Clinical radiotherapy application of N-vinylpyrrolidone-containing 3D polymer gel dosimeters with remote external MR-reading

PurposeAdvanced 3D dosimetry is required for verifications of complex dose distributions in modern radiotherapy. Two 3D polymer gel dosimeters, coupled with magnetic resonance (MR) imaging (3 T MRI) readout and data processing with polyGeVero® software, were tested for the verification of calculated 3D dose distributions by a treatment planning system (TPS) and ArcCHECK®–3DVH®, related to eradication of a lung tumour.MethodsN-vinylpyrrolidone-containing 3D polymer gel dosimeters were used: VIC (containing ascorbic acid and copper sulfate pentahydrate) and VIC-T (containing tetrakis(hydroxymethyl)phosphonium chloride). Three remote centers were involved in the dosimeters preparation and irradiation (Poland), and MRI (Austria). Cross beam calibration of the dosimeters and verification of a 3D dose distribution calculated with an Eclipse External Beam TPS and ArcCHECK®–3DVH® were performed. The 3D-to-3D comparisons of the VIC and VIC-T with TPS and ArcCHECK®–3DVH® along with ArcCHECK®–3DVH® versus TPS dose matrixes were performed with the aid of the polyGeVero® by analyzing dose profiles, isodoses lines, gamma index, gamma angle, dose difference, and related histograms.ResultsThe measured MR-relaxation rate (R₂ = 1/T₂) for the dosimeters relates to the dose, as follows: R₂ = 0.0928 ± 0.0008 [Gy⁻¹ s⁻¹] × D [Gy] + 2.985 ± 0.012 [s⁻¹] (VIC) and 0.1839 ± 0.0044 [Gy⁻¹ s⁻¹] × D [Gy] + 2.519 ± 0.053 [s⁻¹] (VIC-T). The 3D-to-3D comparisons revealed a good agreement between the measured and calculated 3D dose distributions.ConclusionsVIC and VIC-T with 3T MRI readout and polyGeVero® showed potential for verifications of calculated irradiation plans. The results obtained suggest the implementation of the irradiation plan for eradication of the lung tumour.     

Comprehensive quality assurance phantom for the small animal radiation research platform (SARRP)

PurposeTo develop and test the suitability and performance of a comprehensive quality assurance (QA) phantom for the Small Animal Radiation Research Platform (SARRP).Methods and materialsA QA phantom was developed for carrying out daily, monthly and annual QA tasks including: imaging, dosimetry and treatment planning system (TPS) performance evaluation of the SARRP. The QA phantom consists of 15 (60 × 60 × 5 mm³) kV-energy tissue equivalent solid water slabs. The phantom can incorporate optically stimulated luminescence dosimeters (OSLD), Mosfet or film. One slab, with inserts and another slab with hole patterns are particularly designed for image QA.ResultsOutput constancy measurement results showed daily variations within 3%. Using the Mosfet in phantom as target, results showed that the difference between TPS calculations and measurements was within 5%. Annual QA results for the Percentage depth dose (PDD) curves, lateral beam profiles, beam flatness and beam profile symmetry were found consistent with results obtained at commissioning. PDD curves obtained using film and OSLDs showed good agreement. Image QA was performed monthly, with image-quality parameters assessed in terms of CBCT image geometric accuracy, CT number accuracy, image spatial resolution, noise and image uniformity.ConclusionsThe results show that the developed QA phantom can be employed as a tool for comprehensive performance evaluation of the SARRP. The study provides a useful reference for development of a comprehensive quality assurance program for the SARRP and other similar small animal irradiators, with proposed tolerances and frequency of required tests.     

Photoneutron depth dose equivalent distributions in high-energy X-ray medical accelerators by a novel position-sensitive dosimeter

PurposeThe purpose of this study was to; (1) investigate employing a novel position-sensitive mega-size polycarbonate (MSPC) dosimeter for photoneutron (PN) depth, profile and dose equivalent distributions studies in a multilayer polyethylene phantom in a Siemens ONCOR accelerator, and (2) develop depth dose equivalent distribution matrix data at different depths and positions of the phantom for patient PN dose equivalent determination and in particular for PN secondary cancer risk estimation.MethodsPosition-sensitive MSPC dosimeters were successfully exposed at 9 different depths of the phantom in a 10 × 10 cm² X-ray field. The dosimeters were processed in mega-size electrochemical chambers at optimum conditions. Each MSPC dosimeter was placed at a known phantom depth for PN depth dose equivalents and profiles on transverse, longitudinal and diagonal axes and isodose equivalent distribution studies in and out of the X-ray beam.ResultsPN dose equivalent distributions at any depth showed the highest value at the beam central axis and decreases as the distance increases. PN dose equivalent at any position studied in the axes has a maximum value on the phantom surface which decreases as depth increases due to flux reduction by multi-elastic scattering interactions.ConclusionsExtensive PN dose equivalent matrix data at different depths and positions in the phantom were determined. The position-sensitive MSPC dosimeters proved to be highly efficient for PN depth, profile and isodose equivalent distribution studies. The extensive data obtained highly assists for determining PN dose equivalent of a patient undergoing high-energy X-ray therapy and for PN secondary cancer risk estimation.     

Characterization of passive dosimeters in proton pencil beam scanning – A EURADOS intercomparison for mailed dosimetry audits in proton therapy centres

The lack of mailed dosimetry audits of proton therapy centres in Europe has encouraged researchers of EURADOS Working Group 9 (WG9) to compare response of several existing passive detector systems in therapeutic pencil beam scanning.Alanine Electron Paramagnetic Resonance dosimetry systems from 3 different institutes (ISS, Italy; UH, Belgium and IFJ PAN, Poland), ^natLiF:Mg, Ti (MTS-N) and ^natLiF:Mg, Cu, P (MCP-N) thermoluminescent dosimeters (TLDs), GD-352M radiophotoluminescent glass dosimeters (RPLGDs) and Al₂O₃:C optically stimulated dosimeters (OSLDs) were evaluate. Dosimeter repeatability, batch reproducibility and response in therapeutic Pencil Beam Scanning were verified for implementation as mail auditing system.Alanine detectors demonstrated the lowest linear energy transfer (LET) dependence with an agreement between measured and treatment planning system (TPS) dose below 1%. The OSLDs measured on average a 6.3% lower dose compared to TPS calculation, with no significant difference between varying modulations and ranges. Both GD-352M and MCP-N measured a lower dose than the TPS and luminescent response was dependent on the LET of the therapeutic proton beam. Thermoluminescent response of MTS-N was also found to be dependent on the LET and a higher dose than TPS was measured with the most pronounced increase of 11%.As alanine detectors are characterized by the lowest energy dependence for different parameters of therapeutic pencil beam scanning they are suitable candidates for mail auditing in proton therapy. The response of luminescence detector systems have shown promises even though more careful calibration and corrections are needed for its implementation as part of a mailed dosimetry audit system.     

An optimized calibration method for surface measurements with MOSFETs in shaped-beam radiosurgery

Nowadays MOSFET dosimeters are widely used for dose verification in radiotherapy procedures. Although their sensitive area satisfies size requirements for small field dosimetry, their use in radiosurgery has rarely been reported. The aim of this study is to propose and optimize a calibration method to perform surface measurements in 6 MV shaped-beam radiosurgery for field sizes down to 18 × 18 mm². The effect of different parameters such as recovery time between 2 readings, batch uniformity and build-up cap attenuation was studied. Batch uniformity was found to be within 2% and isocenter dose attenuation due to the build-up cap over the MOSFET was near 2% irrespective of field size. Two sets of sensitivity coefficients (SC) were determined for TN-502RD MOSFET dosimeters using experimental and calculated calibration; the latter being developed using an inverse square law model. Validation measurements were performed on a realistic head phantom in irregular fields. MOSFET dose values obtained by applying either measured or calculated SC were compared. For calibration, optimal results were obtained for an inter-measurement time lapse of 5 min. We also found that fitting the SC values with the inverse square law reduced the number of measurements required for calibration. The study demonstrated that combining inverse square law and Sterling–Worthley formula resulted in an underestimation of up to 4% of the dose measured by MOSFETs for complex beam geometries. With the inverse square law, it is possible to reduce the number of measurements required for calibration for multiple field–SSD combinations. Our results suggested that MOSFETs are suitable sensors for dosimetry when used at the surface in shaped-beam radiosurgery down to 18 × 18 mm².     

Influence of beam incidence and irradiation parameters on stray neutron doses to healthy organs of pediatric patients treated for an intracranial tumor with passive scattering proton therapy

PurposeIn scattering proton therapy, the beam incidence, i.e. the patient’s orientation with respect to the beam axis, can significantly influence stray neutron doses although it is almost not documented in the literature.MethodsMCNPX calculations were carried out to estimate stray neutron doses to 25 healthy organs of a 10-year-old female phantom treated for an intracranial tumor. Two beam incidences were considered in this article, namely a superior (SUP) field and a right lateral (RLAT) field. For both fields, a parametric study was performed varying proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and air gap size.ResultsUsing a standard beam line configuration for a craniopharyngioma treatment, neutron absorbed doses per therapeutic dose of 63 μGy Gy⁻¹ and 149 μGy Gy⁻¹ were found at the heart for the SUP and the RLAT fields, respectively. This dose discrepancy was explained by the different patient’s orientations leading to changes in the distance between organs and the final collimator where external neutrons are mainly produced. Moreover, investigations on neutron spectral fluence at the heart showed that the number of neutrons was 2.5 times higher for the RLAT field compared against the SUP field. Finally, the influence of some irradiation parameters on neutron doses was found to be different according to the beam incidence.ConclusionBeam incidence was thus found to induce large variations in stray neutron doses, proving that this parameter could be optimized to enhance the radiation protection of the patient.     

Development of a phantom for dose distribution verification in Stereotactic Radiosurgery

A geometric acrylic phantom was designed and built for dose distribution verification in Stereotactic Radiosurgery. Acrylic objects representing the tumor tissue, (target volume (TV)), and the organ at risk (OAR), the brainstem, were inserted inside this phantom. The TV is represented by two semi-spheres of acrylic with a diameter of 13.0 mm, both having a central cavity for accommodation of a TLD-100 detector and a small radiochromic Gafchromic EBT film. The OAR is represented by the two parts of a 38.0 mm length acrylic cylinder with a diameter 18.0 mm and cavities along the cylinder central axis able to accommodate 5 TLD – 100 detectors and another of EBT film between the two cylinder parts. This experimental setup was submitted to a radiosurgical treatment, after which the TL dosimeters were evaluated and their responses were compared with the planned dose values. The radiochromic EBT films showed the dose distributions. The linear accelerator used was a Varian 2300 C/D, generating a 6 MV photon beam. The investigated phantom system was able to check the accuracy of dose delivery to predetermined points and the dose distribution due to stereotactic radiosurgery treatments and proved to be a good tool for quality control in these situations.     

Accurate dosimetric measurement of large extended SSD fields for comparison to TPS models

PurposeThere is little evidence in the literature which quantifies the accuracy of Treatment Planning Systems (TPSs) using large fields at extended SSD (eSSD). This paper introduces the approach taken at Christchurch Hospital, New Zealand to validate the use of the Monaco TPS for Total Body Irradiation (TBI) treatments.MethodsA purpose-built device for allowing precise movements of block-like phantoms called a Phantom Mobility Device (PMD) was used for collecting measurements at eSSD. These measurements were used for determining the ability of the Monaco TPS (originally validated for SSDs between 80 and 110 cm) to accurately model dose distributions for TBI treatments at Christchurch Hospital on either treatment machine one (T1) or two (T2) with SSD values of 341 and 432.6 and clinically useful field sizes of 120 and 170 cm, respectively.ResultsWe found that within the limits of measurement uncertainty the PMD contributed no determinable scatter to the measurements and proved a reliable approach for eSSD dose measurements. Additionally, by applying depth and off-axis distance constraints of use for TPS information it is possible to use the existing Monaco CCC model at eSSD for block phantom geometries. Dose Difference (DD) analysis showed a clinically acceptable agreement between the CCC model and measured data over a range of depths and off-axis distances.ConclusionsThe PMD was determined to be a useful tool for accurate measurement of extended SSD treatment fields. Monaco TPS CCC model agreed well for block phantoms so future comparisons to anthropomorphic phantoms or patient data are feasible.     

Optical-CT 3D Dosimetry Using Fresnel Lenses with Minimal Refractive-Index Matching Fluid

Telecentric optical computed tomography (optical-CT) is a state-of-the-art method for visualizing and quantifying 3-dimensional dose distributions in radiochromic dosimeters. In this work a prototype telecentric system (DFOS—Duke Fresnel Optical-CT Scanner) is evaluated which incorporates two substantial design changes: the use of Fresnel lenses (reducing lens costs from $10-30K t0 $1-3K) and the use of a ‘solid tank’ (which reduces noise, and the volume of refractively matched fluid from 1ltr to 10cc). The efficacy of DFOS was evaluated by direct comparison against commissioned scanners in our lab. Measured dose distributions from all systems were compared against the predicted dose distributions from a commissioned treatment planning system (TPS). Three treatment plans were investigated including a simple four-field box treatment, a multiple small field delivery, and a complex IMRT treatment. Dosimeters were imaged within 2h post irradiation, using consistent scanning techniques (360 projections acquired at 1 degree intervals, reconstruction at 2mm). DFOS efficacy was evaluated through inspection of dose line-profiles, and 2D and 3D dose and gamma maps. DFOS/TPS gamma pass rates with 3%/3mm dose difference/distance-to-agreement criteria ranged from 89.3% to 92.2%, compared to from 95.6% to 99.0% obtained with the commissioned system. The 3D gamma pass rate between the commissioned system and DFOS was 98.2%. The typical noise rates in DFOS reconstructions were up to 3%, compared to under 2% for the commissioned system. In conclusion, while the introduction of a solid tank proved advantageous with regards to cost and convenience, further work is required to improve the image quality and dose reconstruction accuracy of the new DFOS optical-CT system.     

Comprehensive methodology for commissioning modern 3D-image-based treatment planning systems for high dose rate gynaecological brachytherapy: A review

PurposeCorrect commissioning of treatment planning systems (TPSs) is important for reducing treatment failure events. There is currently no comprehensive and robust methodology available for TPS commissioning in modern brachytherapy. This review aimed to develop a comprehensive template for commissioning modern 3D-image-based brachytherapy TPSs for high dose rate (HDR) gynaecological applications.MethodsThe literature relevant to TPS commissioning, including both external beam radiation therapy (EBRT) and brachytherapy, as well as guidelines by the International Atomic Energy Agency (IAEA), the American Association of Physicists in Medicine (AAPM), and the European Society for Radiotherapy and Oncology (ESTRO) were searched, studied and appraised. The applied relevant EBRT TPS commissioning tests were applied to brachytherapy. The developed template aimed to cover all dosimetric and non-dosimetric issues.ResultsThe essential commissioning items could be categorized into six parts: geometry, dose calculation, plan evaluation tools, plan optimization, TPS output, and end-to-end verification. The final template consists of 43 items. This paper presents the purpose and role of each test, as well as tolerance limits, to facilitate the use of the template.ConclusionThe information and recommendations available in a collection of publications over many years have been reviewed in order to develop a comprehensive template for commissioning complex modern 3D-image-based brachytherapy TPSs for HDR gynaecological applications. The up-to-date and concise information contained in the template can aid brachytherapy physicists during TPS commissioning as well as devising a regular quality assurance program and allocation of time and resources.     

Dosimetric validation of a redundant independent calculation software for VMAT fields

A redundant independent dosimetric calculation (RIDC) prior to treatment has become a basic part of the QA process for 3D conventional radiotherapy, and is strongly recommended in several international publications. On the other hand, the rapid growth in the number of intensity modulated treatments has led to a significant increase in the workflow associated with QA treatments. Diamond (“K&S Associates”) is RIDC software which is capable of calculating VMAT (Volumetric Modulated Arc Therapy) fields. Modeling, validation and commissioning are necessary steps thereby making it a useful tool for VMAT QA. In this paper, a procedure for the validation of the calculation algorithm is demonstrated. A set 3D conventional field was verified in two ways: firstly, a comparison was made between Diamond calculations and experimental measures obtaining an average deviation of ?0.1 ± 0.7%(1SD), and secondly, a comparison made between Diamond and the treatment planning system (TPS) Eclipse, obtaining an average deviation of 0.4 ± 0.8%(1SD). For both steps, a plastic slab phantom was used. VMAT validation was carried out by analyzing 59 VMAT plans in two ways: first, Diamond calculation versus experimental measurement with an average deviation of ?0.2 ± 1.7%(1SD), and second, Diamond calculation versus TPS calculation with an average deviation of 0.0 ± 1.6%(1SD). In this phase a homogeneous cylindrical phantom was used. These results led us to consider this calculation algorithm validated for use in VMAT verifications.     

Utilisation des gels de polymères MAGIC pour la dosimétrie d’une source non scellée d’yttrium 90

Polymer gels are relative chemical dosimeters. They allow to access to three-dimensional dose distribution. The aim of this study has been to investigate the preparation and the use of a polymer gel with a tissue equivalent density known as MAGIC gel from magnetic resonance imaging and x-ray computed tomography for non-sealed source dosimetry. This kind of gel is “normoxic” because it can be manufactured and used in normal room atmosphere. In the first part of this study, its accuracy and sensibility were studied using external beam irradiation by photons. Spin-spin relaxation rate (R₂) and Computed Tomography (CT) number had been used to record gel responses. Using the same manufacture process, radiolabelled gels composed of 95% MAGIC gel and 5% of ⁹⁰Y termed ⁹⁰Y-MAGIC₉₅, with varying activity ranged from 0 to 30 MBq were made. In case of photon external beam irradiation, a linear response is observed whatever the calibration method and the imaging system used (the correlation coefficient r² > 0.98 in all cases). ⁹⁰Y-MAGIC₉₅ radiolabelled gel responses were recorded after 28, 76 and 124 h. The R₂/dose curves are not linear; three phases can be described, the first being linear with a slow slope (0.14 s⁻¹ Gy⁻¹ instead of 0.41 s⁻¹ Gy⁻¹ for external beam irradiation of the same gel batch). This study shows safety of radiolabelled MAGIC gels manufacturing process and their large dosimetric feasibility. ⁹⁰Y-MAGIC₉₅ gel response appears to be reproducible and related to the absorbed dose, thus this gel is a promising tool for non-sealed source dosimetry.     

Monte Carlo comparison of superficial dose between flattening filter free and flattened beams

This study investigates the superficial dose from FFF beams in comparison with the conventional flattened ones using a Monte Carlo (MC) method. Published phase-space files which incorporated real geometry of a TrueBeam accelerator were used for the dose calculation in phantom and clinical cases. The photon fluence on the central axis is 3 times that of a flattened beam for a 6 MV FFF beam and 5 times for a 10 MV beam. The mean energy across the field in air at the phantom surface is 0.92–0.95 MeV for the 6 MV FFF beam and 1.18–1.30 MeV for the corresponding flattened beam. At 10 MV, the values are 1.52–1.72 and 2.15–2.87 MeV for the FFF and flattened beams, respectively. The phantom dose at the depth of 1 mm in the 6 MV FFF beam is 6% ± 2.5% (of the maximum dose) higher compared to the flattened beam for a 25 × 25 cm² field and 14.6% ± 1.9% for the 2 × 2 cm² field. For the 10 MV beam, the corresponding differences are 3.4% ± 1.5% and 10.7% ± 0.6%. The skin dose difference at selected points on the patient's surface between the plans using FFF and flattened beams in the head-and-neck case was 6.5% ± 2.3% (1SD), and for the breast case it was 6.4% ± 2.3%. The Monte Carlo simulations showed that due to the lower mean energy in the FFF beam, the clinical superficial dose is higher without the flattening filter compared to the flattened beam.     

Planning and dosimetric evaluation of three total body irradiation techniques: Standard SSD VMAT,Extended SSD VMAT and Extended SSD Field-in-Field

The aim of this study was to dosimetrically compare three total body irradiation (TBI) techniques which can be delivered by a standard linear accelerator, and to deduce which one is preferable. Specifically, Extended Source to Surface Distance (SSD) Field-in-Field (FiF), Extended SSD Volumetric Modulated Arc Therapy (VMAT), and Standard SSD VMAT TBI techniques were dosimetrically evaluated. Percent depth dose and dose profile measurements were made under treatment conditions for each specified technique. After having generated treatment plans with a treatment planning system (TPS), dose homogeneity and critical organ doses were investigated on a Rando phantom using radiochromic films and optically stimulated luminescence dosimeters (OSLDs). TBI dose of 12 Gy in six fractions was prescribed for each technique. The gamma index (5%/5 mm) was used for the analysis of radiochromic films. Passing rates for Extended SSD FiF, Extended SSD VMAT and Standard SSD VMAT techniques were found to be 90%, 87% and 94%, respectively. OSLD measurements were within?±?5% agreement with TPS calculations for the first two techniques whereas the agreement was found to be within?±?3% for the Standard SSD VMAT technique. TPS calculations demonstrated that mean lung doses in the first two techniques were around 8.5 Gy while it was kept around 7 Gy in Standard SSD VMAT. It is concluded that Standard SSD VMAT is superior in sparing the lung tissue while all three TBI techniques are feasible in clinical practice with acceptable dose homogeneity. In the absence of VMAT-based treatment planning, Extended SSD FiF would be a reasonable choice compared to other conventional techniques.

     

A Deep Learning-based correction to EPID dosimetry for attenuation and scatter in the Unity MR-Linac system

PurposeEPID dosimetry in the Unity MR-Linac system allows for reconstruction of absolute dose distributions within the patient geometry. Dose reconstruction is accurate for the parts of the beam arriving at the EPID through the MRI central unattenuated region, free of gradient coils, resulting in a maximum field size of ~10 × 22 cm² at isocentre. The purpose of this study is to develop a Deep Learning-based method to improve the accuracy of 2D EPID reconstructed dose distributions outside this central region, accounting for the effects of the extra attenuation and scatter.MethodsA U-Net was trained to correct EPID dose images calculated at the isocenter inside a cylindrical phantom using the corresponding TPS dose images as ground truth for training. The model was evaluated using a 5-fold cross validation procedure. The clinical validity of the U-Net corrected dose images (the so-called DEEPID dose images) was assessed with in vivo verification data of 45 large rectum IMRT fields. The sensitivity of DEEPID to leaf bank position errors (±1.5 mm) and ±5% MU delivery errors was also tested.ResultsCompared to the TPS, in vivo 2D DEEPID dose images showed an average γ-pass rate of 90.2% (72.6%–99.4%) outside the central unattenuated region. Without DEEPID correction, this number was 44.5% (4.0%–78.4%). DEEPID correctly detected the introduced delivery errors.ConclusionsDEEPID allows for accurate dose reconstruction using the entire EPID image, thus enabling dosimetric verification for field sizes up to ~19 × 22 cm² at isocentre. The method can be used to detect clinically relevant errors.     

A Monte Carlo study on dose distribution evaluation of Flexisource 192Ir brachytherapy source

Aim

The aim of this study is to evaluate the dose distribution of the Flexisource ¹⁹²Ir source.

Background

Dosimetric evaluation of brachytherapy sources is recommended by task group number 43 (TG. 43) of American Association of Physicists in Medicine (AAPM).

Materials and methods

MCNPX code was used to simulate Flexisource ¹⁹²Ir source. Dose rate constant and radial dose function were obtained for water and soft tissue phantoms and compared with previous data on this source. Furthermore, dose rate along the transverse axis was obtained by simulation of the Flexisource and a point source and the obtained data were compared with those from Flexiplan treatment planning system (TPS).

Results

The values of dose rate constant obtained for water and soft tissue phantoms were equal to 1.108 and 1.106, respectively. The values of the radial dose function are listed in the form of tabulated data. The values of dose rate (cGy/s) obtained are shown in the form of tabulated data and figures. The maximum difference between TPS and Monte Carlo (MC) dose rate values was 11% in a water phantom at 6.0 cm from the source.

Conclusion

Based on dosimetric parameter comparisons with values previously published, the accuracy of our simulation of Flexisource ¹⁹²Ir was verified. The results of dose rate constant and radial dose function in water and soft tissue phantoms were the same for Flexisource and point sources. For Flexisource ¹⁹²Ir source, the results of TPS calculations in a water phantom were in agreement with the simulations within the calculation uncertainties. Furthermore, the results from the TPS calculation for Flexisource and MC calculation for a point source were practically equal within the calculation uncertainties.     

Evaluation of the effects of implementing a diode transmission device into the clinical workflow

PurposeThis work investigated effects of implementing the Delta⁴ Discover diode transmission detector into the clinical workflow.MethodsPDD and profile scans were completed with and without the Discover for a number of photon beam energies. Transmission factors were determined for all beam energies and included in Eclipse TPS to account for the attenuation of the Discover. A variety of IMRT plans were delivered to a Delta⁴ Phantom+ with and without the Discover to evaluate the Discover’s effects on IMRT QA. An imaging QA phantom was used to assess the detector’s effects on MV image quality. OSLDs placed on the Phantom+ were used to determine the detector’s effects on superficial dose.ResultsThe largest effect on PDDs after d_max was 0.5%. The largest change in beam profile symmetry and flatness was 0.2% and 0.1%, respectively. An average difference in gamma passing rates (2%/2 mm) of 0.2% was observed between plans that did not include the Discover in the measurement and calculation to plans that did include the Discover in the measurement and calculation. The Discover did not significantly change the MV image quality, and the largest observed increase in the relative superficial dose when the Discover was present was 1%.ConclusionsThe effects the Discover has on the linac beam were found to be minimal. The device can be implemented into the clinic without the need to alter the TPS beam modeling, other than accounting for the device’s attenuation. However, a careful workflow review to implement the Discover should be completed.     

Novel radio-chromic solution dosimeter for radiotherapy treatment planning

Nitro blue tetrazolium (NBT) solution dosimeters were prepared and investigated based on radiation-induced reduction of NBT²⁺. NBT solution dosimeters containing different concentrations of NBT dye from 1 to 5 mM were prepared in a solution of ethanol. The dosimeters were irradiated with 6 MV X-ray beam at doses up to 30 Gy. The dose sensitivity of NBT solution increases strongly with increase of concentrations of NBT dye. The dose response of NBT dosimeters increases remarkably by addition of various concentrations of sodium formate (0.5, 2.5 and 5 mM). It becomes more remarkable with increasing pH value of NBT-sodium formate dosimeters. The sensitivity of the solution increased fairly with increase of irradiation temperature, therefore, the response of the solutions has to be corrected under actual processing conditions. The stability of solution dosimeters after irradiation was very high up to 30 days.     

Evaluation of a commercial VMC++ Monte Carlo based treatment planning system for electron beams using EGSnrc/BEAMnrc simulations and measurements

In the present work, Monte Carlo (MC) models of electron beams (energies 4, 12 and 18 MeV) from an Elekta SL25 medical linear accelerator were simulated using EGSnrc/BEAMnrc user code. The calculated dose distributions were benchmarked by comparison with measurements made in a water phantom for a wide range of open field sizes and insert combinations, at a single source-to-surface distance (SSD) of 100 cm. These BEAMnrc models were used to evaluate the accuracy of a commercial MC dose calculation engine for electron beam treatment planning (Oncentra MasterPlan Treament Planning System (OMTPS) version 1.4, Nucletron) for two energies, 4 and 12 MeV. Output factors were furthermore measured in the water phantom and compared to BEAMnrc and OMTPS. The overall agreement between predicted and measured output factors was comparable for both BEAMnrc and OMTPS, except for a few asymmetric and/or small insert cutouts, where larger deviations between measurements and the values predicted from BEAMnrc as well as OMTPS computations were recorded. However, in the heterogeneous phantom, differences between BEAMnrc and measurements ranged from 0.5 to 2.0% between two ribs and 0.6–1.0% below the ribs, whereas the range difference between OMTPS and measurements was the same (0.5–4.0%) in both areas. With respect to output factors, the overall agreement between BEAMnrc and measurements was usually within 1.0% whereas differences up to nearly 3.0% were observed for OMTPS. This paper focuses on a comparison for clinical cases, including the effects of electron beam attenuations in a heterogeneous phantom. It, therefore, complements previously reported data (only based on measurements) in one other paper on commissioning of the VMC++ dose calculation engine.These results demonstrate that the VMC++ algorithm is more robust in predicting dose distribution than Pencil beam based algorithms for the electron beams investigated.