Relative Output Factors Research Articles

Accurate machine-specific reference and small-field dosimetry for a self-shielded neuro-radiosurgical system.

The newly available ZAP-X stereotactic radiosurgical system is designed for the treatment of intracranial lesions, with several unique features that include a self-shielding, gyroscopic gantry, wheel collimation, non-orthogonal kV imaging, short source-axis distance, and low-energy megavoltage beam. Systematic characterization of its radiation as well as other properties is imperative to ensure its safe and effective clinical application. To accurately determine the radiation output of the ZAP-X with a special focus on the smaller diameter cones and an aim to provide useful recommendations on quantification of small field dosimetry. Six different types of detectors were used to measure relative output factors at field sizes ranging from 4to 25mm, including the PTW microSilicon and microdiamond diodes, Exradin W2 plastic scintillator, Exradin A16 and A1SL ionization chambers, and the alanine dosimeter. The 25mm cone served as the reference field size. Absolute dose was determined with both TG-51-based dosimetry using a calibrated PTW Semiflex ion chamber and measurements using alanine dosimeters. The average radiation output factors (maximum deviation from the average) measured with the microDiamond, microSilicon, and W2 detectors were: for the 4mm cone, 0.741 (1.0%); for the 5mm cone: 0.817 (1.0%); for the 7.5mm cone: 0.908 (1.0%); for the 10mm cone: 0.946 (0.4%); for the 12.5mm cone: 0.964 (0.2%); for the 15mm cone: 0.976 (0.1%); for the 20mm cone: 0.990 (0.1%). For field sizes larger than 10mm, the A1SL and A16 micro-chambers also yielded consistent output factors within 1.5% of those obtained using the microSilicon, microdiamond, and W2 detectors. The absolute dose measurement obtained with alanine was within 1.2%, consistent with combined uncertainties, compared to the PTW Semiflex chamber for the 25mm reference cone. For field sizes less than 10mm, the microSilicon diode, microDiamond detector, and W2 scintillator are suitable devices for accurate small field dosimetry of the ZAP-X system. For larger fields, the A1SL and A16 micro-chambers can also be used. Furthermore, alanine dosimetry can be an accurate verification of reference and absolute dose typically measured with ion chambers. Use of multiple suitable detectors and uncertainty analyses were recommended for reliable determination of small field radiation outputs.

Influence of magnetic field on a novel scintillation dosimeter in a 1.5 T MR-linac.

For commissioning and quality assurance for adaptive workflows on the MR-linac, a dosimeter which can measure time-resolved dose during MR image acquisition is desired. The Blue Physics model 10 scintillation dosimeter is potentially an ideal detector for such measurements. However, some detectors can be influenced by the magnetic field of the MR-linac. To assess the calibration methods and magnetic field dependency of the Blue Physics scintillator in the 1.5 T MR-linac. Several calibration methods were assessed for robustness. Detector characteristics and the influence of the calibration methods were assessed based on dose reproducibility, dose linearity, dose rate dependency, relative output factor (ROF), percentage depth dose profile, axial rotation and the radial detector orientation with respect to the magnetic field. The potential application of time-resolved dynamic dose measurements during MRI acquisition was assessed. A variation of calibration factors was observed for different calibration methods. Dose reproducibility, dose linearity and dose rate stability were all found to be within tolerance and were not significantly affected by different calibration methods. Measurements with the detector showed good correspondence with reference chambers. The ROF and radial orientation dependence measurements were influenced by the calibration method used. Axial detector dependence was assessed and relative readout differences of up to 2.5% were observed. A maximum readout difference of 10.8% was obtained when rotating the detector with respect to the magnetic field. Importantly, measurements with and without MR image acquisition were consistent for both static and dynamic situations. The Blue Physics scintillation detector is suitable for relative dosimetry in the 1.5 T MR-linac when measurements are within or close to calibration conditions.

A multi-detector comparison to determine convergence of measured relative output factors for small field dosimetry.

The TRS-483 Code of Practice (CoP) provides generic relative output correction factors, [Formula: see text], for a range of detectors and beam energies as used in small field dosimetry. In this work, the convergence of the relative output factors (ROFs) for 6MV X-ray beams with and without flattening filters was investigated under different combinations of beam collimation and published detector correction factors. The SFD, PFD and CC04 (IBA) were used to measure ROFs of a TrueBeam STx linear accelerator with small fields collimated by the high-definition MLC, which has 2.5 and 5.0mm projected leaves. Two configurations were used for the collimators: (1) fixed jaws at 10 × 10 cm2 and (2) with a 2mm offset from the MLC edge, in line with the recommended geometry from IROC-H as part of their auditing program and published dataset. The [Formula: see text] factors for the three detectors were taken from the TRS483 CoP and other published works. The average differences of ROFs measured by detectors under MLC fields with fixed jaws and with 2mm jaws offset for the 6MV-WFF beam are 1.4% and 1.9%, respectively. Similarly, they are 2.3% and 2.4% for the 6MV-FFF beam. The relative differences between the detector-average ROFs and the corresponding IROC-H dataset are 2.0% and 3.1% for the 6MV-WFF beam, while they are 2.4% and 3.2% for the 6MV-FFF beam at the smallest available field size of 2 × 2 cm2. For smaller field sizes, the average ROFs of the three detectors and corresponding results from Akino and Dufreneix showed the largest difference to be 6.6% and 6.2% under the 6MV-WFF beam, while they are 3.4% and 3.6% under the 6MV-WFF beam at the smallest field size of 0.5 × 0.5 cm2. Some well-published specific output correction factors for different small field detector types give better convergence in the calculation of the relative output factor in comparison with the generic data provided by the TRS-483 CoP. Relative output factor measurements should be performed as close as possible to the clinical settings including a combination of collimation systems, beam types and using at least three different types of small field detector for more accurate computation of the treatment planning system. The IROC-H dataset is not available for field size smaller than 2 × 2 cm2 for double checks and so that user should carefully check with other publications with the same setting.

First Demonstration of the Commissioning of a New Multi-Modality Radiotherapy Platform

A new multi-modality radiotherapy platform was developed and introduced into clinical application, which has received US FDA 510k(K210921) and National Medical Products Administration (NMPA) clearance in China (20223050973). This study, for the first time, presents the technological characteristics and commissioning results of the new platform. The platform consists of 3 modules: linear accelerator, rotating gamma system, and a kV imaging system within an O-ring gantry. The O-ring gantry can rotate continuously achieved by using a slip ring. The Linac delivers a 6 MV FFF photon beam with a variable dose rate of 50 to 1400 MU/min. The delivery techniques include 3D-CRT, IMRT, and VMAT. The rotating gamma system utilizes 18 Co-60 sources with a reference dose rate of 350 cGy/min. The image-guided techniques consist of kV-kV pairs and kV-CBCT. The X-ray intensity-modulated radiotherapy and γ-ray stereotactic radiotherapy can be delivered on the same platform. The acceptance test and commissioning were performed following the vendor's customer acceptance tests (CAT) and several AAPM Task Group reports/guidelines. Regarding the Linac, all applicable validation tests recommended by the MPPG 5.a (basic photon beam model validation, IMRT/VMAT validation, E2E tests, and patient-specific QA) were performed. For the rotating gamma system, the absorbed doses were measured using a PTW31014 and PTW60016. EBT3 films were employed to measure the relative output factors (ROFs). The E2E tests were performed using a PTW31014 and EBT3 films. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity. All tests included in the CAT met the vendor's specifications. All MPPG 5.a tests complied with the tolerances. The confidence limits for IMRT/VMAT validation were achieved according to TG-119. The point dose differences were below 1.68% and gamma pass rates (3%/2 mm) were above 95.9% for the Linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma pass rates (3%/2 mm) above 96.1% suggested by TG-218. For the rotating gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films. The point dose differences were below 2.57% and gamma pass rates (2%/1 mm) were above 95.3% for the E2E tests. The coincidence between the imaging isocenter and the Linac/gamma treatment isocenter was within 0.5 mm. The image quality fully complied with the vendor's specifications regarding the CNR, spatial resolution, and uniformity. This is the first report about the commissioning of a new multi-modality radiotherapy platform. The platform has been successfully commissioned and exhibits good performance in mechanical and dosimetry accuracy.

Characterization and commissioning of a new collaborative multi-modality radiotherapy platform.

TaiChi, a new multi-modality radiotherapy platform that integrates a linear accelerator, a focusing gamma system, and a kV imaging system within an enclosed O-ring gantry, was introduced into clinical application. This work aims to assess the technological characteristics and commissioning results of the TaiChi platform. The acceptance testing and commissioning were performed following the manufacturer's customer acceptance tests (CAT) and several AAPM Task Group (TG) reports/guidelines. Regarding the linear accelerator (linac), all applicable validation measurements recommended by the MPPG 5.a (basic photon beam model validation, intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) validation, end-to-end(E2E) tests, and patient-specific quality assurance (QA)) were performed. For the focusing gamma system, the absorbed doses were measured using a PTW31014 ion chamber (IC) and PTW60016 diode detector. EBT3 films and a PTW60016 diode detector were employed to measure the relative output factors (ROFs). The E2E tests were performed using PTW31014 IC and EBT3 films. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were investigated using EBT3 films. The image quality was evaluated regarding the contrast-to-noise ratio (CNR), spatial resolution, and uniformity. All tests included in the CAT met the manufacturer's specifications. All MPPG 5.a measurements complied with the tolerances. The confidence limits for IMRT/VMAT point dose and dose distribution measurements were achieved according to TG-119. The point dose differences were below 1.68% and gamma passing rates (3%/2 mm) were above 95.1% for the linac E2E tests. All plans of patient-specific QA had point dose differences below 1.79% and gamma passing rates above 96.1% using the 3%/2 mm criterion suggested by TG-218. For the focusing gamma system, the differences between the calculated and measured absorbed doses were below 1.86%. The ROFs calculated by the TPS were independently confirmed within 2% using EBT3 films and a PTW60016 detector. The point dose differences were below 2.57% and gamma passing rates were above 95.3% using the 2%/1 mm criterion for the E2E tests. The coincidences between the imaging isocenter and the linac/gamma mechanical isocenter were within 0.5mm. The image quality parameters fully complied with the manufacturer's specifications regarding the CNR, spatial resolution, and uniformity. The multi-modality radiotherapy platform complies with the CAT and AAPM commissioning criteria. The commissioning results demonstrate that this platform performs well in mechanical and dosimetry accuracy.

Monte Carlo modelling and validation of the elekta synergy medical linear accelerator equipped with radiosurgical cones

Monte Carlo simulations of medical linear accelerator heads help in visualizing the energy spectrum and angular spread of photons and electrons, energy deposition, and scattering from each of the head components. Hence, the purpose of this study was to validate the Monte Carlo model of the Elekta synergy medical linear accelerator equipped with stereotactic radio surgical connical collimators. For this, the Elekta synergy medical linear accelerator was modelled using the EGSnrc Monte Carlo code. The model results were validated using the measured data. The primary electron beam parameters, beam size, and energy were tuned to match the measured data; a dose profile with a field size of 40 × 40 cm2 and percentage depth dose with a field size of 10 × 10 cm2 were matched during tuning. The validation of the modelled data with the measurement results was performed using gamma analysis, point dose, and field size comparisons. For small radiation fields, relative output factors were also compared. The gamma analysis revealed good agreement between the Monte Carlo modeling results and the measured data. A gamma pass rate of more than 95% was obtained for field sizes of 40 × 40 cm2 to 2 × 2 cm2 with gamma criteria of 1% and 1 mm for the dose difference (DD) and distance to agreement (DTA), respectively; this gamma pass rate was more than 98% for the corresponding values of 2% and 2 mm for the DD and DTA, respectively. A gamma pass rate of more than 99% was obtained for a percentage depth dose with 1 mm and 1% criteria. The field size was also in good agreement with the measurement results, and the maximum deviation observed was 1.1%. The stereotactic cone field also passed this analysis with a gamma pass rate of more than 98% for dose profiles and 99% for the percentage depth dose. The small field output factor exhibited a deviation of 4.3%, 3.4%, and 1.9% for field sizes of 5 mm, 7.5 mm, and 10 mm, respectively. Thus, the Monte Carlo model of the Elekta Linear accelerator was successfully validated. The validation of radio surgical cones passed the analysis in terms of the dose profiles and percentage depth dose. The small field relative output factors exhibited deviations of up to 4.3%, and to resolve this, detector-specific and field-specific correction factors must be derived.

Characterization of Inorganic Scintillator Detectors for Dosimetry in Image-Guided Small Animal Radiotherapy Platforms.

The purpose of the study was to characterize a detection system based on inorganic scintillators and determine its suitability for dosimetry in preclinical radiation research. Dose rate, linearity, and repeatability of the response (among others) were assessed for medium-energy X-ray beam qualities. The response's variation with temperature and beam angle incidence was also evaluated. Absorbed dose quality-dependent calibration coefficients, based on a cross-calibration against air kerma secondary standard ionization chambers, were determined. Relative output factors (ROF) for small, collimated fields (≤10 mm × 10 mm) were measured and compared with Gafchromic film and to a CMOS imaging sensor. Independently of the beam quality, the scintillator signal repeatability was adequate and linear with dose. Compared with EBT3 films and CMOS, ROF was within 5% (except for smaller circular fields). We demonstrated that when the detector is cross-calibrated in the user's beam, it is a useful tool for dosimetry in medium-energy X-rays with small fields delivered by Image-Guided Small Animal Radiotherapy Platforms. It supports the development of procedures for independent "live" dose verification of complex preclinical radiotherapy plans with the possibility to insert the detectors in phantoms.

Dosimetric characteristics of the LIAC intraoperative radiotherapy beams: Assessment of sensitivity to measurement errors at the commissioning phase

Commissioning of the LIAC intraoperative electron radiotherapy (IOERT) unit relies on the vendor's SWL-LIAC software. This software simulates the percentage depth-doses (PDDs), off-axis dose profiles and relative output factors (ROFs) for all beams based on a small set of input measurements. To date, the impact of various possible measurement errors during commissioning on LIAC dosimetric characteristics has not been studied in detail. We aimed to assess the sensitivity of the dosimetric characteristics of the ‘LIAC 12 MeV’ IOERT unit beams to various measurement errors in the commissioning phase by obtaining the magnitude of the influence of each error.The required SWL-LIAC inputs (PDDs of applicator diameters 3, 7, and 10 cm and open field) were measured with intentional applicator misalignments including 1° rotation or lateral (2 mm) or vertical (±2 mm) displacements. Also, inaccurate water surface definition for the detector was simulated by using PDDs that were shifted by ±2 mm. The errors were applied one at a time. To identify the most influential errors, the computed relative dosimetric characteristics resulting from such erroneous measurement conditions were compared to the corresponding ‘error-free’ ones. The depths of 90% and 50% doses (R90 and R50, respectively) were investigated further.All the resulting errors in R90, R50, flatness, symmetry and penumbra were within 3.9 mm, 2.8 mm, 4.3%, 4.6% and 3.5 mm, respectively. The overall averages of the absolute differences in these indices from the error-free fields were 0.8 mm, 0.8 mm, 0.6%, 0.4% and 0.5 mm, respectively. Errors in water surface definition for the detector had 4.4 to 22 times greater influence on PDDs than the other errors. The corresponding values for the profiles were 1.3–5.8 times. Among the errors in applicator alignment, PDDs and profiles were more affected by rotational and vertical ‘stand-in’ applicator misalignments, respectively. The R90 and R50 values were less affected by the errors in the small (3 and 4 cm diameter) and 45° bevelled applicators.To conclude, on average, the studied errors caused relatively small changes in beam characteristics although the maximum magnitudes of the observed errors were fairly substantial. Among the investigated errors, defining the water surface inaccurately has the largest impact on the dosimetric characteristics. Overall, sensitivity to the studied errors was found to be greatest with large-diameter flat applicators and/or lower electron energies. Although individual errors in applicator alignment have less effect on dosimetric characteristics compared to water surface error, given that these errors may occur simultaneously during dosimetry, special attention should be paid to placing the applicator correctly at the surface. Special set-up aids, such as our in-house tool for aligning applicators, are therefore indicated. The findings also further highlight the need for checking the water level periodically in long-term dosimetry procedures.

Utilize empirical models of measured relative dose output factor (rDOF) and transverse penumbra (TP) to evaluate dosimetric uncertainties of in-air spot modelling for spot-scanning carbon-ion and proton radiotherapy

ABSTRACT To evaluate the dosimetric uncertainties of symmetric Gaussian modelled in-air spot size/shape in our Syngo treatment planning system, we performed measurements of rDOF and TP width at a shadow depth of 2.7 mm. They are related to the effects of low dose halo and asymmetric spot shape. Empirically, a two-component Gaussian analytical model predicted the trend of rDOF and TP as a function of field size. From the result, the in-air spot size was described by a single Gaussian function for carbon-ion and high energy proton. The weights and widths for the second component of double Gaussian increased significantly as the beam energy decreases for protons. The TP fitting agreed with the rDOF fit for the scanned field (SF) of larger than 78 mm. For proton, the TP for SF of 12.0 mm for energies of 153.36 MeV/u and197.23 MeV/u, SF of 60.0 mm for energy of 48.08 MeV/u were fit better by single Gaussian component. The width of TP showed no field size dependence for each energy. Obtained Gaussian width by fitting TP was smaller than by fitting rDOF for carbon-ion. The empirical model allowed us to investigate the effects of beam emittance and scattering. They could provide reference values for clinical use and quality assurance.

Monte Carlo-based independent dose verification of radiosurgery HyperArc plans

PurposeTo investigate the feasibility of using the free PRIMO Monte Carlo software for independent dose check of cranial SRS plans designed with the Varian HyperArc (HA) technique. Materials and methodsIn this study, the PRIMO Monte Carlo software v. 0.3.64.1800 was used with the phase-space files (v. 2, Feb. 27, 2013) provided by Varian for 6 MV flattening-filter-free (FFF) photon beams from a Varian TrueBeam linear accelerator (linac), equipped with a Millennium 120 multileaf collimator (MLC). This configuration was validated by comparing the percentage depth doses (PDDs), lateral profiles and relative output factors (OFs) simulated in a water phantom against measurements for field sizes from 1 × 1 to 40 × 40 cm2. The agreement between simulated and experimental relative dose curves was evaluated using a global (G) gamma index analysis. In addition, the accuracy of PRIMO to model the MLC was investigated (dosimetric leaf gap, tongue and groove, leaf transmission and interleaf leakage).Thirty-five HA SRS plans computed in the Eclipse treatment planning system (TPS) were simulated in PRIMO. The Acuros XB algorithm v. 16.10 (dose to medium) was used in Eclipse. Sixty targets with diameters ranging from 6 to 33 mm were included. Agreement between the dose distributions given by Eclipse and PRIMO was evaluated in terms of 3D global gamma passing rates (GPRs) for the 2 %/2 mm criteria. ResultsAverage GPR greater than 95 % with the 2 %(G)/1 mm criteria were obtained over the PDD and profiles of each field size. Differences between PRIMO calculated and measured OFs were within 0.5 % in all fields, except for the 1 × 1 cm2 with a discrepancy of 1.5 %. Regarding the MLC modeling in PRIMO, an agreement within 3 % was achieved between calculated and experimental doses. Excellent agreement between PRIMO and Eclipse was found for the 35 HA plans. The 3D global GPRs (2 %/2 mm) for the targets and external patient contour were 99.6 % ± 1.1 % and 99.8 % ± 0.5 %, respectively. ConclusionsAccording to the results described in this study, the PRIMO Monte Carlo software, in conjunction with the 6X FFF Varian phase-space files, can be used as secondary dose calculation software to check stereotactic radiosurgery plans from Eclipse using the HyperArc technique.

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.

Evaluation of SRS MapCHECK with StereoPHAN phantom as a new pre-treatment system verification for SBRT plans

Abstract Introduction: The aim of this study was to evaluate the new 2-Dimensional diode array SRS MapCHECK (SunNuclear, Melbourne, USA) with dedicated phantom StereoPHAN (SunNuclear, Melbourne, USA) for the pre-treatment verification of the stereotactic body radiotherapy (SBRT). Material and methods: For the system, the short and mid-long stability, dose linearity with MU, angular dependence, and field size dependence (ratio of relative output factor) were measured. The results of verification for 15 pre-treatment cancer patients (5 brains, 5 lungs, and 5 livers) performed with SRS MapCHECK and EBT3 Gafchromic films were compared. All the SBRT plans were optimized with the Eclipse (v. 15.6, Varian, Palo Alto, USA) treatment planning system (TPS) using the Acuros XB (Varian, Palo Alto, USA) dose calculation algorithm and were delivered to the Varian EDGE® (Varian, Palo Alto, USA) accelerator equipped with a high-definition multileaf collimator. The 6MV flattening-filter-free beam (FFF) was used. Results: Short and mid-long stability of SRS MapCHECK was very good (0.1%-0.2%), dose linearity with MU and dependence of the response of the detector on field size results were also acceptable (for dose linearity R2 = 1 and 6% difference between microDiamond and SRS MapCHECK response for the smallest field of 1 × 1 cm2). The angular dependence was very good except for the angles close to 90° and 270°. For pre-treatment plan verification, the gamma method was used with the criteria of 3% dose difference and 3 mm distance to agreement (3%/3 mm), and 2%/2 mm, 1%/1 mm, 3%/1 mm, and 2%/1 mm. The highest passing rate for all criteria was observed on the SRS MapCHECK system. Conclusions: It is concluded that SRS MapCHECK with StereoPHAN has sufficient potential for pre-treatment verification of the SBRT plans, so that verification of stereotactic plans can be significantly accelerated.

An evaluation of solid state detectors for the relative dosimetry of kilovoltage X-ray beams.

Kilovoltage (kV) X-ray beams are an essential modality in radiotherapy. Solid state detectors are widely available in radiotherapy departments, but their use for kV dosimetry has been limited to date. This study aimed to evaluate the dosimetric performance of a range of solid state detectors for kV dosimetry. Percentage depth doses (PDDs) and relative output factors (ROFs) were measured on an XStrahl 300 unit (XStrahl-Ltd., UK) using 60, 100, 150, and 300 kVp X-ray beams. The fields were defined by circular applicators with field sizes of 2, 5, 8, and 10 cm diameter and square applicators of field sizes 10 × 10 and 20 × 20 cm2 . The following Physikalisch-Technische Werkstätten (PTW) dosimeters were used for measurements: Advanced Markus, PinPoint 3D and Semiflex ionization chambers; photon, electron, and stereotactic radiosurgery (SRS) diodes plus the microDiamond detector. All PDDs were normalized at 5mm depth, and ROFs were measured at 3mm depth to avoid collisions with the end of the applicators. ROFs measured using chambers were corrected for polarity and ion-recombination effects. PDD measurements for 60, 100, and 150 kVp beams exhibited good agreement between all diodes and the ionization chambers over the entire range of depths except in the first few millimeters near the surface. However, for the 300 kVp, all diode detectors exhibited an overresponding behavior compared to reference depth dose data measured with the Advanced Markus chamber. ROFs with the diodes were higher than the Advanced Markus chamber at low energy, and the magnitude of these differences is inversely proportional to the field sizes. The PTW P diode showed the highest variation of up to 15% in the output factor compared to the Advanced Markus chamber. This study evaluated the dosimetric performance of a range of solid state detectors in kV relative dosimetry. This study showed that diode detectors are a suitable replacement for ionization chambers for the PDD measurement of low energy kV beams (60-150 kVp) except for the PDD of 60 kVp with the smaller field sizes. However, an overresponding behavior of diode detectors at 300 kVp beams shows that diode detectors are not suitable for the PDD measurement of high energy kV beams. Generally, all solid state detectors overresponded to ROF measurements, indicating that it is not suitable for ROF measurements. In general, both shielded and unshielded diodes produced a similar dosimetric response, which demonstrates that the energy dependence of solid state detectors should be considered before they are used for any kV relative dosimetric measurements.

Replacing gamma knife beam‐profiles on film with point‐detector scans

Detector arrays and profile-scans have widely replaced film-measurements for quality assurance (QA) on linear accelerators. Film is still used for relative output factor (ROF) measurements, positioning, and dose-profile verification for annual Leksell Gamma Knife (LGK) QA. This study shows that small-field active detector measurements can be performed in the easily accessed clinical mode and that they are an effective replacement to time-consuming and exacting film measurements. Beam profiles and positioning scans for 4-mm, 8-mm, and 16-mm-collimated fields were collected along the x-, y-, and z-axes. The Exradin W2-scintillator and the PTW microdiamond-detector were placed in custom inserts centered in the Elekta solid-water phantom for these scans. GafChromic EBT3-film was irradiated with single uniformly collimated exposures as the clinical-standard reference, using the same solid-water phantom for profile tests and the Elekta film holder for radiation focal point (RFP)/patient-positioning system (PPS) coincidence. All experimental data were compared to the tissue-maximum-ratio-based (TMR10) dose calculation. The detector-measured beam profiles and film-based profiles showed excellent agreement with TMR10-predicted full-width, half-maximum (FWHM) values. Absolute differences between the measured FWHM and FWHM from the treatment-planning system were on average 0.13mm, 0.08mm, and 0.04mm for film, microdiamond, and scintillator, respectively. The coincidence between the RFP and the PPS was measured to be ≤0.5mm with microdiamond, ≤0.41mm with the W2-1×1 scintillator, and ≤0.22mm using the film-technique. Small-volume field detectors, used in conjunction with a clinically available phantom, an electrometer with data-logging, and treatment plans created in clinical mode offer an efficient and viable alternative for film-based profile tests. Position verification can be accurately performed when CBCT-imaging is available to correct for residual detector-position uncertainty. Scans are easily set up within the treatment-planning-system and, when coupled with an automated analysis, can provide accurate measurements within minutes.

Influence of Jaw Setting in the Determination of Stereotactic Small-Field Output Factors with Different Detectors.

Background:The experimental determination of relative output factors presents the greatest challenge, especially for small fields with different detectors. The aim of this study is to evaluate the influence of jaw positions on small-field output factors for the fields defined by micro-multileaf collimator and circular cones with different detectors.Materials and Methods:The stereotactic output factors were measured on Primus linear accelerator with BrainLab micro-multileaf collimator (mMLC) and circular cones as add-on tertiary collimators. Square field sizes ranging from 0.6 cm × 0.6 cm to 9.8 cm × 9.8 cm and circular fields of diameter ranging from 1.0 cm to 4.0 cm were defined by mMLC and circular cones, respectively. The influence of jaw position on output factor was assessed for different geometric configurations with three different detectors.Results:The values obtained with PinPoint ion chamber were consistent with microDiamond detector for fields greater than 24 mm × 24 mm, but an underestimation of 23.9% was noticed in 6 mm x 6 mm field size. For the mMLC defined field size of 6 mm × 6 mm, when the X-Y jaw was moved from 8 mm × 8 mm to 80 mm × 80 mm, an increase in the output by a factor of 1.7 was observed with both microDiamond and stereotactic radiosurgery diode, whereas an increase in output by a factor of 1.9 was noticed with PinPoint ion chamber.Conclusion:Output factors obtained with different detectors show high differences in the smallest field size for all collimating systems. This study confirms that the position of X and Y jaw above the tertiary collimator significantly influences the small-field output factor.

RELATIVE OUTPUT FACTOR (ROF) OF GAMMA KNIFE’S MEASUREMENT USING IONIZATION CHAMBER AND GAFCHROMIC FILMS

<p>The important things on Leksell Gamma Knife (LGK) is determination of Relative Output Factor (ROF), which is required for beam data collection (BDC) process, as an input value to the Treatment Planning System (TPS). The ROF is also needed to traceability of dosimetry measurements and patient safety. ROF measurements on LGK using PTW PinPoint 3D ionization chamber: 0.016 cm<sup>3</sup>, PTW Semiflex: 0.125 cm<sup>3</sup>, and Exradin A16: 0.017 cm<sup>3</sup> at collimators 4, 8 and 16 mm. and gafchromic films. ROF values obtained in hospital-A, using PTW PinPoint 3D was: [(1.00 ± 0.002)], [(0.80 ± 0.02]); [(0.42 ± 0.002)]; and using Exradin A16 [(1.00 ± 0]; [(0, 87 ± 0)]; [(0.69 ± 0.0002)]. And using gafchromic films was: [(1.00 ± 0.006]; (0.96 ± 0.005); (0.86 ± 0.06)]; respectively for collimators 4, 8 and 16 mm, and Measurement of ROF in hospital-B using using a PTW PinPoint 3D was: [(1 ± 0); (0.75 ± 0); and (0.33 ± 0)] and using Exradin A16 was: [(1; 0.87; and 0.69)] and gafchromic films was: [(1.00 ± 0.03); (0.98 ± 0.045); and (0.85 ± 0.09)]; The results of ROF’s measurement were compared with the ROF values of Novotny, et al (2009) and TPS. The Gafchromic’s ROF values were relatively closer than both of them, while the ROF value of ionization. chamber at 4 mm collimators was relatively lower, because measurement in a small field occurs an averaging effect volume and lack of lateral charge particle equilibrium (LCPE).</p>

Relative output factors of different collimation systems in truebeam STx medical linear accelerator

The IAEA TRS483 and TRS398 Code of Practices (CoP) were used to calculate relative output factors for small photon beams of 6X, 6XFFF energies shaped by High Definition Multileaf Collimator (HDMLC), jaws and cones mounted on TrueBeam STx medical linear accelerator (Varian Medical Systems), respectively. A comparison between these results were made. The results show a large discrepancy in relative output factor curves found among different collimation systems of the same equivalent field sizes and between the CoPs. Therefore, the specific beam modelling in treatment planning system for each type of the collimation system to be used for small fields maybe required for better computational accuracy.

Independent validation of a dedicated commissioning software and investigation of the direction dependence of the field symmetry for the LIAC intraoperative electron radiotherapy accelerator

Commissioning of the LIAC intraoperative electron radiotherapy accelerator relies heavily on the manufacturer's SWL-LIAC simulation software, which substantially reduces the number of difficult-to-set-up measurements needed. The aim of this study was to independently validate the accuracy of SWL-LIAC's calculated outputs, namely, percentage depth-doses (PDDs), off-axis dose profiles and relative output factors (ROFs), against experimental data. For all the available energies (6, 8, 10, 12 MeV), PDD measurements were made for all sizes of the flat-ended applicators (3–10 cm) and several beveled applicators. Profiles and ROFs were measured for the more frequently used applicators in clinical practice and the reference 10 cm diameter applicator. Meticulous measurements were made using a p-type electron diode in a water phantom, aided by inhouse custom-made positioning tools and confirmed using radiochromic film dosimetry. The measured and calculated scans were compared using multi-criteria gamma analysis. Eighty-five percent of the calculated ROFs showed a 2% or better agreement with the measurements. The average gamma passing rate for PDDs was 100% using a 2mm/1% (global dose difference) criterion. Repeated measurements showed that the measured in-plane profiles were somewhat tilted, which was confirmed by the manufacturer. The average gamma passing rate of all profiles was 95.5% (2mm/3%); Without considering in-plane profiles, this value was 97.6%. It can be concluded that the accuracy of the SWL-LIAC calculations may be deemed acceptable for most clinical applications. However, assuming isotropic off-axis profiles is unwarranted and measuring profiles in both directions for all energies at installation and acceptance testing is indicated.

Monte Carlo calculated detector-specific correction factors for Elekta radiosurgery cones

A radiation field is considered small if its dimension is lower than the range of secondary electrons and the collimating devices partially occlude the source. Different detector types, such as unshielded diodes, diamond detectors, and small-volume ion chambers, are used for small-field measurements. Although the active volumes of these detectors are small, their non-water equivalent materials cause response variations. Herein, we aim to calculate the correction factors for our clinical detectors, EDGE detector (Sun Nuclear), 60017 diode (PTW), and CC01 ion chamber (IBA), for stereotactic radiosurgery cones of diameters of 5–15 mm in an Elekta Synergy linear accelerator using a Monte Carlo simulation. An Elekta Synergy linear accelerator treatment head was simulated using BEAMnrc Monte Carlo code as per the manufacturer specification. All three detectors were simulated as per the manufacturer specification. Three EGSnrc user codes were used for the detector simulation based on the detector geometry. The Monte Carlo model of the treatment head was validated against the measured data for a standard field size of 10 × 10 cm2. The off-axis profile, percentage depth dose, and tissue phantom ratio were verified in the validation procedure. The measured and Monte Carlo calculated relative output factors (ROFs) were not consistent. In a 5 mm field size, EDGE diode overestimated the ROF by 7.06%, and 60017 diode to 4.611%. In a 7.5 mm field size, the variations were 4.295% and 3.691% for EDGE and 60017 diodes, respectively. CC01 ion chamber under-responded up to 10% because of its low-density active volume. The maximum corrections were obtained in the smallest field size, which were 0.939(0.007), 0.962(0.006), and 1.117(0.008) for EDGE, PTW T60017, and CC01 detectors, respectively. After applying the Monte Carlo calculated correction factor to the measured ROF, it became consistent with the Monte Carlo calculated ROF.

Application of radiochromic gel dosimetry to commissioning of a megavoltage research linear accelerator for small-field animal irradiation studies.

To develop and implement an efficient and accurate commissioning procedure for small-field static beam animal irradiation studies on an MV research linear accelerator (Linatron-M9) using radiochromic gel dosimetry. The research linear accelerator (Linatron-M9) is a 9MV linac with a static fixed collimator opening of 5.08cm diameter. Lead collimators were manually placed to create smaller fields of 2×2cm2 , 1×1cm2 , and 0.5×0.5cm2 . Relative dosimetry measurements were performed, including profiles, percent depth dose (PDD) curves, beam divergence, and relative output factors using various dosimetry tools, including a small volume ionization chamber (A14), GAFCHROMIC™ EBT3 film, and Clearview gel dosimeters. The gel dosimeter was used to provide a 3D volumetric reference of the irradiated fields. The Linatron profiles and relative output factors were extracted at a reference depth of 2cm with the output factor measured relative to the 2×2cm2 reference field. Absolute dosimetry was performed using A14 ionization chamber measurements, which were verified using a national standards laboratory remote dosimetry service. Absolute dosimetry measurements were confirmed within 1.4% (k=2, 95% confidence=5%). The relative output factor of the small fields measured with films and gels agreed with a maximum relative percent error difference between the two methods of 1.1 % for the 1×1cm2 field and 4.3 % for the 0.5×0.5cm2 field. These relative errors were primarily due to the variability in the collimator positioning. The measured beam profiles demonstrated excellent agreement for beam size (measured as FWHM), within approximately 0.8mm (or less). Film measurements were more accurate in the penumbra region due to the film's finer resolution compared with the gel dosimeter. Following the van Dyk criteria, the PDD values of the film and gel measurements agree within 11% in the buildup region starting from 0.5cm depth and within 2.6 % beyond maximum dose and into the fall-off region for depths up to 5cm. The 2D beam profile isodose lines agree within 0.5mm in all regions for the 0.5×0.5cm2 and the 1×1cm2 fields and within 1mm for the larger field of 2×2cm2 . The 2D PDD curves agree within approximately 2% of the maximum in the typical therapy region (1-4cm) for the 1×1cm2 and 2×2cm2 and within 5% for the 0.5×0.5cm2 field. This work provides a commissioning process to measure the beam characteristics of a fixed beam MV accelerator with detailed dosimetric evaluation for its implementation in megavoltage small animal irradiation studies. Radiochromic gel dosimeters are efficient small-field relative dosimetry tools providing 3D dose measurements allowing for full representation of dose, dosimeter misalignment corrections and high reproducibility with low inter-dosimeter variability. Overall, radiochromic gels are valuable for fast, full relative dosimetry commissioning in comparison to films for application in high-energy small-field animal irradiation studies.