Output Factor Measurements Research Articles

Technical note: Characterization of a multi-point scintillation dosimetry research platform for a low-field MR-Linac.

MRI-guided radiation therapy (MRgRT) requires unique quality assurance equipment to address MR-compatibility needs, minimize electron return effect, handle complex dose distributions, and evaluate real-time dosimetry for gating. Plastic scintillation detectors (PSDs) are an attractive option to address these needs. To perform a comprehensive characterization of a multi-probe PSD system in a low-field 0.35T MR-linac, including detector response assessment and gating performance. A four-channel PSD system (HYPERSCINT RP-200) was assembled. A single channel was used to evaluate repeatability, percent depth dose (PDD), detector response as a function of orientation with respect to the magnetic field, and intersession variability. All four channels were used to evaluate repeatability, linearity, and output factors. The four PSDs were integrated into an MR-compatible motion phantom at isocenter and in gradient regions. Experiments were conducted to evaluate gating performance and tracking efficacy. For repeatability, the maximum standard deviation of repeated measurements was 0.13% (single PSD). Comparing the PSD to reference data, PDD had a maximum difference of 1.12% (10cm depth, 6.64×6.64 cm2). Percent differences for rotated detector setups were negligible (<0.3%). All four PSDs demonstrated linear response over 10-1000 MU delivered and the maximum percent difference between the baseline and measured output factors was 0.78% (2.49×2.49 cm2). Gating experiments had 400 cGy delivered to isocenter with<0.8 cGy variation for central axis measures and<0.7 cGy for the gradient sampled region. Real-time dosimetry measurements captured spurious beam-on incidents that correlated to tracking algorithm inaccuracies and highlighted gating parameter impact on delivery efficiency. Characterization of the multi-point PSD dosimetry system in a 0.35T MR-linac demonstrated reliability in a low-field MR-Linac setting, with high repeatability, linearity, small intersession variability, and similarity to baseline data for PDD and output factors. Time-resolved, multi-point dosimetry also showed considerable promise for gated MR-Linac applications.

Uncertainty of scintillator-based field-output factor measurements in MR-Linacs with the two-channel chromatic stem removal technique

Current international protocols such as the IAEA/AAPM TRS-483 for small field dosimetry do not include recommendations for measurements in strong magnetic fields as found in MR-Linacs (i.e. megavoltage x-ray radiotherapy units with built-in magnetic resonance imaging). A EURAMET research project was therefore launched to support the traceability of such measurements and to contribute to the metrological basis for future recommendations. Given the high degree of water equivalence and the small size of fiber-coupled plastic scintillators, one objective of the project was to study the suitability of this detector type for dosimetry in MR-Linacs and to demonstrate their use in a clinical environment. This manuscript reports results of that work. A protocol for measuring field output factors with plastic scintillation detectors was developed. The protocol is based on calibration of the scintillators directly in a water phantom positioned in the MR-Linac rather than in a water-equivalent solid phantom as has been a common technique for conventional linacs. A detailed uncertainty budget was established involving all known sources of uncertainty including the systematic influence of light attenuation through the fiber when measuring in different field sizes. The protocol was used to measure field output factors at five MR-Linac's (four Viewray MRIdian's and one Elekta Unity). The protocol showed a high level of robustness leading to a less than 0.3 % deviation between field output factors calculated based on calibration data obtained before or after the field-output factor measurements. The correction for light attenuation was less than 0.4 % for all fields measured but showed a systematic offset, with larger corrections needed for small field sizes.This robustness of the protocol was further demonstrated by the closeness of agreement (agreement within uncertainty) for field-output factor measurements with two different scintillators (BCF-12 and BCF-60) for square fields (size: 0.83 cm × 0.83 cm or larger) in four nominally identical Viewray MRIdian's. To test the accuracy of the scintillator measurements, the system was used for characterization of a PTW 60019 micro diamond detector in a Viewray MRIdian. Scintillator based correction factors for output factor measurements with the micro diamond detector were found to be in agreement with independent Monte-Carlo computations. The study therefore supports that plastic scintillation detectors are an excellent option for measuring field output factors in MR-Linacs.

The IAEA remote audit of small field dosimetry for testing the implementation of the TRS-483 code of practice.

The TRS‑483, an IAEA/AAPM International Code of Practice on dosimetry of small static photon fields, underwent testing via an IAEA coordinated research project (CRP). Alongside small field output factors (OFs) measurements using active dosimeters by CRP participants, the IAEA Dosimetry Laboratory received a mandate to formulate a remote small field dosimetry audit method using its passive dosimetry systems. This work aimed to develop a small field dosimetry audit methodology employing radiophotoluminescent dosimeters (RPLDs) and radiochromic films. The methodology was subsequently evaluated through a multicenter pilot study with CRP participants. The developments included designing and manufacturing a dosimeter holder set and the characterization of an RPLD system for measurements in small photon fields using the new holder. The audit included verification of small field OFs and lateral beam profiles for small fields. At first, treatment planning system (TPS) calculated OFs were checked against a reference data set that was available for conventional linacs. Second, calculated OFs were verified through the RPLD measurement of point doses in a machine-specific reference field, 4cm × 4cm, 2cm × 2cm, and 1cm × 1cm, corresponding size circularfields or nearest achievable field sizes. Lastly, profile checks in in-plane and cross-plane directions were done for the two smallest fields by comparing film measurements with TPS calculations at 20%, 50%, and 80% isodose levels. RPLD correction factors for small field measurements were approximately unity. However, they influenced the dose determination's overall uncertainty in small fields, estimated at 2.30% (k=1 level). Considering the previous experience in auditing reference beam output following the TRS-398 Code of Practice, the acceptance limit of 5% for the ratio of the dose determined by RPLD to the dose calculated by TPS, DRPLD/DTPS, was considered adequate. The multicenter pilot study included 15 participants from 14 countries (39 beams). Consistent with the previous findings, the results of the OF check against the reference data confirmed that TPSs tend to overestimate OFs for the smallest fields included in this exercise. All except three RPLD measurement results were within the acceptance limit, and the spread of results increased for smaller field sizes. The differences between the film measured and TPS calculated dose profiles were within 3mm for most of the beams checked; deviated results revealed problems with TPS commissioning and calibration of the treatment unit collimation systems. The newly developed small field dosimetry audit methodology proved effective and successfully complemented the CRP OF measurements by participants with RPLD audit results.

Evaluation of radiation detectors for the determination of field output factors in Leksell Gamma Knife dosimetry using 3D printed phantom inserts

The Leksell Gamma Knife® Perfexion™ and Icon™ have a unique geometry, containing 192 60Co sources with collimation for field sizes of 4 mm, 8 mm, and 16 mm. 4 mm and 8 mm collimated fields lack lateral charged particle equilibrium, so accurate field output factors are essential. This study performs field output factor measurements for the microDiamond, microSilicon, and RAZOR™ Nano detectors.3D printed inserts for the spherical Solid Water® Phantom were fabricated for microDiamond detector, the microSilicon unshielded diode and the RAZOR™ Nano micro-ionisation chamber. Detectors were moved iteratively to identify the peak detector signal for each collimator, representing the effective point of measurement of the chamber.In addition, field output correction factors were calculated for each detector relative to vendor supplied Monte Carlo simulated field output factors and field output factors measured with a W2 scintillator. All field output factors where within 1.1 % for the 4 mm collimator and within 2.3 % for the 8 mm collimator.The 3D printed phantom inserts were suitable for routine measurements if the user identifies the effective point of measurement, and ensures a reproducible setup by marking the rotational alignment of the cylindrical print. Measurements with the microDiamond and microSilicon can be performed faster compared to the RAZOR™ Nano due to differences in the signal to noise ratio. All detectors are suitable for field output factor measurements for the Leksell Gamma Knife® Perfexion™ and Icon™.

Validation of Microionization Chambers in Small-field Dosimetry.

This study aims to validate the Razor Nano Chamber (RNC) and Razor Chamber (RC) dosimetric characteristics in a small field. The dosimetric parameters of the two chambers were compared. The chamber characteristics of leakage (pre and post), stability, energy dependency, dose linearity, dose rate effect, stem effect, angular dependency, ion recombination effect, and polarity effect were studied. Relative dose measurements of the percentage depth dose, profile measurement, and output factor (OF) measurements were performed for small fields. All measurements were performed in a Theratron 780E telecobalt unit and an Elekta Versa HD™ Linear Accelerator. The measured pre- and postirradiation leakage and energy dependency were within 0.5% of the acceptable limit. In the stability check, the standard error and standard error of mean were 0.047% and 0.068%, respectively, for both RNC and RC. The deviation in the angular responses of the RNC and RC ion chambers was negligible. In the ion recombination measurements, both the RNC and RC were overestimated for the 10 flattening filter-free photon beam. In small fields, there were no significant differences in the kpol values for either chamber. The RNC showed good agreement in the relative dose measurements compared to the RC. RNC and RC showed good agreement in small-field dosimetry. The RNC angular dependency and OF showed a superior response compared to the RC because of the small volume spherical shape and high spatial resolution, which gives a reduced penumbra and no volume averaging effect.

Pencil beam kernel-based dose calculations on CT data for a mixed neutron-gamma fission field applying tissue correction factors.

Objective.For fast neutron therapy with mixed neutron and gamma radiation at the fission neutron therapy facility MEDAPP at the research reactor FRM II in Garching, no clinical dose calculation software was available in the past. Here, we present a customized solution for research purposes to overcome this lack of three-dimensional dose calculation.Approach.The applied dose calculation method is based on two sets of decomposed pencil beam kernels for neutron and gamma radiation. The decomposition was performed using measured output factors and simulated depth dose curves and beam profiles in water as reference medium. While measurements were performed by applying the two-chamber dosimetry method, simulated data was generated using the Monte Carlo code MCNP. For the calculation of neutron dose deposition on CT data, tissue-specific correction factors were generated for soft tissue, bone, and lung tissue for the MEDAPP neutron spectrum. The pencil beam calculations were evaluated with reference to Monte Carlo calculations regarding accuracy and time efficiency.Main results.In water, dose distributions calculated using the pencil beam approach reproduced the input from Monte Carlo simulations. For heterogeneous media, an assessment of the tissue-specific correction factors with reference to Monte Carlo simulations for different tissue configurations showed promising results. Especially for scenarios where no lung tissue is present, the dose calculation could be highly improved by the applied correction method.Significance.With the presented approach, time-efficient dose calculations on CT data and treatment plan evaluations for research purposes are now available for MEDAPP.

Multi-point calorimeter using distributed fiber Bragg gratings for small field dosimetry in radiotherapy.

The interest of using fiber Bragg gratings (FBGs) dosimeters in radiotherapy (RT) lies in their (i) microliter detection volume, (ii) customizable spatial resolution, (iii) multi-point dose measurement, (iv) real-time data acquisition and (v) insensitivity to Cherenkov light. These characteristics could prove very useful for characterizing dose distributions of small and nonstandard fields with high spatialresolution. We developed a multi-point FBGs dosimeter customized for small field RT dosimetry with a spatial resolution of 1mm. The 3cm-long multi-point dosimeter is made by embedding a 80 silica fiber containing an array of thirty (30) co-located 1mm-long fs-written FBGs inside a plastic cylinder with an UV curing optical adhesive. With its higher thermal expansion coefficient, the plastic cylinder increases the sensitivity of the dosimeter by stretching the fiber containing the FBGs when the temperature rises slightly due to radiation energy deposition. Irradiations (2000MU at 600MU/min) were performed with a Varian TrueBeam linearaccelerator. The dose profile of a 2 2cm 6MV beam was measured with a mean relative difference of 1.8% (excluding the penumbra region). The measured output factors for a 6MV beam are in general agreement with the expected values within the experimental uncertainty (except for the 2 2cm field). The detector response to different energy of photon and electron beams is within 5% of the mean response ( pm/Gy). The calorimeter's post-irradiation thermal decay is in agreement with thetheory. An energy-independent small field calorimeter that allows dose profile and output factor measurements for RT using FBGs was developed, which, to our knowledge, has never been done before. This type of detector could prove really useful for small field dosimetry, but also potentially for MRI-LINAC since FBGs are insensitive to magnetic fields and for FLASH since FBGs have been used to measure doses up to100kGy.

Effect of Detector Orientation and Influence of Jaw Position in the Determination of Small-field Output Factor with Various Detectors for High-energy Photon Beams.

Accurate dose measurements are difficult in small fields due to charge particle disequilibrium, partial source occlusion, steep dose gradient, and the finite size of the detector. The study aims to determine the output factor using various detectors oriented in parallel and perpendicular orientations for three different tertiary collimating systems using 15 MV photon beams. In addition, this study analyzes how the output factor could be affected by different configurations of X and Y jaws above the tertiary collimators. Small field output factor measurements were carried out with three detectors for different tertiary collimating systems such as BrainLab stereotactic cones, BrainLab mMLC and Millennium MLC namely. To analyze the effect of jaw position on output factor, measurements have been carried out by positioning the jaws at the edge, 0.25, 0.5, and 1.0 cm away from the tertiary collimated field. The data acquired with 15 MV photon beams show significant differences in output factor obtained with different detectors for all collimating systems. For smaller fields when compared to microDiamond, the SRS diode underestimates the output by up to -1.7% ± 0.8% and -2.1% ± 0.3%, and the pinpoint ion chamber underestimates the output by up to -8.1% ± 1.4% and -11.9% ± 1.9% in their parallel and perpendicular orientation respectively. A large increase in output factor was observed in the small field when the jaw was moved 0.25 cm symmetrically away from the tertiary collimated field. The investigated data on the effect of jaw position inferred that the position of the X and Y jaw highly influences the output factors of the small field. It also confirms that the output factor highly depends on the configuration of X and Y jaw settings, the tertiary collimating system as well as the orientation of the detectors in small fields.

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 .

Dosimetric characterization of a new surface-conforming electron MLC prototype.

The purpose is toreduce normal tissue radiation toxicity for electron therapy through the creation of a surface-conforming electron multileaf collimator (SCEM). The SCEM combines the benefits of skin collimation, electron conformal radiotherapy, and modulated electron radiotherapy. An early concept for the SCEM was constructed. It consists of leaves that protrude towards the patient, allowing the leaves to conform closely to irregular patient surfaces. The leaves are made of acrylic to decrease bremsstrahlung, thereby decreasing the out-of-field dose. Water tank scans were performed with the SCEM in place for various field sizes for all available electron energies (6, 9, 12, and 15 MeV) with a 0.5cm air gap to the water surface at 100cm source-to-surface distance (SSD). These measurements were compared with Cerrobend cutouts with the field size-matched at 100 and 110cm SSD. Output factor measurements were taken in solid water for each energy at dmax for both the cerrobend cutouts and SCEM at 100cm SSD. Percent depth dose (PDD) curves for the SCEM shifted shallower for all energies and field sizes. The SCEM also produced a higher surface dose relative to Cerrobend cutouts, with the maximum being a 9.8% increase for the 3cm × 9cm field at 9 MeV. When compared to the Cerrobend cutouts at 110cm SSD, the SCEM showed a significant decrease in the penumbra, particularly for lower energies (i.e., 6 and 9 MeV). The SCEM also showed reduced out-of-field dose and lower bremsstrahlung production than the Cerrobend cutouts. The SCEM provides significant improvement in the penumbra and out-of-field dose by allowing collimation close to the skin surface compared to Cerrobend cutouts. However, the added scatter from the SCEM increases shallow PDD values. Future work will focus on reducing this scatter while maintaining the penumbra and out-of-field benefits the SCEM has over conventional collimation.

Impact of Measurement Conditions and Design Features of IBA Detectors on the Small Radiation Fields Output Factors

The use of modern diagnostic equipment in oncology has made it possible to detect small tumor foci, as&#x0D; well as to detect distant metastases of the disease at an early stage of their formation. In these cases, it&#x0D; becomes possible to refuse surgical interventions, replacing them with stereotactic radiosurgery using&#x0D; radiation therapy devices. In this case, small irradiation fields can be used (from fields less than 1 cm to&#x0D; 4 cm). In such cases, there is a problem of delivering large doses to small foci. It consists in the accuracy of determining the absorbed doses delivered to small targets. The complexity of monitoring the quality of dosimetric support of irradiation with the use of various radiotherapy devices is increasing. Increased requirements are also imposed on the detectors used for measurements.&#x0D; This work has several goals:&#x0D; 1) to study the results of measurements of the output factors using five different detectors of small&#x0D; sizes;&#x0D; 2) to determine the changes in the output factors when using two types of beam collimation (collimator&#x0D; shutters - JAWS and multileaf collimator - MLC) of linear electron accelerators;&#x0D; 3) to study the dependence of the output factors on the source-to-surface distance (SSD), on the depth&#x0D; of measurements and on the type of detectors.&#x0D; The measurements were carried out in 6 MV photon beams with a flattening filter on a TrueBeam linear&#x0D; accelerator. Five IBA detectors were used: two diode detectors (PFD and SFD) and three ionization&#x0D; chambers (CC01, CC04 and CC13). The field sizes varied from 1010 cm to 11 cm. The studies were&#x0D; carried out for the following combinations of parameters: SSD is 100 cm and the measurement depth is&#x0D; 10 cm; SSD is 95 cm and the measurement depth is 5 cm. The fields were formed by JAWS and MLC.&#x0D; The analysis of the obtained results made it possible to compare the data obtained from each detector&#x0D; in similar combinations of measurements. Based on the analysis of the output factors measured by all&#x0D; five detectors, conclusions were drawn about the parameters that affect the change in the output factors.

Comprehensive Beam Modeling, Secondary Dose Computations and Treatment Planning for a 1.5 T MRgRT System

Magnetic resonance imaging guided radiotherapy (MRgRT) combines soft tissue visualization with online adaptive radiotherapy. The MRgRT workflow is characterized by many steps which needs to be performed swiftly and therefore greatly benefits from automation. The purpose of this study was to model a MRgRT system for dose computation and intensity modulated radiotherapy (IMRT) planning within a 1.5 T magnetic field in an independent treatment planning system (iTPS) with automation functionalities. A beam model for a 1.5 T MRgRT system was commissioned in an iTPS using beam profiles and output factor measurements. The cryostat of the MRgRT system was modeled using a cylindrical multi-layer combination of epoxy and aluminum and matched to source-to-surface dependent cryostat scatter measurement in air, and corrected for angular dependent cryostat transmission readings. The beam model was used with a fast Monte Carlo dose engine to account for the electron return and electron streaming effects within an external magnetic field. The multi-leaf collimator (MLC) was characterized with a novel synchronous and asynchronous sweeping gap (aSG) test. The aSGs have a shift (between 0 - 40 mm) between adjacent leaves which remains constant over the sweep. Measured doses map the shadowing due to the tongue-and-groove (TG) exposure and TG and leaf tip (LT) parameters are derived to match this within the iTPS. Clinical IMRT plans of 10 prostate, 5 lymph node and 5 rectal plans created in the default clinical TPS were recomputed in the iTPS and evaluated with the corresponding plan-specific quality assurance measurements. In addition, three IMRT plans were optimized within the iTPS, delivered with the MRgRT system and evaluated using PSQA using a 3%/3mm gamma criterium with a 10% threshold. Monte Carlo dose computation in the iTPS closely resembled the measured profiles in the presence of the 1.5 T magnetic field. The cryostat scatter simulations were <0.7% compared to the measurements and literature. The aSG/SGs test demonstrated that the TG width gradually increased up to 1 mm for a distance of 15 mm away from the leaf tip end. These effects were closely replicated in the iTPS with a difference of <1.5% for 95% of the aSGs. The difference between the clinical dose and the dose calculation in the iTPS was, on average, <0.5% within the volume receiving 50% of the maximum dose. The gamma pass rate was 100% for 98% of the PSQA results. The plans optimized within the iTPS were successfully delivered at the MRgRT system. We successfully modeled and commissioned a 1.5 T MRgRT system in an independent TPS. The beam model can be used for a second opinion dose computation in a magnetic field and for direct treatment planning. Next, the beam model will be incorporated in a semi-automated and adaptive workflow using the iTPS.

A Monte Carlo study to evaluate and optimise the angular dependence of the Octa – A 2D silicon array detector used for dosimetry in stereotactic radiotherapy

PurposeA detector assembly based on a 2D silicon array sensor, Octa, was previously demonstrated to be accurate for small field relative dosimetry. Experimental studies showed angular dependence of the response that has also variations with the field size. A Monte Carlo simulation model was developed and used in this work to study how the detector assembly's components contribute to the observed angular dependence. MethodsGeant4 was used as the Monte Carlo code. A detailed model of the Octa detector and its packaging was placed in the centre of a solid water phantom with the central sensitive volumes (SVs) located at the isocentre and irradiated at polar angles from 0 to 180° (the beam was normal to the detector plane at 0°). Phase-space files from the IAEA database were used to model a CyberKnife X-ray beam with collimator diameters of 5, 10, and 15 mm. Reference simulations were compared with previous experimental results. To investigate the impact of the assembly's materials, simulations were conducted by iteratively substituting the non-water-equivalent materials of certain components with solid water. In terms of geometry, the influence of the dimensions of an air gap on top of the SVs and the silicon substrate thickness were investigated. ResultsPresence of the silicon surrounding the detector's SVs caused the highest decrease in energy deposition – up to (27 ± 1)%. Thickness of the air gap placed on top of the SVs had no effect at angles below 90°, but for 90–180°, it showed the largest impact on the variation in angular dependence between fields of different sizes – from (6 ± 2)% for 1 mm gap to (24 ± 2)% for 2 mm gap. The variation in the silicon substrate thickness and the air gap's lateral length, as well as presence of the PCB layer did not show significant influence on the angular response. ConclusionFurther development of the detector assembly's design can be driven by mechanical robustness to provide reliability for clinical routine without sacrificing angular dependence. Current design is recommended for use at angles 0–90°: it has shown independence of the angular response from small field size variation and it was previously optimised to be correction-free in output factor measurements. The air gap dimensions are recommended as the main variable parameters for optimisation for further studies when small X-ray beams are measured by the detector positioned in axial plane.

Leaf-individual calibration for a double stack multileaf collimator in photon radiotherapy.

In online adaptive stereotactic body radiotherapy treatments, linear accelerator delivery accuracy is essential. Recently introduced double stack multileaf collimators (MLCs) have new facets in their calibration. We established a radiation-based leaf-individual calibration (LIMCA) method for double stack MLCs. MLC leaf positions were evaluated from four cardinal angles with test patterns at measurement positions throughout the radiation field on EBT3 radiochromic film for each single stack. The accuracy of the method and repeatability of the results were assessed. The effect of MLC positioning errors was characterized for a measured output factor curve and a clinical patient plan. All positions in the motor step - position calibration file were optimized in the established LIMCA method. The resulting double stack mean accuracy for all angles was 0.2±0.1 mm for X1 (left bank) and 0.2±0.2 mm for X2 (right bank). The accuracy of the leaf position evaluation was 0.2 mm (95% confidence level). The MLC calibration remained stable over four months. Small MLC leaf position errors (e.g. 1.2 mm field size reduction) resulted in important dose errors (-5.8 %) for small quadratic fields of 0.83×0.83 cm2. Single stack position accuracy was essential for highly modulated treatment plans. LIMCA is a new double stack MLC calibration method that increases treatment accuracy from four angles and for all moving leaves.

Comprehensive investigation of lateral dose profile and output factor measurements in small proton fields from different delivery techniques.

As a part of the commissioning and quality assurance in proton beam therapy, lateral dose profiles and output factors have to be acquired. Such measurements can be performed with point detectors and are especially challenging in small fields or steep lateral penumbra regions as the detector's volume effect may lead to perturbations. To address this issue, this work aims to quantify and correct for such perturbations of six point detectors in small proton fields created via three different delivery techniques. Lateral dose profile and output measurements of three proton beam delivery techniques (pencil beam scanning, pencil beam scanning combined with collimators, passive scattering with collimators) were performed using high-resolution EBT3 films, a PinPoint 3D 31022 ionization chamber, a microSilicon diode 60023 and a microDiamond detector 60019 (all PTW Freiburg, Germany). Detector specific lateral dose response functions K(x,y) acting as the convolution kernel transforming the undisturbed dose distribution D(x,y) into the measured signal profiles M(x,y) were applied to quantify perturbations of the six investigated detectors in the proton fields and correct the measurements. A signal theoretical analysis in Fourier space of the dose distributions and detector's K(x,y) was performed to aid the understanding of the measurement process with regard to the combination of detector choice and delivery technique. Quantification of the lateral penumbra broadening and signal reduction at the fields center revealed that measurements in the pencil beam scanning fields are only compromised slightly even by large volume ionization chambers with maximum differences in the lateral penumbra of 0.25mm and 4% signal reduction at the field center. In contrast, radiation techniques with collimation are not accurately represented by the investigated detectors as indicated by a penumbra broadening up to 1.6mm for passive scattering with collimators and 2.2mm for pencil beam scanning with collimators. For a 3mm diameter collimator field, a signal reduction at field center between 7.6% and 60.7% was asserted. Lateral dose profile measurements have been corrected via deconvolution with the corresponding K(x,y) to obtain the undisturbed D(x,y). Corrected output ratios of the passively scattered collimated fields obtained for the microDiamond, microSilicon and PinPoint 3D show agreement better than 0.9% (one standard deviation) for the smallest field size of 3mm. Point detector perturbations in small proton fields created with three delivery techniques were quantified and found to be especially pronounced for collimated small proton fields with steep dose gradients. Among all investigated detectors, the microSilicon diode showed the smallest perturbations. The correction strategies based on detector's K(x,y) were found suitable for obtaining unperturbed lateral dose profiles and output factors. Approximation of K(x,y) by considering only the geometrical averaging effect has been shown to provide reasonable prediction of the detector's volume effect. The findings of this work may be used to guide the choice of point detectors in various proton fields and to contribute toward the development of a code of practice for small field proton dosimetry.

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

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

Commissioning an Exradin W2 plastic scintillation detector for clinical use in small radiation fields.

PurposeThe purpose of this work is to evaluate the Standard Imaging Exradin W2 plastic scintillation detector (W2) for use in the types of fields used for stereotactic radiosurgery.MethodsPrior to testing the W2 in small fields, the W2 was evaluated in standard large field conditions to ensure good detector performance. These tests included energy dependence, short‐term repeatability, dose‐response linearity, angular dependence, temperature dependence, and dose rate dependence. Next, scan settings and calibration of the W2 were optimized to ensure high quality data acquisition. Profiles of small fields shaped by cones and multi‐leaf collimator (MLCs) were measured using the W2 and IBA RAZOR diode in a scanning water tank. Output factors for cones (4–17.5 mm) and MLC fields (1, 2, 3 cm) were acquired with both detectors. Finally, the dose at isocenter for seven radiosurgery plans was measured with the W2 detector.ResultsW2 exhibited acceptable warm‐up behavior, short‐term reproducibility, axial angular dependence, dose‐rate linearity, and dose linearity. The detector exhibits a dependence upon energy, polar angle, and temperature. Scanning measurements taken with the W2 and RAZOR were in good agreement, with full‐width half‐maximum and penumbra widths agreeing to within 0.1 mm. The output factors measured by the W2 and RAZOR exhibited a maximum difference of 1.8%. For the seven point‐dose measurements of radiosurgery plans, the W2 agreed well with our treatment planning system with a maximum deviation of 2.2%. The Čerenkov light ratio calibration method did not significantly impact the measurement of relative profiles, output factors, or point dose measurements.ConclusionThe W2 demonstrated dosimetric characteristics that are suitable for radiosurgery field measurements. The detector agreed well with the RAZOR diode for output factors and scanned profiles and showed good agreement with the treatment planning system in measurements of clinical treatment plans.

Determination of correction factors in small MLC-defined fields for the Razor and microSilicon diode detectors and evaluation of the suitability of the IAEA TRS-483 protocol for multiple detectors.

Small field output factors for Multileaf collimator (MLC)‐defined field sizes between 0.5 × 0.5 cm2 and 3 × 3 cm2 were measured with six different detectors for a Varian TrueBeam in 6‐MV, 6‐FFF, 10‐MV, and 10‐FFF photon beams. Correction factors kQclin,Qreffclin,fref from the IAEA publication TRS‐483 were used to correct the measured output factors. The corrected output factors from the six detectors were used to calculate correction factors for the PTW microSilicon T60023 (PTW, Freiburg, Germany) and IBA Razor (IBA Dosimetry, Schwarzenbruck, Germany) detectors. The uncertainty of the output and correction factors in this study was calculated and the calculations presented in detail. The application of the TRS‐483 correction factors significantly reduced the variation in output factors between the various detectors, with the exception of the PTW 60016 diode in 6‐MV and 6‐FFF beams, and the IBA PFD in 10‐MV and 10‐FFF beams. Correction factors calculated for the Razor agreed within 2.9% of existing literature for all energies, while the microSilicon correction factors agreed within 1.6% to the literature for 6‐MV beams. The uncertainty in the microSilicon and Razor correction factors was calculated to be less than 0.9% (k = 1). This study shows that TRS‐483 correction factors reduce the variation in output factors between the detectors used in this study and presents a suitable method for determining correction factors for detectors with unpublished values.

Treatment planning system commissioning of the first clinical biology-guided radiotherapy machine.

PurposeThe RefleXion X1 is a novel radiotherapy machine designed for image‐guided radiotherapy (IGRT) and biology‐guided radiotherapy (BgRT). Its treatment planning system (TPS) generates IMRT and SBRT plans for a 6MV‐FFF beam delivered axially via 50 firing positions with the couch advancing every 2.1 mm. The purpose of this work is to report the TPS commissioning results for the first clinical installation of RefleXion™ X1.MethodsCT images of multiple phantoms were imported into the RefleXion TPS to evaluate the accuracy of data transfer, anatomical modeling, plan evaluation, and dose calculation. Comparisons were made between the X1, Eclipse™, and MIM™. Dosimetric parameters for open static fields were evaluated in water and heterogeneous slab phantoms. Representative clinical IMRT and SBRT cases were planned and verified with ion chamber, film, and ArcCHECK@ measurements. The agreement between TPS and measurements for various clinical plans was evaluated using Gamma analysis with a criterion of 3%/2 mm for ArcCHECK@ and film. End‐to‐end (E2E) testing was performed using anthropomorphic head and lung phantoms.ResultsThe average difference between the TPS‐reported and known HU values was −1.4 ± 6.0 HU. For static fields, the agreements between the TPS‐calculated and measured PDD10, crossline profiles, and inline profiles (FWHM) were within 1.5%, 1.3%, and 0.5 mm, respectively. Measured output factors agreed with the TPS within 1.3%. Measured and calculated dose for static fields in heterogeneous phantoms agreed within 2.5%. The ArcCHECK@ mean absolute Gamma passing rate was 96.4% ± 3.4% for TG 119 and TG 244 plans and 97.8% ± 3.6% for the 21 clinical plans. E2E film analysis showed 0.8 mm total targeting error for isocentric and 1.1 mm for off‐axis treatments.ConclusionsThe TPS commissioning results of the RefleXion X1 TPS were within the tolerances specified by AAPM TG 53, MPPG 5.a, TG 119, and TG 148. A subset of the commissioning tests has been identified as baseline data for an ongoing QA program.

Beam commissioning of the first clinical biology‐guided radiotherapy system

This study reports the beam commissioning results for the first clinical RefleXion Linac. Methods: The X1 produces a 6 MV photon beam and the maximum clinical field size is 40 × 2 cm2 at source‐to‐axis distance of 85 cm. Treatment fields are collimated by a binary multileaf collimator (MLC) system with 64 leaves with width of 0.625 cm and y‐jaw pairs to provide either a 1 or 2 cm opening. The mechanical alignment of the radiation source, the y‐jaw, and MLC were checked with film and ion chambers. The beam parameters were characterized using a diode detector in a compact water tank. In‐air lateral profiles and in‐water percentage depth dose (PDD) were measured for beam modeling of the treatment planning system (TPS). The lateral profiles, PDDs, and output factors were acquired for field sizes from 1.25 × 1 to 40 × 2 cm2 field to verify the beam modeling. The rotational output variation and synchronicity were tested to check the gantry angle, couch motion, and gantry rotation. Results: The source misalignments were 0.049 mm in y‐direction, 0.66% out‐of‐focus in x‐direction. The divergence of the beam axis was 0.36 mm with a y‐jaw twist of 0.03°. Clinical off‐axis treatment fields shared a common center in y‐direction were within 0.03 mm. The MLC misalignment and twist were 0.57 mm and 0.15°. For all measured fields ranging from the size from 1.25 × 1 to 40 × 2 cm2, the mean difference between measured and TPS modeled PDD at 10 cm depth was −0.3%. The mean transverse profile difference in the field core was −0.3% ± 1.1%. The full‐width half maximum (FWHM) modeling was within 0.5 mm. The measured output factors agreed with TPS within 0.8%. Conclusions: This study summarizes our specific experience commissioning the first novel RefleXion linac, which may assist future users of this technology when implementing it into their own clinics.