AAPM WGTG51 Report 385: Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy electron beams.

An Addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water is presented for electron beams with energies between 4 MeV and 22 MeV ( 1.70 cm ≤ R 50 ≤ 8.70 cm $1.70\nobreakspace {\rm cm} \le R_{\text{50}} \le 8.70\nobreakspace {\rm cm}$ ). This updated formalism allows simplified calibration procedures, including the use of calibrated cylindrical ionization chambers in all electron beams without the use of a gradient correction. New k Q $k_{Q}$ data are provided for electron beams based on Monte Carlo simulations. Implementation guidance is provided. Components of the uncertainty budget in determining absorbed dose to water at the reference depth are discussed. Specifications for a reference-class chamber in electron beams include chamber stability, settling, ion recombination behavior, and polarity dependence. Progress in electron beam reference dosimetry is reviewed. Although this report introduces some major changes (e.g., gradient corrections are implicitly included in the electron beam quality conversion factors), they serve to simplify the calibration procedure. Results for absorbed dose per linac monitor unit are expected to be up to approximately 2 % higher using this Addendum compared to using the original TG-51 protocol.

Refinement of MLC modeling improves commercial QA dosimetry system for SRS and SBRT patient-specific QA.

PURPOSE: Mobius 3D (M3D) provides a volumetric dose verification of the treatment planning system's calculated dose using an independent beam model and a collapsed cone convolution superposition algorithm. However, there is a lack of investigation into M3D's accuracy and effectiveness for stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) quality assurance (QA). Here, we collaborated with the vendor to develop a revised M3D beam model for SRS/SBRT cases treated with a 6X flattening filter-free (FFF) beam and high-definition multiple leaf collimator (HDMLC) on an Edge linear accelerator. METHODS: Eighty SRS/SBRT cases, planned with AAA dose algorithm and validated with Gafchromic film, were compared to M3D dose calculations using 3D gamma analysis with 2%/2 mm gamma criteria and a 10% threshold. A revised beam model was developed by refining the HD-MLC model in M3D to improve small field dose calculation accuracy and beam profile agreement. All cases were reanalyzed using the revised beam model. The impact of heterogeneity corrections for lung cases was investigated by applying lung density overrides to five cases. RESULTS: For the standard and revised beam models, respectively, the mean gamma passing rates were 94.6% [standard deviation (SD): 6.1%] and 98.0% [SD: 1.7%] (for the overall patient), 88.2% [SD: 17.3%] and 93.8% [SD: 6.8%] (for the brain PTV), 71.4% [SD: 18.4%] and 81.5% [SD: 14.3%] (for the lung PTV), 83.3% [SD: 16.7%] and 67.9% [SD: 23.0%] (for the spine PTV), and 78.6% [SD: 14.0%] and 86.8% [SD: 12.5%] (for the PTV of all other sites). The lung PTV mean gamma passing rates improved from 74.1% [SD: 7.5%] to 89.3% [SD: 7.2%] with the lung density overridden. The revised beam model achieved an output factor within 3% of plastic scintillator measurements for 2 × 2 cm2 MLC field size, but larger discrepancies are still seen for smaller field sizes which necessitate further improvement of the beam model. CONCLUSION: Special attention needs to be paid to small field dosimetry, MLC modeling, and inhomogeneity corrections in the beam model for SRS/SBRT QA. The improvements noted in this study, and further collaborations between clinical physicists and the vendor to refine the M3D beam model could enable M3D to become a premier SRS/SBRT QA tool.

Measurement of gold nanofilm dose enhancement using unlaminated radiochromic film.

PURPOSE: Bombarding high-Z material with x-ray radiation releases Auger electrons and Coster-Kronig electrons, along with deeper penetrating fluorescent x-rays and photoelectrons. The Auger and Coster-Kronig electron penetration distance is on the order of nanometers to micrometers in water or tissue, creating a large dose enhancement accompanied by a RBE greater than 1 at the cellular level. The authors' aim is to measure the gold nanofilm dose enhancement factor (DEF) at the cellular level with unlaminated radiochromic film via primary 50 kVp tungsten x-ray spectrum interaction, similar to an electronic brachytherapy spectrum. METHODS: Unlaminated Gafchromic(®) EBT2 film and Monte Carlo modeling were combined to derive DEF models. Gold film of thickness 23.1 ± 4.3 nm and surface roughness of 1.2 ± 0.2 nm was placed in contact with unlaminated radiochromic film in a downstream orientation and exposed to a 50 kVp tungsten bremsstrahlung, mean energy 19.2 keV. Film response correction factors were derived by Monte Carlo modeling of electron energy deposition in the film's active layer, and by measuring film energy dependence from 4.5 keV to 50 kVp. RESULTS: The measured DEF within a 13.6 µm thick water layer was 0.29 with a mean dose of 94 ± 9.4 cGy from Au emissions and 324 ± 32.4 cGy from the 50 kVp primary beam. Monte Carlo derived correction factors allowed determination of Au contributed dose in shallower depths at 0.25 µm intervals. Maximum DEF of 18.31 was found in the first 0.25 µm water depth. CONCLUSIONS: Dose enhancement from Au nanofilm can be measured at the cellular level using unlaminated radiochromic film. Complementing the measured dose value with Monte Carlo calculations allows estimation of dose enhancement at depth increments within the cellular range.