End-to-end quality assurance for stereotactic radiotherapy with Fricke-Xylenol orange-Gelatin gel dosimeter and dual-wavelength cone-beam optical CT readout.

PURPOSE: The end-to-end (E2E) quality assurance (QA) test is a unique tool for validating the treatment chain undergone by patients in external radiotherapy. It should be conducted in three dimensions (3D) to get accurate results. This study aims to implement these tests with Fricke-Xylenol orange-Gelatin (FXG) gel dosimeter and a newly developed dual-wavelength reading method on the Vista16™ optical Computed Tomography (CT) scanner (ModusQA) for three treatment techniques in stereotactic radiotherapy, on Novalis (Varian) and CyberKnife (Accuray) linear accelerators. METHODS: The tests were performed in head phantoms. Gel measurements were compared with planned dose distributions and measured by film and ion chamber measurements by plotting isodose curves and dose profiles, and by conducting a 3D local gamma-index analysis (2%/2mm criteria). RESULTS: Gamma passing rates were higher than 95 %. Point dose differences between treatment planning and gel and ion chamber measurements at the isocenter were < 2.3 % for both treatments delivered on the Novalis accelerator, while this difference was higher than 4 % for the treatment delivered on the CyberKnife, highlighting a small overdosing of the tumor volume. A good agreement was observed between gel and film dose profiles. CONCLUSIONS: This study presents the successful implementation of 3D E2E QA tests for stereotactic radiotherapy with FXG gel dosimetry and a dual-wavelength reading method on an optical CT scanner. This dosimetric method provides 3D absolute dose distributions in the 0.25 - 10 Gy dose range with a high spatial resolution and a dose uncertainty of around 2 % (k=1).

Fricke-Xylenol orange-Gelatin gel characterization with dual wavelength cone-beam optical CT scanner for applications in stereotactic and dynamic radiotherapy.

PURPOSE: This study is about the development of a new dual wavelength reading method of Fricke-Xylenol orange-Gelatin (FXG) gel dosimeters on the Vista16™ optical Computed Tomography (CT) scanner to perform 3D dose distribution measurements in stereotactic and dynamic radiotherapy treatments. METHODS: The dosimetric characteristics of an optimized FXG gel composition and its optical CT readout have been evaluated. A dual wavelength reading method has been developed on the CT scanner at wavelengths 590 nm and 633 nm. Small-field dose profile measurements with FXG gel and microDiamond (PTW) detectors were compared by γ-index analysis (0.5%/0.5 mm) to validate this method. RESULTS: This reading method exhibits linear calibration curves in the 0-4 Gy and 2-10 Gy dose ranges at 590 nm and 633 nm respectively. The absorbed dose values below 4 Gy, measured at 590 nm, and those above 4 Gy, measured at 633 nm, are combined to plot a complete profile. A γ passing rate of 93.4% was achieved. CONCLUSIONS: The new reading method of FXG gel dosimeters has been implemented on the Vista16™ scanner to span absorbed doses representative of stereotactic and dynamic radiotherapy treatments and enable 3D measurements in tumor volumes and surrounding healthy tissues. Small-field profile measurements validated this reading method as FXG gel dosimeters and microDiamond detectors were in very close agreement. This dosimetric method is a promising candidate for 3D quality assurance end-to-end tests in stereotactic and dynamic radiotherapy.

Accuracy of skin dose mapping in interventional cardiology: Comparison of 10 software products following a common protocol.

PURPOSE: Online and offline software products can estimate the maximum skin dose (MSD) delivered to the patient during interventional cardiology procedures. The capabilities and accuracy of several skin dose mapping (SDM) software products were assessed on X-ray systems from the main manufacturers following a common protocol. METHODS: Skin dose was measured on four X-ray systems following a protocol composed of nine fundamental irradiation set-ups and three set-ups simulating short, clinical procedures. Dosimeters/multimeters with semiconductor-based detectors, radiochromic films and thermoluminescent dosimeters were used. Results were compared with up to eight of 10 SDM products, depending on their compatibility. RESULTS: The MSD estimates generally agreed with the measurements within ± 40% for fundamental irradiation set-ups and simulated procedures. Only three SDM products provided estimates within ± 40% for all tested configurations on at least one compatible X-ray system. No SDM product provided estimates within ± 40% for all combinations of configurations and compatible systems. The accuracy of the MSD estimate for lateral irradiations was variable and could be poor (up to 66% underestimation). Most SDM products produced maps which qualitatively represented the dimensions, the shape and the relative position of the MSD region. Some products, however, missed the MSD region when situated at the intersection of multiple fields, which is of radiation protection concern. CONCLUSIONS: It is very challenging to establish a common protocol for quality control (QC) and acceptance testing because not all information necessary for accurate MSD calculation is available or standardised in the radiation dose structured reports (RDSRs).

Activation of Collimators Irradiated With Clinical Proton Beams and Development of a Semiempirical Model for Activity Calculation.

Patient-specific collimators used in proton therapy are activated after use. The aim of this work is to assess the residual activity in brass collimators considering clinical beams, so far studied only for monoenergetic beams, and to develop a model to calculate the activity. Eight brass collimators irradiated with different clinical and monoenergetic beams were included in the study. The collimators were analyzed with gamma spectrometry in the framework of three independent studies carried out at the two French proton therapy sites. Using FLUKA (a fully integrated particle physics Monte Carlo simulation package), simulations were performed to determine radionuclides and activities for all the collimators. The semiempirical model was built using data calculated with FLUKA for a range of clinical beams (different maximum proton energies, modulations, and doses). It was found that there was global coherence in experimental results from different studies. The relevant radionuclides at 1 mo postirradiation were Co, Co, and Zn, and additionally, Mn, Co, and Co for high-energy beams. For nondegraded monoenergetic beams, differences between FLUKA and spectrometry were within those reported in reference benchmark studies (±30%). Due to the use of perfect monochromatic sources in the FLUKA model, FLUKA results systematically underestimated experimental activities for clinical beams, especially for Zn, depending on the beam energy spread (modulation, degradation, beam line characteristics). To account for the energy spread, correction factors were derived for the semiempirical model. The model is applicable to the most relevant radionuclides and total amounts. Secondary neutrons have a negligible contribution to the activity during treatment with respect to proton activation.

EURADOS intercomparison exercise on Monte Carlo modelling of a medical linear accelerator.

BACKGROUND: In radiotherapy, Monte Carlo (MC) methods are considered a gold standard to calculate accurate dose distributions, particularly in heterogeneous tissues. EURADOS organized an international comparison with six participants applying different MC models to a real medical linear accelerator and to one homogeneous and four heterogeneous dosimetric phantoms. AIMS: The aim of this exercise was to identify, by comparison of different MC models with a complete experimental dataset, critical aspects useful for MC users to build and calibrate a simulation and perform a dosimetric analysis. RESULTS: Results show on average a good agreement between simulated and experimental data. However, some significant differences have been observed especially in presence of heterogeneities. Moreover, the results are critically dependent on the different choices of the initial electron source parameters. CONCLUSIONS: This intercomparison allowed the participants to identify some critical issues in MC modelling of a medical linear accelerator. Therefore, the complete experimental dataset assembled for this intercomparison will be available to all the MC users, thus providing them an opportunity to build and calibrate a model for a real medical linear accelerator.