Gafchromic EBT3 Film Research Articles

The physics of radiochromic process: one calibration equation for all film types

A unique calibration equation for all radiochromic film types is proposed. The determination of this equation comes from an analogy that the authors made between the radiochromic and photographic processes. Photography dynamics is ruled by a differential equation, the logistic equation, describing phenomena of growth versus competition. A solution of the logistic equation is the Green-Saunders equation which was used for the first time by the same authors in a previous referred work for the calibration of a set of EBT3 Gafchromic films. Since this equation has a fundamental physical interpretation, the fitting parameters also represent important physical quantities and two of them in particular fix the film dynamics; one being the contrast and the other the abscissa of the inflection point of the sensitometric curve. In order to show the validity of this approach for more than one radiochromic film type, two sets of radiochromic films, the B3 and HD-V2 Gafchromic films were exposed to several known doses and the Green-Saunders equation was found to perfectly fit the experimental data. A comparison with the same procedure used for EBT3 Gafchromic films is proposed. The findings of this work are an important step forward in the understanding of an interesting and widely used dosimetry technique.

Pre-clinical and small field dosimetry

Preclinical in vivo studies have drastically improved over the past decade with the development of cone beam computed tomography (CBCT) image-guided small animal irradiation systems. Such systems produce 220 or 225 kV x-rays with square and circular field sizes ranging from 0.5 to 10 mm. The dosimetry of such equipment involving kilovoltage small-field dosimetry has not received as much attention as the megavoltage small-field dosimetry. The dosimetry of megavoltage small fields can be challenging due to lateral charged particle disequilibrium, detector volume averaging effect, and high dose gradients. Clinically there has been a rapid increase in the use of small fields in modern radiotherapy techniques such as stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SBRT). This study presents dosimetric properties of image-guided small animal irradiation systems. Both EBT Gafchromic films and 3-D PRESAGE measured beam data were presented and compared with the calculated dose distribution from a commissioned planning system. For megavoltage small-field dosimetry, EBT3 films and PRESAGE dosimeters were used to measure the dose distributions for MLC-delimited 6 x 6 to 20 x 20 mm2 square fields, and for selected IMRT and VMAT plans with small field sizes or segments of 1-4 cm. A single-beam optical CT scanner was used as the readout mechanism of the radiation-induced 3-D information in the PRESAGE phantoms. Measured data sets were compared with calculated results from Eclipse Acuros XB. The results for kilovoltage small animal irradiator showed that PDD data measured from EBT films and PRESAGE dosimeters are in agreement within 3%; profiles and 2-D dose distributions measured from PRESAGE present a larger penumbra compared with those from EBT films. Discrepancies between measured beam data and treatment planning data were identified. For megavoltage small fields, the measured data percent depth dose, beam profiles, and dose distributions were found to agree within experimental uncertainties for EBT films and PRESAGE dosimeters. Beam profiles for MLC-delimited field sizes less than 10 mm reveal some discrepancies in the penumbra region between measured data and calculated results. Dose distributions from EBT film and PRESAGE measurements demonstrate that 3-D dosimetry measurement for small-field IMRT and VMAT QA may be necessary to ensure a complete verification of dose delivery and accuracy.

Validation of an ultrasound-guided prostate HDR brachytherapy dose delivery

As part of a recent commissioning process for an ultrasound-guided prostate HDR technique at our centre, a representative dose delivery was validated using Gafchromic EBT3 film dosimetry. Agreement between Oncentra Prostate-calculated plan dose and measured film dose was within 5-10% over most of the 2D film dose planes, except in the regions within 5 mm of the catheter axes. Given the uncertainties associated with the measurement, this result was deemed to be clinically acceptable.

Surface dose accuracy in VMAT head and neck radiation treatment using bolus

The accuracy of EclipseTM-calculated head and neck VMAT plan dose delivery was assessed in the situation when there is a gap between placed bolus on a head and neck thermoplastic mask and the body surface. GafchromicEBT3 film dosimetry was used for dose delivery validation. The results from 3%, 3 mm 2D gamma comparison indicate better than 95% agreement between measured film dose and calculated plan dose for gap widths up to 25 mm between placed bolus and body surface.

A feasibility study for high-resolution silicon array detector performance in the magnetic field of a permanent magnet system.

Magnetic field effects on dose distribution and detector functionality must be well understood. The detector utilized to investigate these magnetic field effects was the DUO silicon array detector; the performance of this high spatial resolution detector was assessed under these conditions. The results were compared to Gafchromic EBT3 film to highlight any intrinsic magnetic field effects in the silicon. The results were also compared to previously published MagicPlate-512 (M512) data. The DUO has an improved spatial resolution (200µm) over the M512 (2mm). A permanent magnet named Magnetic Apparatus for RaDiation Oncology Studies (MARDOS) paired with a standard linear accelerator (linac) enables either transverse (1.2T) or inline (0.95T) orientations of the magnetic field with respect to the radiation beam. A 6MV Varian 2100C Linac provided the radiation component for the measurements. The DUO detector has 505 sensitive volumes (each volume measuring 800×40×100µm3 ) organized in two orthogonal, linear arrays. The DUO was embedded in a solid water phantom in the first set-up and then a solid lung phantom in the second set-up and placed between the magnet cones. Beam profiles were compared under the magnetic field conditions and 0T. Small field sizes from 0.8×0.8cm2 up to 2.3×2.3cm2 were investigated. The size of the air gap above the sensitive volumes of the DUO was investigated in the transverse orientation to assess the anticipated magnetic field effects. Full width at half maximum (FWHM), 80-20% penumbral widths and maximum dose differences between detectors and between the presence/absence of a magnetic field were investigated. Symmetry was also assessed for investigation of profile skewness under the transverse field. The penumbral widths measured by the DUO detector demonstrated good agreement with film and the M512 to within an average of 0.5mm (within uncertainty: ±1mm). The static inline magnetic field had minimal effect on the profiles in solid water. As expected, the lower density of solid lung meant that this material was more susceptible to demonstrating magnetic field effects in the dose deposited. The greatest penumbral narrowing due to the inline field (0.7mm) occurred in lung. Central axis dose increase was greatest in lung (maximum: 9%). The transverse field widened penumbra, most notably in the solid lung phantom, by a maximum of 2.3mm. The largest asymmetry due to the transverse field (4.6%) was also in solid lung. When the air gap above the DUO was filled with bolus, the dose maximum measured by the DUO was within 1.4% of film. The DUO detector has been shown to be successful in accurately describing the dose changes for small field sizes to within a 200-µm resolution in an environment resembling that of an MRI-linac. The DUO measurements were in agreement with both film and the M512 measurements, and therefore the DUO was found to be an appropriate alternative to the M512, with improvement in terms of its higher spatial resolution. MARDOS provided a suitable environment for these preliminary tests before progressing to the MRI-linac.

DOSIMETRIC INVESTIGATION OF RADIOTHERAPY OF SMALL SIZE TUMORS IN RADIOSURGERY DEVICES

In stereotactic radiotherapy, high radiation doses were delivered to tumors using small fields in 1-5 fractions. It is very important to make sure accuracy of dose and position of given dose in stereotactic radiotherapy. In this study, dosimetric measurements of small sized brain tumors irradiated in CONE- based linear accelator (linac) and the volumetric arc therapy (VMAT) linac modalities were performed with EBT3 film. 1,2 and 3 cm diameter tumors were virtually created in Cyberknife head and neck phantom. Gafchromic EBT3 film was placed into the phantom to evaluate the accuracy of the doses given. The phantom was irradiated with Gafchromic EBT3 film according to treatment plans created in the treatment planning system of two separate devices for each tumor size. Conformity Index (CI) and Homogeneity Index (HI) were calculated for the quality of created treatment plans. The dose distributions calculated in the film and the TPS were compared. When the CI and HI values were examined, the CI and HI values of the cone-based linac device were close to 1. The EBT3 measurement results indicate that all SRT treatment modalities achieved accurate doses. According to results, if a critical organ, such as the brainstem, is located near the tumor and the situation requires a steep dose gradient, the cone-based linac should be used for SRT therapy. This study has shown that on CONE-based linac or VMAT-based linac devices can be used instead of each other in small-area irradiations.

Неопределенности поглощенной дозы, измеренной дозиметром GAFCHROMIC EBT3 на клинических электронных и фотонных пучках медицинских ускорителей

Purpose: Investigation of the relative errors of absorbed dose measurement based on polymer films Gafchromic EBT3 for clinical electron and photon beams of medical accelerators.
 Material and methods: Polymer Gafchromic EBT3 films were calibrated using different radiation beams, namely photon and electron beams of Elekta Axesse medical accelerator with beam energy equal to 10 MV and 10 MeV, correspondingly, and electron beam of a betatron for intraoperative radiotherapy with beam energy equal to 6 MeV. The film pieces were irradiated by the uniform dose field in the dose range from 0.5 to 40 Gy. The dose value was controlled by cylindrical ionization chamber in the case of Elekta Axesse accelerator and by the Markus parallel chamber in the case of betatron. The irradiated films were scanned using Epson Perfection V750 Pro flatbed scanner in 16 bit RGB color mode with 150 dpi resolution. The red and green channels were used for further analysis. The central part of each film was used for calculation of average values of net optical density and its root-mean-square. As a result, the calibration curves, i.e. dependence on the reference absorbed dose measured by ionization chamber on the net optical density were constructed taking into account uncertainties of dose measurement and optical density measurement.
 Results: The relative uncertainty for the dose measurement lies within 7 % for low doses (less than 1 Gy) and within 4 % for higher doses. The green channel is less sensitive to the radiation, but its relative uncertainty values are in general 1–2 % lower than the ones for the red channel. The use of different calibration sources results in different calibration curves with difference up to ±6 % for the green channel.
 Conclusion: The polymer Gafchromic EBT3 films could be used for absorbed dose measurement for the doses not less than 0.5 Gy. For lower dose values the dose measurement uncertainty caused by statistical reasons amounts 15 %. For dose values of about 1 Gy and higher the dose measurement uncertainty amounts 5 % that allows to use the films for transverse and longitudinal prescription treatment dose distribution measurement with very high spatial resolution.

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

Blood irradiators (BI) initial acceptance testing and routine annual dosimetry checks require radiation dose measurements in order to comply with regulatory requirements. Traditionally thermo-luminescence dosimeters (TLD) have been used to measure the dose. The EBT3 film is reported to be a better dosimeter for low energy X-rays than its predecessors EBT2 and EBT. To the best of our knowledge, the use of EBT3 films to perform dosimetry on X-ray based BI has not been reported yet. We performed routine radiation dosimetry checks using EBT3 films on a new X-ray based BI and compared the results with TLD dosimetry. Calibration films were irradiated with radiation beam from a Co-60 Gamma Knife (GK) radiosurgery machine and, alternatively, using an Ir-192 high dose rate (HDR) brachytherapy device. The films were calibrated to cover a wide dose range from 1 to 40Gy. Such a wide dose range has not been reported yet in BI film dosimetry. We obtained a relative difference of about 6.6% between doses measured using TLD and those measured using EBT3 films. Both irradiation methods using GK or HDR were found to be adequate for the calibration of the EBT3 Gafchromic films. We recommend the use of EBT3 films in routine X-ray based BI dosimetry checks. The presented method takes advantage of available radiotherapy equipment that can be efficiently used for EBT3 films calibration. The method is fast, reproducible and saves valuable medical physicist's time.

Feasibility of a Tungsten Rubber Grid Collimator for Electron Grid Therapy

Spatially fractionated radiotherapy (grid therapy) can control some bulky tumors which is challenging for conventional radiotherapy. This study aimed to investigate whether a novel tungsten contained rubber (TCR) grid collimator can be employed in electron grid therapy. The TCR grid collimator placed on a solid water phantom, and percentage depth doses (PDDs) and lateral dose profiles were measured for 9 MeV electron beam with Gafchromic EBT3 films. At the lateral dose profile, the ratios of the dose in the areas with and without shielding (valley-to-peak ratios) were evaluated. The dmax values with the 1, 2 and 3 mm TCR grid collimators were 1.2, 1.1 and 0.7 cm, respectively, while the valley-to-peak ratios at each dmax were 0.566, 0.412 and 0.293, respectively. Only the 2 mm TCR grid collimator had adequate dosimetric features compared to the conventional grid collimator and could be substituted.

Small field correction factors determination for several active detectors using a Monte Carlo method in the Elekta Axesse linac equipped with circular cones

A Monte Carlo (MC) method was used to determine small field output correction factors for several active detectors (Exradin A16, Exradin A26, PTW microLion, PTW microDiamond, Exradin W1 and IBA RAZOR) for an Elekta Axesse linac equipped with circular cones. MC model of the linac was built with the GamBet software, using the Penelope code system. The dose-to-water simulation for each cone, ranging from 5 to 30 mm of diameter size, was used to calculate field factors and the results were validated together with Gafchromic EBT3 film. Output factors (OFs) were measured with the active detectors and correction factors were determined using the MC results. The MC simulations agreed with films within 1.2%. OFs measured with Exradin W1 scintillator were in agreement within 0.8% with MC simulations. The Exradin A16 and A26 microchambers under-responded for small fields relative to the MC (−13.1% and −4.6%, respectively). PTW microLion, IBA RAZOR and PTW microDiamond overestimated the output factor for the smallest field (+3.9%, +5.4 and +7.1%, respectively). The present study pointed out that it is crucial to apply the appropriate correction factors in order to provide accurate measurements in small beams geometry. The results showed that the Exradin W1 can be used for very small field dosimetry without correction factors, which shall be contrariwise employed for other detectors.

Characterization of EBT3 radiochromic films for dosimetry of proton beams in the presence of magnetic fields.

PurposeRadiochromic film dosimetry is extensively used for quality assurance in photon and proton beam therapy. So far, GafchromicTM EBT3 film appears as a strong candidate to be used in future magnetic resonance (MR) based therapy systems. The response of Gafchromic EBT3 films in the presence of magnetic fields has already been addressed for different MR‐linacs systems. However, a detailed evaluation of the influence of external magnetic fields on the film response and calibration curves for proton therapy has not yet been reported. This study aims to determine the dose responses of EBT3 films for clinical proton beams exposed to magnetic field strengths up to 1 T in order to investigate the feasibility of EBT3 film as an accurate dosimetric tool for a future MR particle therapy system (MRPT).MethodsThe dosimetric characteristics of EBT3 films were studied for a proton beam passing through magnetic field strengths of B = 0, 0.5, and 1 T. Absorbed dose calibration and measurements were performed using clinical proton beams in the nominal energy range of 62.4–252.6 MeV. Irradiations were done using an in‐house developed PMMA slab phantom placed in the center of a dipole research magnet. Monte Carlo (MC) simulations using the GATE/Geant4 toolkit were performed to predict the effect of magnetic fields on the energy deposited by proton beams in the phantom. Planned and measured doses from 3D box cube irradiations were compared to assess the accuracy of the dosimetric method using EBT3 films with/without the external magnetic field.ResultsNeither for the mean pixel value nor for the net optical density, any significant deviations were observed due to the presence of an external magnetic field (B ≤ 1T) for doses up to 10 Gy. Dose‐response curves for the red channel were fitted by a three‐parameter function for the field‐free case and for B = 1T, showing for both cases an R‐square coefficient of unity and almost identical fitting parameters. Independently of the magnetic field, EBT3 films showed an under‐response as high as 8% in the Bragg peak region, similarly to previously reported effects for particle therapy. No noticeable influence of the magnetic field strength was observed on the quenching effect of the EBT3 films.ConclusionsFor the first time detailed absorbed dose calibrations of EBT3 films for proton beams in magnetic field regions were performed. Results showed that EBT3 films represent an attractive solution for the dosimetry of a future MRPT system. As film response functions for protons are not affected by the magnetic field strenght, they can be used for further investigations to evaluate the dosimetric effects induced due to particle beams bending in magnetic fields regions.

Dose verification for liver target volumes undergoing respiratory motion.

Respiratory motion has a significant impact on dose delivered to abdominal targets during radiotherapy treatment. Accurate treatment of liver tumours adjacent to the diaphragm is complicated by large respiratory movement, as well as differing tissue densities at the lung-liver interface. This study aims to evaluate the accuracy of dose delivered to superior liver tumours using passive respiratory monitoring, in the absence of gating technology, for a range of treatment techniques. An in-house respiratory phantom was designed and constructed to simulate the lung and liver anatomy. The phantom consisted of adjacent slabs of lung and liver equivalent materials and a cam drive system to emulate respiratory motion. A CC04 ionisation chamber and Gafchromic EBT3 film were used to perform point dose and dose plane measurements respectively. Plans were calculated using an Elekta Monaco treatment planning system (TPS) on exhale phase study sets for conformal, volume modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) techniques, with breathing rates of 8, 14 and 23bpm. Analysis confirmed the conformal delivery protocol currently used for this site within the department is suitable. The experiments also determined that VMAT is a viable alternative technique for treatment of superior liver lesions undergoing respiratory motion and was superior to IMRT. Furthermore, the measurements highlighted the need for respiratory management in these cases. Displacements due to respiration exceeding planned margins could result in reduced coverage of the clinical target volume and much higher doses to the lung than anticipated.

A novel method for EBT3 Gafchromic films read-out at high dose levels

In this work, we report on a novel approach for measuring the dose absorbed by the EBT3 Gafchromic™ films exposed to 1 MeV electron beam and 250 kV X-rays in the range 0.5–100 Gy. Although EBT3 is specifically designed to obtain best performance for applications where the maximum dose is less than 10 Gy, there are certain clinical applications requiring dose ranges well above this value. In order to cover wider dose ranges, further models characterized by a thinner sensitive layer and/or different chemical composition have been released. Another method exploiting the three-channel flatbed scanner to delay the saturation point of EBT3 has been also reported. The technique proposed here, aimed at extending the sensitivity of the EBT3 film to high doses up to 100 Gy while ensuring a low dose uncertainty, is based on a broadband analysis of the absorption spectrum of the film in response to irradiation. By combining a wavelength-based approach with the monitoring of two characteristic peaks of the EBT3 absorption spectrum, we demonstrated the capability of measuring the dose in the range 0.5–100 Gy with an experimental uncertainty below 4% for doses lower than 5.52 Gy and below 2% for higher dose levels. Finally, through a dynamic fitting procedure integrating the two aforesaid approaches, a total uncertainty lower than 4%, including both the experimental and fitting errors, was achieved in the whole range 0.5–100 Gy. These results are promising in view of a potential application of this technique in the field of clinical dosimetry at high dose levels.

Radiochromic films in Radiation Hardness Space Application

The characteristics of radiochromic films such as the direct visualization of radiation field, ease of use and data analysis are suited for the dosimetry monitoring in tests of radiation hardness space applications. In particular, in this work, in order to study the dependence of radiation type, energy and dose rate, as well as the dynamic range of EBT3 Gafchromic films, a set of films was exposed to radiation sources used in total ionizing dose (60Co gamma- and 90Sr/90Y beta-rays). The results have been found to be particularly suited for the employment of this kind of films in radiation hardness assurance tests.

Relative efficiency of Gafchromic EBT3 and MD-V3 films exposed to low-energy photons and its influence on the energy dependence

Energy-dependence of Gafchromic films exposed to low-energy photons has been reported to be a function of absorbed-dose. However, these studies are based on a relative-response, R, which considers the absorbed-dose in water and not within the film sensitive-volume. This work investigated the relative-efficiency, REfilm, (ratio of absorbed-dose required to produce the same net optical density (netOD) by 60Co gamma and by x-ray) of Gafchromic EBT3 and MD-V3 films exposed to five x-ray beams from 20 kV to 160 kV and 60Co gamma rays. A factor that accounts for the energy-dependence, fx,Q,med, based on REfilm, phantom-material and depth at which the films are placed during irradiation was used to remove the influence of absorbed dose. Values of REfilm indicated that the absorbed dose from 60Co gamma rays needs to be 4 and 3 times larger than those from 20 kV x-rays to produce the same netOD within the EBT3 and MD-V3 sensitive volumes, respectively. Thus, saturation could help explain why Gafchromic films show under-response to very low doses from low-energy photon beams, regardless of film model. Furthermore, REfilm, was found to be nearly independent of netOD and colour-channels. Consequently, fx,Q,med is independent of the absorbed dose and colour-channels. In contrast, besides the variation with the photon energy, fx,Q,med varied with film model, depth and phantom material used during the irradiation. Thus, the results suggest that fx,Q,med is a more reliable wide-ranging parameter for evaluating the degree of energy-dependence of the film rather than the relative-response method commonly considered.

Patient QA System Using Delta4 Phantom for Tomotherapy: A Comparative Study with EBT3 Film

In this study for delivery quality assurance (DQA) of helical tomotherapy, we compared the Delta4 phantom system with the Gafchromic EBT3 film dosimetry system in eight cases and analyzed the global gamma-index passing rate (GPR) of various treatment sites in 109 cases. The mean GPR values for Delta4 and EBT3 film were 98.8% and 97.8%, respectively. GPR values were similar between Delta4 and film dosimetry, with a linear correlation factor of 72.4%. About 70% of the Delta4 cases had GPR values greater than 99%, although the GPR value was highly dependent on the clinical target size; GPR decreased approximately 3.7% when the target size increased by 3 cm. The GPR results show that Delta4 could be a better dosimetry tool than EBT3 film for tomotherapy DQA.

PO-0907 Gafchromic EBT3 film for absolute dosimetry in proton therapy based on averaging of beam quality

PO-0907 Gafchromic EBT3 film for absolute dosimetry in proton therapy based on averaging of beam quality

Patient organ doses from megavoltage computed tomography delivery with a helical tomotherapy unit using a general treatment planning system.

The purpose of this study was to quantify actual patient organ doses from megavoltage computed tomography (MVCT) using an MVCT beam model of a helical tomotherapy unit in a general treatment planning system (TPS). Dosimetric parameters (percentage depth dose, lateral beam profile, and longitudinal beam profile) of the MVCT beam were measured using Gafchromic EBT3 films (ISP Corporation, Wayne, NJ, USA) and used for beam modeling in a Pinnacle3 TPS (Philips, Amsterdam, Netherlands); this TPS is widely used with linear accelerators. The created beam model was adjusted and validated by assessing point doses in a cylindrical phantom in static and helical beam plans with fine, normal and coarse pitches. Maximum doses delivered to important organs from MVCT delivery for five clinical cases were calculated using the created beam model. The difference (average ± one standard deviation for all evaluation points) between calculated and measured doses was −0.69 ± 1.20% in the static beam plan. In the helical beam plan, the differences were 1.83 ± 2.65%, 1.35 ± 5.94% and −0.66 ± 8.48% for fine, normal and coarse pitches, respectively. The average maximum additional dose to important organs from MVCT in clinical cases was 0.82% of the prescribed dose. In conclusion, we investigated a method for quantifying patient organ dose from MVCT delivery on helical tomotherapy using an MVCT beam model in a general TPS. This technique enables estimation of the patient-specific organ dose from MVCT delivery, without the need for additional equipment.

Real-time dosimetry with radiochromic films

Radiochromic film dosimetry has been widely employed in most of the applications of radiation physics for over twenty years. This is due to a number of appealing features of radiochromic films, such as reliability, accuracy, ease of use and cost. However, current radiochromic film reading techniques, based on the use of commercial densitometers and scanners, provide values of dose only after the exposure of the films to radiation. In this work, an innovative methodology for the real-time reading of radiochromic films is proposed for some specific applications. The new methodology is based on opto-electronic instrumentation that makes use of an optical fiber probe for the determination of optical changes of the films induced by radiation and allows measurements of dose with high degree of precision and accuracy. Furthermore, it has been demonstrated that the dynamic range of some kinds of films, such as the EBT3 Gafchromic films (intensively used in medical physics), can be extended by more than one order of magnitude. Owing to the numerous advantages with respect to the commonly used reading techniques, a National Patent was filed in January 2018.

LET response variability of Gafchromic EBT3 film from a Co calibration in clinical proton beam qualities.

To establish a method of accurate dosimetry required to quantify the expected linear energy transfer (LET) quenching effect of EBT3 film used to benchmark the dose distribution for a given treatment field and specified measurement depth. In order to facilitate this technique, a full analysis of film calibration which considers LET variability at the plane of measurement and as a function of proton beam quality is demonstrated. Additionally, the corresponding uncertainty from the process was quantified for several measurement scenarios. The net change in optical density (OD) from a single version of Gafchromic EBT3 film was measured using an Epson flatbed scanner and NIST-traceable OD filters. Film OD response was characterized with respect to the known dose to water at the point of measurement for both a NIST-traceable beam at the UWADCL and several clinical single-energy and spread-out Bragg peak (SOBP) proton beam qualities at the Northwestern Medicine Chicago Proton Center. Increasing proton LET environments were acquired by placing film at increasing depths of Gammex HE Solid Water® whose water-equivalent thickness was characterized prior to measurement. A strong LET dependence was observed near the Bragg peak (BP) consistent with previous studies performed with earlier versions of EBT3 film. The influence of range straggling on the film's LET response appears to have a uniform effect toward the BP regardless of the nominal beam energy. Proximal to this depth, the film's response decreased with decreasing energy at the same dose-average LET. The opposite trend was observed for depths past the BP. Changes in the SOBP energy modulation showed a linear relationship between the film's relative response and dose-averaged LET. Relative effectiveness factors (RE) were observed to range between 2%-7% depending on the width of the SOBP and depth of the film. Using the field-specific calibration technique, a total k=1 uncertainty in the absorbed dose to water was estimated to range from 4.68%-5.21%. While EBT3 film's strong LET dependence is a common problem in proton beam dosimetry, this work has shown that the LET dependence can be taken into account by carefully considering the depth and energy modulation across the film using field-specific corrections. RE factors were determined with a combined k=1 uncertainty of 3.57% for SOBP environments and between3.17%-4.69% for uniform, monoenergetic fields proximal to the distal 80% of the BP.