Hamed Bekerat

Improving the energy response of external beam therapy (EBT) GafChromicTM dosimetry films at low energies (≤ 100 keV).

PURPOSE Purpose of this work is to investigate the effects of varying the active layer composition of external beam therapy (EBT) GafChromic(TM) films on the energy dependence of the film, as well as try to develop a new prototype with more uniform energy response at low photon energies (⩽ 100 keV). METHODS First, the overall energy response (S(AD, W)(Q)) of different commercial EBT type film models that represent the three different generations produced to date, i.e., EBT, EBT2, and EBT3, was investigated. Pieces of each film model were irradiated to a fixed dose of 2 Gy to water for a wide range of beam qualities and the corresponding S(AD, W)(Q) was measured using a flatbed document scanner. Furthermore, the DOSRZnrc Monte Carlo code was used to determine the absorbed dose to water energy dependence of the film, f(Q). Moreover, the intrinsic energy dependence, kbq(Q), for each film model was evaluated using the corresponding S(AD, W)(Q) and f(Q). In the second part of this study, the authors investigated the effects of changing the chemical composition of the active layer on SAD, W(Q). Finally, based on these results, the film manufacturer fabricated several film prototypes and the authors evaluated their S(AD, W)(Q). RESULTS The commercial EBT film model shows an under response at all energies below 100 keV reaching 39% ± 4% at about 20 keV. The commercial EBT2 and EBT3 film models show an under response of about 27% ± 4% at 20 keV and an over response of about 16% ± 4% at 40 keV.S(AD, W)(Q) of the three commercial film models at low energies show strong correlation with the corresponding f(-) (1)(Q) curves. The commercial EBT3 model with 4% Cl in the active layer shows under response of 22% ± 4% at 20 keV and 6% ± 4% at about 40 keV. However, increasing the mass percent of chlorine makes the film more hygroscopic which may affect the stability of the films readout. The EBT3 film prototype with 7.5% Si shows a significant improvement in the energy response at very low energies compared to the commercial EBT3 films with 4% Cl. It shows under response of 15% ± 5% at about 20 keV to 2% ± 5% at about 40 keV. However, according to the manufacturer, the addition of 7.5% Si as SiO2 adversely affected the viscosity of the active fluid and therefore affected the potential use in commercial machine coating. The latest commercial EBT3 film model with 7% Al as Al2O3 shows an overall improvement in SAD, W(Q) compared to previous commercial EBT3 films. It shows under response at all energies <100 keV, varying from 20% ± 4% at 20 keV to 6% ± 4% at 40 keV. CONCLUSIONS The energy response of films in the energy range <100 keV can be improved by adjusting the active layer chemical composition. Removing bromine eliminated the over response at about 40 keV. The under response at energies ≤ 30 keV is improved by adding 7% Al to the active layer in the latest commercial EBT3 film models.

Characterization of calibration curves and energy dependence GafChromicTM XR‐QA2 model based radiochromic film dosimetry system

PURPOSE The authors investigated the energy response of XR-QA2 GafChromic™ film over a broad energy range used in diagnostic radiology examinations. The authors also made an assessment of the most suitable functions for both reference and relative dose measurements. METHODS Pieces of XR-QA2 film were irradiated to nine different values of air kerma in air, following reference calibration of a number of beam qualities ranging in HVLs from 0.16 to 8.25 mm Al, which corresponds to effective energy range from 12.7 keV to 56.3 keV. For each beam quality, the authors tested three functional forms (rational, linear exponential, and power) to assess the most suitable function by fitting the delivered air kerma in air as a function of film response in terms of reflectance change. The authors also introduced and tested a new parameter χ = netΔR·e(m netΔR) that linearizes the inherently nonlinear response of the film. RESULTS The authors have found that in the energy range investigated, the response of the XR-QA2 based radiochromic film dosimetry system ranges from 0.222 to 0.420 in terms of netΔR at K(air)(air) = 8 cGy. For beam qualities commonly used in CT scanners (4.03-8.25 mm Al), the variation in film response (netΔR at K(air)(air) = 8 cGy) amounts to ± 5%, while variation in K(air)(air) amounts to ± 14%. CONCLUSIONS Results of our investigation revealed that the use of XR-QA2 GafChromic™ film is accompanied by a rather pronounced energy dependent response for beam qualities used for x-ray based diagnostic imaging purposes. The authors also found that the most appropriate function for the reference radiochromic film dosimetry would be the power function, while for the relative dosimetry one may use the exponential response function that can be easily linearized.

Dual-Energy CT: Balance Between Iodine Attenuation and Artifact Reduction for the Evaluation of Head and Neck Cancer

Objective Dual-energy computed tomography high energy virtual monochromatic images (VMIs) can reduce artifact but suppress iodine attenuation in enhancing tumor. We investigated this trade-off to identify VMI(s) that strike the best balance between iodine detection and artifact reduction. Methods The study was performed using an Alderson radiation therapy phantom. Different iodine solutions (based on estimated tumor iodine content in situ using dual-energy computed tomography material decomposition) and different dental fillings were investigated. Spectral attenuation curves and quality index (QI: 1/SD) were evaluated. Results The relationship between iodine attenuation and QI depends on artifact severity and iodine concentration. For low to average concentration solutions degraded by mild to moderate artifact, the iodine attenuation and QI curves crossed at 95 keV. Conclusions High energy VMIs less than 100 keV can achieve modest artifact reduction while preserving sufficient iodine attenuation and could represent a useful additional reconstruction for evaluation of head and neck cancer.

Radiochromic film–based quality assurance for CT-based high-dose-rate brachytherapy

PURPOSE In the past, film dosimetry was developed into a powerful tool for external beam radiotherapy treatment verification and quality assurance. The objective of this work was the development and clinical testing of the EBT3 model GafChromic film based brachytherapy quality assurance (QA) system. METHODS AND MATERIALS Retrospective dosimetry study was performed to test a patient-specific QA system for preoperative endorectal brachytherapy that uses a radiochromic film dosimetry system. A dedicated phantom for brachytherapy applicator used for rectal cancer treatment was fabricated enabling us to compare calculated-to-measured dose distributions. Starting from the same criteria used for external beam intensity-modulated radiation therapy QA (3%, 3 mm), passing criteria for high- and low-dose gradient regions were subsequently determined. Finally, we investigated the QA systems sensitivity to controlled source positional errors on selected patient plans. RESULTS In low-dose gradient regions, measured dose distributions with criteria of 3%, 3 mm barely passed the test, as they showed 95% passing pixels. However, in the high-dose gradient region, a more stringent condition could be established. Both criteria of 2%, 3 mm and 3%, 2 mm with gamma function calculated using normalization to the same absolute dose value in both measured and calculated dose distributions, and matrix sizes rescaled to match each other showed more than 95% of pixels passing, on average, for 15 patient plans analyzed. CONCLUSIONS Although the necessity of the patient-specific brachytherapy QA needs yet to be justified, we described a radiochromic film dosimetry-based QA system that can be a part of the brachytherapy commissioning process, as well as yearly QA program.

SU-E-T-462: Impact of the Radiochromic Film Energy Response On Dose Measurements of Low Energy Electronic Brachytherapy Sources

Purpose: We investigated the effect of the EBT3 GafChromicTM film model absorbed dose energy response when used for percent depth dose (PDD) measurements in low-energy photon beams. Methods: We measured PDDs in water from a Xoft 50 kVp source using EBT3 film, and compared them to PDD measurements acquired with a PTW-TN34013 parallel-plate ionization chamber. For the x-ray source, we simulated spectra using the EGSnrc (BEAMnrc) Monte Carlo code, and calculated Half Value Layer (HVL) at different distances from the source in water. Pieces of EBT3 film were irradiated in air and calibration curves were created in terms of air-kerma in air ((Kair)air) for different beam qualities. Pieces of EBT3 film were positioned at distances of 2–6 cm from the Xoft source in a water phantom using a custom-made holder, and irradiated at the same time. As scatter is incorporated in the measured film signal in water, measured (Kair)wat was subsequently converted into absorbed dose to water by the ratio of mass energy absorption coefficients following the AAPM TG-61 dosimetry protocol. Results: Our results show that film calibration curves obtained at beam qualities near the effective energy of the Xoft 50 kVp source in water lead to variation in absorbed dose energy dependence of the response of around 3%. However, if the calibration curve was established at MV beam quality, the error in absorbed dose could be as large as 15%. We observed agreement within 1% between PDD measurements using EBT3 film model (using a calibration curve obtained at 80 kVp, HVL=2.18 mm Al, Eeff=29.5 keV) and the parallel-plate ionization chamber. Conclusion: Accurate dose measurements using radiochromic films at low photon energies require that the radiochromic film dosimetry system be calibrated at corresponding low energies, as large absorbed dose errors are expected for calibrations performed at MV beam qualities.

An investigation into the INTRABEAM miniature x‐ray source dosimetry using ionization chamber and radiochromic film measurements

PURPOSE Intraoperative radiotherapy using The INTRABEAM System (Carl Zeiss Meditec AG, Jena, Germany), a miniature low-energy x-ray source, has proven to be an effective modality in the treatment of breast cancer. However, some uncertainties remain in its dosimetry. In this work, we investigated the INTRABEAM system dosimetry by performing ionization chamber and radiochromic film measurements of absorbed dose in a water phantom. METHODS Ionization chamber measurements were performed with a PTW 34013 parallel-plate soft x-ray chamber at source to detector distances of 5 to 30 mm calculated using (a) the dose formula consistent with the TARGIT breast protocol (TARGIT), (b) the formula recommended by the manufacturer (Zeiss), and (c) the recently proposed CQ formalism of Watson et al. (Physics in Medicine & Biology, 2018;63:015016) EBT3 Gafchromic film measurements were made at the same depths in water. To account for the energy dependence of EBT3 film, multiple dose response calibration curves were employed across a range of photon beam qualities relevant to the INTRABEAM spectrum in water. RESULTS At all depths investigated, the TARGIT dose was significantly lower than that measured by the Zeiss and CQ methods, as well as film. These dose differences ranged from 14% to as large as 80%. In general, the doses measured by film, and the Zeiss and CQ methods were in good agreement to within measurement uncertainties (5-6%). CONCLUSIONS These results suggest that the TARGIT dose underestimates the physical dose to water from the INTRABEAM source. Understanding the correlation between the TARGIT and physical dose is important for any studies wishing to make dosimetric comparisons between the INTRABEAM and other radiation emitting devices.

SU-F-T-398: Improving Radiotherapy Treatment Planning Using Dual Energy Computed Tomography Based Tissue Characterization

PURPOSE Both kVp settings and geometric distribution of various materials lead to significant change of the HU values, showing the largest discrepancy for high-Z materials and for the lowest CT scanning kVp setting. On the other hand, the dose distributions around low-energy brachytherapy sources are highly dependent on the architecture and composition of tissue heterogeneities in and around the implant. Both measurements and Monte Carlo calculations show that improper tissue characterization may lead to calculated dose errors of 90% for low energy and around 10% for higher energy photons. We investigated the ability of dual-energy CT (DECT) to characterize more accurately tissue equivalent materials. METHODS We used the RMI-467 heterogeneity phantom scanned in DECT mode with 3 different set-ups: first, we placed high electron density (ED) plugs within the outer ring of the phantom; then we arranged high ED plugs within the inner ring; and finally ED plugs were randomly distributed. All three setups were scanned with the same DECT technique using a single-source DECT scanner with fast kVp switching (Discovery CT750HD; GE Healthcare). Images were transferred to a GE Advantage workstation for DECT analysis. Spectral Hounsfield unit curves (SHUACs) were then generated from 50 to 140-keV, in 10-keV increments, for each plug. RESULTS The dynamic range of Hounsfield units shrinks with increased photon energy as the attenuation coefficients decrease. Our results show that the spread of HUs for the three different geometrical setups is the smallest at 80 keV. Furthermore, among all the energies and all materials presented, the largest difference appears at high Z tissue equivalent plugs. CONCLUSION Our results suggest that dose calculations at both megavoltage and low photon energies could benefit in the vicinity of bony structures if the 80 keV reconstructed monochromatic CT image is used with the DECT protocol utilized in this work.

Poster — Thur Eve — 20: CTDI Measurements using a Radiochromic Film-based clinical protocol

The purpose of the study was evaluating accuracy and reproducibility of a radiochromic film-based protocol to measure computer tomography dose index (CTDI) as a part of annual QA on CT scanners and kV-CBCT systems attached to linear accelerators. Energy dependence of Gafchromic XR-QA2 ® film model was tested over imaging beam qualities (50 – 140 kVp). Film pieces were irradiated in air to known values of air-kerma (up to 10 cGy). Calibration curves for each beam quality were created (Film reflectance change Vs. Air-kerma in air). Film responses for same air-kerma values were compared. Film strips were placed into holes of a CTDI phantom and irradiated for several clinical scanning protocols. Film reflectance change was converted into dose to water and used to calculate CTDIvol values. Measured and tabulated CTDIvol values were compared. Average variations of ±5.2% in the mean film reflectance change were observed in the energy range of 80 to 140 keV, and 11.1% between 50 and 140 keV. Measured CTDI values were in average 10% lower than tabulated CTDI values for CT-simulators, and 44% higher for CBCT systems. Results presented a mean variation for the same machine and protocol of 2.6%. Variation of film response is within ±5% resulting in ±15% systematic error in dose estimation if a single calibration curve is used. Relatively large discrepancy between measured and tabulated CTDI values strongly support the trend towards replacing CTDI value with equilibrium dose measurement in the center of cylindrical phantom, as suggested by TG- 111.

TH‐E‐BRB‐01: Improving the Energy Dependence of GAFChromic Dosimetry Films at Low Energies

Purpose: Several studies have investigated the energy dependence of GAFChromic dosimetryfilms and shown a 5% to 10% energy dependence for energies below 100 keV. The purpose of this work is to improve the energy dependence of GAFChromic films and develop a new prototype with more uniform energy response at low energies (less than 100keV) Methods: The energy dependence of three commercial GAFChromic films, EBT‐1, EBT‐2 and EBT‐3, has been investigated by irradiating the films to 2 Gy (Dose to water) at different beam qualities (50 kVp to 60Co). Also, the extrinsic energy dependence of the films is investigated using DOSRZnrc user‐code of the EGSnrcMP Monte Carlo Package, by determining ratio of dose to water to dose to the active volume of the film using beam spectra calculated from SpekCalc. This software generates a nominal x‐ray spectrum based on input information on experimental HVL, tube potential and added filtration data. The investigation of the extrinsic energy response combined with experimental evaluation of the overall energy dependence of the film response should help us understand the physics behind the energy variation of the film response and help us in improving the energy dependence at low energies. Results: Current EBT filmmodels show strong intrinsic energy dependence at low energies indicating low polymerization efficiency of the filmsactive layer, which can be compensated for by boosting the dose to the active layer at those energies by the incorporation of moderate atomic number elements such as K, Cl, Al and Na into the active layer of the film and the careful adjustment of the mass percent of these elements and the configuration of the film.Conclusions: Improving the energy dependence is possible by careful adjustment of the composition and mass percent of the elements incorporated into the filmactive layer and film configuration. David Lewis is employed by Ashland Specialty Ingredients the manufacturer of Gafchromic radiochromic films