P. Carrasco

Comparison of dose calculation algorithms in phantoms with lung equivalent heterogeneities under conditions of lateral electronic disequilibrium

An extensive set of benchmark measurement of PDDs and beam profiles was performed in a heterogeneous layer phantom, including a lung equivalent heterogeneity, by means of several detectors and compared against the predicted dose values by different calculation algorithms in two treatment planning systems. PDDs were measured with TLDs, plane parallel and cylindrical ionization chambers and beam profiles with films. Additionally, Monte Carlo simulations by means of the PENELOPE code were performed. Four different field sizes (10 x 10, 5 x 5, 2 x 2, and 1 x 1 cm2) and two lung equivalent materials (CIRS, p(w)e=0.195 and St. Bartholomew Hospital, London, p(w)e=0.244-0.322) were studied. The performance of four correction-based algorithms and one based on convolution-superposition was analyzed. The correction-based algorithms were the Batho, the Modified Batho, and the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system and the TMS Pencil Beam from the Helax-TMS (Nucletron) treatment planning system. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. The only studied calculation methods that correlated successfully with the measured values with a 2% average inside all media were the Collapsed Cone and the Monte Carlo simulation. The biggest difference between the predicted and the delivered dose in the beam axis was found for the EqTAR algorithm inside the CIRS lung equivalent material in a 2 x 2 cm2 18 MV x-ray beam. In these conditions, average and maximum difference against the TLD measurements were 32% and 39%, respectively. In the water equivalent part of the phantom every algorithm correctly predicted the dose (within 2%) everywhere except very close to the interfaces where differences up to 24% were found for 2 x 2 cm2 18 MV photon beams. Consistent values were found between the reference detector (ionization chamber in water and TLD in lung) and Monte Carlo simulations, yielding minimal differences (0.4%+/-1.2%). The penumbra broadening effect in low density media was not predicted by any of the correction-based algorithms, and the only one that matched the experimental values and the Monte Carlo simulations within the estimated uncertainties was the Collapsed Cone Algorithm.

Comparison study of MOSFET detectors and diodes for entrance in vivo dosimetry in 18 MV x‐ray beams

The feasibility of dual bias dual metal oxide semiconductor field effect transistors (MOSFETs) for entrance in vivo dose measurements in high energy x-rays beams (18 MV) was investigated. A comparison with commercially available diodes for in vivo dosimetry for the same energy range was performed. As MOSFETs are sold without an integrated build-up cap, different caps were tested: 3 cm bolus, 2 cm bolus, 2 cm hemispherical cap of a water equivalent material (Plastic Water) and a metallic hemispherical cap. This metallic build-up cap is the same as the one that is mounted on the in vivo diode used in this study. Intrinsic precision and response linearity with dose were determined for MOSFETs and diodes. They were then calibrated for entrance in vivo dosimetry in an 18 MV x-ray beam. Calibration included determination of the calibration factor in standard reference conditions and of the correction factors (CF) when irradiation conditions differed from those of reference. Correction factors for field size, source surface distance, wedge, and temperature were determined. Sensitivity variation with accumulated dose and the lifetime of both types of detectors were also studied. Finally, the uncertainties of entrance in vivo measurements using MOSFET and diodes were discussed. Intrinsic precision for MOSFETs for the high sensitivity mode was 0.7% (1 s.d.) as compared to the 0.05% (1 s.d.) for the studied diodes. The linearity of the response with dose was excellent (R2 = 1.000) for both in vivo dosimetry systems. The absolute values of the studied correction factors for the MOSFETs when covered by the different build-up caps were of the same order of those determined for the diodes. However, the uncertainties of the correction factors for MOSFETs were significantly higher than for diodes. Although the intrinsic precision and the uncertainty on the CF was higher for MOSFET detectors than for the studied diodes, the total uncertainty in entrance dose determination, once they were calibrated, was of 2.9% (1 s.d.) while for diodes it was 2.0% (1 s.d.). MOSFETs showed no sensitivity variation with accumulated dose or temperature. When used in the high sensitivity mode, after approximately 50 Gy of accumulated dose MOSFETs could no longer be used as radiation dosimeters. In conclusion, MOSFETs can be used for entrance in vivo dosimetry in high energy x-rays beams if covered by an appropriate build-up cap. Metallic build-up caps, such as those used for in vivo diodes, have the advantage of greater patient comfort and less perturbation of the treatment field than the other build-up caps tested, while keeping the correction factors of the same order.

3D DVH-based metric analysis versus per-beam planar analysis in IMRT pretreatment verification

PURPOSE To evaluate methods of pretreatment IMRT analysis, using real measurements performed with a commercial 2D detector array, for clinical relevance and accuracy by comparing clinical DVH parameters. METHODS We divided the work into two parts. The first part consisted of six in-phantom tests aimed to study the sensitivity of the different analysis methods. Beam fluences, 3D dose distribution, and DVH of an unaltered original plan were compared to those of the delivered plan, in which an error had been intentionally introduced. The second part consisted of comparing gamma analysis with DVH metrics for 17 patient plans from various sites. Beam fluences were measured with the MapCHECK 2 detector, per-beam planar analysis was performed with the MapCHECK software, and 3D gamma analysis and the DVH evaluation were performed using 3DVH software. RESULTS In a per-beam gamma analysis some of the tests yielded false positives or false negatives. However, the 3DVH software correctly described the DVH of the plan which included the error. The measured DVH from the plan with controlled error agreed with the planned DVH within 2% dose or 2% volume. We also found that a gamma criterion of 3%∕3 mm was too lax to detect some of the forced errors. Global analysis masked some problems, while local analysis magnified irrelevant errors at low doses. Small hotspots were missed for all metrics due to the spatial resolution of the detector panel. DVH analysis for patient plans revealed small differences between treatment plan calculations and 3DVH results, with the exception of very small volume structures such as the eyes and the lenses. Target coverage (D(98) and D(95)) of the measured plan was systematically lower than that predicted by the treatment planning system, while other DVH characteristics varied depending on the parameter and organ. CONCLUSIONS We found no correlation between the gamma index and the clinical impact of a discrepancy for any of the gamma index evaluation possibilities (global, local, 2D, or 3D). Some of the tests yielded false positives or false negatives in a per-beam gamma analysis. However, they were correctly accounted for in a DVH analysis. We also showed that 3DVH software is reliable for our tests, and is a viable method for correlating planar discrepancies with clinical relevance by comparing the measured DVH of target and OARs with clinical tolerance.

Comparison of dose calculation algorithms in slab phantoms with cortical bone equivalent heterogeneities

To evaluate the dose values predicted by several calculation algorithms in two treatment planning systems, Monte Carlo (MC) simulations and measurements by means of various detectors were performed in heterogeneous layer phantoms with water- and bone-equivalent materials. Percentage depth doses (PDDs) were measured with thermoluminescent dosimeters (TLDs), metal-oxide semiconductor field-effect transistors (MOSFETs), plane parallel and cylindrical ionization chambers, and beam profiles with films. The MC code used for the simulations was the PENELOPE code. Three different field sizes (10 x 10, 5 x 5, and 2 x 2 cm2) were studied in two phantom configurations and a bone equivalent material. These two phantom configurations contained heterogeneities of 5 and 2 cm of bone, respectively. We analyzed the performance of four correction-based algorithms and one based on convolution superposition. The correction-based algorithms were the Batho, the Modified Batho, the Equivalent TAR implemented in the Cadplan (Varian) treatment planning system (TPS), and the Helax-TMS Pencil Beam from the Helax-TMS (Nucletron) TPS. The convolution-superposition algorithm was the Collapsed Cone implemented in the Helax-TMS. All the correction-based calculation algorithms underestimated the dose inside the bone-equivalent material for 18 MV compared to MC simulations. The maximum underestimation, in terms of root-mean-square (RMS), was about 15% for the Helax-TMS Pencil Beam (Helax-TMS PB) for a 2 x 2 cm2 field inside the bone-equivalent material. In contrast, the Collapsed Cone algorithm yielded values around 3%. A more complex behavior was found for 6 MV where the Collapsed Cone performed less well, overestimating the dose inside the heterogeneity in 3%-5%. The rebuildup in the interface bone-water and the penumbra shrinking in high-density media were not predicted by any of the calculation algorithms except the Collapsed Cone, and only the MC simulations matched the experimental values within the estimated uncertainties. The TLD and MOSFET detectors were suitable for dose measurement inside bone-equivalent materials, while parallel ionization chambers, applying the same calibration and correction factors as in water, systematically underestimated dose by 3%-5%.

Characterization of the Exradin W1 scintillator for use in radiotherapy.

PURPOSE To evaluate the main characteristics of the Exradin W1 scintillator as a dosimeter and to estimate measurement uncertainties when used in radiotherapy. METHODS We studied the calibration procedure, energy and modality dependence, short-term repeatability, dose-response linearity, angular dependence, temperature dependence, time to reach thermal equilibrium, dose-rate dependence, water-equivalent depth of the effective measurement point, and long-term stability. An uncertainty budget was derived for relative and absolute dose measurements in photon and electron beams. RESULTS Exradin W1 showed a temperature dependence of -0.225% °C(-1). The loss of sensitivity with accumulated dose decreased with use. The sensitivity of Exradin W1 was energy independent for high-energy photon and electron beams. All remaining dependencies of Exradin W1 were around or below 0.5%, leading to an uncertainty budget of about 1%. When a dual channel electrometer with automatic trigger was not used, timing effects became significant, increasing uncertainties by one order of magnitude. CONCLUSIONS The Exradin W1 response is energy independent for high energy x-rays and electron beams, and only one calibration coefficient is needed. A temperature correction factor should be applied to keep uncertainties around 2% for absolute dose measurements and around 1% for relative measurements in high-energy photon and electron beams. The Exradin W1 scintillator is an excellent alternative to detectors such as diodes for relative dose measurements.

Monte Carlo simulation of MOSFET detectors for high-energy photon beams using the PENELOPE code.

The aim of this work was the Monte Carlo (MC) simulation of the response of commercially available dosimeters based on metal oxide semiconductor field effect transistors (MOSFETs) for radiotherapeutic photon beams using the PENELOPE code. The studied Thomson&Nielsen TN-502-RD MOSFETs have a very small sensitive area of 0.04 mm(2) and a thickness of 0.5 microm which is placed on a flat kapton base and covered by a rounded layer of black epoxy resin. The influence of different metallic and Plastic water build-up caps, together with the orientation of the detector have been investigated for the specific application of MOSFET detectors for entrance in vivo dosimetry. Additionally, the energy dependence of MOSFET detectors for different high-energy photon beams (with energy >1.25 MeV) has been calculated. Calculations were carried out for simulated 6 MV and 18 MV x-ray beams generated by a Varian Clinac 1800 linear accelerator, a Co-60 photon beam from a Theratron 780 unit, and monoenergetic photon beams ranging from 2 MeV to 10 MeV. The results of the validation of the simulated photon beams show that the average difference between MC results and reference data is negligible, within 0.3%. MC simulated results of the effect of the build-up caps on the MOSFET response are in good agreement with experimental measurements, within the uncertainties. In particular, for the 18 MV photon beam the response of the detectors under a tungsten cap is 48% higher than for a 2 cm Plastic water cap and approximately 26% higher when a brass cap is used. This effect is demonstrated to be caused by positron production in the build-up caps of higher atomic number. This work also shows that the MOSFET detectors produce a higher signal when their rounded side is facing the beam (up to 6%) and that there is a significant variation (up to 50%) in the response of the MOSFET for photon energies in the studied energy range. All the results have shown that the PENELOPE code system can successfully reproduce the response of a detector with such a small active area.

Monte Carlo based water/medium stopping-power ratios for various ICRP and ICRU tissues.

Water/medium stopping-power ratios, s(w,m), have been calculated for several ICRP and ICRU tissues, namely adipose tissue, brain, cortical bone, liver, lung (deflated and inflated) and spongiosa. The considered clinical beams were 6 and 18 MV x-rays and the field size was 10 x 10 cm(2). Fluence distributions were scored at a depth of 10 cm using the Monte Carlo code PENELOPE. The collision stopping powers for the studied tissues were evaluated employing the formalism of ICRU Report 37 (1984 Stopping Powers for Electrons and Positrons (Bethesda, MD: ICRU)). The Bragg-Gray values of s(w,m) calculated with these ingredients range from about 0.98 (adipose tissue) to nearly 1.14 (cortical bone), displaying a rather small variation with beam quality. Excellent agreement, to within 0.1%, is found with stopping-power ratios reported by Siebers et al (2000a Phys. Med. Biol. 45 983-95) for cortical bone, inflated lung and spongiosa. In the case of cortical bone, s(w,m) changes approximately 2% when either ICRP or ICRU compositions are adopted, whereas the stopping-power ratios of lung, brain and adipose tissue are less sensitive to the selected composition. The mass density of lung also influences the calculated values of s(w,m), reducing them by around 1% (6 MV) and 2% (18 MV) when going from deflated to inflated lung.

Ionizing radiation or mitomycin-induced micronuclei in lymphocytes of BRCA1 or BRCA2 mutation carriers

BRCA1 and BRCA2 genes are essential in preserving the integrity of genome, and it is not unambiguously clear whether the heterozygosity status may affect BRCA1 or BRCA2 functions. This may have implications for the clinical management of BRCA1 and BRCA2 mutation carriers both in breast cancer (BC) screening modality and in cancer treatment based on DNA-damaging or DNA-repair-inhibiting drugs. We investigated whether lymphocytes carrying BRCA1 or BRCA2 mutations displayed an increased sensitivity to radiation or mitomycin C (MMC) in vitro treatments. Peripheral blood from 21 BRCA1 mutation carriers (12 with BC and 9 healthy), 24 BRCA2 carriers (13 with BC and 11 healthy), 15 familial BC patients without detected mutation in BRCA1 or BRCA2 and 16 controls without familial history of cancer (5 with BC and 11 healthy) were irradiated or treated with MMC. Chromosomal damage was measured using the cytokinesis-block micronucleus assay. We evaluated micronuclei (MN) and nucleoplasmic bridges (NPBs). The BRCA2 mutation carriers and familial BC patients without detected mutation in BRCA1 or BRCA2 showed less basal NPB than BRCA1 carriers and controls. The BRCA1+/− or BRCA2+/− lymphocytes did not have increased frequencies of MN or NPB after irradiation. In contrast, BRCA2+/− lymphocytes presented higher levels of MN after MMC exposure than BRCA1 carriers and controls. The monoallelic BRCA1 or BRCA2 pathogenic mutations seem not to be associated with an enhanced radiosensitivity. The mutation of one BRCA2 allele conferred an increased sensitivity to MMC, presumably because of the role of this gene in the repair of MMC-induced DNA damage. This finding indicates that the MMC-induced MN analysis could be useful in identifying functional deficiencies of BRCA2 or genes related to BRCA2. Since MMC can be used as an anti-cancer drug, these data may be relevant for the management and follow-up of BRCA2 mutation carriers.

Multicentre validation of IMRT pre-treatment verification: comparison of in-house and external audit.

BACKGROUND AND PURPOSE We performed a multicentre intercomparison of IMRT optimisation and dose planning and IMRT pre-treatment verification methods and results. The aims were to check consistency between dose plans and to validate whether in-house pre-treatment verification results agreed with those of an external audit. MATERIALS AND METHODS Participating centres used two mock cases (prostate and head and neck) for the intercomparison and audit. Compliance to dosimetric goals and total number of MU per plan were collected. A simple quality index to compare the different plans was proposed. We compared gamma index pass rates using the centres equipment and methodology to those of an external audit. RESULTS While for the prostate case, all centres fulfilled the dosimetric goals and plan quality was homogeneous, that was not the case for the head and neck case. The number of MU did not correlate with the plan quality index. Pre-treatment verifications results of the external audit did not agree with those of the in-house measurements for two centres: being within tolerance for in-house measurements and unacceptable for the audit or the other way round. CONCLUSIONS Although all plans fulfilled dosimetric constraints, plan quality is highly dependent on the planner expertise. External audits are an excellent tool to detect errors in IMRT implementation and cannot be replaced by intercomparison using results obtained by centres.

Radiation dose assessment in a 320-detector-row CT scanner used in cardiac imaging.

PURPOSE In the present era of cone-beam CT scanners, the use of the standardized CTDI100 as a surrogate of the idealized CTDI is strongly discouraged and, consequently, so should be the use of the dose-length product (DLP) as an estimate of the total energy imparted to the patient. However, the DLP is still widely used as a reference quantity to normalize the effective dose for a given scan protocol mainly because the CTDI100 is an easy-to-measure quantity. The aim of this article is therefore to describe a method for radiation dose assessment in large cone-beam single axial scans, which leads to a straightforward estimation of the total energy imparted to the patient. The authors developed a method accessible to all medical physicists and easy to implement in clinical practice in an attempt to update the bridge between CT dosimetry and the estimation of the effective dose. METHODS The authors used commercially available material and a simple mathematical model. The method described herein is based on the dosimetry paradigm introduced by the AAPM Task Group 111. It consists of measuring the dose profiles at the center and the periphery of a long body phantom with a commercial solid-state detector. A weighted dose profile is then calculated from these measurements. To calculate the CT dosimetric quantities analytically, a Gaussian function was fitted to the dose profile data. Furthermore, the Gaussian model has the power to condense the z-axis information of the dose profile in two parameters: The single-scan central dose, f(0), and the width of the profile, sigma. To check the energy dependence of the solid-state detector, the authors compared the dose profiles to measurements made with a small volume ion chamber. To validate the overall method, the authors compared the CTDI100 calculated analytically to the measurement made with a 100 mm pencil ion chamber. RESULTS For the central and weighted dose profiles, the authors found a good agreement between the measured dose profile data and the fitted Gaussian functions. The solid-state detector had no energy dependence--within the energy range of interest--and the analytical model succeeded in reproducing the absolute dose values obtained with the pencil ion chamber. For the case of large cone-beam single axial scans, the quantity that better characterizes the total energy imparted to the patient is the weighted dose profile integral (DPI(w)). The DPI(w) can be easily determined from the two parameters that define the Gaussian functions: f(0) and sigma. The authors found that the DLP underestimated the total energy imparted to the patient by more than 20%. The authors also found that the calculated CT dosimetric quantities were higher than those displayed on the scanner console. CONCLUSIONS The authors described and validated a method to assess radiation dose in large cone-beam single axial scans. This method offers a simple and more accurate estimation of the total energy imparted to the patient, thus offering the possibility to update the bridge between CT dosimetry and the estimation of the effective dose for cone-beam CT examinations in radiology, nuclear medicine, and radiation therapy.