Pavlos Papaconstadopoulos

On the correction, perturbation and modification of small field detectors in relative dosimetry.

The purpose of this study was to derive a complete set of correction and perturbation factors for output factors (OF) and dose profiles. Modern small field detectors were investigated including a plastic scintillator (Exradin W1, SI), a liquid ionization chamber (microLion 31018, PTW), an unshielded diode (Exradin D1V, SI) and a synthetic diamond (microDiamond 60019, PTW). A Monte Carlo (MC) beam model was commissioned for use in small fields following two commissioning procedures: (1) using intermediate and moderately small fields (down to 2xa0×xa02xa0cm(2)) and (2) using only small fields (0.5xa0×xa00.5xa0cm(2)xa0-2xa0×xa02xa0cm(2)). In the latter case the detectors were explicitly modelled in the dose calculation. The commissioned model was used to derive the correction and perturbation factors with respect to a small point in water as suggested by the Alfonso formalism. In MC calculations the design of two detectors was modified in order to minimize or eliminate the corrections needed. The results of this study indicate that a commissioning process using large fields does not lead to an accurate estimation of the source size, even if a 2xa0×xa02xa0cm(2) field is included. Furthermore, the detector should be explicitly modelled in the calculations. On the output factors, the scintillator W1 needed the smallest correction (+0.6%), followed by the microDiamond (+1.3%). Larger corrections were observed for the microLion (+2.4%) and diode D1V (-2.4%). On the profiles, significant corrections were observed out of the field on the gradient and tail regions. The scintillator needed the smallest corrections (-4%), followed by the microDiamond (-11%), diode D1V (+13%) and microLion (-15%). The major perturbations reported were due to volume averaging and high density materials that surround the active volumes. These effects presented opposite trends in both OF and profiles. By decreasing the radius of the microLion to 0.85xa0mm we could modify the volume averaging effect in order to achieve a discrepancy less than 1% for OF and 5% for profiles compared to water. Similar results were observed for the diode D1V if the radius was increased to 1xa0mm.

A protocol for EBT3 radiochromic film dosimetry using reflection scanning

PURPOSEnTo evaluate the performance of the EBT3 radiochromic film dosimetry system using reflection measurements and to suggest a calibration protocol for precise and accurate reflection film dosimetry.nnnMETHODSnA set of 14 Gafchromic EBT3 film pieces were irradiated to various doses ranging from 0 to 8 Gy and subsequently scanned using both the reflection and transmission mode. Scanning resolution varied from 50 to 508 dpi (0.5-0.05 mm/pixel). Both the red and green color channels of scanned images were used to relate the film response to the dose. A sensitivity, uncertainty, and accuracy analysis was performed for all scanning modes and color channels. The total uncertainty, along with the fitting and experimental uncertainty components, was identified and analyzed. A microscope resolution target was used to evaluate possible resolution losses under reflection scanning. The calibration range was optimized for reflection scanning in the low (<2 Gy) and high (>2 Gy) dose regions based on the reported results.nnnRESULTSnReflection scanning using the red channel exhibited the highest sensitivity among all modes, being up to 150% higher than transmission mode in the red channel for the lowest dose level. Furthermore, there was no apparent loss in resolution between the two modes. However, higher uncertainties and reduced accuracy were observed for the red channel under reflection mode, especially at dose levels higher than 2 Gy. These uncertainties were mainly attributed to saturation effects which were translated in poor fitting results. By restricting the calibration to the 0-2 Gy dose range, the situation is reversed and the red reflection mode was superior to the transmission mode. For higher doses, the green channel in reflection mode presented comparable results to the red transmission.nnnCONCLUSIONSnA two-color reflection scanning protocol can be suggested for EBT3 radiochromic film dosimetry using the red channel for doses less than 2 Gy and the green channel for higher doses. The precision and accuracy are significantly improved in the low dose region following such a protocol.

Delivery validation of an automated modulated electron radiotherapy plan.

PURPOSEnModulated electron radiation therapy (MERT) represents an active area of interest that offers the potential to improve healthy tissue sparing in treatment of certain cancer cases. Challenges remain however in accurate beamlet dose calculation, plan optimization, collimation method, and delivery accuracy. In this work, the authors investigate the accuracy and efficiency of an end-to-end MERT plan and automated delivery method.nnnMETHODSnTreatment planning was initiated on a previously treated whole breast irradiation case including an electron boost. All dose calculations were performed using Monte Carlo methods and beam weights were determined using a research-based treatment planning system capable of inverse optimization. The plan was delivered to radiochromic film placed in a water equivalent phantom for verification, using an automated motorized tertiary collimator.nnnRESULTSnThe automated delivery, which covered four electron energies, 196 subfields, and 6183 total MU was completed in 25.8 min, including 6.2 min of beam-on time. The remainder of the delivery time was spent on collimator leaf motion and the automated interfacing with the accelerator in service mode. Comparison of the planned and delivered film dose gave 3%/3mm gamma pass rates of 62.1%, 99.8%, 97.8%, 98.3%, and 98.7% for the 9, 12, 16, and 20 MeV, and combined energy deliveries, respectively. Delivery was also performed with a MapCHECK device and resulted in 3%/3 mm gamma pass rates of 88.8%, 86.1%, 89.4%, and 94.8% for the 9, 12, 16, and 20 MeV energies, respectively.nnnCONCLUSIONSnResults of the authors study showed that an accurate delivery utilizing an add-on tertiary electron collimator is possible using Monte Carlo calculated plans and inverse optimization, which brings MERT closer to becoming a viable option for physicians in treating superficial malignancies.

A source model for modulated electron radiation therapy using dynamic jaw movements.

PURPOSEnThe development of fast and accurate source models (SMs) might be of crucial importance for the future clinical implementation of modulated electron radiation therapy (MERT). In this study, a SM is presented for reconstructing phase-space information of modulated electron beams using a few-leaf electron collimator (FLEC) and the photon jaws.nnnMETHODSnDuring a FLEC-based delivery, two collimation devices (jaws and FLEC) modulate the electron beam characteristics dynamically. The SM separates the beam into a primary and a scattered component. The primary component is derived by a fast Monte Carlo (MC) transport calculation in air using the EGSnrc/BEAMnrc code. The scattered beam is modeled analytically. The accelerator was decomposed into its individual leaf components and the scattered beam was characterized at various levels of the accelerator. Scattered particles are assigned an energy and position by sampling pre-calculated probability distributions. The direction is estimated by geometrical arguments. Particles were assumed to emerge from tunable virtual sources on the side of each collimator leaf. A leaf-hit algorithm was developed to dynamically reject particles that are incident on any collimating leaf. Electron transport in air between the two collimation levels was calculated based on a MC-modified version of the Fermi-Eyges scattering theory. Correlations between direction and position were observed and taken into account at the final collimation level.nnnRESULTSnTo validate the model, reconstructed phase-space data were compared with the full accelerator MC phase-space data. The model accurately reproduced the beam characteristics and preserved important correlations. Depth and profile dose distributions in water were derived for square, rectangular, and off-axis field sizes and for a range of clinical energies. Discrepancies in the dose distributions and dose output were within 3% in all cases.nnnCONCLUSIONSnFast and accurate SMs open the possibility for fast treatment planning in MERT, based on an inverse optimization MC treatment planning scheme.

Image quality for radiotherapy CT simulators with different scanner bore size

PURPOSEnWe compare image quality parameters derived from phantom images taken on three commercially available radiotherapy CT simulators. To make an unbiased evaluation, we assured images were obtained with the same surface dose measured using XR-QA2 model GafChromic™ film placed at the imaging phantom surface for all three CT-simulators.nnnMETHODSnRadiotherapy CT simulators GE LS 16, Philips Brilliance Big Bore, and Toshiba Aquilion LB were compared in terms of spatial resolution, low contrast detectability, image uniformity, and contrast to noise ratio using CATPHAN-504 phantom, scanned with Head and Pelvis protocols. Dose was measured at phantom surface, with CT scans repeated until doses on all scanners were within 2%.nnnRESULTSnIn terms of spatial resolution, the GE simulator appears slightly better, while Philips CT images are superior in terms of SNR for both scanning protocols. The CNR results show that Philips CT images appear to be better, except for high Z material, while Toshiba appears to fit in between the two simulators.nnnCONCLUSIONSnWhile the image quality parameters for three RT CT simulators show comparable results, the scanner bore size is of vital importance in various radiotherapy applications. Since the image quality is a function of a large number of confounding parameters, any loss in image quality due to scanner bore size could be compensated by the appropriate choice of scanning parameters, including the exposure and by balancing between the additional imaging dose to the patient and high image quality required in highly conformal RT techniques.

Technical Note: Response time evolution of XR‐QA2 GafChromic™ film models

PURPOSEnTo evaluate the response of the newest XR-QA2 GafChromic™ film model in terms of postexposure signal growth and energy response in comparison with the older XR-QA (Version 2) model.nnnMETHODSnPieces of film were irradiated to air kerma in air values up to 12 cGy with several beam qualities (5.3-8.25 mm Al) commonly used for CT scanning. Film response was scored in terms of net reflectance from scanned film images at various points in time postirradiation ranging from 1 to 7 days and 5 months postexposure. To reconstruct the measurement signal changes with postirradiation delay, we irradiated one film piece and then scanned it at different point times starting from 2 min and up to 3 days postexposure.nnnRESULTSnFor all beam qualities and dose range investigated, it appears that the XR-QA2 film signal completely saturated after 15 h. Compared to 15 h postirradiation scanning time, the observed variation in net reflectance were 3%, 2%, and 1% for film scanned 2 min, 20 min, and 3 h after exposure, respectively, which is well within the measurement uncertainty of the XR-QA2 based reference radiochromic film dosimetry system. A comparison between the XR-QA (Version 2) and the XR-QA2 film response after several months (relative to their responses after 24 h) show differences in up to 8% and 1% for each film model respectively.nnnCONCLUSIONSnThe replacement of cesium bromide in the older XR-QA (Version 2) film model with bismuth oxide in the newer XR-QA2 film, while keeping the same single sensitive layer structure, lead to a significantly more stable postexposure response.

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

PURPOSEnIntraoperative 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.nnnMETHODSnIonization 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.nnnRESULTSnAt 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%).nnnCONCLUSIONSnThese 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.

TH‐CD‐201‐04: A Study of Cherenkov Light Generated and Collected in Plastic Scintillation Detector

PURPOSEnTo study Cherenkov light emission in plastic scintillation detectors (PSDs) from a theoretical point of view to identify situations that may arise where the calibration coefficient obtained in one condition is not applicable to another condition. By identifying problematic situations, we hope to provide guidance on how to confidently use PSDs.nnnMETHODSnCherenkov light emission in PSD was modelled using basic physical principles. In particular, changes in refractive index as a function of wavelength were accounted for using the Sellmeier empirical equation. Both electron and photon beams were considered. For photons, realistic distributions of secondary charged particles were calculated using Klein-Nishinas formula. Cherenkov production and collection in PSDs were studied for a range of parameters including beam energy, charged particle momentum distribution, detector orientation and material composition. Finally, experimental validation was made using a commercial plastic scintillation detector.nnnRESULTSnIn specific situations, results show that the Cherenkov spectrum coupled in the PSD can deviate from its expected behaviour (i.e. one over the square of the wavelength). In these cases were the model is realistic it is possible to see a peak wavelength instead of a monotonically decreasing function. Consequences of this phenomenon are negligible when the momentum of charged particle is distributed randomly, but in some clinically relevant cases, such as an electron beam at depth close to R50 or for photon beams with minimal scatter component, the value of the calibration coefficient can be altered. Experimental tests with electron beams showed changes in the Cherenkov light ratio, the parameter used in the calibration of PSDs, up to 2-3% depending on the PSD orientation.nnnCONCLUSIONnThis work is the first providing a physical explanation for apparent change in PSD calibration coefficient. With this new information at hand, it will be possible to better guide the clinical use of PSDs.

SU-C-304-03: Experimental Investigation On the Accuracy of Plastic Scintillation Dosimeters in Small Fields

Purpose: To investigate the accuracy of the Exradin W1 (SI) and of an “in-house” plastic scintillation dosimeter (CHUQ PSD) in small radiation fields. Methods: Output factor (OF) measurements with the W1 and CHUQ PSD were performed for field sizes of 0.5 x 0.5, 1 x 1 and 2 x 2 cm2. Both detectors were placed parallel to the central axis (CAX) in water. The spectrum discrimination calibration method was performed in each set-up to account for the Cerenkov (CRV) signal created in the fiber. The OFs were compared to the expected field factors in water derived using i) Monte Carlo (MC) simulations of an accurate accelerator model and ii) microLion (PTW) and D1V diode (SI) OFs. MC-derived correction factors were applied to both the microLion and D1V OFs. For the CHUQ PSD the calibration was repeated in water (// CAX), solid water (perpendicular to CAX) and under a shielded configuration. The signal was collected using a spectrometer (wavelength range = 185–1100 nm). Spectral analysis was performed to evaluate potential changes of the spectral distributions under the various calibration set-up configurations. Results: The W1 OFs presented an over-response for the 0.5 x 0.5 cm2 in the range of 3 – 4.1% relative to the expected field factor. The CHUQ PSD presented an under-response in the range of 1.5 – 2.7%, without accounting for volume averaging. The CRV spectra under the various calibration procedures appeared similar to each other and only minor changes were observed to the respective OFs. Conclusion: The W1 and CHUQ PSD can be used in small fields down to a 1 x 1 cm2 field size. Discrepancies were encountered between the two detectors for the smallest field size of 0.5 x 0.5 cm2 with the CHUQ PSD exhibiting a closer agreement to the expected field factor. Funding sources: 1) Alexander S. Onassis Public Benefit Foundation in Greece and 2) CREATE Medical Physics Research Training Network grant of the Natural Sciences and Engineering Research Council, Grant number: 432290, RGPIN-2014-06475

Sci—Thur PM: Planning & Delivery — 03: Automated delivery and quality assurance of a modulated electron radiation therapy plan

Modulated electron radiation therapy (MERT) offers the potential to improve healthy tissue sparing through increased dose conformity. Challenges remain, however, in accurate beamlet dose calculation, plan optimization, collimation method and delivery accuracy. In this work, we investigate the accuracy and efficiency of an end-to-end MERT plan and automated-delivery workflow for the electron boost portion of a previously treated whole breast irradiation case. Dose calculations were performed using Monte Carlo methods and beam weights were determined using a research-based treatment planning system capable of inverse optimization. The plan was delivered to radiochromic film placed in a water equivalent phantom for verification, using an automated motorized tertiary collimator. The automated delivery, which covered 4 electron energies, 196 subfields and 6183 total MU was completed in 25.8 minutes, including 6.2 minutes of beam-on time with the remainder of the delivery time spent on collimator leaf motion and the automated interfacing with the accelerator in service mode. The delivery time could be reduced by 5.3 minutes with minor electron collimator modifications and the beam-on time could be reduced by and estimated factor of 2–3 through redesign of the scattering foils. Comparison of the planned and delivered film dose gave 3%/3 mm gamma pass rates of 62.1, 99.8, 97.8, 98.3, and 98.7 percent for the 9, 12, 16, 20 MeV, and combined energy deliveries respectively. Good results were also seen in the delivery verification performed with a MapCHECK 2 device. The results showed that accurate and efficient MERT delivery is possible with current technologies.