbed scanner. The calibration curve relating the readings from a calibrated ionisation chamber and the films' net optical density (NOD) could not be obtained. The examination of the calibration data revealed non-sensitivity of the films to resolve dose differences below 20 mGy at 28 kVp. Therefore, radiochromic films were found not to be suitable for measuring ESD profiles in DM. A 2D map of the NOD of the irradiated films obtained using in-house developed MATLAB computer program is presented.

Radiographic film dosimetry of proton beams for depth-dose constancy check and beam profile measurement

Radiographic film dosimetry suffers from its energy dependence in proton dosimetry. This study sought to develop a method of measuring proton beams by the film and to evaluate film response to proton beams for the constancy check of depth dose (DD). It also evaluated the film for profile measurements. To achieve this goal, from DDs measured by film and ion chamber (IC), calibration factors (ratios of dose measured by IC to film responses) as a function of depth in a phantom were obtained. These factors imply variable slopes (with proton energy and depth) of linear characteristic curves that relate film response to dose. We derived a calibration method that enables utilization of the factors for acquisition of dose from film density measured at later dates by adapting to a potentially altered processor condition. To test this model, the characteristic curve was obtained by using EDR2 film and in-phantom film dosimetry in parallel with a 149.65 MeV proton beam, using the method. An additional validation of the model was performed by concurrent film and IC measurement perpendicular to the beam at various depths. Beam profile measurements by the film were also evaluated at the center of beam modulation. In order to interpret and ascertain the film dosimetry, Monte Carlos simulation of the beam was performed, calculating the proton fluence spectrum along depths and off-axis distances. By multiplying respective stopping powers to the spectrum, doses to film and water were calculated. The ratio of film dose to water dose was evaluated. Results are as follows. The characteristic curve proved the assumed linearity. The measured DD approached that of IC, but near the end of the spread-out Bragg peak (SOBP), a spurious peak was observed due to the mismatch of distal edge between the calibration and measurement films. The width of SOBP and the proximal edge were both reproducible within a maximum of 5mm; the distal edge was reproducible within 1 mm. At 5 cm depth, the dose was reproducible within 10%. These large discrepancies were identified to have been contributed by film processor uncertainty across a layer of film and the misalignment of film edge to the frontal phantom surface. The deviations could drop from 5 to 2 mm in SOBP and from 10% to 4.5% at 5 cm depth in a well-controlled processor condition(i.e., warm up). In addition to the validation of the calibration method done by the DD measurements, the concurrent film and IC measurement independently validated the model by showing the constancy of depth-dependent calibration factors. For profile measurement, the film showed good agreement with ion chamber measurement. In agreement with the experimental findings, computationally obtained ratio of film dose to water dose assisted understanding of the trend of the film response by revealing relatively large and small variances of the response for DD and beam profile measurements, respectively. Conclusions are as follows. For proton beams, radiographic film proved to offer accurate beam profile measurements. The adaptive calibration method proposed in this study was validated. Using the method, film dosimetry could offer reasonably accurate DD constancy checks, when provided with a well-controlled processor condition. Although the processor warming up can promote a uniform processing across a single layer of the film, the processing remains as a challenge.

Proposed linear energy transfer areal detector for protons using radiochromic film

Radiation therapy depends on predictably and reliably delivering dose to tumors and sparing normal tissues. Protons with kinetic energy of a few hundred MeV can selectively deposit dose to deep seated tumors without an exit dose, unlike x-rays. The better dose distribution is attributed to a phenomenon known as the Bragg peak. The Bragg peak is due to relatively high energy deposition within a given distance or high Linear Energy Transfer (LET). In addition, biological response to radiation depends on the dose, dose rate, and localized energy deposition patterns or LET. At present, the LET can only be measured at a given fixed point and the LET spatial distribution can only be inferred from calculations. The goal of this study is to develop and test a method to measure LET over extended areas. Traditionally, radiochromic films are used to measure dose distribution but not for LET distribution. We report the first use of these films for measuring the spatial distribution of the LET deposited by protons. The radiochromic film sensitivity diminishes for large LET. A mathematical model correlating the film sensitivity and LET is presented to justify relating LET and radiochromic film relative sensitivity. Protons were directed parallel to radiochromic film sandwiched between solid water slabs. This study proposes the scaled-normalized difference (SND) between the Treatment Planning system (TPS) and measured dose as the metric describing the LET. The SND is correlated with a Monte Carlo (MC) calculation of the LET spatial distribution for a large range of SNDs. A polynomial fit between the SND and MC LET is generated for protons having a single range of 20 cm with narrow Bragg peak. Coefficients from these fitted polynomial fits were applied to measured proton dose distributions with a variety of ranges. An identical procedure was applied to the protons deposited from Spread Out Bragg Peak and modulated by 5 cm. Gamma analysis is a method for comparing the calculated LET with the LET measured using radiochromic film at the pixel level over extended areas. Failure rates using gamma analysis are calculated for areas in the dose distribution using parameters of 25% of MC LET and 3 mm. The processed dose distributions find 5%-10% failure rates for the narrow 12.5 and 15 cm proton ranges and 10%-15% for proton ranges of 15, 17.5, and 20 cm and modulated by 5 cm. It is found through gamma analysis that the measured proton energy deposition in radiochromic film and TPS can be used to determine LET. This modified film dosimetry provides an experimental areal LET measurement that can verify MC calculations, support LET point measurements, possibly enhance biologically based proton treatment planning, and determine the polymerization process within the radiochromic film.

Outdoor solar UVA dose assessment with EBT2 radiochromic film using spectrophotometer and densitometer measurements

Direct measurements of solar ultraviolet radiations (UVRs) have an important role in the protection of humans against UVR hazard. This work presents simple technique based on the application of EBT2 GAFCHROMIC(®) film for direct solar UVA dose assessment. It demonstrates the effects of different parts of the solar spectrum (UVB, visible and infrared) on performed UVA field measurements and presents the measurement uncertainty budget. The gradient of sunlight exposure level permitted the authors to establish the mathematical relationships between the measured solar UVA dose and two measured quantities: the first was the changes in spectral absorbance at the wavelength 633 nm (A633) and the second was the optical density (OD). The established standard relations were also applied to calculate the solar UVA dose variations during the whole day; 15 min of exposure each hour between 8:00 and 17:00 was recorded. Results show that both applied experimental methods, spectrophotometer absorbance and densitometer OD, deliver comparable figures for EBT2 solar UVA dose assessment with relative uncertainty of 11% for spectral absorbance measurements and 15% for OD measurements.

Investigation of EBT2 and EBT3 films for proton dosimetry in the 4-20 MeV energy range

Radiochromic films such as Gafchromic EBT2 or EBT3 films are widely used for dose determination in radiation therapy because they offer a superior spatial resolution compared to any other digital dosimetric 2D detector array. The possibility to detect steep dose gradients is not only attractive for intensity-modulated radiation therapy with photons but also for intensity-modulated proton therapy. Their characteristic dose rate-independent response makes radiochromic films also attractive for dose determination in cell irradiation experiments using laser-driven ion accelerators, which are currently being investigated as future medical ion accelerators. However, when using these films in ion beams, the energy-dependent dose response in the vicinity of the Bragg peak has to be considered. In this work, the response of these films for low-energy protons is investigated. To allow for reproducible and background-free irradiation conditions, the films were exposed to mono-energetic protons from an electrostatic accelerator, in the 4-20 MeV energy range. For comparison, irradiation with clinical photons was also performed. It turned out that in general, EBT2 and EBT3 films show a comparable performance. For example, dose-response curves for photons and protons with energies as low as 11 MeV show almost no differences. However, corrections are required for proton energies below 11 MeV. Care has to be taken when correction factors are related to an average LET from depth-dose measurements, because only the dose-averaged LET yields similar results as obtained in mono-energetic measurements.

Dosimetry of very high energy electrons (VHEE) for radiotherapy applications: using radiochromic film measurements and Monte Carlo simulations

Very high energy electrons (VHEE) in the range from 100-250 MeV have the potential of becoming an alternative modality in radiotherapy because of their improved dosimetry properties compared with MV photons from contemporary medical linear accelerators. Due to the need for accurate dosimetry of small field size VHEE beams we have performed dose measurements using EBT2 Gafchromic® film. Calibration of the film has been carried out for beams of two different energy ranges: 20 MeV and 165 MeV from conventional radio frequency linear accelerators. In addition, EBT2 film has been used for dose measurements with 135 MeV electron beams produced by a laser-plasma wakefield accelerator. The dose response measurements and percentage depth dose profiles have been compared with calculations carried out using the general-purpose FLUKA Monte Carlo (MC) radiation transport code. The impact of induced radioactivity on film response for VHEEs has been evaluated using the MC simulations. A neutron yield of the order of 10(-5) neutrons cm(-2) per incident electron has been estimated and induced activity due to radionuclide production is found to have a negligible effect on total dose deposition and film response. Neutron and proton contribution to the equivalent doses are negligible for VHEE. The study demonstrates that EBT2 Gafchromic film is a reliable dosimeter that can be used for dosimetry of VHEE. The results indicate an energy-independent response of the dosimeter for 20 MeV and 165 MeV electron beams and has been found to be suitable for dosimetry of VHEE.

EBT2 films response to alpha radiation at 48.3 MeV

To advance the development of a radiobiological experimental set-up for alpha particle irradiations at the Arronax cyclotron, experiments were performed to get the dose response of Gafchomic EBT2 films for alpha particles at 48.3 MeV. A system has been developed using a thin monitor copper foil and an X-ray spectrometer to measure the beam intensity and to calculate the delivered dose. On the other hand, the authors have irradiated EBT2 films, with 6-MV X rays, to get the dose response of EBT2 films for photons. The dose response curve for alpha particles shows an effect of polymerisation saturation compared with the dose response curve for photons.

Note: Calibration of EBT3 radiochromic film for measuring solar ultraviolet radiation

Solar (UVA + UVB) exposure was assessed using the Gafchromic EBT3 film. The coloration change was represented by the net reflective optical density (Net ROD). Through calibrations against a UV-tube lamp, operational relationships were obtained between Net ROD and the (UVA + UVB) exposures (in J cm(-2) or J m(-2)). The useful range was from ∼0.2 to ∼30 J cm(-2). The uniformity of UV irradiation was crucial for an accurate calibration. For solar exposures ranging from 2 to 11 J cm(-2), the predicted Net ROD agreed with the recorded values within 9%, while the predicted exposures agreed with the recorded values within 15%.

In vivo dosimetry in intraoperative electron radiotherapy: microMOSFETs, radiochromic films and a general-purpose linac

INTRODUCTION

In vivo dosimetry is desirable for the verification, recording, and eventual correction of treatment in intraoperative electron radiotherapy (IOERT). Our aim is to share our experience of metal oxide semiconductor field-effect transistors (MOSFETs) and radiochromic films with patients undergoing IOERT using a general-purpose linac.

MATERIALS AND METHODS

We used MOSFETs inserted into sterile bronchus catheters and radiochromic films that were cut, digitized, and sterilized by means of gas plasma. In all, 59 measurements were taken from 27 patients involving 15 primary tumors (seven breast and eight non-breast tumors) and 12 relapses. Data were subjected to an outliers' analysis and classified according to their compatibility with the relevant doses. Associations were sought regarding the type of detector, breast and non-breast irradiation, and the radiation oncologist's assessment of the difficulty of detector placement. At the same time, 19 measurements were carried out at the tumor bed with both detectors.

RESULTS

MOSFET measurements ([Formula: see text]  = 93.5 %, sD  =  6.5 %) were not significantly shifted from film measurements ([Formula: see text]  =  96.0 %, sD  =  5.5 %; p  =  0.109), and no associations were found (p = 0.526, p = 0.295,  and p = 0.501, respectively). As regards measurements performed at the tumor bed with both detectors, MOSFET measurements ([Formula: see text]  =  95.0 %, sD  =  5.4 % were not significantly shifted from film measurements ([Formula: see text]  =  96.4 %, sD  =  5.0 %; p  =  0.363).

CONCLUSION

In vivo dosimetry can produce satisfactory results at every studied location with a general-purpose linac. Detector choice should depend on user factors, not on the detector performance itself. Surgical team collaboration is crucial to success.

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

The objective of this study is to evaluate the suitability of recently introduced radiochromic film EBT3 for clinical dosimetry in the kilovoltage (kV) range. For this purpose, a kV X-ray irradiator, X RAD 320ix in the range 70 to 300 kVp, a clinical 60Co source, a 6 MV and an 18 MV X-ray clinical beam from a Varian linear accelerator were calibrated following AAPM dosimetry protocols. EBT3 films from two different EBT3 batches were placed side-by-side on the surface of a water phantom; doses from 0.5 to 4 Gy were delivered. Similarly, irradiations were performed for 60Co and 6 and 18 MV beams in a water equivalent phantom. Films were reproducibly placed at the center of a flatbed scanner and 48-bit RGB scans were obtained both pre- and postirradiations. Net optical density (netOD) and response for a given radiation quality relative to 60Co was determined for each EBT3 film. The netOD of the red color showed reproducible response (within 1%) for both batches when irradiated using the 60Co source. For a given dose of 1 Gy of kVp X-ray, the response relative to 60Co using the three color channels (red, green, and blue) decreases with decrease in kVp, reaching a maximum underresponse of ~ 20% for the 70 kVp. A significant underresponse of ~ 5% was observed at 300kVp. Responses of MV X-ray beams with respect to 60Co at the 1 Gy dose level showed no statistically significant difference. A relatively small difference in the response was observed between the two EBT3 batches used in this study in the kV X-ray range.

Three-dimensional radiochromic film dosimetry for volumetric modulated arc therapy using a spiral water phantom

We validated 3D radiochromic film dosimetry for volumetric modulated arc therapy (VMAT) using a newly developed spiral water phantom. The phantom consists of a main body and an insert box, each of which has an acrylic wall thickness of 3 mm and is filled with water. The insert box includes a spiral film box used for dose-distribution measurement, and a film holder for positioning a radiochromic film. The film holder has two parallel walls whose facing inner surfaces are equipped with spiral grooves in a mirrored configuration. The film is inserted into the spiral grooves by its side edges and runs along them to be positioned on a spiral plane. Dose calculation was performed by applying clinical VMAT plans to the spiral water phantom using a commercial Monte Carlo-based treatment-planning system, Monaco, whereas dose was measured by delivering the VMAT beams to the phantom. The calculated dose distributions were resampled on the spiral plane, and the dose distributions recorded on the film were scanned. Comparisons between the calculated and measured dose distributions yielded an average gamma-index pass rate of 87.0% (range, 91.2-84.6%) in nine prostate VMAT plans under 3 mm/3% criteria with a dose-calculation grid size of 2 mm. The pass rates were increased beyond 90% (average, 91.1%; range, 90.1-92.0%) when the dose-calculation grid size was decreased to 1 mm. We have confirmed that 3D radiochromic film dosimetry using the spiral water phantom is a simple and cost-effective approach to VMAT dose verification.

Establishment of diagnostic reference levels for dental intraoral radiography

Diagnostic reference levels (DRLs) is a tool for the optimisation of radiological procedures. Establishment of a DRL is a requirement of national regulations. Measurements performed by the Greek Atomic Energy Commission on 529 dental intraoral radiographic facilities have been used in order to define DRLs for digital and film imaging modalities, taking into account the region of the mouth to be imaged. Thus, different DRL values have been proposed for minimum (usually incisors), maximum (usually maxillary molars) and average exposure settings, both for film and digital imaging. The results have been compared with similar studies performed in Europe and the USA and are in line with the most recent ones.

Radiochromic film dosimetry: considerations on precision and accuracy for EBT2 and EBT3 type films

Gafchromic® EBT2 film is a widely used dosimetric tool for quality assurance in radiation therapy. In 2012 EBT3 was presented as a replacement for EBT2 films. The symmetric structure of EBT3 films to reduce face-up/down dependency as well as the inclusion of a matte film surface to frustrate Newton Ring artifacts present the most prominent improvements of EBT3 films. The aim of this study was to investigate the characteristics of EBT3 films, to benchmark the films against the known EBT2-features and to evaluate the dosimetric behavior over a time period greater than 6 months. All films were irradiated to clinical photon beams (6 MV, 10 MV and 18 MV) on an Elekta Synergy Linac equipped with a Beam Modulator MLC in solid water phantom slabs. Film digitalization was done with a flatbed transparency scanner (Type Epson Expression 1680 Pro). MATLAB® was used for further statistical calculations and image processing. The investigations on post-irradiation darkening, film orientation, film uniformity and energy dependency resulted in negligible differences between EBT2 and EBT3 film. A minimal improvement in face-up/down dependence was found for EBT3. The matte film surface of EBT3 films turned out to be a practical feature as Newton rings could be eliminated completely. Considering long-term behavior (> 6 months) a shift of the calibration curve for EBT2 and EBT3 films due to changes in the dynamic response of the active component was observed. In conclusion, the new EBT3 film yields comparable results to its predecessor EBT2. The general advantages of radiochromic film dosimeters are completed by high film homogeneity, low energy dependence for the observed energy range and a minimized face-up/down dependence. EBT2 dosimetry-protocols can also be used for EBT3 films, but the inclusion of periodical recalibration-interval (e.g. once a quarter) is recommended for protocols of both film generations.

Assessment of concomitant testicular dose with radiochromic film

To assess the suitability of EBT2 and XRQA2 Gafchromic film for measuring low doses in the periphery of treatment fields, and to measure the accumulative concomitant dose to the contralateral testis resulting from CT imaging, pre-treatment imaging (CBCT) and seminoma radiotherapy with and without gonadal shielding. Superficial peripheral dose measurements made using EBT2 Gafchromic film on the surface of water equivalent material were compared to measurements made with an ionisation chamber in a water phantom to evaluate the suitability and accuracy of the film dosimeter for such measurements. Similarly, XRQA2 was used to measure surface doses within a kilovoltage beam and compared with ionisation chamber measurements. Gafchromic film was used to measure CT, CBCT and seminoma treatment related testicular doses on an anthropomorphic phantom. Doses were assessed for two clinical plans, both with and without gonadal shielding. Testicular doses resulting from the treatment of up to 0.83 ± 0.17 Gy were measured per treatment. Additional doses of up to 0.49 ± 0.01 and 2.35 ± 0.05 cGy were measured per CBCT and CT image, respectively. Reductions in the testicular dose in the order of 10, 36 and 78% were observed when gonadal shielding was fitted for treatment, CT and CBCT imaging, respectively. Gafchromic film was found to be suitable for measuring dose in the periphery of treatment fields. The dose to the testis should be limited to minimise the risk of radiation related side effects. This can be achieved by using appropriate gonadal shielding, irrespective of the treatment fields employed.

Dosimetric accuracy of Gafchromic EBT2 and EBT3 film for in vivo dosimetry

Radiochromic film has the potential to provide accurate in vivo dosimetry measurements. However, it is not known whether small film pieces can still provide accurate dosimetric results. The use of small film pieces is of particular interest in regions of interest (ROIs) such as the eye, or where the patient's contour changes rapidly. This study examines the dosimetric accuracy of Gafchromic EBT2 and EBT3 models of radiochromic film and its dependence on film size, ROI size, and height above the scan bed for 6 MV photons and 9 MeV electrons. Films cut to sizes of 5.0 × 5.0, 10.0 × 10.0, 20.0 × 20.0, and 40.0 × 40.0 mm² were tested and it was found that there was no increase in uncertainty of dose when even the smallest film sizes were used. For a film 5.0 × 5.0 mm², ROIs of 1.4 × 1.4, 2.1 × 2.1 and 3.5 × 3.5 mm² were tested and it was found that the ROI size of 2.1 × 2.1 mm² was the most accurate. The standard deviation of the EBT3 placed on the glass (2.1%) was larger than the standard deviation of the EBT3 film raised above the glass (1.2%), therefore it is recommended that film is scanned raised above the scan bed. The general dosimetric performance of EBT3 was comparable to EBT2. We conclude that film pieces as small as 5.0 × 5.0 mm² could be used for the purpose of in vivo dosimetry of radiotherapy treatments.

Comparison of methods for the measurement of radiation dose distributions in high dose rate (HDR) brachytherapy: Ge-doped optical fiber, EBT3 Gafchromic film, and PRESAGE® radiochromic plastic

PURPOSE

Dose distribution measurement in clinical high dose rate (HDR) brachytherapy is challenging, because of the high dose gradients, large dose variations, and small scale, but it is essential to verify accurate treatment planning and treatment equipment performance. The authors compare and evaluate three dosimetry systems for potential use in brachytherapy dose distribution measurement: Ge-doped optical fibers, EBT3 Gafchromic film with multichannel analysis, and the radiochromic material PRESAGE(®) with optical-CT readout.

METHODS

Ge-doped SiO2 fibers with 6 μm active core and 5.0 mm length were sensitivity-batched and their thermoluminescent properties used via conventional heating and annealing cycles. EBT3 Gafchromic film of 30 μm active thickness was calibrated in three color channels using a nominal 6 MV linear accelerator. A 48-bit transmission scanner and advanced multichannel analysis method were utilized to derive dose measurements. Samples of the solid radiochromic polymer PRESAGE(®), 60 mm diameter and 100 mm height, were analyzed with a parallel beam optical CT scanner. Each dosimetry system was used to measure the dose as a function of radial distance from a Co-60 HDR source, with results compared to Monte Carlo TG-43 model data. Each system was then used to measure the dose distribution along one or more lines through typical clinical dose distributions for cervix brachytherapy, with results compared to treatment planning system (TPS) calculations. Purpose-designed test objects constructed of Solid Water and held within a full-scatter water tank were utilized.

RESULTS

All three dosimetry systems reproduced the general shape of the isolated source radial dose function and the TPS dose distribution. However, the dynamic range of EBT3 exceeded those of doped optical fibers and PRESAGE(®), and the latter two suffered from unacceptable noise and artifact. For the experimental conditions used in this study, the useful range from an isolated HDR source was 5-40 mm for fibers, 3-50 mm for EBT3, and 4-21 mm for PRESAGE(®). Fibers demonstrated some over-response at very low dose levels, suffered from volume averaging effects in the dose distribution measurement, and exhibited up to 9% repeatability variation over three repeated measurements. EBT3 demonstrated excellent agreement with Monte Carlo and TPS dose distributions, with up to 3% repeatability over three measurements. PRESAGE(®) gave promising results, being the only true 3D dosimeter, but artifacts and noise were apparent.

CONCLUSIONS

The comparative response of three emerging dosimetry systems for clinical brachytherapy dose distribution measurement has been investigated. Ge-doped optical fibers have excellent spatial resolution for single-direction measurement but are currently too large for complex dose distribution assessment. The use of PRESAGE(®) with optical-CT readout gave promising results in the measurement of true 3D dose distributions but further development work is required to reduce noise and improve dynamic range for brachytherapy dose distribution measurements. EBT3 Gafchromic film with multichannel analysis demonstrated accurate and reproducible measurement of dose distributions in HDR brachytherapy. Calibrated dose measurements were possible with agreement within 1.5% of TPS dose calculations. The suitability of EBT3 as a dosimeter for 2D quality control or commissioning work has been demonstrated.

Lessons learned: Radiological protection for emergency workers at the TEPCO Fukushima Daiichi APP (part 1)

During the emergency work at the Fukushima Daiichi Atomic Power Plant (APP), Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in radiological exposure management for emergency workers. To improve the implementation of appropriate radiological protection, the Ministry of Health, Labour and Welfare (MHLW) issued a series of compulsory directives and provided administrative guidance to TEPCO. Based on the experiences and lessons learned, the MHLW recognized that to properly manage radiological exposure should a similar accident occur at another APP, sufficient measures and systematic preparation for radiological management should be ensured, including the following: a) Should an APP accident occur, assistance from the power company's corporate office or off-site support facilities outside the evacuation area is indispensable; b) Primary contractors must independently implement exposure management operations for the employees of their sub-contractors; c) APP operators should compile an operations manual, stockpile personal protective equipment, and personal alarm dosimeters (PADs) and prepare emergency systems and whole body counters (WBCs); and the labor standards authorities should compile an emergency operations manual.