Superficial Dose Research Articles

A Monte Carlo study of the effect of an ultrasound transducer on surface dose during intrafraction motion imaging for external beam radiation therapy

The aim of this study was to estimate changes in surface dose due to the presence of the Clarity Autoscan™ ultrasound (US) probe during prostate radiotherapy using Monte Carlo (MC) methods. MC models of the Autoscan US probe were developed using the BEAMnrc/DOSXYZnrc code based on kV and MV CT images. CT datasets were converted to voxelized mass density phantoms using a CT number-to-mass density calibration. The dosimetric effect of the probe, in the contact region (an 8 mm × 12 mm single layer of voxels), was investigated using a phantom set-up mimicking two scenarios (a) a transperineal imaging configuration (radiation beam perpendicular to the central US axial direction), and (b) a transabdominal imaging configuration (radiation beam parallel to the central US axial direction). For scenario (a), the dosimetric effect was evaluated as a function of the probe to inferior radiation field edge distance. Clinically applicable distances from 5 mm separation to 2 mm overlap were determined from the radiotherapy plans of 27 patients receiving Clarity imaging. Overlaps of 3 to 14 (1 to 3 SD) mm were also considered to include the effect of interfraction motion correction. The influence of voxel size on surface dose estimation was investigated. Approved clinical plans from two prostate patients were used to simulate worst-case dosimetric impact of the probe when large couch translations were applied to correct for interfraction prostate motion. The dosimetric impact of both the MV and kV probe models agreed within ±2% for both beam configurations. For scenario (a) and 1 mm voxel model, the probe gave mean dose increases of 1.2% to 4.6% (of the dose at isocenter) for 5 mm separation to 0 mm overlap in the probe-phantom contact region, respectively. This increased to 27.5% for the largest interfraction motion correction considered (14 mm overlap). For separations of ≥ 2 mm dose differences were < 2%. Simulated dose perturbations were found to be superficial; for the 14 mm overlap the dose increase reduced to < 3% at 5.0 mm within the phantom. For scenario (b), dose increases due to the probe were < 5% in all cases. The dose increase was underestimated by up to ~13% when the voxel size was increased from 1 mm to 3 mm. MC simulated dose to the PTV and OARs for the two clinical plans considered showed good agreement with commercial treatment planning system results (within 2%). Mean dose increases due to the presence of the probe, after the maximum interfraction motion correction, were ~16.3% and ~8.0%, in the contact region, for plan 1 and plan 2, respectively. The presence of the probe results in superficial dose perturbations for patients with an overlap between the probe and the radiation field present in either the original treatment plan or due to translation of the radiation field to simulate correction of interfraction internal prostate motion.

EP-1449: The effect of a build-up screen on superficial dose in total body irradiation

EP-1449: The effect of a build-up screen on superficial dose in total body irradiation

Measurements of superficial dose distributions in radiation therapy using translucent cryogel dosimeters

Superficial dose distributions were measured using radiochromic translucent poly(vinyl alcohol) cryogels. The relationship between dose to the skin surface and dose measured with the bolus (cryogel) was established using a series of oblique irradiations. Gafchromic film was placed under the bolus, and the ratio of bolus-film dose was determined for angle ranging from 0o to 90o. The average ratio over 0-67.5 degrees (0.800 ± 0.064) was used as the single correction factor to convert dose in bolus to dose to the skin surface, and applied to bolus measurements of skin dose from head and neck intensity modulated radiation therapy (IMRT) treatments delivered to a RANDO phantom. The resulting dose distributions were compared to film measurements using gamma analysis with a 3%/3mm tolerance and a 10% threshold. The minimum gamma pass rate was 95.2%. This study is the first report on the use of a poly(vinyl alcohol) cryogels based dosimeter to provide an accurate estimation of superficial dose distributions in megavoltage photon beams.

Measurement of skin surface dose distributions in radiation therapy using poly(vinyl alcohol) cryogel dosimeters.

In external beam radiation therapy (EBRT), skin dose measurement is important to evaluate dose coverage of superficial target volumes. Treatment planning systems (TPSs) are often inaccurate in this region of the patient, so in vivo measurements are necessary for skin surface dose estimation. In this work, superficial dose distributions were measured using radiochromic translucent poly(vinyl alcohol) cryogels. The cryogels simultaneously served as bolus material, providing the necessary buildup to achieve the desired superficial dose. The relationship between dose to the skin surface and dose measured with the bolus was established using a series of oblique irradiations with gantry angles ranging from 0° to 90°. EBT‐2 Gafchromic film was placed under the bolus, and the ratio of bolus‐film dose was determined ranging from 0.749 ± 0.005 to 0.930 ± 0.002 for 0° and 90° gantry angles, respectively. The average ratio over 0–67.5° (0.800 ± 0.064) was used as the single correction factor to convert dose in bolus to dose to the skin surface. The correction factor was applied to bolus measurements of skin dose from head and neck intensity‐modulated radiation therapy (IMRT) treatments delivered to a RANDO phantom. The resulting dose distributions were compared to film measurements using gamma analysis with a 3%/3 mm tolerance and a 10% threshold. The minimum gamma pass rate was 95.2% suggesting that the radiochromic bolus may provide an accurate estimation of skin surface dose using a simple correction factor. This study demonstrates the suitability of radiochromic cryogels for superficial dose measurements in megavoltage photon beams.

Superficial and peripheral dose in compensator-based FFF beam IMRT.

Flattening filter‐free (FFF) beams produce higher dose rates. Combined with compensator‐based intensity modulated radiotherapy (IMRT) techniques, the dose delivery for each beam can be much shorter compared to the flattened beam MLC‐based or flattened beam compensator‐based IMRT. This ‘snap shot’ IMRT delivery is beneficial to patients for tumor motion management. Due to softer energy, superficial doses in FFF beam treatment are usually higher than those from flattened beams. Due to no flattening filter, thus less photon scattering, peripheral doses are usually lower in FFF beam treatment. However, in compensator‐based IMRT using FFF beams, the compensator is in the beam pathway. Does it introduce beam hardening effects and scattering such that the superficial dose is lower and peripheral dose is higher compared to FFF beam MLC‐based IMRT? This study applied Monte Carlo techniques to investigate the superficial and peripheral doses in compensator‐based IMRT using FFF beams and compared it to the MLC‐based IMRT using FFF beams and flattened beams. Besides varying thicknesses of brass slabs to simulate varying thicknesses of compensators, a simple cone‐shaped compensator was simulated to mimic a clinical application. The dose distribution in water phantom by the cone‐shaped compensator was then simulated by multiple MLC‐defined FFF and flattened beams with varying apertures. After normalization to the maximum dose, Dmax, the superficial and peripheral doses were compared between the FFF beam compensator‐based IMRT and FFF/flattened beam MLC‐based IMRT. The superficial dose at the central 0.5 mm depth was about 1% (of Dmax) lower in the compensator‐based 6 MV FFF (6FFF) IMRT compared to the MLC‐based 6FFF IMRT, and about 8% higher than the flattened 6 MV MLC‐based IMRT dose. At 8 cm off‐axis at depth of central maximum dose, dmax, the peripheral dose between the 6FFF and flattened 6 MV MLC demonstrated similar doses, while the compensator dose was about 1% (of Dmax) higher. Compensators reduce the superficial doses slightly compared to open FFF beams, but increases the peripheral doses due to scatter in the compensator.

In phantom assessment of superficial doses under TomoTherapy irradiation

PurposeAim of this work is the assessment of build-up and superficial doses of different clinical Head&Neck plans delivered with Helical TomoTherapy (HT) (Accuray, Sunnyvale, CA). Depth dose profiles and superficial dose points were measured in order to evaluate the Treatment Planning System (TPS) capability of an accurate dose modeling in regions of disequilibrium. Geometries and scattering conditions were investigated, similar to the ones generally encountered in clinical treatments. MethodsMeasurements were performed with two dosimeters: Gafchromic® EBT3 films (Ashland Inc., Wayne, NJ) and a synthetic single crystal diamond detector (PTW-Frieburg microDiamond, MD). A modified version of the Alderson RANDO phantom was employed to house the detectors. A comparison with TPS data was carried out in terms of dose difference (DD) and distance-to-agreement (DTA). ResultsDD between calculated data and MD measurements are within 4% even in points with high spatial dose variation. For depth profiles, EBT3 data show a DDmax of 3.3% and DTAmax of 2.2mm, in low and high gradient regions, respectively, and compare well with MD data. EBT3 superficial points always results in measured doses lower than TPS evaluated ones, with a maximum DTA value of 1.5mm. ConclusionsDoses measured with the two devices are in good agreement and compare well with calculated data. The deviations found in the present work are within the reference tolerance level, suggesting that the HT TPS is capable of a precise dose estimation both in superficial regions and in correspondence with interfaces between air and PMMA.

3D-printed applicators for high dose rate brachytherapy: Dosimetric assessment at different infill percentage

PurposeDosimetric assessment of high dose rate (HDR) brachytherapy applicators, printed in 3D with acrylonitrile butadiene styrene (ABS) at different infill percentage. Materials and methodsA low-cost, desktop, 3D printer (Hamlet 3DX100, Hamlet, Dublin, IE) was used for manufacturing simple HDR applicators, reproducing typical geometries in brachytherapy: cylindrical (common in vaginal treatment) and flat configurations (generally used to treat superficial lesions). Printer accuracy was investigated through physical measurements. The dosimetric consequences of varying the applicator’s density by tuning the printing infill percentage were analysed experimentally by measuring depth dose profiles and superficial dose distribution with Gafchromic EBT3 films (International Specialty Products, Wayne, NJ). Dose distributions were compared to those obtained with a commercial superficial applicator. ResultsMeasured printing accuracy was within 0.5mm. Dose attenuation was not sensitive to the density of the material. Surface dose distribution comparison of the 3D printed flat applicators with respect to the commercial superficial applicator showed an overall passing rate greater than 94% for gamma analysis with 3% dose difference criteria, 3mm distance-to-agreement criteria and 10% dose threshold. ConclusionLow-cost 3D printers are a promising solution for the customization of the HDR brachytherapy applicators. However, further assessment of 3D printing techniques and regulatory materials approval are required for clinical application.

Dosimetric assessment of brass mesh bolus for postmastectomy photon radiotherapy

Brass mesh bolus has been shown to be an acceptable substitute for tissue‐equivalent bolus to increase superficial dose for chest wall tangent photon radiotherapy. This work investigated the increase in surface dose, the change in the dose at depth, and the safety implications of higher energy photon beams when using brass mesh bolus for postmastectomy chest wall radiotherapy. A photon tangent plan was delivered to a thorax phantom, and the superficial dose ranged from 40%–72% of prescription dose with no bolus. The surface dose increased to 75%–110% of prescription dose with brass mesh bolus and 85%–109% of prescription dose with tissue‐equivalent bolus. It was also found that the dose at depth when using brass mesh bolus is comparable to that measured with no bolus for en face and oblique incidence. Monte Carlo calculations were used to assess the photoneutron production from brass mesh bolus used with 15 MV and 24 MV photon beams. The effective dose from photoneutrons was approximated and found to be relatively small, yet not negligible. Activation products generated by these photoneutrons, the surface dose rate due to the activation products, and the half‐life of the activation products were also considered in this work. The authors conclude that brass mesh bolus is a reasonable alternative to tissue‐equivalent bolus, and it may be used with high‐energy beam; but one should be aware of the potential increased effective dose to staff and patients due to the activation products produced by photoneutrons.PACS number(s): 87.53.Kn, 87.55.K

SU-F-T-379: Dosimetric Impacts of Topical Agents and Dressings On Skin in Radiotherapy

Purpose: This study investigated the superficial dose enhancement in the application of topical agents, clinical materials (thermal mask and bolus) and dressings in megavoltage photon beam radiotherapy. Different topical skin agents, clinical materials and dressings were evaluated and compared for their skin dosimetric impacts on the patients during radiation treatment. Methods: Superficial dose enhancements, or percentage doses with and without the studying materials, were measured using the 6 MV (Field size = 10×10 cm2) photon beams produced by a Varian TrueBeam linear accelerator. Twelve topical agents, five dressings (dry and wet conditions) and three clinical materials were studied. A solid water phantom was used with a MOSFET dose detector (TN-1002RD, Thomson and Nielsen Electronic, Ottawa, Ontario, Canada) located under a 1-mm PMMA slab to measure the skin dose. The distance between the radiation source and phantom surface was set to 100 cm in all measurements. The topical agents were distributed evenly with 1.5 mm thickness using our specific sample holder on the phantom surface. Extrapolations were made of 0.5 mm thickness for the agents to provide meaningful clinical value. Results: By comparing surface doses without studying materials, it is found that no topical agents had superficial dose enhancement higher than the clinical materials namely, thermoplastic mask (128%), 5-mm Superflab™ bolus (158%) and 10-mm Superflab™ bolus (171%) regarding the same thickness. Superficial dose enhancement of dry dressing did not exceed 110.5%, while wet dressings produced higher dose enhancements (133% for wet Mepilex lite and 141% for wet Mepilex Ag transfer). Conclusion: It is concluded that the evaluated topical agents and dry dressings did not increase the superficial dose to a concerning level, even using excessive thickness in every fraction of radiation treatment. Wet dressings were found producing the bolus effect, but was still substantially less than applying a thin 5-mm bolus.

SU‐F‐T‐151: Measurement Evaluation of Skin Dose in Scanning Proton Beam Therapy for Breast Cancer

Purpose:To measure the skin dose and compare it with the calculated dose from a treatment planning system (TPS) for breast cancer treatment using scanning proton beam therapy (SPBT).Methods:A single en‐face‐beam SPBT plan was generated by a commercial TPS for two breast cancer patients. The treatment volumes were the entire breasts (218 cc and 1500 cc) prescribed to 50.4 Gy (RBE) in 28 fractions. A range shifter of 5 cm water equivalent thickness was used. The organ at risk (skin) was defined to be 5 mm thick from the surface. The skin doses were measured in water with an ADCL calibrated parallel plate (PP) chamber. The measured data were compared with the values calculated in the TPS. Skin dose calculations can be subject to uncertainties created by the definition of the external contour and the limitations of the correction based algorithms, such as proton convolution superposition. Hence, the external contours were expanded by 0, 3 mm and 1 cm to include additional pixels for dose calculation. In addition, to examine the effects of the cloth gown on the skin dose, the skin dose measurements were conducted with and without gown.Results:On average the measured skin dose was 4% higher than the calculated values. At deeper depths, the measured and calculated doses were in better agreement (&lt; 2%). Large discrepancy occur for the dose calculated without external expansion due to volume averaging. The addition of the gown only increased the measured skin dose by 0.4%.Conclusion:The implemented TPS underestimated the skin dose for breast treatments. Superficial dose calculation without external expansion would result in large errors for SPBT for breast cancer.

SU‐F‐T‐194: Analyzing the Effect of Range Shifter Air Gap On TPS Dose Modeling Accuracy in Superficial PBS Proton Therapy

Purpose:Treatment planning systems (TPS) may not accurately model superficial dose distributions of range shifted proton pencil beam scanning (PBS) treatments. Numerous patient‐specific QA tests performed on superficially treated PBS plans have shown a consistent overestimate of dose by the TPS. This study quantifies variations between TPS planned dose and measured dose as a function of range shifter air gap and treatment depths up to 5 cm.Methods:PBS treatment plans were created in the TPS to uniformly irradiate a volume of solid water. One plan was created for each range shifter position analyzed, and all plans utilized identical dose optimization parameters. Each optimized plan was analyzed in the TPS to determine the planned dose at varying depths. A PBS proton therapy system with a 3.5 cm lucite range shifter delivered the treatment plans, and a parallel plate chamber embedded in RW3 solid water measured dose at shallow depths for each air gap. Differences between measured and planned doses were plotted and analyzed.Results:The data show that the TPS more accurately models superficial dose as the air gap between the range shifter and patient surface decreases. Air gaps less than 10 cm have an average dose difference of only 1.6%, whereas air gaps between 10 and 20 cm differ by 3.0% and gaps greater than 20 cm differ by 4.4%.Conclusion:This study has shown that the TPS is unable to accurately model superficial dose with a large range shifter air gap. Dose differences greater than 3% will likely cause QA failure, as many institutions analyze patient QA with a 3%/3mm gamma analysis. For superficial PBS therapy, range shifter positions should be chosen to keep the air gap less then 10 cm when patient setup and gantry geometry allow.

Superficial dose evaluation of four dose calculation algorithms

Accurate superficial dose calculation is of major importance because of the skin toxicity in radiotherapy, especially within the initial 2mm depth being considered more clinically relevant. The aim of this study is to evaluate superficial dose calculation accuracy of four commonly used algorithms in commercially available treatment planning systems (TPS) by Monte Carlo (MC) simulation and film measurements. The superficial dose in a simple geometrical phantom with size of 30cm×30cm×30cm was calculated by PBC (Pencil Beam Convolution), AAA (Analytical Anisotropic Algorithm), AXB (Acuros XB) in Eclipse system and CCC (Collapsed Cone Convolution) in Raystation system under the conditions of source to surface distance (SSD) of 100cm and field size (FS) of 10×10cm2. EGSnrc (BEAMnrc/DOSXYZnrc) program was performed to simulate the central axis dose distribution of Varian Trilogy accelerator, combined with measurements of superficial dose distribution by an extrapolation method of multilayer radiochromic films, to estimate the dose calculation accuracy of four algorithms in the superficial region which was recommended in detail by the ICRU (International Commission on Radiation Units and Measurement) and the ICRP (International Commission on Radiological Protection). In superficial region, good agreement was achieved between MC simulation and film extrapolation method, with the mean differences less than 1%, 2% and 5% for 0°, 30° and 60°, respectively. The relative skin dose errors were 0.84%, 1.88% and 3.90%; the mean dose discrepancies (0°, 30° and 60°) between each of four algorithms and MC simulation were (2.41±1.55%, 3.11±2.40%, and 1.53±1.05%), (3.09±3.00%, 3.10±3.01%, and 3.77±3.59%), (3.16±1.50%, 8.70±2.84%, and 18.20±4.10%) and (14.45±4.66%, 10.74±4.54%, and 3.34±3.26%) for AXB, CCC, AAA and PBC respectively. Monte Carlo simulation verified the feasibility of the superficial dose measurements by multilayer Gafchromic films. And the rank of superficial dose calculation accuracy of four algorithms was AXB>CCC>AAA>PBC. Care should be taken when using the AAA and PBC algorithms in the superficial dose calculation.

A.234 - EBT3 and microDiamond for superficial dose measurements under a tomotherapy H&N irradiation

A.234 - EBT3 and microDiamond for superficial dose measurements under a tomotherapy H&N irradiation

A.68 - Evaluation of superficial dose in tomotherapy: A phantom study

A.68 - Evaluation of superficial dose in tomotherapy: A phantom study

SU‐E‐I‐87: Calibrating Cherenkov Emission to Match Superficial Dose in Tissue

Purpose:Through Monte Carlo simulations and phantom studies, the dominant factors affecting the calibration of superficial Cherenkov intensity to absolute surface dose was investigated, including tissue optical properties, curvatures, beam properties and imaging angle.Methods:The phasespace files for the TrueBeam system from Varian were used in GAMOS (a GEANT4 based Monte Carlo simulation toolkit) to simulate surface emission Cherenkov signals and the correlated deposited dose. The parameters examined were: i) different tissue optical properties (skin color from light to dark), ii) beam types (X‐ray and electron beam), iii) beam energies, iv) thickness of tissues (2.5 cm to 20 cm), v) SSD (80 cm to 120 cm), vi) field sizes (0.5×0.5 cm2 to 20×20 cm2), vii) entrance/exit sides, viii) curvatures (cylinders with diameters from 2.5 cm to 20cm) and ix) imaging angles (0 to 90 degrees). In a specific case, for any Cherenkov photon emitted from the surface, the original position and direction, final position and direction and energy were recorded. Similar experimental measurements were taken in a range of the most pertinent parameters using tissue phantoms.Results:Combining the dose distribution and sampling sensitivity of Cherenkov emission, quantitatively accurate calibration factors (the amount of radiation dose represented by a single Cherenkov photon) were calculated. The data showed relatively large dependence upon different optical properties, curvature, entrance/exit and beam types. For a diffusive surface, the calibration factor was insensitive to imaging angles smaller than 60 degrees. Normalization with the reflectance image was experimentally validated as a simple and accurate method for calibrations of different optical properties.Conclusion:This study sheds light on how and to what extent different conditions affect the calibration from Cherenkov intensity to absolute superficial dose and provides practical solutions to allow quantitative Cherenkov imaging to be used as a dose surrogate for imaging.

SU‐E‐T‐86: A Systematic Method for GammaKnife SRS Fetal Dose Estimation

Purpose:Estimating fetal dose is critical to the decision‐making process when radiation treatment is indicated during pregnancy. Fetal doses less than 5cGy confer no measurable non‐cancer developmental risks but can produce a threefold increase in developing childhood cancer. In this study, we estimate fetal dose for a patient receiving Gamma Knife stereotactic radiosurgery (GKSRS) treatment and develop a method to estimate dose directly from plan details.Methods:A patient underwent GKSRS on a Perfexion unit for eight brain metastases (two infratentorial and one brainstem). Dose measurements were performed using a CC13, head phantom, and solid water. Superficial doses to the thyroid, sternum, and pelvis were measured using MOSFETs during treatment. Because the fetal dose was too low to accurately measure, we obtained measurements proximally to the isocenter, fitted to an exponential function, and extrapolated dose to the fundus of the uterus, uterine midpoint, and pubic synthesis for both the preliminary and delivered plans.Results:The R‐squared fit for the delivered doses was 0.995. The estimated fetal doses for the 72 minute preliminary and 138 minute delivered plans range from 0.0014 to 0.028cGy and 0.07 to 0.38cGy, respectively. MOSFET readings during treatment were just above background for the thyroid and negligible for all inferior positions. The method for estimating fetal dose from plan shot information was within 0.2cGy of the measured values at 14cm cranial to the fetal location.Conclusion:Estimated fetal doses for both the preliminary and delivered plan were well below the 5cGy recommended limit. Due to Pefexion shielding, internal dose is primarily governed by attenuation and drops off exponentially. This is the first work that reports fetal dose for a GK Perfexion unit. Although multiple lesions were treated and the duration of treatment was long, the estimated fetal dose remained very low.

SU‐E‐T‐489: Incorporating Skin Flash Into VMAT WBI: Impacts On Surface Dosimetry

Purpose:Increased use of inverse planning limits the amount of skin flash in whole breast irradiation (WBI). Strategies to incorporate flash into inverse‐planned treatments involve overriding air to the density of water or tissue. This introduces uncertainties to the superficial dose distribution, potentially degrading the coverage at the skin‐bolus interface. We investigate the accuracy of various commonly used bolus materials to incorporate flash in VMAT WBI plans while minimizing the perturbation near the skin.Methods:We obtained a CT‐simulation of an anthropomorphic phantom with a breast attachment. Three VMAT plans were created with different boluses: 1 cm of 1 g/cm3 bolus (Superflab), 1 cm of 0.65 g/cm3 bolus (wet towels), and 1 cm of g/cm3 bolus with 2 dose levels accounting for the difference between bolus and tissue density. The PTV was extended into the bolus, outside the patient body contour to incorporate flash. OSLDs were used to obtain surface doses at the medial, lateral and tip sites of the breast. Each plan was irradiated four times using CBCT for positioning and dosimeter localization.Results:The average thickness of the wet‐towel bolus on delivery was 8 mm with a CBCT‐measured density of 0.6 g/cm3. OSLD measurements demonstrated good agreement with predicted doses from Pinnacle. Average deviations were −5.7%, −2.5%, and −2.6% for plans 1, 2, and 3, respectively. OSLDs placed at the medial and lateral portions of the breast showed the largest average deviations. The maximum recorded deviation from planned values was −8.6%. The largest dose fluctuations occurred near areas where the bolus failed to properly conform to the breast contour.Conclusion:Use of wet‐towel bolus improved dose delivery accuracy compared to standard Superflab bolus. Areas of poor bolus conformity adversely affected dose delivery. We recommend the use of wet‐towel bolus over Superflab bolus for VMAT WBI.

SU‐E‐I‐15: Quantitative Evaluation of Dose Distributions From Axial, Helical and Cone‐Beam CT Imaging by Measurement Using a Two‐Dimensional Diode‐Array Detector

Purpose:To evaluate quantitatively dose distributions from helical, axial and cone‐beam CT clinical imaging techniques by measurement using a two‐dimensional (2D) diode‐array detector.Methods:2D‐dose distributions from selected clinical protocols used for axial, helical and cone‐beam CT imaging were measured using a diode‐array detector (MapCheck2). The MapCheck2 is composed from solid state diode detectors that are arranged in horizontal and vertical lines with a spacing of 10 mm. A GE‐Light‐Speed CT‐simulator was used to acquire axial and helical CT images and a kV on‐board‐imager integrated with a Varian TrueBeam‐STx machine was used to acquire cone‐beam CT (CBCT) images.Results:The dose distributions from axial, helical and cone‐beam CT were non‐uniform over the region‐of‐interest with strong spatial and angular dependence. In axial CT, a large dose gradient was measured that decreased from lateral sides to the middle of the phantom due to large superficial dose at the side of the phantom in comparison with larger beam attenuation at the center. The dose decreased at the superior and inferior regions in comparison to the center of the phantom in axial CT. An asymmetry was found between the right‐left or superior‐inferior sides of the phantom which possibly to angular dependence in the dose distributions. The dose level and distribution varied from one imaging technique into another. For the pelvis technique, axial CT deposited a mean dose of 3.67 cGy, helical CT deposited a mean dose of 1.59 cGy, and CBCT deposited a mean dose of 1.62 cGy.Conclusions:MapCheck2 provides a robust tool to measure directly 2D‐dose distributions for CT imaging with high spatial resolution detectors in comparison with ionization chamber that provides a single point measurement or an average dose to the phantom. The dose distributions measured with MapCheck2 consider medium heterogeneity and can represent specific patient dose.

SU-E-T-298: Dosimetric Assessment of Using Brass Mesh Bolus with High Energy X-Ray Beams

Purpose: Brass mesh bolus has been shown to be an acceptable substitute for tissue equivalent bolus to increase superficial dose for 6 MV chest wall tangent plans. It may be advantageous to deliver a portion of the treatment using higher energy beams to decrease dose heterogeneity. The purpose of this study is to investigate the photoneutron production and activation of brass mesh bolus by high energy x-ray beams. Methods: MCNPX was used to determine brass mesh photoneutron energy spectrum and PDDs for 15 MV and 24 MV beams. PDD and photoneutron spectra were determined with and without photoneutron production to assess the contribution of photoneutrons to CAX dose. Brass mesh was placed on a solid water slab phantom and irradiated with 500 MU of 15 MV photons at 100cm SSD. A Geiger-Mueller counter was used to record counts in 10-second intervals for 30 minutes. A survey meter was used to estimate dose on contact immediately following irradiation. Results: The thickness of brass mesh bolus for MCNPX simulation was 0.4 mm. The PDDs with and without photoneutron production were statistically equivalent (i.e. the increase in neutron dose at the central axis is insignificant). Using ICRP 103 dose conversion coefficients, the increase in effective dose from en-face delivery of 300 MU was 0.047 mSv for 15 MV and 0.525 mSV for 24 MV. The dose rate on contact after the 500 MU irradiation was 0.4 mrem/hr. The effective half-life was estimated to approximately 6 minutes. Conclusion: The use of brass mesh bolus with high energy beams does not significantly affect central axis PDD. The use of a 24 MV beam with brass bolus results in nearly 10 times the increase in effective dose as with 15 MV. The activation products produced by brass bolus have an effective half-life of approximately 6 minutes.

Tolerance of Superficial Dose to Setup Error With Tomotherapy: Is a Skin Flash Tool Required?

In cancers of the head and neck, gross tumor or areas at risk of microscopic disease often lie close to the skin, while the skin itself may not be at risk. With intensity-modulated radiotherapy, setup errors can lead to underdosage of superficial structures because the collimator will not by default open beyond the skin surface to apply coverage in the air overlying the skin. Thus, small setup errors can move superficial structures out of field for some beams. Some planning systems allow for manually extrapolating fluence for beams tangential to superficial targets. It is unclear whether this problem is significant with tomotherapy. A head and neck phantom was utilized. A 3-mm bolus was used to represent the skin and allow placement of dosimeters at 3 mm depth. Thermoluminescent dosimeters were placed at reproducible points on the skin surface and at 3 mm depth. The phantom was irradiated, with the target volume deep to the thermoluminescent dosimeters receiving a dose of 5 Gy. This process was repeated with the phantom displaced 2.5 mm and again with a displacement of 5 mm. These displacements simulated setup errors that in clinical practice would correspond to bending or twisting of the neck that could not be corrected with rotations or translations. When the phantom was displaced 2.5 mm, the dose measured at 3 mm depth was 99.2% (95.9%-102.5%) of the control. With a 5-mm displacement, the dose at 3 mm only dropped to 91.1% (88.8%-93.4%) of the control. Dose measured at skin surface decreased to a greater degree with such setup error. Dose at superficial depths degraded only slightly with 2.5-mm and even 5-mm displacements. With the tomotherapy system, superficial dose appears to be robust to clinically relevant setup errors. However, if the skin is at risk, bolus should be used to ensure adequate coverage.