Sonja Wegener

Influence of the Integral Quality Monitor transmission detector on high energy photon beams: A multi-centre study

PURPOSE The influence of the Integral Quality Monitor (IQM) transmission detector on photon beam properties was evaluated in a preclinical phase, using data from nine participating centres: (i) the change of beam quality (beam hardening), (ii) the influence on surface dose, and (iii) the attenuation of the IQM detector. METHODS For 6 different nominal photon energies (4 standard, 2 FFF) and square field sizes from 1×1cm2 to 20×20cm2, the effect of IQM on beam quality was assessed from the PDD20,10 values obtained from the percentage dose depth (PDD) curves, measured with and without IQM in the beam path. The change in surface dose with/without IQM was assessed for all available energies and field sizes from 4×4cm2 to 20×20cm2. The transmission factor was calculated by means of measured absorbed dose at 10cm depth for all available energies and field sizes. RESULTS (i) A small (0.11-0.53%) yet statistically significant beam hardening effect was observed, depending on photon beam energy. (ii) The increase in surface dose correlated with field size (p<0.01) for all photon energies except for 18MV. The change in surface dose was smaller than 3.3% in all cases except for the 20×20cm2 field and 10MV FFF beam, where it reached 8.1%. (iii) For standard beams, transmission of the IQM showed a weak dependence on the field size, and a pronounced dependence on the beam energy (0.9412 for 6MV to 0.9578 for 18MV and 0.9440 for 6MV FFF; 0.9533 for 10MV FFF). CONCLUSIONS The effects of the IQM detector on photon beam properties were found to be small yet statistically significant. The magnitudes of changes which were found justify treating IQM either as tray factors within the treatment planning system (TPS) for a particular energy or alternatively as modified outputs for specific beam energy of linear accelerators, which eases the introduction of the IQM into clinical practice.

Energy and field size dependence of a silicon diode designed for small‐field dosimetry

Purpose To investigate the energy dependence/spectral sensitivity of silicon diodes designed for small‐field dosimetry and obtain response factors (RFs) for arbitrary photon spectra using Monte Carlo (MC) simulations. Methods The EGSnrc user‐code DOSRZnrc was used to calculate the dose deposition in water and in the active volume of a stereotactic diode field detector (SFD). Then, the RFs of the SFD were calculated for several circular field sizes and energies at 5 cm depth in water. Several low‐energy photon spectra (mean energy 55 to 200 keV), as well as Co‐60 radiation (mean energy 1.25 MeV) and a 6 MV Elekta Synergy beam (mean energy 2.9 MeV), in 10 × 10 cm2 field size were used to validate the MC calculations, using a simple beam model. The RFs of the SFD detector for a 6 MV Elekta Synergy linac photon beam in different field sizes were calculated. These were also measured with EBT3 Gafchromic film and the SFD detector. Results For the reference field size, differences between measured and calculated RFs were less than 5% at mean energies below 1 MeV and less than 1% at energies above 1 MeV. The calculated RFs for a 6 MV Elekta Synergy linac photon beam as a function of different field sizes showed a good agreement between the measurements and previously reported results. This agreement was within 2% for all considered field sizes. Conclusion While at high photon energies, the change of response of the SFD is marginal, whereas it is extreme at low energies. Therefore, it is desirable to benchmark response calculations also in the low‐energy domain. Our results, with a simple beam model and geometry, indicate that a validation of the simulations by experimental results is achievable. The present work provides a comprehensive table that can be used to calculate SFD detector response factors depending on both, field size and photon energy.

Separation of scatter from small MV beams and its effect on detector response

Purpose: Separating the scatter from the primary component of a MV beam to study detector response separately in each case for a better understanding of the role of different effects influencing the response in nonstandard fields. Methods: Detector response in three different experimental setups was investigated for a variety of different types (diamond, shielded and unshielded diodes, ionization chamber and film): (a). Detectors positioned in water under a thin steel pole blocking the central part of the beam, yielding only the response to the scatter part of the beam. (b). Detectors positioned in air under a PMMA cap to approximate the contribution of the primary beam without scatter. (c). Detectors positioned in water in the standard open field configuration to obtain a superposition of both. Results: Detector differences became more clearly observable when the primary beam was blocked and detector behavior heavily depended on the construction type. It was possible to calculate the response in the open fields from the values measured in the blocked configuration with 1% accuracy for all studied field sizes between 0.8 and 10 cm and for all detectors. Conclusions: The limitations of clinically used detectors in nonstandard situations were illustrated in the extreme situation of just scattered radiation reaching the detector. By experimentally separating scatter from the primary beam, the roles of different effects on the detector response were observed.

Influence of a transverse magnetic field on the response of different detectors in a high energy photon beam near the surface

PURPOSE The characteristics of radiation detectors have to be assessed for dosimetry in the presence of magnetic fields, i.e. in conditions found in combined machines for magnetic resonance imaging and radiotherapy. While a lot of attention is directed toward correction factors for absolute dosimetry in magnetic fields, relative dose measurements are an equally important task to be performed. There is a need to experimentally analyze detector response differences in the build-up region in the presence of a transverse magnetic field. METHODS Depth dose curves with different detectors (microDiamond PTW 60019, unshielded diode PTW 60012, ionization chamber PTW Semiflex 31010 and EBT3 film) were acquired for a beam quality of 6MV in an 8×10cm2 field at SSD 110cm with and without a transverse magnetic field of up to 1.1T. For these experiments, an electromagnet was placed in front of a conventional linear accelerator of the type Elekta Precise. The detectors were positioned in a water phantom fitting between the poles of the electromagnet. The beam entered through a 0.3mm thin PMMA foil window, which enabled measurements even close to the surface. Ratios of the response with and without the magnetic field for different detectors were investigated. The film served as a reference. RESULTS Changes in the depth dose curve near the surface due to the magnetic field were not correctly reproduced by all detectors. EBT3 film and the microDiamond detector agreed up to the surface. The diode showed up to 2% deviation from the film in the build-up region, but it could still be considered within the uncertainties. However, the curves obtained with the ionization chamber showed up to 6% deviation from the film and even completely different trends in the surface-near region. At depths larger than 2cm, there were no noticeable differences between the different detectors for relative depth dose curves. CONCLUSIONS At the descending part of the depth dose, the tested detectors did not show artifacts within the magnetic field. However, air-filled ionization chambers cannot be recommended for relative dosimetry in magnetic fields near the surface. Diamond detectors might be a suitable alternative and future investigations should concentrate on the performance of such detectors.

Electrometer offset current due to scattered radiation

Abstract Relative dose measurements with small ionization chambers in combination with an electrometer placed in the treatment room (“internal electrometer”) show a large dependence on the polarity used. While this was observed previously for percent depth dose curves (PDDs), the effect has not been understood or preventable. To investigate the polarity dependence of internal electrometers used in conjunction with a small‐volume ionization chamber, we placed an internal electrometer at a distance of 1 m from the isocenter and exposed it to different amounts of scattered radiation by varying the field size. We identified irradiation of the electrometer to cause a current of approximately −1 pA, regardless of the sign of the biasing voltage. For low‐sensitivity detectors, such a current noticeably distorts relative dose measurements. To demonstrate how the current systematically changes PDDs, we collected measurements with nine ionization chambers of different volumes. As the chamber volume decreased, signal ratios at 20 and 10 cm depth (M20/M10) became smaller for positive bias voltage and larger for negative bias voltage. At the size of the iba CC04 (40 mm³) the difference of M20/M10 was around 1% and for the smallest studied chamber, the iba CC003 chamber (3 mm³), around 7% for a 10 × 10 cm² field. When the electrometer was moved further from the source or shielded, the additional current decreased. Consequently, PDDs at both polarities were brought into alignment at depth even for the 3 mm³ ionization chamber. The apparent polarity effect on PDDs and lateral beam profiles was reduced considerably by shielding the electrometer. Due to normalization the effect on output values was low. When measurements with a low‐sensitivity probe are carried out in conjunction with an internal electrometer, we recommend careful monitoring of the particular setup by testing both polarities, and if deemed necessary, we suggest shielding the electrometer.

Distance-dependent penumbra and MLC-width: new insights in determinants of healthy tissue sparing in stereotactic irradiation

Abstract For stereotactic irradiation, both, penumbra and MLC leaf width make an impact on the sparing of healthy tissue around the target. Mostly, MLC design is regarded as the one influenceable parameter. However, also penumbra can be varied by choosing different distances between the source of radiation and the patient. The authors investigate the distance- dependent penumbra effects of idealized collimators as well as for real 5 mm MLCs. Test objects are small spherical targets of varying diameters to be irradiated under differing prescription conditions. A method to calculate exact stereotactic radial dose distributions from beam profiles or 2D dose distributions of single beams is developed for circular and MLC shaped targets. Also, a planning study is performed using a Pinnacle3™ planning system. Also, in a theoretical analysis perfect top hat profile beams and beams with varying penumbra are compared for better understanding of penumbra effects with respect to radial dose distributions. It is shown, that the penumbra changes for small targets are more relevant than the beam shaping by 5 mm MLCs. Quasi-isotropic irradiated MLC shaped (quadratic) beams at virtual SAD 700 mm produce steeper radial dose decrease than ideal circular beam shapes with a penumbra typical for SAD 1000 mm. A reduced source-to-patient distance allows better sparing of healthy tissue because of two reasons: The smaller effective leaf width but even more due to steeper penumbra. First, the authors suggest for future recommendations on stereotactic irradiations to specify not only MLC widths but also penumbra characteristics. Second, a so-called “virtual isocentre” could be useful to take advantage of the penumbra effect: Dependent on gantry angle and isocentric couch angle, the couch should be steered automatically in a way that the central axes of all beams always intersect in the same point at the same distance from the source.

SU-F-T-310: Does a Head-Mounted Ionization Chamber Detect IMRT Errors?

PURPOSE The conventional plan verification strategy is delivering a plan to a QA-phantom before the first treatment. Monitoring each fraction of the patient treatment in real-time would improve patient safety. We evaluated how well a new detector, the IQM (iRT Systems, Germany), is capable of detecting errors we induced into IMRT plans of three different treatment regions. Results were compared to an established phantom. METHODS Clinical plans of a brain, prostate and head-and-neck patient were modified in the Pinnacle planning system, such that they resulted in either several percent lower prescribed doses to the target volume or several percent higher doses to relevant organs at risk. Unaltered plans were measured on three days, modified plans once, each with the IQM at an Elekta Synergy with an Agility MLC. All plans were also measured with the ArcCHECK with the cavity plug and a PTW semiflex 31010 ionization chamber inserted. Measurements were evaluated with SNC patient software. RESULTS Repeated IQM measurements of the original plans were reproducible, such that a 1% deviation from the mean as warning and 3% as action level as suggested by the manufacturer seemed reasonable. The IQM detected most of the simulated errors including wrong energy, a faulty leaf, wrong trial exported and a 2 mm shift of one leaf bank. Detection limits were reached for two plans - a 2 mm field position error and a leaf bank offset combined with an MU change. ArcCHECK evaluation according to our current standards also left undetected errors. Ionization chamber evaluation alone would leave most errors undetected. CONCLUSION The IQM detected most errors and performed as well as currently established phantoms with the advantage that it can be used throughout the whole treatment. Drawback is that it does not indicate the source of the error.

SU-F-T-408: On the Determination of Equivalent Squares for Rectangular Small MV Photon Fields

PURPOSE It is common practice to tabulate dosimetric data like output factors, scatter factors and detector signal correction factors for a set of square fields. In order to get the data for an arbitrary field, it is mapped to an equivalent square, having the same scatter as the field of interest. For rectangular fields both, tabulated data and empiric formula exist. We tested the applicability of such rules for very small fields. METHODS Using the Monte-Carlo method (EGSnrc-doseRZ), the dose to a point in 10cm depth in water was calculated for cylindrical impinging fluence distributions. Radii were from 0.5mm to 11.5mm with 1mm thickness of the rings. Different photon energies were investigated. With these data a matrix was constructed assigning the amount of dose to the field center to each matrix element. By summing up the elements belonging to a certain field, the dose for an arbitrary point in 10cm depth could be determined. This was done for rectangles up to 21mm side length. Comparing the dose to square field results, equivalent squares could be assigned. The results were compared to using the geometrical mean and the 4Xperimeter/area rule. RESULTS For side length differences less than 2mm, the difference between all methods was in general less than 0.2mm. For more elongated fields, relevant differences of more than 1mm and up to 3mm for the fields investigated occurred. The mean square side length calculated from both empiric formulas fitted much better, deviating hardly more than 1mm and for the very elongated fields only. CONCLUSION For small rectangular photon fields, deviating only moderately from square both investigated empiric methods are sufficiently accurate. As the deviations often differ regarding their sign, using the mean improves the accuracy and the useable elongation range. For ratios larger than 2, Monte-Carlo generated data are recommended. SW is funded by Deutsche Forschungsgemeinschaft (SA481/10-1).