Ion Chamber Measurements Research Articles

Validation of MLC leaf open time calculation methods for PSQA in adaptive radiotherapy with tomotherapy units.

Treatment delivery safety and accuracy are essential to control the disease and protect healthy tissues in radiation therapy. For usual treatment, a phantom-based patient specific quality assurance (PSQA) is performed to verify the delivery prior to the treatment. The emergence of adaptive radiation therapy (ART) adds new complexities to PSQA. In fact, organ at risks and target volume re-contouring as well as plan re-optimization and treatment delivery are performed with the patient immobilized on the treatment couch, making phantom-based pretreatment PSQA impractical. In this case, phantomless PSQA tools based on multileaf collimator (MLC) leaf open times (LOTs) verifications provide alternative approaches for the Radixact® treatment units. However, their validity is compromised by the lack of independent and reliable methods for calculating the LOT performed by the MLC during deliveries. To provide independent and reliable methods of LOT calculation for the Radixact® treatment units. Two methods for calculating the LOTs performed by the MLC during deliveries have been implemented. The first method uses the signal recorded by the build-in detector and the second method uses the signal recorded by optical sensors mounted on the MLC. To calibrate the methods to the ground truth, in-phantom ionization chamber LOT measurements have been conducted on a Radixact® treatment unit. The methods were validated by comparing LOT calculations with in-phantom ionization chamber LOT measurements performed on two Radixact® treatment units. The study shows a good agreement between the two LOT calculation methods and the in-phantom ionization chamber measurements. There are no notable differences between the two methods and the same results were observed on the different treatment units. The two implemented methods have the potential to be part of a PSQA solution for ART in tomotherapy.

Multi-section fission ionization chamber for measurement of [formula omitted] reaction in fission tagging method

The 239Pu(n,γ) reaction cross section is very important for operation of both thermal and fast reactors, when loaded with MOX fuels. According to the NEA/OECD High Priority Request List the precision of cross section data for this reaction should be improved. The cross section of (n,f) reaction is much higher compared to (n,γ) for this isotope. In such conditions the fission tagging technique could be applied to identify the fission background. In the past, this technique was successfully used for capture measurements at the n_TOF facility at CERN. The multi-section fission ionization chamber was constructed and used in the combination with Total Absorption Calorimeter (TAC) for detecting gamma rays for the precise measurement of 239Pu(n,γ) reaction cross section at the n_TOF facility.

Validation of Acuros for total body irradiation at extended distance.

Standardized and accurately reported doses are essential in conventional total body irradiation (TBI), especially lung doses. This study evaluates the accuracy of the Acuros algorithm in predicting doses for extended-distance TBI. Measurements and calculations were done with both 6 and 18 MV. Tissue Maximum Ratio (TMR), output and off axis ratios (OAR) were measured at 200 and 500cm source to detector distance and compared to Acuros calculated values. Two end-to-end tests were carried out, one with an in-house phantom (solid water and Styrofoam) with inserted ion chambers and the other was with the Imaging and Radiation Oncology Core (IROC) TBI anthropomorphic phantom equipped with TLDs. The end-to-end test was done for 6 and 18 MV both with and without lung blocks. The source to midplane distance for both phantoms were at 518 and 508cm respectively. Lung blocks were placed at the phantom surface and a beam spoiler was positioned 30cm from the surface of the phantoms as per our clinical set up. The agreement between measured and calculated TMR, output and off axis ratios for both 6 and 18 MV were within 2%. Ion chamber measurements in both the Styrofoam and solid water for both energies carried out with and without lung blocks were within 2% of calculated values. TLD measured doses for both 6 and 18 MV in the IROC phantom were within 5% of calculated doses which is within the uncertainty of the TLD measurement. The results indicate that the clinical beam model for Acuros 16.1 commissioned at standard clinical distances is capable of calculating doses accurately at extended distances up to 500cm.

Implementation of an ionization chamber array for linear accelerator monthly dosimetry QA.

The IC Profiler (ICP) manufactured by Sun Nuclear Corporation (SNC) is an ionization chamber (IC) array used for linear accelerator dosimetry measurements. Previous work characterized response of the ICP under various conditions, but there is limited work of its implementation into monthly QA measurement procedures. This work quantifies ICP accuracy and variables that affect accuracy for beam output measurements, and demonstrates feasibility of using the ICP for all recommended monthly dosimetry measurements. A total of 1985 output measurements on six Varian TrueBeam and Edge linear accelerators were performed using three ICP with quad wedges (QWs) and were compared with conventional IC measurements. The accuracy of the ICP for beam output was characterized as the difference between the ICP and IC. Variables that affect ICP accuracy, including gain settings, calibrations, and template baselining as well as machine or energy-specific bias were investigated. Measurements of profile constancy, energy, dose rate constancy, wedge factors, and gating were performed. The initially observed mean output difference between the ICP and IC was 0.16% (0.61%). When gain settings were optimized, the output difference accuracy improved to -0.02% (0.38%). The output accuracy of the ICP was not dependent on array, dose, temperature and pressure calibrations, or template baselining. Statistically, ICP output accuracy was dependent on machine and beam energy, but clinically, all measurements fell within 0.5% of unity. ICP measurements of energy, dose rate constancy, and wedge factors matched passing results with conventional IC in water measurements. Gating and beam profile constancy measurements demonstrated good stability using the ICP. Finally, monthly dosimetry QA using ICP was completed in an average of 33 min compared to 66 min using the IC. This work demonstrated the feasibility and efficiency of using the ICP, with specific considerations, as a measurement device for dosimetric linear accelerator monthly QA.

The feasibility of CT simulation-free adaptive radiation therapy.

Novel on-board CBCT allows for improved image quality and Hounsfield unit accuracy. When coupled with online adaptive tools, this may have potential to allow for simulation and treatment to be completed in a single on-table session. To study the feasibility of a high-efficiency radiotherapy treatment workflow without the use of a separate session for simulation imaging. The dosimetric accuracy, overall efficiency, and technical feasibility were used to evaluate the clinical potential of CT simulation-free adaptive radiotherapy. Varian's Ethos adaptive radiotherapy treatment platform was upgraded with a novel CBCT system, HyperSight which reports image quality and Hounsfield unit accuracy specifications comparable to standard fan-beam CT. Using in-house developed MATLAB software, CBCT images were imported into the system and used for planning. Two test cases were completed on anthropomorphic phantoms equipped with small volume ion chambers (cross-calibrated to an ADCL traceable dose standard) to evaluate the feasibility and accuracy of the workflows. A simulated palliative spine treatment was planned with 8Gy in one fraction, and an intact prostate treatment was planned with 60Gy in 20 fractions. The CBCTs were acquired using HyperSight with default thorax and pelvis imaging protocols and reconstructed using an iterative algorithm with scatter removal, iCBCT Acuros. CBCTs were used for contouring and planning, and treatment was delivered via an online adaptive workflow. In addition, an external dosimetry audit was completed using only on-board CBCT imaging in an end-to-end head and neck phantom irradiation. An extended-field CBCT acquisition can be acquired in 12s, in addition to the time for longitudinal table shifts, and reconstructed in approximately 1min. The superior-inferior extent for the CBCT planning images was 38.2cm, which captured the full extent of relevant anatomy. The contouring and treatment planning for the spine and prostate were completed in 30 and 18min, respectively. The dosimetric agreement between ion chamber measurements and the treatment plan was within a range of -1.4 to 1.6%, and a mean and standard deviation of 0.41±1.16%. All metrics used in the external audit met the passing criteria, and the dosimetric comparison between fan-beam and CBCT techniques had a gamma passing rate of 99.0% with a criteria of 2%/2mm. Using an in-house workflow, CT simulation-free radiation therapy was shown to be feasible with acceptable workflow efficiency and dosimetric accuracy. This approach may be particularly applicable for urgent palliative treatments. With the availability of software to enable this workflow, and the continued advancement of on-treatment adaptation, single-visit radiation therapy may replace current practice for some clinical indications.

Skin dose investigations on a 0.5 T parallel rotating biplanar linac-MR using Monte Carlo simulations and measurements.

The Alberta rotating biplanar linac-MR has a 0.5 T magnetic field parallel to the beamline. When developing a new linac-MR system, interactions of charged particles with the magnetic field necessitate careful consideration of skin dose and tissue interface effects. To investigate the effect of the magnetic field on skin dose using measurements and Monte Carlo (MC) simulations. We develop an MC model of our linac-MR, which we validate by comparison with ion chamber measurements in a water tank. Additionally, MC simulation results are compared with radiochromic film surface dose measurements on solid water. Variations in surface dose as a function of field size are measured using a parallel plate ion chamber in solid water. Using an anthropomorphic computational phantom with a 2mm-thick skin layer, we investigate dose distributions resulting from three beam arrangements. Magnetic field on and off scenarios are considered for all measurements and simulations. For a 20×20cm2 field size, (the minimum dose to the hottest contiguous 0.2 cc volume) for the top 2mm of a simple water phantom is 72% when the magnetic field is on, compared to 34% with magnetic field off (values are normalized to the central axis dose maximum). Parallel plate ion chamber measurements demonstrate that the relative increase in surface dose due to the magnetic field decreases with increasing field size. For the anthropomorphic phantom, (minimum skin dose in the hottest 1×1×1 cm3 cube) shows relative increases of 20%-28% when the magnetic field is on compared to when it is off. With magnetic field off, skin is 71%, 56%, and 21% for medial-lateral tangents, anterior-posterior beams, and a five-field arrangement, respectively. For magnetic field on, the corresponding skin values are 91%, 67%, and 25%. Using a validated MC model of our linac-MR, surface doses are calculated in various scenarios. MC-calculated skin dose varies depending on field sizes, obliquity, and the number of beams. In general, the parallel linac-MR arrangement results in skin dose enhancement due to charged particles spiraling along magnetic field lines, which impedes lateral motion away from the central axis. Nonetheless, considering the results presented herein, treatment plans can be designed to minimize skin dose by, for example, avoiding oblique beams and using a larger number of fields.

Beam Position Projection Algorithms in Proton Pencil Beam Scanning.

Beam position uncertainties along the beam trajectory arise from the accelerator, beamline, and scanning magnets (SMs). They can be monitored in real time, e.g., through strip ionization chambers (ICs), and treatments can be paused if needed. Delivery is more reliable and accurate if the beam position is projected from monitored nozzle parameters to the isocenter, allowing for accurate online corrections to be performed. Beam position projection algorithms are also used in post-delivery log file analyses. In this paper, we investigate the four potential algorithms that can be applied to all pencil beam scanning (PBS) nozzles. For some combinations of nozzle configurations and algorithms, however, the projection uses beam properties determined offline (e.g., through beam tuning or technical commissioning). The best algorithm minimizes either the total uncertainty (i.e., offline and online) or the total offline uncertainty in the projection. Four beam position algorithms are analyzed (A1-A4). Two nozzle lengths are used as examples: a large nozzle (1.5 m length) and a small nozzle (0.4 m length). Three nozzle configurations are considered: IC after SM, IC before SM, and ICs on both sides. Default uncertainties are selected for ion chamber measurements, nozzle entrance beam position and angle, and scanning magnet angle. The results for other uncertainties can be determined by scaling these results or repeating the error propagation. We show the propagation of errors from two locations and the SM angle to the isocenter for all the algorithms. The best choice of algorithm depends on the nozzle length and is A1 and A3 for the large and small nozzles, respectively. If the total offline uncertainty is to be minimized (a better choice if the offline uncertainty is not stable), the best choice of algorithm changes to A1 for the small nozzle for some hardware configurations. Reducing the nozzle length can help to reduce the gantry size and make proton therapy more accessible. This work is important for designing smaller nozzles and, consequently, smaller gantries. This work is also important for log file analyses.

The development of a cylindrical phantom for nanoDotTM calibration with multiple beam angles

Background: The nanoDotTM dosimeter, an optically stimulated luminescent dosimeter (OSLD), is compact and precise, ideal for various applications like radiation dosimetry. The nanoDotTM requires calibration before use with the detector alignment perpendicular to the central beam axis. It exhibits angular dependence that may impact the calibration factor, requiring the fabrication of a specific cylindrical phantom for the calibration procedure. Objective: This study aimed to develop a cylindrical phantom for nanoDotTM calibration to facilitate dose measurements in composite fields with various beam angles and to evaluate the nanoDotTM calibration factors for different plans. Materials and methods: The cylindrical phantom was constructed using cast nylon material to accommodate the nanoDotTM or a cylindrical ionization chamber (IC). The novel phantom underwent validation for physical characteristics, including dimensions, density, and uniformity. Validation for the calibration factor, using cylindrical phantom (CF cylin) under standard conditions with a 10x10 cm² field size at 10 cm depth was conducted with 6 MV X-rays, comparing it with calibration factor using slab solid water phantoms (CFsolid). The CFcylin for different numbers of beams were determined and validated against a reference IC in various planning conditions. Furthermore, angular correction factors were determined for their application in the single-beam calibration factor. Results: The cylindrical phantom had dimensions of 20 cm in diameter and 30 cm in length, a density of 1.145 g/cm³ and good uniformity. As a result of single beam, the CF cylin, agreed well with CFsolid, showing a difference of -0.069%. The CFcylin increased with the number of beams, ranging between 1.179 and 1.242. Additionally, the angular correction factor increased as the number of beams increased, peaking at 1.058 with 9 beams. When comparing the results to the IC, it was observed that with an increase in the number of beams to 4 beams, the single-beam calibration factor exhibited a variation of more than 2%. However, when applying the CF cylin specific to the number of beams or correcting for the angular correction factor, the dose differences between nanoDotTM and IC measurements were within 2%. Conclusion: The developed cylindrical phantom is suitable for nanoDotTM calibration under single beam angle and in composite fields with various beam angles. The new calibration factors for specific numbers of beams allow for accurate dose measurements using nanoDotTM, thus reducing the dose difference from the IC to acceptable levels. Further studies should investigate its application in clinical situations.

Technical note: Radiological clinical equivalence for phantom materials in carbon ion therapy.

As carbon ion radiotherapy increases in use, there are limited phantom materials for heterogeneous or anthropomorphic phantom measurements. This work characterized the radiological clinical equivalence of several phantom materials in a therapeutic carbon ion beam. Eight materials were tested for radiological material-equivalence in a carbon ion beam. The materials were computed tomography (CT)-scanned to obtain Hounsfield unit (HU) values, then irradiated in a monoenergetic carbon ion beam to determine relative linear stopping power (RLSP). The corresponding HU and RLSP for each phantom material were compared to clinical carbon ion calibration curves. For absorbed dose comparison, ion chamber measurements were made in the center of a carbon ion spread-out Bragg peak (SOBP) in water and in the phantom material, evaluating whether the material perturbed the absorbed dose measurement beyond what was predicted by the HU-RLSP relationship. Polyethylene, solid water (Gammex and Sun Nuclear), Blue Water (Standard Imaging), and Techtron HPV had measured RLSP values that agreed within ±4.2% of RLSP values predicted by the clinical calibration curve. Measured RLSP for acrylic was 7.2% different from predicted. The agreement for balsa wood and cork varied between samples. Ion chamber measurements in the phantom materials were within 0.1% of ion chamber measurements in water for most materials (solid water, Blue Water, polyethylene, and acrylic), and within 1.9% for the rest of the materials (balsa wood, cork, and Techtron HPV). Several phantom materials (Blue Water, polyethylene, solid water [Gammex and Sun Nuclear], and Techtron HPV) are suitable for heterogeneous phantom measurements for carbon ion therapy. Low density materials should be carefully characterized due to inconsistencies between samples.

Commissioning and dosimetric verification of volumetric modulated arc therapy for multiple modalities using electronic portal imaging device-based 3D dosimetry system: a novel approach.

The purpose of this study was to validate an electronic portal imaging device (EPID) based 3-dimensional (3D) dosimetry system for the commissioning of volumetric modulated arc therapy (VMAT) delivery for flattening filter (FF) and flattening filter free (FFF) modalities based on test suites developed according to American Association of Physicists in Medicine Task Group 119 (AAPM TG 119) and pre-treatment patient specific quality assurance (PSQA).With ionisation chamber, multiple-point measurement in various planes becomes extremely difficult and time-consuming, necessitating repeated exposure of the plan. The average agreement between measured and planned doses for TG plans is recommended to be within 3%, and both the ionisation chamber and PerFRACTION™ measurement were well within this prescribed limit. Both point dose differences with the planned dose and gamma passing rates are comparable with TG reported multi-institution results. From our study, we found that no significant differences were found between FF and FFF beams for measurements using PerFRACTION™ and ion chamber. Overall, PerFRACTION™ produces acceptable results to be used for commissioning and validating VMAT and for performing PSQA. The findings support the feasibility of integrating PerFRACTION™ into routine quality assurance procedures for VMAT delivery. Further multi-institutional studies are recommended to establish global baseline values and enhance the understanding of PerFRACTION™'s capabilities in diverse clinical settings.

Commissioning and Assessment of Radiation Field and Dose Inhomogeneity for a Dual X-ray Tube Cabinet Irradiator: To Ensure Accurate Dosimetry in Radiation Biology Experiments

PurposeStandardization of X-ray cabinet irradiators dose, geometry, and calibration reporting is an ongoing process. Multi-tube designs have been introduced onto the pre-clinical market and give a theoretical benefit but have not been widely assessed for use in pre-clinical irradiation conditions. The aim of this study was to report on our experience commissioning a dual x-ray source cabinet irradiator (CIXD, Xstrahl Limited, United Kingdom) and assess the dose distribution for various experimental conditions. Materials and MethodsHalf-value layer (HVL) measurement, profile measurements, and output calibration were performed with a calibrated ion chamber. Constancy measurements were performed twice daily over two weeks to assess output fluctuations. Film measurements were completed using solid water to assess percent depth dose and homogeneity within the field and within variable thickness of solid water and phosphate-buffered saline (PBS) solution. Film measurements were repeated for various arrangements of petri dishes filled with PBS or water and in a 3D printed mouse phantom. ResultsThe X-ray tubes measured in-air output was 1.27 Gy/min. The HVL was 1.7 mm Cu. The upper and lower tubes both exhibited the heel effect, but when operated simultaneously the effect was reduced. Ion chamber measurements revealed 15% dose inhomogeneity within the tray area (18 × 18 cm2). Film measurements in the petri dishes indicated minor non-uniformities with the arrangements of experimental apparatus. The mouse phantom with film agreed with ion chamber measurements for various phantom placement and orientations. ConclusionX-ray cell culture irradiation with the dual tube cabinet irradiation is efficient and robust when utilizing established dosimetric tools to confirm output and homogeneity. The conditions assumed for calibrations are often not maintained during experiments. We have confirmed that inhomogeneities are present for single tube use, however they are reduced with simultaneous tube use. Additional dosimetric monitoring should be performed for each unique irradiation setup.

A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD.

To develop a Total Body Irradiation (TBI) technique using IMRT at extended SSD that can be performed in any size Linac room. Patients studied were placed on a platform close to the floor, directly under the gantry with cranial-caudal axis parallel to the gantry rotation plane and at SSD ∼200cm. Two abutting fields with the same external isocenter at gantry angles of±21˚, collimator angle of 90˚, and field size of 25×40 cm2 are employed for both supine and prone positions. An iterative optimization algorithm was developed to generate a uniform dose at the patient mid-plane with adequate shielding to critical organs such as lungs and kidneys. The technique was validated in both phantom and patient CT images for treatment planning, and dose measurement and QA were performed in phantom. A uniform dose distribution in the mid-plane within±5% of the prescription dose was reached after a few iterations. This was confirmed with ion-chamber measurements in phantom. The mean dose to lungs and kidneys can be adjusted according to clinical requirements and can be as low as ∼25% of the prescription dose. For a typical prescription dose of 200 cGy/fraction, the total MU was ∼2400/1200 for the superior/inferior field. The overall treatment time for both supine/prone positions was ∼54 min to meet the maximum absorbed dose rate criteria of 15 cGy/min. IMRT QA with portal dosimetry shows excellent agreement. We have developed a promising TBI technique using abutting IMRT fields at extended SSD. The patient is in a comfortable recumbent position with good reproducibility and less motion during treatment. An additional benefit of this technique is that full 3D dose distribution is available from the TPS with a DVH summary for organs of interest. The technique allows precise sparing of lungs and kidneys and can be executed in any linac room.

Intraoperative radiation therapy with 50kV x-rays: A multi-institutional review.

This report covers clinical implementation of a low kV intraoperative radiation therapy (IORT) program with the INTRABEAM® System (Carl Zeiss Meditec AG, Jena, Germany). Based on collective user experience from eight institutions, we discuss best methods of INTRABEAM quality assurance (QA) tests, commissioning measurements, clinical workflow, treatment planning, and potential avenues for research. The guide provides pertinent background information and clinical justification for IORT. It describes the INTRABEAM system and commissioning measurements along with a TG100 risk management analysis to ensure safety and accuracy of the IORT program. Following safety checks, dosimetry measurements are performed for verification of field flatness and symmetry, x-ray output, and depth dose. Also discussed are dose linearity checks, beam isotropy, ion chamber measurements, calibration protocols, and in-vivo dosimetry with optically stimulated luminescence dosimeters OSLDs, and radiochromic film. Emphasis is placed on the importance of routine QA procedures (daily, monthly, and annual) performed at regular intervals for a successful IORT program. For safe and accurate dose delivery, tests of important components of IORT clinical workflow are emphasized, such as, dose prescription, pre-treatment QA, treatment setup, safety checks, radiation surveys, and independent checks of delivered dose. Challenges associated with in-vivo dose measurements are discussed, along with special treatment procedures and shielding requirements. The importance of treatment planning in IORT is reviewed with reference to a Monte Carlo-based commercial treatment planning system highlighting its main features and limitations. The report concludes with suggested topics for research including CT-based image-guided treatment planning and improved prescription dose accuracy. We hope that this multi-institutional report will serve as a guidance document on the clinical implementation and use of INTRABEAM IORT.

Comprehensive characterisation of the IBA myQA SRS for SRS and SBRT patient specific quality assurance.

The myQA SRS (IBA) is a new to market 2D complementary metal oxide semiconductor detector array with an active area 140 × 120mm2 and 0.4mm resolution, making it a potential real-time dosimetry alternative to radiochromic film for stereotactic plan verification. Characterisation of the device was completed to assess performance. The dosimetric properties of the device were assessed for 6FF and 6FFF beams from a Varian TrueBeam STx with high definition multileaf collimator. Clinical suitability of the device for Patient Specific Quality Assurance was verified using ten SRS/SBRT plans, compared against other detectors, as well as multi leaf collimator (MLC) tests including picket fence and chair. Gamma analysis was performed using myQA software with criteria of 4%/1mm. The device demonstrated compliance with recommended specifications for basic tests. After the required warm-up period, the maximum deviation in detector signal from initial readings was 0.2%. Short-term and long-term reproducibility was 0.1% (6FF) and 1.0% (6FFF), respectively. Dose linearity was within 0.3% (6FF) and 0.7% (6FFF) and dose-rate dependence within 1.7% (6FF) and 2.9% (6FFF) and were verified with a Farmer type ionization chamber (PTW 30013). Angular dependence was quantified for coplanar and non-coplanar situations. Output factors and beam profiles measured on the device showed agreement within 1% of baseline RAZOR diode (IBA) and CC04 ionisation chamber (IBA) measurements for field sizes 1 × 1 to 10 × 10cm2. The minimum gamma (4%/1mm) pass rates for MLC-pattern tests were 96.5% and 98.1% for the myQA SRS and film, respectively. The average gamma (4%/1mm) pass rates for SBRT and SRS plans were 98.8% and 99.8% respectively. This work represents one of the first studies performed on the commissioning and performance characterisation of this novel device, demonstrating its accuracy and reliability, making it highly useful as a film alternative in stereotactic treatment plan verification.

Adapting a practical EPR dosimetry protocol to measure output factors in small fields with alanine.

Modern radiotherapy techniques often deliver small radiation fields. In this work, a practical Electron Paramagnetic Resonance (EPR) dosimetry protocol is adapted and applied to measure output factors (OF) in small fields of a 6 MV radiotherapy system. Correction factors and uncertainties are presented and OFs are compared to the values obtained by following TRS-483 using an ionization chamber (IC). Irradiations were performed at 10cm depth inside a water phantom positioned at 90cm source to surface distance with a 6 MV flattening filter free photon beam of a Halcyon radiotherapy system. OFs for different nominal field sizes (1×1, 2×2, 3×3, 4×4, normalized to 10×10 cm2 ) were determined with a PinPoint 3D (PTW 31022) IC following TRS-483 as well as with alanine pellets with a diameter of 4mm and a height of 2.4mm. EPR readout was performed with a benchtop X-band spectrometer. Correction factors due to volume averaging and due to positional uncertainties were derived from 2D film measurements. OFs obtained from both dosimeter types agreed within 0.7% after applying corrections for the volume averaging effect. For the used alanine pellets, volume averaging correction factors of 1.030(2) for the 1×1 cm2 field and <1.002 for the larger field sizes were determined. The correction factor for positional uncertainties of 1mm was in the order of 1.018 for the 1×1 cm2 field. Combined relative standard uncertainties uc for the OFs resulting from alanine measurements were estimated to be below 1.5% for all field sizes. For IC measurements, uc was estimated to be below 1.0%. A practical EPR dosimetry protocol is adaptable for precisely measuring OFs in small fields down to 1×1cm2 . It is recommended to consider the effect of positional uncertainties for field sizes <2×2cm2 .

Validation of an in vivo transit dosimetry algorithm using Monte Carlo simulations and ionization chamber measurements.

Transit dosimetry is a safety tool based on the transit images acquired during treatment. Forward-projection transit dosimetry software, as PerFRACTION, compares the transit images acquired with an expected image calculated from the DICOM plan, the CT, and the structure set. This work aims to validate PerFRACTION expected transit dose using PRIMO Monte Carlo simulations and ionization chamber measurements, and propose a methodology based on MPPG5a report. The validation process was divided into three groups of tests according to MPPG5a: basic dose validation, IMRT dose validation, and heterogeneity correction validation. For the basic dose validation, the fields used were the nine fields needed to calibrate PerFRACTION and three jaws-defined. For the IMRT dose validation, seven sweeping gaps fields, the MLC transmission and 29 IMRT fields from 10 breast treatment plans were measured. For the heterogeneity validation, the transit dose of these fields was studied using three phantoms: 10, 30, and a 3cm cork slab placed between 10cm of solid water. The PerFRACTION expected doses were compared with PRIMO Monte Carlo simulation results and ionization chamber measurements. Using the 10cm solid water phantom, for the basic validation fields, the root mean square (RMS) of the difference between PerFRACTION and PRIMO simulations was 0.6%. In the IMRT fields, the RMS of the difference was 1.2%. When comparing respect ionization chamber measurements, the RMS of the difference was 1.0% both for the basic and the IMRT validation. The average passing rate with a γ(2%/2mm, TH=20%) criterion between PRIMO dose distribution and PerFRACTION expected dose was 96.0%±5.8%. We validated PerFRACTION calculated transit dose with PRIMO Monte Carlo and ionization chamber measurements adapting the methodology of the MMPG5a report. The methodology presented can be applied to validate other forward-projection transit dosimetry software.

Intrafraction Dosimetric Evaluation of Biology-Guided Radiotherapy to a Target Under Respiratory Motion

To evaluate the reproducibility and variability of biology-guided radiotherapy (BgRT) treatments using a large anthropomorphic phantom modeling the motion amplitude of a lung tumor. RefleXion X1 is equipped with two opposing 90 degrees PET detector arcs to capture the radionuclide emissions and direct the 6MV Linac to treat the lesions in real time. A custom-built phantom filled with a liquid [¹⁸F]Fluorodeoxyglucose (FDG) solution was used. Fillable target and OAR structures were 3D printed and attached to motion stages. The GTV = CTV was matched to the spherical 22 mm diameter target, and the PTV was a 5 mm expansion from the CTV volume. The Biology Tracking Zone (BTZ) was generated after adding 5 mm margin to the motion extent of the CTV. The OAR was a large C-shape annulus (emulating a heart) that was approximately 3 cm from the target. The 3D independent motion trajectory of the target was designed to mimic lung motion: range of +5.8 mm to -4.9 mm in LR, range of +14.4 mm to -11.3 mm in SI, and range of +5.2 mm to -5.1 mm in AP directions. The OAR motion waveform used a 1D sinusoidal pattern with a 5 mm amplitude in SI direction. The target and the OAR were filled with 40 kBq/mL while the background had 5 kBq/mL FDG. A BgRT Modeling (imaging-only) PET acquisition was performed using RefleXion X1 and used to generate a 4-fraction BgRT treatment plan prescribing 10 Gy/fraction to PTV. For each delivery, target, OAR and background were filled with the same FDG concentrations as in the BgRT Modeling PET planning scan. Dosimetry to the target and OAR were both measured using an ion-chamber (Exradin A14SL) and film in the coronal plane through the center of the GTV for all 4 fractions. The mean activity concentration within the (BTZ) was 7.4 ± 0.8 kBq/mL. The calculated signal-to-noise ratio metric (Normalized Target Signal) within the BTZ was 4.0 ± 0.3. Total treatment times were all less than 35 minutes (34.3 ± 0.2). Prescription dose coverage to the CTV for all 4 fractions was 100%. Ion chamber measurements in the CTV were -1.6 ± 1.3% relative to the planned dose over the active area of the ion-chamber. Minimum and maximum doses to the CTV, measured on film, were -7.7 ± 2.2% and 1.3 ± 1.4%, calculated relative to the planned dose distribution, respectively. The OAR maximum point dose measured on film was -8.7 ± 2.9%, calculated relative to the maximum OAR dose predicted on the bounded dose-volume histogram. Based on this initial study, accurate and reproducible dosimetry can be achieved for targets under respiratory motion using biology-guided radiotherapy over the course of a complete course of treatment. Further studies are needed to evaluate the intrafraction dosimetry of BgRT delivery under various motion models and tumor sizes.

Commissioning and Assessment of Radiation Field and Dose Inhomogeneity for a Dual X-Ray Tube Cabinet Irradiator: To Ensure Accurate Dosimetry in Radiation Biology Experiments

Standardization of X-ray cabinet irradiators calibration and dose reporting is an ongoing process. Multi-tube designs have been introduced and provide theoretical benefit but have not been assessed for pre-clinical irradiation conditions. This study was to report our experience commissioning a dual x-ray tube cabinet irradiator and assess dose distribution for various conditions. Homogeneity and percent depth dose (PDD) of various tube designs in single-tube setting have been previously reported, however multi-tube designs can overcome field asymmetry caused by the heel effect and improve dose fall-off at depth. Profile measurements and output calibration were performed with a calibrated ion chamber. We measured the percent-depth-dose (PDD) with film for each tube individually (PDDind) and both tubes simultaneously (PDDsim). To replicate conditions similar to petri dishes, we evaluated the range of attenuation and scatter under variable solid water thickness up to 9 mm with 3 mm build-up below (i.e., 1.2 cm total backscatter) under several geometries. The films were placed at a fixed position with variable amount of solid water placed above the film. We measured the output with variable water volumes with a 6 cm petri dish to simulate variable solution volumes that are frequently used during in vitro experiments. Film was also placed in a 3D printed mouse phantom with dimensions of (9.5 × 3.6 × 3.0 cm) and constructed to be roughly cylindrical. The dose in the 20 × 20 cm2 tray was within 8.4% of the central axis dose with both tubes. Dose rates decreased at the furthest points on the tray, but remained within 5% within the 15 × 15 cm2 central area. PDDsim with total 7.9 cm backscatter shows that the output is within 95% of the maximum dose at 4 cm depth. PDDsim with 1.2 cm backscatter is also within 95% of the maximum. The PDDind was less than 90% at 1.8 cm, which is similar to other single-tube systems. Slight increase in dose was seen with increasing solution; however, the doses were within 7% of the measured max dose at 6.3 mm depth. This agrees well with the solid water measurements. The results for both solid water and petri dish with variable medium is shown in Table 1. The 3D printed mouse phantom profiles for each plane showed results consistent with the ion chamber measurements. X-ray cell culture irradiation with dual-tube cabinet irradiation is robust when utilizing established dosimetric tools to confirm output and homogeneity. The conditions assumed for calibrations are often not maintained during experiments. We have confirmed that inhomogeneities are present for single tube use, however they are reduced with simultaneous tube use. Additional monitoring should be performed for each unique irradiation setup.

A Novel Approach to Support Quality Assurance (QA) of Intensity Modulated Neutron Therapy (IMNT)

Neutron therapy is a form of high linear energy transfer (LET) radiation treatment shown to be beneficial for the treatment of locally advanced head and neck cancers (HNC) resistant to low LET x-ray and proton therapy treatments. The Clinical Neutron Therapy System (CNTS) at our institution has been in clinical operation for over 35 years, and over 3,400 patients have been treated using 3D conformal neutron radiation therapy. In October of 2022, the clinical commissioning of IMNT was completed and the first-ever patient was treated. A novel patient specific quality assurance (PSQA) program has been developed to support IMNT. We present an analysis of our early experiences and PSQA findings for the first 16+ patients treated with IMNT. Our pre-treatment IMNT PSQA program includes (1) ionization chamber measurements, (2) a log-file analysis of treatment delivery, and (3) a γ-analysis of the expected and measured doses (fluences) from a novel positron emission portal imaging system based on 12C(n,2n)11C reactions. Patient setup is confirmed on a daily basis with kV portal imaging. We use a modulation factor (MF), defined as the total number of monitor units (MU)/prescribed dose (cGy) per fraction, to identify and help anticipate IMNT plans that may fail our PSQA program. We have found that IMNT treatments for large, irregularly shaped treatment volumes (e.g., chest wall or head and neck cancers that require treatment of nodes in the lower neck) are more likely to fail PSQA when the MF exceeds 3 MU/cGy. For smaller, more spherical treatment volumes (e.g., base of tongue cancers), plans with a MF up to 3.5 MU/cGy pass our PSQA criteria. Re-optimized plans subsequently passed PSQA with insignificant or no change in tumor coverage and organ-at-risk (OAR) dose. Re-optimized plans also reduced the total number of MU and number of segments, which has the added benefit of decreasing the overall treatment time and patient time on the table. About 10% of early IMNT patients have required plan re-optimization. Our pre-treatment clinical PSQA program and workflow provides useful information to guide IMNT treatment planning and delivery, and helps ensure the safe and accurate delivery of IMNT. Our early experiences suggest IMNT plans with smaller MF values are more likely to pass PSQA than plans with larger values of the MF.

An Investigation of High-Z Material for Bolus in Electron Beam Therapy

Electron beams are frequently used for superficial tumors including: primary skin cancers, surgical scars, cutaneous lymphomas and benign conditions like keloids. However, due to electron beam characteristics the surface dose is 75-95% of the prescribed dose depending on beam energy thus requiring placement of bolus to augment surface dose. Various types of boluses; wet gauge/towel, superflab, superstuff, aquaplast, 3D printed plastics, customized dot-decimal bolus, thermoshield, brass and tantalum wire mesh are commonly used in clinics with variable difficulties that are not perfect. As majority of these devices do not snug to the skin contour and create air-gap that is known to produce significant dose perturbations creating hot and cold spot. The variable dosimetry has cosmetic implications and potentially increased risk of recurrence. A new cloth-like high-Z materials; Tungsten, (Z = 74) and Bismuth, (Z = 83) impregnated with silicone gel are now commercially available which is investigated in this study for bolus purpose. Commercially available, super soft silicone-gel based submillimeter thin Tungsten and Bismuth sheets were investigated for bolus properties in electron beams in the range of 6-12 MeV using 10x10 cm2 applicator. These materials were tested on various body contour for perfect snug without any air traps. Using parallel plate ion chamber measurements were performed in a solid water phantom on a medical linear accelerator machine. Depth dose characteristics were measured to optimize the thickness for surface dose to be 100% for selected electron therapy. Surface dose for a 10x10 cm2 cone for 6, 9, 12 MeV beams were measured to be 75.1%, 80.1% and 86.2%, respectively. Silicone-gel Tungsten and Bismuth sheets produce significant electrons thus increasing surface dose. Based on measured depth dose, our data showed that Tungsten sheets of 0.14 mm, 0.18 mm and 0.2 mm and Bismuth sheets of 0.42 mm, 0.18 mm and 0.2 mm provide 100% surface dose for 6, 9 and 12 MeV beams, respectively without any changes in depth dose except increasing surface dose. The new Tungsten and Bismuth based silicone-gel clothlike sheets are extremely soft but high tensile metallic bolus materials that can fit flawlessly on any skin contour without any air trap or variable thickness or spillage of the water as in conventionally used wet gauge. Only 0.2 mm thick sheets are needed for 100% surface dose without degradation of the depth dose characteristics. These materials are reusable and ideal for bolus in electron beam treatment. This investigation opens a new frontier in designing new bolus materials optimum for patient treatment.