Clarification of the AAPM Task Group 21 protocol

Advances in the determination of absorbed dose to water in clinical high-energy photon and electron beams using ionization chambers

During the last two decades, absorbed dose to water in clinical photon and electron beams was determined using dosimetry protocols and codes of practice based on radiation metrology standards of air kerma. It is now recommended that clinical reference dosimetry be based on standards of absorbed dose to water. Newer protocols for the dosimetry of radiotherapy beams, based on the use of an ionization chamber calibrated in terms of absorbed dose to water, N(D,w), in a standards laboratory's reference quality beam, have been published by several national or regional scientific societies and international organizations. Since the publication of these protocols multiple theoretical and experimental dosimetry comparisons between the various N(D,w) based recommendations, and between the N(D,w) and the former air kerma (NK) based protocols, have been published. This paper provides a comprehensive review of the dosimetry protocols based on these standards and of the intercomparisons of the different protocols published in the literature, discussing the reasons for the observed discrepancies between them. A summary of the various types of standards of absorbed dose to water, together with an analysis of the uncertainties along the various steps of the dosimetry chain for the two types of formalism, is also included. It is emphasized that the NK-N(D,air) and N(D,w) formalisms have very similar uncertainty when the same criteria are used for both procedures. Arguments are provided in support of the recommendation for a change in reference dosimetry based on standards of absorbed dose to water.

Calculated absorbed-dose ratios, TG51/TG21, for most widely used cylindrical and parallel-plate ion chambers over a range of photon and electron energies

Task Group 51 (TG51), of the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM), has developed a calibration protocol for high-energy photon and electron therapy beams based on absorbed dose standards. This protocol is intended to replace the air-kerma based protocol developed by an earlier AAPM task group (TG21). Conversion to the newer protocol introduces a change in the determined absorbed dose. In this work, the change in dose is expressed as the ratio of the doses (TG51/TG21) based on the two protocols. Dose is compared at the TG-51 reference depths of 10 cm for photons and d(ref) for electrons. Dose ratios are presented for a variety of ion chambers over a range of photon and electron energies. The TG51/TG21 dose ratios presented here are based on the dosimetry factors provided by the two protocols and the chamber-specific absorbed dose and exposure calibration factors (N60Co(D,w) and Nx) provided by the Accredited Dosimetry Calibration Laboratory (ADCL) at The University of Texas, M. D. Anderson Cancer Center (MDACC). As such, the values presented here represent the expected discrepancies between the two protocols due only to changes in the dosimetry parameters and the differences in chamber-specific dose and air-kerma standards. These values are independent of factors such as measurement uncertainties, setup errors, and inconsistencies arising from the mix of different phantoms and ion chambers for the two protocols. Therefore, these ratios may serve as a guide for institutions performing measurements for the switch from TG21-to-TG51 based calibration. Any significant deviation in the ratio obtained from measurements versus those presented here should prompt a review to identify possible errors and inconsistencies. For all cylindrical chambers included here, the TG51/TG21 dose ratios are the same within +/-0.6%, irrespective of the make and model of the chamber, for each photon and electron beam included. Photon beams show the TG51/TG21 dose ratios decreasing with energy, whereas electrons exhibit the opposite trend. The dose ratio for photons is near 1.00 at 18 mV increasing to near 1.01 at 4 mV while the dose ratio for electrons is near 1.02 at 20 MeV decreasing only 0.5% to near 1.015 at 6 MeV. For parallel-plate chambers, the situation is complicated by the two possible methods of obtaining calibration factors: through an ADCL or through a cross-comparison with a cylindrical chamber in a high-energy electron beam. For some chambers, the two methods lead to significantly different calibration factors, which in turn lead to significantly different TG51/TG21 results for the same chamber. Data show that if both N60Co(D,w) and Nx are obtained from the same source, namely an ADCL or a cross comparison, the TG51/TG21 results for parallel-plate chambers are similar to those for cylindrical chambers. However, an inconsistent set of calibration factors, i.e., using N60Co(D,w) x k(ecal) from an ADCL but Ngas from a cross comparison or vice versa, can introduce an additional uncertainty up to 2.5% in the TG51/TG21 dose ratios.

Proton beam dosimetry for radiosurgery: implementation of the ICRU Report 59 at the Harvard Cyclotron Laboratory

Recent proton dosimetry intercomparisons have demonstrated that the adoption of a common protocol, e.g. ICRU Report 59, can lead to improved consistency in absorbed dose determinations. We compared absorbed dose values, measured in the 160 MeV proton radiosurgery beamline at the Harvard Cyclotron Laboratory, based on ionization chamber methods with those from a Faraday cup technique. The Faraday cup method is based on a proton fluence determination that allows the estimation of absorbed dose with the CEMA approximation, under which the dose is equal to the fluence times the mean mass stopping power. The ionization chamber technique employs an air-kerma calibration coefficient for 60Co radiation and a calculated correction in order to take into account the differences in response to 60Co and proton beam radiations. The absorbed dose to water, based on a diode measurement calibrated with a Faraday cup technique, is approximately 2% higher than was obtained from an ionization chamber measurement. At the Bragg peak depth, the techniques agree to within their respective uncertainties, which are both approximately 4% (1 standard deviation). The ionization chamber technique exhibited superior reproducibility and was adopted in our standard clinical practice for radiosurgery.

Absorbed dose to water based dosimetry versus air kerma based dosimetry for high-energy photon beams: an experimental study

In recent years, a change has been proposed from air kerma based reference dosimetry to absorbed dose based reference dosimetry for all radiotherapy beams of ionizing radiation. In this paper, a dosimetry study is presented in which absorbed dose based dosimetry using recently developed formalisms was compared with air kerma based dosimetry using older formalisms. Three ionization chambers of each of three different types were calibrated in terms of absorbed dose to water and air kerma and sent to five hospitals. There, reference dosimetry with all the chambers was performed in a total of eight high-energy clinical photon beams. The selected chamber types were the NE2571, the PTW-30004 and the Wellhöfer-FC65G (previously Wellhöfer-IC70). Having a graphite wall, they exhibit a stable volume and the presence of an aluminium electrode ensures the robustness of these chambers. The data were analysed with the most important recommendations for clinical dosimetry: IAEA TRS-398, AAPM TG-51, IAEA TRS-277, NCS report-2 (presently recommended in Belgium) and AAPM TG-21. The necessary conversion factors were taken from those protocols, or calculated using the data in the different protocols if data for a chamber type are lacking. Polarity corrections were within 0.1% for all chambers in all beams. Recombination corrections were consistent with theoretical predictions, did not vary within a chamber type and only slightly between different chamber types. The maximum chamber-to-chamber variations of the dose obtained with the different formalisms within the same chamber type were between 0.2% and 0.6% for the NE2571, between 0.2% and 0.6% for the PTW-30004 and 0.1% and 0.3% for the Wellhöfer-FC65G for the different beams. The absorbed dose results for the NE2571 and Wellhöfer-FC65G chambers were in good agreement for all beams and all formalisms. The PTW-30004 chambers gave a small but systematically higher result compared to the result for the NE2571 chambers (on the average 0.1% for IAEA TRS-277, 0.3% for NCS report-2 and AAPM TG-21 and 0.4% for IAEA TRS-398 and AAPM TG-51). Within the air kerma based protocols, the results obtained with the TG-21 protocol were 0.4-0.8% higher mainly due to the differences in the data used. Both absorbed dose to water based formalisms resulted in consistent values within 0.3%. The change from old to new formalisms is discussed together with the traceability of calibration factors obtained at the primary absorbed dose and air kerma standards in the reference beams (60Co). For the particular situation in Belgium (calibrations at the Laboratory for Standard Dosimetry of Ghent) the change amounts to 0.1-0.6%. This is similar to the magnitude of the change determined in other countries.

Comparison of the IAEA TRS-398 and AAPM TG-51 absorbed dose to water protocols in the dosimetry of high-energy photon and electron beams

The International Atomic Energy Agency (IAEA TRS-398) and the American Association of Physicists in Medicine (AAPM TG-51) have published new protocols for the calibration of radiotherapy beams. These protocols are based on the use of an ionization chamber calibrated in terms of absorbed dose to water in a standards laboratory's reference quality beam. This paper compares the recommendations of the two protocols in two ways: (i) by analysing in detail the differences in the basic data included in the two protocols for photon and electron beam dosimetry and (ii) by performing measurements in clinical photon and electron beams and determining the absorbed dose to water following the recommendations of the two protocols. Measurements were made with two Farmer-type ionization chambers and three plane-parallel ionization chamber types in 6, 18 and 25 MV photon beams and 6, 8, 10, 12, 15 and 18 MeV electron beams. The Farmer-type chambers used were NE 2571 and PTW 30001, and the plane-parallel chambers were a Scanditronix-Wellhöfer NACP and Roos, and a PTW Markus chamber. For photon beams, the measured ratios TG-51/TRS-398 of absorbed dose to water Dw ranged between 0.997 and 1.001, with a mean value of 0.999. The ratios for the beam quality correction factors kQ were found to agree to within about +/-0.2% despite significant differences in the method of beam quality specification for photon beams and in the basic data entering into kQ. For electron beams, dose measurements were made using direct N(D,w) calibrations of cylindrical and plane-parallel chambers in a 60Co gamma-ray beam, as well as cross-calibrations of plane-parallel chambers in a high-energy electron beam. For the direct N(D,w) calibrations the ratios TG-51/TRS-398 of absorbed dose to water Dw were found to lie between 0.994 and 1.018 depending upon the chamber and electron beam energy used, with mean values of 0.996, 1.006, and 1.017, respectively, for the cylindrical, well-guarded and not well-guarded plane-parallel chambers. The Dw ratios measured for the cross-calibration procedures varied between 0.993 and 0.997. The largest discrepancies for electron beams between the two protocols arise from the use of different data for the perturbation correction factors p(wall) and p(dis) of cylindrical and plane-parallel chambers, all in 60Co. A detailed analysis of the reasons for the discrepancies is made which includes comparing the formalisms, correction factors and the quantities in the two protocols.

Reference dosimetry in clinical high-energy photon beams: comparison of the AAPM TG-51 and AAPM TG-21 dosimetry protocols

Task Group 51 (TG-51) of the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM) has recently developed a new protocol for the calibration of high-energy photon and electron beams used in radiation therapy. The formalism and the dosimetry procedures recommended in this protocol are based on the use of an ionization chamber calibrated in terms of absorbed dose-to-water in a standards laboratory's 60Co gamma ray beam. This is different from the recommendations given in the AAPM TG-21 protocol, which are based on an exposure calibration factor of an ionization chamber in a 60Co beam. The purpose of this work is to compare the determination of absorbed dose-to-water in reference conditions in high-energy photon beams following the recommendations given in the two dosimetry protocols. This is realized by performing calibrations of photon beams with nominal accelerating potential of 6, 18 and 25 MV, generated by an Elekta MLCi and SL25 series linear accelerator. Two widely used Farmer-type ionization chambers having different composition, PTW 30001 (PMMA wall) and NE 2571 (graphite wall), were used for this study. Ratios of AAPM TG-51 to AAPM TG-21 doses to water are found to be 1.008, 1.007 and 1.009 at 6, 18 and 25 MV, respectively when the PTW chamber is used. The corresponding results for the NE chamber are 1.009, 1.010 and 1.013. The uncertainties for the ratios of the absorbed dose determined by the two protocols are estimated to be about 1.5%. A detailed analysis of the reasons for the discrepancies is made which includes comparing the formalisms, correction factors and quantities in the two protocols, as well as the influence of the implementation of the different standards for chamber calibration. The latter has been found to have a considerable influence on the differences in clinical dosimetry, even larger than the adoption of the new data and recommended procedures, as most intrinsic differences cancel out due to the adoption of the new formalism.

Absorbed-dose beam quality conversion factors for cylindrical chambers in high energy photon beams

Recent working groups of the AAPM [Almond et al., Med. Phys. 26, 1847 (1999)] and the IAEA (Andreo et al., Draft V.7 of "An International Code of Practice for Dosimetry based on Standards of Absorbed Dose to Water," IAEA, 2000) have described guidelines to base reference dosimetry of high energy photon beams on absorbed dose to water standards. In these protocols use is made of the absorbed-dose beam quality conversion factor, kQ which scales an absorbed-dose calibration factor at the reference quality 60Co to a quality Q, and which is calculated based on state-of-the-art ion chamber theory and data. In this paper we present the measurement and analysis of beam quality conversion factors kQ for cylindrical chambers in high-energy photon beams. At least three chambers of six different types were calibrated against the Canadian primary standard for absorbed dose based on a sealed water calorimeter at 60Co [TPR10(20)=0.572, %dd(10)x=58.4], 10 MV [TPR10(20)=0.682, %dd(10)x=69.6), 20 MV (TPR10(20)=0.758, %dd(10)x= 80.5] and 30 MV [TPR10(20) = 0.794, %dd(10)x= 88.4]. The uncertainty on the calorimetric determination of kQ for a single chamber is typically 0.36% and the overall 1sigma uncertainty on a set of chambers of the same type is typically 0.45%. The maximum deviation between a measured kQ and the TG-51 protocol value is 0.8%. The overall rms deviation between measurement and the TG-51 values, based on 20 chambers at the three energies, is 0.41%. When the effect of a 1 mm PMMA waterproofing sleeve is taken into account in the calculations, the maximum deviation is 1.1% and the overall rms deviation between measurement and calculation 0.48%. When the beam is specified using TPR10(20), and measurements are compared with kQ values calculated using the version of TG-21 with corrected formalism and data, differences are up to 1.6% when no sleeve corrections are taken into account. For the NE2571 and the NE2611A chamber types, for which the most literature data are available, using %dd(10)x, all published data show a spread of 0.4% and 0.6%, respectively, over the entire measurement range, compared to spreads of up to 1.1% for both chambers when the kQ values are expressed as a function of TPR10(20). For the PR06-C chamber no clear preference of beam quality specifier could be identified. When comparing the differences of our kQ measurements and calculations with an analysis in terms of air-kerma protocols with the same underlying calculations but expressed in terms of a compound conversion factor CQ, we observe that a system making use of absorbed-dose calibrations and calculated kQ values, is more accurate than a system based on air-kerma calibrations in combination with calculated CQ (rms deviation of 0.48% versus 0.67%, respectively).

Determination of the air w-value in proton beams using ionization chambers with gas flow capability

The purpose of this work was to determine the w-value of air for protons using the paired gas method. Several plastic- and magnesium-walled chambers were used with air, synthetic air, nitrogen, and argon flowing gases. Using argon as a reference gas, the w-value of air was measured and ranged from 32.7 to 34.5 J/C for protons with energies encountered in radiotherapy. Using nitrogen as a reference gas, the w-value of air ranged from 35.2 to 35.4 J/C over the same range of proton energies. The w-value was found, at a given energy, to be independent of the ion chamber used. The uncertainty in these measurements was estimated at 5.2% at the 2sigma level. This uncertainty was dominated by the 4.4% uncertainty in the w-value of the reference gas.

Comparison of dosimetry calibration factors at the NRCC and the NIST. National Research Council of Canada. National Institute of Standards and Technology

In early 1998, three transfer ionization chambers were used to compare the air-kerma and absorbed-dose-to-water calibration factors measured by the National Research Council of Canada (NRCC) and the National Institute of Standards and Technology (NIST). The ratios between the NRCC and NIST calibration factors are 0.9950 and 1.0061 in the case of the absorbed-dose-to-water and air-kerma standards, respectively. In the case of the standard of absorbed dose to water, the combined uncertainty of the ratio between the standards of the two laboratories is about 0.6% and consequently, the observed difference of 0.5% is not significant at the one sigma level. In the case of the standard of air kerma, the combined uncertainty of the ratio between the standards of the two laboratories is about 0.4%, and so the observed difference of 0.61% is significant at the one sigma level. However, this discrepancy is due to the known differences in the methods of assessing the wall correction factor at the two laboratories. Taking into account changes implemented in the standards that form the basis of the calibrations, the present results are consistent with those of the previous comparison done in 1990/91. As a direct result of these differences in the calibration factors, changing from an air-kerma based protocol following TG-21 to an absorbed-dose-to-water based protocol following TG-51, would alter the relationship between clinical dosimetry in Canada and the United States by about 1%. For clinical reference dosimetry, the change from TG-21 to TG-51 could result in an increase of up to 2% depending upon the ion chamber used, the details of the protocol followed and the source of traceability, either NRCC or NIST.

Clinical reference dosimetry: comparison between AAPM TG-21 and TG-51 protocols

We compare the results of absorbed dose determined at reference conditions according to the AAPM TG-21 dose calibration protocol and the new AAPM TG-51 protocol. The AAPM TG-21 protocol for absorbed dose calibration is based on ionization chambers having exposure calibration factors for 60Co gamma rays, N(x). The new AAPM TG-51 dosimetry protocol for absorbed dose calibration is based on ionization chambers having 60Co absorbed dose-to-water calibration factor, N60Co(D,w). This study shows that the dose changes are within 1% for a cobalt beam, 0.5% for photon energies of 6 and 18 MV, and 2%-3% for electron beams with energies of 6 to 20 MeV. The chamber primary calibration factors, Nx and N60Co(D,w), are traceable to the Canadian primary standards laboratory (NRCC). We also present estimated dose changes between the two protocols when calibration factors are traceable to NIST in the United States.

Comparison between TG-51 and TG-21: Calibration of photon and electron beams in water using cylindrical chambers

A new calibration protocol, developed by the AAPM Task Group 51 (TG-51) to replace the TG-21 protocol, is based on an absorbed-dose to water standard and calibration factor (N(D,w)), while the TG-21 protocol is based on an exposure (or air-kerma) standard and calibration factor (N(x)). Because of differences between these standards and the two protocols, the results of clinical reference dosimetry based on TG-51 may be somewhat different from those based on TG-21. The Radiological Physics Center has conducted a systematic comparison between the two protocols, in which photon and electron beam outputs following both protocols were compared under identical conditions. Cylindrical chambers used in this study were selected from the list given in the TG-51 report, covering the majority of current manufacturers. Measured ratios between absorbed-dose and air-kerma calibration factors, derived from the standards traceable to the NIST, were compared with calculated values using the TG-21 protocol. The comparison suggests that there is roughly a 1% discrepancy between measured and calculated ratios. This discrepancy may provide a reasonable measure of possible changes between the absorbed-dose to water determined by TG-51 and that determined by TG-21 for photon beam calibrations. The typical change in a 6 MV photon beam calibration following the implementation of the TG-51 protocol was about 1%, regardless of the chamber used, and the change was somewhat smaller for an 18 MV photon beam. On the other hand, the results for 9 and 16 MeV electron beams show larger changes up to 2%, perhaps because of the updated electron stopping power data used for the TG-51 protocol, in addition to the inherent 1% discrepancy presented in the calibration factors. The results also indicate that the changes may be dependent on the electron energy.

Saturation current and collection efficiency for ionization chambers in pulsed beams

Saturation currents and collection efficiencies in ionization chambers exposed to pulsed megavoltage photon and electron beams are determined assuming a linear relationship between 1/I and 1/V in the extreme near-saturation region, with I and V the chamber current and polarizing voltage, respectively. Careful measurements of chamber current against polarizing voltage in the extreme near-saturation region reveal a current rising faster than that predicted by the linear relationship. This excess current combined with conventional "two-voltage" technique for determination of collection efficiency may result in an up to 0.7% overestimate of the saturation current for standard radiation field sizes of 10X10 cm2. The measured excess current is attributed to charge multiplication in the chamber air volume and to radiation-induced conductivity in the stem of the chamber (stem effect). These effects may be accounted for by an exponential term used in conjunction with Boag's equation for collection efficiency in pulsed beams. The semiempirical model follows the experimental data well and accounts for both the charge recombination as well as for the charge multiplication effects and the chamber stem effect.

Dosimetry of a W-188/Re-188 beta line source for endovascular brachytherapy

PURPOSE

The objective was to determine the dosimetry of a potential endovascular brachytherapy source consisting of a coiled tungsten wire mounted on the distal end of a drive wire and neutron-activated to contain the parent-daughter nuclides tungsten-188 (188W) and rhenium-188 (188Re).

METHODS

A coiled tungsten wire 40 mm in length was neutron-activated by double-neutron capture for 78 hours at 1.9 x 10(15) h/cm2/s to contain 925 MBq (25 mCi) of 188W/188Re in equilibrium. The dose-fall off from this source was determined using three independent methods: (a) Thermoluminescence dosimetry with small LiF-100 rods, (b) Gafchromic film dosimetry, and (c) Bang gel dosimetry. In addition, a Monte Carlo simulation was performed to compute the beta-dose.

RESULTS

Each of the three measurement methods recorded similar values for the dose fall-off within the distances useful for endovascular brachytherapy. The Monte Carlo calculations closely approximated the measured results in the treatment range between 1 and 3 mm and may thus be useful for evaluating changing geometries in the development of catheters and source setups. A 2 min restenosis treatment delivering 20 Gy at a radius of 2 mm would require a source of 1384.8 MBq/cm (37.4 mCi/cm).

CONCLUSIONS

The dose distribution from a 188W/188Re source is similar to that of a 90Y-source. An added advantage of the 188W/188Re source is that it can be used for at least two months and still provides fast treatment times because of the parent isotope's half-life of 69 days. The additional gamma emission from the source is too small to impose a serious radiological hazard. The high atomic number and density of the source material allows direct fluoroscopic imaging without additional markers.

Dose model for a beta-emitting stent in a realistic artery consisting of soft tissue and plaque

A model for the description of the near-field dose deposition from a 32p impregnated stent in an arterial system consisting of soft tissue and dense plaque is presented. The model is based on the scaling property of the dose-point-kernel (DPK) function which is extended to a heterogeneous medium consisting of a series of layers of different materials. It is shown that, for each point source originating from the stent surface, the DPK function for water can be scaled consistently along the path through the different layers of material to predict the dose at a given point in the heterogeneous medium. Radiochromic film dosimetry on actual 32p stents is used to test the new model. The experimental setup consists of a water-equivalent phantom in which a stent is deployed and on which a thin layer of polytetrafluoroethylene (PTFE) is deposited to simulate the presence of plaque. Layers of radiochromic films stacked over the phantom are used to measure the dose at distances varying from approximately 0.1 mm to approximately 3 mm from the stent surface with and without PTFE. It is shown that the proposed new DPK model for a heterogeneous medium agrees very well with the experimental data and that it compares favorably to the usual homogeneous DPK model. These results indicate that the new model can be used with confidence to predict the dose in a realistic artery in the presence of plaque.

AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams

A protocol is prescribed for clinical reference dosimetry of external beam radiation therapy using photon beams with nominal energies between 60Co and 50 MV and electron beams with nominal energies between 4 and 50 MeV. The protocol was written by Task Group 51 (TG-51) of the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM) and has been formally approved by the AAPM for clinical use. The protocol uses ion chambers with absorbed-dose-to-water calibration factors, N(60Co)D,w which are traceable to national primary standards, and the equation D(Q)w = MkQN(60Co)D,w where Q is the beam quality of the clinical beam, D(Q)w is the absorbed dose to water at the point of measurement of the ion chamber placed under reference conditions, M is the fully corrected ion chamber reading, and kQ is the quality conversion factor which converts the calibration factor for a 60Co beam to that for a beam of quality Q. Values of kQ are presented as a function of Q for many ion chambers. The value of M is given by M = PionP(TP)PelecPpolMraw, where Mraw is the raw, uncorrected ion chamber reading and Pion corrects for ion recombination, P(TP) for temperature and pressure variations, Pelec for inaccuracy of the electrometer if calibrated separately, and Ppol for chamber polarity effects. Beam quality, Q, is specified (i) for photon beams, by %dd(10)x, the photon component of the percentage depth dose at 10 cm depth for a field size of 10x10 cm2 on the surface of a phantom at an SSD of 100 cm and (ii) for electron beams, by R50, the depth at which the absorbed-dose falls to 50% of the maximum dose in a beam with field size > or =10x10 cm2 on the surface of the phantom (> or =20x20 cm2 for R50>8.5 cm) at an SSD of 100 cm. R50 is determined directly from the measured value of I50, the depth at which the ionization falls to 50% of its maximum value. All clinical reference dosimetry is performed in a water phantom. The reference depth for calibration purposes is 10 cm for photon beams and 0.6R50-0.1 cm for electron beams. For photon beams clinical reference dosimetry is performed in either an SSD or SAD setup with a 10x10 cm2 field size defined on the phantom surface for an SSD setup or at the depth of the detector for an SAD setup. For electron beams clinical reference dosimetry is performed with a field size of > or =10x10 cm2 (> or =20x20 cm2 for R50>8.5 cm) at an SSD between 90 and 110 cm. This protocol represents a major simplification compared to the AAPM's TG-21 protocol in the sense that large tables of stopping-power ratios and mass-energy absorption coefficients are not needed and the user does not need to calculate any theoretical dosimetry factors. Worksheets for various situations are presented along with a list of equipment required.

Determination of saturation charge and collection efficiency for ionization chambers in continuous beams

The procedure recommended by radiation dosimetry protocols for determining the collection efficiency f of an ionization chamber assumes the predominance of general recombination and ignores other charge loss mechanisms such as initial recombination and ionic diffusion. For continuous radiation beams, general recombination theory predicts that f can be determined from a linear relationship between 1/Q and 1/V2 in the near saturation region (f > 0.7), where Q is the measured charge and V the applied chamber potential. Measurements with Farmer-type cylindrical ionization chambers exposed to cobalt-60 gamma rays reveal that the assumed linear relationship between 1/Q and 1/V2 breaks down in the extreme near-saturation region (f > 0.99) where Q increases with V at a rate exceeding the predictions of general recombination theory. A comprehensive model is developed to describe the saturation characteristics of ionization chambers. The model accounts for dosimetric charge loss (initial recombination, ionic diffusion, and general recombination) and nondosimetric charge multiplication in an ionization chamber, and suggests that charge multiplication plays a significant role under typical chamber operating conditions (300 V) used in radiation dosimetry. Through exclusion of charge multiplication from the measured chamber signal Q, the model predicts the breakdown of the 1/Q vs 1/V2 relationship and shows that the final approach to saturation is governed by initial recombination and ionic diffusion which are characterized by a linear relationship between 1/Q and 1/V. Collection efficiencies calculated with this model differ by up to 0.4% from those determined through a rigorous application of general recombination theory alone.

Deduction of the air w value in a therapeutic proton beam

Utilization of air-filled ionization chambers with 60Co-based reference calibrations in proton dosimetry requires application of water to air stopping power ratios and the mean energy required to produce an ion pair (W or w). Accepted uncertainties in current w values for protons leads to a dosimetric uncertainty of 4 per cent when ionization chambers are employed to measure absorbed dose. For this reason, proton dosimetry protocols recommend the use of calorimetry as the absorbed dose standard. We used calorimetry in conjunction with an ionization chamber with 60Co reference calibrations to deduce the proton w value in the entrance region of a 250 MeV proton beam: 34.2 +/- 0.5 eV. Application of this w value, with its 1.5 per cent uncertainty, allows determination of dose in therapeutic proton beams, with uncertainties comparable to photon and electron values.

Total skin electron therapy: a technique which can be implemented on a conventional electron linear accelerator

PURPOSE

A technique for treating whole-body skin with an electron linear accelerator with nominal energies in the range 4-8 MeV is presented. Stationary fields at an extended source-skin distance are used with the patient treated in a reclined position.

METHODS AND MATERIALS

The relative beam data, absolute dosimetry measurements and the patient setup parameters are presented. The calculations required to correct for patient size are discussed.

RESULTS

The technique described uses a six field circumferential cycle, with longitudinally matched fields along the length of the patient. Treatment times are reasonable using the standard dose rate of the machine. The uniformity of the skin dose measured on three patients was found to be comparable to that of other total skin treatment techniques.

CONCLUSION

A technique for treating conditions like mycosis fungoides is presented requiring relatively simple supporting dosimetry. No modifications to the unit are required and no sophisticated treatment apparatus is necessary, which makes the technique attractive to smaller Institutions, especially in developing countries, where technical support may be limited.

The status of high-energy photon and electron beam dosimetry five years after the implementation of the IAEA Code of Practice in the Nordic countries

The status of the dosimetry of high-energy photon and electron beams is analysed, taking into account the main developments in the field since the implementation of the IAEA Code of Practice in the Nordic countries. In electron beam dosimetry, energy-range relationships are discussed; Monte-Carlo results with different codes are compared with the experimentally derived empirical expression used in most protocols. Updated calculations of water-to-air stopping-power ratios following the changes in the Monte-Carlo code used to compute actual Sw,air values are compared with the data included in most dosimetry protocols. The validity of the commonly used procedure to select stopping-power ratios for a clinical beam from the mean energy at the phantom surface and the depth of measurement, is analysed for 'realistic' electron beams. In photon beam dosimetry, calculated correction factors including the effect of the wall plus waterproofing sleeve and existing data on the shift of the effective point of measurement of an ionization chamber, are discussed. New calculations of medium-to-air stopping-power ratios and their correlation with the quality of the beam obtained from the convolution of Monte-Carlo kernels are presented together with their possible practical implications in dosimetry. Trends in Primary Standard Dosimetry Laboratories towards implementing calibrations in terms of absorbed dose to water are presented, emphasizing controversial proposals for the specification of photon beam qualities. Plane-parallel ionization chambers are discussed regarding aspects that affect determinations of absorbed dose, either through the different methods used for the calibration of these chambers or by means of correction factors. Recent studies on the effect of the central electrode in Farmer-type cylindrical chambers are described.

A formulation for high-energy photon and electron beam dosimetry

A formalism is derived to estimate the absorbed dose to a medium irradiated by high-energy photon and electron beams using an ionization chamber calibrated in terms of the exposure and this is compared with those in particular NACP and AAPM protocols. The influence of the humidity in air on the response of the chamber is taken into account in combination with various correction factors. In the present proposal, the fundamental factors needed for converting the reading of a chamber, calibrated in exposure (or air kerma), into absorbed dose are calculated for dry air in the calibration beam. For the user's beam, correction factors depending on the atmospheric conditions prevailing in the laboratory are given.

Code of practice for clinical proton dosimetry

The objective of this document is to make recommendations for the determination of absorbed dose to tissue for clinical proton beams and to achieve uniformity in proton dosimetry. A Code of Practice has been chosen, providing specific guidelines for the choice of the detector and the method of determination of absorbed dose for proton beams only. This Code of Practice is confined specifically to the determination of absorbed dose and is not concerned with the biological effects of proton beams. It is recommended that dosimeters be calibrated by comparison with a calorimeter. If this is not available, a Faraday cup, or alternatively, an ionization chamber, with a 60Co calibration factor should be used. Physical parameters for determining the dose from tissue-equivalent ionization chamber measurements are given together with a worksheet. It is recommended that calibrations be carried out in water at the centre of the spread-out-Bragg-peak and that dose distributions be measured in a water phantom. It is estimated that the error in the calibrations will be less than +/- 5% (1 S.D.) in all cases. Adoption and implementation of this Code of Practice will facilitate the exchange of clinical information.

Radiation qualities of x-ray beams in cooperative clinical trials

X-ray beams are usually described by "MV" numbers which represent accelerating potentials (AP) and approximations to the maximum energies in the photon spectra. However, these numbers do not uniquely specify the properties of the beams. Current high energy photon dosimetry protocols specify radiation quality in terms of a measured ionization ratio which is equivalent to the ratio of the tissue-maximum ratios at depths 10 cm and 20 cm, for field size 10 cm X 10 cm [TMR)20(10]. For convenience, the American Association of Physicists in Medicine introduced a new parameter, known as the Nominal Accelerating Potential (NAP), which was derived from (TMR)20(10) and features values in MV units that are similar to those of the conventional accelerating potentials. (TMR)20(10) and Nominal Accelerating Potential may be considered to be expressions of the penetrating powers of x-ray beams. We determined (TMR)20(10) and Nominal Accelerating Potential for 460 treatment machines with stated accelerating potentials from 4 MV to 25 MV in the Quality Assurance Review Center's files of machine data from institutions that participate in cooperative clinical trials. The results demonstrate appreciable variability of the two parameters at each stated accelerating potential, with overlapping of adjacent groups of machines. It is concluded that the manufacturers' MV numbers do not reliably identify x-ray beams in terms of their depth dose properties. To promote standardization and consistency of energy specification in clinical trials as well as in general practice, we propose that x-ray beams be designated by their Nominal Accelerating Potential values as an adjunct to the use of (TMR)20(10) in radiation therapy.