The IPEM code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV based on an absorbed dose to water calibration

This report contains the recommendations of the Electron Dosimetry Working Party of the UK Institute of Physics and Engineering in Medicine (IPEM). The recommendations consist of a code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV. The code is based on the absorbed dose to water calibration service for electron beams provided by the UK standards laboratory, the National Physical Laboratory (NPL). This supplies direct N(D,w) calibration factors, traceable to a calorimetric primary standard, at specified reference depths over a range of electron energies up to approximately 20 MeV. Electron beam quality is specified in terms of R(50,D), the depth in water along the beam central axis at which the dose is 50% of the maximum. The reference depth for any given beam at the NPL for chamber calibration and also for measurements for calibration of clinical beams is 0.6R(50.D) - 0.1 cm in water. Designated chambers are graphite-walled Farmer-type cylindrical chambers and the NACP- and Roos-type parallel-plate chambers. The practical code provides methods to determine the absorbed dose to water under reference conditions and also guidance on methods to transfer this dose to non-reference points and to other irradiation conditions. It also gives procedures and data for extending up to higher energies above the range where direct calibration factors are currently available. The practical procedures are supplemented by comprehensive appendices giving discussion of the background to the formalism and the sources and values of any data required. The electron dosimetry code improves consistency with the similar UK approach to megavoltage photon dosimetry, in use since 1990. It provides reduced uncertainties, approaching 1% standard uncertainty in optimal conditions, and a simpler formalism than previous air kerma calibration based recommendations for electron dosimetry.

A systematic review of the precision and accuracy of dose measurements in photon radiotherapy using polymer and Fricke MRI gel dosimetry

The purpose of this work is to undertake a critical appraisal of the evidence in the published literature concerning the basic parameters of accuracy and precision associated with the use of Fricke and polymer gels (in conjunction with MR imaging) as radiation dosimeters in photon radiotherapy, condensing and analysing the body of published information (to the end of April 2002). A systematic review was undertaken addressing specific issues of precision and accuracy asking defined questions of the published literature. Accuracy and precision in relation to gel dosimetry were defined. Information was obtained from published, peer-reviewed journals. A defined search strategy utilizing MeSH headings and keywords, with extensive use of cross-referencing, identified 115 references dealing with gel dosimetry. Exclusion criteria were used to select only data from publications which would give unequivocal evidence. For accuracy, results had to be compared with an ionization chamber as gold standard and all gel samples had to be manufactured in the same batch. For precision, in addition to gels being from the same batch, samples must all have been irradiated at the same time and scanned simultaneously (or within a short time frame). Many results were found demonstrating 'dose mapping' examples using gels. However, there were very few publications containing firm evidence of precision and accuracy. There was no evidence which fulfilled our criteria about accuracy or precision using Fricke gels. For polymer gels only one paper was found for accuracy (4% (Low et al 1999 Med. Phys. 26 1542-51)) and precision (1.7% (Baldock et al 1998 Phys. Med. Biol. 43695-702)); however, both were carried out at only one dose level. If the exclusion criteria were relaxed to include accuracy results comparing gel to a non gold standard dosimeter (e.g. TLD), results give a median accuracy of 10% (range 8-23.5%) for polymer gel (Cosgrove et al 2000 Phys. Med. Biol. 45 1195-210, De Deene et al 1998 Radiother: Oncol. 48 283-91, Farajollahi et al 2000 Br. J. Radiol. 72 1085-92, McJury et al 1999b Phys. Med. Biol. 44 2431-44, Murphy et al 2000b Phys. Med. Biol. 45 835-45, Oldham et al 2001 Med. Phys. 28 1436-45) and 5% for Fricke gel (Chan and Ayyangar 1995b Med. Phys. 22 1171-5). Evidence also points to accuracy worsening at lower dose levels for both gels. The precision data should be viewed with caution as repeated MR measurements were not performed with the same samples. The only precision data for Fricke gels was 1.5% (Johansson Back et al 1998 Phys. Med. Biol. 43 261-76), but for zero dose. In conclusion, despite the amount of published data, sparse research has been undertaken which provides clear evidence of the accuracy and precision for both gels. That which has been published has used higher doses than would be routine in radiotherapy. The basic radiation dosimeter qualities of accuracy and precision have yet to be fully quantified for polymer and Fricke gels at clinically relevant dose levels.

Toxicity and dosimetry of fractionated total body irradiation prior to allogeneic bone marrow transplantation using a straightforward radiotherapy technique

Since 1989, we have used a relatively straightforward technique for giving total body irradiation (TBI), using anterior and posterior parallel opposed fields with the arms and fists acting as compensators. The dosimetry, toxicity and outcome of 48 patients (26 adults, 22 children) treated with TBI using this technique have been audited. A dose of 14.4 Gy in eight fractions over 4 days was prescribed to all patients with an unrelated donor and 12 Gy in six fractions over 3 days to those with a sibling donor. From May 1994, all children received 14.4 Gy because of a recommendation from the United Kingdom Children's Cancer Study Group. The range of lung dosimetry was -6% to +7% when the dose was specified to the lung maximum. The trunk doses were all within +/-10% of the prescribed dose. Doses to other regions of the body were less homogeneous but clinically acceptable in that the minimum doses were never less than -10% of the prescribed dose. Mucositis was the most common side effect; its treatment with opioids was more frequent after 14.4 Gy than after 12 Gy (P=0.0004) and in adults than in children (P=0.01). No cataracts have yet been seen in these patients. The radiation was not found to be a proven cause of clinical pneumonitis, although there was one death due to interstitial pneumonitis, which was likely to have been caused by cytomegalovirus infection in which radiation pneumonitis could not be excluded. There were no other suspected TBI-related deaths. In conclusion, this straightforward technique achieved acceptable dosimetry and was well tolerated.

Commissioning a p-type silicon diode for use in clinical electron beams

Commissioning measurements were carried out on a p-type silicon diode detector for use in patient monitoring in high energy electron beams. Characteristics specific to the diode were examined. The variation in diode sensitivity with dose per pulse was found to be less than 1% over a range 0.069-0.237 mGy/pulse. The diode exhibited a sensitivity variation with accumulated dose of 10% per kGy and a sensitivity variation with surface temperature of 0.26%/degree C. The dependence of the diode response on the direction of the incident electron beam was investigated. Results were found to exceed the manufacturer's specifications. Output factors measured with the diode agree to within 1.5% of those measured with an NACP-02 air ionization chamber. The detector showed a variation in response with energy of 0.8% over the energy range 4-15 MeV. Prior to introducing the diode into clinical use, an assessment of beam perturbation directly behind the diode was made. The maximum reduction in local dose directly behind the diode at a depth of 1.0 cm below the surface was approximately 13% at 4 and 15 MeV.

An experimental evaluation of recent electron dosimetry codes of practice

As from the 1 January 1997, the recent IPEMB code of practice for electron dosimetry is the recommended protocol for electron beam dosimetry in the UK, replacing the previous HPA code of practice and its IPSM addendum. New recommendations for electron beam dosimetry have also been formulated recently by the AAPM and the IAEA on the use of parallel-plate ionization chambers in high-energy electron beams. Against this background, the procedures recommended in each of these codes of practice have been followed from intercomparison of the field instrument ionization chamber with a secondary standard through to the determination of absorbed dose at the reference position in the electron beam. Absorbed doses have been determined for a number of electron beam energies ranging from nominal 5 MeV through to 17 MeV, and for four different types of field instrument ionization chamber: an NE2571 graphite walled cylindrical chamber; an NACP parallel-plate chamber; a Markus parallel-plate chamber; and a Roos parallel-plate chamber. The differences in the determination of absorbed dose between the IPEMB protocol and the HPA/IPSM protocol vary from +0.5% to +1.6% at the depth of maximum dose. In addition the IPEMB measured doses are 0.2% larger than those measured following the IAEA code of practice. It may also be stated that the IPEMB measured doses at the depth of maximum dose are up to 1.5%, but generally less than 1.0%, lower than those measured by the AAPM protocol.