Reference dosimetry for helical tomotherapy: practical implementation and a multicenter validation.

PURPOSE: The aim of this study was to implement a protocol for reference dosimetry in tomotherapy and to validate the beam output measurements with an independent dosimetry system. METHODS: Beam output was measured at the reference depth of 10 cm in water for the following three cases: (1) a 5 × 10 cm(2) static machine specific reference field (MSR), (2) a rotational 5 × 10 cm(2) field without modulation and no tabletop in the beam, (3) a plan class specific reference (PCSR) field defined as a rotational homogeneous dose delivery to a cylindrical shaped target volume: plan with modulation and table-top movement. The formalism for reference dosimetry of small and nonstandard fields [Med.Phys.35: 5179-5186, 2008] and QA recommendations [Med.Phys.37: 4817-4853, 2010] were adopted in the dose measurement protocol. All ionization chamber measurements were verified independently using alanine∕EPR dosimetry. As a pilot study, the beam output was measured on tomotherapy Hi-art systems at three other centers and directly compared to the centers specifications and to alanine dosimetry. RESULTS: For the four centers, the mean static output at a depth of 10 cm in water and SAD = 85 cm, measured with an A1SL chamber following the TG-148 report was 6.238 Gy∕min ± 0.058 (1 SD); the rotational output was 6.255 Gy∕min ± 0.069 (1 SD). The dose stated by the center was found in good agreement with the measurements of the visiting team: D(center)∕D(visit) = 1.000 ± 0.003 (1 SD). The A1SL chamber measurements were all in good agreement with Alanine∕EPR dosimetry. Going from the static reference field to the rotational ∕ non modulated field the dose rate remains constant within 0.2% except for one center where a deviation of 1.3% was detected. CONCLUSIONS: Following the TG-148 report, beam output measurements in water at the reference depth using a local protocol, as developed at different centers, was verified. The measurements were found in good agreement with alanine∕EPR dosimetry. The presented methodology may provide a good concept for reference dosimetry.

Experimental determination of the energy response of alanine pellets in the high dose rate 192Ir spectrum.

An experimental determination of the energy correction factor for alanine/paraffin pellets in the 192Ir spectrum at varying distances from the source is presented. Alanine dosimeters were irradiated in water under full scatter conditions with a high dose rate (HDR) 192Ir source (Flexisource), using a dedicated holder. Up to six line sources (catheters) fit in a regular pattern at fixed radial distances from the holder axis, the alanine detector being placed at the centre of the holder. The HDR source was stepping every 0.5 cm within a trocar needle within ± 3.0 cm around the medial plane through the detector in order to achieve dose homogeneity within the detector volume. The energy correction factor of alanine/paraffin pellets in 192Ir relative to 60Co was experimentally determined as the inverse ratio of the dose to water measured in water around the 192Ir source to the dose to water calculated in water using the TG-43 formalism. The pellets were read out with a Bruker EMX(micro) spectrometer (X-band). The amplitude of the central line in the alanine absorption spectrum from pellets irradiated within the 192Ir spectrum was directly compared with the amplitude from 60Co-irradiated pellets. The energy correction factors of Harwell pellets irradiated in the 192Ir spectrum are 1.029 ± 0.02, 1.027 ± 0.02 and 1.045 ± 0.02 at a mean weighted source­detector distance of 2.0, 2.9 and 5.3 cm, respectively. The experimentally obtained values for the energy response are 1.3% lower compared to the theoretical values for radial distances smaller than 3 cm.

Implementation of alanine/EPR as transfer dosimetry system in a radiotherapy audit programme in Belgium.

A measurement procedure based on alanine/electron paramagnetic resonance (EPR) dosimetry was implemented successfully providing simple, stable, and accurate dose-to-water (D(w)) measurements. The correspondence between alanine and ionization chamber measurements in reference conditions was excellent. Alanine/EMR dosimetry might be a valuable alternative to thermoluminescent (TLD) and ionization chamber based measuring procedures in radiotherapy audits.

Alanine/EPR dosimetry applied to the verification of a total body irradiation protocol and treatment planning dose calculation using a humanoid phantom.

PURPOSE: To avoid complications in total body irradiation (TBI), it is important to achieve a homogeneous dose distribution throughout the body and to deliver a correct dose to the lung which is an organ at risk. The purpose of this work was to validate the TBI dose protocol and to check the accuracy of the 3D dose calculations of the treatment planning system. METHODS: Dosimetry based on alanine/electron paramagnetic resonance (EPR) was used to measure dose at numerous locations within an anthropomorphic phantom (Alderson) that was irradiated in a clinical TBI beam setup. The alanine EPR dosimetry system was calibrated against water calorimetry in a Co-60 beam and the absorbed dose was determined by the use of "dose-normalized amplitudes" A(D). The dose rate of the TBI beam was checked against a Farmer ionization chamber. The phantom measurements were compared to 3D dose calculations from a treatment planning system (Pinnacle) modeled for standard dose calculations. RESULTS: Alanine dosimetry allowed accurate measurements which were in accordance with ionization chamber measurements. The combined relative standard measurement uncertainty in the Alderson phantom was U(r)(A(D))=0.6%. The humanoid phantom was irradiated to a reference dose of 10 Gy, limiting the lung dose to 7.5 Gy. The ratio of the average measured dose midplane in the craniocaudal direction to the reference dose was 1.001 with a spread of +/- 4.7% (1 sd). Dose to the lung was measured in 26 locations and found, in average, 1.8% lower than expected. Lung dose was homogeneous in the ventral-dorsal direction but a dose gradient of 0.10 Gy cm(-1) was observed in the craniocaudal direction midline within the lung lobe. 3D dose calculations (Pinnacle) were found, in average, 2% lower compared to dose measurements on the body axis and 3% lower for the lungs. CONCLUSIONS: The alanine/EPR dosimetry system allowed accurate dose measurements which enabled the authors to validate their TBI dose protocol. Dose calculations based on a collapsed cone convolution dose algorithm modeled for regular treatments are accurate within 3% and can further be improved when the algorithm is modeled for TBI.

Automated detection of irradiated food with the comet assay.

Food irradiation is the process of exposing food to ionising radiation in order to disinfect, sanitise, sterilise and preserve food or to provide insect disinfestation. Irradiated food should be adequately labelled according to international and national guidelines. In many countries, there are furthermore restrictions to the product-specific maximal dose that can be administered. Therefore, there is a need for methods that allow detection of irradiated food, as well as for methods that provide a reliable dose estimate. In recent years, the comet assay was proposed as a simple, rapid and inexpensive method to fulfil these goals, but further research is required to explore the full potential of this method. In this paper we describe the use of an automated image analysing system to measure DNA comets which allow the discrimination between irradiated and non-irradiated food as well as the set-up of standard dose-response curves, and hence a sufficiently accurate dose estimation.

Dosimetry of beta-ray ophthalmic applicators: comparison of different measurement methods.

An international intercomparison of the dosimetry of three beta particle emitting ophthalmic applicators was performed, which involved measurements with radiochromic film, thermoluminescence dosimeters (TLDs), alanine pellets, plastic scintillators, extrapolation ionization chambers, a small fixed-volume ionization chambers, a diode detector and a diamond detector. The sources studied were planar applicators of 90Sr-90Y and 106Ru-106Rh, and a concave applicator of 106Ru-106Rh. Comparisons were made of absolute dosimetry determined at 1 mm from the source surface in water or water-equivalent plastic, and relative dosimetry along and perpendicular to the source axes. The results of the intercomparison indicate that the various methods yield consistent absolute dosimetry results at the level of 10%-14% (one standard deviation) depending on the source. For relative dosimetry along the source axis at depths of 5 mm or less, the agreement was 3%-9% (one standard deviation) depending on the source and the depth. Crucial to the proper interpretation of the measurement results is an accurate knowledge of the detector geometry, i.e., sensitive volume and amount of insensitive covering material. From the results of these measurements, functions which describe the relative dose rate along and perpendicular to the source axes are suggested.

Determination of the accuracy of implant reconstruction and dose delivery in brachytherapy in The Netherlands and Belgium.

PURPOSE: To gain insight into the accuracy of brachytherapy treatments, the accuracy of implant reconstruction and dose delivery was investigated in 33 radiotherapy institutions in The Netherlands and Belgium. MATERIALS AND METHODS: The accuracy of the implant reconstruction method was determined using a cubic phantom containing 25 spheres at well-known positions. Reconstruction measurements were obtained on 41 brachytherapy localizers, 33 of which were simulators. The reconstructed distances between the spheres were compared with the true distances. The accuracy of the dose delivery was determined for high dose rate (HDR), pulsed dose rate (PDR) and low dose rate (LDR) afterloading systems using a polymethyl methacrylate cylindrical phantom containing a NE 2571 ionization chamber in its centre. The institutions were asked to deliver a prescribed dose at the centre of the phantom. The measured dose was compared with the prescribed dose. RESULTS: The average reconstruction accuracy was -0.07 mm (+/-0.4 mm, 1 SD) for 41 localizers. The average deviation of the measured dose from the prescribed dose was +0.9% (+/-1.3%, 1 SD) for 21 HDR afterloading systems, +1.0% (+/-2.3%, 1 SD) for 12 PDR afterloaders, and +1.8% (+/-2.5%, 1 SD) for 15 LDR afterloaders. CONCLUSIONS: This comparison showed a good accuracy of brachytherapy implant reconstruction and dose delivery in The Netherlands and Belgium.

The effect of carbon fibre inserts on the build-up and attenuation of high energy photon beams.

BACKGROUND AND PURPOSE: The use of new materials in radiotherapy requires an investigation of the effects of these materials on the relevant beam parameters. The high strength and low density of carbon fibre suggest an excellent material for table inserts with minimal attenuation, without changing the skin sparing effect in the build-up zone. MATERIALS AND METHODS: In this paper three different carbon fibre plates and two conventionally table top materials are studied in Co-60, 6 MV and 23 MV photon beams. RESULTS AND CONCLUSIONS: From depth dose measurements it is clear that the dose in the build-up zone is influenced in the qualities of the beams. The mutual differences for the three carbon plates are minimal. For Co-60 the depth of the maximum dose is decreased by carbon from 5 to 2 mm and the surface dose is increased from 18 to 76%. For 6 and 23 MV the surface dose is increased from 21 to 52% and 20 to 32%, respectively, as well as the dose in the build-up region. A transmission of 99% was measured for two carbon plates out of three in Co-60 and for one out of three in 6 MV.

One year of experience with alanine dosimetry in radiotherapy.

Commercially available alanine dosimeters from different manufacturers were purchased for this study. The response of the detectors was evaluated with 60Co gamma radiation in the dose range 0.2-200 Gy, using a small EPR spectrometer dedicated to dosimetry. The batch sensitivity, inter-specimen scattering and background signal for the different selection of dosimeters were evaluated. The usefulness of the alanine dosimetry system for clinical routine is illustrated by in vivo measurements during 192Ir brachytherapy of cervix carcinoma.