Quantitative evaluation of dosimetric uncertainties associated with small electron fields

An empirical model for small circular electron fields was developed. This can be of great help in the treatment planning process for small circular electron fields. A complete dosimetric analysis of the circular fields defined by electron cutouts diameters (2 cm–9 cm) was done for nominal electron energies ranging between 6 MeV and 20 MeV using a 3D water phantom and a pin-point ion chamber. Properties studied included depth dose, in-air inverse-square fall-off, and beam profiles. The Varian Clianc 2100 C accelerator was modelled, benchmarked and Monte Carlo simulations were performed using the EGSnrc/BEAMnrc code for the small circular cutouts. A simple exponential model was found to accurately predict the very important therapeutic depth (90% of Dmax) for the small circular field size within an accuracy of better than 2 mm in most cases. The model has only two parameters (d90 and ‘b’). Also, the penumbra widths (90% of the off-axis profiles) of these small circular electron fields were studied and least square fitted to a simple quadratic model. Full dosimetric profiles of these small circular electron fields were further studied using the benchmarked Monte Carlo simulations. This study presents a simple model to predict the very important therapeutic depth (90% of Dmax) and a recipe to develop such an electron treatment model for any linear accelerator system. Such predictions can be extremely valuable and time saving prior to treatment planning involving not only small circular shaped electron fields but also irregularly shaped electron fields.

Electron radiotherapy fields are commonly used to treat superficial cancers. Field shaping can be achieved by placing lead on the patient surface to minimise the dose to surrounding areas. However, significant dosimetry changes under high density material edges for electron fields have been reported in the literature. This project evaluated the dosimetry of small dimension electron fields shaped with lead placed on the surface. Comparisons were made between circular lead cutouts placed on the skin and low melting point alloy cutouts placed in an applicator. Depth doses, profiles and output factors were measured using a diode detector in a water phantom. Film was also used to determine surface dose delivered when the lead cutouts were placed on the surface. Minimal differences were observed between the different setups for the depth dose curves, although significant differences were seen in the penumbra and the surface doses. The penumbra is smaller for the lead cutouts placed on the surface, however, significant dose increases at the edge of the field were observed for larger fields and energies; this may result in undesirable clinical effects.

To develop an efficient and robust tool for output measurement and absolute dose verification of electron beam therapy by using a high spatial-resolution and high frame-rate amorphous silicon flat panel electronic portal imaging device (EPID). The dosimetric characteristics of the EPID, including saturation, linearity, and ghosting effect, were first investigated on a Varian Clinac 21EX accelerator. The response kernels of the individual pixels of the EPID to all available electron energies (6, 9, 12, 16, and 20 MeV) were calculated by using Monte Carlo (MC) simulations, which formed the basis to deconvolve an EPID raw images to the incident electron fluence map. The two-dimensional (2D) dose distribution at reference depths in water was obtained by using the constructed fluence map with a MC simulated pencil beam kernel with consideration of the geometric and structural information of the EPID. Output factor measurements were carried out with the EPID at a nominal source-surface distance of 100 cm for 2 × 2, 3 × 3, 6 × 6, 10 × 10, and 15 × 15 cm(2) fields for all available electron energies, and the results were compared with that measured in a solid water phantom using film and a Farmer-type ion chamber. The dose distributions at a reference depth specific to each energy and the flatness and symmetry of the 10 × 10 cm(2) electron beam were also measured using EPID, and the results were compared with ion chamber array and water scan measurements. Finally, three patient cases with various field sizes and irregular cutout shapes were also investigated. EPID-measured dose changed linearly with the monitor units and showed little ghosting effect for dose rate up to 600 MU/min. The flatness and symmetry measured with the EPID were found to be consistent with ion chamber array and water scan measurements. The EPID-measured output factors for standard square fields of 2 × 2, 3 × 3, 6 × 6, 10 × 10, 15 × 15 cm(2) agreed with film and ion chamber measurements. The average discrepancy between EPID and ion chamber/film measurements was 0.81% ± 0.60% (SD) and 1.34% ± 0.75%, respectively. For the three clinical cases, the difference in output between the EPID- and ion chamber array measured values was found to be 1.13% ± 0.11%, 0.54% ± 0.10%, and 0.74% ± 0.11%, respectively. Furthermore, the γ-index analysis showed an excellent agreement between the EPID- and ion chamber array measured dose distributions: 100% of the pixels passed the criteria of 3%/3 mm. When the γ-index was set to be 2%/2 mm, the pass rate was found to be 99.0% ± 0.07%, 98.2% ± 0.14%, and 100% for the three cases. The EPID dosimetry system developed in this work provides an accurate and reliable tool for routine output measurement and dosimetric verification of electron beam therapy. Coupled with its portability and ease of use, the proposed system promises to replace the current film-based approach for fast and reliable assessment of small and irregular electron field dosimetry.

Purpose: This work studies beam characteristics of small electron fields using Monte Carlo methods and evaluate its feasibility for small animal irradiation. Method and Materials: Small electron fields with diameters 4, 6, 14 and 30 mm were generated with 1.5‐cm‐thick Cerrobend inserts on a Varian 2100 C/D linear accelerator. Full simulations were performed using the BEAMnrc and DOSXYZ codes for geometries including the treatment head, electron cones, block inserts and water phantom. Input parameters of the initial energy, angular and spacial distrbutions at the beam exit window for 6 and 18 MeV beams were optimized to insure depth dose discrepancy with measurement to less than 2 % for a 6 × 6 cm field. Dependence of PDDs, lateral profiles and beam outputs at dmax on beam energy, beam diameter and photon jaw setting were studied. Results: Results revealed that photon jaw setting has minimum impact on lateral dose distributions except for, however, it can changes beam outputs dramatically. With photon jaws fixed at 3 × 3 cm, relative output for 4, 6, 14 and 30 mm inserts are 0.13, 0.26, 0.64, 0.88 for 6 MeV and 0.61, 0.78, 0.92, 0.97 for 18 MeV beams when normalized to the output for a open 6 × 6 cm cone. Two effects of reducing beam sizes on PDD were observed: (1) dmax shiftes toward the surface and (2) the beams become less penetrating. For beam energy selection, 18 MeV beams can generate broder area of uniform dose distribution than 6 MeV beams which makes them more favorable for small animal irradiation. Conclusion: Investigations were performed to study beam characteristics of small electron fields. We have concluded that 18 MeV beams are more favorable than 6 MeV beams for small animal irradiation.

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

BackgroundLack of an ideal detector for small field dosimetry has led to the development of many new types of detectors. Recent studies have shown that plastic scintillation detectors (PSDs) provide favorable dosimetric characteristics, such as minimal volume averaging and fluence perturbation effects, real time response rates, high signal to noise ratio (SNR), and independence to temperature, energy spectrum, dose rate, and irradiation direction, in the field of small field dosimetry, largely due to their small size and water‐equivalent composition materials, which eliminates the need for certain correction factors.PurposeThe goal of this study was to evaluate a new 0.5 × 0.5 mm2 PSD (called in this study Medscint0.5), with detailed uncertainty analysis, for its suitability in small field dosimetry and in comparison, to other commercially available PSDs.MethodsThis detector characterization was performed for small field output factors, pre‐ and post‐ irradiation leakage, short‐term repeatability, angular dependency, dose rate and energy dependency, dose response linearity, and temperate dependency. The small field output factors measured with this detector were also evaluated to determine if any correction factors were needed for extremely small fields.ResultsThe Medscint0.5 showed negligible leakage (< 0.1%) and short‐term repeatability (< 0.1% response deviations), similar to other commercially available PSDs. It also demonstrated comparable dose rate (< 0.47%) and dose response linearity (< 0.73%) to an ion chamber. Moreover, it also showed excellent angular (< 0.30%) and temperature independence (< 0.38%) relative to other commercially available PSDs. Stereotactic cone factor measurements showed good agreement (< 1.10%) with MC for all SRS cone sizes for both 6 and 10 MV FFF beams. The total uncertainty for absolute dosimetry using this detector was found to be ∼1.1% at one standard deviation from the mean. The uncertainty can be reduced to 0.8% at one standard deviation when this detector is used for relative small field dosimetry, that is, field output measurements.ConclusionThe latest small size Medscint0.5 detector is suitable for small field dosimetry with its unique advantage in measuring field output factors without need of any correction factor even in measuring small circular fields down to 4 mm diameter.

Due to multiple Coulomb scattering in complex geometries, small field dosimetry in proton therapy is challenging. Our goal was to define an indicator for the accuracy of dose delivery based on analytical dose calculations in treatment planning systems for small (e.g. radiosurgery) proton therapy fields. Seven patients whose treatment involved one or more small fields (below ∼3.6cm in diameter) were selected. We developed a fast methodology to quantify the inhomogeneity of the tissue traversed by a single beam using a heterogeneity index (HI). The implementation was based on the dose calculation approach taken by our pencil beam algorithm. Plans created with the treatment planning system were verified against Monte Carlo dose calculations on a field- by-field basis. DVHs were analyzed and differences in the dose to the GTV were assessed. The correlation between the HI-values and the discrepancies between planning system and Monte Carlo in terms of absolute dose to the target was studied. Our treatment planning system overestimates the dose within the GTV for very small fields by up to ∼8%, even if proper output factor normalization is done in water. The differences are strongly correlated to HI (Spearman's ρ=0.8, rho<0.0001). More complex heterogeneities within the beam path caused larger errors by the analytical algorithm. With the established correlation a threshold for the HI can be set by choosing a tolerance level. The HI as defined in this study appears to be a good indicator of the accuracy of proton field delivery in terms of GTV prescription dose when small fields are being delivered. Each HI-value was obtained in less than 2 minutes allowing implementation of the HI algorithm in clinical routine. For HI- values exceeding a certain threshold, either a change in beam incidence or a Monte Carlo dose calculation should be considered.

Background: Accurate small radiation field dosimetry is essential in modern radiotherapy techniques such as stereotactic radiosurgery (SRS) and intensity modulated radiotherapy (IMRT). Precise measurement of dosimetric parameters such as beam profile, percentage depth doses and output factor of these beams are complicated due to the electron disequilibrium and the steep dose gradients. In the present work the MAGIC polymer gel was used for dosimetry of small circular photon beams. The results of MAGIC were compared with EBT2 measurements and Monte Carlo (MC) calculations. Materials and Methods: Experimental measurements were made by mentioned dosimeters in four small field sizes 5, 10, 20 and 30 mm. The BEAMnrc code based on EGSnrc was used for simulation to calculate dosimetric parameters at these small fields. The phantoms were irradiated in a 6 MV photon beam Varian 2100C linear accelerator at SSD=100 cm. gel readout performed by 3 Tesla MRI scanner. Results: The results showed that the Percent depth dose (PDD) values measured and calculated by EBT2 film and MC had maximum local differences 4% and 5% with PDD values measured by MAGIC for field size of 5mm respectively. These differences decreased for larger field sizes. The measurements of output factor and penumbra (80%-20%) and (90%-10%) showed good agreement between the measurements and MC calculation. Conclusion: This study showed that the MAGIC polymer gel based on high resolution MRI images is useful detector for small field dosimetry but its agreement with MC is less than agreement of EBT2 film with MC.

The inherent problems in the existence of electron equilibrium and steep dose fall-off pose difficulties for small- and narrow-field dosimetry. To investigate the cutout factors for keloid electron radiotherapy using various dosimetry detectors for small and narrow fields. The measurements were performed in a solid water phantom with nine different cutout shapes. Five dosimetry detectors were used in the study: pinpoint 3D ionization chamber, Farmer chamber, semiflex chamber, Classic Markus parallel plate chamber, and EBT3 film. The results demonstrated good agreement between the semiflex and pinpoint chambers. Furthermore, there was no difference between the Farmer and pinpoint chambers for large cutouts. For the EBT3 film, half of the cases had differences greater than 1%, and the maximum discrepancy compared with the reference chamber was greater than 2% for the narrow field. The parallel plate, semiflex chamber and EBT3 film are suitable dosimeters that are comparable with pinpoint 3D chambers in small and narrow electron fields. Notably, a semiflex chamber could be an alternative option to a pinpoint 3D chamber for cutout widths≥3 cm. It is very important to perform patient-specific cutout factor calibration with an appropriate dosimeter for keloid radiotherapy.

Evaluation of perturbation effects for various size TLDs in small field dosimetry

Purpose: An international IAEA/AAPM working group is preparing recommendations for reference dosimetry in small fields and composite fields. A proposed formalism for dosimetry in small and composite fields was published that introduces machine specific reference (msr) fields for static small fields and plan‐class specific reference (pcsr) fields for composite fields such as an IMRT sequence. The status of present activities, based on the proposed formalism, will be reviewed. Method and Materials: For msr fields a literature review is conducted and for some modalities experiments and Monte Carlo simulations are performed. For composite fields various routes are explored to arrive at suitable pcsr fields. Some of these start from clinical plans and try to distil most representative reference deliveries, while others start from treatment unit specific features to arrive at relevant modulated plans. Experiments and Monte Carlo simulations are performed as well to determine correction factors for ionisation chambers in pcsr fields and to evaluate their suitability to represent a class of clinical plans. One idea being explored is that for a composite field where full charged particle equilibrium is established, the overall correction factor equals the reciprocal of the gradient correction factor in the conventional reference field. Results: State‐of‐the‐art results on the correction factors for msr and pcsr fields will be reviewed. Experimental work performed on pcsr fields in TomoTherapy and step‐and‐shoot prostate plans indicates that correction factors for suitably sized ion chambers are not more than 1% different from unity. Monte Carlo simulations confirm this. Studies are underway to test the sensitivity of the correction factors to characteristics of the pcsr field. Conclusion: Results indicate that reference dosimetry in msr and pcsr fields is feasible with acceptably small corrections. A working document on static small field dosimetry is aimed for by the end of this year.

Purpose: Because of its small detector volume, the PinPoint ion chamber has been widely used for small field dosimetry measurements. This work investigates the limitations of the PinPoint chamber for cone‐based SRS commissioning and treatment dose verification. Method and Materials:Extensive measurements of PDD were performed in water using three types of ion chambers (0.015 cc PinPoint, 0.125 cc Semiflex and 0.65 cc Exradin), field sizes including one square field (10 × 10 cm2), and five cone‐shaped circular fields (4, 3, 2, 1.5 and 1.0 cm, respectively, in diameter). Two orientations of ion chamber, the chamber axis parallel (vertical setup) or perpendicular (transverse setup) to the beam axis, were used for measurements in the 10×10 cm2 square field while in the circular fields, only the vertical setup is used for the chamber sensitive volume to be covered by the small radiation fields. In addition, Monte Carlo(MC) simulations were also performed to compare with the measurements. Results: Two different chamber orientations (transverse and vertical) gave identical PDDs for each type of ion chambers. Measurements between 0.125 cc and 0.65 cc chambers agree well for all field sizes.MC simulations showed agreement with measurements of 0.125 cc and 0.65 cc chambers for all the field sizes. However, as compared to the other two chamber measurements or MC calculations, the PinPoint chamber presented obvious over‐response beyond certain depths, depending on field sizes (e.g. beyond 4 cm for a 4 cm circular field and beyond 15 cm for a 1 cm circular field). Conclusions: Over‐response of the PinPoint chamber may lead to undesirable measurement uncertainties in small field dosimetry. One should be aware of this limitation when measuring TMR or PDD with the PinPoint chamber beyond certain depths for field sizes typically used in SRS commissioning and treatment dose verification.

Dosimeters often consist of several components whose mass densities differ substantially from water. These components cause small-field correction factors to vary significantly as lateral electronic equilibrium breaks down. Even amongst instruments designed for small-field dosimetry, inter-detector variation in the correction factors associated with very small (∼0.5 cm) fields can amount to tens of per cent. For a given dosimeter, small-field correction factors vary not only with field size but also with detector azimuthal angle and position within the field. Furthermore the accurate determination of these factors typically requires time-intensive Monte Carlo simulations. Thus, if achievable, ‘correction factor free’ small-field dosimetry would be highly desirable. This study demonstrates that a new generation of mass-density compensated detectors could take us towards this goal. Using a 6 MV beam model, it shows that ‘mass-density compensation’ can be utilized to improve the performance of a range of different detectors under small-field conditions. Non-sensitive material of appropriate mass-density is incorporated into detector designs in order to make the instruments behave as if consisting only of water. The dosimeter perturbative effects are then reduced to those associated with volume averaging. An even better solution—which modifies detectors to obtain profiles that look like those measured by a point-like water structure—is also considered. Provided that adequate sensitivity can be achieved for a small measurement volume, this study shows that it may be possible to use mass-density compensation (and Monte Carlo-driven design) to produce a solid-state dosimeter/ionization chamber with a near-perfect non-equilibrium response.

Background Small megavoltage photon fields are increasingly used in modern radiotherapy techniques such as stereotactic radiotherapy. Therefore, it is important to study the reliability of dosimetry in the small-field conditions. The IBA Razor Nano Chamber (Nano chamber) ionization chamber is particularly intended for small-field measurements. In this work, properties of the Nano chamber were studied with both measurements and Monte Carlo (MC) simulations. Material and methods The measurements and MC simulations were performed with 6 MV, 6 MV FFF and 10 MV FFF photon beams from the Varian TrueBeam linear accelerator. The source-to-surface distance was fixed at 100 cm. The measurements and MC simulations included profiles, percentage depth doses (PDD), and output factors (OF) in square jaw-collimated fields. The MC simulations were performed with the EGSnrc software system in a large water phantom. Results The measured profiles and PDDs obtained with the Nano chamber were compared against IBA Razor Diode, PTW microDiamond and the PTW Semiflex ionization chamber. These results indicate that the Nano chamber is a high-resolution detector and thus suitable for small field profile measurements down to field sizes 2 × 2 cm2 and appropriate for the PDD measurements. The field output correction factors and field OFs were determined according to TRS-483 protocol In the 6 MV FF and FFF beams, the determined correction factors were within 1.2% for the field sizes of 1 × 1 cm2–3 × 3 cm2 and the experimental and MC defined field output factors showed good agreement. Conclusion The Nano chamber with its small cavity volume is a potential detector for the small-field dosimetry. In this study, the properties of this detector were characterized with measurements and MC simulations. The determined correction factors are novel results for the NC in the TrueBeam fields.

The performance of an L-alanine dosimeter with millimeter dimensions was evaluated for dosimetry in small radiation fields. Relative output factor (ROF) measurements were made for 0.5 x 0.5, 1 x 1, 3 x 3, 5 x 5, 10 x 10 cm(2) square fields and for 5-, 10-, 20-, 40-mm-diam circular fields. In beam profile (BP) measurements, only 1 x 1, 3 x 3, 5 x 5 cm2 square fields and 10-, 20-, 40-mm-diam circular fields were used. For square and circular field irradiations, Varian/Clinac 2100, and a Siemens/Mevatron 6 MV linear accelerators were used, respectively. For a batch of 800 L-alanine minidosimeters (miniALAs) the average mass was 4.3+/-0.5 (1 sigma) mg, the diameter was 1.22+/-0.07 (1 sigma) mm, and the length was 3.5+/-0.2 (l sigma) mm. A K-Band (24 GHz) electron paramagnetic resonance (EPR) spectrometer was used for recording the spectrum of irradiated and nonirradiated miniALAs. To evaluate the performance of the miniALAs, their ROF and BP results were compared with those of other types of detectors, such as an ionization chamber (PTW 0.125 cc), a miniTLD (LiF: Mg,Cu,P), and Kodak/X-Omat V radiographic film. Compared to other dosimeters, the ROF results for miniALA show differences of up to 3% for the smallest fields and 7% for the largest ones. These differences were within the miniALA experimental uncertainty (-5-6% at 1 sigma). For BP measurements, the maximum penumbra width difference observed between miniALA and film (10%-90% width) was less than 1 mm for square fields and within 1-2 mm for circular fields. These penumbra width results indicate that the spatial resolution of the miniALA is comparable to that of radiographic film and its dimensions are adequate for the field sizes used in this experiment. The K-Band EPR spectrometer provided adequate sensitivity for assessment of miniALAs with doses of the order of tens of Grays, making this dosimetry system (K-Band/miniALA) a potential candidate for use in radiosurgery dosimetry.