A graphite calorimeter for absolute measurements of absorbed dose to water: application in medium-energy x-ray filtered beams.

The Italian National Institute of Ionizing Radiation Metrology (ENEA-INMRI) has designed and built a graphite calorimeter that, in a water phantom, has allowed the determination of the absorbed dose to water in medium-energy x-rays with generating voltages from 180 to 250 kV. The new standard is a miniaturized three-bodies calorimeter, with a disc-shaped core of 21 mm diameter and 2 mm thickness weighing 1.134 g, sealed in a PMMA waterproof envelope with air-evacuated gaps. The measured absorbed dose to graphite is converted into absorbed dose to water by means of an energy-dependent conversion factor obtained from Monte Carlo simulations. Heat-transfer correction factors were determined by FEM calculations. At a source-to-detector distance of 100 cm, a depth in water of 2 g cm(-2), and at a dose rate of about 0.15 Gy min(-1), results of calorimetric measurements of absorbed dose to water, D(w), were compared to experimental determinations, D wK, obtained via an ionization chamber calibrated in terms of air kerma, according to established dosimetry protocols. The combined standard uncertainty of D(w) and D(wK) were estimated as 1.9% and 1.7%, respectively. The two absorbed dose to water determinations were in agreement within 1%, well below the stated measurement uncertainties. Advancements are in progress to extend the measurement capability of the new in-water-phantom graphite calorimeter to other filtered medium-energy x-ray qualities and to reduce the D(w) uncertainty to around 1%. The new calorimeter represents the first implementation of in-water-phantom graphite calorimetry in the kilovoltage range and, allowing independent determinations of D(w), it will contribute to establish a robust system of absorbed dose to water primary standards for medium-energy x-ray beams.

A novel synthetic single crystal diamond device for in vivo dosimetry.

PURPOSE: Aim of the present work is to evaluate the synthetic single crystal diamond Schottky photodiode developed at the laboratories of "Tor Vergata" University in Rome in a new dosimeter configuration specifically designed for offline wireless in vivo dosimetry (IVD) applications. METHODS: The new diamond based dosimeter, single crystal diamond detector (SCDD-iv), consists of a small unwired detector and a small external reading unit that can be connected to commercial electrometers for getting the detector readout after irradiation. Two nominally identical SCDD-iv dosimeter prototypes were fabricated and tested. A basic dosimetric characterization of detector performances relevant for IVD application was performed under irradiation with (60)Co and 6 MV photon beams. Preirradiation procedure, response stability, short and long term reproducibility, leakage charge, fading effect, linearity with dose, dose rate dependence, temperature dependence, and angular response were investigated. RESULTS: The SCDD-iv is simple, with no cables linked to the patient and the readout is immediate. The range of response with dose has been tested from 1 up to 12 Gy; the reading is independent of the accumulated dose and dose rate independent in the range between about 0.5 and 5 Gy/min; its temperature dependence is within 0.5% between 25 and 38 °C, and its directional dependence is within 2% from 0° to 90°. The combined relative standard uncertainty of absorbed dose to water measurements is estimated lower than the tolerance and action level of 5%. CONCLUSIONS: The reported results indicate the proposed novel offline dosimeter based on a synthetic single crystal diamond Schottky photodiode as a promising candidate for in vivo dosimetry applications with photon beams.

Radiotherapy electron beams collimated by small tubular applicators: characterization by silicon and diamond diodes.

High-energy electron beams generated by linear accelerators, typically in the range 6 to 20 MeV, are used in small field sizes for radiotherapy of localized superficial tumors. Unshielded silicon diodes (Si-D) are commonly considered suitable detectors for relative dose measurements in small electron fields due to their high spatial resolution. Recently, a novel synthetic single crystal diamond diode (SCDD) showed suitable properties for standard electron beams and small photon beams dosimetry. The aim of the present study is twofold: to characterize 6 to 15 MeV small electron beams shaped by using commercial tubular applicators with 2, 3, 4 and 5 cm diameter and to assess the dosimetric performance under such irradiation conditions of the novel SCDD dosimeter by comparison with commercially available dosimeters, namely a Si-D and a plane­parallel ionization chamber. Percentage depth dose curves, beam profiles and output factors (OFs) were measured. A good agreement among the dosimeters was observed in all of the performed measurements. As for the tubular applicators, two main effects were evidenced: (i) OFs larger than unity were measured for a number of field sizes and energies, with values up to about 1.3, that is an output 30% greater than that obtained at the 10 × 10 cm2 reference field; (ii) for each diameter of the tubular applicator a noticeable increase of the OF values was observed with increasing beam energy, up to about 100% in the case of the smaller applicator. This OF behavior is remarkably different from what typically observed for small blocked fields having the same size and energy as those used in this study. OFs for tubular applicators depend considerably on the field size, so interpolation is unadvisable to predict the linear accelerator output for such applicators whereas reliable high-resolution detectors, as the silicon and diamond diodes used in this work allow OF measurements with uncertainties of about 1%.

Dosimetric characteristics of electron beams produced by a mobile accelerator for IORT.

Energy and angular distributions of electron beams with different energies were simulated by Monte Carlo calculations. These beams were generated by the NOVAC7 system (Hitesys, Italy), a mobile electron accelerator specifically dedicated to intra-operative radiation therapy (IORT). The electron beam simulations were verified by comparing the measured dose distributions with the corresponding calculated distributions. As expected, a considerable difference was observed in the energy and angular distributions between the IORT beams studied in the present work and the electron beams produced by conventional accelerators for non-IORT applications. It was also found that significant differences exist between the IORT beams used in this work and other IORT beams with different collimation systems. For example, the contribution from the scattered electrons to the total dose was found to be up to 15% higher in the NOVAC7 beams. The water-to-air stopping power ratios of the IORT beams used in this work were calculated on the basis of the beam energy distributions obtained by the Monte Carlo simulations. These calculated stopping power ratios, s(w,air), were compared with the corresponding s(w,air) values recommended by the TRS-381 and TRS-398 IAEA dosimetry protocols in order to estimate the deviations between a dosimetry based on generic parameters and a dosimetry based on parameters specifically obtained for the actual IORT beams. The deviations in the s(w,air) values were found to be as large as up to about 1%. Therefore, we recommend that a preliminary analysis should always be made when dealing with IORT beams in order to assess to what extent the possible differences in the s(w,air) values have to be accounted for or may be neglected on the basis of the specific accuracy needed in clinical dosimetry.

Charge collection efficiency in ionization chambers exposed to electron beams with high dose per pulse.

The correction for charge recombination was determined for different plane-parallel ionization chambers exposed to clinical electron beams with low and high dose per pulse, respectively. The electron energy was nearly the same (about 7 and 9 MeV) for any of the beams used. Boag's two-voltage analysis (TVA) was used to determine the correction for ion losses, k(s), relevant to each chamber considered. The presence of free electrons in the air of the chamber cavity was accounted for in determining k(s) by TVA. The determination of k(s) was made on the basis of the models for ion recombination proposed in past years by Boag, Hochhäuser and Balk to account for the presence of free electrons. The absorbed dose measurements in both low-dose-per-pulse (less than 0.3 mGy per pulse) and high-dose-per-pulse (20-120 mGy per pulse range) electron beams were compared with ferrous sulphate chemical dosimetry, a method independent of the dose per pulse. The results of the comparison support the conclusion that one of the models is more adequate to correct for ion recombination, even in high-dose-per-pulse conditions, provided that the fraction of free electrons is properly assessed. In this respect the drift velocity and the time constant for attachment of electrons in the air of the chamber cavity are rather critical parameters because of their dependence on chamber dimensions and operational conditions. Finally, a determination of the factor k(s) was also made by zero extrapolation of the 1/Q versus 1/V saturation curves, leading to the conclusion that this method does not provide consistent results in high-dose-per-pulse beams.

Calidad de vida de pacientes en hemodialisis / Quality of life in patients on hemodialysis

El estudio de la calidad de vida es en la actualidad una medida necesaria de resultado de tratamiento que se agrega a las medidas tradicionales de morbimortalidad, incorporando la percepción del paciente. El presente trabajo estudia la aplicación de una medida genérica de calidad de vida, el SF-36, en una población de pacientes en hemodiálisis y el comportamiento de dicha escala en función de la edad, sexo, trabajo, diabetes, rechazo de trasplante y síntomas clínicos específicos. Se compararon los resultados obtenidos con datos publicados de Holanda. Se incluyeron 294 pacientes de 7 centros de hemodiálisis de Montevideo, Uruguay, 163 hombres y 131 mujeres, con una media de edad de 57 años y tiempo promedio en hemodiálisis de 6O meses. Se concluyó que el SF-36 es una medida de calidad de vida confiable y aceptable para nuestra población, que permitió detectar diferencias en calidad de vida entre los pacientes hemodializados, mostrando mejores resultados en los pacientes menores de 60 años y en aquellos que trabajan y peores resultados en los diabéticos y pacientes con múltiples síntomas. No hubo diferencias entre los pacientes que volvieron a diálisis luego del fracaso del trasplante y el resto de la población. Se encontró un perfil temporal con mejores resultados entre los 3 y 6 años de hemodiálisis, que debe confirmarse en el estudio longitudinal. La comparación con los resultados de Holanda mostró mejores puntajes en nuestra población que requieren ulteriores estudios para su análisis definitivo

Characteristics of the absorbed dose to water standard at ENEA.

The primary standard of absorbed dose to water established at ENEA for the Co-60 gamma-ray quality is based on a graphite calorimeter and an ionometric transfer system. This standard was recently improved after a more accurate assessment of some perturbation effects in the calorimeter and a modification of the water phantom shape and size. The conversion procedure requires two corresponding depths, one in graphite and one in water, where the radiation energy spectra must be the same. The energy spectra at the corresponding points were determined by a Monte Carlo simulation in water and graphite scaled phantoms. A thorough study of the calorimeter gap effect corrections was also made with regard to their dependence on depth and field size. A comparison between the ionization chamber calibration procedures based on the standards of absorbed dose to water and of air kerma was also made, confirming the consistency of the two methods.

Experimental determination of the beam quality dependence factors, kQ, for ionization chambers used in photon and electron dosimetry.

Dosimetry in radiotherapy with ionization chambers calibrated in 60Co gamma beams in terms of absorbed dose to water, DW, can be performed if a factor conventionally denoted as kQ is known. The factor kQ depends on the beam quality and the chamber characteristics. Calculated values of the kQ factors for many types of ionization chamber have been recently published. In this work the experimental determination of the kQ factors for various ionization chambers was performed for 6 MV and 15 MV photon beams and for a 14 MeV electron beam. The kQ factors were determined by a procedure based on relative measurements performed with the ionization chamber and ferrous sulphate solution in 60Co gamma radiation and accelerator beams, respectively. The experimental kQ values are compared with the calculated values so far published. Theoretical and experimental kQ values are in fairly good agreement. The uncertainty in the experimental kQ factors determined in this work is less than about 1%, that is, appreciably smaller than the uncertainty of about 1.5% reported for the calculated values.

A juvenile variant of glycogenosis IV (Andersen disease).

An unusual patient with Andersen disease (glycogenosis type IV) is presented, with only relatively mild clinical symptoms at the age of 8 years. The patient has a profound deficiency of glycogen-branching enzyme.