Dosimetric Characteristics of the Siemens IGRT Carbon Fiber Tabletop

In this work, the dosimetric characteristics of a new commercial carbon fiber treatment table are investigated. The photon beam attenuation properties of the Siemens image-guided radiation therapy (IGRT) tabletop were studied in detail. Two sets of dosimetric measurements were performed. In the first experiment a polystyrene slab phantom was used: the central axis attenuation and the skin-sparing detriment were investigated. In the second experiment, the off-axis treatment table transmission was investigated using a polystyrene cylindrical phantom. Measurements were taken at the isocenter for a 360° rotation of the radiation beam. Our results show that the photon beam attenuation of the Siemens IGRT carbon fiber tabletop varies from a minimum of 2.1% (central axis) to a maximum of 4.6% (120° and 240° beam incidence). The beam entrance dose increases from 82% to 97% of the dose at the depth of maximum for a clinical 6-MV radiation field. The depth of maximum also decreases by 0.4 cm. Despite the wedge cross section of the table the beam attenuation properties of the IGRT tabletop remain constant along the longitudinal direction. American Association of Medical Dosimetrists.     

Dosimetric Characteristics of the Siemens IGRT Carbon Fiber Tabletop

In this work, the dosimetric characteristics of a new commercial carbon fiber treatment table are investigated. The photon beam attenuation properties of the Siemens image-guided radiation therapy (IGRT) tabletop were studied in detail. Two sets of dosimetric measurements were performed. In the first experiment a polystyrene slab phantom was used: the central axis attenuation and the skin-sparing detriment were investigated. In the second experiment, the off-axis treatment table transmission was investigated using a polystyrene cylindrical phantom. Measurements were taken at the isocenter for a 360° rotation of the radiation beam. Our results show that the photon beam attenuation of the Siemens IGRT carbon fiber tabletop varies from a minimum of 2.1% (central axis) to a maximum of 4.6% (120° and 240° beam incidence). The beam entrance dose increases from 82% to 97% of the dose at the depth of maximum for a clinical 6-MV radiation field. The depth of maximum also decreases by 0.4 cm. Despite the wedge cross section of the table the beam attenuation properties of the IGRT tabletop remain constant along the longitudinal direction. American Association of Medical Dosimetrists.     

Forward Scatter Dose Effect at Metallic Interfaces Irradiated by X and Gamma Ray Therapy Beams

AIM: In this study forward scattering effects near different metallic interfaces are measured for Co-60 gamma and 6 and 18 MV photon beams. The studied effects are the transport of secondary electrons across the metallic interface and the scattering of photons by the metallic inhomogeneity. MATERIALS AND METHODS: All measurements were carried out with a PTW thin-window, parallel plate ionisation chamber (B 23344-036) and an RDM-1F electrometer with digital readout. Thin sheets of aluminium, mild steel, copper, cadmium and lead were used as inhomogeneities. The inhomogeneities were placed between the polystyrene phantom and the front window of the chamber which was maintained at 100 cm SSD. RESULTS: It was noticed that for a high energy photon beam (18 MV) the forward scatter dose factor (FSDF) increases rapidly as the thickness of the metallic inhomogeneity increases. For low energy photons, there is a sharp initial decrease of the FSDF until a minimum value is reached followed by a slow increase with increasing thickness of the inhomogeneity. It was also noted that the FSDF variation at off-axis distances has slightly more slope compared with the ionization ratio (IR) curves for both 6 MV and 18 MV photons. However, the variation in slope is prominent for 18 MV compared with 6 MV photon beam. CONCLUSION: The sharp dose decrease observed downstream of a metallic inhomogeneity at relatively low photon energies (Co-60, 6 MV) is attributed to the internal scattering of secondary electrons within the metal. The dose enhancement observed for high energy photon beams is attributed to the domination of the pair production process, increasing with atomic number. Since FSDF is dependent on the photon beam spectra, it can be used as a measure of beam quality across the beam.     

Dose Measurements in the Build-Up Region for the Photon Beams from Clinac-1800 Dual Energy Medical Linear Accelerator

AIM: Since the skin dose becomes the limiting factor while deciding the tumorcidal dose, the detailed analysis of dose distribution in the build-up region is necessary for high-energy photon beams. In this study the beam characteristics affecting the build-up and skin dose for 6- and 18-MV photons are analyzed. MATERIALS AND METHODS: Measurements were made with 6- and 18-MV photons using a PTW parallel-plate ionization chamber (B 23344-036) and a RDM-1F electrometer. Build-up ionization measurements were made with the chamber fitted into a 25 x 25 x 25 cm polystyrene phantom with a fixed SSD of 100 cm. The entrance and build-up dose measurements were made with a polycarbonate and a mesh type metallic shielding tray and a 45 degrees wedge. Exit dose measurements were carried out for the graphite patient supporting assembly table top, 1.0 cm thick piece of wood and the 1.0 cm thick patient supporting perspex base frame for head and neck treatments. RESULTS: It was observed that the dmax decreased slightly with field size as with other accelerators. For both photon energies the surface dose was observed to increase with increase in field size. It was also noticed that the dose in the build-up region increases slightly when the polycarbonate secondary blocking tray is introduced with the increase in surface dose. The data show that the tray perturbation factor (TPF) at surface decreases steadily with tray-surface distance for both photon beams for all field sizes. It was noted that the TPF was more when the polycarbonate tray was introduced at shorter tray-surface distances for both energies. At tray-surface distances above 60 cm the TPF almost remained close to unity for 6-MV photons for all field sizes, whereas the continuous decrease in TPF could be noted for 18-MV photon beams even after the TPF reached unity. CONCLUSION: The increase in surface dose with field size for both photon energies is due to the electron scattering from the intervening materials. The use of wedge filters absorbs low-energy scattered electrons significantly and hence, the relative surface dose (RSD) is always less than unity. The increase in dose enhancement percentage with graphite compared to perspex supporting assembly indicates that the electron backscatter is proportional to the atomic number of the medium.     

In vivo dosimetry. Assessment of exit dose correction factors]

INTRODUCTION: In vivo dosimetry allows to verify dose delivering accuracy in radiotherapy treatments. Exit dose measurements add more information about delivered dose than entrance dose evaluations. MATERIALS AND METHODS: Commercial semiconductor diodes are used for exit dose measurements. The diodes are calibrated by comparison with an ionization chamber at a reference condition. Diode reading was compared with the dose measured by the ionization chamber at the exit point. The exit point is defined as the point on the central axis of the beam, at a distance equal to the maximum dose from the exit surface of a homogeneous water-like phantom. As clinical irradiation conditions are always different from reference conditions, exit dose correction factors have been investigated as a function of phantom thickness, field size at the isocenter, source-surface distance, wedge and tray. Measurements have been performed by irradiating a set of p-type semiconductor detectors with 6 MV photon beam (four diodes--mod. EDP10--Scanditronix) and 18 MV photon beam (three diodes--mod. EDP20--Scanditronix) from a Clinac 1800 linear accelerator (Varian, Palo Alto, CA, USA). RESULTS: The most relevant exit dose correction factors are related to field size and phantom thickness for 6 MV photons. The variation of these factors as a function of field size may be greater than 1% with a standard deviation of the same order. On the contrary, the correction factors for field, thickness and tray photons are negligible for 18 MV. CONCLUSIONS: Applying exit dose correction factors may require a great effort, particularly when many silicon diodes must be used. The actual effectiveness of each calibration factor is evaluated through the statistical analysis of experimental data. In this way, the usefulness of correction factor calculation, as depending from both experimental conditions and diode responses, can be derived from its effects on the exit dose value.     

The Effect of a Carbon-Fiber Couch on the Depth-Dose Curves and Transmission Properties for Megavoltage Photon Beams

PURPOSE: To investigate the attenuation of a carbon-fiber tabletop and a combiboard, alongside with the depth-dose profile in a solid-water phantom. MATERIAL AND METHODS: Depth-dose measurements were performed with a Roos chamber for 6- and 10-MV beams for a typical field size (15 cm x 15 cm, SSD [source-surface distance] 100 cm). A rigid-stem ionization chamber was used to measure transmission factors. RESULTS: Transmission factors varied between 93.6% and 97.3% for the 6-MV beam, and 95.1% and 97.7% for the 10-MV photon beam. The lowest transmission factors were observed for the oblique gantry angle of 150 degrees with the table-combiboard combination. The surface dose normalized to a depth of 5 cm increased from 59.4% (without table, 0 degrees gantry), to 108.6% (tabletop present, 180 degrees gantry), and further to 120% (table-combiboard combination) for 6-MV photon beam. For 10 MV, the increase was from 39.6% (without table), to 88.9% (with table), and to 105.6% (table-combiboard combination). For the 150 degrees angle (tablecombiboard combination), the dose increased from 59.4% to 120% (6 MV) and from 39% to 108.1% (10 MV). CONCLUSION: Transmission factors for tabletops and accessories directly interfering with the treatment beam should be measured and implemented into the treatment-planning process. The increased surface dose to the skin should be considered.     

Study on the Tongue and Groove Effect of the Elekta Multileaf Collimator Using Monte Carlo Simulation and Film Dosimetry

BACKGROUND: Nowadays, multileaf collimation of the treatment fields from medical linear accelerators is a common option. Due to the design of the leaf sides, the tongue and groove effect occurs for certain multileaf collimator applications such as the abutment of fields where the beam edges are defined by the sides of the leaves. MATERIAL AND METHODS: In this study, the tongue and groove effect was measured for two pairs of irregular multileaf collimator fields that were matched along leaf sides in two steps. Measurements were made at 10 cm depth in a polystyrene phantom using Kodak EDR2 films for a photon beam energy of 6 MV on an Elekta Sli-plus accelerator. To verify the measurements, full Monte Carlo simulations were done. In the simulations, the design of the leaf sides was taken into account and one component module of BEAM code was modified to correctly simulate the Elekta multileaf collimator. RESULTS AND CONCLUSION: The results of measurements and simulations are in good agreement and within the tolerance of film dosimetry.     

Measurement of Backscattered Radiation from Secondary Collimator Jaws into the Beam Monitor Chamber from a Dual Energy Linear Accelerator

AIM: The photons and electrons backscattered from the upper and lower secondary collimator jaws give rise to a significant increase in the ion charge measured by the monitor chamber, and this increase varies between different accelerators. We have studied the effect of backscatter into the monitor chamber at 6 MV and 18 MV photon energies for the linear accelerator Clinac-1800. MATERIALS AND METHODS: The variation of the output factor was first studied for variable asymmetric fields of fixed field size defined by variable right upper collimator jaw together with a variable Cerrobend block low melting point alloy, with constant lower jaw position. Output measurements were carried out at Dmax in a polystyrene phantom at the geometric center of the asymmetric field. The backscatter radiation effect was also analyzed applying a pair of 20 x 20 x 7.5 cm Cerrobend alloy blocks with 6.0 mm diameter pin-holes in the center aligned telescopically with the field defining light beam. The ion chamber with build-up cap was placed at 25 cm behind the second pin-hole. The in air measurements were made varying upper and lower collimators individually and together. For comparison, a similar study was conducted in a Theratron-780C cobalt-60 beam. RESULTS: In the asymmetric field experiment it was noticed that till the collimator jaw crosses the midline, the output factor is almost constant for 6 and 18 MV photon beams. For extreme field asymmetry, the decreases in output factor were 3.2% and 4.3% for 6 and 18 MV, respectively. The telescopic experiment demonstrated 4.0% and 3.9% reduction in output factor for 6 and 18 MV beams when only the upper jaws were varied. Field definition by the lower jaws only reduced the output factor by 3.3% and 3% for 6 and 18 MV photon beams. For square fields achieved by both the jaws, the output factor variation was similar to that achieved with the upper collimator for both energies. Cobalt-60 measurements with the telescopic arrangement did not show significant dependency of output with field variation, provided that the field-dependent scatter from source capsule and collimator jaws is excluded. CONCLUSION: From this study a maximum reduction of 4% and 4.3% in dose delivery was observed for 6 MV and 18 MV photon beams due to backscattered radiation originating mainly from upper collimator reaching the beam monitor chamber. For asymmetric fields it is felt that direct output measurement is more reliable in order to avoid errors in output factor due to radiation backscattered from the collimator jaws into beam monitor chamber.     

Effect of a carbon fiber tabletop on the surface dose and attenuation for high-energy photon beams

Purpose  The dose changes in the buildup region and beam attenuation by a carbon fiber tabletop were investigated for 6-and 18-MV photon beams. Materials and methods  Measurements were performed for 2 × 2 cm to 40 × 40 cm field sizes. The surface dose and percentage depth doses (PDD) were measured by a Markus parallel plate chamber. Attenuation measurements were made at the cylindrical phantom for 180° rotation of the beam. Results  A carbon fiber tabletop increases the surface dose from 7.5% to 63.0% and from 4% to 43% for small fields at 6 and 18 MV, respectively. The increase was nearly fivefold for the 10 × 10 cm field and nearly twofold for the 40 × 40 cm field. Beam attenuation of the tabletop varies from 3.0% to 5.6% for 180° and 120° gantry angles for 6 MV. Conclusion  The carbon fiber tabletop significantly decreases the skin-sparing effect. The dosimetric effect of the tabletop may be higher, especially for the intensity-modulated radiation therapy depending on the beam orientation. Attenuation should be considered and corrected such as any material under the patient at the treatment planning stage.     

External beam profiles measured with film or ionization chamber

Radiation therapy beam profiles measured with an ionization chamber in a scanning water phantom are compared with profiles measured with a standard film dosimetry technique. An 18 cm field was filmed with 4 MV photons in a polystyrene phantom at depths of 1, 7, and 13 cm. The film was scanned with a scanning densitometer and the resulting profiles were converted to dose profiles with a sensitometric curve. To determine the effect of backscatter on the film a special phantom was constructed to eliminate the backscatter from the film measurement. This provided a comparison with the solid film phantom where full backscattering was present. The beam profiles measured with the film differed by less than 3% from the ionization chamber profiles and there was less than 1% difference between the film techniques.     

Influence of air cavities on central depth dose curves for 33 MV roentgen rays.

The relative central absorbed dose preceding and following air layers and channels in a polytetrafluorethylene (teflon) phantom has been measured with LiF-teflon dosimeters. Focus phantom distance is set to 100 cm and the field sizes range from 3 cm X 3 cm to 6 cm X 6 cm. Absorbed dose decrease and build-up factors in front of and behind the air cavity are evaluated. The build-up factor is strongly dependent on field size. Measurements of absorbed dose in water and polystyrene yield approximately the same results as in teflon if the linear dimensions of the irradiation geometry (including depth in phantom) in water and polystyrene are equal to 1.84 and 1.99 respectively times the corresponding parameter in teflon. The underlying transformation procedure is derived. The absorbed dose correction factors in the region behind the slab are discussed in terms of tissue-air-ratio and effective attenuation formulae.     

Photon beam attenuation for a patient support assembly during arc therapy for a medical linear accelerator.

Arc therapy is one of the treatment techniques for small, centrally located deep-seated tumors. However, care must be taken to remove any components that would interfere with the beam as the gantry rotates around the patient. One such component that may interfere with the beam is the patient support assembly (PSA) or treatment table. Beam attenuation factors due to the presence of the couch side-rails and the centerspine bar of the PSA are presented for both 6 MV and 18 MV photon beams of a Clinac 1800 during a 360 degrees rotation. Dose perturbations arising from these obstructions are displayed using an Alderson Rando phantom. A method is described to calculate the start and stop angles for the largest unobstructed arc for a given field size (FS), centerspine bar to the isocenter height (H), centerspine bar width (W), and SAD. As an illustration, for an SAD of 100 cm and a W of 4 cm, the start and stop angles for arc therapy with a FS of 10 x 10 cm2 and an H of 12.7 cm would be 29 degrees and 331 degrees.     

A study of Rhizophora spp wood phantom for dosimetric purposes using high-energy photon and electron beams.

Previous scattering and depth-dose investigations involving use of the Malaysian hardwood Rhizophora spp have shown this medium to produce good agreement with measurements made in water. Present study extends the comparison, now including measurements of percentage depth-dose made for photons at 6MV and 5 and 12MeV electron beams. For the 6 MV photon and 5 MeV electron beams, discrepancies between percentage depth-dose for Rhizophora spp and water, at all depths, are found to be within 2.6 and 2.4% respectively. At 12 MeV electron energies, measured percentage depth-doses in Rhizophora spp beyond 3.5cm depth are found to be in significant discord with those for water. The absorbed dose in water measured in Rhizophora spp at d(max) for all three beams produces discrepancies of no more than 1.1% when compared with measurements made in water.     

EBT GAFCHROMICTM film dosimetry in compensator-based intensity modulated radiation therapy

The electron benefit transfer (EBT) GAFCHROMIC films possess a number of features making them appropriate for high-quality dosimetry in intensity-modulated radiation therapy (IMRT). Compensators to deliver IMRT are known to change the beam-energy spectrum as well as to produce scattered photons and to contaminate electrons; therefore, the accuracy and validity of EBT-film dosimetry in compensator-based IMRT should be investigated. Percentage-depth doses and lateral-beam profiles were measured using EBT films in perpendicular orientation with respect to 6 and 18 MV photon beam energies for: (1) different thicknesses of cerrobend slab (open, 1.0, 2.0, 4.0, and 6.0 cm), field sizes (5×5, 10×10, and 20×20 cm²), and measurement depths (D_max, 5.0 and 10.0 cm); and (2) step-wedged compensator in a solid phantom. To verify results, same measurements were implemented using a 0.125 cm³ ionization chamber in a water phantom and also in Monte Carlo simulations using the Monte Carlo N-particle radiation transport computer code. The mean energy of photons was increased due to beam hardening in comparison with open fields at both 6 and 18 MV energies. For a 20×20 cm² field size of a 6 MV photon beam and a 6.0 cm thick block, the surface dose decreased by about 12% and percentage-depth doses increased up to 3% at 30.0 cm depth, due to the beam-hardening effect induced by the block. In contrast, at 18 MV, the surface dose increased by about 8% and depth dose reduced by 3% at 30.0 cm depth. The penumbral widths (80% to 20%) increase with block thickness, field size, and beam energy. The EBT film results were in good agreement with the ionization chamber dose profiles and Monte Carlo N-particle radiation transport computer code simulation behind the step-wedged compensator. Also, there was a good agreement between the EBT-film and the treatment-planning results on the anthropomorphic phantom. The EBT films can be accurately used as a 2D dosimeter for dose verification and quality assurance of compensator-based C-IMRT.     

Radiation Therapy Photon Beams Dose Conformation According to Dose Distribution Around Intracavitary-Applied Brachytherapy Sources

Intracavitary application of brachytherapy sources followed by external beam radiation is essential for the local treatment of carcinoma of the cervix. Due to very high doses to the central portion of the target volume delivered by brachytherapy sources, this part of the target volume must be shielded while being irradiated by photon beams. Several shielding techniques are available, from rectangular block and standard cervix wedge to more precise, customized step wedge filters. Because the calculation of a step wedge filter's shape was usually based on effective attenuation coefficient, an approach that accounts, in a more precise way, for the scattered radiation, is suggested. The method was verified under simulated clinical conditions using film dosimetry. Measured data for various compensators were compared to the numerically determined sum of the dose distribution around brachytherapy sources and one of compensated beam. Improvements in total dose distribution are demonstrated, using our method. Agreement between calculation and measurements were within 3%. Sensitivity of the method on sources displacement during treatment has also been investigated.     

Measurements of Gamma-Knife helmet output factors using a radiophotoluminescent glass rod dosimeter and a diode detector

A radiophotoluminescent (RPL) glass rod dosimeter (GRD) and a small active volume p-type silicon diode detector (stereotactic field detector, SFD) were used for the measurement of Gamma-Knife output factors. All measurements were done using a 16 cm diameter spherical polystyrene phantom with the detector at the focal spot of Gamma-Knife. The GRD system consists of small rod-shaped glass chip detectors and an automatic readout device. The output factors measured with GRD of the 14, 8 and 4 mm helmets relative to the 18 mm helmet are 0.981, 0.942 and 0.877, respectively. Similarly, the corresponding output factors measured with SFD are 0.980, 0.949 and 0.867, respectively. These output factors are comparable with the values given in a recent publication and the values recommended by Elekta, the manufacture. The angular dependence of these detectors is also measured using a linear accelerator-based stereotactic radiosurgery system. For the Gamma-Knife angle ranging from 6 to 36 degrees from the vertical axis, the measured angular dependence of the GRD is approximately 1.0% at a 4 MV x-ray beam. The response of SFD indicates approximately 3-4% directional dependence for the same angle range for a 6 MV x-ray beam. The Gamma-Knife helmet output factors measured with SFD are corrected for angular dependence. In summary, GRD can be a good candidate in measuring small field output factor. Due to an angular dependence the small p-type diode detector needs care when calculating the Gamma-Knife dose.     

Attenuation correction in SPECT based on transmission studies and Monte Carlo simulations of build-up functions

The quantitative information in SPECT images is distorted by photon attenuation and contribution of photons scattered in the object. It is, therefore, important to know the distribution of different attenuating tissues in order to be able to perform a proper attenuation correction. A correction method, based on correcting one pixel at a time by using density maps and build-up functions, has been developed. The density map has been produced by transmission measurements of the object using an external, solid 57Co flood source mounted on the scintillation camera head. The outline of the object is accurately defined by the map since the density values outside the object are very close to zero. The build-up of photons scattered in the object has been simulated by a Monte-Carlo code. SPECT-studies with 99mTc, 201T1 and 111In line sources in different parts of a non homogeneous Alderson phantom have been performed. The emission images have been corrected for photon attenuation using the measured density maps and the simulated build-up functions. The results show that quantitative measurements of the radioactivity in nonhomogeneous area can be accomplished to within +/- 10% for different radionuclides by using the attenuation correction described.     

Quantitative image reconstruction with weighted backprojection for single photon emission computed tomography

A new method of image reconstruction for single photon emission computed tomography is presented. The method is basically a filtered backprojection with some modifications. The algorithm consists of three steps: normalization of observed projections, modified convolution operation, and weighted backprojection. The weighting function for backprojection is determined to provide perfect attenuation compensation for a uniform attenuation medium and to keep the statistical noise in the reconstructed image low. The relative contributions of two conjugate projections to the image can be controlled by the reconstruction parameters, enabling improvement of the signal-to-noise ratio and spatial resolution at off-center area compared with the conventional averaging method of two conjugate projections. Simulation studies indicated that the method provides a satisfactory image for an extended source of 99mTc (mu = 0.15 cm-1) having a diameter of up to approximately 35 cm. A myocardium phantom is adequately reconstructed from a 180 approximately 225 degrees angle scan. The effect of nonuniform attenuation medium surrounding the source region can be corrected. This paper presents the mathematical basis of the procedure, the evaluation of the statistical noise, and some illustrative computer simulations.     

Design and fabrication of a half-beam wedge for treatment of breast patients

Purpose: The Radiation Oncology Department of Kansas University Cancer Center on the average treats approximately 60 breast patients per year. Many of them require large field sizes with widths greater than 20 cm. Our purpose is to design a half-beam wedge that is lighter in weight than a standard wedge for larger field sizes. This could replace the compensator and reduce the number of monitor units. We have designed and fabricated half-beam wedges for a Varian linear accelerator, with the angles of 15, 30 and 45 degrees for a 6 MV photon beam. A set of dosimetry data for these wedges was entered into a treatment planning computer. The treatment plans generated using these newly designed wedges were compared with those using standard wedges. Methods and materials: From basic principles, the geometry for the design of the wedges was calculated for three angles, 15, 30 and 45. Using trays provided by Varian, three brass wedges were milled and attached to the trays. Measurements were taken in a water phantom with three wedge angles, 15, 30 and 45, for treatment planning purposes. Conclusion: The design and fabrication of a half-beam wedge for the use of treatment with large field sizes could reduce the need for fabrication of a compensator. This would also reduce the time required for treatment and give a better dose distribution.