Small Field Output Factors Research Articles

SU-F-T-572: Small Fields Output Factors Measurement and Correction Factor Determination for Several Active and Passive Detectors

Purpose: To measure the output factor (OF) and output correction factors (OCF) of small circular cones using various active and passive detectors. Methods: The OF of BrainLab circular cones of 4, 6, 7.5, 10, 12.5 and 15mm diameter were measured isocentrically at 15mm depth for 6 MV X-rays at 1000 MU/min from Novalis-Tx Linac using high resolution diodes (SFD, Edge, PTW60008), plastic scintillator (ExtradinW1), small ionization chamber (CC01), EBT3 film and Al2O3:C OSLDs (nanoDot). OCF was calculated as a ratio of the OF of each detector relative to EBT3. Long term overall measurement uncertainty were estimated from the 15 repeat measurement performed for each detector over a period of 1year Results: The mean OF measured using various detectors are shown in the figure. In comparison to EDR3 measurement, nanoDot, CC01 and ExtradinW1 showed consistently lower OF upto −25.7% (nanoDot) which gradually improves with cone size (Table). The variation in OF measure with CC01 and ExtradinW1 for cone size >10mm is within −1.4% and −1.9%. Whereas, Edge and PTW60008 measured consistently larger OF except for 4mm cone. All diodes showed better agreement with EDR3 with maximum variation within ±1.7% (SFD), 2.5% (Edge) and 4.4% (PTW60008). The OCF was largest for nanoDot (range 1.04–1.35) and least for the diodes (range 0.97–1.04). The estimated overall long term standard uncertainty (k=2, 95% confidence) were highest for nanoDot at 3% followed by 2.43% for EDR3, 1% for SFD, 0.49% for ExtradinW1, 0.42% for CC01 and PTW60008, 0.16% for edge. Conclusion: Largest OF for the smallest cone was observed from EDR3. Although correction factor needed for all diodes were very similar, Edge showed most consistent result. nanoDot in its present form is not suitable for OF measurement from small fields. ExtradinW1 with its stem oriented perpendicular to beam axis underestimate OF for field size ≤10mm and need further investigation.

Small field detector correction factors: effects of the flattening filter for Elekta and Varian linear accelerators.

Flattening filter‐free (FFF) beams are becoming the preferred beam type for stereotactic radiosurgery (SRS) and stereotactic ablative radiation therapy (SABR), as they enable an increase in dose rate and a decrease in treatment time. This work assesses the effects of the flattening filter on small field output factors for 6 MV beams generated by both Elekta and Varian linear accelerators, and determines differences between detector response in flattened (FF) and FFF beams. Relative output factors were measured with a range of detectors (diodes, ionization chambers, radiochromic film, and microDiamond) and referenced to the relative output factors measured with an air core fiber optic dosimeter (FOD), a scintillation dosimeter developed at Chris O'Brien Lifehouse, Sydney. Small field correction factors were generated for both FF and FFF beams. Diode measured detector response was compared with a recently published mathematical relation to predict diode response corrections in small fields. The effect of flattening filter removal on detector response was quantified using a ratio of relative detector responses in FFF and FF fields for the same field size. The removal of the flattening filter was found to have a small but measurable effect on ionization chamber response with maximum deviations of less than ±0.9% across all field sizes measured. Solid‐state detectors showed an increased dependence on the flattening filter of up to ±1.6%. Measured diode response was within ±1.1% of the published mathematical relation for all fields up to 30 mm, independent of linac type and presence or absence of a flattening filter. For 6 MV beams, detector correction factors between FFF and FF beams are interchangeable for a linac between FF and FFF modes, providing that an additional uncertainty of up to ±1.6% is accepted.PACS number(s): 87.55.km, 87.56.bd, 87.56.Da

Technical Report: Reference photon dosimetry data for Varian accelerators based on IROC-Houston site visit data.

Accurate data regarding linear accelerator (Linac) radiation characteristics are important for treatment planning system modeling as well as regular quality assurance of the machine. The Imaging and Radiation Oncology Core-Houston (IROC-H) has measured the dosimetric characteristics of numerous machines through their on-site dosimetry review protocols. Photon data are presented and can be used as a secondary check of acquired values, as a means to verify commissioning a new machine, or in preparation for an IROC-H site visit. Photon data from IROC-H on-site reviews from 2000 to 2014 were compiled and analyzed. Specifically, data from approximately 500 Varian machines were analyzed. Each dataset consisted of point measurements of several dosimetric parameters at various locations in a water phantom to assess the percentage depth dose, jaw output factors, multileaf collimator small field output factors, off-axis factors, and wedge factors. The data were analyzed by energy and parameter, with similarly performing machine models being assimilated into classes. Common statistical metrics are presented for each machine class. Measurement data were compared against other reference data where applicable. Distributions of the parameter data were shown to be robust and derive from a student's t distribution. Based on statistical and clinical criteria, all machine models were able to be classified into two or three classes for each energy, except for 6 MV for which there were eight classes. Quantitative analysis of the measurements for 6, 10, 15, and 18 MV photon beams is presented for each parameter; supplementary material has also been made available which contains further statistical information. IROC-H has collected numerous data on Varian Linacs and the results of photon measurements from the past 15 years are presented. The data can be used as a comparison check of a physicist's acquired values. Acquired values that are well outside the expected distribution should be verified by the physicist to identify whether the measurements are valid. Comparison of values to this reference data provides a redundant check to help prevent gross dosimetric treatment errors.

OC-0459: Small fields output factors and correction factors determination for a linac with circular cones

OC-0459: Small fields output factors and correction factors determination for a linac with circular cones

EP-1486: Evaluation of detectors response for small field output factor measurement using Gafchromic film

EP-1486: Evaluation of detectors response for small field output factor measurement using Gafchromic film

Determination of small field output factors in 6 and 10 MV flattening filter free photon beams using various detectors

The study aimed to determine appropriate detectors for output factor measurement of small fields in 6 and 10 MV flattening filter free photon beams using five different detectors. Field sizes were varied between 0.6 × 0.6 and 4.0 × 4.0 cm2. An indirect method (daisy-chaining) was applied to normalize the output factors. For the smallest field size, the variations of output factors compared among the detectors were 13%. Exradin A16 had the lowest output factor and increasing in sequence with CC01, microDiamond, microLion and EDGE detectors, respectively, for both energies. The similarity between CC01 and microDiamond output factor values were within 1.6% and 1% for all field sizes of 6 and 10 MV FFF, respectively. EDGE and microLion presented the highest values while ExradinA16 gave lowest values. In conclusion, IBACC01, Exradin A16, microLion, microDiamond and EDGE detectors seem to be the detectors of choices for small field output factor measurement of FFF beams down to 1.6 × 1.6 cm2. However, we could not guarantee which detector is the most suitable for output factor measurement in small field less than 1.6 × 1.6 cm2 of FFF beams. Further studies are required to provide reference information for validation purposes.

Determination of output factor for 6 MV small photon beam: comparison between Monte Carlo simulation technique and microDiamond detector

In order to improve the life's quality for a cancer patient, the radiation techniques are constantly evolving. Especially, the two modern techniques which are intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are quite promising. They comprise of many small beam sizes (beamlets) with various intensities to achieve the intended radiation dose to the tumor and minimal dose to the nearby normal tissue. The study investigates whether the microDiamond detector (PTW manufacturer), a synthetic single crystal diamond detector, is suitable for small field output factor measurement. The results were compared with those measured by the stereotactic field detector (SFD) and the Monte Carlo simulation (EGSnrc/BEAMnrc/DOSXYZ). The calibration of Monte Carlo simulation was done using the percentage depth dose and dose profile measured by the photon field detector (PFD) of the 10×10 cm2 field size with 100 cm SSD. Comparison of the values obtained from the calculations and measurements are consistent, no more than 1% difference. The output factors obtained from the microDiamond detector have been compared with those of SFD and Monte Carlo simulation, the results demonstrate the percentage difference of less than 2%.

A.200 - Small field output factor evaluation with a microDiamond detector over 30 Italian centers

Introduction: The current study is conducted in the framework of AIFM SBRT working group and presents measured MLC-defined small field output factors (OF) for the three major linear accelerator manufacturers and for different X-ray energies.

Small field output factors: Comparison of measurements with various detectors and effects of detector orientation with primary jaw setting

Accurate dosimetry in small photon fields used in modern radiotherapy is a challenging task due to electronic disequilibrium, steep dose gradients, source occlusion and size of the sensitive volume of the detector. These challenging effects and the lack of metrological dosimetric reference instigated an investigation on the acquisition of output factor with various detectors in parallel and perpendicular orientations. Small field output factor measurements of tertiary collimators such as BrainLab circular cones, BrainLab mMLC and Millennium MLC were carried out in this study. The data acquired show the differences between output factor results with different detectors for all collimating systems. Good agreement in output values was observed in field sizes greater than ∼2 × 2 cm2 for all detectors and all tertiary collimators. For smaller fields when compared to electron field diode (EFD), 0.125 cm3 ion chamber underestimates the output by up to −11.1% and −20.4% and pinpoint ion chamber underestimates the output by up to −1.5% and −6.1% in their parallel and perpendicular orientation, respectively. In contrast, PTW SRS diode and photon field diode (PFD) overestimate the output factor by up to 2.5% and 6.9% respectively in its parallel orientation. The investigated data for the effect of jaw position (0.25 × 0.25 cm2, 0.5 × 0.5 cm2 and 1 × 1 cm2) away from the field edge generated by different tertiary collimating systems inferred that the opening of X–Y jaw highly influences the small field output factors. The orientation of the detectors and the position of the jaws could influence the output factors considerably in small fields.

Small field detector correction factors kQclin,Qmsr (fclin,fmsr) for silicon-diode and diamond detectors with circular 6 MV fields derived using both empirical and numerical methods.

The use of radiotherapy fields smaller than 3 cm in diameter has resulted in the need for accurate detector correction factors for small field dosimetry. However, published factors do not always agree and errors introduced by biased reference detectors, inaccurate Monte Carlo models, or experimental errors can be difficult to distinguish. The aim of this study was to provide a robust set of detector-correction factors for a range of detectors using numerical, empirical, and semiempirical techniques under the same conditions and to examine the consistency of these factors between techniques. Empirical detector correction factors were derived based on small field output factor measurements for circular field sizes from 3.1 to 0.3 cm in diameter performed with a 6 MV beam. A PTW 60019 microDiamond detector was used as the reference dosimeter. Numerical detector correction factors for the same fields were derived based on calculations from a geant4 Monte Carlo model of the detectors and the Linac treatment head. Semiempirical detector correction factors were derived from the empirical output factors and the numerical dose-to-water calculations. The PTW 60019 microDiamond was found to over-respond at small field sizes resulting in a bias in the empirical detector correction factors. The over-response was similar in magnitude to that of the unshielded diode. Good agreement was generally found between semiempirical and numerical detector correction factors except for the PTW 60016 Diode P, where the numerical values showed a greater over-response than the semiempirical values by a factor of 3.7% for a 1.1 cm diameter field and higher for smaller fields. Detector correction factors based solely on empirical measurement or numerical calculation are subject to potential bias. A semiempirical approach, combining both empirical and numerical data, provided the most reliable results.

55 - Evaluation of detectors response for small field output factor measurement using multichannel film dosimetry

55 - Evaluation of detectors response for small field output factor measurement using multichannel film dosimetry

Optimizing the MLC model parameters for IMRT in the RayStation treatment planning system.

Unlike other commercial treatment planning systems (TPS) which model the rounded leaf end differently (such as the MLC dosimetric leaf gap (DLG) or rounded leaf‐tip radius), the RayStation TPS (RaySearch Laboratories, Stockholm, Sweden) models transmission through the rounded leaf end of the MLC with a step function, in which the radiation transmission through the leaf end is the square root of the average MLC transmission factor. We report on the optimization of MLC model parameters for the RayStation planning system. This (TPS) models the rounded leaf end of the MLC with the following parameters: leaf‐tip offset, leaf‐tip width, average transmission factor, and tongue and groove. We optimized the MLC model parameters for IMRT in the RayStation v. 4.0 planning system and for a Varian C‐series linac with a 120‐leaf Millennium MLC, and validated the model using measured data. The leaf‐tip offset is the geometric offset due to the rounded leaf‐end design and resulting divergence of the light/radiation field. The offset value is a function of the leaf‐tip position, and tabulated data are available from the vendor. The leaf‐tip width was iteratively evaluated by comparing computed and measured transverse dose profiles of MLC defined fields at dmax in water. In‐water profile comparisons were also used to verify the MLC leaf position (leaf‐tip offset). The average transmission factor and leaf tongue‐and‐groove width were derived iteratively by maximizing the agreement between measurements and RayStation TPS calculations for five clinical IMRT QA plans. Plan verifications were performed by comparing MapCHECK2 measurements and Monte Carlo calculations. The MLC model was validated using five test IMRT cases from the AAPM Task Group 119 report. Absolute gamma analyses (3 mm/3% and 2 mm/2%) were applied. In addition, computed output factors for MLC‐defined small fields (2×2,3×3,4×4,6×6 cm2) of both 6 MV and 18 MV photons were compared to those independently measured by the Imaging and Radiation Oncology Core (IROC), Houston, TX. 6 MV and 18 MV models were both determined to have the same MLC parameters: leaf‐tip offset=0.3 cm,2.5% transmission, and leaf tongue‐and‐groove width=0.05 cm. IMRT QA analysis for five test cases in TG‐119 resulted in a 100% passing rate with 3 mm/3% gamma analysis for 6 MV, and >97.5% for 18 MV. The passing rate was >94.6% for 6 MV and >90.9% for 18 MV when the 2 mm/2% gamma analysis criteria was applied. These results compared favorably with those published in AAPM Task Group 119. The reported MLC model parameters serve as a reference for other users.PACS number(s): 87.55.D, 87.56.nk

TU-F-CAMPUS-T-04: Variations in Nominally Identical Small Fields From Photon Jaw Reproducibility and Associated Effects On Small Field Dosimetric Parameters

Purpose: To investigate uncertainties in small field output factors and detector specific correction factors from variations in field size for nominally identical fields using measurements and Monte Carlo simulations. Methods: Repeated measurements of small field output factors are made with the Exradin W1 (plastic scintillation detector) and the PTW microDiamond (synthetic diamond detector) in beams from the Elekta Precise linear accelerator. We investigate corrections for a 0.6x0.6 cm2 nominal field size shaped with secondary photon jaws at 100 cm source to surface distance (SSD). Measurements of small field profiles are made in a water phantom at 10 cm depth using both detectors and are subsequently used for accurate detector positioning. Supplementary Monte Carlo simulations with EGSnrc are used to calculate the absorbed dose to the detector and absorbed dose to water under the same conditions when varying field size. The jaws in the BEAMnrc model of the accelerator are varied by a reasonable amount to investigate the same situation without the influence of measurements uncertainties (such as detector positioning or variation in beam output). Results: For both detectors, small field output factor measurements differ by up to 11 % when repeated measurements are made in nominally identical 0.6x0.6 cm2 fields. Variations in the FWHM of measured profiles are consistent with field size variations reported by the accelerator. Monte Carlo simulations of the dose to detector vary by up to 16 % under worst case variations in field size. These variations are also present in calculations of absorbed dose to water. However, calculated detector specific correction factors are within 1 % when varying field size because of cancellation of effects. Conclusion: Clinical physicists should be aware of potentially significant uncertainties in measured output factors required for dosimetry of small fields due to field size variations for nominally identical fields.

SU‐E‐T‐192: Commissioning of a Commercial 3D Dose Calculation Program

Purpose:To commission a commercial software package (CSP) that is used as secondary dose calculation check. The CSP uses an independent golden data beam model. However, some parameters can be modified to generate a customer specific model. Plan comparisons and point dose measurements were performed to test if and to what extent the beam model needed adjustment to optimize results.Methods:Beam parameter configurations were compared between the CSP and both TPS. Twelve phantom test plans ranging from simple to complex were generated in two treatment planning systems (TPS). Tests included small field, off axis, EDW, IMRT and VMAT plans. For each plan a point dose was measured to establish ground truth. Lastly, patient plans were compared for both TPS systems and the CSP.Results:Beam parameters agreed within 2%. The output factors for small fields were changed for the 15 MV beam by 2 and 1.5 % for the 1 cm and 2 cm field sizes, respectively. For the 6 MV beam output factors were adjusted by 3−0.8% for field sizes ranging from 1 to 5 cm. The MLC dynamic leaf gap was adjusted by 1.5 mm for 18 MV beam. Differences between the CSP and the TPS were noted in the built‐up region. These differences affected the gamma pass rate in the surface region, however this effect is reduced with increasing number of beam angles and does not affect point dose calculations at depth. All IMRT and VMAT plans agreed with the CSP using a gamma pass rate of 95% (3%, 3mm).Conclusion:The CSP is used to verify point doses for all 3D plans generated in our clinic for the last 6 months. No point dose mismatches were encountered since the CSP was implemented. Next, the CSP will be adapted for secondary checks of all IMRT plans.KL had a beta tester agreement with Mobius Medical for an in‐kind equipment and software loan.

SU‐E‐T‐376: Evaluation of a New Stereotactic Diode for Small Field Dosimetry

Purpose:To evaluate the performance of a new stereotactic diode for dosimetry of small photon fields.Methods:A new stereotactic diode, consisting of an unshielded p‐type silicon chip, and with improved radiation hardness energy dependence was recently developed (IBA Dosimetry, Schwarzenbruch, Germany). The diode has an active volume of 0.6 mm dia. × 0.02 mm thick. Two new diodes were evaluated, one which was pre‐irradiated to 100kGy with 10 MeV electrons and another which received no prior irradiation. Sensitivity, stability, reproducibility, and linearity as a function of dose were assessed. Beam profiles and small field output factors were measured on a CyberKnife (CK) and compared with measurements using two commercially available diodes.Results:The new diodes exhibit linear behavior (within 0.6%) over a dose range 0.02 – 50 Gy; a commercially available device exhibits excursions of up to 4% over the same range. The sensitivity is 4.1 and 3.8 nC/Gy for the un‐irradiated and pre‐irradiated diodes, respectively. When irradiated with 150 Gy in dose increments of 5, 20 and 35 Gy, both new diodes provide a stable response within 0.5%. Output factors measured with the two new diodes are identical and compare favorably with other commercially available diodes and published data. Similarly, no differences in measured field size or penumbra were observed among the devices tested.Conclusion:The new diodes show excellent stability and sensitivity. The beam characterization in terms of output factors and beam profiles is consistent with that obtained with commercially available diodes.

SU‐E‐T‐124: Anthropomorphic Phantoms for Confirmation of Linear Accelerator Based Small Animal Irradiation

Purpose:To document the support of radiobiological small animal research by a modern radiation oncology facility. This study confirms that a standard, human use linear accelerator can cover the range of experiments called for by researchers performing animal irradiation. A number of representative, anthropomorphic murine phantoms were made. The phantoms confirmed the small field photon and electron beams dosimetry validated the use of the linear accelerator for rodents.Methods:Laser scanning a model, CAD design and 3D printing produced the phantoms. The phantoms were weighed and CT scanned to judge their compatibility to real animals. Phantoms were produced to specifically mimic lung, gut, brain, and othotopic lesion irradiations. Each phantom was irradiated with the same protocol as prescribed to the live animals. Delivered dose was measured with small field ion chambers, MOS/FETs or TLDs.Results:The density of the phantom material compared to density range across the real mice showed that the printed material would yield sufficiently accurate measurements when irradiated. The whole body, lung and gut irradiations were measured within 2% of prescribed doses with A1SL ion chamber. MOSFET measurements of electron irradiations for the orthotopic lesions allowed refinement of the measured small field output factor to better than 2% and validated the immunology experiment of irradiating one lesion and sparing another.Conclusion:Linacs are still useful tools in small animal bio‐radiation research. This work demonstrated a strong role for the clinical accelerator in small animal research, facilitating standard whole body dosing as well as conformal treatments down to 1cm field. The accuracy of measured dose, was always within 5%. The electron irradiations of the phantom brain and flank tumors needed adjustment; the anthropomorphic phantoms allowed refinement of the initial output factor measurements for these fields which were made in a large block of solid water.

Field size consistency of nominally matched linacs.

Given that there is increasing recognition of the effect that sub-millimetre changes in collimator position can have on radiotherapy beam dosimetry, this study aimed to evaluate the potential variability in small field collimation that may exist between otherwise matched linacs. Field sizes and field output factors were measured using radiochromic film and an electron diode, for jaw- and MLC-collimated fields produced by eight dosimetrically matched Varian iX linacs (Varian Medical Systems, Palo Alto, USA). This study used nominal sizes from 0.6×0.6 to 10×10cm(2), for jaw-collimated fields, and from 1×1 to 10×10cm(2) for MLC-collimated fields, delivered from a zero (head up, beam directed vertically downward) gantry angle. Differences between the field sizes measured for the eight linacs exceeded the uncertainty of the film measurements and the repositioning uncertainty of the jaws and MLCs on one linac. The dimensions of fields defined by MLC leaves were more consistent between linacs, while also differing more from their nominal values than fields defined by orthogonal jaws. The field output factors measured for the different linacs generally increased with increasing measured field size for the nominal 0.6×0.6 to 1×1cm(2) fields, and became consistent between linacs for nominal field sizes of 2×2cm(2) and larger. The inclusion in radiotherapy treatment planning system beam data of small field output factors acquired in fields collimated by jaws (rather than the more-reproducible MLCs), associated with either the nominal or the measured field sizes, should be viewed with caution. The size and reproducibility of the fields (especially the small fields) used to acquire treatment planning data should be investigated thoroughly as part of the linac or planning system commissioning process. Further investigation of these issues, using different linac models, collimation systems and beam orientations, is recommended.

Clinical use of diodes and micro-chambers to obtain accurate small field output factor measurements.

There have been substantial advances in small field dosimetry techniques and technologies, over the last decade, which have dramatically improved the achievable accuracy of small field dose measurements. This educational note aims to help radiation oncology medical physicists to apply some of these advances in clinical practice. The evaluation of a set of small field output factors (total scatter factors) is used to exemplify a detailed measurement and simulation procedure and as a basis for discussing the possible effects of simplifying that procedure. Field output factors were measured with an unshielded diode and a micro-ionisation chamber, at the centre of a set of square fields defined by a micro-multileaf collimator. Nominal field sizes investigated ranged from 6×6 to 98×98mm(2). Diode measurements in fields smaller than 30 mm across were corrected using response factors calculated using Monte Carlo simulations of the diode geometry and daisy-chained to match micro-chamber measurements at intermediate field sizes. Diode measurements in fields smaller than 15 mm across were repeated twelve times over three separate measurement sessions, to evaluate the reproducibility of the radiation field size and its correspondence with the nominal field size. The five readings that contributed to each measurement on each day varied by up to 0.26%, for the "very small" fields smaller than 15 mm, and 0.18% for the fields larger than 15 mm. The diode response factors calculated for the unshielded diode agreed with previously published results, within uncertainties. The measured dimensions of the very small fields differed by up to 0.3 mm, across the different measurement sessions, contributing an uncertainty of up to 1.2% to the very small field output factors. The overall uncertainties in the field output factors were 1.8% for the very small fields and 1.1% for the fields larger than 15 mm across. Recommended steps for acquiring small field output factor measurements for use in radiotherapy treatment planning system beam configuration data are provided.

Small field dosimetry and analysis of flattening filter free beams in true beam system

The purpose of this study was to report the dosimetric characteristics of the small fields in flattening filter free (FFF) beams (output measurements, profile analysis, surface dose and consistency) generated by medical linear accelerator and its variation with respect to flattened beams (FB). Surface doses were obtained for field sizes 1 × 1-40 × 40 cm(2). Field width and penumbra were analyzed for field sizes 1 × 1-40 × 40 cm(2). To take output factors for small fields, diode and micro chamber were used and data was taken at a source-to-surface distance (SSD) and extended SSD. Consistency checked for the dosimetric data for 1 year. Surface doses were higher in FFF compared with FB up to 20 × 20 cm(2) field size. Measured field sizes were slightly lesser in FFF and penumbra values were increased with respect to field size in both FB and FFF. For small fields, diode values have shown more promising results than micro chamber. Small field output measurements at nominal SSD and extended SSD were well in agreement with each other. FFF beams showed good data consistency in 1 year duration. Small field dosimetry, surface dose, profile analysis and consistency of FFF beams in FFF photon beams were derived and data shown good consistency during 1 year duration.

PRESAGE 3D dosimetry accurately measures Gamma Knife output factors

Small-field output factor measurements are traditionally very difficult because of steep dose gradients, loss of lateral electronic equilibrium, and dose volume averaging in finitely sized detectors. Three-dimensional (3D) dosimetry is ideal for measuring small output factors and avoids many of these potential challenges of point and 2D detectors. PRESAGE 3D polymer dosimeters were used to measure the output factors for the 4 mm and 8 mm collimators of the Leksell Perfexion Gamma Knife radiosurgery treatment system. Discrepancies between the planned and measured distance between shot centers were also investigated. A Gamma Knife head frame was mounted onto an anthropomorphic head phantom. Special inserts were machined to hold 60 mm diameter, 70 mm tall cylindrical PRESAGE dosimeters. The phantom was irradiated with one 16 mm shot and either one 4 mm or one 8 mm shot, to a prescribed dose of either 3 Gy or 4 Gy to the 50% isodose line. The two shots were spaced between 30 mm and 60 mm apart and aligned along the central axis of the cylinder. The Presage dosimeters were measured using the DMOS-RPC optical CT scanning system. Five independent 4 mm output factor measurements fell within 2% of the manufacturer’s Monte Carlo simulation-derived nominal value, as did two independent 8 mm output factor measurements. The measured distances between shot centers varied by ±0.8 mm with respect to the planned shot displacements. On the basis of these results, we conclude that PRESAGE dosimetry is excellently suited to quantify the difficult-to-measure Gamma Knife output factors.