Verification of high dose rate brachytherapy dose distributions with EBT3 Gafchromic film quality control techniques

Early results of a remote dosimetry audit program for lung stereotactic body radiation therapy

Background and purpose

A dosimetry audit program based on alanine electron paramagnetic resonance (EPR) and radiochromic film dosimetry, may be a valuable tool for monitoring and improving the quality of lung stereotactic body radiotherapy (SBRT). The aim of this study was to report the initial, independent assessment of the dosimetric accuracy for lung SBRT practice using these dosimeters in combination with a novel phantom design.

Materials and Methods

The audit service was a remote audit program performed on a commercial lung phantom preloaded with film and alanine detectors. An alanine pellet was placed in the centre of the target simulated using silicone in a 3D-printed mould. Large film detectors were placed coronally through the target and the lung/tissue interface and analysed using gamma analysis. The beam output was always checked on the same day with alanine dosimetry in water. We audited 29 plans from 14 centres up to now.

Results

For the alanine results 28/29 plans were within 5 % with 19/29 plans being within 3 %. The passing rates were > 95 % for the film through the target for 27/29 plans and 17/29 plans for the film at the lung/tissue interface. For three plans the passing rate was < 90 % for the film on top of the lungs.

Conclusions

The preliminary results were very satisfactory for both detectors. The high passing rates for the film in the interface region indicate good performance of the treatment planning systems. The phantom design was robust and performed well on several treatment systems.

Evaluation of a new radiochromic film dosimeter, Gafchomic EBT4, for VMAT, SABR and HDR treatment delivery verification

Objective.To evaluate a new film for radiotherapy dosimetry, Gafchromic EBT4, compared to the current EBT3. To evaluate dose-response and verify test cases in MV external beam and HDR brachytherapy.Approach. Three lots (batches) of EBT4 and three lots of EBT3 films were calibrated at 6 MV over 0-1200 cGy range, using FilmQAPro software. Signal-to-noise of pixel value, reported dose (RD), and factors affecting dosimetry accuracy were evaluated (rotation of the film at scanning, energy response and post-exposure darkening). Both films were exposed to clinical treatment plans (VMAT prostate, SABR lung, single HDR source dwell, and 'pseudo' 3-channel HDR cervix brachytherapy). Film-RD was compared to TPS-calculated dose.Main results.EBT4 calibration curves had characteristics more favourable than EBT3 for radiation dosimetry, with improved signal to noise in film-RD of EBT4 compared to EBT3 (increase of average 46% in red and green channels at 500 cGy). Film rotation at scanning and post-exposure darkening was similar for the two films. The energy response of EBT4 is similar to EBT3. For all clinical case studies, EBT4 provided better agreement with the TPS-planned doses than EBT3. VMAT prostate gamma 3%/3 mm passing rate, EBT4 100.0% compared to EBT3 97.9%; SABR lung gamma 2%/2 mm, EBT4 99.6% and EBT3 97.9%; HDR cervix gamma 3%/2 mm, EBT4 97.7% and EBT3 95.0%.Significance.These results show EBT4 is superior to EBT3 for radiotherapy dosimetry validation of TPS plan delivery. Fundamental improvements in noise profile and calibration curve are reported for EBT4. All clinical test cases showed EBT4 provided equivalent or smaller difference in measured dose to TPS calculated dose than EBT3. Baseline data is presented on the achievable accuracy of film dosimetry in radiotherapy using the new Gafchromic EBT4 film.

Validation of an individualized home-made superficial brachytherapy mold applied for deep nonmelanoma skin cancer

Background

This study was conducted to evaluate the effect of brachytherapy (BT) customized mold [Condensation silicone elastomer (Protesil^TM)] and its thickness on the dose distribution pattern of deep nonmelanoma skin cancers (NMSC).

Materials and methods

Four blocks of mold material were constructed in 5, 10, 15, and 20 mm thickness and 100 × 100 mm² area by a plastic cast. The high dose rate (HDR) plus treatment planning system (TPS) (Version 3, Eckert & Ziegler BEBIG Gmbh, Berlin, Germany) with a ⁶⁰Co source (model: Co0.A86, EZAG BEBIG, Berlin, Germany) as an high dose rate brachytherapy (HDR-BT) source was used. Solid phantom and MOSFET^TM and GAFCHROMIC^TM EBT3 film dosimeters were used for experimental dosimetry of the different thicknesses (up to 20 mm) of BT customized mold. Skin dose and dose to different depths were evaluated.

Result

The TPS overestimated the calculated dose to the surface. Skin dose can be reduced from 250% to 150% of the prescription dose by increasing mold thickness from 5 mm to 20 mm. There was a 7.7% difference in the calculated dose by TPS and the measured dose by MOSFET. There was a good agreement between film dosimetry, MOSFET detector, and TPS' results in depths less than 5 mm.

Conclusion

Each BT department should validate any individualized material chosen to construct the customized surface BT mold. Increasing the mold thickness can treat lesions without overexposing the skin surface. Superficial BT can be recommended as an appropriate treatment option for some deep NMSC lesions (up to 20 mm) with pre-planning considerations employing thicker molds.

Evaluating dosimetric accuracy of the 6 MV calibration on EBT3 film in the use of Ir-192 high dose rate brachytherapy

Purpose

To evaluate the dosimetric accuracy of EBT3 film calibrated with a 6 MV beam for high dose rate brachytherapy and propose a novel method for direct film calibration with an Ir‐192 source.

Methods

The 6 MV calibration was performed in water on a linear accelerator (linac). The Ir‐192 calibration was accomplished by irradiating the film wrapped around a cylinder applicator with an Ir‐192 source. All films were scanned 1‐day post‐irradiation to acquire calibration curves for all three (red, blue, and green) channels. The Ir‐192 calibration films were also used for single‐dose comparison. Moreover, an independent test film under a H.A.M. applicator was irradiated and the 2D dose distribution was obtained separately for each calibration using the red channel data. Gamma analysis and point‐by‐point profile comparison were performed to evaluate the performance of both calibrations. The uncertainty budget for each calibration system was analyzed.

Results

The red channel had the best performance for both calibration systems in the single‐dose comparison. We found a significant 4.89% difference from the reference for doses <250 cGy using the 6 MV calibration, while the difference was only 0.87% for doses >600 cGy. Gamma analysis of the 2D dose distribution showed the Ir‐192 calibration had a higher passing rate of 91.9% for the 1 mm/2% criterion, compared to 83.5% for the 6 MV calibration. Most failing points were in the low‐dose region (<200 cGy). The point‐by‐point profile comparison reported a discrepancy of 2%–3.6% between the Ir‐192 and 6 MV calibrations in this low‐dose region. The linac‐ and Ir‐192‐based dosimetry systems had an uncertainty of 4.1% (k = 2) and 5.66% (k = 2), respectively.

Conclusions

Direct calibration of EBT3 films with an Ir‐192 source is feasible and reliable, while the dosimetric accuracy of 6 MV calibration depends on the dose range. The Ir‐192 calibration should be used when the measurement dose range is below 250 cGy.

Evaluation of dosimetric functions for a new 169 Yb HDR Brachytherapy Source

169 Yb has been recently used as an HDR brachytherapy source for cancer treatment. In this paper, dosimetric parameters of a new design of 169 Yb HDR brachytherapy source were determined by Monte Carlo (MC) method and film dosimetry. In this new source, the radioactive core has been encapsulated twice for safety purposes. The calculations of dosimetric parameters carried out using MC simulation in water and air phantom. In order to exclude photon contamination's cutoff energy, δ was set at 10 keV. TG-43U1 data dosimetric, including Sk , Λ, g(r), F(r, θ) was computed using outputs from the simulation and their statistical uncertainties were calculated. Dose distribution around the new prototype source in PMMA phantom in the framework of AAPM TG-43 and TG-55 recommendations was measured by Radiochromic film (RCF) Gafchromic EBT3. Obtained air kerma strength, Sk , and the dose rate constant, Λ, from simulation has a value of 1.03U ± 0.03 and 1.21 cGyh-1 U-1  ± 0.03, respectively. The radial dose function was calculated at radial distances between 0.5 and 10 cm with a maximum value of 1.15 ± 0.03 at 5-6 cm distances. The anisotropy functions for radial distances of 0.5-7 cm and angle distances 0° to180° were calculated. The dosimetric data of the new HDR 169 Yb source were compared with another reference source of 169 Yb-HDR and were found that has acceptable compatibility. In addition, the anisotropy function of the MC simulation and film dosimetry method at a distance of 1 cm from this source was obtained and a good agreement was found between the anisotropy results.

Development of Dosimetric Verification System for Patient-Specific Quality Assurance of High-Dose-Rate Brachytherapy

Purpose: The aim of this study was to develop a dosimetric verification system (DVS) using a solid phantom for patient-specific quality assurance (QA) of high-dose-rate brachytherapy (HDR-BT).

Methods: The proposed DVS consists of three parts: dose measurement, dose calculation, and analysis. All the dose measurements were performed using EBT3 film and a solid phantom. The solid phantom made of acrylonitrile butadiene styrene (ABS, density = 1.04 g/cm³) was used to measure the dose distribution. To improve the accuracy of dose calculation by using the solid phantom, a conversion factor [CF(r)] according to the radial distance between the water and the solid phantom material was determined by Monte Carlo simulations. In addition, an independent dose calculation program (IDCP) was developed by applying the obtained CF(r). To validate the DVS, dosimetric verification was performed using gamma analysis with 3% dose difference and 3 mm distance-to-agreement criterion for three simulated cases: single dwell position, elliptical dose distribution, and concave elliptical dose distribution. In addition, the possibility of applying the DVS in the high-dose range (up to 15 Gy) was evaluated.

Results: The CF(r) between the ABS and water phantom was 0.88 at 0.5 cm. The factor gradually increased with increasing radial distance and converged to 1.08 at 6.0 cm. The point doses 1 cm below the source were 400 cGy in the treatment planning system (TPS), 373.73 cGy in IDCP, and 370.48 cGy in film measurement. The gamma passing rates of dose distributions obtained from TPS and IDCP compared with the dose distribution measured by the film for the simulated cases were 99.41 and 100% for the single dwell position, 96.80 and 100% for the elliptical dose distribution, 88.91 and 99.70% for the concave elliptical dose distribution, respectively. For the high-dose range, the gamma passing rates in the dose distributions between the DVS and measurements were above 98% and higher than those between TPS and measurements.

Conclusion: The proposed DVS is applicable for dosimetric verification of HDR-BT, as confirmed through simulated cases for various doses.

Comprehensive methodology for commissioning modern 3D-image-based treatment planning systems for high dose rate gynaecological brachytherapy: A review

PURPOSE

Correct commissioning of treatment planning systems (TPSs) is important for reducing treatment failure events. There is currently no comprehensive and robust methodology available for TPS commissioning in modern brachytherapy. This review aimed to develop a comprehensive template for commissioning modern 3D-image-based brachytherapy TPSs for high dose rate (HDR) gynaecological applications.

METHODS

The literature relevant to TPS commissioning, including both external beam radiation therapy (EBRT) and brachytherapy, as well as guidelines by the International Atomic Energy Agency (IAEA), the American Association of Physicists in Medicine (AAPM), and the European Society for Radiotherapy and Oncology (ESTRO) were searched, studied and appraised. The applied relevant EBRT TPS commissioning tests were applied to brachytherapy. The developed template aimed to cover all dosimetric and non-dosimetric issues.

RESULTS

The essential commissioning items could be categorized into six parts: geometry, dose calculation, plan evaluation tools, plan optimization, TPS output, and end-to-end verification. The final template consists of 43 items. This paper presents the purpose and role of each test, as well as tolerance limits, to facilitate the use of the template.

CONCLUSION

The information and recommendations available in a collection of publications over many years have been reviewed in order to develop a comprehensive template for commissioning complex modern 3D-image-based brachytherapy TPSs for HDR gynaecological applications. The up-to-date and concise information contained in the template can aid brachytherapy physicists during TPS commissioning as well as devising a regular quality assurance program and allocation of time and resources.

The dosimetric effect of variations in source position on treatments using Leipzig-style brachytherapy skin applicators

Leipzig-style skin brachytherapy applicators are an excellent choice for the treatment of small surface lesions, since they can be used with a high dose rate source to produce a tightly constrained treatment field on the desired area of the skin. The dosimetry of these applicators is challenging to independently verify due to their small dimensions, complex energy spectrum and steep dose gradients. In particular the close proximity of the brachytherapy source to the treatment region is cause for concern, since small variations in the position of the radioactive source may significantly affect the resulting dose distribution. The aim of this work was to assess the dosimetry of these applicators using three independently techniques and use these results to examine the effect of variation in source position on the dose distribution. Simulation of different sized applicators in conjunction with a Gammamed + Ir¹⁹² source was performed using the EGSnrc Monte Carlo code. Dose distributions at the prescription depth and at the surface generated by Monte Carlo were compared to the outputs of a commercially available treatment planning system and measurements using radiochromic film. Source displacements of up to 0.5 mm in the vertical direction, 0.65 mm in the horizontal direction, and rotations of the source by up to 5° were all simulated. Changes in dose of over 6% at the prescription point and reductions in coverage at the 100% isodose level of several millimetres were observed even for small shifts of the source from its intended position. This work demonstrates that variation in the position of the radiation source is the dominant source of uncertainty in the use of these types of applicators. Centres wishing to perform treatments using these applicators are advised to take steps to control the uncertainty and ensure it remains at an acceptable level.

Selection of gamma analysis acceptance criteria in IMRT QA using Gafchromic EBT3 film dosimetry

Background and purpose

This study reported the justification and selection of acceptable γ criteria with respect to low (6 MV) and high (15 MV) photon beams for intensity-modulated radiation therapy quality assurance (IMRT QA) using the Gafchromic external beam therapy 3 (EBT3) film.

Materials and methods

Five-field step-and-shoot IMRT was used to treat 16 brain IMRT patients using the dual-energy DHX-S linear accelerator (Varian Medical System, Palo Alto, CA, USA). Dose comparisons between computed values of the treatment planning system (TPS) and Gafchromic EBT3 film were evaluated based on γ analysis using the Film QA Pro software. The dose distribution was analysed with gamma area histograms (GAHs) generated using different γ criteria (3%/2 mm, 3%/3 mm and 5%/3 mm) for the 6 and 15 MV photon beams, to optimise the best distance-to-agreement (DTA) criteria with respect to the beam energy.

Results

From the comparison between the dose distributions acquired from the TPS and EBT3 film, a DTA criterion of 3%/2 mm showed less dose differences (DDs) with passing rates up to 93% for the 6 MV photon beams, while for the 15 MV a relaxed DTA criterion of 5%/3 mm was consistent with the DD acceptability criteria with a 95% passing rate.

Conclusions

Our results suggested that high-energy photon beams required relaxed DTA criteria for the brain IMRT QA, while low-energy photon beams showed better results even with tight DTA criteria.

Real-time dosimetry with radiochromic films

Radiochromic film dosimetry has been widely employed in most of the applications of radiation physics for over twenty years. This is due to a number of appealing features of radiochromic films, such as reliability, accuracy, ease of use and cost. However, current radiochromic film reading techniques, based on the use of commercial densitometers and scanners, provide values of dose only after the exposure of the films to radiation. In this work, an innovative methodology for the real-time reading of radiochromic films is proposed for some specific applications. The new methodology is based on opto-electronic instrumentation that makes use of an optical fiber probe for the determination of optical changes of the films induced by radiation and allows measurements of dose with high degree of precision and accuracy. Furthermore, it has been demonstrated that the dynamic range of some kinds of films, such as the EBT3 Gafchromic films (intensively used in medical physics), can be extended by more than one order of magnitude. Owing to the numerous advantages with respect to the commonly used reading techniques, a National Patent was filed in January 2018.

LET dependent response of GafChromic films investigated with MeV ion beams

The change in optical properties of GafChromic films depends not only on the absorbed dose, but also on the linear energy transfer (LET) of the ionizing radiation. The influence of LET on the film dose-response relationship is especially important when films are applied for dosimetry of energetic charged particles. In the present study, we examined the response of the unlaminated EBT3 and MD-V3 films to proton, deuterium and helium beams with energies in the range of several megaelectronvolts (MeV). Films were exposed to doses up to 200 Gy and a model based on the bimolecular chemical reaction was chosen to fit the measured film signals. The LET in the active layers of the films and the dose correction factors were computed with Monte Carlo software TRIM. Signal quenching, observed for all ion beams in comparison to x-rays, was investigated as a function of the LET in the range of 10-100 keV µm-1. The response of the films got weaker with increasing the LET and showed no dependence on the ion species. The LET effect was quantified by introducing a modified expression for the relative effectiveness (RE) by which a unique RE value is assigned to a single LET. The RE defined in that way decreased from about 90% for LET of 10 keV µm-1 to less than 50% for LET of 100 keV µm-1. Similar behavior was observed for EBT3 and MD-V3 film models.

Commissioning and evaluation of a radiochromic EBT3 film dosimetry system

Purpose

This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.

Materials and Methods

A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.

Results

The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.

Conclusion

Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.

The Multigaussian method: a new approach to mitigating spatial heterogeneities with multichannel radiochromic film dosimetry

The main objective of multichannel radiochromic film dosimetry methods is to correct, or at least mitigate, spatial heterogeneities in the film-scanner response, especially variations in the active layer thickness. To this end, films can also be scanned prior to irradiation. In this study, the abilities of various single channel and multichannel methods to reduce spatial heterogeneities, with and without scanning before irradiation, were tested. Red, green and blue single channel models, two additive channel independent perturbation (CHIP) models and two multiplicative CHIP models were compared with the Multigaussian method. The Multigaussian method is a new approach to multichannel dosimetry, based on experimental findings. It assumes that the probability density function of the response vector formed by the pixel values of the different color channels, including irradiated and non-irradiated scans, follows a multivariate Gaussian distribution. The Multigaussian method provided more accurate doses than the other models under comparison, especially when incorporating the information of the film prior to irradiation. The relative dose differences between reference doses measured with MatriXX and film doses were examined. After applying inter-scan and lateral corrections, the lowest mean absolute errors were 0.8% and 1.0% for the Multigaussian method with and without the information of the scan before irradiation, respectively. Followed by the uniform multiplicative CHIP and red single channel models, using pixel values and net optical density, respectively, both with 1.1%.

Verification of high-dose-rate brachytherapy treatment planning dose distribution using liquid-filled ionization chamber array

Purpose

This study aims to investigate the dosimetric performance of a liquid-filled ionization chamber array in high-dose-rate (HDR) brachytherapy dosimetry. A comparative study was carried out with air-filled ionization chamber array and EBT3 Gafchromic films to demonstrate its suitability in brachytherapy.

Material and methods

The PTW OCTAVIUS detector 1000 SRS (IA 2.5-5 mm) is a liquid-filled ionization chamber array of area 11 x 11 cm² and chamber spacing of 2.5-5 mm, whereas the PTW OCTAVIUS detector 729 (IA 10 mm) is an air vented ionization chamber array of area 27 x 27 cm² and chamber spacing of 10 mm. EBT3 films were exposed to doses up to a maximum of 6 Gy and evaluated using multi-channel analysis. The detectors were evaluated using test plans to mimic a HDR intracavitary gynecological treatment. The plan was calculated and delivered with the applicator plane placed 20 mm from the detector plane. The acquired measurements were compared to the treatment plan. In addition to point dose measurement, profile/isodose, gamma analysis, and uncertainty analysis were performed. Detector sensitivity was evaluated by introducing simulated errors to the test plans.

Results

The mean point dose differences between measured and calculated plans were 0.2% ± 1.6%, 1.8% ± 1.0%, and 1.5% ± 0.81% for film, IA 10 mm, and IA 2.5-5 mm, respectively. The average percentage of passed gamma (global/local) values using 3%/3 mm criteria was above 99.8% for all three detectors on the original plan. For IA 2.5-5 mm, local gamma criteria of 2%/1 mm with a passing rate of at least 95% was found to be sensitive when simulated positional errors of 1 mm was introduced.

Conclusion

The dosimetric properties of IA 2.5-5 mm showed the applicability of liquid-filled ionization chamber array as a potential QA device for HDR brachytherapy treatment planning systems.

Monte Carlo uncertainty analysis of dose estimates in radiochromic film dosimetry with single-channel and multichannel algorithms

PURPOSE

To provide a multi-stage model to calculate uncertainty in radiochromic film dosimetry with Monte-Carlo techniques. This new approach is applied to single-channel and multichannel algorithms.

MATERIAL AND METHODS

Two lots of Gafchromic EBT3 are exposed in two different Varian linacs. They are read with an EPSON V800 flatbed scanner. The Monte-Carlo techniques in uncertainty analysis provide a numerical representation of the probability density functions of the output magnitudes. From this numerical representation, traditional parameters of uncertainty analysis as the standard deviations and bias are calculated. Moreover, these numerical representations are used to investigate the shape of the probability density functions of the output magnitudes. Also, another calibration film is read in four EPSON scanners (two V800 and two 10000XL) and the uncertainty analysis is carried out with the four images.

RESULTS

The dose estimates of single-channel and multichannel algorithms show a Gaussian behavior and low bias. The multichannel algorithms lead to less uncertainty in the final dose estimates when the EPSON V800 is employed as reading device. In the case of the EPSON 10000XL, the single-channel algorithms provide less uncertainty in the dose estimates for doses higher than four Gy.

CONCLUSION

A multi-stage model has been presented. With the aid of this model and the use of the Monte-Carlo techniques, the uncertainty of dose estimates for single-channel and multichannel algorithms are estimated. The application of the model together with Monte-Carlo techniques leads to a complete characterization of the uncertainties in radiochromic film dosimetry.

The incidence of the different sources of noise on the uncertainty in radiochromic film dosimetry using single channel and multichannel methods

The influence of the various sources of noise on the uncertainty in radiochromic film (RCF) dosimetry using single channel and multichannel methods is investigated in this work. These sources of noise are extracted from pixel value (PV) readings and dose maps. Pieces of an RCF were each irradiated to different uniform doses, ranging from 0 to 1092 cGy. Then, the pieces were read at two resolutions (72 and 150 ppp) with two flatbed scanners: Epson 10000XL and Epson V800, representing two states of technology. Noise was extracted as described in ISO 15739 (2013), separating its distinct constituents: random noise and fixed pattern (FP) noise. Regarding the PV maps, FP noise is the main source of noise for both models of digitizer. Also, the standard deviation of the random noise in the 10000XL model is almost twice that of the V800 model. In the dose maps, the FP noise is smaller in the multichannel method than in the single channel ones. However, random noise is higher in this method, throughout the dose range. In the multichannel method, FP noise is reduced, as a consequence of this method's ability to eliminate channel independent perturbations. However, the random noise increases, because the dose is calculated as a linear combination of the doses obtained by the single channel methods. The values of the coefficients of this linear combination are obtained in the present study, and the root of the sum of their squares is shown to range between [Formula: see text] and [Formula: see text] over the dose range studied. These results indicate the random noise to play a fundamental role in the uncertainty of RCF dosimetry: low levels of random noise are required in the digitizer to fully exploit the advantages of the multichannel dosimetry method. This is particularly important for measuring high doses at high spatial resolutions.

[Dosimetric verification of MammoSite treatment plans using Monte Carlo simulations and measurements with a 2D ionization chamber array]

The surgical removal of a breast tumour is often followed by postoperative irradiation of the surrounding tissue with a radioactive source (brachytherapy). When performing the MammoSite procedure, a spherical silicone balloon is inserted and filled with a NaCl solution. In a period of about five days in several sessions an iridium-192 source with high activity travels through a catheter into the balloon (afterloading) to irradiate the tumour cells remaining in the cavity. In this study, dose distributions of a MammoSite applicator are investigated based on measurements with a 2D detector array, Monte Carlo simulations and calculations with BrachyVision. The focus is set on the 2D detector array and its possible application in the verification process in 3D brachytherapy treatment planning. The measured dose distributions conform well to the doses of BrachyVision with deviations of less than 5% within the clinically relevant field range. The deviations of the measured and calculated distributions from the simulation results are below 3%. The 2D detector array allows a new verification method for MammoSite treatment plans with sufficient accuracy. Future verifications can be performed without additional Monte Carlo simulations.

Gafchromic EBT3 film dosimetry in electron beams - energy dependence and improved film read-out

For megavoltage photon radiation, the fundamental dosimetry characteristics of Gafchromic EBT3 film were determined in 60Co gamma ray beam with addition of experimental and Monte Carlo (MC)-simulated energy dependence of the film for 6 MV photon beam and 6 MeV, 9 MeV, 12 MeV, and 16 MeV electron beams in water phantom. For the film read-out, two phase correction of scanner sensitivity was applied: a matrix correction for scanning area and dose-dependent correction by iterative procedure. With these corrections, the uniformity of response can be improved to be within ± 50 pixel values (PVs). To improve the read-out accuracy, a procedure with flipped film orientations was established. With the method, scanner uniformity can be improved further and dust particles, scratches and/or dirt on scan-ner glass can be detected and eliminated. Responses from red and green channels were averaged for read-out, which decreased the effect of noise present in values from separate channels. Since the signal level with the blue channel is considerably lower than with other channels, the signal variation due to different perturbation effects increases the noise level so that the blue channel is not recommended to be used for dose determination. However, the blue channel can be used for the detection of emulsion thickness variations for film quality evaluations with unexposed films. With electron beams ranging from 6 MeV to 16 MeV and at reference measurement conditions in water, the energy dependence of the EBT3 film is uniform within 0.5%, with uncertainties close to 1.6% (k = 2). Including 6 MV photon beam and the electron beams mentioned, the energy dependence is within 1.1%. No notable differences were found between the experimental and MC-simulated responses, indicating negligible change in intrinsic energy dependence of the EBT3 film for 6 MV photon beam and 6 MeV-16 MeV electron beams. Based on the dosimetric characteristics of the EBT3 film, the read-out procedure established, the nearly uniform energy dependence found and the estimated uncertainties, the EBT3 film was concluded to be a suitable 2D dosimeter for measuring electron or mixed photon/electron dose distributions in water phantom. Uncertainties of 3.7% (k = 2) for absolute and 2.3% (k = 2) for relative dose were estimated.

Anthropomorphic phantom to investigate the bladder dose in gynecological high-dose-rate brachytherapy

PURPOSE

This study presents a prototype of a phantom appropriate for experimental bladder dosimetry. This work presents details of the phantom construction and dosimetric results obtained using radiochromic film and optically stimulated luminescence dosimeters (OSLDs).

METHODS AND MATERIALS

The phantom was constructed of polymethyl methacrylate. Two artificial bladders were three-dimensional printed using previous computed tomography images. Radiochromic films and OSLDs were positioned on the artificial bladder walls, and the applicators were placed according to the original computed tomography image.

RESULTS

The prototype phantom simulated the behavior of the dose on the bladder surface, enabling bladder movement in all directions. The dosimetric study that was performed using radiochromic film and OSLDs exhibited concordance, in most cases, with the results obtained from the planning system.

CONCLUSIONS

The methodology presented offers conditions for researchers to investigate more accurately the behavior of the dose on the bladder surface during intracavitary brachytherapy procedures.

Evaluation and mitigation of potential errors in radiochromic film dosimetry due to film curvature at scanning

This work considers a previously overlooked uncertainty present in film dosimetry which results from moderate curvature of films during the scanning process. Small film samples are particularly susceptible to film curling which may be undetected or deemed insignificant. In this study, we consider test cases with controlled induced curvature of film and with film raised horizontally above the scanner plate. We also evaluate the difference in scans of a film irradiated with a typical brachytherapy dose distribution with the film naturally curved and with the film held flat on the scanner. Typical naturally occurring curvature of film at scanning, giving rise to a maximum height 1 to 2 mm above the scan plane, may introduce dose errors of 1% to 4%, and considerably reduce gamma evaluation passing rates when comparing film‐measured doses with treatment planning system‐calculated dose distributions, a common application of film dosimetry in radiotherapy. The use of a triple‐channel dosimetry algorithm appeared to mitigate the error due to film curvature compared to conventional single‐channel film dosimetry. The change in pixel value and calibrated reported dose with film curling or height above the scanner plate may be due to variations in illumination characteristics, optical disturbances, or a Callier‐type effect. There is a clear requirement for physically flat films at scanning to avoid the introduction of a substantial error source in film dosimetry. Particularly for small film samples, a compression glass plate above the film is recommended to ensure flat‐film scanning. This effect has been overlooked to date in the literature.

PACS numbers: 87.55.Qr, 87.56.bg, 87.55.km

Quality Assurance of a 50-kV Radiotherapy Unit Using EBT3 GafChromic Film

Purpose:

Radiochromic EBT3 film is gaining acceptance as a valuable dosimetry system for high-energy photon beams. The advantages of these films over other dosimetry systems are low spectral sensitivity and high spatial resolution. The aim of this study was to validate EBT3 film as a dosimeter for machine and treatment quality assurance (QA) of a 50-kV radiotherapy unit.

Methods and Materials:

Absolute and relative doses were acquired using EBT3 GafChromic films and compared to a parallel-plate ionization chamber (IC), the standard IC for low-energy X-rays. EBT3 was also used to evaluate beam profiles and output factors. Two films above each other, mimicking the clinical situation of a dosimeter on top of the skin, were simultaneously irradiated to evaluate EBT3 as in vivo dosimeter. All films were irradiated for 3 minutes, which corresponds with a surface dose of 3.25 ± 0.07 Gy.

Results:

A fifth-order polynomial function was found to be the best fit for the calibration curves. Good agreement between IC and EBT3 was found for absolute (0.92% for green and red color channels) and relative (1.2% and 1.0% for green and red color channels, respectively) dosimetry. Output factors for IC and EBT3 were comparable within 2.04% and 1.02% for the green and red color channels, respectively. Flatness and symmetry at the surface were within 2%. By applying film as in vivo dosimeter, an absorption of 4.70% needs to be taken into account with respect to the surface dose.

Conclusion:

EBT3 GafChromic film is a feasible and valuable QA and dosimetry tool for a 50-kV radiotherapy unit. EBT3 can be used for absolute and relative dosimetry, measurement of output factors and beam profiles. In vivo patient-specific QA can also be performed if one corrects for the dose absorption of the film.

Optimising treatment distance and treatment area for HDR surface mould brachytherapy

The purpose of this study was to quantify the effect of treatment area and treatment distance on dose distributions for geometrically optimised surface mould plans in order to provide guidance in choosing treatment parameters and constructing moulds for individual patients. Geometrically optimised plans were generated with a typical brachytherapy planning system and measurements were taken with radiochromic film over depths of 5-32 mm with an (192)Ir high dose rate source. Films were calibrated with a cylindrical geometry technique utilising the (192)Ir source and readout was performed with a flatbed scanner. The rate of dose fall-off about the prescription plane, as well as the magnitude and extent of local dose maxima superficial to the prescription plane, increased with decreasing treatment areas when inter-catheter spacing and treatment distance were kept constant. The dose fall-off was highly dependent on treatment distance, with a 16 % reduction in dose 4 mm superficial to the treatment depth occurring when the distance was increased from 10 to 20 mm while maintaining a 10 mm inter-catheter spacing. The table generated using the measured planar geometry data, can be used as an initial guide for mould construction and planning. The properties of high dose regions near to the catheter plane are highly dependent on the treatment area, which must be considered when normal tissue dose tolerances are a concern. Treatment distance is a key variable influencing the overall dose distribution and should be adjusted as a function of the desired tumour to skin dose ratio, controlled by mould thickness.

Comparison of methods for the measurement of radiation dose distributions in high dose rate (HDR) brachytherapy: Ge-doped optical fiber, EBT3 Gafchromic film, and PRESAGE® radiochromic plastic

PURPOSE

Dose distribution measurement in clinical high dose rate (HDR) brachytherapy is challenging, because of the high dose gradients, large dose variations, and small scale, but it is essential to verify accurate treatment planning and treatment equipment performance. The authors compare and evaluate three dosimetry systems for potential use in brachytherapy dose distribution measurement: Ge-doped optical fibers, EBT3 Gafchromic film with multichannel analysis, and the radiochromic material PRESAGE(®) with optical-CT readout.

METHODS

Ge-doped SiO2 fibers with 6 μm active core and 5.0 mm length were sensitivity-batched and their thermoluminescent properties used via conventional heating and annealing cycles. EBT3 Gafchromic film of 30 μm active thickness was calibrated in three color channels using a nominal 6 MV linear accelerator. A 48-bit transmission scanner and advanced multichannel analysis method were utilized to derive dose measurements. Samples of the solid radiochromic polymer PRESAGE(®), 60 mm diameter and 100 mm height, were analyzed with a parallel beam optical CT scanner. Each dosimetry system was used to measure the dose as a function of radial distance from a Co-60 HDR source, with results compared to Monte Carlo TG-43 model data. Each system was then used to measure the dose distribution along one or more lines through typical clinical dose distributions for cervix brachytherapy, with results compared to treatment planning system (TPS) calculations. Purpose-designed test objects constructed of Solid Water and held within a full-scatter water tank were utilized.

RESULTS

All three dosimetry systems reproduced the general shape of the isolated source radial dose function and the TPS dose distribution. However, the dynamic range of EBT3 exceeded those of doped optical fibers and PRESAGE(®), and the latter two suffered from unacceptable noise and artifact. For the experimental conditions used in this study, the useful range from an isolated HDR source was 5-40 mm for fibers, 3-50 mm for EBT3, and 4-21 mm for PRESAGE(®). Fibers demonstrated some over-response at very low dose levels, suffered from volume averaging effects in the dose distribution measurement, and exhibited up to 9% repeatability variation over three repeated measurements. EBT3 demonstrated excellent agreement with Monte Carlo and TPS dose distributions, with up to 3% repeatability over three measurements. PRESAGE(®) gave promising results, being the only true 3D dosimeter, but artifacts and noise were apparent.

CONCLUSIONS

The comparative response of three emerging dosimetry systems for clinical brachytherapy dose distribution measurement has been investigated. Ge-doped optical fibers have excellent spatial resolution for single-direction measurement but are currently too large for complex dose distribution assessment. The use of PRESAGE(®) with optical-CT readout gave promising results in the measurement of true 3D dose distributions but further development work is required to reduce noise and improve dynamic range for brachytherapy dose distribution measurements. EBT3 Gafchromic film with multichannel analysis demonstrated accurate and reproducible measurement of dose distributions in HDR brachytherapy. Calibrated dose measurements were possible with agreement within 1.5% of TPS dose calculations. The suitability of EBT3 as a dosimeter for 2D quality control or commissioning work has been demonstrated.